General Cost Research Articles

Promoting mental health equality by investing in organizations: lessons from implementation science

Purpose Mental health inequalities based on race and ethnicity in the USA and globally persist despite efforts to address them. The COVID-19 epidemic accentuated these inequalities and demonstrated the extent to which they are linked to social determinants. However, the organizations that are best placed to ameliorate mental health inequalities are often underfunded and under-resourced. Investment strategies that restrict funding for programmatic costs rather than general operating costs often disproportionately impact small organizations that serve communities of color. This study aims to argue that effectively addressing mental health inequalities requires investing in these organizations by applying the lessons learned from implementation science. Findings This study demonstrates how organizational factors such as leadership, supervision and organizational culture and climate are key to programmatic success and how implementation strategies can target these factors. As promoting health equity is increasingly recognized as a priority outcome for implementation science research, these organizational approaches can inform funders on how to support small organizations that serve marginalized communities, giving them the capacity and flexibility to address mental health inequalities. Originality/value This paper applies the findings from implementation science to consider how best to support mental health organizations, particularly those well suited to serving the mental health needs of diverse communities.

Major Customer Reliance and SG&A Cost Sensitivity

ABSTRACTThis paper examines the impact of major customer reliance on the sensitivity of selling, general and administrative (SG&A) costs in response to sales fluctuations. Utilising an expanded cost sensitivity model and conducting a thorough analysis of US‐listed firms, we uncover that supplier firms with a higher degree of dependence on major customers demonstrate a notably decreased sensitivity of SG&A costs to both increases and decreases in sales. Furthermore, our analysis reveals that the negative association between major customer reliance and SG&A cost sensitivity is significantly influenced by factors such as industry characteristics, relationship‐specific investments and customer types. Finally, our insights into SG&A costs can be extended to encompass total costs and operating costs, offering valuable insights into broader cost management dynamics and strategies.

Health-Care Costs for Patients with a Lower-Extremity Fracture Have Increased Disproportionately Over the Past 10 Years: A Medical Expenditure Panel Survey Analysis of Total Expenditure and Out-of-Pocket Costs.

Increasing U.S. health-care costs raise concerns regarding the sustainability of the U.S. health-care system, with the potential for negative effects on the mental and physical health of patients. Orthopaedic injuries often impose considerable financial burdens on patients and hospitals, but the trends in, and drivers of, costs remain unclear. This study evaluated the total expenditure and out-of-pocket (OOP) costs of patients with a lower-extremity (LE) fracture in the non-institutionalized U.S. population from 2010 to 2021. A total of 3,016 participants with an LE fracture from the Medical Expenditure Panel Survey (MEPS) were propensity score matched with 15,080 MEPS participants with no LE fracture. Patients with an LE fracture were predominantly between 40 and 64 years old (43.2%), female (66.0%), and White (78.8%). Total expenditure and OOP costs were compared between the groups. A multivariable regression analysis was performed to identify factors that were associated with costs. Outcomes were adjusted on the basis of the 2022 Consumer Price Index. Patients with an LE fracture had greater total expenses than the control group ($20,230 [95% confidence interval (CI), $18,916 to $21,543] versus $10,678 [95% CI, $10,302 to $11,053]; p < 0.001) as well as greater OOP costs ($1,634 [95% CI, $1,516 to $1,753] versus $1,089 [95% CI, $1,050 to $1,128]; p < 0.001). Between 2010 and 2021, total expenses increased more for patients with an LE fracture than for the control group (101.2% versus 51.4%; p < 0.001), whereas OOP costs increased to a lesser degree in both groups (61.1% versus 44.5%; p = 0.17). In the LE fracture group, total expenditure was driven by inpatient care, office-based visits, and prescription costs, whereas OOP costs were driven by office-based visits, prescription costs, and "other" sources. Femoral fracture, hospitalization, and certain comorbidities were associated with higher total expenses. Hospitalization, uninsured status, and a higher income level were associated with increased OOP costs, whereas African American or Hispanic background and a lower educational level were associated with lower OOP costs. An LE fracture was associated with considerable total expenditure and OOP costs, which increased disproportionately compared with general health-care costs over the past decade. Post-hospitalization care was the biggest driver of both total expenses and OOP costs. Due to limitations inherent to the MEPS database, the impact of financial burden on not only payers but also individuals and their medical decision-making remains unclear and requires further investigation. Economic Level III. See Instructions for Authors for a complete description of levels of evidence.

