CAN STATE TAX POLICIES BE USED TO GROW SMALL AND LARGE BUSINESSES?

The existing literature studying the relationship between small business activity and U.S. state tax policy has focused primarily on a few measures of small business. We expand this literature by estimating the effect of state tax policy on small businesses by using broader measures of small business activity using a longitudinal dataset for the U.S. states. We also estimate the relationship between state tax policy and large business activity. Results provide evidence that state tax policy can influence small business firm, establishment, payroll, and employment growth in important ways but provide limited evidence that such policy significantly influences large business growth. (JEL H2, H7, R1)     

The impact of persistence with therapy on inpatient admissions and emergency room visits in the US among patients with multiple sclerosis

Objective:

Disease-modifying therapy (DMT) for multiple sclerosis (MS) can reduce relapses and delay progression; however, poor adherence and persistence with DMT can result in sub-optimal outcomes. The associations between DMT adherence and persistence and inpatient admissions and emergency room (ER) visits were investigated.

Methods:

Patients with MS who initiated a DMT in a US administrative claims database were followed for 1 year. Persistence to initiated DMT was measured as the time from DMT initiation to discontinuation (a gap of >60 days without drug ‘on hand’) or end of 1-year follow-up. Adherence to initiated DMT was measured during the persistent period and was operationalized as the medication possession ratio (MPR). Patients with an MPR <0.80 were considered non-adherent. Claims during the 1-year follow-up period were evaluated for the presence of an all-cause inpatient admission or an ER visit. Adjusted odds ratios (AORs) for inpatient admission or ER visit comparing persistent vs non-persistent and adherent vs non-adherent patients were estimated using logistic regression models adjusted for patient characteristics.

Results:

The final sample included 16,218 patients. During the 1-year follow-up period, 35.3% of patients discontinued their initiated DMT and 13.9% were not adherent while on therapy. During that same period, 10.0% of patients had an inpatient admission and 24.9% had an ER visit. The likelihoods of inpatient admission and ER visit were significantly decreased in persistent patients (AOR [95% CI]?=?0.50 [0.45, 0.56] and 0.65 [0.60, 0.69], respectively) and in adherent patients (AOR [95% CI]?=?0.83 [0.71, 0.97] and 0.86 [0.77, 0.95], respectively).

Conclusions:

Persistence and adherence with initiated DMT are associated with decreased likelihoods of inpatient admission or ER visit, which may translate to improved clinical outcomes.     

Persistence,adherence, and all-cause healthcare costs in atazanavir- and darunavir-treated patients with human immunodeficiency virus in a real-world setting

Objectives:

Atazanavir (ATV) and darunavir (DRV) are protease inhibitors approved for HIV treatment in combination with ritonavir (/r). The objectives of this study were to compare persistence (time to treatment discontinuation/modification), adherence, and healthcare costs among patients with human immunodeficiency virus (HIV) initiating ATV/r or DRV/r.

Methods:

This retrospective cohort study used commercial and Medicaid administrative insurance claims data. Patients initiating ATV/r or DRV/r from 2006–2013 with continuous enrollment for ≥6 months before and ≥3 months after initiation were included. Patients were followed from initiation until discontinuation/modification (≥30 day gap in ATV or DRV or initiation of a new antiretroviral medication), during which time adherence (proportion of days covered [PDC], with PDC ≥80% or 95% considered adherent) and per-patient per-month (PPPM) total healthcare costs were measured. DRV/r patients were propensity score matched to ATV/r patients at a 1:1 ratio to achieve balance on potentially confounding demographic and clinical factors. Commercial and Medicaid samples were analyzed separately, as were antiretroviral (ART)-naïve and experienced patients.

Results:

The final samples comprised 2988 commercially-insured and 1158 Medicaid-insured patients. There were no significant differences in hazards of discontinuation/modification between the ATV/r or DRV/r cohorts. With respect to odds of being adherent, the only marginally significant result was comparing odds of achieving PDC ≥80% among ART-naïve Medicaid patients, which favored ATV/r. All other adherence comparisons were not significant. Although ATV/r cohorts tended to have lower PPPM costs, the majority of these differences were not statistically significant.

Conclusions:

Patients with HIV treated with either ATV/r or DRV/r had similar time to treatment discontinuation/modification, adherence, and monthly healthcare costs. Results were similar across the pre-specified sub-groups. These findings are useful not only as an insight into clinical practice, but also as a resource for healthcare providers and payers evaluating treatment options for HIV+ individuals.     

‘Gay’ tourists and host community attitudes

Despite the growing interest in tourism by gay men, there is little evidence (other than journalistic) of host communities' views towards such tourists. This paper describes a study of such views in a small Mexican beach destination popular with gay tourists. The village is also popular with heterosexual visitors and is known for nude bathing and drug consumption. Interviews were undertaken with a number of residents and revealed disapproval of the gay tourists. This was attributed by residents to overt sexual behaviour, and although there was no evident homophobia, it is postulated that this underlay the attitudes. Copyright © 2010 John Wiley & Sons, Ltd.     

Manufacturer and retailer perceptions of in‐store promotions in South Africa

The objective of this article was to investigate the perceptions of retailers and manufacturers with regard to in‐store promotions A literature review of in‐store promotions was undertaken in the context of channel conflict between manufacturers and retailers In this study, the perceptions of a sample of 133 manufacturers and 144 retailers in South Africa were measured Perceptions of these two groups were obtained about the promotional activities conducted, promotion objectives, price and non‐price promotions and the effectiveness and evaluation methods for promotions The results indicate that there are differences between the two groups, with the retailers being the dominant group Also there is a lack of sound measurement of in‐store promotion Implications for manufacturers are discussed     

Visitor management practices and operational sustainability: Expedition cruising in the Kimberley,Australia

The expedition cruise industry along the remote 3000 km Kimberley coast in Australia’s northwest draws on the area’s environmental and cultural assets for its tourism product and provides the main means of access for visitors. Cruises involve frequent on-shore excursions to attractions including rock pools, rock art and historic sites. This study used visitor observations and stakeholder interviews to examine potential impacts on environmental and cultural site assets, and visitor safety and experience. Visitor management practices varied strongly between operators, with vast room for improvement by some operations. Inconsistent visitor management practices contributed to a high level of avoidable risks in terms of visitor safety and negative cultural and environmental impacts. Findings from this study highlight the central role of tour guides and operational procedures for improving visitor management practices.     

Using neo-institutionalism to advance social and environmental accounting

Neo-institutional theory can increase understanding of an organization's general response to social and environmental issues and social activism. More particularly, it can frame an organization's accounting responses. The analytical schema proposed by Lounsbury (1997) is deployed to explore social and environmental accounting issues that occurred in two local government authorities—one in Canada, one in England. Our analysis highlights possibilities for better and more complete theories of organizational transformation, and social and environmental accounting. We stress the importance of ethical values and ecological thinking if change (including accounting change) is to help institutions behave in a way that is conducive to achieving a sustainable future.