Higher Spending Research Articles

Factors associated with high health care spending among patients with schizophrenia.

Understanding the reasons for the wide variation in health care spending among patients with schizophrenia may benefit the development of interventions aimed at improving patient outcomes and health care spending efficiency. The aim of our study was to determine factors associated with high health care spending in the patient population. A serial cross-sectional study used the administrative health records of residents of Alberta, Canada between 1 January 2008 and 31 December 2017 and provincial costing methodologies to calculate total health care spending and sector-specific costs. Factors that modified the odds of being a high cost (i.e. 95th percentile or higher) patient with schizophrenia were estimated using generalized estimating equations. This study captured 242 818 person-years of observations among 38 177 unique patients with schizophrenia. Increased odds of being a high-cost patient were associated with younger age (18-29 years), male sex, unstable housing status and requiring care from multiple medical specialties. The strongest estimated associations between high cost status and comorbidity were for metastatic cancer (OR = 2.26) and cirrhosis (OR = 2.07). In contrast, polypharmacy was associated with a decreased odds of being high cost compared with untreated patients. Factors associated with being a high-cost patient are the result of complex interactions between individual, structural and treatment-related factors. Efforts to improve patient outcomes and address rising health care costs must consider the value of allocating resources towards early detection and support of patients with schizophrenia along with the prevention/management of comorbidity.

Caffeine’s Effects on Consumer Spending

Caffeine is the world's most popular stimulant and is consumed daily by a significant portion of the world's population through coffee, tea, soda, and energy drinks. Consumers often shop online and in physical stores immediately after or while consuming caffeine. This is further facilitated by the increasing prevalence of coffee shops and by the phenomenon of some retail stores having in-store coffee bars and offering complimentary caffeinated beverages. This research examines how caffeine consumption before shopping influences purchase behavior. The results of a series of experiments conducted in the field (at multiple retail stores across different countries) and in the lab show that consuming a caffeinated (vs. noncaffeinated) beverage before shopping enhances impulsivity in terms of more items purchased and higher spending. This effect is stronger for “high-hedonic” products and attenuated for “low-hedonic” products. These findings are important for managers to understand how a seemingly unrelated behavior (i.e., caffeine consumption) in and/or around the store affects spending. From a consumer perspective, although moderate amounts of caffeine consumption can have positive health benefits, there can be unintended negative financial consequences of caffeine intake on spending. Thus, consumers trying to control impulsive spending should avoid consuming caffeinated beverages before shopping.

Articles: Multinational enterprises and the welfare state

This paper presents an empirical analysis on the extent to which a country’s welfare spending influences foreign direct investment (FDI) decisions, particularly as they relate to relocations. We argue, and subsequently empirically test, that higher welfare spending by governments attracts foreign investment. Moreover, multinational enterprises (MNEs) located in high welfare spending countries have a lower likelihood of relocating to foreign markets compared with MNEs in countries with lower levels of welfare spending. Using data for MNEs in 27 OECD countries, our results show that MNE location decisions are positively related to welfare spending. These findings appear to be more pronounced for MNEs operating in high-tech rather than in low-tech manufacturing industries. Our results suggest that high welfare spending does deter FDI in the case of host developing economies, but that these effects are small. We suggest that this is a result of firms being more hesitant to invest in developing countries where they will be expected to contribute to welfare. This suggests that a degree of trust between firms and host country governments is required on institution building and the delivery of welfare. Our results suggest that the conventional wisdom of firms avoiding or relocating away from locations due to the associated additional costs of high welfare spending is questionable, but that firms need to be confident on the efficacy of this welfare expenditure.

Who are the Big Spenders at a Grand Prix In a Gaming Destination?

Market segmentation by expenditure enables the identification of high-spending visitors to festivals and events, enabling organizers to target this group with appropriate product offerings and promotions, thereby facilitating the achievement of economic goals from smaller participant numbers. Despite the potential usefulness of this tool, few studies have applied this technique in the festival and event literature. This article examines the existing studies with a view to identifying similarities and differences among high spenders and other points of interest. An additional case study of visitors to the 2019 Macau Grand Prix is added to the current research. High, medium, and light spending categories of Grand Prix attendees are identified and profiled. High spenders are found to differ from their counterparts on a number of sociodemographic and trip-related characteristics, including age, income, length of stay in Macau, and most of all a desire to thoroughly enjoy their whole Grand Prix trip, staying in comfortable accommodation, dinning and drinking, and trying their luck in the city's casinos. In addition, they exhibit a higher level of interest or attachment to the Macau Grand Prix and to motor sports more broadly. These outcomes support the findings of other studies using expenditure to segment festival and event goers, and provide valuable information for the event organizers and tourism operators in Macau.

