Healthcare utilization and costs associated with treatment for opioid dependence

Objective: Opioid use disorder (OUD) can be managed with medication assisted therapy (MAT) (methadone [MET], buprenorphine [BUP], or extended-release naltrexone [XR-NTX]) or counseling alone (non-pharmacological therapy [NPT]). The objective of this study was to evaluate healthcare resource utilization and costs associated with XR-NTX compared with alternative treatments for opioid dependence.

Methods: Adults with a diagnosis of opioid dependence who initiated treatment with XR-NTX, BUP, MET, or NPT between January 1, 2011 and December 31, 2014 were identified in the Truven Health MarketScan Commercial administrative claims database. Healthcare resource utilization, costs (inpatient [IP], emergency department [ED], outpatient [OP], and pharmacy) and adherence were evaluated for each cohort during 12-month baseline and follow-up periods.

Results: A total of 29,235 patients were included in the analysis; 1,041, 20,566, 745, and 6,883 received XR-NTX, BUP, MET, and NPT, respectively. Patients in the XR-NTX cohort were significantly younger and had more comorbidities compared with the other cohorts. Patients in the XR-NTX group had the largest percentage decrease in IP and ED utilization and costs from baseline to follow-up. OP and pharmacy costs increased significantly from baseline to follow-up for all cohorts. Overall, there was no significant change in total healthcare costs for the XR-NTX group, whereas the costs increased significantly for other groups (BUP?=?+43%, MET?=?+47.7%, NPT?=?+38.8%).

Conclusions: Healthcare resource utilization and costs increased from baseline to follow-up in BUP, MET, and NPT patients, whereas patients receiving XR-NTX experienced no such increase. This analysis suggests there may be economic value in the use of XR-NTX for OUD.     

EXPLAINING PREMIUMS AND DISCOUNTS ON CLOSED-END EQUALITY COUNTRY FUNDS

Over the past decade or so, the surge of interest among U.S. investors in international investing has led to the creation of numerous foreign equity country funds. Like U.S. closed-end mutual funds, the prices of such closed-end country funds fluctuate widely in relation to their underlying net asset values (NAVs).
In this paper, the authors summarize the major findings of their recent study of the performance of 28 country funds relative to their NAVs over the period 1978–1995. While 20 of the 28 funds traded at average discounts to their net asset values, the discounts for the country funds were smaller than those of the average U.S. fund, and over a quarter of the funds sold at premiums.
In an attempt to explain such premiums or discounts, the authors examined primarily three factors: (1) the sensitivity of country-fund returns (relative to that of local market indices) to U.S. returns; (2) the possible effects of local government investment restrictions; and (3) the impact of exchange rate changes. Although most of the eight funds that traded at average premiums represented countries with significant restrictions on capital flows and foreign ownership, there were also a number of funds with similar restrictions trading at significant discounts. In exploring the reasons for such discounts, the authors noted that the returns to the country funds were "surprisingly sensitive" to U.S. market conditions, thus reducing the extent of their diversification benefits for U.S. investors. The article also raises the possibility that if such country funds are not "priced at the margin" by globally diversified investors, U.S investors' "country-risk sentiments" could cause such funds to trade at discounts.     

Motivational pathways for farmer learning behaviour in the student-to-farmer university outreach

In recent times, calls for practical training of agricultural extension workers, who exhibit the right mix of competences for responsiveness to farmer learning needs, have intensified. This comes at the time when there is an increasingly growing desire for more community-engaged African universities, and as such, making the integration of agricultural students into community outreach services a necessity. However, empirical evidence on whether student-led outreach and training models adequately respond to the psychological learning needs of host farmers and subsequent motivation of these farmers for learning is lacking. This study uses a structural equation modelling technique on a sample of 283 farmers who had previously participated in the student-to-farmer outreach of Gulu University. Results reveal that satisfying farmer learning needs influences intrinsic motivation, formation of learning intentions and farmer learning behaviour. Intrinsic motivation mediates the relationship between satisfying farmer learning needs and the outcome learning behaviour. We conclude that satisfying farmer learning needs is a strong initiator of motivational pathways for farmer learning behaviour in the student-to-farmer university outreach. We call for more public financing of university outreach programmes so as to enable not only training for churning out graduates with the right competences of responsiveness to community needs but also fostering creative innovations involving both universities and communities.     

Did the PCAOB's 2009 Office Expansion Improve Audit Quality?*

We investigate whether the PCAOB's decision to expand the number and location of its inspection offices in 2009 improved the reliability of US audits. We use a difference-in-differences empirical design to consider the impacts of the expansion on audit quality and find that audit quality significantly improved following the PCAOB's expansion in markets where new offices opened relative to markets without an office opening. We find that the improvement in audit quality appears to be driven by auditors' reaction to real changes in PCAOB oversight and that triennially inspected auditors appear to be impacted the most by this office expansion. Our findings provide new insights into the PCAOB's operational decision-making and suggest that the regulator's additional investment in audit oversight was effective in improving audit quality.     

Impacts of news media coverage on Canadian medical crowdfunding campaigns

While donation-based crowdfunding for health-related purposes raises hundreds of millions of dollars yearly, most campaigns fail to meet their fundraising goals. Crowdfunding campaigners are advised to seek traditional news media coverage of their campaigns to increase donor interest and fundraising success. In this study, we seek to better understand what happens to donor behavior via donation-based crowdfunding campaigns after they receive news media coverage. While research has focused on the impact of social media sharing on donation-based crowdfunding, academic analyses of the impact of news media coverage is largely speculative. We searched the Newsstream and Factiva databases for Canadian news coverage of domestic donation-based health-related crowdfunding campaigns. This news coverage was paired with the crowdfunding campaign reported on in the story. Campaign text and daily fundraising totals and donor amounts were recorded for the 7 days before and after publication of the news article. The authors identified emergent patterns in this data around the amplification of personal information from the crowdfunding campaign to a wider audience and inclusion of new personal details. This process identified 17 relevant pairs of news stories and crowdfunding campaigns over a review period of just under 5 months in 2021–22. These campaigns raised a total of CAD$443,134 (median CAD$20,030) out of a total goal of CAD$772,500 (median CAD$40,000) or 57.4% of the requested funds. Median campaign donations and donor numbers increased for the 3 days following publication of the news article. Our exploratory analysis shows a relationship between crowdfunding campaigns that receive news media coverage and the numbers of donations and total amount donated shortly after this coverage. Campaigners may feel pressure to participate in news media coverage in order to reach their fundraising goals. Media coverage has implications for campaign recipient privacy and the equitable distribution of health-related funding. This exploratory analysis establishes the need for additional research on this topic.     

Regulatory capital and asset risk transfer

We explore whether life insurers use a unique reinsurance arrangement to manage assets tied to their regulatory capital. Typical reinsurance allows insurers to reduce their regulatory capital by transferring liabilities (reserves), and the associated assets, to reinsurers. With modified coinsurance (ModCo), insurers maintain control of their liabilities and assets while transferring regulatory capital requirements to the reinsurer. Holding fixed an insurer's reported capital, we find that ModCo allows insurers to report higher risk-based capital ratios. Insurers with ModCo are less likely to fire sale downgraded bonds. We also find suggestive evidence of regulatory arbitrage, as most ModCo is purchased from reinsurers in countries with low capital requirements or within the same insurance group.     

Regulation,entrepreneurship, and firm size

Journal of Regulatory Economics - We empirically investigate the theory that regulatory growth within an industry disproportionately burdens small businesses relative to their larger competitors....