Needs-based health care funding: implications for resource distribution in Ontario

Capitation models have been suggested as an alternative to funding methods based on historical utilization patterns. Capitation funding distributes esources to regions or programs according to their population, adjusted for the age and gender composition and relative need. The most commonly used relative needs measure is the Standardized Mortality Ratio (SMR). This paper compares the distribution of resources in Ontario implied by a variety of capitation formula. Another aspect of this research is to design a mechanism that translates the SMR into a funding allocation index. We specify a non‐linear model to capture the relationship between current expenditures and the SMR while controlling for historical utilization factors. In contrast to previous work, in which a linear relationship between expenditures and need was assumed, our estimates suggest that the relationship may actually be highly non‐linear. This non‐linearity ncreases transfers to regions of relative need relative to a linear capitation program. JEL Classification: I0, H51 On a suggéré des modèles de financement per capita des soins de santé pour remplacer les méthodes de financement fondées sur les patterns historiques d'utilisation. Cette solution de rechange distribuerait les ressources aux régions et programmes selon la population (avec des ajustements pour tenir compte de la structure 'âges, de sexes, et de besoins relatifs). La mesure la plus commune des besoins relatifs est le taux de mortalité standardisé (TMS). Ce mémoire compare la répartition des ressources en Ontario qui découlerait de l'emploi d'une variété de formules. On tente aussi de construire un mécanisme qui traduise le TMS en un indice d'allocation des fonds. Les auteurs construisent un odèle non‐linéaire qui saisit la relation entre TMS et épenses courantes tout en normalisant pour tenir compte des facteurs historiques d'utilisation. Contrairement aux résultats des travaux antérieurs qui postulaient une relation linéaire entre épenses et besoins, les résultats de cette étude uggèrent que cette relation peut être fortement non‐linéaire, et que cette non‐linéarité tend à ccroître les transferts aux régions qui ont les besoins les plus grands.     

Continuity in the gains from trade with similar consumers

The conditions under which one can prove directly that all consumers gain from the elimination of prohibitive tariffs are very stringent. Yet it is intuitively plausible that if these conditions were ‘almost’ met, the results would still obtain and all would gain. We establish this rigorously by use of a topology on economic agents, as developed by Kannai, Debreu and Hildenbrand. Specifically, we show that if, in a given economy, all agents gain in going from autarky to free trade, then in any economies composed of agents sufficiently similar to those in the given one, all will gain.     

A correlation of R & D laboratory performance with critical functions analysis

Five similar government R & D laboratories have been studied using ‘Critical Functions Analysis’ to determine the relative fractions of their staffs performing one or more of seven critical functions; a profile was developed for each laboratory. In order to test the hypothesis that variations in these critical functions profiles would be recognized by laboratory users, fifteen different customers of these laboratories—weapons system project managers and headquarters staff technology managere—were asked questions—designed to determine their perceptions of the relative performance of the five laboratories. Significant variations were found in role profiles among the several laboratories: important variations were also identified in customers' perceptions about laboratory performance. In general, the three laboratories that had higher percentages of their professional staff performing the critical functions also were rated higher in performance by their customers. This difference was particularly striking when an aggregate performance parameter, which summed the numerical values of several performance-sensitive customer questionnaire responses, was used. Customers were found to be especially sensitive to the strength of the laboratories' manufacturing/marketing gatekeeper functions.     

Technical analysis and genetic programming: Constructing and testing a commodity portfolio

Although academic research on the usefulness of technical analysis is mixed at best, its use remains widespread in commodity markets. Much prior research into technical analysis suffers from data‐snooping biases. Using genetic programming, ex ante optimal technical trading strategies are identified. Because they are mechanically generated from simple arithmetic operators, they are free of the data‐snooping bias common in technical analysis research. Futures prices from 24 markets are used in rule generation. Rules for only two of the markets are capable of generating profits at the 5% level of significance using out‐of‐sample data, lending little support for technically based systems. © 2005 Wiley Periodicals, Inc. Jrl Fut Mark 25:643–660, 2005     

The cost of warfarin treatment for stroke prevention in patients with non-valvular atrial fibrillation in Mexico from a collective perspective

Aims: To describe the collective costs of vitamin K antagonist (VKA) treatment for stroke prevention in non-valvular atrial fibrillation (NVAF). VKA drug costs are relatively low, but they necessitate frequent international normalized ratio (INR) monitoring. There are currently minimal data describing the economic impact of this in Mexico.

Materials and methods: Cardiologists provided data on their NVAF patients (n?=?400) to quantify direct medical costs (INR testing, appointments, drug costs). A sub-set of patients (n?=?301) completed a patient questionnaire providing data to calculate direct non-medical costs (travel and other expenses for attendance at VKA-associated appointments) and indirect costs (opportunity cost and reduced work productivity associated with VKA treatment).

Results: Estimated annual direct medical costs totaled $753.6 per patient. Annual direct non-medical and indirect costs were USD$149.8 and $132.1, respectively.

Limitations: Recruited patients were those who consulted with a cardiologist during the study period and selected due to inclusion criteria. All had received uninterrupted treatment for 12–24 months. Consequently, the results are not fully generalizable to all VKA treated NVAF patients.

Conclusions: The true cost of VKA treatment cannot be appreciated by a consideration of drug costs alone. Ongoing monitoring appointments incur additional expenses for both patients and the healthcare system.     

