Quantifying the defensive medicine contribution to primary care costs

Background:

Defensive medicine represents one cause of economic losses in healthcare. Studies that measured its cost have produced conflicting results.

Objective:

To directly measure the proportion of primary care costs attributable to defensive medicine.

Research design and methods:

Six-week prospective study of primary care physicians from four outpatient practices. On 3 distinct days, participants were asked to rate each order placed the day before on the extent to which it represented defensive medicine, using a 5-point scale from 0 (not at all defensive) to 4 (entirely defensive).

Main outcome measures:

This study calculated the order defensiveness score for each order (the defensiveness/4) and the physician defensive score (the mean of all orders defensiveness scores). Each order was assigned a weighted cost by multiplying the total cost of that order (based on Medicare reimbursement rates) by the order defensiveness score. The proportion of total cost attributable to defensive medicine was calculated by dividing the weighted cost of defensive orders by the total cost of all orders.

Results:

Of 50 eligible physicians, 23 agreed to participate; 21 returned the surveys and rated 1234 individual orders on 347 patients. Physicians wrote an average of 3.6?±?1.0 orders/visit with an associated total cost of $72.60?±?18.5 per order. Across physicians, the median physician defensive score was 0.018 (IQR?=?[0.008, 0.049]) and the proportion of costs attributable to defensive medicine was 3.1% (IQR?=?[0.5%, 7.2%]). Physicians with defensive scores above vs below the median had a similar number of orders and total costs per visit. Physicians were more likely to place defensive orders if trained in community hospitals vs academic centers (OR?=?4.29; 95% CI?=?1.55–11.86; p?=?0.01).

Conclusions:

This study describes a new method to directly quantify the cost of defensive medicine. Defensive medicine appears to have minimal impact on primary care costs.     

Should They Stay or Should They Go? Attitudes Towards Immigration in Europe

This paper examines the main determinants of individual attitudes towards immigration in Europe. Our results suggest that both economic and non‐economic variables shape attitudes towards immigration, but the relative importance of these factors depends crucially on the race/ethnicity of the arriving immigrants. While fears over labour market competition are more likely to shape attitudes towards the arrival of same race immigrants, more exposure to immigrants reduces opposition towards the arrival of different race immigrants. These findings persist after controlling for socioeconomic characteristics, and after exploiting the data to allow for cohort‐specific effects.     

Adapting a book to make a film: how strategy is adapted through professional practices of marketing middle managers

Abstract

For an organisation to be competitive its strategy must be highly responsive to both environmental challenges and customers continuously shifting demands. Yet many organisations treat strategy making as an exclusively top management concern, even though the top management team is often remote from the daily interactions and communications taking place at the organisation, market, and customer interface. We challenge the assumption that strategy making ‘belongs’ to top managers and argue that marketing middle managers, possessing expert market and customer knowledge and insights, adapt top manager’s strategy to shifting customer demands in a changing environment. We explore this argument by adopting a strategy-as-practice perspective and analysing marketing middle manager’s practices across three case companies operating in a dynamic retail environment. Our research enables two key contributions. Our primary confirmation is to demonstrate that marketers are not passive implementers, but active adapters of top management strategy through three critical practices of sensing, challenging, and transmitting. We use the novel analogy of how adapting a book to make a film involves minor changes to the story line and characters to suit the new medium and to illustrate the strategically relevant and influential role marketing plays in adapting the strategy developed by the top management team for implementation. By demonstrating the value of the strategic practices of functional middle managers we also contribute to the growing debate of the need for greater inclusion and transparency in strategy making.     

Trading incentives to meet the analyst forecast

We examine stock sales as a managerial incentive to help explain the discontinuity around the analyst forecast benchmark. We find that the likelihood of just meeting versus just missing the analyst forecast is strongly associated with subsequent managerial stock sales. Moreover, we provide evidence that managers manage earnings prior to just meeting the threshold and selling their shares. Finally, the relation between just meeting and subsequently selling shares does not hold for non-manager insiders, who arguably cannot affect the earnings outcome, and is weaker in the presence of an independent board, suggesting that good corporate governance mitigates this strategic behavior.

