scholarly journals Do Individuals Skimp on Health Care After Spouse’s Dementia Diagnosis?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 17-18
Author(s):  
Yi Chen
Keyword(s):  
Health Care ◽  
Fixed Effects ◽  
Time Frame ◽  
Policy Support ◽  
Dementia Diagnosis ◽  
Doctor Visits ◽  
Before And After ◽  
Flu Shot ◽  
Socio Demographic Factors ◽  
The Impact

Abstract Dementia is a costly disease that places great burden on individuals and families. The substantial time and financial resources taken away by living with persons with dementia (PWDs) may make their spouses forgo essential health care, thus deteriorating long-term health and increasing downstream healthcare costs. However, such negative externality is understudied. This paper studied the impacts of spouse's incident dementia diagnosis on an individual's use of needed care, defined as annual flu shot and regular doctor visits for those with preexisting conditions. Using HRS linked to Medicare claims, I employed a fixed effects approach to compare the use of flu shot and doctor visit during 1 year before and after the index, for individuals whose spouse had dementia (N=691) and otherwise similar controls (N=5,073). After adjusting for time-varying health, caregiving roles, and other socio-demographic factors, spouse’s dementia onset was associated with greater likelihood of getting flu shot and seeing doctors. Among those transitioning into caregiving, spouses of PWDs had a marginally higher risk of skimping on doctor visits, compared to controls (p=0.053). In this broadly representative sample, there lacks evidence for rationed health care ensuing spouse’s dementia incidence, at least within a 1-year time frame. However, for new spousal caregivers, the impact of dementia is more profound and complex than deprivation of time. This group may face a trade-off between caring for spouses with dementia and caring for themselves, for whom policy support merits further study and consideration.

scholarly journals The impact of the 2006 Massachusetts health care reform law on spine surgery patient payer-mix status and age

2017 ◽  
Vol 27 (6) ◽  
pp. 694-699 ◽  
Author(s):  
Nicolas W. Villelli ◽  
Hong Yan ◽  
Jian Zou ◽  
Nicholas M. Barbaro
Keyword(s):  
Health Care ◽  
New York ◽  
Health Care Reform ◽  
Health Care System ◽  
Spine Surgery ◽  
Private Insurance ◽  
New York State ◽  
Before And After ◽  
The Impact ◽  
Care System

OBJECTIVESeveral similarities exist between the Massachusetts health care reform law of 2006 and the Affordable Care Act (ACA). The authors’ prior neurosurgical research showed a decrease in uninsured surgeries without a significant change in surgical volume after the Massachusetts reform. An analysis of the payer-mix status and the age of spine surgery patients, before and after the policy, should provide insight into the future impact of the ACA on spine surgery in the US.METHODSUsing the Massachusetts State Inpatient Database and spine ICD-9-CM procedure codes, the authors obtained demographic information on patients undergoing spine surgery between 2001 and 2012. Payer-mix status was assigned as Medicare, Medicaid, private insurance, uninsured, or other, which included government-funded programs and workers’ compensation. A comparison of the payer-mix status and patient age, both before and after the policy, was performed. The New York State data were used as a control.RESULTSThe authors analyzed 81,821 spine surgeries performed in Massachusetts and 248,757 in New York. After 2008, there was a decrease in uninsured and private insurance spine surgeries, with a subsequent increase in the Medicare and “other” categories for Massachusetts. Medicaid case numbers did not change. This correlated to an increase in surgeries performed in the age group of patients 65–84 years old, with a decrease in surgeries for those 18–44 years old. New York showed an increase in all insurance categories and all adult age groups.CONCLUSIONSAfter the Massachusetts reform, spine surgery decreased in private insurance and uninsured categories, with the majority of these surgeries transitioning to Medicare. Moreover, individuals who were younger than 65 years did not show an increase in spine surgeries, despite having greater access to health insurance. In a health care system that requires insurance, the decrease in private insurance is primarily due to an increasing elderly population. The Massachusetts model continues to show that this type of policy is not causing extreme shifts in the payer mix, and suggests that spine surgery will continue to thrive in the current US health care system.