Assessing the impact on mode competitiveness of improvements of the Trans-Eurasian railway network

This paper deals with the potential of the different modes of transport on the Eurasian connection, focusing on rail, and comparing with sea and air. Since 2008, a substantial uptake of the rail connection has been observed. The main question then is whether the competitiveness of this land bridge is actual and sustainable or not. First, the paper focuses on the latest developments of the actual physical capacity on the Eurasian connection. Mainly under Chinese impetus, substantial improvements of rail connections but also border crossings have been made. Second, the paper focuses on the actual competitiveness of the different modes on the Eurasian connection in the current-day transport volumes. It can be observed that also the transport on the Eurasian connection has been growing, especially by rail. However, by far the largest volumes of transport still happen by maritime transport. The third and main question of the paper is on whether the land bridge by rail would cost-wise be competitive enough to favour a large shift from sea to land. An adapted version of a chain cost model applied to seven city pairs shows that the cost of the maritime solution is notably higher the further away from the coast origin and/or destination are located. For rail, such significant cost differences are not found. Furthermore, the value of the goods plays a bigger role for rail than for maritime transport. Air transport, due to its higher charges, typically is only used by higher-value goods. When comparing the (combinations of) transport modes, it turns out that the rail costs are on average 1.5 times to twice as high as when using maritime transport, but the more westward the origin on the Chinese territory, the closer the ratio gets to 1. The sensitivity analysis shows that in particular using longer trains will allow strongly further reducing generalized rail chain costs, easily over a third of the base case costs. Substantially less generalized chain cost reductions are achieved when shortening transit times, even when the latter goes up to half the initial transit time. Fourth, looking at what would be needed to make a further shift to rail materialize on the Eurasian connection, three items pop up: rail border crossing capacity, traffic balance between both directions and backups to the TEN-T rail network.

Application of State Models in a Binary–Temporal Representation for the Prediction and Modelling of Crude Oil Prices

Crude oil prices have a key meaning for the economies of most countries. Their levels shape the general production costs in many sectors. Oil prices are also a base for financial derivatives like CFD contracts, which are popular nowadays. Due to these reasons, the possibility of an effective prediction of the direction of future changes in the price of crude oil is especially significant. Most existing works focus on the analysis of daily closing prices. This kind of approach results, on the one hand, in losing important information about the dynamics of changes during the day. On the other hand, it does not allow for the modelling of short-term price changes that are especially important in cases of financial derivatives having crude oil as their base instrument. The goal of the following article is the analysis of possible applications of a binary–temporal representation in the modelling and construction of effective decision support systems on the crude oil market. The analysis encompasses all researched state models, e.g., those applying mean and trend analysis. Also, the selection of parameters was optimized for Brent crude oil rates. The presented research confirms the high effectiveness of our state modelling system in predicting oil prices on a level that allows for the construction of financially effective investment decision support systems. The obtained results were verified based on proper backtests from different quotation periods. The presented results can be used both in scientific analyses and in the construction of investment support tools for the crude oil market.

A Reversible Investment Problem with General Cost Function in Finite Horizon: Free Boundaries Analysis

A Reversible Investment Problem with General Cost Function in Finite Horizon: Free Boundaries Analysis

Optimal Regulator for Linear Stochastic Systems with Multiple State-Delay

We consider an optimal control problem for linear stochastic systems with multiple state delays. By formulating a general quadratic-linear cost functional, we provide an explicit solution involving coupled Riccati and partial differential equations. The derived optimal control law is in an affine feedback form with respect to the current state, the delayed state, and the integral of past state values. Additionally, we demonstrate the application of this solution to an optimal investment problem with logarithmic utility in market with interest rate influenced by a multi-delayed factor process.

