Effects of overweight and obesity on economic outcomes among U.S. adults with kidney disease

Background. Kidney disease is a growing public health phenomenon in the U.S. and in the world. Downstream interventions, dialysis and renal transplants covered by Medicare's renal disease entitlement policy in those who are 65 years and over have been expensive treatments that have been not foolproof. The shortage of kidney donors in the U.S. has grown in the last two decades. Therefore study of upstream events in kidney disease development and progression is justified to prevent the rising prevalence of kidney disease. Previous studies have documented the biological route by which obesity can progress and accelerate kidney disease, but health services literature on quantifying the effects of overweight and obesity on economic outcomes in the context of renal disease were lacking. Objectives . The specific aims of this study were (1) to determine the likelihood of overweight and obesity in renal disease and in three specific adult renal disease sub-populations, hypertensive, diabetic and both hypertensive and diabetic (2) to determine the incremental health service use and spending in overweight and obese renal disease populations and (3) to determine who financed the cost of healthcare for renal disease in overweight and obese adult populations less than 65 years of age. Methods. This study was a retrospective cross-sectional study of renal disease cases pooled for years 2002 to 2009 from the Medical Expenditure Panel Survey. The likelihood of overweight and obesity was estimated using chi-square test. Negative binomial regression and generalized gamma model with log link were used to estimate healthcare utilization and healthcare expenditures for six health event categories. Payments by self/family, public and private insurance were described for overweight and obese kidney disease sub-populations. Results. The likelihood of overweight and obesity was 0.29 and 0.46 among renal disease and obesity was common in hypertensive and diabetic renal disease population. Among obese renal disease population, negative binomial regression estimates of healthcare utilization per person per year as compared to normal weight renal disease persons were significant for office-based provider visits and agency home health visits respectively (p=0.001; p=0.005). Among overweight kidney disease population health service use was significant for inpatient hospital discharges (p=0.027). Over years 2002 to 2009, overweight and obese renal disease sub-populations had 53% and 63% higher inpatient facility and doctor expenditures as compared to normal weight renal disease population and these result were statistically significant (p=0.007; p=0.026). Overweigh renal disease population had significant total expenses per person per year for office-based and outpatient associated care. Overweight and obese renal disease persons paid less from out-of-pocket overall compared to normal weight renal disease population. Medicare and Medicaid had the highest mean annual payments for obese renal disease persons, while mean annual payments per year were highest for private insurance among normal weight renal disease population. Conclusion. Overweight and obesity were common in those with acute and chronic kidney disease and resulted in higher healthcare spending and increased utilization of office-based providers, hospital inpatient department and agency home healthcare. Healthcare for overweight and obese renal disease persons younger than 65 years of age was financed more by private and public insurance and less by out of pocket payments. With the increasing epidemic of obesity in the U.S. and the aging of the baby boomer population, the findings of the present study have implications for public health and for greater dissemination of healthcare resources to prevent, manage and delay the onset of overweight and obesity that can progress and accelerate the course of the kidney disease.^

Estimates of hospital and physician costs of epilepsy in the United States for 1995 comparing the provider -based survey method and a patient -based medical charts and billing method

