The economic burden of depression among adults with rheumatoid arthritis in the United States

Aims: Depression is the most frequent comorbidity reported among patients with rheumatoid arthritis (RA). Comorbid depression negatively impacts RA patients’ health-related quality-of-life, physical function, mental function, mortality, and experience of pain and symptom severity. The objective of this study was to assess healthcare utilization, expenditures, and work productivity among patients with RA with or without depression.

Materials and methods: Data from adult patients who had at least two visits each related to RA and depression over a 1-year period were extracted from the Truven Health MarketScan research databases. Outcomes comprised healthcare resource utilization, work productivity loss, and direct healthcare costs comparing patients with RA with depression (n?=?3,478) vs patients with RA without depression (n?=?43,222).

Results: Patients with RA and depression had a significantly greater relative risk of hospitalization and number of all-cause and RA-related hospitalizations, utilization of emergency services, days spent in the hospital, physician visits, and RA-related surgeries compared with RA patients without depression. Patients with RA and depression had a higher risk of and experienced more events and days of short-term disability compared with patients without depression. The incremental adjusted annual all-cause and RA-related direct costs were $8,488 (95% CI = $6,793–$10,223) and $578 (95% CI = –$98–$1,243), respectively, when comparing patients with RA and depression vs RA only.

Limitations: The current analysis is subject to the known limitations of retrospective studies based on administrative claims data.

Conclusions: This study suggested increased healthcare utilization, work productivity loss, and economic burden among RA patients due to comorbid depression. These findings emphasize the importance of managing depression and including depression as a factor when devising treatment algorithms for patients with RA.     

New development: China renews reform of central–local fiscal relations and provides for basic national public services

China’s reform on central–local fiscal reform has slowed down in recent years. The appointment of a new finance minister experienced in local government affairs is expected to renew the reform affirmed by the Chinese Communist Party (CCP) congress in late 2017. China has unprecedentedly identified a comprehensive list of 81 national basic public services as entitlements. Eighteen of them are subject to national and local standards, and co-financed by central and local governments. A new cost-sharing method for 10 of these services classifies sub-national jurisdictions into five tiers, in which the central government’s share declines from 80% to 10%. These measures, effective in 2019, aim at creating a ‘harmonious and moderately prosperous society’.     

Labour market characteristics and surviving import shocks

This paper investigates whether different labour market characteristics amplify or dampen the local labour market impacts from Chinese import competition exposure. I exploit state‐level variation in initial, pre‐shock labour market characteristics and regional variation across local labour markets in exposure to Chinese imports for identification. I find that local labour markets in states with higher union density experience more severe adverse consequences as a result of increased import exposure. Conversely, higher initial minimum wages help mute the negative impacts of the China shock. I also provide some evidence that exceptions to employment‐at‐will legislation can affect employment responses to increased Chinese imports. Finally, examining all policies together in an index, I show that higher levels of policies intended to benefit and protect workers can actually magnify the extent of the damage inflicted by import competition. My results suggest that initial labour market characteristics and policies can play an important role in understanding why local labour markets react differently to trade shocks.     

Marketing online banking services: The voice of the customer

US banks have invested heavily in developing online capabilities, with the expectation of migrating customers to the new cheaper delivery system. Results in the USA thus far have been mixed at best; market penetration is low and customer usage is sporadic, focusing mainly on simple tasks. This paper reports on the first of two studies conducted to investigate the reasons for the mediocre performance. A qualitative consumer study revealed significant differences in attitudes and opinions between early users and those that banks hope will adopt next. Most importantly, future prospects could be characterised as indifferent about online banking; many were not convinced about its benefits and the value it provides. While the potential to expand the market for online banking services exists, banks need to re-examine their marketing approach.     

