Excessive Spending Research Articles

To Profit or Not to Profit? The Role of Greed Perceptions in Consumer Support for Social Ventures

An increasing number of social ventures are for-profit companies (i.e., for-profit social ventures) that seek to advance a social cause while making a profit. In a series of seven studies, this research investigates consumer support for organizations as a function of their social mission and profit orientation. The impact of profit orientation on consumer support depends on the prominence of the organization’s social mission. For organizations with a prominent social mission, profits are interpreted as a signal of greed; absent a prominent social mission, a for-profit orientation can instead imply greater competence. As a result, consumer support of for-profit social ventures suffers in comparison to both nonprofits and traditional for-profits—a downside to the organizational benefits of for-profit social ventures identified in prior research. In addition, this research investigates organizational factors—including excessive organizational spending, profit perceptions, and operational efficiency cues—that alter greed perceptions and consequently support for for-profit social ventures. Together, this research sheds light on consumer reaction to organizations that support social causes, with implications for the social venture marketplace, including the nonprofit versus for-profit quandary faced by social entrepreneurs.

Trends in Cervical Cancer Screening Versus National Guidelines [23J

INTRODUCTION: Guidelines for cervical cancer screening via pap smear changed in 2012. Previous studies suggest mixed opinions about extended screening intervals. This descriptive study relates trends in pap smear use with the new recommendations. METHODS: Self-reported pap smear information from 2012-2014 Behavioral Risk Factor Surveillance System (BRFSS) surveys were weighted for the US population and subsequently analyzed using SPSS per The BRFSS Data User Guide. Age groups were determined by the 2012 cervical cancer screening guidelines. RESULTS: American women who reported “ever having a pap” declined 1.3% from 2012-2014. Specifically, Paps performed in 18-20 year olds decreased from 38.6% (n=2,580,856) to 27% (n=1,703,912). During this time period, the estimated percentage of women who “had a pap within the last year” declined from 53.6% (n=57,395,954) to 48.4% (n=49,965,054). In 2014 alone, approximately 70% (n=1,184,449) of 18-20 year olds and 23.6% (n=4,832,250) of women over 65 had their most recent pap within the previous year. Conversely, the number of women with a 3-year interval between Paps increased from 7.8% (n=8,327,940) to 9.5% (n=9,831,709) from 2012-2014. CONCLUSION: National Pap smear use is slowly aligning with 2012 guidelines, yet screening trends remain problematic. From 2012-2014, many women aged 18-20 or over 65 underwent a pap while no longer indicated, and few women utilized the extended interval. This can increase use of invasive follow-up procedures, anxiety, and cost, therefore contributing to excessive healthcare spending. Continued analysis of national pap testing will guide future studies that may unveil causes of excessive cervical cancer screening from the physician and patient perspective.

Choose to Lose: Health Plan Choices from a Menu with Dominated Option*

Abstract We examine the health plan choices that 23,894 employees at a U.S. firm made from a large menu of options that differed only in financial cost-sharing and premium. These decisions provide a clear test of the predictions of the standard economic model of insurance choice in the absence of choice frictions because plans were priced so that nearly every plan with a lower deductible was financially dominated by an otherwise identical plan with a high deductible. We document that the majority of employees chose dominated plans, which resulted in excess spending equivalent to 24% of chosen plan premiums. Low-income employees were significantly more likely to choose dominated plans, and most employees did not switch into more financially efficient plans in the subsequent year. We show that the choice of dominated plans cannot be rationalized by standard risk preference or any expectations about health risk. Testing alternative explanations with a series of hypothetical-choice experiments, we find that the popularity of dominated plans was not primarily driven by the size and complexity of the plan menu, nor informed preferences for avoiding high deductibles, but by employees’ lack of understanding of health insurance. Our findings challenge the standard practice of inferring risk preferences from insurance choices and raise doubts about the welfare benefits of health reforms that expand consumer choice.

