Financial Margins Research Articles

Influence of financial conditions on stress in colorectal cancer patients undergoing outpatient chemotherapy

Abstract Objective This study was performed to clarify the influence of financial conditions on stress in patients with advanced recurrent colorectal cancer undergoing outpatient chemotherapy. Methods A self-administered questionnaire survey was completed by patients with advanced and recurrent colorectal cancer receiving outpatient chemotherapy in five hospitals in the Kansai region. The questionnaire included basic information (age, sex, current employment availability, and subjective financial condition (3 choices)), and the 29-item stress scale from Japanese version of the Mastery of Stress Instrument (5-point scale with a total score of 29-140 points) . Results Responses were received from 76 outpatients (response rate: 95%). The patients’ mean age was 66.6 ± 8.5 years, and they comprised 50 men (65.8%) and 26 jobholders (34.2%). Three patients (3.9%) always had financial leeway (Yutori group), 37 (48.7%) had a satisfactory financial margin (sufficient group), and 36 (47.4%) had no financial margin (marginless group). The mean stress score was 70.0 ± 15.3 points. The stress score was significantly higher in the unemployed group than in the working group. With respect to the patients’ subjective financial condition, the stress score was significantly higher in the marginless group than in the sufficient group. The Yutory group did not differ significantly from any other groups. Discussion and Conclusion Patients with advanced recurrent colorectal cancer undergoing outpatient chemotherapy often follow a long-term treatment course. Therefore, financial problems while undergoing cancer treatment may be a heavy burden. Patients who are unemployed and have no income appear to experience stressful conditions during treatment, such as distress and confusion. These findings suggest the need to provide both mental support and employment support to patients undergoing treatment for cancer. This work was supported by KAKENHI Grant Number A16H055760.

Transformation to Academic Leadership: The Role of Mentorship and Executive Coaching.

The transition to academic leadership entails learning to utilize an enormous new collection of skills. Executive leadership coaching is a personalized training approach that is being increasingly used to accelerate the onboarding of effective leaders. Vanderbilt University Medical Center has invested in a robust coaching strategy that is offered broadly to institutional leaders. This case study details the early transformational learning of leadership skills by one new institutional leader in the first two years in an academic leadership role, telling the first-person account of the experience of being coached while independently leading a division of hematology and oncology at a highly ranked medical center. Over two years' time, assessed in 6-month intervals, the academician transitions into the role, and using scenarios from regular practice in this position, learns to incorporate core leadership principles into the daily activities of running a division. The transition to academic leadership involves a transformation; a conversion that can be accelerated, guided, and applied with a greater deal of sophistication through intentional coaching, and the application of principles of behavioral science and psychology. Much like the process of coaching a high performing athlete, an elite academician can be trained in skills that enhance their game and succeed in creating a winning team. The academic medical center (AMC) is an interesting social organization, made up of highly accomplished and well-educated people, brought together around a variety of missions and motivations: education, patient service, research, community building, financial margins, and citizenship to name a few. Moreover, the leadership of AMCs almost entirely comes from within this community, drawing people with talents in science, teaching, clinical research, and service into roles that industries reserve usually for MBAs, lawyers, and other professionals who undergo rigorous guided training. Fortunately, academics are well-equipped with skills in lifelong learning, focused curiosity, and tend to be ambitious to a fault. Thus, there is a steady pipeline of budding leaders in AMC's eager to tackle new challenges that will further their missions. Like major industries in the public and private sectors, the demands of leadership are significant. How to navigate the transitions from physician, teacher, or scientist to academic leader is not covered easily in any text. Vanderbilt University Medical Center has adopted a model of Leadership Coaching, akin to the Trusted Leadership Advisor model (Wasylyshyn, 2017). This case study details the experience of one new leader (first author), freshly plucked from the medical science proving ground. Accounts and description of the experiences and intentions of the leadership coach, Dick Kilburg, provide insight into the processes applied in facilitating this transition. Finally, observations of the transition from the vantage point of the primary supervisor (Department Chair, Nancy Brown) provide a further description of the coaching effect on the early development of an AMC leader. The experience of the client, Kimryn Rathmell (Kim), is told in first person narrative format-fitting for the intense and personal experience that accompanies the transition to a leadership role.