Analysis of the Level of Public Transportation Accessibility at the Type A Bimoku Inter-Border Terminal (Albn), Kupang City

The Bimoku Type A Cross Border Terminal located in Kupang City, East Nusa Tenggara, is a cross-border transport hub that has been operating since 2023. However, its performance has not been optimal and accessibility to this terminal is still low. This study aims to analyse the level of accessibility of public transport to the Type A Bimoku Cross-Border Terminal in Kupang City and provide recommendations for improving performance. The method used is Generalised Cost (GC) analysis with a do nothing and do something approach. The results show that the largest GC values in the existing conditions are in the Fatukoa, Naioni, and Bello zones. The implementation of the new route network in the do something scenario succeeded in significantly reducing the GC value, thereby increasing the accessibility and efficiency of transportation to the Bimoku Type A Cross Border Terminal in Kupang City. Recommendations are to develop new public transport routes and improve intermodal connectivity to support overall terminal performance.

Is Transparency Good in a Supply Chain? The Downside of Information Acquisition Transparency

ABSTRACTIn the supply chain, retailers usually have inherent advantages over manufacturers in obtaining demand information because they are closer to the final market and can directly interact with consumers. However, manufacturers cannot make sure whether their retailers have obtained extra demand information. The retailer's information acquisition state is also an important aspect of information asymmetry among supply chain participants, besides the demand information itself. We examine two modes observed in practice regarding the transparency of the retailer's information acquisition state: non‐transparency and full transparency. By incorporating a manufacturer's information belief adjustment strategy, our study thus addresses a retailer's acquisition and ex‐post sharing of information (i.e., the decision on how to share acquired information) under the two transparency modes. The main findings show that under the non‐transparency mode, the retailer shares low‐demand information but hides high‐demand information. With respect to the interim profit (i.e., after the acquisition cost is realized), the preferences of the manufacturer, retailer, and supply chain on the two modes depend on the information acquisition cost. With respect to the ex‐ante profit (i.e., before acquisition cost is realized), surprisingly, the manufacturer and supply chain always prefer the non‐transparency mode, whereas the retailer's preference for the two modes still depends on the acquisition cost. In addition, our equilibrium outcome reveals that the retailer and the manufacturer will never sign an internal information sharing agreement (i.e., never achieve the full transparency mode), whether before or after the realization of information acquisition cost. We also find that the expected consumer surplus under the non‐transparency mode is always higher than that under the full transparency mode, which is also a counterintuitive outcome. Finally, our main findings in the core model are relatively robust when considering acquisition cost sharing, general demand distribution, general acquisition cost distribution, ex‐ante informed retailer, and imperfect information acquisition.

Critical Review of Healthcare Policy Innovations: Transforming Global Health Delivery Systems

This paper reviews recent contributions to the development of healthcare policies and analyzes their implications for the ongoing and future changes in healthcare delivery systems worldwide. It looks at how policy innovations that seek to solve persistent issues and problems relating to healthcare, such as access, quality, and costs, are achieved. There is a particular emphasis on the coming collaborative ideas like UHC, accounts receivable systems, MACRA, MAC-P, and RECOVERY models, as well as digital health technology. These innovations are analyzed for their effectiveness in enhancing the health of patients, the general cost of the provision of healthcare, and the total satisfaction of the patient. Through comparisons of national and international policy changes, the paper shows the strengths and weaknesses of these reforms. It also points to some of the areas that need better improvement in healthcare systems all over the world. The main topics, such as health inequalities, the involvement of private-public partnerships, and technology, are presented so that the reader gets a clear picture of all the existing problems. Thus, the study indicates there have been strides made towards attaining the objectives of increasing coverage of health facilities and the quality of delivered health care; however, continued effort is required to remove barriers restricted by race and ethnicity to guarantee equal coverage for every society. In the same tone, the paper outlines recommendations that may be put to use and implemented in future reforms of healthcare policies in order to enhance healthcare delivery systems, operational efficiency, and stability in the global market.