The Changing Health Care Landscape and Implications of Organizational Ethics on Modern Medical Practice

Medicine is rapidly changing, both in the level of collective medical knowledge and in how it is being delivered. The increased presence of administrators in hospitals helps to facilitate these changes and ease administrative workloads on physicians; however, tensions sometimes form between physicians and administrators. This situation is based on perceptions from both sides that physicians obstruct cost-saving measures and administrators put profits before patients. In reality, increasing patient populations and changes in health care are necessitating action by hospitals to prevent excessive spending as health care systems become larger and more difficult to manage. Recognizing the cause of changes in health care, which do not always originate with physicians and administrators, along with implementing changes in hospitals such as increased physician leadership, could help to ease tensions and promote a more collaborative atmosphere. Ethically, there is a need to preserve physician autonomy, which is a tenet of medical professionalism, and a need to rein in spending costs and ensure that patients receive the best possible care. Physicians and administrators both need to have a well-developed personal ethic to achieve these goals. Physicians need be allowed to retain relative autonomy over their practices as they support and participate in administrator-led efforts toward distributive justice.

Editor's Letter

Editor's Letter

Increased utilization of advanced imaging technology and its economic impact for patients diagnosed with bladder cancer in the United States.

368 Background: This study examined utilization patterns and predictors for use of positron emission tomography-computed tomography (PET/CT), magnetic resonance imaging (MRI), and computed tomography (CT) among Medicare beneficiaries diagnosed with bladder cancer. Methods: We used the Surveillance, Epidemiology and End Results (SEER)-Medicare linked databases to analyze claims data for 36,855 patients aged 60-90 years diagnosed with bladder cancer from 2004 to 2011. The Cochran-Armitage test for trend was used to determine whether significant changes in the proportion of patients receiving advanced imaging after cancer diagnosis occurred during the time interval; trends in the usage of the imaging modality types were assessed. Multivariable logistic regression modeling was conducted to analyze potential demographic and clinical predictors associated with receipt of advanced imaging. The costs of imaging were measured using Medicare payments. Results: While the overall trend of imaging use remained essentially unchanged over the study period, there was a significant decrease in the proportion of patients who received conventional imaging modalities (MRI and CT; P < .05) and a significant increase in the proportion of patients receiving the more advanced imaging modality (PET/CT; P < .0001). On multivariable analysis, receipt of PET/CT was significantly higher in female patients, Non-Hispanics, residents in West Census region, patients with higher grade tumors, those diagnosed with advanced stage disease, hydronephrosis, and those that received radical cystectomy and chemotherapy. In the cost analysis, the estimated national excess medical spending for advanced imaging was $6.1 million. Conclusions: The sharp increase of advanced imaging (PET/CT) and substantial costs associated with this rapid adoption as we have documented suggests that further efforts should be made to evaluate the clinical and economic benefits of PET/CT imaging and to elucidate its appropriateness of use among bladder cancer patients.

Assessing the Efficiency Justifications for the NCAA Player Compensation Restrictions

College football and basketball generate huge broadcast and attendance revenues. The NCAA, however, limits the compensation to athletes in these sports to cover, at most, the cost of attending college, which is well below the financial contribution to the schools of the top level college athletes. These compensation restrictions have recently come under attack in the courts in the O’Bannon and Jenkins cases, among others, as being anticompetitive. The NCAA has argued that its restrictions have procompetitive justifications. In this paper we set out first to evaluate the purported justification for the NCAA’s pay restrictions related to amateurism. We argue that the evidence from a number of Olympic and other now professional sports reveals little relationship between amateurism and demand. Rather than amateurism, we propose that the defining and distinguishing characteristic of college sports is the linkage to the universities. That athletes are also students is integral to the demand for college sports rather than whether these students get paid. We next examine the competitive balance justifications for restraints on payments to athletes. We summarize evidence that the current restrictions do not contribute to making college sports more competitively balanced. Nonetheless, we argue against going too far and lifting all restrictions on athlete compensation due to the inefficiency arising from “positional” competition, sometimes known as an “arms race.” We suggest instead that colleges and universities follow the models set up by professional sports for dealing with excessive spending, and that such models can reduce the anticompetitive effects from the NCAA’s salary restrictions. Such compensation schemes can take the form of player unions bargaining for payroll caps, tiered salary caps, and team revenue sharing.

