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.     

Where can obesity management policy make the largest impact? Evaluating sub-populations through a microsimulation approach

Background: There is a critical need to focus limited resources on sub-groups of patients with obesity where we expect the largest return on investment. This paper identifies patient sub-groups where an investment may result in larger positive economic and health outcomes.

Methods: The baseline population with obesity was derived from a public survey database and divided into sub-populations defined by demographics and disease status. In 2016, a validated model was used to simulate the incidence of diabetes, absenteeism, and direct medical cost in five care settings. Research findings were derived from the difference in population outcomes with and without weight loss over 15 years. Modeled weight loss scenarios included initial 5% or 12% reduction in body mass index followed by a gradual weight regain. Additional simulations were conducted to show alternative outcomes from different time courses and maintenance scenarios.

Results: Univariate analyses showed that age 45–64, pre-diabetes, female, or obesity class III are independently predictive of larger savings. After considering the correlation between these factors, multivariate analyses projected young females with obesity class I as the optimal sub-group to control obesity-related medical expenditures. In contrast, the population aged 20–35 with obesity class III will yield the best health outcomes. Also, the sub-group aged 45–54 with obesity class I will produce the biggest productivity improvement. Each additional year of weight loss maintained showed increased financial benefits.

Conclusions: This paper studied the heterogeneity between many sub-populations affected by obesity and recommended different priorities for decision-makers in economic, productivity, and health realms.     

美国医疗保健模式及其改革

由于倡导自由市场经济的文化和社会背景,美国是唯一没有实行全国统一的医疗保障制度的发达国家。本文对美国医疗保险制度、美国医院的管理运行机制、美国医疗保险付费方式的沿革进行了系统的介绍,并梳理了美国医疗保健管理模式的特点与问题,结合奥巴马政府医疗保健改革要点,对我国医疗保健体系改革提出了几点建议。     

我国证券公司法人治理结构规范与发展探析

证券公司法人治理结构的规范与发展是证券公司健康发展的内在需要 ,也是我国证券市场乃至国民经济健康发展的需要。本文通过阐述公司法人治理结构的基本范畴、治理原则、组织形式 ,阐明其基本作用 ,通过比较国际上证券公司法人治理结构的特点及我国特征 ,指出了中国证券公司法人治理结构存在的问题和缺陷 ,提出完善中国证券公司法人治理结构的具体措施 ,强调了法人治理结构的规范和发展中应进一步鼓励股权结构多元化、分散化 ,积极引入独立董事制度 ,进行以经营者为主体的约束和激励制度创新 ,建立完善风险监控机制和信息披露规则。     

Financial amplification of foreign exchange risk premia

Theories of financial frictions in international capital markets suggest that financial intermediaries' balance sheet constraints amplify fundamental shocks. We present empirical evidence for such theories by decomposing the U.S. dollar risk premium into components associated with macroeconomic fundamentals, and a component associated with financial intermediary balance sheets. Relative to the benchmark model with only macroeconomic state variables, balance sheets amplify the U.S. dollar risk premium. We discuss applications to financial stability monitoring.     

Monitoring trends of technological changes based on the dynamic patent lattice: A modified formal concept analysis approach

The strategic importance of monitoring technological changes is highlighted given the ever faster pace and increasing complexity of technological innovation. In this respect, patent citation analysis has been the most frequently adopted tool among others. However, patent citation analysis is subject to certain drawbacks that stem from only consideration of citing-cited information and time lags between citing and cited patents. This study proposes a formal concept analysis (FCA)-based approach to developing a dynamic patent lattice that can analyze complex relations among patents and monitor trends of technological changes. The FCA is a mathematical tool for grouping objects with shared properties based on the lattice theory. The distinct strengths of FCA, vis-á-vis other methods, lie in structuring and displaying the relations among objects from a massive amount of data. For the purpose of technology monitoring, the FCA is modified to take into account time periods and changes of patent keywords. A patent context is first constructed with the aid of domain experts and text mining technique. Two types of dynamic patent lattices are then developed by executing the modified FCA algorithm. A case study of laser technology in lithography for semiconductor manufacturing shows that the suggested dynamic patent lattice has considerable advantages over conventional patent citation maps in terms of visualization and informative power.     

经济学视角下自然保护区有效管理行为研究——以甘肃白水江自然保护区李子坝社区为例

以甘肃白水江自然保护区李子坝社区巡护监测为例,从经济学的视角,运用比较优势和竞合模型分析该社区巡护监测与专业巡护监测的两种行为。模型分析显示两者各有优势,在专业巡护监测的基础上,如果辅之以社区巡护监测能更有效地促进环境与生物的多样性的保护,既可以提升有效管理的水平,又可以达到社区保护利益的最大化。     

我国能耗监测管理现状及未来发展趋势

适应节能形势发展的新变化,能耗监测的内涵也正在逐步延伸。实践表明,建立有效的能耗监测管控体系,对于提高能效、推进节能减排作用明显。近年来我国能耗监测管理得到了不同程度的改善,但在管理理念、制度安排、技术创新、资金支持等方面还存在着较多问题。利用信息技术,建立能耗在线实时监测管理体系,将成为未来能耗监测的发展目标。适应这种发展要求,我国需要在计量设备基础管理、能耗监测考核制度、监测机构设置和人员培训、资金渠道等方面进行不断创新。     

中日农村医疗保险制度比较研究

纵向比较分析中日两国农村医疗保险制度的发展历程,从覆盖范围、筹资方式、补偿方式、资金收支情况等方面横向比较中日两国的农村医疗保险制度,探讨中日两国农村医疗保险制度的优缺点,为我国完善新型农村合作医疗制度提供相关建议。     

职业院校开展大学生心理健康教育活动新思考

开展大学生心理健康教育活动,是大学生心理健康教育的两翼之一,对提高大学生的心理健康水平至关重要。笔者通过三年的一线实践活动,就职业院校大学生心理健康教育活动的开展及大学生人格完善的心理问题进行了有益的探索。