Corporate self-greenewal: Strategic responses to environmentalism

The rise of environmentalism in the past decade has become a major transforming force in pollutive and hazard prone industries. Corporate environmental responsiveness is not simply a peripheral and one of the many ‘social’ or ‘ethical’ issues facing business. It is becoming a central concern for competitiveness, productivity, and profitability. It is creating strategic transformation of companies in a diverse range of industries such as, Autos, Chemicals, Oil, Fast Foods, Power Generation, Pharmaceuticals, etc. The process of environmentally directed self-renewal, called ‘greenewal’ here, affects all aspects of companies. It implies changes in products, production systems, waste management practices and internal systems. It seeks to make companies simultaneously more competitive and environmentally responsible. This paper describes the pressures of and responses to environmentalism in a selected set of industries. It examines the processes of greenewal that companies are undergoing. It identifies implications for strategic greening of firms.     

Violations of Service Fairness and Legal Ramifications: The Case of the Managed Care Industry

Adapted from Chan's (2000) model depicting success of litigation, this paper argues that with the application of various legislation, health maintenance organizations' (HMOs') violations of service fairness to each group: enrollees, physicians, and hospitals give rise to each group's lawsuits against the HMOs. Various authors (Bowen et al., 1999; Seiders and Berry, 1998) indicate that justice concepts such as distributive, procedural, and interactional justice can be applied to the area of service fairness. The violation of these underlying justice principles with HMOs' service unfairness to enrollees, physicians, and hospitals is examined. A general synopsis of the ethical issues in the managed care industry is provided. The various lawsuits launched by each group: enrollees, physicians, and hospitals together with the key statutes used are discussed. This paper also highlights the provisions and ramifications of the 11 April 2000 landmark agreement that Aetna made with Texas Attorney General John Cornyn to settle the 1998 lawsuit brought against the company. Lastly, the current ethical issues in the managed care industry are further discussed. The value of this paper can be adapted to the study of organizations' service fairness violations in other industries or in the educational, governmental, and not-for-profit sectors both nationally and internationally.     

Quality Management Systems Certification: Research Note

Although International Quality Standards 9000 certification is one of the most popular quality assurance systems in the world, its contribution to a firm's value is still a controversial issue. This project re-examines this issue by using stock market reactions to the announcements of the award of certification made by a sample of Hong Kong listed companies, as a proxy for its contribution to a firm's value. The results suggest that on average certification increased a firm's value. However, most of this value increase was incorporated into stock prices before formal announcements were published in newspapers. In addition, the contribution of certification to value was greater in smaller firms than in larger ones. This can be attributed to fewer stock traders and professional analysts following smaller firms.     

A theory of global strategic alliances: The case of the global auto industry

The theory articulated in this paper suggests that the desire to reduce demand and competitive uncertainty are two separate, important motives for alliance formation. Taking this as a starting point, we predict the configuration of horizontal alliances that we might expect to observe within an industry when firms experience these uncertainties to different degrees. An empirical test of this theory using data from the global auto industry yields results consistent with the view (1) that alliances are a device for reducing both the uncertainties that arise from unpredictable demand conditions and those that arise from competitive interdependence, and (2) that variation of demand uncertainty and competitive uncertainty across firms explains differentials in both the intensity and structure of their horizontal alliance activity.     

Estimating the effectiveness of extension information systems using farm trials and subjective probabilities

A method of combining survey data and Dairy Herd Improvement Association (DHIA) records to achieve low cost farm trials is presented. Farm trials and surveys of current practices and production responses are useful to identify yield gaps between expectations predicted from experimental findings and actual field results. Different management schemes can be ranked using subjective probabilities and stochastic dominance to enhance successful implementation of research findings and to increase the feedback between researchers, extension workers, and producers. A survey of current masitis control practices and expected milk yield response is the example. Combining survey results with DHIA records allowed estimating the relationship between somatic cell counts (SCC) and milk yield. Eliciting beliefs about the relationship between SCC and milk yield showed that producers agreed with predictions from the statistical model. Subjective probabilities about SCC and mastitis control practices showed that our sample of experts and producers consistently ranked the different practices but extension agents had no consensus about the the most or least effective ones.