Prostate cancer and life insurance

Prostate cancer is comprehensively reviewed from the perspective of risk-stratification. Epidemiology and staging are assessed. The diagnostic implications are described. Treatment strategies are outlined and underwriting implications are presented.     

How Corporate Diversity and Size Influence Spinoffs and Other Breakups

In recent months, the list of large diversified companies that have decided they would be worth more as several smaller, focused companies has grown sharply. In many of these cases, it has been outside pressure from activist investors that has motivated these actions by management—and with some pretty favorable results. But what is driving these strategic actions and what is most important in determining whether breakups create value? To answer this fundamental questions, it is critical to decide whether large, diversified companies have a value recognition problem or a value creation problem. In this article, the authors present and try to integrate the findings of two separate but related research studies on business diversity and size with the aim of identifying their implications for corporate strategy and helping company executives create more value for their investors. The specific reasons for underperformance by large diverse companies vary greatly, but there are a number of potential problems discussed in this article, including organizational “distance,” capital allocation, human capital allocation, cross subsidies, and ineffective governance. Instead of waiting for activist investors to demand a breakup, executives of large diverse companies should be proactive in addressing the potential weaknesses of their organizations. Private equity firms understand how to make diversification work and many of today's executives could learn some valuable lessons from these firms. Large diverse businesses should embrace “Internal Capitalism,” a corporate culture and set of practices that emphasizes the importance of strategic decision‐making that is linked through continuous performance assessment to the corporate goals of boosting efficiency and sustainable growth.     

Is More Information Always Better? An Experimental Study of Charitable Giving and Hurricane Katrina

We report results of an experiment designed to assess the impact of Hurricane Katrina on the pattern and level of charitable contributions of donors. The study includes an experimental measure of charitable giving and targets three charities: the American Red Cross, the Salvation Army, and Oxfam International. In the experiment subjects make allocation decisions from three endowments ($10, $20, and $50) and with four different matching subsidies (0%, 25%, 50%, and 100%), with the matching amount provided by the experimenter. Two locations (Texas and Minnesota) and two information conditions are used. Survey measures of sympathy, risk perceptions, and perceptions of Katrina victims are also collected. The probability and amount of giving are responsive to the experimental design parameters—the endowment and match. We find evidence of “Katrina overload” as those closest to the disaster respond negatively to Katrina-related priming information. Perceptions of the psychological attitudes of the victims of the disaster have a significant effect on the amount given.     

Tourism and community resilience in the Anthropocene: accentuating temporal overtourism

Abstract

Global tourism growth is unprecedented. Consequently, this has elevated the sector as a key plank for economic development, and its utility is deeply embedded in political, economic and social-ecological discourse. Where the expansion of the sector leverages natural and cultural landscapes, this applies pressure to social and ecological underpinnings that if not reconciled, can become problematic. The way this plays out in Australia’s Shipwreck Coast and the wider Great Ocean Road region, especially the implications for community resilience, is the focus. Emphasis is placed on the vulnerability of peripheral coastal areas to development that withdraws from destination endowments, yet fails to provide commensurate economic yield as a suitable trade-off. This is obvious where tourism intensification has led to concerns about the breach of normative carrying capacities. Temporal overtourism driven by seasonal overcrowding is countenanced as emblematic of tourism in the Anthropocene where focus tends to be largely growth-oriented, with much less attention given to bolstering social-ecological resilience, especially community resilience. At stake is the resilience of regional areas and their communities, who in the absence of garnering commensurate economic returns from tourism expansion find themselves in social and ecological deficit.     

Improving the Health of Healthcare Companies

The healthcare sector has been extremely effective in improving human health while at the same time delivering outstanding returns to shareholders, at least on average. But averages can hide a lot of poor performance, and careful examination of the sector shows a sizable disparity between the long‐run productivity and value added of the top companies and the rest. To better understand the reasons for this disparity, the authors undertook a comprehensive study of how differences in capital deployment strategies, financial policies, and measures of corporate operating performance such as sales growth and return on capital are associated with returns to shareholders. Perhaps the most striking finding is the strong positive correlation in the healthcare industry between higher rates of reinvestment, especially in the form of spending on R&D and acquisitions, and stock price performance. And given the importance of such reinvestment, it is not surprising that maintaining financial flexibility by paying down net debt and otherwise limiting corporate leverage—and even issuing significant equity—are all associated with higher stock returns. When it comes to operating performance, moreover, it's not enough just to be good; it takes growth and improvement in cash flow and earnings to drive share prices higher. Measures of changes in performance such as increases in EBIT and ROIC, and high rates of growth in sales, all show consistently strong and positive relationships with stock returns while measures of levels of performance, especially EBIT margins and EBITDA margins, demonstrate relationships that are weak and in some cases even negative. Last, and consistent with the findings reported above, despite often vocal investor demands to pay dividends and buy back shares, in the case of healthcare as a whole such distributions have a clearly inverse relationship with share price performance. That is to say, the larger the payouts to shareholders, the lower the shareholder returns.     