Public health and the economy could be served by reallocating medical expenditures to social programs

As much as 30% of US health care spending in the United States does not improve individual or population health. To a large extent this excess spending results from prices that are too high and from administrative waste. In the public sector, and particularly at the state level, where budget constraints are severe and reluctance to raise taxes high, this spending crowds out social, educational, and public-health investments. Over time, as spending on medical care increases, spending on improvements to the social determinants of health are starved. In California the fraction of General Fund expenditures spent on public health and social programs fell from 34.8% in fiscal year 1990 to 21.4% in fiscal year 2014, while health care increased from 14.1% to 21.3%. In spending more on healthcare and less on other efforts to improve health and health determinants, the state is missing important opportunities for health-promoting interventions with a strong financial return. Reallocating ineffective medical expenditures to proven and cost-effective public health and social programs would not be easy, but recognizing its potential for improving the public's health while saving taxpayers billions of dollars might provide political cover to those willing to engage in genuine reform. National estimates of the percent of medical spending that does not improve health suggest that approximately $5 billion of California's public budget for medical spending has no positive effect on health. Up to 10,500 premature deaths could be prevented annually by reallocating this portion of medical spending to public health. Alternatively, the same expenditure could help an additional 418,000 high school students to graduate.

The ASEAN Market: Cross-Border Collaboration in Islamic Finance between Malaysia and Thailand

Islamic finance offers a viable and moral-ethical alternative when the world economy suffers from global financial crises due to high debt-gearing and excessive speculations leading to liquidations and losses. In the casino-like scenario of the conventional order, Islamic finance is viewed as a game-changer, setting new rules and behavioral patterns that appeal to humanity and other civilizations due to its adherence to the universal principles of justice, equity and good conscience. In the beginning, Islamic finance may have started off with a nationalistic or religious fervor due to independence from colonialism and reassertion of an Islamic identity. But it has become evident to the world that its core principles, if implemented sincerely, can prevent exploitation, monopoly, bribery and corruption, excessive spending and hoarding of wealth, high debt- gearing and speculation. Ideally, Islamic finance should be promoting values such as entrepreneurship, transparent dealings, risk sharing, profit and loss sharing rather than making profits from a predetermined return. Islamic finance is also based on ethical principles such as trustworthiness and honest dealings, sanctity of contracts, moderate and pragmatic behavior and equitable treatment of stakeholders. This paper examines the role of Islamic finance in developing the ASEAN financial market through cross- border collaboration, specifically with Thailand, through three engines of growth: the Sukuk market, Halal market and Waqf. Islamic finance has opened up many opportunities to the minority Muslims in Thailand and has helped speeded up the integration process. As the world becomes smaller and cross-border players increase, there is a need to have greater legal and regulatory certainty. To ensure Islamic finance is on a level playing field with conventional finance as it crosses borders, the present authors recommend a mutual relaxation of taxation laws and a trade liberalization policy. Lastly, a unified and concerted effort is needed to promote equitable development of ASEAN member nations within the Islamic framework of “prospering thy neighbors”.

Can Emergency Medicine Residents Predict Cost of Diagnostic Testing?

IntroductionDiagnostic testing represents a significant portion of healthcare spending, and cost should be considered when ordering such tests. Needless and excessive spending may occur without an appreciation of the impact on the larger healthcare system. Knowledge regarding the cost of diagnostic testing among emergency medicine (EM) residents has not previously been studied.MethodsA survey was administered to 20 EM residents from a single ACGME-accredited three-year EM residency program, asking for an estimation of patient charges for 20 commonly ordered laboratory tests and seven radiological exams. We compared responses between residency classes to evaluate whether there was a difference based on level of training.ResultsThe survey completion rate was 100% (20/20 residents). We noted significant discrepancies between the median resident estimates and actual charge to patient for both laboratory and radiological exams. Nearly all responses were an underestimate of the actual cost. The group median underestimation for laboratory testing was $114, for radiographs $57, and for computed tomography exams was $1,058. There was improvement in accuracy with increasing level of training.ConclusionThis pilot study demonstrates that EM residents have a poor understanding of the charges burdening patients and health insurance providers. In order to make balanced decisions with regard to diagnostic testing, providers must appreciate these factors. Education regarding the cost of providing emergency care is a potential area for improvement of EM residency curricula, and warrants further attention and investigation.

