Relational Co-ordination and Stigma at Work: How Frontline Employees Compensate for Failures in Public Health Systems

Co-ordinating collective work and communicating a shared understanding of tasks is necessary to accomplishing organizational goals. Stigma could exacerbate co-ordination challenges between public and private organizations by further widening differences in goals and incentives among employees. Using relational co-ordination theory, we explore how stigma can influence employee behaviour in the context of healthcare delivery. We study healthcare professionals and frontline workers involved in the fight against AIDS in India to examine how public health systems fail due to a lack of communication and co-ordination, and that these failures are worsened by stigma. When stigma is present, relationships between employees become strained due to misaligned work routines, lack of information sharing and cooperation failure. Our findings reveal emergent responses from frontline employees that mitigate co-ordination failures through: (1) role adaptation to improve predictability of tasks; (2) social purpose identification to promote a common understanding and engage stigmatized clients; and (3) affective attachment that encourages extra-role behaviours and task ownership. We draw implications for relational co-ordination and stigma, as well as public-private co-ordination in public health systems.     

Segmented trend modelling of the US GNP series

Structural changes in economic time series are modelled as piecewise linear trends. A statistical method is considered to estimate and select the number and location of trend-breakks simultaneously. The method is applied to the GNP series of the US.     

A commentary on “Déjà Vu All Over Again: The Causes of U.S. Commercial Bank Failures This Time Around”

Cole and White (J Financ Serv Res 2012) show that small banks which failed during the financial crisis–like small banks which faile in previous crises–tended to have high concentration of loans financing commercial real estate and real estate development several years before failure. In contrast, large banks failed during the financial crisis due to the novel strategy of investing in poorly underwritten subprime mortgages. The fact that large banks fail as a resut of changing business models while small banks fail for predictable reasons makes justifies a heightened level of supervision of large banks (consistent with the Dodd-Frank Act).     

Cost-effectiveness of sacubitril/valsartan versus enalapril in patients with heart failure and reduced ejection fraction

Background: Sacubitril/valsartan reduces cardiovascular death and hospitalizations for heart failure (HF). However, decision-makers need to determine whether its benefits are worth the additional costs, given the low-cost generic status of traditional standard of care.

Aims: To evaluate the cost-effectiveness of sacubitril/valsartan compared to enalapril in patients with HF and reduced ejection fraction, from the Singapore healthcare payer perspective.

Methods: A Markov model was developed to project clinical and economic outcomes of sacubitril/valsartan vs enalapril for 66-year-old patients with HF over 10 years. Key health states included New York Heart Association classes I–IV and deaths; patients in each state incurred a monthly risk of hospitalization for HF and cardiovascular death. Sacubitril/valsartan benefits were modeled by applying the hazard ratios (HRs) in PARADIGM-HF trial to baseline probabilities. Primary model outcomes were total and incremental costs and quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) for sacubitril/valsartan relative to enalapril

Results: Compared to enalapril, sacubitril/valsartan was associated with an ICER of SGD 74,592 (USD 55,198) per QALY gained. A major driver of cost-effectiveness was the cardiovascular mortality benefit of sacubitril/valsartan. The uncertainty of this treatment benefit in the Asian sub-group was tested in sensitivity analyses using a HR of 1 as an upper limit, where the ICERs ranged from SGD 41,019 (USD 30,354) to SGD 1,447,103 (USD 1,070,856) per QALY gained. Probabilistic sensitivity analyses showed the probability of sacubitril/valsartan being cost-effective was below 1%, 12%, and 71% at SGD 20,000, SGD 50,000, and SGD 100,000 per QALY gained, respectively.

Conclusions: At the current daily price sacubitril/valsartan may not represent good value for limited healthcare dollars compared to enalapril in reducing cardiovascular morbidity and mortality in HF in the Singapore healthcare setting. This study highlights the cost-benefit trade-off that healthcare professionals and patients face when considering therapy.     

Data mining and automated prediction: A pedagogical primer for classroom discussion

The authors present a pedagogical primer on the highly controversial business strategies of data mining and automated prediction. They provide a summary that allows business professors and students the opportunity to better understand the privacy and ethical issues that arise from high-tech, Internet-based organizations implementing programs to collect and analyze large quantities of personal data from the users of their systems, and then using this data to make assumptions and projections on individual behaviors. The teaching summary also includes a consideration of the role that governments can play in limiting the ability of large tech-based companies to mine personal information for commercial application.     