Medical resource utilization and costs among Australian patients with genotype 1 chronic hepatitis C: results of a retrospective observational study

Objective: To evaluate medical resource utilization (MRU) and associated costs among Australian patients with genotype 1 chronic hepatitis C (GT1 CHC), including both untreated patients and those receiving treatment with first-generation protease inhibitor-based regimens (telaprevir, boceprevir with pegylated interferon and ribavirin).

Methods: Medical records were reviewed for a stratified random sample of GT1 CHC patients first attending two liver clinics between 2011–2013 (principal population; PP), supplemented by all GT1 CHC patients attending one transplant clinic in the same period (transplant population; TP). CHC-related MRU and associated costs are reported for the PP by treatment status (treated/not treated) stratified by baseline fibrosis grade; and for the TP for the pre-transplant, year of transplant and post-transplant periods.

Results: A total 1636 patients were screened and 590 patients (36.1%) were included. Comprehensive MRU data were collected for 276 PP patients (F0–1 n?=?59, F2 n?=?58, F3 n?=?53, F4 n?=?106; mean follow-up?=?17.3 months). Thirty-eight (13.8%) were treatment-experienced prior to enrolment; 55 (19.9%) received triple therapy during the study. Data were collected for 112 TP patients (mean follow-up?=?29.9 months), 33 (29.5%) received a transplant during the study, and 51 (45.5%) beforehand. The annual direct medical costs, excluding drug costs, were higher among treated PP vs untreated PP (AU$: $1,954 vs $1,202); and year of transplant TP vs pre-/post-transplant TP (AU$: pre-transplant $32,407, transplant $155,138, post-transplant $7,358).

Limitations: To aid interpretation of results, note that only patients with GT1 CHC who are actively managed are included, and MRU data were collected specifically from liver outpatient clinics. That said, movement of patients between hospitals is rare, and any uncaptured MRU is expected to be minimal.

Conclusions: CHC-related MRU increases substantially with disease severity. These real-world MRU data for GT1 CHC will be valuable in assessing the impact of new hepatitis C treatments.     

The cost of warfarin treatment for stroke prevention in patients with non-valvular atrial fibrillation in Russia from a collective perspective

Aims: Vitamin K antagonists (VKAs) are used for stroke prevention in patients with non-valvular atrial fibrillation (NVAF), but necessitate regular monitoring of prothrombin time via international normalized ratio (INR) testing. This study explores the economic burden of VKA therapy for Russian patients with NVAF.

Method: Cardiologists provided clinical characteristics and healthcare resource use data relating to the patient’s first year of treatment. Data were used to quantify direct medical costs (INR testing, consultations, drug costs). The same patients completed a questionnaire providing data on direct non-medical costs (travel/expenses for attendance at VKA appointments) and indirect costs (opportunity cost and reduced work productivity). Mean costs per patient per year are described (US dollars).

Results: Cardiologists (n?=?50) provided data on 400 patients (mean age?=?63, 47% female), and 351 patients (88%) completed the patient questionnaire. Patients had a mean of nine INR tests. Estimated direct medical costs totaled $151.06, and 18.5% of direct medical costs were attributable to drug costs. Estimated annual direct non-medical costs were $22.89 per patient, and indirect costs were $275.59 per patient.

Limitations: Included patients had been treated for 12–24 months, so are not fully representative of the broader treatment population.

Conclusion: Although VKA drugs costs are relatively low, regular INR testing and consultations drive the economic burden for Russian NVAF patients treated with VKA.     

The Virtuous Influence of Ethical Leadership Behavior: Evidence from the Field

This study examines a moderated/mediated model of ethical leadership on follower job satisfaction and affective organizational commitment. We proposed that managers have the potential to be agents of virtue or vice within organizations. Specifically, through ethical leadership behavior we argued that managers can virtuously influence perceptions of ethical climate, which in turn will positively impact organizational members’ flourishing as measured by job satisfaction and affective commitment to the organization. We also hypothesized that perceptions of interactional justice would moderate the ethical leadership-to-climate relationship. Our results indicate that ethical leadership has both a direct and indirect influence on follower job satisfaction and affective commitment. The indirect effect of ethical leadership involves shaping perceptions of ethical climate, which in turn, engender greater job satisfaction and affective organizational commitment. Furthermore, when interactional justice is perceived to be high, this strengthens the ethical leadership-to-climate relationship.     

The politics of constitutional amendment in postcommunist Europe

This paper analyzes the causes and consequences of constitutional amendments in Eastern Europe. Its results challenge the conventional wisdom that constitutional change is a consequence of institutions and that major changes will increase executive powers and limit rights. It finds that the political and social context rather than institutions is the main cause of amendments. These amendments moreover tend to reduce the power of executives and strengthen guarantees of human rights. The paper attributes these results to the particular circumstances of the postcommunist transition.

Corporate Charitable Contributions: A Corporate Social Performance or Legitimacy Strategy?

This study examines the relation between firms’ corporate philanthropic giving and their performance in three other social domains – employee relations, environmental issues, and product safety. Based on a sample of 384 U.S. companies and using data pooled from 1998 through 2000, we find that worse performers in the other social areas are both more likely to make charitable contributions and that the extent of their giving is larger than for better performers. Analyses of each separate area of social performance, however, indicate that the relation between giving and negative social performance (cited concerns) only holds for the environmental issues and product safety areas. We find no significant association between corporate philanthropy and employee relations concerns. In general, these findings suggest that corporate philanthropy may be more a tool of legitimization than a measure of corporate social responsibility.