Financial Margins for Prostate Cancer Surgery: Quantifying the Impact of Modifiable Cost Inputs in an Episode Based Reimbursement Model.

The United States health care system is rapidly moving away from fee for service reimbursement in an effort to improve quality and contain costs. Episode based reimbursement is an increasingly relevant value based payment model of surgical care. We sought to quantify the impact of modifiable cost inputs on institutional financial margins in an episode based payment model for prostate cancer surgery. A total of 157 consecutive patients underwent robotic radical prostatectomy in 2016 at a tertiary academic medical center. We compiled comprehensive episode costs and reimbursements from the most recent urology consultation for prostate cancer through 90 days postoperatively and benchmarked the episode price as a fixed reimbursement to the median reimbursement of the cohort. We identified 2 sources of modifiable costs with undefined empirical value, including preoperative prostate magnetic resonance imaging and perioperative functional recovery counseling visits, and then calculated the impact on financial margins (reimbursement minus cost) under an episode based payment. Although they comprised a small proportion of the total episode costs, varying the use of preoperative magnetic resonance imaging (33% vs 100% of cases) and functional recovery counseling visits (1 visit in 66% and 2 in 100%) reduced average expected episode financial margins up to 22.6% relative to the margin maximizing scenario in which no patient received these services. Modifiable cost inputs have a substantial impact on potential operating margins for prostate cancer surgery under an episode based payment model. High cost health systems must develop the capability to analyze individual cost inputs and quantify the contribution to quality to inform value improvement efforts for multiple service lines.

Education of the Head and Financial Vulnerability of Households: Evidence from a Household’s Survey Data in Pakistan

This paper is aimed at to ascertain the relationship between education of head of the households and their financial vulnerability using data comprising of 17,031 households obtained from Household Integrated Economic Survey 2015–2016 in Pakistan. We have compiled three measures of financial vulnerability at household level i.e. financial margins excluding and including the rental payments and Financial Vulnerability Index (FVI). According to the results, proportion of financially vulnerable households in both measures of financial margin declines along with increase in level of education of the head of households and stands at 66% and 77% for no formal education of the head, 56% and 70% for primary, 42% and 61% for secondary, 27% and 44% for higher secondary, 14% and 32% for graduate and 13% and 24% for post graduate levels of education. FVI results indicate that out of 2504 highly vulnerable households i.e. falling in the bottom 10% of the distribution, 63.8% were those with no formal education of their heads followed by 19.3% with primary, 14.3% with secondary and 1.9% with higher secondary level of education. Further, various levels of education and individual characteristics such as marital status, gender, region, province and employment status of the heads, have been emerged as significant determinants of financial vulnerability in all three estimated measures along with household’s income, consumption, savings and rental payments. Findings of the study calls for greater human capital investment both by households and the government of Pakistan in order to stabilize the financial conditions of the households at micro level, which in turn can promote stability and resilience at macro level.

Abstract 286: The Heart Failure Clinic: Empowering the Armor Against 30-day All-cause Readmissions