Save the Buyback,Save Jobs

In response to a recent New York Times op‐ed by Senators Schumer and Sanders deploring the effects of stock buybacks on workers and the economy, the authors explain the role of buybacks in increasing corporate productivity and in recycling “excess capital” from mature companies with limited growth and employment opportunities to the next generation of Apples and Amazons. Some companies, as Schumer and Sanders charge, are guilty of repurchasing shares in the name of “shareholder value maximization” instead of pursuing job‐creating investments. But as the authors argue, well‐run companies increase shareholder value not by boosting EPS through buybacks, but mainly by earning competitive returns on capital and investing in their long‐run “earnings power.” And by paying out capital they have no productive uses for, such companies give their own shareholders the opportunity to reinvest in other companies with promising prospects for growth and jobs. But the authors go on to note the tendency of companies to buy back shares not when their stock prices are low, but instead when the companies are flush with cash and nearer the top than the bottom of the business cycle. The result of this tendency, as research by Fortuna Advisors (the authors' firm) shows, is that fully three quarters of companies doing large buybacks during the period 2013‐2017 failed to produce an adequate “Buyback ROI,” a metric developed by Fortuna that indicates management's effectiveness in “timing” its stock repurchases. Given the usefulness of buybacks in recycling capital, the authors conclude that the most reliable solution to the corporate short termism and underinvestment problem is for companies to adopt better financial performance measures—including Buyback ROI—to guide their capital allocation. And when management determines that it has significantly more capital than value‐adding investments, but wants to avoid committing to unsustainable dividend increases, it should consider buybacks—but only if management is convinced that its stock price has not outpaced performance.     

Beyond EVA

A former partner of Stern Stewart begins by noting that the recent acquisition of EVA Dimensions by the well‐known proxy advisory firm Institutional Shareholder Services (ISS) may be signaling a resurgence of EVA as a widely followed corporate performance measure. In announcing the acquisition, ISS said that it's considering incorporating the measure into its recommendations and pay‐for‐performance model. While applauding this decision, the author also reflects on some of the shortcomings of EVA that ultimately prevented broader adoption of the measure after it was developed and popularized in the early 1990s. Chief among these obstacles to broader use is the measure's complexity, arising mainly from the array of adjustments to GAAP accounting. But even more important is EVA's potential for encouraging “short‐termism”—a potential the author attributes to EVA's front‐loading of the costs of owning assets, which causes EVA to be negative when assets are “new” and can discourage managers from investing in the business. These shortcomings led the author and his colleagues to design an improved economic profit‐based performance measure when founding Fortuna Advisors in 2009. The measure, which is called “residual cash earnings,” or RCE, is like EVA in charging managers for the use of capital; but unlike EVA, it adds back depreciation and so the capital charge is “flat” (since now based on gross, or undepreciated, assets). And according to the author's latest research, RCE does a better job than EVA of relating to changes in TSR in all of the 20 (non‐financial) industries studied during the period 1999 through 2018. The article closes by providing two other testaments to RCE's potential uses: (1) a demonstration that RCE does a far better job than EVA of explaining Amazon's remarkable share price appreciation over the last ten years; and (2) a brief case study of Varian Medical Systems that illustrates the benefits of designing and implementing a customized version of RCE as the centerpiece for business management. Perhaps the most visible change at Varian, after 18 months of using a measure the company calls “VVA” (for Varian Value Added), has been a sharp increase in the company's longer‐run investment (not to mention its share price) while holding management accountable for earning an adequate return on investors’ capital.     

Postmodern Corporate Finance

One of the core tenets of modern finance theory is that corporations create value by producing operating rates of return on capital that are greater than the cost of capital. “Postmodern” corporate finance, while reaffirming the importance of earning an adequate return on capital, also attempts to restore at least part of the traditional corporate emphasis on top-line growth that prevailed before the intense focus on returns by modern shareholder value advocates. One important reason for the heightened emphasis on growth in addition to returns is that most rate-of-return measures used by companies and investors are based on conservative accounting practices that make old assets look more profitable than new ones, thereby discouraging investments in growth. This article introduces a new return measure called “Gross Business Return” that, when evaluated against a Required Return framework that reflects the level of current stock prices, has a stronger correlation with how companies are valued by the stock market. Moreover, in reviewing historical returns over time for both the market and specific industries, the author's research suggests that the market appears to demand considerably lower current returns than those implied by traditional weighted average cost of capital (WACC) approaches. And to the extent corporate executives rely on WACC, they could be passing up valuable growth opportunities. To help evaluate tradeoffs between growth and return, the author introduces a cash-based measure of corporate economic profit called Residual Cash Earnings. Unlike most traditional return and economic profit measures, Residual Cash Earnings, when expressed as a percentage of sales, provides a way for corporate managers to identify growth opportunities that, while producing current returns lower than WACC, are likely to add value over a multi-year time horizon. These new measures and analytical tools are suitable for strategic planning, budgeting, resource allocation, performance measurement, and rewards. Consistent application of these principles across these management processes provides a framework for constantly rebalancing the emphasis on growth and return to adapt to changes in the economy, industry, and competitive landscape.     

Coronary heart disease and life insurance

Coronary heart disease morbidity and mortality are dynamic issues. Outcomes from medical and surgical treatments are having dramatic effects. For the life insurer it is vital to follow closely the changing history of the disease.     

On the economics of trials: adversarial process, evidence, and equilibrium bias

The adversarial provision of evidence is modeled as a game inwhich two parties engage in strategic sequential search. Anaxiomatic approach is used to characterize a court's decisionbased on the evidence provided. Although this process treatsthe evidence submissions in an unbiased way, the equilibriumoutcome may still exhibit bias. Bias arises from differencesin the cost of sampling or asymmetry in the sampling distribution.In a multistage model, a prodefendant bias arises in the firststage from a divergence between the parties' stakes. Finally,the adversarial process generates additional costs that screenout some otherwise meritorious cases.