This investigation compares two different methodologies for calculating the national cost of epilepsy: provider-based survey method (PBSM) and the patient-based medical charts and billing method (PBMC&BM). The PBSM uses the National Hospital Discharge Survey (NHDS), the National Hospital Ambulatory Medical Care Survey (NHAMCS) and the National Ambulatory Medical Care Survey (NAMCS) as the sources of utilization. The PBMC&BM uses patient data, charts and billings, to determine utilization rates for specific components of hospital, physician and drug prescriptions. ^ The 1995 hospital and physician cost of epilepsy is estimated to be $722 million using the PBSM and $1,058 million using the PBMC&BM. The difference of $336 million results from $136 million difference in utilization and $200 million difference in unit cost. ^ Utilization. The utilization difference of $136 million is composed of an inpatient variation of $129 million, $100 million hospital and $29 million physician, and an ambulatory variation of $7 million. The $100 million hospital variance is attributed to inclusion of febrile seizures in the PBSM, $−79 million, and the exclusion of admissions attributed to epilepsy, $179 million. The former suggests that the diagnostic codes used in the NHDS may not properly match the current definition of epilepsy as used in the PBMC&BM. The latter suggests NHDS errors in the attribution of an admission to the principal diagnosis. ^ The $29 million variance in inpatient physician utilization is the result of different per-day-of-care physician visit rates, 1.3 for the PBMC&BM versus 1.0 for the PBSM. The absence of visit frequency measures in the NHDS affects the internal validity of the PBSM estimate and requires the investigator to make conservative assumptions. ^ The remaining ambulatory resource utilization variance is $7 million. Of this amount, $22 million is the result of an underestimate of ancillaries in the NHAMCS and NAMCS extrapolations using the patient visit weight. ^ Unit cost. The resource cost variation is $200 million, inpatient is $22 million and ambulatory is $178 million. The inpatient variation of $22 million is composed of $19 million in hospital per day rates, due to a higher cost per day in the PBMC&BM, and $3 million in physician visit rates, due to a higher cost per visit in the PBMC&BM. ^ The ambulatory cost variance is $178 million, composed of higher per-physician-visit costs of $97 million and higher per-ancillary costs of $81 million. Both are attributed to the PBMC&BM's precise identification of resource utilization that permits accurate valuation. ^ Conclusion. Both methods have specific limitations. The PBSM strengths are its sample designs that lead to nationally representative estimates and permit statistical point and confidence interval estimation for the nation for certain variables under investigation. However, the findings of this investigation suggest the internal validity of the estimates derived is questionable and important additional information required to precisely estimate the cost of an illness is absent. ^ The PBMC&BM is a superior method in identifying resources utilized in the physician encounter with the patient permitting more accurate valuation. However, the PBMC&BM does not have the statistical reliability of the PBSM; it relies on synthesized national prevalence estimates to extrapolate a national cost estimate. While precision is important, the ability to generalize to the nation may be limited due to the small number of patients that are followed. ^

Link between energy consumption per hour of activity and productivity of labour

The data set shows energy consumption per hour of work (in MJ/hour), and labour productivity (in USD/hour) in the PS economic sector (Energy & Mining + Industry + Construction) for the period 1970-2009 and for the following countries: Germany, Spain, USA, Canada, Italy, UK, France, Japan. The intention is to look at the relationship between energy consumption as a driver of improvements in the productivity of labour. This is of particular relevance for the discussion of reducing working time in the context of the 'degrowth' debate, as it is done in the article to which this data is a suplement.

Separation of Control and Cash-Flow Rights of State Owned Listed Enterprises: Channels of Expropriation after the Discriminated Share Reform in China

Literature on agency problems arising between controlling and minority owners claim that separation of cash flow and control rights allows controllers to expropriate listed firms, and further that separation emerges when dual class shares or pyramiding corporate structures exist. Dual class share and pyramiding coexisted in listed companies of China until discriminated share reform was implemented in 2005. This paper presents a model of controller to expropriate behavior as well as empirical tests of expropriation via particular accounting items and pyramiding generated expropriation. Results show that expropriation is apparent for state controlled listed companies. While reforms have weakened the power to expropriate, separation remains and still generates expropriation. Size of expropriation is estimated to be 7 to 8 per cent of total asset at mean. If the "one share, one vote" principle were to be realized, asset inflation could be reduced by 13 percent.

Chapter 2 Equilibrium locations of upstream and downstream firms

This paper explores the interaction between upstream firms and downstream firms in a two-region general equilibrium model. In many countries, lower tariff rates are set for intermediate manufactured goods and higher tariff rates are set for final manufactured goods. The derived results imply that such settings of tariff rates tend to preserve a symmetric spread of upstream and downstream firms, and continuing tariff reduction may cause core-periphery structures. In the case in which the circular causality between upstream and downstream firms is focused as agglomeration forces, the present model is fully solved. Thus, we find that (1) the present model displays, at most, three interior steady states, (2) when the asymmetric steady-states exist, they are unstable and (3) location displays hysteresis when the transport costs of intermediate manufactured goods are sufficiently high.