Out Of Pocket (OOP) Health Expenditure and Utilization of Financial Risk Protection Measures Among COVID-19 Affected Individuals in Chennai- A Cross-Sectional Study

Background: Pandemic has affected people physically, mentally and economically. India being a growing economic power house, spends only around 1.2% of GDP on health which thereby leads to high OOP spending. This study aims to estimate out of pocket health expenditure and proportion of financial risk protection.
 Methods: Cross sectional study conducted among Covid-19 affected individuals in Chennai. It was a questionnaire based study with questions about covid-19 management status, cost and insurance utilization. Descriptive statistics and regression analysis was used for analysis.
 Results: Total of 47 were treated at hospital and 85% of them were treated at private hospital.. The mean cost investigations for patients treated at hospital was of Rs. 50000+11547 and for medicines was Rs. 110000+57735. 53% of study participants had health insurance. 29 (54.72%) of them had Covid-19 treatment cost covered under insurance. The multiple regression analysis showed a statistically significant association between total OOPE incurred and age, religion and socio-economic status.
 Conclusion: Majority of participants spent for their treatment through savings and borrowing money. OOPE was compensated by reimbursement through health insurance. Provision of quality health care in government hospitals, increase public health spending and creating awareness about health insurance are ways to reduce OOP costs.

Clustering Pengunjung Mall Menggunakan Metode K-Means dan Particle Swarm Optimization

This research aims to cluster mall visitors. This is motivated by the mall's income which has decreased since the pandemic. Later from these several clusters we can find out the characteristics of the mall's visitors. Those characteristics will be used later to increase the income from the mall. In this research, we use a dataset from Kaggle named Pengunjung_mall in CSV format which will later be processed using Python language on Jupiter Notebooks using the K-Means method. To ensure how accurate the K-Means method is, optimization is carried out using the PSO (Particle Swarm Optimization) method. After performing clustering and optimization using Jupyter Notebook, the results will then be evaluated with DBI (Davies Bouldin Index) in Microsoft Excel to find out how well the Clustering is generated. The Clustering results obtained are used as a reference to determine the characteristics of mall visitors which is one strategy to increase Mall profits. As a result, we have succeeded in dividing mall customers into 5 clusters based on their annual earned income and expense scores. The cluster has been optimized with PSO and has succeeded in increasing the cluster resulting from the K-Means method which is proven by the Davies Bouldin Index method. This research has concluded that customers who have high income levels and have high spending scores are the targets with the highest priority level for malls.

The Effect of E-Procurement Policy on Corruption in Government Procurement: Evidence from Indonesia

ABSTRACT This study investigates the effect of E-Procurement policy on corruption in government procurement across 34 provinces in Indonesia. Using the difference-in-differences (DD) approach, this study analyses the panel data of 103 government procurement corruption cases handled by Indonesia’s Corruption Eradication Commission (KPK) from 2005 to 2017. This study finds that the use of E-Procurement significantly decreases the amount of government procurement corruption in provinces that have relatively high government procurement spending or capital expenditure. This finding shows the positive effect of E-Procurement on reducing the number of corruption cases in government procurement; it is in line with previous studies suggesting that E-Procurement supports the implementation of good governance in government procurement.

E-cigarette use and conventional cigarette smoking among European students: findings from the 2019 ESPAD survey.

Representative data on e-cigarette use among European adolescents are scant. This study reports current vaping and tobacco smoking individual and country-specific correlates among European students. Cross-sectional survey: 2019 European School Survey Project on Alcohol and Other Drugs (ESPAD) collecting data on risk behaviours on a representative sample of 16-year-old students. A total of 35 European countries, 25-30 with Tobacco Control Scale (TCS) and TCS components PARTICIPANTS: A total of 99 648 students (49.1% males) turning 16 years in the survey year. Data on current cigarette and e-cigarette use were gathered through a self-administered questionnaire which also collected socio-demographics and individual and family characteristics. ESPAD data were integrated with country-level data on TCS and selected TCS parameters to assess their association with the prevalence of current cigarette and e-cigarette use. Of the 99 648 participating students, 12.4% were current e-cigarette users, from 5.5% in Serbia to 41.4% in Monaco; 19.3% current smokers, from 5.1% in Iceland to 32.4% in Italy. Compared with non-users, current e-cigarette users less frequently came from an average well-off family [odds ratio (OR) =0.85, 95% confidence interval (CI) =0.80-0.90] and lived in countries with higher cigarette prices (OR =0.71, 95% CI =0.50-0.99), restrictive measures on tobacco advertising and promotion (OR =0.79, 95% CI =0.63-0.99) and intermediate implementation of tobacco control measures (OR =0.57, 95% CI =0.38-0.85). Current vapers were more frequently life ever smokers (OR =7.31, 95% CI =6.47-8.25), were early smokers (OR =4.35, 95% CI =3.66-5.17), males (OR =1.61, 95% CI =1.55-1.67), from non-traditional families (OR =1.43, 95% CI =1.34-1.53), with relatively low parental education (OR =1.15, 95% CI =1.10-1.20). Compared with non-smokers, current smokers had similar family characteristics to vapers, and were less likely to live in countries with higher cigarette prices (OR =0.70, 95% CI =0.49-0.99) and higher spending on public anti-tobacco media campaigns (OR =0.23, 95% CI =0.10-0.50). E-cigarette use among European adolescents is associated with weaker tobacco control measures, particularly on tobacco price, advertising and promotion. Besides preventing tobacco smoking, the adoption of governmental tobacco control policies in European countries also seems to contribute to the prevention of vaping among adolescents.