IMPACT OF JOINT COMMISSION INTERNATIONALACCREDITATION (JCIA) ON HEALTH CARE PROCESSES AND THE CHALLENGES FACED BY PHYSICIANS AND NURSES.

2021 ◽  
pp. 34-35
Author(s):  
Binu Thomas ◽  
Ankur Joshi
Keyword(s):  
Health Care ◽  
Employee Engagement ◽  
Interdisciplinary Collaboration ◽  
Joint Commission ◽  
Health Centers ◽  
Cross Sectional ◽  
Care Processes ◽  
Before And After ◽  
Collaboration And Communication ◽  
The Impact

Purpose: To evaluate the impact of joint commission international accreditation on health care processes as well as to assess the challenges faced by the physicians and nurses . Method: Conducted a cross sectional study in 11 health centers belong to Dubai health authority. Prepared a checklist and questionnaire to assess the changes in the processes brought by accreditation as well as the challenges faced by employees respectively. Studied perceived challenges by recruiting physician (n=106) and nurses (n=194) using convenience sampling technique. Done content validity of the tools with clinical quality experts. Conducted pilot study for the questionnaire and checked the reliability using Cronbach alpha (0.924). After obtaining ethical clearance and consent from subjects, the researcher visited health centers and administered questionnaire to the participants. To evaluate the process improvements, the researcher audited documents for the availability of processes before and after accreditation using the validated checklist, which consisted of 25 processes reecting various domains of quality, employee engagement, interdisciplinary collaboration and communication. Results: Observed tremendous improvements in the availability of processes. The proportion of processes before and after the accreditation was statistically signicantly different (p <.001) for quality of health care. However for employee engagement (p=.250) and interdisciplinary collaboration and communication (p=1.000) no statistical signicance were noted even though there were signicant improvements. Majority (57.5%) of doctors and nurses perceived that the accreditation processes were challenging. Discussion: Observed processes improvements ensuring quality, employee engagement, interdisciplinary collaboration and communication after accreditation.However,majority ofthe employees perceived that, the accreditationwas challenging in terms ofworkload, communication and documentation.

scholarly journals Maths Sparks engagement programme: investigating the impact on under-privileged pupils’ attitudes towards mathematics

2020 ◽  
Author(s):  
Aoibhinn Ni Shuilleabhain ◽  
Anthony Cronin ◽  
Mark Prendergast
Keyword(s):  
Social Research ◽  
Time Frame ◽  
Mathematics Students ◽  
Undergraduate Mathematics ◽  
High Stakes ◽  
Mathematical Concepts ◽  
Attitudes Towards Mathematics ◽  
Before And After ◽  
The Subject ◽  
The Impact

Abstract In this paper we explore the attitudes of under-privileged secondary school pupils in Ireland towards mathematics and investigate the impact of attending a 4-week engagement programme on these attitudes. The pupils involved in this research attended schools recognized by the Department of Education & Skills as socio-economically deprived. Pupils attending these schools, known as Delivering Equality of Opportunity in Schools (DEIS), are 40% less likely than their counterparts in non-DEIS schools to pursue mathematics at a higher level in state examinations (Smyth, E., Mccoy, S. & Kingston, G., 2015, Learning From the Evaluation of DEIS. Dublin: Economic and Social Research Institute). However, little research has reported on these pupils’ experiences of and attitudes towards mathematics at senior secondary level. An engagement programme entitled ‘Maths Sparks’ was purposefully designed for secondary pupils from DEIS schools, with the aim of positively influencing their attitudes towards and confidence in mathematics. The programme consisted of weekly out-of-school workshops exploring extra-curricular mathematics topics, designed and delivered by undergraduate mathematics students. Questionnaires were utilized to evaluate pupils’ attitudes towards mathematics before and after their participation in the programme. Despite its relatively short time frame, qualitative and quantitative analysis suggests an increase in participating pupils’ attitudes towards, enjoyment of and self-confidence in mathematics due to their participation in the programme. Findings also suggest that while these pupils liked the subject of mathematics, their experience of learning the subject in school was not always positive and was sometimes hindered by the absence of higher-level mathematics as an option in school. The high-stakes examination content and teachers’ beliefs in the ability of their students also sometimes negatively impacted learners’ intentions to pursue mathematics at a higher level. Findings suggest that longitudinal mathematics engagement programmes, which focus on problem solving, involve extra-curricular mathematical concepts and are presented by undergraduate mathematics students, may provide a valuable way of positively impacting pupils’ intentions to pursue the subject.