Pengaruh Penerapan Green Accounting Terhadap Kinerja Perusahaan (Studi Pada Perusahaan Peraih Penghargaan Industri Hijau Yang Listing Di BEI 2020-2022)

This study aims to assess the effect of green accounting implementation on the performance of award-winning companies in the green industry listed on the IDX from 2020 to 2022. This study applies a quantitative methodology making use of secondary data from the Indonesia Stock Exchange publication for 2020 to 2022. The study population consists of companies that receive the PROPER predicate, especially those in the Gold and Green categories. The sample was identified by means of a purposive sampling strategy, resulting in 13 selected organizations, with a research technique involving multiple linear regression analysis. The research findings confirm that environmental spending has no impact on the company performance. This is because profit-oriented companies will take into account all expenses, including environmental expenses that reduce profit margins. Some companies categorize environmental costs as administrative and general costs, while others classify them as voluntary costs in their annual reports. Environmental performance positively affects company performance. Environmental performance (PROPER) effectively attracts stakeholders to invest in the organization. Companies that demonstrate strong environmental performance will receive positive responses from investors and stakeholders, thereby contributing to long-term revenue growth.

Cost effectiveness of empagliflozin in adult patients with chronic kidney disease in the Netherlands.

The recent EMPA-KIDNEY trial showed evidence for preventing disease progression in adult patients with chronic kidney disease (CKD) treated with empagliflozin. It is however yet unknown if use of empagliflozin is cost effective in the Netherlands. We aimed to evaluate the cost effectiveness of empagliflozin in adult patients with CKD in the Netherlands. A cost-effectiveness analysis was conducted using a Markov state microsimulation model, simulating kidney progression of CKD patients with eGFR <90 ml/min per 1.73 m2 comparing empagliflozin plus standard of care (SoC) and SoC alone. KDIGO classification was used to describe the risk of CKD progression. The input data were taken from the EMPA-KIDNEY trial (baseline characteristics, treatment effect, and utilities), and published data and national sources were used for general population mortality, treatment and event costs. The analyses were performed from a societal perspective with applying a lifetime horizon. Discounting was done according to the Dutch pharmacoeconomic guidelines. The incremental cost-effectiveness ratio (ICER) was compared to a willingness-to-pay threshold of €50,000/QALY. Deterministic and probabilistic sensitivity analyses were performed to explore the impact of uncertainty around the input parameters. The base-case results showed total discounted costs for empagliflozin plus SoC and SoC alone of €200,193 and €234,574 respectively, indicating total savings of €34,380. Empagliflozin plus SoC was associated with higher total discounted health benefits of 11.06 life years (LYs) and 9.01 quality-adjusted life years (QALYs), compared with 9.74 LYs and 7.79 QALYs for SoC alone, resulting in an additional 1.31 LYs and 1.22 QALYs for empagliflozin plus SoC. Empagliflozin plus SoC is a dominant alternative compared to SoC alone. Sensitivity analyses confirmed the robustness of the findings and conclusion. Using empagliflozin in addition to SoC in adult patients with CKD is likely to be cost saving compared to the current SoC in the Netherlands, irrespective of diabetes status and albuminuria.

Perhitungan Harga Pokok Produksi Serta Harga Pokok Penjualan Terhadap Laba Penjualan: Studi Kasus pada UMKM Cilok Wonogiri

This research aims to determine the effect of production costs and cost of goods sold on profits generated by MSMEs in Cilok Wonogiri. The elements that form production costs are production costs, including: raw material costs, direct and indirect labor costs, general production costs and inventory of goods in process, including: inventory of goods in process and inventory of goods. ongoing. Meanwhile, the cost of goods sold factor includes total production costs and finished product inventory (initial finished product inventory and final finished product inventory). These factors will influence the selling price of the product. Primary and secondary data are the types of data used in research. Primary data was taken from direct observation of subjects to obtain accurate data along with the results of company interviews. Secondary data was collected through company records regarding data relating to production costs and cost of goods sold which will affect the profits obtained from sales of Wonogiri cilok. Researchers examine production costs using company calculations and production cost data for 2022. The analysis technique used by the author is a quantitative descriptive analysis method. Quantitative descriptive analysis is used to explain the calculation of production costs according to the full cost method, then this information is used as a basis for determining product selling prices to determine MSME profits.