Rebalancing China's Economy: Domestic and International Implications

This paper considers interactions between China's domestic and external imbalances and their global implications. We present scenarios detailing how a rebalancing of China's growth pattern from investment‐driven growth towards more consumption‐driven growth may occur in practice. Using input–output tables for 2012, we illustrate the knife‐edged nature of Chinese rebalancing, the linkages between expenditure‐side and production‐side rebalancing, and how an internal rebalancing could exacerbate external imbalances. A policy implication for China is that for rebalancing to be fast, consumption must be exceptionally resilient and the efficiency of investment must increase sharply. If rebalancing is too slow, the capital‐to‐output ratio will rise to potentially unsustainable levels and consumption will fail to attain levels of contemporary upper middle‐income economies by 2030. Global input–output tables (1995–2011) suggest that the patterns of Chinese rebalancing considered in our scenarios may generate substantial headwinds for exports to China by its trading partners.     

Disappearing Dividends, Catering, and Risk

Fama and French (2001a) show that the propensity to pay dividendsdeclines significantly between 1978 and 1999. We examine this"disappearing dividends" puzzle through the lens of risk andreport two main findings: (i) Risk is a significant determinantof the propensity to pay dividends, and it explains roughly40% of disappearing dividends; (ii) We find little support forthe view that disappearing dividends reflects firms' cateringto transient fads for dividends. Absent risk controls, proxiesfor fads matter, but these proxies are insignificant once wecontrol for risk. Our results are robust to an extensive batteryof robustness tests that vary samples, time periods, proxiesfor fads, the types of empirical tests, and the nature of payoutdecisions made by firms.     

The creation and use of scorecards in tourism planning: A Spanish example

This paper proposes a preliminary model of a balanced scorecard for tourism destinations, with a specific emphasis on sustainable development. We begin with a review of the perspectives and critical performance variables for the traditional balanced scorecard. We then present empirical work based upon quantitative analysis techniques. A survey was completed by 1531 Spanish municipalities that are oriented towards tourism and have demonstrated interest in management issues. Based on the constructs emerging from this analysis, we then show how the balanced scorecard can be modified to support the strategic planning of tourism destinations. We conclude by discussing the advantages for long-term strategic planning and sustainable tourism management.     

Does Agricultural Productivity Actually Matter for Food Security in a Landlocked Sub‐Saharan African Country? The Case of Burkina Faso

This paper makes use of a Computable General Equilibrium model to analyze the impact of two agricultural productivity trends on poor households’ food security in Burkina Faso: a negative trend that could arise from many different factors, including land degradation, climate change, and harmful agricultural practices; and a positive trend which may result from enhanced public investment in agriculture, notably in research and development, extension, irrigation, rural roads, rural electrification, and rural education. The results point to a high sensitivity of the poor's consumption to agricultural productivity as well as to stronger impacts on the urban poor than on the rural poor. The current situation is already characterized by severe food insecurity, such that a decline in agricultural productivity is likely to further plunge the urban poor into a deep food crisis. By contrast, positive agricultural productivity trends may help alleviate poverty and food insecurity. Agricultural productivity may indeed affect the poor's food consumption mainly through large changes in agricultural prices and real incomes. Cet article utilise un modèle d’Équilibre Général Calculable pour analyser l'impact des différentes tendances de la productivité agricole sur la sécurité alimentaire des ménages pauvres au Burkina Faso. D'une part, les tendances négatives peuvent résulter de plusieurs facteurs, y compris la dégradation des terres, le changement climatique, et les pratiques agricoles nuisibles. D'autre part, la tendance positive peut résulter de l'investissement public accru dans l'agriculture, notamment dans la recherche et développement, la vulgarisation, l'irrigation, les routes rurales, l′électrification rurale et l′éducation rurale. Les résultats montrent une sensibilité élevée de la consommation des pauvres à la productivité agricole, ainsi que des impacts plus forts sur les populations urbaines pauvres. La situation actuelle est déjà caractérisée par une insécurité alimentaire grave de sorte qu'une baisse de la productivité agricole est susceptible de plonger davantage les pauvres en milieu urbain dans une crise alimentaire profonde. En revanche, la tendance positive sur la productivité agricole peut contribuer à atténuer la pauvreté et l'insécurité alimentaire. La productivité agricole peut en effet affecter la consommation alimentaire des pauvres principalement par le biais de grandes variations des prix agricoles et des revenus réels.