scholarly journals The Effect of Initiation of Anti-TNF Therapy on the Subsequent Direct Health Care Costs of Inflammatory Bowel Disease

2019 ◽  
Vol 25 (10) ◽  
pp. 1718-1728 ◽  
Author(s):  
Laura E Targownik ◽  
Eric I Benchimol ◽  
Julia Witt ◽  
Charles N Bernstein ◽  
Harminder Singh ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Expenditures ◽  
Population Based ◽  
World Population ◽  
Median Cost ◽  
Future Health ◽  
Before And After ◽  
Future Health Care ◽  
The Cost ◽  
The Impact

Abstract Background Anti–tumor necrosis factor (anti-TNF) drugs are highly effective in the treatment of moderate-to-severe Crohn’s disease (CD) and ulcerative colitis (UC), but they are very costly. Due to their effectiveness, they could potentially reduce future health care spending on other medical therapies, hospitalization, and surgery. The impact of downstream costs has not previously been quantified in a real-world population-based setting. Methods We used the University of Manitoba IBD Database to identify all persons in a Canadian province with CD or UC who received anti-TNF therapy between 2004 and 2016. All inpatient, outpatient, and drug costs were enumerated both in the year before anti-TNF initiation and for up to 5 years after anti-TNF initiation. Costs before and after anti-TNF initiation were compared, and multivariate linear regression analyses were performed to look for predictors of higher costs after anti-TNF initiation. Results A total of 928 people with IBD (676 CD, 252 UC) were included for analyses. The median cost of health care in the year before anti-TNF therapy was $4698 for CD vs $6364 for UC. The median cost rose to $39,749 and $49,327, respectively, in the year after anti-TNF initiation, and to $210,956 and $245,260 in the 5 years after initiation for continuous anti-TNF users. Inpatient and outpatient costs decreased in the year after anti-TNF initiation by 12% and 7%, respectively, when excluding the cost of anti-TNFs. Conclusions Direct health care expenditures markedly increase after anti-TNF initiation and continue to stay elevated over pre-initiation costs for up to 5 years, with only small reductions in the direct costs of non-drug-related health care.

Handling Regional Variation in Health State Preferences within a Country

2016 ◽  
Vol 37 (3) ◽  
pp. 252-261
Author(s):  
Eleanor M. Pullenayegum ◽  
Kelly M. Sunderland ◽  
Jeffrey A. Johnson ◽  
Feng Xie ◽  
Keyword(s):  
Health Care ◽  
British Columbia ◽  
Regional Variation ◽  
Fixed Effects ◽  
Health State ◽  
Scoring Algorithm ◽  
Scoring Algorithms ◽  
The Impact ◽  
State Preferences ◽  
Health State Preferences