Introduction: Heart failure related recurrent hospitalizations are widely recognized as a source of burden to both patients and the health system. Hospital discharges represent a transition of care from a controlled environment to one of lesser physician oversight and can often become a catalyst for readmission. One strategy in reducing this burden is the implementation of dedicated heart failure clinics by providing ease of transition whilst ensuring disease specific care. Methods: A retrospective review of all patients discharged from the Kings County Hospital Center from October 1 st 2017 to June 30 th 2018 with a discharge diagnosis of heart failure was conducted. Patients following in the Heart Clinic (HC) were compared to those who opted for their standard follow up (SF). The option of following in the HC (intervention group) was made at the time of discharge. All included cases were followed for 30 days after discharge to determine whether an all-cause readmission occurred at any New York City Health and Hospitals affiliated hospital. Demographic data was extracted via chart review and analyzed by descriptive statistics. A Kaplan-Meier survival analysis was done to compare the time-to-event between both study cohorts. Results: There were 258 patient discharges after exclusion-criteria were applied. Overall, a sicker population was present in the HC cohort evidenced by greater NYHA Class 3 and 4 symptomatology (54.1% vs 30.4%, p=0.007) and more patients with an ejection fraction <30% (58.2% vs 36.8%, p=0.014). A Kaplan Meier analysis was conducted for the 9 months of follow up. Readmission within 30 days of discharge occurred in 5 (5.4%) of the 93 patients in the intervention group, compared with 27 (16.4%) of the 165 patients without intervention. The Heart clinic group had a better event free survival with a 67.1% reduction in readmission (log rank p=0.009). The mean time to readmission in the HC cohort was lower at 27.1 days compared to 29.5 days in the SF cohort (p=0.002). Conclusion: Our study revealed a 67.1% reduction in 30-day all-cause readmission following the initiation of the clinic. There is noticeable clinical interpretation of this outcome since the heart clinic patients were a sicker cardiac population at a safety net hospital that has a large volume of uninsured, low socioeconomic status patients. The compounded biological, social and environmental factors make the case load highly prone to CHF readmissions and underscores the need for a clinically useful strategy in fighting the high morbidity, mortality and economic burden of chronic heart failure. The presented study has wide implications in promoting high quality care, reducing readmission penalties, and minimizing the cost associated with inpatient admission, especially in centers where tight financial operating margins can be a barrier to allocation of resources.

Traditional management accounting tools in SMEs' network. Do they foster partner dialogue and business innovation?

This paper aims to understand whether traditional management accounting tools (e.g. financial statement, reclassification and contribution margin analysis) contribute to foster dialogue and innovation in business networks composed of SMEs (small and medium-sized enterprises). Through the analysis of a case study, the paper focuses on a contractual network operating in the paper&print sector in Italy. Framing the analysis in the Simons’ construct (1990 and 1995), who distinguishes between and controls, the paper provides insights on the use of management control in inter-organizational settings, arguing that the traditional accounting tools can play an innovative role in network success. The contribution of the paper is on the ongoing debate on which functions, accounting information and MCSs (management control systems) may play in networks. In particular, findings shed light on the need to adapt the distinction between diagnostic and interactive in the network setting, given the horizontal and non-hierarchical relationships between the units involved.

Digital Scalability and Growth Options of Intangible Assets

Scalability indicates the ability of a process, network, or system to handle a growing amount of work. Scalability fosters economic marginality, especially in intangible-driven businesses where variable costs are typically negligible. Massive volumes may offset low margins, producing economic gains. Digitalization is defined as the concept of “going paperless”, the technical process of transforming analog information or physical products into digital form. Digital scalability operates in a web context, where networked agents interact to generate co-created value. Economic and financial margins that represent a primary parameter for valuation are boosted by cost savings and scalable increases of expected revenues. Digitalized intangibles synergistically interact through networked platforms that reshape traditional supply chains.

Multi-objective simulation and optimisation of dairy sheep farms: Exploring trade-offs between economic and environmental outcomes

A decision support tool for sheep farming systems (PASTOR-DSS) was developed to investigate trade-offs between economic and environmental objectives on Spanish dairy sheep farms. The tool combines a hierarchical stochastic simulation model at three levels with a multi-objective optimisation procedure based on genetic algorithms. The first level of simulation includes rumen, reproduction and nutrient balance submodels. These three submodels are integrated into an animal model, which constitutes the second level. The third level is the farm, which includes the flock, the feeding and reproductive management, the availability of feeding resources, and the farm economics. The multi-objective genetic algorithm applies to the farm level. The tool was validated for the different levels of simulation, with outputs having an acceptable level of accuracy and representing correctly the links between feeding and reproduction. The tool was used to optimise the Latxa breed farming systems of the Basque Country (Spain). Two farm types were simulated: a COAST farm located in low-altitude Atlantic conditions and longer grazing period, and the INLAND farm located in mountain areas with a shorter grazing period. The optimisation provided a set of optimal solutions with different economic and environmental (N excretion) performances. The optimal solutions increased the financial margin over feed costs in both farms (+24% and + 22% for COAST and INLAND, respectively). The final space of solutions showed a clear trade-off between the economic and environmental performance (nitrogen excretion). The difference in the financial margin over feed costs between the solutions could be interpreted as the opportunity cost of greening in policy design, i.e., the payment that farmers should receive to change their farming methods to reduce nitrogen pollution.

