Patient value: its nature,measurement, and role in real world evidence studies and outcomes-based reimbursement

The assessment of “patient value” is fundamental to clinical trials, real world evidence studies, and outcomes-based reimbursement schemes. Measures of health-related quality-of-life (HRQoL) are widely used in health research. Such measures are effective in determining the presence or absence of symptoms and functional ability. However, HRQoL measures were not intended, nor designed, to determine the value to patients of alternative health states. Functions have no intrinsic value—they are a means to fulfil human needs. However, needs can be met in a variety of ways, for example by adopting different functions or by the provision of social services. It is possible to analyze all functions in terms of the needs they satisfy. A needs model has been applied in health research since the 1990s. It is concerned with the extent to which human needs are fulfilled in the presence of disease and its treatment. It is argued that this is the major concern of the patient. Needs-based measures are patient-centric and produce a valid unidimensional index of outcome. Consequently, they provide a direct means of measuring patient value. This approach provides the possibility of evaluating health services in terms of the value they provide to consumers and payers. It also has a role to play in real-world evidence studies and outcomes-based reimbursement. It is recommended that greater attention is given in future to the development of patient-reported outcome measures that provide direct assessments of patient value.     

Provision of a pure local public good in a spatial model with many jurisdictions

This paper examines the provision of a pure local public good in jurisdictions that are spaced evenly along an infinite line. Each jurisdiction either supplies the local public good, or else its residents travel to another jurisdiction to consume the local public good. The equilibrium spacing between jurisdictions which supply the local public good, which can be uneven (varying between a minimum spacing and a maximum spacing for given exogenous parameters), can be greater than, equal to, or less than the socially optimal spacing.     

Measurement of patient-reported outcomes. 1: The search for the Holy Grail

Abstract

Patient-reported outcome measures (PROMs) are used to collect information directly from patients. They may cover several different types of outcomes ranging from symptoms, functioning, utility, satisfaction, through to quality-of-life (QoL). They generally consist of self-completed questionnaires that can be administered by means of hard copies or in a range of electronic formats. PROMs vary considerably in terms of the constructs they assess, the care with which they are developed, and their scientific quality. However, none of the PROMs available approach the quality of measurement achieved by measures/instruments used in physics. PROs are examples of latent variables. These are not directly observable, but can be inferred from, for example, responses to a questionnaire. The only measure of a latent variable that approaches the quality of measurement achieved by the physical sciences is the Lexile Framework for Reading. This framework is based on a construct theory that grew out of an analysis of several available reading measures. A specification equation was generated that was able to link the construct theory to scores obtained with the Lexile measure. A fundamental requirement of this quality of measurement is that the data collected with the model fit Rasch Measurement Theory (RMT). It is argued that PROM developers should aspire to match this level of measurement sophistication if their instruments are to provide valid insights into the impacts of disease and its treatment.     

Rent extraction,principal–agent relationships,and pricing strategies: vendor licensing during the 1996 Olympic Games in Atlanta

Two‐part pricing, price‐discrimination, rent creation and extraction, principal–agent theory, and public choice perspectives on public bureaucracies are used to interpret a vendor‐license marketing arrangement and controversy arising out of the 1996 Olympic Games in Atlanta, GA. Containing features predicted by principal–agency theory, Atlanta's arrangement with its marketing agent was a response to the behavior of public bureaucracies and a low cost method of converting visitors' consumer surplus to rent, which could be extracted by the marketing agent and then by Atlanta. Atlanta's incentive to enforce vendor property rights was influenced by the nature of the game between Atlanta and prospective vendors. Copyright © 2001 John Wiley & Sons, Ltd.     

Family business goal formation: a literature review and discussion of alternative algorithms

Management Review Quarterly - Goals represent an organization’s desired outcomes, and family businesses are known to pursue multiple goals, which commonly include both financial and...     

Incorporating a tracking signal into a state space model

It is a common practice to complement a forecasting method such as simple exponential smoothing with a monitoring scheme to detect those situations where forecasts have failed to adapt to structural change. It will be suggested in this paper that the equations for simple exponential smoothing can be augmented by a common monitoring statistic to provide a method that automatically adapts to structural change without human intervention. The resulting method, which turns out to be a restricted form of damped trend corrected exponential smoothing, is compared with related methods on the annual data from the M3 competition. It is shown to be better than simple exponential smoothing and more consistent than traditional damped trend exponential smoothing.     

The rise of economics in competition policy: A Canadian perspective

Competition policy in Canada and elsewhere has changed remarkably over the last 50 years—in large measure due to advances in economics. In this article, we trace the impact of developments in industrial organization on the three central areas of competition policy: cartels, single firm conduct and mergers. We focus on Canadian competition policy but draw comparisons with developments in the United States and Europe.     

A Model for Partnering with Not-for-Profits to Develop Socially Responsible Businesses in a Global Environment

Corporate social responsibility (CSR) is increasingly important in the global environment. Businesses that want to be socially responsible, but do not have the resources of multinational corporations, can partner with non-governmental (NGO), not-for-profit (NFP), and religious organizations to access information about the culture, customs, and needs of the people in areas where they wish to do business. Without such information, CSR projects can have unintended consequences that are not beneficial for the community. Suggesting that local farmers sell corn to ethanol producers may increase the farmers’ income but also increase the cost of a food staple to the community. Providing food aid may result in local farmers being unable to sell their crops for enough money to buy seed for the next harvest. Donating cheaper cinder blocks instead of adobe bricks may result in more available housing, but the housing may be unlivable in the summer heat. This paper presents a three-part model for businesses to follow to develop socially responsible projects. The first strategy is to use electronic sources of information about a country and area for background information. The second strategy is to gather on-the-ground information about important issues from the people who are already operating in a community as part of NGO, NFP and missionary initiatives. The third strategy is to develop scenarios that will help identify possible negative consequences of socially responsible projects so that the project implementation can be monitored for such consequences and interventions designed to decrease or counter the impact of negative consequences.     

Restructuring and Workplace Unionism at Manchester Airport

This paper provides evidence from empirical case-study research into the impact of compulsory competitive tendering on workplace union organization among the baggage-handling workforce at Manchester Airport. It documents the main processes of development within an historical context, assessing the strengths and weaknesses of workplace unionism during the 1980s, the recent challenge posed by managerial restructuring in the early 1990s, and the wider implications for debates about the 'state' of workplace unionism in Britain today.
Compared with the union resilience displayed by the baggage handlers during the 1980s, the nature of shop-stewards' organization appears to have changed drastically to managemenťs advantage during the last few years. However, continuing underlying tensions in worker-management relations suggest that this situation may not necessarily amount to a fundamental and irreversible transformation in the nature of workplace unionism in the manner in which those who use the vocabulary of the 'New Industrial Relations' would suggest.