On the economics of energy consumption in 4G networks: the case of Spain

Reducing energy consumption is one of the main challenges in most countries. For example, European Member States agreed to reduce greenhouse gas (GHG) emissions by 20% in 2020 compared to 1990 levels (EC 2008). Considering each sector separately, ICTs account nowadays for 2% of total carbon emissions. This percentage will increase as the demand of communication services and applications steps up. At the same time, the expected evolution of ICT-based developments - smart buildings, smart grids and smart transportation systems among others - could result in the creation of energy-saving opportunities leading to global emission reductions (Labouze et al. 2008), although the amount of these savings is under debate (Falch 2010). The main development required in telecommunication networks ?one of the three major blocks of energy consumption in ICTs together with data centers and consumer equipment (Sutherland 2009) ? is the evolution of existing infrastructures into ultra-broadband networks, the so-called Next Generation Networks (NGN). Fourth generation (4G) mobile communications are the technology of choice to complete -or supplement- the ubiquitous deployment of NGN. The risk and opportunities involved in NGN roll-out are currently in the forefront of the economic and policy debate. However, the issue of which is the role of energy consumption in 4G networks seems absent, despite the fact that the economic impact of energy consumption arises as a key element in the cost analysis of this type of networks. Precisely, the aim of this research is to provide deeper insight on the energy consumption involved in the usage of a 4G network, its relationship with network main design features, and the general economic impact this would have in the capital and operational expenditures related with network deployment and usage.

Economics of Wheat in Egypt

Este estudio pretende estimar la eficiencia y la productividad de las principales provincias de la producción de trigo en Egipto. Los datos utilizados en este estudio son datos de panel a nivel de provincias del período 1990-2012, obtenidos del Ministerio de Agricultura y Recuperación Tierras, y de la Agencia Central de Movilización Pública y Estadística, Egipto. Se aplica el enfoque de fronteras estocásticas para medir la eficiencia (función de producción de Cobb-Douglas) y se emplean las especificaciones de Battese y Coelli (1992) y (1995). También se utiliza el índice de Malmquist como una aproximación no paramétrica (Análisis de Envolvente de Datos) para descomponer la productividad total de los factores de las principales provincias productoras de trigo en Egipto en cambio técnico y cambio de eficiencia. El coeficiente de tierra es positivo y significativo en los dos especificaciones Battese y Coelli (1992) y (1995), lo que implica que aumentar la tierra para este cultivo aumentaría significativamente la producción de trigo. El coeficiente de trabajo es positivo y significativo en la especificación de Battese y Coelli (1992), mientras que es positivo y no significativo en la especificación de Battese y Coelli (1995). El coeficiente de la maquinaria es negativo y no significativo en las dos especificaciones de Battese y Coelli (1992) y (1995). El coeficiente de cambio técnico es positivo y no significativo en la especificación de Battese y Coelli (1992), mientras que es positiva y significativo en la especificación de Battese y Coelli (1995). Las variables de efectos del modelo de ineficiencia Battese y Coelli (1995) indican que no existe impacto de las diferentes provincias en la producción de trigo en Egipto; la ineficiencia técnica de la producción de trigo tendió a disminuir durante el período de estudio; y no hay ningún impacto de género en la producción de trigo en Egipto. Los niveles de eficiencia técnica varían entre las diferentes provincias para las especificaciones de Battese y Coelli (1992) y (1995); el nivel mínimo medio de eficiencia técnica es 91.61% en la provincia de Fayoum, mientras que el nivel máximo medio de la eficiencia técnica es 98.69% en la provincia de Dakahlia. La eficiencia técnica toma un valor medio de 95.37%, lo que implica poco potencial para mejorar la eficiencia de uso de recursos en la producción de trigo. La TFPCH de la producción de trigo en Egipto durante el período 1990-2012 tiene un valor menor que uno y muestra un declive. Esta disminución es debida más al componente de cambio técnico que al componente de cambio de eficiencia. La disminución de TFPCH mejora con el tiempo. La provincia de Menoufia tiene la menor disminución en TFPCH, 6.5%, mientras que dos provincias, Sharkia y Dakahlia, son las que más disminuyen en TFPCH, 13.1%, en cada uno de ellas. Menos disminución en TFPCH ocurre en el período 2009-2010, 0.3%, mientras que más disminución se produce en TFPCH en el período 1990-1991, 38.9%. La disminución de la PTF de la producción de trigo en Egipto se atribuye principalmente a la mala aplicación de la tecnología. ABSTRACT The objectives of this study are to estimate the efficiency and productivity of the main governorates of wheat production in Egypt. The data used in this study is a panel data at the governorates level, it represents the time period 1990-2012 and taken from the Ministry of Agriculture and Land Reclamation, and the Central Agency for Public Mobilization and Statistics, Egypt. We apply the stochastic frontier approach for efficiency measurement (Cobb-Douglas production function) and the specifications of Battese and Coelli (1992) and (1995) are employed. Also we use Malmquist TFP index as a non-parametric approach (DEA) to decompose total factor productivity of the main governorates of wheat production in Egypt into technical change and efficiency change. The coefficient of land is positive and significant at Battese and Coelli (1992) and (1995) specifications, implying that increasing the wheat area could significantly enhance the production of wheat. The coefficient of labor is positive and significant at Battese and Coelli (1992) specification, while it is positive and insignificant at Battese and Coelli (1995) specification. The coefficient of machinery is negative and insignificant at the specifications of Battese and Coelli (1992) and (1995). The technical change coefficient is positive and insignificant at Battese and Coelli (1992) specification, while it is positive and significant at Battese and Coelli (1995) specification. The variables of the inefficiency effect model indicate that there is no impact from the location of the different governorates on wheat production in Egypt, the technical inefficiency of wheat production tended to decrease through the period of study, and there is no impact from the gender on wheat production in Egypt. The levels of technical efficiency vary among the different governorates for the specifications of Battese and Coelli (1992) and (1995); the minimum mean level of technical efficiency is 91.61% at Fayoum governorate, while the maximum mean level of technical efficiency is 98.69% at Dakahlia governorate. The technical efficiency takes an average value of 95.37%, this implying that little potential exists to improve resource use efficiency in wheat production. The TFPCH of wheat production in Egypt during the time period 1990-2012 has a value less than one and shows a decline; this decline is due mainly to the technical change component than the efficiency change component. The decline in TFPCH is generally improves over time. Menoufia governorate has the least declining in TFPCH by 6.5%, while two governorates, Sharkia and Dakahlia have the most declining in TFPCH by 13.1% for each of them. The least declining in TFPCH occurred at the period 2009- 2010 by 0.3%, while the most declining in TFPCH occurred at the period 1990-1991 by 38.9%. The declining in TFP of wheat production in Egypt is attributed mainly to poor application of technology.