The nexus between exchange rate and long-term investment in Indian manufacturing industry

PurposeThe purpose of this paper is to examine the impact of changes in the exchange rate on long-term investment decisions of Indian manufacturing firms at the sector level.Design/methodology/approachThe study is undertaken on a sample of 1,222 firms from six key manufacturing sectors of Indian economy during the period 2000-2016. The non-linear relationship between real exchange rate and long-term investment is studied using the two-step generalized model of moments estimator.FindingsThe study finds a concave (i.e. inverted U-shaped) relationship between the long-term investment and real exchange rate, particularly in case of chemical, construction, machinery and textile sector, in particular, and Indian manufacturing industry as a whole. It implies that investments in these sectors increase with depreciation of real exchange rate up to a point of inflection and subsequent to which it starts decreasing if exchange rate continues to depreciate further. But consumer goods and metal product sectors ensure a convex pattern, which demonstrates that investment is decreasing at the initial stage of depreciation of the exchange rate. The study moves one-step forward in validating this nexus between investment and exchange rate with respect to the price-cost margin and the extent of financial flexibility of firms. It is found that high price cost margin and financial flexibility moderates the adverse impact of exchange rate depreciation and immunizes the long-term investments in the scenario of a weak domestic currency and induce long-term investments.Research limitations/implicationsThe study measures the impact of exchange rate changes, but the impact of exchange rate volatility on investment has not been studied, which is absolutely different with different implications.Practical implicationsThe study provides a clear guideline to firm managers for using the exchange rate movements in a favorable manner. The findings can be used to ensure sustainable long-term investments with respect to the core competence of firms in terms of price cost margin and financial flexibility at sector level of Indian manufacturing firms.Originality/valueThe study analyzes the non-linear relationship between exchange rate changes and long-term investment behavior of manufacturing firms from six key sectors of India. Further, the study moves one step forward to analyze this nexus under different scenarios of financial flexibility and price cost margin using dynamic panel models.

Destination country financial development and margins of international trade

We demonstrate theoretically and empirically that financial development of the destination country is as important as that of the origin country in shaping bilateral trade patterns, on both the extensive margin and the intensive margin of international trade.

INTELLECTUAL CAPITAL TERHADAP KINERJA KEUANGAN PERUSAHAAN FARMASI DI INDONESIA

This study aims to analyze the effects of Intellectual Capital to Financial Performances of Pharmaceutical Company. Independent variable in this study is Intellectual Capital . Intellectual Capital which consist of Human Capital (HC), Structural Capital (SC), and the Capital Employed which uses a method Value Added Intellectual Coefficients (VAICTM.). Financial Company’s Performance is proxied by Return On Assest (ROA) and Net Profit Margin (NPM).
 This research samples are pharmaceutical company in the Indonesia Stock Exchange in 2011- 2015. Samples were collected by purposive sampling method and resulted in 7 firms as the samples. This study used simple linear regression to analyze data. The results of this study indicate that intellectual capital (IC) has effect on variable financial performance Return On Assets (ROA) and intellectual capital (IC) has effect on variable financial performance Net Profit Margin (NPM).