Do Medicare Beneficiaries Living With HIV/AIDS Choose Prescription Drug Plans That Minimize Their Total Spending?

This article examines whether California Medicare beneficiaries with HIV/AIDS choose Part D prescription drug plans that minimize their expenses. Among beneficiaries without low-income supplementation, we estimate the excess cost, and the insurance policy and beneficiary characteristics responsible, when the lowest cost plan is not chosen. We use a cost calculator developed for this study, and 2010 drug use data on 1453 California Medicare beneficiaries with HIV who were taking antiretroviral medications. Excess spending is defined as the difference between projected total spending (premium and cost sharing) for the beneficiary’s current drug regimen in own plan vs spending for the lowest cost alternative plan. Regression analyses related this excess spending to individual and plan characteristics. We find that beneficiaries pay more for Medicare Part D plans with gap coverage and no deductible. Higher premiums for more extensive coverage exceeded savings in deductible and copayment/coinsurance costs. We conclude that many beneficiaries pay for plan features whose costs exceed their benefits.

Nonlinearities in Wagner's law: further evidence from South Africa

Recently, it has being speculated that the linear relationship between government expenditure and economic growth may be misspecified. In our study, we contribute to the literature by investigating a nonlinear expenditure-growth relationship for South Africa by applying threshold cointegration analysis to six variations of Wagner's law. Indeed, our empirical analysis reveal a nonlinear relationship between the time series for four out of the six versions of Wagner's law thus providing strong evidence of existing nonlinearities for the case of South Africa. We further find uni-directional causality running from government spending to output productivity with positive increases in government expenditure leading to improved GDP levels hence lending support to the Keynesian hypothesis. And yet, we also find that negative deviations from the steady-state are eradicated slower than positive ones hence implying that increases in government spending would be offset by negative shocks to the macroeconomy over the long-run. This implies that excessive spending by South African Government is not a panacea in overcoming the adverse effects of the recent global recession on the macroeconomy.

The Limits of Political Compromise: Debt Ceilings and Political Turnover

We study the desirability of limits on the public debt and of political turnover in an economy where incumbents have an incentive to set public expenditures above the socially optimal level due to rent-seeking motives. Parties alternate in office and cannot commit to future policies, but they can forge a political compromise where each party curbs excessive spending when in office if it expects future governments to do the same. In contrast to the received literature, we find that strict limits on government borrowing can exacerbate political economy distortions by making a political compromise unsustainable. This tends to happen when political turnover is limited. Conversely, a tight limit on the public debt fosters a compromise that yields the efficient outcome if political turnover is vigorous. Our analysis thus suggests that to sustain good economic policies, a society needs to restrict either the extent of political turnover or the ability of governments to issue debt, but not both.

패션 테라피 고찰과 프로토콜 제안

This study proposes an execution protocol for fashion therapy. Research on fashion therapy are limited and insufficient for the current need for the establishment of a fashion therapy theory. This study introduces cognitive behavior therapy, embodied cognition, and object relations theory as theories that underlie fashion therapy. A fashion therapy system model is provided based on the analysis of art therapy to explore its applicability to fashion therapy. The fashion therapy system model utilizes fashion items to managing pain and stress to better competence, encouragement and self-expression mechanisms to improve social, psychological, emotional and behavioral functions. In addition, 8 phases of the fashion therapy process (inquiry, forming rapport, assessment, goal-objective, observation, selection of strategy and design, practice, and the final evaluation and closing of fashion therapy) are suggested for developing a practical fashion therapy program. This study is to help overcome a negative perspective on fashion that provokes an excessive spending behavior and to make a practical contribution by creating more social value through fashion. The significance of the study is in the attempt to create an interdisciplinary approach of psychotherapy and fashion that can be extend into the fashion and textile discipline.

