scholarly journals Use of past care markers in risk-adjustment: accounting for systematic differences across providers

2021 ◽  
Author(s):  
Laura Anselmi ◽  
Yiu-Shing Lau ◽  
Matt Sutton ◽  
Anna Everton ◽  
Rob Shaw ◽  
...  
Keyword(s):  
Risk Adjustment ◽  
Fixed Effects ◽  
Goodness Of Fit ◽  
Reporting Quality ◽  
Cost Of Care ◽  
Local Health ◽  
Administrative Records ◽  
Practice Level ◽  
Improve Model ◽  
The Cost

AbstractRisk-adjustment models are used to predict the cost of care for patients based on their observable characteristics, and to derive efficient and equitable budgets based on weighted capitation. Markers based on past care contacts can improve model fit, but their coefficients may be affected by provider variations in diagnostic, treatment and reporting quality. This is problematic when distinguishing need and supply influences on costs is required.We examine the extent of this bias in the national formula for mental health care using administrative records for 43.7 million adults registered with 7746 GP practices in England in 2015. We also illustrate a method to control for provider effects.A linear regression containing a rich set of individual, GP practice and area characteristics, and fixed effects for local health organisations, had goodness-of-fit equal to R2 = 0.007 at person level and R2 = 0.720 at GP practice level. The addition of past care markers changed substantially the coefficients on the other variables and increased the goodness-of-fit to R2 = 0.275 at person level and R2 = 0.815 at GP practice level. The further inclusion of provider effects affected the coefficients on GP practice and area variables and on local health organisation fixed effects, increasing goodness-of-fit at GP practice level to R2 = 0.848.With adequate supply controls, it is possible to estimate coefficients on past care markers that are stable and unbiased. Nonetheless, inconsistent reporting may affect need predictions and penalise populations served by underreporting providers.

scholarly journals Privatization and the Postsocialist Fertility Decline

2020 ◽  
Author(s):  
Gábor Scheiring ◽  
Bryant P.H. Hui ◽  
Darja Irdam ◽  
Aytalina Azarova ◽  
Eva Fodor ◽  
...  
Keyword(s):  
Eastern Europe ◽  
Social Reproduction ◽  
Fertility Decline ◽  
Fixed Effects ◽  
Cost Of Care ◽  
Low Fertility ◽  
Random Effects Models ◽  
Cross Country ◽  
The Cost ◽  
And Control

The ten countries with the fastest shrinking population are all located in Eastern Europe, with low fertility as one of the leading causes. In this article, we analyze the privatization of companies as a potential but so far neglected factor behind the postsocialist fertility decline. We argue that privatization is linked to lower fertility by catalyzing uncertainty, shifting the cost of care work onto families, and reducing the resources available to support social reproduction. We test this hypothesis using a novel database comprising information on the demographic and enterprise trajectories of 52 Hungarian towns between 1989-2006 and a cross-country dataset of 28 countries in Eastern Europe. We fit fixed and random-effects models adjusting for potential confounding factors and control for time-variant factors and common trends. We find that company privatization is significantly associated with the postsocialist fertility decline. The observed level of privatization among Hungarian towns corresponds to 0.37 fewer childbirths per woman on average, i.e., approximately 54.3% of the overall fertility decline. Cross-country fixed effects models covering 28 former socialist-bloc countries for the 1989-2012 period confirm the town-level findings. The observed level of privatization among postsocialist countries might explain approximately 49.75% of the overall fertility decline.