Венчурне фінансування суб’єктів агробізнесу

The article is devoted to the analysis of problems and prospects of development of Ukrainian venture industry in agriculture, taking into account the comprehensive methodological approach to ensuring the profitability of financial assets of subjects in the distribution of investment resources of venture funds. The axiom of value and the universal method of discrete venture financing in agriculture were singled out. The basis of the favorable institutional infrastructure of venture funds for regulation of financial support of high-tech projects of subjects at the macro level was determined. To achieve the purpose of the study, the authors used the synchronization of flexible methods for the gradual financing of in-vestment projects, as well as methods of analysis of the dynamics of the innovation process of venture financing in Ukraine and countries of the world. The binomial model of estimating the value of the basic financial assets of venture funds at a risk-free rate was constructed by transforming the tree of the financial flows of the latter into the tree value of sources of venture financing of agrarian enterprises. It was proved that the attraction of long-term (due to Euro-bonds) and non-maturity (at the expense of placement of shares) of venture financing in the amount of 1 EUR., in the foreign equity market of venture capital allows ensuring an increase in agricultural GDP in Ukraine by an average of 6.8 EUR. Under the ideal conditions of the financial environment and achieving the risk-free margin of the financial flow margin for all the same type of agro holdings that form the volume of gross agricultural output, must have the same access to investment resources and equal rates of yield of financial assets in the investment portfolios of foreign venture funds.

Achieving Service Process Excellence With Connected Customer

This article studies the service process and evaluates the need of a connected customer for achieving customer satisfaction and customer ecstasy, in-turn improving service process excellence for the organization. The method used was an exploratory analysis of research studying the CRM concept and usage data generated from IoT devices. Through a literature review process, various preliminary information constructs on IoT and CRM system with digital enablers are evaluated. References from research papers, journals, internet sites, statistical data sites and books were used to collate the relevant content on the subject. The study of all the relevant scenarios and impact assessment on all the relevant stakeholders was undertaken. Further primary data was gathered from the customer sample and was evaluated to substantiate the importance of connected customer for an organization and its linkage to customer satisfaction. It was found that customer demands are continuously evolving, and it is very relevant for all the organizations to align and keep pace with the change. Connected customers help organizations maintain a complete customer profile, needs, and ability to customize for the individual customer. With this, customers become active participants in the whole ecosystem. The usage of real time data becomes a reality with IoT data transmitted over the internet and analyzed by the CRM system. It gives a better understanding of the customer relationship aspect, helping organizations to operate within healthy financial margins. It also resolves the softer issues arising out of such strategic alliances such as trust and ensures that the organization remains competitive.

Governance of Academic Health Centers and Systems: A Conceptual Framework for Analysis.

Health care has evolved from a cottage industry to a very complex one constituting nearly one-fifth of the U.S. economy. Large aggregated health care systems have evolved primarily for the purpose of optimizing financial performance by capturing greater market share and taking advantage of economies of scale in care delivery. With the noble intent of providing a broader base of support for the academic mission, academic health centers (AHCs) have followed suit by partnering with community hospitals and organizations with variable prior experience in the education and research arenas. Such a strategy makes good business sense, but it creates challenges for the academic mission. Singular emphasis on physicians' clinical productivity enhances financial margin but often reduces faculty time and effort dedicated to the academic mission. While individual AHC governance is varied, the leadership structure of large aggregated health systems built around an AHC is even more complex and heterogeneous. Yet, to ensure the prosperity of the academic mission, the governance structure of such health care systems is of critical importance. Preservation of academic oversight of the faculty practice plan, a unifying central focal point of organizational decision making, and genuine physician leadership are three overarching governance characteristics that strengthen the prosperity of the academic mission within large aggregated health systems. Despite the heterogeneous nature of academic health system governance, these critical components of organizational leadership structure facilitate support of a robust academic mission. Understanding these principles and objectives of governance is essential for critical faculty engagement in AHC leadership activities.