Background. Health state preferences vary among countries, and country-specific value sets are important in health care reimbursement decisions. When decisions are made at the regional level, regional variation in health state preferences may be important. We propose that shrinkage analysis and Bland-Altman plots can be a helpful way to investigate regional variation. Methods. The presence of regional variation can be investigated by introducing interactions between regions and the regression coefficients in the scoring algorithm. When variation is present, regional scoring algorithms can be derived through shrinkage analysis. The impact of using regional algorithms in place of the national algorithm can be investigated using simulation and illustrated using Bland-Altman plots. We applied this methodological approach to the Canadian EQ-5D-5L valuation study, which used time-tradeoff (TTO) tasks to elicit health state preferences from 1073 participants from 4 regions (Alberta, British Columbia, Ontario, and Quebec). Results. There were statistically significant interactions between the fixed effects of the scoring algorithm and region. On computing regional scoring algorithms and applying them to the EQ-5D-5L health states reported by our population, the mean utility using the Canada-wide scoring algorithm was 0.87 (standard error, 0.0013), compared to 0.85 (0.0013) on using the algorithm for Alberta, 0.80 (0.0013) on using the algorithm for British Columbia, 0.91 (0.0013) for Ontario, and 0.89 (0.0014) for Quebec. Conclusions. When health care falls under regional jurisdiction, shrinkage estimators can be used to generate regional scoring algorithms for the EQ-5D-5L and Bland-Altman plots used to assess the importance of regional variation in health state preferences. Our results suggest that mean health state preferences vary among Canada’s regions and make a sizable impact on estimates of population mean utility.

How the peer-to-peer market for tourist accommodation has responded to COVID-19

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Beatriz Benítez-Aurioles
Keyword(s):  
Panel Data ◽  
Fixed Effects ◽  
Design Methodology ◽  
Peer To Peer ◽  
Content Type ◽  
Public Managers ◽  
Before And After ◽  
Tourist Accommodation ◽  
The Impact ◽  
Practical Implications

Purpose This study aims to analyze the COVID-19 pandemic’s impact on the peer-to-peer (p2p) market for tourist accommodation. Design/methodology/approach Using monthly panel data from Airbnb listings in 22 cities worldwide, the authors run a differences-in-differences analysis comparing the period of February–October 2020 to the previous year. Findings Besides a decline in accommodation supply, the pandemic made prices and demand fall in all cities significantly, after controlling for room characteristics, host traits, booking policies and individual fixed effects. There is also evidence of an alteration of the influence on prices of certain variables such as superhost and instant booking. Research limitations/implications The main limitations are related to the reference spatial and temporal environment. Besides, the samples are limited to listings that stayed before and after the pandemic; therefore, it is possible that the real effect on review growth and/or prices is actually more negative. Practical implications The analysis performed shows a scenario that represents an opportunity for public managers to test more imaginative regulations that overcome the limitations of those implemented so far. Likewise, hosts who aspire to make their accommodations profitable must adapt to the conditions imposed by the economic environment of the cities in which they operate. Originality/value This is the first study to econometrically estimate the impact of COVID-19 on prices in the p2p market for tourist accommodation in a set of cities worldwide.

scholarly journals CHANGES IN THE MEDICARE HOME HEALTH CARE MARKET: THE IMPACT OF ACA REIMBURSEMENT POLICY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S690-S691
Author(s):  
Jamila M Torain ◽  
Joan Davitt ◽  
Charlotte L Bright ◽  
Nancy Miller ◽  
Sarah Chard ◽  
...  
Keyword(s):  
Health Care ◽  
New York ◽  
Home Health Care ◽  
Geographic Region ◽  
Home Health ◽  
Health Care Market ◽  
Free Standing ◽  
For Profit ◽  
Before And After ◽  
The Impact

Abstract This study evaluated the effect of recent ACA changes to Medicare Home Health Care (HHC) reimbursements on the mix of agencies and staff in the HHC market. We used Provider of Services (POS) data and logistic regression, to determine which agency characteristics were associated with the likelihood of exiting the HHC market and likelihood of decreasing staff before (n=13,878) and after (n=13,702) implementation of the ACA-mandated reimbursement cuts. Free standing agencies had 1.35 times the odds of exiting from the HHC market post ACA cuts. There were no differences in the odds of exiting the HHC market between for-profit and non-profit agencies. Agencies in the New York, Atlanta, and Chicago regions had a greater likelihood of exiting the HHC market post ACA cuts. Small agencies had two times the odds of exiting (aOR= 2.09) and agencies with one or more branch had less than half the odds of exiting (aOR= 0.46) from the HHC market. The average number of all staff was similar before and after the ACA cuts; however, office staff and home health aides experienced the greatest decrease in number. Agencies that were for-profit, free-standing, small, and/or with one or more branch were more likely to decrease staff post the ACA cuts. Agencies in the New York, Atlanta, Chicago, Dallas and Kansas regions were more likely to decrease staff. Overall, the reimbursement cut effects varied by geographic region and had greater impact on more vulnerable agencies and staff that were non-skilled.