An Analysis of Macroeconomic Impacts of Fiscal Policy in Pakistan: A Structural Vector Auto-Regressive Approach

Fiscal policy is important for the economy through spending, taxes, and debt. For this purpose, the government of Pakistan uses different fiscal policy tools to achieve the targets of output, inflation, and unemployment. In this context, the present study analyzes the macroeconomic impacts of fiscal policy tools by using the annual time series data from 1975 to 2020 of Pakistan. The Structural Vector Auto-Regression methodology is used to estimate the effects through shocks produced by government spending and taxes. The results show that a spending shock has a positive effect on variations in output while a negative on unemployment whereas a positive tax shock has a negative impact on output, spending, and inflation. From the policy perspective, the government should use prudent fiscal policy by not increasing the tax rate but widening the tax base. This higher spending can be used to curtail unemployment and increase output

Analyzing the main determinants of being a cultural traveler: the case of domestic cultural trips in Spain

PurposeAnalyzing the main determinants that lead a traveler to make a cultural trip is an important issue to understand where the cultural tourism market is going, and where the decision-makers should intervene. This study helps develop a profile of cultural tourism participants, and underscore the changes in this market niche. This information is crucial for the successful marketing and development of cultural tourism in the future.Design/methodology/approachThe authors estimate a binary probabilistic (logit) model to determine the probability of a tourist to travel for cultural reasons, as a function of the traveler's socio-economic characteristic (e.g. age, gender, income or level of studies), of the trip-related characteristics (e.g. distance traveled to destination or mode of transport) and of the characteristics of the province of destination (e.g. weather conditions or existence of cultural sites at destination).FindingsThis study’s estimates reveal that middle-aged individuals, with a higher level of studies and with a medium level of income show a higher propensity to travel for cultural reasons. The latter finding evidences that cultural tourism has evolved from a niche market reserved for an elite clientele to a much wider range of people. Additionally, cultural travelers tend to travel statistically much longer distances. They are less prone to visit crowded destinations, prefer visiting destinations with important cultural sites, and are less sensitive to weather conditions. Finally, the authors discover a complementary effect of culture tourism and other activities carried out during the trip such as visiting cities or theme parks; and a substitution effect with “beach-and-sun” tourism.Practical implicationsThe information given in this study can be crucial for the successful marketing and development of cultural tourism in the future. A better understanding of the main determinants of being a cultural traveler implies a better and a more efficient implementation of managerial and political measures to attract a kind of tourism characterized by a high spending capacity.Originality/valueDiscovering the main determinants of being a cultural traveler is a topic scarcely treated in the literature. This study has the main originality to include characteristics of the destination (pull factors) to explain the individual's decision to take a cultural trip. Moreover, the authors work at a provincial (NUTS-3) level of analysis, which makes this study original in the field of cultural tourism.

The impact of physician-hospital integration on spending and quality of oncology care.