GSS 2011 Linked with TIFF: Exploring the Cost of Child Care in Canada and the Use of the Child Care Tax Benefit

2019 ◽  
Vol 12 (1) ◽  
pp. 81-103
Author(s):  
Leanne Findlay ◽  
Dafna Kohen
Keyword(s):  
Child Care ◽  
General Social Survey ◽  
Cost Of Care ◽  
Indigenous Identity ◽  
Social Survey ◽  
The Cost ◽  
Care Costs ◽  
Compare And Contrast ◽  
Employment Characteristics ◽  
Different Sources

Affordability of child care is fundamental to parents’, in particular, women’s decision to work. However, information on the cost of care in Canada is limited. The purpose of the current study was to examine the feasibility of using linked survey and administrative data to compare and contrast parent-reported child care costs based on two different sources of data. The linked file brings together data from the 2011 General Social Survey (GSS) and the annual tax files (TIFF) for the corresponding year (2010). Descriptive analyses were conducted to examine the socio-demographic and employment characteristics of respondents who reported using child care, and child care costs were compared. In 2011, parents who reported currently paying for child care (GSS) spent almost $6700 per year ($7,500 for children age 5 and under). According to the tax files, individuals claimed just over $3900 per year ($4,700). Approximately one in four individuals who reported child care costs on the GSS did not report any amount on their tax file; about four in ten who claimed child care on the tax file did not report any cost on the survey. Multivariate analyses suggested that individuals with a lower education, lower income, with Indigenous identity, and who were self-employed were less likely to make a tax claim despite reporting child care expenses on the GSS. Further examination of child care costs by province and by type of care are necessary, as is research to determine the most accurate way to measure and report child care costs.

scholarly journals Budget Impact Analysis of Anticoagulation Clinics in Patients with Atrial Fibrillation under Chronic Therapy with Oral Anticoagulants

2021 ◽  
Vol 12 ◽  
pp. 215013272110002
Author(s):  
William Uribe-Arango ◽  
Juan Manuel Reyes Sánchez ◽  
Natalia Castaño Gamboa
Keyword(s):  
Atrial Fibrillation ◽  
Impact Analysis ◽  
Budget Impact ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Group Versus ◽  
Cost Of Care ◽  
Chronic Therapy ◽  
Colombian Government ◽  
The Cost

Objectives To assess budget impact of the implementation of an anticoagulation clinic (AC) compared to usual care (UC), in patients with non-valvular atrial fibrillation (NVAF). Method A decision tree was designed to analyze the cost and events rates over a 1-year horizon. The patients were distributed according to treatment, 30% Direct Oral Anticoagulant (DOAC) regimens and the rest to warfarin. The thromboembolism and bleeding were derived from observational studies which demonstrated that ACs had important impact in reducing the frequency of these events compared with UC, due to higher adherence with DOACs and proportion of time in therapeutic range (TTR) with warfarin. Costs were derived from the transactional platform of Colombian government, healthcare authority reimbursement and published studies. The values were expressed in American dollars (USD). The exchanged rate used was COP $3.693 per dollar. Results During 1 year of follow-up, in a cohort of 228 patients there were estimated 48 bleedings, 6 thromboembolisms in AC group versus 84 bleedings, and 12 thromboembolisms events in patients receiving UC. Total costs related to AC were $126 522 compared with $141 514 in UC. The AC had an important reduction in the cost of clinical events versus UC ($52 085 vs $110 749) despite a higher cost of care facilities ($74 436 vs $30 765). A sensibility analysis suggested that in the 83% of estimations, the AC produced savings varied between $27 078 and $135 391. Conclusions This study demonstrated that AC compared with UC, produced an important savings in the oral anticoagulation therapy for patients with NVAF.

scholarly journals Women’s Attrition from Male-Dominated Workplaces in Norway: The Importance of Numerical Minority Status, Motherhood and Class

2021 ◽  
pp. 095001702110042
Author(s):  
Aleksander Å Madsen ◽  
Idunn Brekke ◽  
Silje Bringsrud Fekjær
Keyword(s):  
Sex Differences ◽  
Fixed Effects ◽  
Minority Status ◽  
Occupational Class ◽  
Attrition Rates ◽  
Administrative Records ◽  
Fixed Effects Models ◽  
Increased Risk ◽  
Male Dominated ◽  
Working Class Women