Behavioral economics: Reunifying psychology and economics

“Behavioral economics” improves the realism of the psychological assumptions underlying economic theory, promising to reunify psychology and economics in the process. Reunification should lead to better predictions about economic behavior and better policy prescriptions.

Assessment of University External Internships. Towards a Mixed Model for Measuring the Acquisition of Skills and the Satisfaction of Parties Involved

The continuous improvement of management and assessment processes for curricular external internships has led a group of university teachers specialised in this area to develop a mixed model of measurement that combines the verification of skill acquisition by those students choosing external internships with the satisfaction of the parties involved in that process. They included academics, educational tutors of companies and organisations and administration and services personnel in the latter category. The experience, developed within University of Alicante, has been carried out in the degrees of Business Administration and Management, Business Studies, Economics, Advertising and Public Relations, Sociology and Social Work, all part of the Faculty of Economics and Business. By designing and managing closed standardised interviews and other research tools, validated outside the centre, a system of continuous improvement and quality assurance has been created, clearly contributing to the gradual increase in the number of students with internships in this Faculty, as well as to the improvement in satisfaction, efficiency and efficacy indicators at a global level. As this experience of educational innovation has shown, the acquisition of curricular knowledge, skills, abilities and competences by the students is directly correlated with the satisfaction of those parties involved in a process that takes the student beyond the physical borders of a university campus. Ensuring the latter is a task made easier by the implementation of a mixed assessment method, combining continuous and final assessment, and characterised by its rigorousness and simple management. This report presents that model, subject in turn to a persistent and continuous control, a model all parties involved in the external internships are taking part of. Its short-term results imply an increase, estimated at 15% for the last course, in the number of students choosing curricular internships and, for the medium and long-term, a major interweaving between the academic world and its social and productive environment, both in the business and institutional areas. The potentiality of this assessment model does not lie only in the quality of its measurement tools, but also in the effects from its use in the various groups and in the actions that are carried out as a result of its implementation and which, without any doubt and as it is shown below, are the real guarantee of a continuous improvement.