The dynamics of cost behavior: Unveiling sticky costs in private companies

Purpose: While research on cost stickiness has predominantly focused on large public companies, the variability in results has cast doubt on the generalizability of sticky cost behavior to all companies. This paper investigates whether cost sticki-ness is observable in smaller private companies – i.e., firms without publicly traded securities – thus addressing a notable gap in the literature. Design/methodology/approach: This study adopts the empirical framework of Anderson et al. (2003), using data from private Italian firms from 1998 to 2022. Furthermore, it extends the scope of analysis to include such diverse cost catego-ries as selling, general, and administrative (SG&amp;A) costs, total labor cost, purchase costs, rent costs, and other operating expenses. Findings: The findings indicate that SG&amp;A costs in private firms are significantly less sticky than those reported for large public firms. Cost stickiness is also ob-served in labor, rent, and other operating costs but not in purchase costs. Notably, cost stickiness varies across industries. Originality/value: This study sheds new light into the dynamics of cost stickiness by highlighting how asymmetrical cost behavior in small and medium-sized pri-vate companies differs from that in large public companies, enhancing the under-standing of cost management practices across business contexts.

Coupled design of urban and interurban transit networks with a park-and-ride system: Analytical formulation and case study in Barcelona

This research presents an analytical model for the coupled design of an urban transit network and an interurban one supported by park-and-ride facilities. The former network facilitates the mobility in the centre of the metropolitan area while the interurban services satisfy the centripetal connections from the metropolitan outskirts where park-and-rides are scattered. These three components of the system are interconnected. Both networks share common transfer stops in the main corridors of the central city while park-and-rides are the access points to the interurban network in the periphery. Consequently, the model introduces the concept of coupled networks to define the interrelations between two transit services and the park-and-ride facilities. The variables of density of park-and-ride stations, spacings among corridors and operating headways, control the design of the entire system. Moreover, the model is adaptive to diverse cities with different geographical constraints (e.g. sea or mountain boundaries).The upper-level of a bi-level formulation minimizes user and agency costs of the system searching for the optimal joint configurations of urban and interurban networks and density of park-and-rides. This optimal design depends on a lower-level that computes the optimal location of the last park-and-ride ring and the resulting modal split derived from the performance of the transit system. This problem has been solved using a grid search method.Lastly, the model is applied with real data from the metropolis of Barcelona (Spain), revelling that the optimal location for the park-and-ride rings is further from the central city when demand at its entrances is higher. In addition, the model prioritizes accessibility for the urban network and maintains low waiting times for the interurban services, establishing a clear hierarchy between them. The coupled optimization of both networks reduces general costs by 4.6%, emphasizing the significance of considering the entire transit system.

Time Efficient &amp; Cost Effective Online teaching tool with iConcepts in Orthodontics for DDS students @ UoM