1584 Background: There has been increasing hospital and health system ownership of physician practices in recent years, particularly in oncology. However, relatively little is known about how this impacts care delivery for patients with cancer, who use many hospital-based services that may be impacted by integration. We evaluated the impact of physician-hospital integration in oncology on spending and quality of care for Medicare beneficiaries with cancer. Methods: We used Medicare Fee-for-Service claims from 2005-2019 linked with a unique Health System and Provider Database, developed by National Bureau of Economic Research and Harvard University researchers, to track practice ownership relationships over time. We used a stacked event study to assess outcomes for patients three years before and after oncologists move from independent practices to hospital- or system- owned practices. We compared outcomes to a control group with oncologists who shifted from independent to hospital- or system-owned practices in later years. We focused on two cohorts of patients. The first cohort included cancer patients with presumed incident or recurrent cancer based on ≥2 visits to an oncologist and no visit in the past year. For these patients, we evaluated the impact of physician-hospital integration on the likelihood of receiving chemotherapy following the visit. The second cohort included 6-month episodes for patients receiving chemotherapy. For these patients we evaluated the impact of physician-hospital integration on spending, utilization, and quality. Quality measures included receipt of timely chemotherapy (within 60 days) following surgery, inpatient readmissions, non-use of tamoxifen + strong CYPD26 inhibitors, and end-of-life intensity of care measures. Results: There was no change in the likelihood of receiving chemotherapy with an initial oncology consultation following an oncologist’s transition to hospital-based employment. Total spending during six-month chemotherapy episodes increased by $1391 (95%CI: $465, $2316). The primary contributors to this growth were increases in spending on inpatient care, chemotherapy administration, and office visits. Spending growth, where observed, was driven primarily by higher Medicare prices for care in hospital outpatient settings. We found no positive impact of physician-hospital integration on timeliness of chemotherapy initiation, readmissions, concurrent use of tamoxifen+strong CYPD26 inhibitors, or intensity of end-of-life care. Conclusions: Physician-hospital integration resulted in higher prices and thus higher spending, but had limited impact on utilization and no detectable impacts on measures of quality. These results suggest that claims of quality improvements and concerns regarding overuse associated with physician-hospital integration may be overstated. Our results also support continued movement towards site-neutral payments.

59-LB: Outcomes of an Employer-Sponsored Virtual Type 2 Diabetes (T2D) Reversal Program in Working-Age Adults

Objective: To evaluate short-term outcomes of an employer-sponsored virtual T2D reversal program, conducted through medically supervised nutritional intervention and provider-led telehealth, in working-age adults. Methods: This pre-post study included 119 employees with T2D and high HbA1c and/or high spending on T2D prescriptions who enrolled in the T2D reversal program October 15, 2020-January 27, 2021. HbA1c, fasting glucose (FG) , body weight, body index mass (BMI) , and waist circumference pre- and post-enrollment were assessed from annual employer-sponsored wellness screening conducted 2019-2021, independently of the T2D reversal program. Program prescriptions (insulin, DPP4, GLP1, meglitinide, sulfonylurea, TZD, SGLT2) were compared pre vs. post (Table footnote 1) . Pharmacy spending for these prescriptions was estimated from a third-party claims database. Results: The program retention rate was 82% at 6 months and 67% at 1 year. Mean levels of all outcome measures declined significantly from pre to post (Table) . The number of prescriptions decreased for 47 (39.5%) of the 119 participants and increased for 3 (2.5%) . For 89 individuals participating for 6 months or more, average monthly prescription spending declined 18% (to $449 from $547) during the first 6 months after enrollment (vs. the prior 12 months) . Conclusions: A virtual T2D reversal program helped lower HbA1c, FG, body weight, BMI, and waist circumference in employees with diabetes while reducing prescriptions and pharmacy spending. Disclosure Z. Chen: Employee; Quest Diagnostics, Stock/Shareholder; Quest Diagnostics. C. E. Birse: Employee; Quest Diagnostics. A. R. Arellano: Employee; Quest Diagnostics. M. S. Fragala: Employee; Quest Diagnostics, Stock/Shareholder; Quest Diagnostics. M. J. Mcphaul: Employee; Quest Diagnostics. L. A. Bare: Employee; Quest Diagnostics.

Monthly Food Spending and Consumption of Promoted Foods Among a Sample of Adults Living in Intervention Neighborhoods of the Baltimore Urban Food Distribution (BUD) Trial

