Treatment patterns and healthcare resource utilization and costs in heavy menstrual bleeding: a Japanese claims database analysis

Aims: Heavy menstrual bleeding (HMB) is a highly prevalent condition, characterized by excessive menstrual blood loss and cramping, that interferes with activities of daily life. The aim of this study was to investigate treatment patterns in HMB in Japan, and to assess healthcare resource utilization and costs among women newly-diagnosed with the condition.

Materials and methods: This study retrospectively analyzed health insurance data available in the Japan Medical Data Center (JMDC) database on women aged 18–49 years who were newly-diagnosed with primary or secondary HMB. Treatment patterns were analyzed, and healthcare utilization and costs were evaluated and compared to matched controls.

Results: The study included a total of 635 patients, 210 with primary HMB and 425 with secondary HMB. In the primary HMB cohort, 60.0% of patients received one or more pharmacological or surgical treatments, compared with 76.2% in the secondary HMB cohort. The most commonly prescribed medications in all patients were hemostatic agents (28.7%), traditional Chinese medicine (TCM) (12.1%), and low-dose estrogen progestins (LEPs) (10.1%). After adjustment for patient baseline characteristics, healthcare costs were 1.93-times higher in primary HMB cases (p?<?.0001) and 4.44-times higher in secondary HMB cases (p?<?.0001) vs healthy controls. Outpatient care was the main cost driver.

Limitations: The main limitations of this study are related to its retrospective nature, and the fact that only reimbursed medications were captured in the source database.

Conclusions: A substantial proportion of HMB patients did not receive the recommended treatments. Healthcare costs were considerably increased in the presence of an HMB diagnosis.     

TESTING THE THEORY OF MULTITASKING: EVIDENCE FROM A NATURAL FIELD EXPERIMENT IN CHINESE FACTORIES

Using a natural field experiment, we quantify the impact of one‐dimensional performance‐based incentives on incentivized (quantity) and nonincentivized (quality) dimensions of output for factory workers with a flat‐rate or a piece‐rate base salary. In particular, we observe output quality by hiring quality inspectors unbeknownst to the workers. We find that workers trade off quality for quantity, but the effect is statistically significant only for workers under a flat‐rate base salary. This variation in treatment effects is consistent with a simple theoretical model that predicts that when agents are already incented at the margin, the quantity–quality trade‐off resulting from performance pay is less prominent.     

Changes in gender wage discrimination in the 1990s: A tale of three very different economies

In this paper gender wage decompositions are performed for three very different countries, that is, Japan, Russia and the USA for the years of 1993 and 2000, using the ISSP data set. From the research of this paper, it is shown that the gender wage differential in Japan has narrowed between 1993 and 2000, and the results reveal price and characteristics effects for this country that differ markedly from those observed elsewhere, with female disadvantage being particularly marked. Also, this paper finds that gender wage differentials in Russia and the USA have increased during the years considered here.     

TFP growth slowdown and the Japanese labor market in the 1990s

Unemployment in Japan nearly tripled during the 1990s. Underlying this upsurge lie an increase in the probability of workers to lose their jobs and a decrease in the probability that the unemployed find jobs. This paper analyzes the sources responsible for these labor market changes in Japan in the decade of the 1990s. We build, calibrate, and simulate a neo-classical growth model with search frictions in the labor market. Using actual TFP data, the model is able to reproduce the path of unemployment and the job flows, as well as that of output. We find it to be the decrease in productivity, coupled with the reduction in hours worked, which curtails the profits of firms, inducing a drop in employment and an increase in unemployment.     

A note on government spending on infrastructure in an endogenous growth model with finite horizon

By extending the work of Mourmouras and Lee (1999), we show that the growth-maximizing income tax rate maximizes also the utilities of not only all current generations but also all future generations. This result means that the statement that the growth-maximizing income tax rate is equivalent to the welfare maximizing one holds true in a stronger sense than Barro (1990) and Mourmouras and Lee (1999) have pointed out.     

The Effects of Uncertain Divestiture as Regulatory Threat

It has been argued that the threat of regulatory intervention affects firm behavior. We investigate the pricing decision of the dominant firm under regulatory threat, considering the probability of intervention as a function of the price. Our focus is on the case where the potential divestiture of the firm serves as a threat of regulatory intervention. It is shown that under certain conditions associated with the marginal expected penalty, the mere threat of divesting a certain portion of the firm’s manufacturing plants leads to a lower price than the actual divestiture of that same portion. Numerical examples illustrate that with relatively small-scale divestiture, the firm’s price under the threat may be lower than that under the actual divestiture, within a relatively broad range of regulator’s attitudes toward intervention.     

A laboratory assessment of the choice of vessel size under individual transferable quota regimes

This paper examines the effect of individual transferable quota regimes on technology choice, such as choice of vessel size, by using the laboratory experiment method. We find that even if vessel sizes change over time, the quota price can converge to the fundamental value conditioned on the vessels chosen. We also find that subjects choose their vessel type to maximise their profits based on the quota trading prices in the previous period. This result implies that the efficiency of quota markets in the beginning period is important because any inefficiency in quota markets may affect vessel sizes in ensuing periods. Moreover, we find that the initial allocations may significantly influence vessel sizes through two channels: first, a higher initial allocation to a subject increases the likelihood that the subject invests in a large‐sized vessel; second, the quota price may be higher and more unstable under unequal allocation than under equal allocation; thus, whether the allocation is equal influences subjects' choice of vessel type.