scholarly journals Impacts of land management on the resilience of Mediterranean dry forests to fire

2016 ◽  
Author(s):  
Matteo Jucker Riva ◽  
Gudrun Schwilch ◽  
Hanspeter Liniger ◽  
Alejandro Valdecantos
Keyword(s):  
Land Management ◽  
Management Practices ◽  
Fire Regime ◽  
Management Strategies ◽  
Time Frame ◽  
Mediterranean Forests ◽  
Before And After ◽  
History Of ◽  
Time Specific ◽  
The Impact

Wildfires have always been a part of the history of Mediterranean forests. However, forest regeneration after a wildfire is not certain. It depends on many factors, some of which may be influenced by land management activities. Failure of regeneration will cause a regime shift in the ecosystem, reducing the provision of ecosystem services and ultimately leading to desertification. How can we increase Mediterranean forests&rsquo; resilience to fire? To answer this question, we did a literature review, investigating chains of processes that allow forests to regenerate (which we label &ldquo;regeneration mechanisms&rdquo;), and assessed the impact of selected management practices documented in the WOCAT database on the regeneration mechanisms. We identified three distinct regeneration mechanisms that enable Mediterranean forests to recover, as well as the time frame before and after a fire in which they are at work, and factors that can hinder or support resilience. The three regeneration mechanisms enabling a forest to regenerate after a fire consist of regeneration (1) from a seed bank; (2) from resprouting individuals; and (3) from unburned plants that escaped the fire. Management practices were grouped into four categories: (1) fuel breaks, (2) fuel management, (3) afforestation, and (4) mulching. We assessed how and under what conditions land management modifies the ecosystem&rsquo;s resilience. The results show that land management influences resilience by interacting with resilience mechanisms before and after the fire, and not just by modifying the fire regime. Our analysis demonstrates a need for adaptive &ndash; i.e. context- and time-specific &ndash; management strategies.

scholarly journals Family Ownership and Firm Performance: Romania Versus Germany

2017 ◽  
Vol 10 (2) ◽  
pp. 169-186 ◽  
Author(s):  
Milena J. Schank ◽  
Aurora Murgea ◽  
Cosmin Enache
Keyword(s):  
Firm Performance ◽  
Financial Performance ◽  
Fixed Effects ◽  
Capital Intensity ◽  
Time Frame ◽  
Ordinary Least Squares ◽  
Family Ownership ◽  
Return On Assets ◽  
Return On Equity ◽  
The Impact

Abstract A consistent body of research is dedicated to the relationship between the ownership structure of a firm and its financial performance. Despite that, the hitherto researches fail to reach a consensus regarding this issue since both negative and positive relationships have been found out. This paper examines the impact of ownership’s type (more precise the impact of the family ownership) on the firm’s financial performance. The analysis includes a comparison between family and non-family firm performance using a sample of 1,161 Romanian companies and 1,342 German companies for a time frame that range between 2008 to 2015. Based on different types of static panel data regressions: Pooled Ordinary Least Squares (OLS), Fixed Effects (FE), Random Effects (RE) and a corrective model (PCSE), the main findings show very different results for the two considered countries. Financial performance, expressed as return on assets (ROA) and return on equity (ROE) seems to be insensitive to family ownership in Romanian companies and statistically positively correlated with it for German ones. A potential explanation for these outputs consists in the different development circumstances in the two countries in the period that forego the Second War. At the same time, other variables considered do not show significant differences in outcome between the two countries: size, age, capital intensity and leverage negatively influence the financial performance of companies.

Sign in / Sign up

Export Citation Format

Share Document