Diplomacia financiera en la periferia global: entre la cooperación y la coerción. Aproximaciones teórico-empíricas a partir de las relaciones crediticias de Argentina con Venezuela y China

El objetivo del presente artículo es analizar las características reportadas por la diplomacia financiera entre los países de la periferia global durante los primeros años del siglo XXI. En términos específicos, el artículo enfoca su escrutinio en los lazos crediticios entretejidos por la República Argentina con la República Bolivariana de Venezuela y la República Popular China (RPC) en aras de sortear su marginación financiera internacional. A modo de hipótesis, el artículo sostiene que los canales y los dispositivos de diplomacia financiera articulados entre Argentina y Venezuela, y Argentina y la rpc resultaron habilitados tanto por la acumulación de reservas internacionales como por la afinidad político-identitaria, aunque condicionados por el grado de asimetrías entre las partes. Tras la validación empírica de la misma, el trabajo concluye que, aunque relevantes para la concreción de las operaciones crediticias, los factores habilitantes de la diplomacia financiera tuvieron una ponderación desigual: la afinidad político-identitaria (instancia ideacional) gravitó detrás de la disponibilidad de recursos (instancia material). Por otra parte, las modalidades que asumieron dichos canales y dispositivos estuvieron, en efecto, condicionadas por el grado de asimetría entre los Estados intervinientes. De este modo, los desequilibrios estructurales crecientes entre Argentina y la rpc redundaron en que las iniciativas de cooperación financiera se reconocieran ante todo signadas por una lógica coercitiva, en contraste con lo reportado con las vinculaciones con Venezuela.

The Analysis of Risk Profile and Financial Vulnerability of Households in Indonesia

This paper identifies the vulnerability of household in Indonesia using both Balance Sheet and Financial Margin Approaches with coping strategy analysis in response to financial pressure. The result concluded that the household sector is solvent and sound with high interconnectivity with the non-financial corporation, particularly with banks. The heatmap coping strategies are in the moderate zone. However, it cumulatively tends to change to a high and extreme zone which potentially creates imbalances in the financial system in Indonesia.

Main Determinants of Profit-Sharing Policy in the French Life Insurance Industry

The current low interest rate environment and the coming into force of Solvency II raise questions about the stability of the life insurance industry in Europe and the sustainability of traditional insurance products. We use a data set built from French supervisory reports to investigate the drivers of the participation rates (equivalent to annual yields) served on euro-denominated life insurance contracts over the period from 1999 to 2013. Our analysis confirms practitioners’ intuition on the alignment with the 10-year French government bond; we later analyse the deviation of the participation rates from this reference. Our data indicate that financial margins are more strictly targeted than participation. We find evidence that surrenders are fairly uncorrelated with participation, suggesting that other levers are used to monitor them. While higher asset returns can imply better yield for policyholders, riskier portfolios do not necessarily translate into better participation.

MP76-08 THE IMPACT OF PRE-OPERATIVE PROSTATE IMAGING AND RESIDENT PARTICIPATION ON THE FINANCIAL MARGIN OF AN EPISODE-BASED PAYMENT MODEL FOR ROBOTIC PROSTATECTOMY