Retirement in the UK

In common with other OECD countries, the UK experienced morethan two decades of declining labour-market activity among oldermen from the 1970s to the early 1990s, a trend that has onlyrecently shown signs of being reversed. Retirement decisionsare heavily shaped by institutional context and in the UK thishas led to there being two distinct groups with very different‘retirement’ experiences. At the top of the wealthdistribution, early retirement has typically been influencedby private, occupational pensions; at the bottom of the wealthdistribution individuals are even more likely to be not workingin their 50s, but do not typically define themselves as retired,and draw on income support, or more usually, disability benefits.Policy-makers keen to increase effective retirement ages willneed to consider the very different circumstances of these twogroups. Footnotes ¹ E-mail addresses: j.banks{at}ifs.org.uk; sarah.smith{at}bristol.ac.uk     

Probing cultural differences in product design and consumer evaluation using repertory grid analysis

International Journal of Technology and Design Education - Culture plays an essential role in the success of product design, especially in the age of a global economy where there is a high...     

Why Can't I Trade? Exchange Discretion in Calling Halts*,†

Stock exchanges are important intermediaries in how firm information enters price. Trading halts are a key tool, often exercised at the exchanges' discretion, to prevent extraordinary price volatility when new information arrives. We investigate how exchanges use discretion and whether the discretion alters the effectiveness of the halts. We provide evidence consistent with halts reflecting the preferences of listed firms rather than the stated exchange objectives (i.e., minimizing excess volatility and off-equilibrium trades). Furthermore, when exchanges exercise more discretion (unexplained by firm and information characteristics), the halts are less effective. Specifically, halts with more discretion are less likely to resume trading with efficient prices and are more likely to have been called unnecessarily (i.e., little to no price movement during the halt). These findings are consistent with exchanges using halts to cater to listed firms rather than to meet exchange objectives such as minimizing excess volatility or avoiding trades at off-equilibrium prices.     

A continuous-time model of self-protection

Finance and Stochastics - This paper deals with an optimal linear insurance demand model, where the protection buyer can also exert a time-dynamic costly prevention effort to reduce her risk...     

Income disclosure and consumer judgment in a multilevel marketing experiment

Consumer protection concerns have been raised related to income misrepresentation in multilevel marketing (MLM) recruitment. Though not required by law, some MLM firms choose to voluntarily disclose income information about previous participants. Through replication and extension of the experiment created in Bosley, Greenman, and Snyder (2020), we investigate the impact of these disclosures on consumer interest and earnings expectations. We test the external validity of their findings with subjects from Mechanical Turk and explore issues regarding treatment heterogeneity and better-than-average bias. Supporting prior findings, we present evidence that income disclosures, on average, do not significantly affect subjects' interest in the MLM opportunity, but they do decrease earnings estimates for most while increasing earnings estimates for a few. These effects depend on a subject's numeracy skills and whether they see their earnings potential as better-than-average. We also find that asking about earnings estimates first tends to decrease interest.     

Overcoming data barriers in spatial agri-food systems analysis: A flexible imputation framework

Suppressions in public data severely limit the usefulness of spatial data and hinder research applications. In this context, data imputation is necessary to deal with suppressed values. We present and validate a flexible data imputation method that can aid in the completion of under-determined data systems. The validations use Monte Carlo and optimisation modelling techniques to recover suppressed data tables from the 2017 US Census of Agriculture. We then use econometric models to evaluate the accuracy of imputations from alternative models. Various metrics of forecast accuracy (i.e., MAPE, BIC, etc.) show the flexibility and capacity of this approach to accurately recover suppressed data. To illustrate the value of our method, we compare the livestock water withdrawal estimations with imputed data and suppressed data to show the bias in research applications when suppressions are simply dropped from analysis.