Background Traditional teaching methods in Orthodontics include plaster models and photos which have been used for decades, however due to the nature of being static still images its difficult for 3-Dimensional (3D) changes in Orthodontics teaching, which has posed immense challenges as the learner is unable to clear concepts on the different planes that affect the final tooth positions not to mention the protracted treatment time ranges from 12 months (simple cases) to 36 months (complex cases). In 2024 with variety of platforms such as videos, 3D animations, interactive changes in face and teeth can be added to teaching tools for Orthodontics. Furthermore, orthodontic movements can pose difficulty in understanding the changes particularly in growing children adding to the 4th dimension. At UQ (Naser-ud-Din, 2015) and internationally (Bridges, 2015) provided experience with creating online teaching modules highlighting its strengths of flexibility, ease of access on demand and global presence. UQ developed SBLi -Scenario Based Learning interactive for Postgraduate Orthodontic students who found it highly engaging, with self-reflective and self-assessment elements useful. (Khoo et al., 2023; Naser-ud-Din, 2016). Generally simulations can be expensive to create (Kröger et al., 2017) and it’s essential to explore cost effective simulation teaching tools with industry partners for authentic learning experience. Aims There is a gap in the dental education sector, particularly with emerging CADCAM (Computer Assisted Design and Computer Assisted Manufacture), which can be used to enhance the learning of core concepts in biomechanics with the aid of 3D simulated online learning. This is reflected particularly for the university students in undergraduate courses who need to feel confident and clinically ready on graduation as Dentists. Thus, greater expectations to be aligned with current technological processes in dentistry. Over the past 5 years, in particular, there has been exponential improvements by the industry providing 3D simulations for treatment planning and patient communication, commonly referred to as the GPS for smile transformations. The aim of this presentation is to highlight the time efficiency and cost effectiveness of the learning tool in sync with contemporary demands in Orthodontics to provide authentic learning platform that prepares the clinician for real patients. Material &amp; Methods Currently the CAD CAM technology provide 3D simulations as open access to general public and doctors portal which can be utilized for teaching core concepts related to biomechanics foundations for student learning, engagement and self-assessment. This project envisages to create a novel forum encompassing education revolution as massive changes in delivery will occur with speed and efficiency internationally with onlinelearning demands. Hence, robust online presence with an interactive textbook such as iConcepts in Orthodontics under the banner of UoM to assist students in Doctor of Dental Surgery at MDS shall pave the way to learning needs for the future. Results The purpose of iConcepts a digital interactive online textbook is to create lifelong learning opportunities in safe space for visual, auditory and kinesthetic with quizzes for interactive learning of concepts without pressure in class learning and feeling judged by peers. Interactive 3D Orthodontic learning directly translates into clinical applications for various orthodontic cases. In the past decade CAD CAM has become clinically relevant particularly with Clear Aligner Therapy adding to higher precision and patient satisfaction. Moreover, it is imperative to have Long Term Retention (LTR) (Irvine, 2020) of learning new tasks. It is essential that students in dentistry are aware of the digital workflows and have clinical preparedness on graduation as it’s the future and certainly here to stay. Both qualitative and quantitative data on student experience shall be collected and analysed to seek out the best practices and processes for instruction of delivery in Orthodontics for DDS cohort in particular and lifelong learning for all ages in general encompassing time efficiency and cost effectiveness. Conclusion The current iConcepts is developed by the author with Apple Education and prototype is being assessed with MSc Data Science cohort at UoM. Furthermore, it is refined by Master of Science Software Engineering students at UoM. Future Recommendations Novel teaching tools shall be marketed to developing universities internationally assisting the dissemination of information a flagship for UoM and revenue generation for department of Education at UoM. In future there will be more and more demand towards interactive concepts clarification (Poblete et al., 2020) and self-assessments hence iConcepts provides that ideal platform. Such technologies will become more prevalent in the future particularly with AI and translated into different languages/ sectors of education. Various faculties that showcase start to finish particularly lengthy/complex outcomes can benefit with timelapse videos and 3D CADCAM for clarity and comprehension for the entire process such as patient journey throughout treatment in Orthodontics.

Cost-effectiveness analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis at low risk of surgical mortality in Sweden.

Transcatheter aortic valve implantation (TAVI) has shown similar or improved clinical outcomes compared with surgical aortic valve replacement (SAVR) in patients with symptomatic severe aortic stenosis at low risk for surgical mortality. This cost-utility analysis compared TAVI with SAPIEN 3 versus SAVR in symptomatic severe aortic stenosis patients at low risk of surgical mortality from the perspective of the Swedish healthcare system. A published, two-stage, Markov-based cost-utility model that captured clinical outcomes from the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated according to Recommended Therapies (SWEDEHEART) registry (2018-2020) was adapted from the perspective of the Swedish healthcare system using local general population mortality, utility and costs data. The model had a lifetime horizon. Model outputs included changes in direct healthcare costs and health-related quality of life from using TAVI as compared with SAVR. TAVI with SAPIEN 3 resulted in lifetime costs per patient of 940,541 Swedish krona (SEK) and lifetime quality-adjusted life years (QALYs) per patient of 7.16, whilst SAVR resulted in lifetime costs and QALYs per patient of 821,380 SEK and 6.81 QALYs, respectively. Compared with SAVR, TAVI offered an incremental improvement of +0.35 QALY per patient at an increased cost of +119,161 SEK per patient over a lifetime horizon, resulting in an incremental cost-effectiveness ratio of 343,918 SEK per QALY gained. TAVI with SAPIEN 3 is a cost-effective option versus SAVR for patients with symptomatic severe aortic stenosis at low risk for surgical mortality treated in the Swedish healthcare setting. These findings may inform policy decisions in Sweden for the management of this patient group.