This study explores women’s attrition from male-dominated workplaces based on Norwegian public administrative records, covering individuals born 1945–1983, in the period between 2003 and 2013. It examines sex differences in rates of attrition and tests the significance of two commonly proposed explanations in the literature, namely the degree of numerical minority status and motherhood. It also investigates whether these explanations vary by occupational class. Selection into male-dominated workplaces is accounted for by using individual fixed effects models. The results show that attrition rates from male-dominated workplaces are considerably higher among women than among men. Moreover, the risk of female attrition to sex-balanced workplaces increases, regardless of occupational class, with increases in the percentage of males. Childbirth is associated with an increased risk of attrition to female-dominated workplaces, while having young children (⩽ 10 years old) lowered the risk. This association, however, was primarily evident among working-class women in manual occupations.

scholarly journals A Network Approach for the Study of Drug Prescriptions: Analysis of Administrative Records from a Local Health Unit (ASL TO4, Regione Piemonte, Italy)

2021 ◽  
Vol 18 (9) ◽  
pp. 4859
Author(s):  
Gianluca Miglio ◽  
Lara Basso ◽  
Lucrezia G. Armando ◽  
Sara Traina ◽  
Elisa Benetti ◽  
...  
Keyword(s):  
Administrative Data ◽  
Anatomical Therapeutic Chemical ◽  
Drug Prescription ◽  
Local Health ◽  
Prescription Data ◽  
Health Unit ◽  
Local Health Unit ◽  
Administrative Records ◽  
Edge Linking ◽  
Novel Approach

In a Drug Prescription Network (DPN), each drug is represented as a node and two drugs co-prescribed to the same patient are represented as an edge linking the nodes. The use of DPNs is a novel approach that has been proposed as a means to study the complexity of drug prescription. The aim of this study is to demonstrate the analytical power of the DPN-based approach when it is applied to the analysis of administrative data. Drug prescription data that were collected at a local health unit (ASL TO4, Regione Piemonte, Italy), over a 12-month period (July 2018–June 2019), were used to create several DPNs that correspond to the five levels of the Anatomical Therapeutic Chemical classification system. A total of 5,431,335 drugs prescribed to 361,574 patients (age 0–100 years; 54.7% females) were analysed. As indicated by our results, the DPNs were dense networks, with giant components that contain all nodes. The disassortative mixing of node degrees was observed, which implies that non-random connectivity exists in the networks. Network-based methods have proven to be a flexible and efficient approach to the analysis of administrative data on drug prescription.

The financial consequences of human capital disclosure as part of integrated reporting

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Antonio Salvi ◽  
Nicola Raimo ◽  
Felice Petruzzella ◽  
Filippo Vitolla
Keyword(s):  
Human Capital ◽  
Firm Value ◽  
Fixed Effects ◽  
Cost Of Capital ◽  
Positive Impact ◽  
Firm Risk ◽  
Integrated Reporting ◽  
Content Type ◽  
Financial Consequences ◽  
The Cost

PurposeThe purpose of this paper is to analyse the financial consequences of the level of human capital (HC) information disclosed by firms through integrated reports. Specifically, this work examines the effect of HC information on the cost of capital and firm value.Design/methodology/approachA manual content analysis is used to measure the level of HC information contained in integrated reports. A fixed-effects regression model is used to analyse 375 observations (a balanced panel of 125 firms for the period 2017–2019) and test the financial consequences of HC disclosure.FindingsThe empirical outcomes indicate that HC disclosure has a significant and negative effect on the cost of capital and a positive impact on firm value. Our results show that companies can reduce investors' perceived firm risk by improving HC disclosure, leading to a lower cost of capital. Moreover, our findings support the notion that increased levels of HC disclosure are linked to firms' improved access to external financial resources, consequently enhancing firm value.Originality/valueThis study is the first contribution to examine the financial consequences of HC disclosure and is one of the first to examine the level of HC information within integrated reports.

Origins of the insulin crisis: how a century of price-fixing controversies affects the cost of care today

The Lancet ◽  
2021 ◽  
Vol 398 (10313) ◽  
pp. 1793-1795
Author(s):  
Rachel J Strodel ◽  
Jeremy A Greene
Keyword(s):  
Cost Of Care ◽  
The Cost
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