The Economics of EU Railway Reform. Bruges European Economic Policy (BEEP) Briefing 8/2004

The EU began railway reform in earnest around the turn of the century. Two ‘railway packages’ have meanwhile been adopted amounting to a series of directives and a third package has been proposed. A range of complementary initiatives has been undertaken or is underway. This BEEP Briefing inspects the main economic aspects of EU rail reform. After highlighting the dramatic loss of market share of rail since the 1960s, the case for reform is argued to rest on three arguments: the need for greater competitiveness of rail, promoting the (market driven) diversion of road haulage to rail as a step towards sustainable mobility in Europe, and an end to the disproportional claims on public budgets of Member States. The core of the paper deals respectively with market failures in rail and in the internal market for rail services; the complex economic issues underlying vertical separation (unbundling) and pricing options; and the methods, potential and problems of introducing competition in rail freight and in passenger services. Market failures in the rail sector are several (natural monopoly, economies of density, safety and asymmetries of information), exacerbated by no less than 7 technical and legal barriers precluding the practical operation of an internal rail market. The EU choice to opt for vertical unbundling (with benefits similar in nature as in other network industries e.g. preventing opaque cross-subsidisation and greater cost revelation) risks the emergence of considerable coordination costs. The adoption of marginal cost pricing is problematic on economic grounds (drawbacks include arbitrary cost allocation rules in the presence of large economies of scope and relatively large common costs; a non-optimal incentive system, holding back the growth of freight services; possibly anti-competitive effects of two-part tariffs). Without further detailed harmonisation, it may also lead to many different systems in Member States, causing even greater distortions. Insofar as freight could develop into a competitive market, a combination of Ramsey pricing (given the incentive for service providers to keep market share) and price ceilings based on stand-alone costs might be superior in terms of competition, market growth and regulatory oversight. The incipient cooperative approach for path coordination and allocation is welcome but likely to be seriously insufficient. The arguments to introduce competition, notably in freight, are valuable and many e.g. optimal cross-border services, quality differentiation as well as general quality improvement, larger scale for cost recovery and a decrease of rent seeking. Nevertheless, it is not correct to argue for the introduction of competition in rail tout court. It depends on the size of the market and on removing a host of barriers; it requires careful PSO definition and costing; also, coordination failures ought to be pre-empted. On the other hand, reform and competition cannot and should not be assessed in a static perspective. Conduct and cost structures will change with reform. Infrastructure and investment in technology are known to generate enormous potential for cost savings, especially when coupled with the EU interoperability programme. All this dynamism may well help to induce entry and further enlarge the (net) welfare gains from EU railway reform. The paper ends with a few pointers for the way forward in EU rail reform.

Determinants of Financial Capital Use: Review of theories and implications for rural businesses. Factor Markets Working Paper No. 19, February 2012

This paper presents a review of financial economics literature and offers a comprehensive discussion and systematisation of determinants of financial capital use. In congruence with modern financial literature, it is acknowledged here that real and financial capital decisions are interdependent. While the fundamental role of the (unconstrained) demand for real capital in the demand for finance is acknowledged, the deliverable focuses on three complementary categories of the determinants of financial capital use: i) capital market imperfections; ii) factors mitigating these imperfections or their impacts; and iii) firm- and sector-related factors, which alter the severity of financial constraints and their effects. To address the question of the optimal choice of financial instruments, theories of firm capital structure are reviewed. The deliverable concludes with theory-derived implications for agricultural and non-agricultural rural business’ finance.

The Performance of Swiss and German Family Firms: Investigating Strategies, Orientations and SEW as Determinants

In this chapter we center our attention on the performance drivers of family firms in Switzerland and Germany and compare the corresponding results with the findings generated in the US. Investigating family firms is justified as this organizational form not only constitutes the majority of all firms globally (Sharma and Carney, 2012), but in particular in Switzerland and Germany. In fact, more than 88 percent of all firms in Switzerland are defined as family firms (Frey, Halter, Klein, and Zellweger, 2004), and numbers for Germany are similar (Klein, 2000). While more than 99 percent of all companies in Switzerland are small and medium-sized (Frey et al., 2004), the share of family firms varies with firm size; more specifically, the share of family firms decreases with increasing firm size, which is in line with findings from Germany (Klein, 2000). The social and economic impact of family firms is remarkable. In Germany for instance, family controlled firms provide 60 percent of all jobs and account for 51 percent of the total sales of the German economy (cf. www.familienunternehmen.de). Even though the interest of both academics and practitioners in family firms has been rising significantly in recent years, the existing body of knowledge in the field is still rather fragmented (Sharma, 2004; Sharma and Carney, 2012).