Predicting zombie firms after the COVID-19 pandemic using explainable artificial intelligence

This study examines various artificial intelligence (AI) models for predicting financially distressed firms with poor profitability (“Zombie firms”). In particular, we adopt the Explainable AI (“XAI”) approach to overcome the limitations of the previous AI models, which is well-known as the black-box problem, by utilizing the Local Interpretable Model-agnostic Explanations (LIME) and the Shapley Additive Explanations (SHAP). This XAI approach thus enables us to interpret the prediction results of the AI models. This study focuses on the Korean sample from 2019 to 2023, as it is expected that the COVID-19 pandemic increases the number of zombie firms. We find that the XGBoost model based on a boosting technique has the best predictive performance among several AI models, including the traditional ones (e.g. the logistic regression). In addition, by using the XAI approach, we provide visualized interpretations for the prediction results from the XGBoost model. The analysis further reveals that the return on sales and the selling, general and administrative costs are the most impactful variables for predicting zombie firms. Overall, this study focusing on several AI models not only shows the improvement for the prediction of zombie firms (relative to the traditional models) but also increases the reliability of the prediction results by adopting the XAI approach, providing several implications for market participants, such as financial institutions and investors.

Impact of bundled payments on healthcare use and costs for cardiovascular diseases in the Netherlands

Abstract Background Bundled payments for patients with cardiovascular diseases (CVD) aim to enhance primary care utilization in the Netherlands. This study assesses changes in healthcare utilization patterns and costs for CVD between 2015 and 2019, while investigating the potential association with bundled payment adoption. Methods We studied patients at very high risk for CVD using routinely recorded nationwide healthcare data. Multilevel logistic- and gamma regressions were conducted to assess healthcare utilizations patterns between 2015 and 2019, and the impact of bundled payments on the likelihood of receiving medical specialist care and the height of associated costs. Results The odds of medical specialist involvement declined over time for the 148,876 patients included in our study. This decline was significantly associated with practices’ use of bundled payments. Medical specialist costs did also significantly decrease between 2015 and 2019, and patients in practices with the highest level of bundled payments had significantly lower medical specialist costs. When general practice costs were included however, healthcare costs per patient stayed the same, both over time and stratified by use of bundled payments. Conclusions Our findings suggest an association between bundled payments and specialized healthcare use, potentially facilitating the transition to primary care. While we found no evidence for costs savings, our findings do support a reduction in spending growth. Key messages • We evaluated the impact of bundled payments as a means to facilitate integrated care, and found that bundled payments were associated with lower uptake of specialized medical care. • We found no cost savings were found, but findings do support reduced spending growth.

Enterprise digital transformation, managerial myopia and cost stickiness

Using Chinese-listed enterprise data from 2010 to 2021, we study the relationships among enterprise digital transformation, managerial myopia and cost stickiness. The results show that enterprise digital transformation inhibits cost stickiness, including operating cost stickiness as well as selling, general and administrative (SG&A) cost stickiness. This result holds after various robustness and endogeneity tests. Additionally, mechanism research indicates that enterprise digital transformation inhibits cost stickiness by reducing adjustment costs (ACs) and alleviating financing constraints (SAs). However, managerial myopia negatively affects the inhibition of enterprise digital transformation on cost stickiness by increasing ACs and aggravating SAs. Furthermore, the relationship between enterprise digital transformation and cost stickiness is stronger for mature, state-owned and high-tech enterprises than for those with better digital economy policy environments.