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost & Outcomes Measures I1 Apr 2018MP76-08 THE IMPACT OF PRE-OPERATIVE PROSTATE IMAGING AND RESIDENT PARTICIPATION ON THE FINANCIAL MARGIN OF AN EPISODE-BASED PAYMENT MODEL FOR ROBOTIC PROSTATECTOMY David Johnson, Aaron Laviana, Jamal Nabhani, Reshma Gupta, Eric Kwok, Christine Ahn, Gerald Kominski, Karim Chamie, Mark Litwin, and Christopher Saigal David JohnsonDavid Johnson More articles by this author , Aaron LavianaAaron Laviana More articles by this author , Jamal NabhaniJamal Nabhani More articles by this author , Reshma GuptaReshma Gupta More articles by this author , Eric KwokEric Kwok More articles by this author , Christine AhnChristine Ahn More articles by this author , Gerald KominskiGerald Kominski More articles by this author , Karim ChamieKarim Chamie More articles by this author , Mark LitwinMark Litwin More articles by this author , and Christopher SaigalChristopher Saigal More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2576AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In response to evolving episode-based payment models, health systems must understand the financial margins under which specific service lines operate. Margins at teaching institutions may be particularly narrow due to the added responsibility of resident education and early adoption of advanced technologies whose value is unclear. We estimate the percent reduction in profit margin under an episode-based payment for robotic prostatectomy (RP) associated with varying utilization of pre-operative multiparametric prostate MRI (mpMRI) and resident participation in the operating room. METHODS Episode costs and reimbursements were calculated to determine the margin for all 160 RPs performed at a single teaching hospital in 2016. The episode spanned the initial urologic oncology consultation preceding surgery and continued 90 days post-operatively. Outpatient costs were calculated using previously described time-driven activity based costing (TDABC). Inpatient hospital costs were calculated using a combination of TDABC and hospital activity based costing. Total reimbursement was calculated using hospital-specific Medicare Diagnosis Related Group and Medicare Fee Schedule amounts for all billed codes within the episode. We determined the impact on financial margin for three combinations of mpMRI utilization (0%, 33%, 100%) and number of residents in the operating room (0, 1, 2) using previously calculated TDABC amounts. Direct Medical Education payments and the impact of resident participation on operative time were not included in these calculations. RESULTS Compared with the reference case of no mpMRI and no resident in the OR, the percent reduction in the margin ranged from 4.8 to 43.0% depending on the utilization of mpMRI and resident participation (Figure 1). CONCLUSIONS Varying degrees of utilization of modifiable cost drivers results in a substantial reduction of margin in a theoretical bundled payment model. Resident education is a core mission for academic centers and this mission may impact margin by 19-43%. Granular analysis of cost and reimbursement informs opportunities for value-based care redesign to help health systems succeed under advanced alternative payment models currently being tested by Medicare. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1021 Advertisement Copyright & Permissions© 2018MetricsAuthor Information David Johnson More articles by this author Aaron Laviana More articles by this author Jamal Nabhani More articles by this author Reshma Gupta More articles by this author Eric Kwok More articles by this author Christine Ahn More articles by this author Gerald Kominski More articles by this author Karim Chamie More articles by this author Mark Litwin More articles by this author Christopher Saigal More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Нетрадиционный подход расчета эффективности аграрной продукции

The purpose of the study is to substantiate some features of planning and analysis of the efficiency of crop production based on the coefficient of advance of the threshold of profitability, as well as the development of practical recommendations for their direct use by specialists of agricultural enterprises (a case study from Moldova). It is emphasized that the indicators of the efficiency of products in agriculture, such as profit per one hectare of crop land or one centner of production, can be calculated precisely without requiring data for crop yield and total production volume of cultivated crops. It is established that the indicators of economic efficiency of produced and realized production depend on the degree of removal (deviation) of the actual yield from the break-even point (profitability threshold). An indicator named as the break-even excess coefficient is used for evaluating the given degree of deviation. An inter-relationship between the value of the break-even excess and the indicators of profit per one hectare of land and one centner of production is determined. The given interrelationship is presented in formulas, in a table and on a graph. Based on the example of a specific agricultural enterprise the calculations of given inter-relationships for leading crop types are performed. In order to identify whether the given inter-relation is specific for the conditions of agricultural production in a particular enterprise, the calculations of analogous indicators are made for two neighboring enterprises likewise. Besides, the inter-relationship between the financial safety margin and operational leverage on the one hand and the coefficient of exceeding the break-even level on the other hand is presented. Our research will allow the professionals at agricultural enterprises to determine the degree of revenues per one unit of area or unit of production as well the values of financial safety margin and operational leverage across of all product nomenclature based on the values of coefficient of exceeding the break-even level.

A NEW METHOD FOR APPLYING VAT TO FINANCIAL SERVICES

While many methods of taxing financial services on VAT have been developed in recent decades, none are considered definitive. This article proposes a new approach to taxing financial services that has desirable properties and could be applied practically: the “mobile-ratio” method. This method uses a periodically updated ratio to allocate the financial margin of the firm to each financial transaction, obtaining near-complete taxation of the value added by financial services. This simple, neutral method can be easily administered. This approach will be of interest to public economists and policy makers seeking to increasing VAT revenue and improving VAT efficiency and neutrality.