What matters more for South African households’ debt repayment difficulties?

ABSTRACTWhile the increased access to consumer credit has helped many families improve their welfare, the rising repayment burdens upon a background of chronically low saving rates have generated concerns that South African families are becoming ever more financially fragile and less able to meet their consumer debt repayment obligations. Using data from the Cape Area Panel Study, this article investigates whether consumer debt repayment problems are better explained by excessive spending which leaves households financially overstretched or by negative income shocks. The results indicate that households are significantly more likely to be delinquent on their financial obligations when they suffer negative events beyond their control rather than due to the size of the expenditure burden. This suggests that consumer repayment problems are likely to endure even when consumers borrow within their means. Thus, regulatory efforts to improve mechanisms for debt relief might be more meaningful than restrictions on lending.

Epidemiology of bovine gastrointestinal helminthiasis

The gastrointestinal helminths are etiologic agents which have a great important in the decreasing of bovine’s livestock productivity. Among the factors that affect the development of the cattle raising, the gastrointestinal and pulmonary helminthosis are really important as long as they cause economical waste related to the low rates of herd’s productivity, delay on animal’s growing, increased mortality rates of young cattle and excessive spending with management and medicaments. The gastrointestinal parasitism of bovines are often associated to the high numbers of animals in the farm and also to the intensive systems of handling, principally at the dairy cattle. However, talking about ruminants, the nutritional standards and particularly availability of minerals and proteins is an important factor in the optimization of animal’s productivity, interposing in the pathogeny and in the immune response of harborers to the gastrointestinal infections caused by nematodes. The effects of this parasitism in animal production can be reduced by changes in pasture control and application of anti-helmintics. For the success of this procedure, it is necessary to know the biology of the parasites of the region that is going to be studied. One stage of this parasite’s cycle occurs in the environment and many factors are involved in the development and survival of larvas in the pasture and in the maintenance of infection at the animals, such as: climatic and genetical factors and pasturage peculiarities. This revision aims to make an epidemiologic weighing of the main species of gastrointestinal helminths that attack bovines in tropical climate, availing helminthosis prevalence in animal population according to the age-group and to the interaction of this parasites with the economical wastes in bovine pecuary.

Supermajority rule and bicameral bargaining

This paper revisits the claim that supermajority rules and bicameral legislative structures restrain excessive government spending and taxation. Our analysis suggests that the extension effect of a supermajority rule—that requires logrolling across additional members—increases with the ratio of seats in the House relative to seats in the Senate. Using a panel of US states, 1970–2008, we find that the ratio of House-to-Senate seats has a robust, positive impact on the tendency of a supermajority rule to inflate the budget. Our finding implies that a supermajority rule can have a perverse effect on budget outcomes in bicameral legislatures owing to two factors: the geographic overlap between chambers and the low price elasticity of demand for public goods.

Excessive Spending on Back Pain: A $19 Billion Problem, According to New Analysis

Excessive Spending on Back Pain: A $19 Billion Problem, According to New Analysis

Watermelon fertigation with electrical conductivity and ph monitoring in the soil solution

In the olericulture, in general, is practiced intensive fertilization, which creates a risk of salinization and change of high pH, ​​which if not well monitored can cause production losses, excessive spending on fertilizers and environmental contamination. We developed this study with the aim of controlling fertigation on watermelon through the behavior of the electrical conductivity (EC) and pH in the soil solution obtained through porous ceramic cups extractors. The EC and pH values ​​were corrected by the current soil moisture for the moisture field capacity, due to different moisture values ​​at the time of extraction. The monitoring comprised 19 assessments during 80 days of cultivation. We can control the pH and EC of the soil and maintain them at optimal levels for the crop through real-time monitoring of the soil solution. The monitoring enabled the achievement of a balanced fertigation.

Excessive Spending on Back Pain: A $19 Billion Problem, According to New Analysis

Excessive Spending on Back Pain: A $19 Billion Problem, According to New Analysis