ObjectivesIt is well documented that under-resourced residents living in Baltimore, Maryland face barriers to accessing healthy foods largely due to low availability in their neighborhoods coupled with a lack of transportation, among other factors. Previous (B’more Healthy Communities for Kids (BHCK)) and ongoing (Baltimore Urban food Distribution (BUD)) systems interventions have sought to provide multi-level solutions to challenges in the Baltimore food environment. Research suggests that food spending is related to diet, however, this study aims to better understand consumption of promoted foods across levels of food spending (low, medium, high spending) to identify points of focus and future directions for the BUD trial. MethodsExtant data from BHCK were collected from July 2013 to July 2014 using an Adult Impact Questionnaire (AIQ) and Food Frequency Questionnaire (FFQ). Baseline data collection for BUD is ongoing and expected to end in April 2022. BUD data collection instruments (AIQ, FFQ) were developed based on those used for BHCK. Participants include Baltimore residents aged 21 to 75 recruited to participate in BHCK or BUD. A model-building approach will be conducted using Stata to assess consumption of promoted foods (fruits, vegetables, whole grains, etc.) across levels of monthly food spending in a merged sample. ResultsAn initial analysis of BHCK data found that all monthly spending levels were significantly associated with lower than recommended daily fruit and vegetable intake (1.5 ± 1.1 (M ± SD) servings of fruit, 1.8 ± 1.7 servings of vegetables) regardless of demographics. We anticipate data from BUD will add to these results, further supporting the need to intervene and improve access to healthier foods for various socioeconomic groups living in Baltimore. We expect to examine similar associations across other food groups (whole grains, low-fat dairy, flavored water beverages) based on the BUD FFQ data. ConclusionsThe BUD intervention aims to increase access to and incentivize the purchase of healthier foods and beverages for customers who frequent participating corner stores. The findings from this study will help to inform strategies for increasing consumer purchasing power for certain desired foods via BUD, and to provide a starting point for a future planned clinical trial. Funding SourcesNHLBI, NIH, award number R34HL145368.

The impact of vertical integration of oncologists on cancer outcomes and healthcare costs among metastatic prostate cancer patients.

e18786 Background: The share of oncology practices that were vertically integrated with hospitals more than doubled in the past decade. Vertical integration leads to higher spending, but evidence on quality and outcomes remains inconclusive. This study examines how integration between hospitals and oncologists affects patient outcomes and spending among patients with metastatic prostate cancer. Methods: Using the SEER-Medicare linkage with the Medicare Data on Provider Practice and Specialty file, we identified Medicare beneficiaries diagnosed with metastatic, castration-resistant prostate cancer who initiated chemotherapy between 2008-2017 (n = 9,167). We used a claims-based approach to identify treating oncologists and their integration status (as indexed by percent of total services billed to hospital outpatient departments). Outcomes included: 1) time on chemotherapy, 2) survival from chemotherapy initiation, 3) supportive care use (i.e. bone-modifying agents [BMA]), 4) Medicare payment for the first 3 months of chemotherapy initiation and last 3 months before end of life (EOL). The differences-in-differences approach was used to compare patient outcomes before and after oncologists became integrated versus those whose oncologists remained non-integrated or always integrated. Weibull survival and linear models were used for regression analysis, adjusting for sociodemographic, clinical, and market characteristics. Results: The proportion of patients treated by integrated oncologists increased from 28% in 2008 to 55% in 2017. Vertical integration was associated with 13.6 percentage points increase (95% CI = 6.1 to 21.1) in the likelihood of BMA use, but no significant changes for time on chemotherapy and survival. Average Medicare spending in the first 3 months of chemotherapy initiation and last 3 months of EOL was $34,324 and $42,624, respectively. Vertical integration did not have a significant effect on overall spending. Further decomposition showed decreases in professional service costs (-$4,264, 95% CI = -$6,642 to -$1,887) along with an increase in outpatient care costs ($3,941, 95% CI = $159 to $7,723) for the first 3 months of chemotherapy. A similar pattern was found for spending in the last 3 months of EOL. Conclusions: Vertical integration of oncologists was associated with increased use of supportive care, but not time on chemotherapy or survival among metastatic prostate cancer patients. Although oncologists switched service billing from physician offices to hospital outpatient departments, we did not detect significant increases in total Medicare spending after vertical integration. This suggests the potential for quality improvement following vertical integration without substantial increases in healthcare spending. Future studies should extend the investigation to other cancer types and patient outcomes.

Inflation: The problems for aquaculture

Inflation: The problems for aquaculture

Real-world evidence of a successful biosimilar adoption program.

Biosimilars have introduced new opportunities to reduce the disproportionately high US healthcare spending on biologic medications. This article describes strategic utilization management program initiatives designed to promote biosimilar utilization, reduce biologic drug costsand increase sustainability in a USnonprofit health system. Key components of these biosimilar utilization management program initiatives included expedited procedures to evaluate and establish the formulary status of biosimilars, enhanced contracting negotiations, specially designed electronic medical record tools to guide physician prescribing, payer coverage analysis, evaluations of biologic-utilization trendsand financial performance analysis. Within 2years (2019-2020), this program has resulted in savings of USD$26.9million for Providence St Joseph Health and biosimilar adoption rates that greatly exceed the USnational average.

Association of Dual Medicare and Medicaid Eligibility With Outcomes and Spending for Cancer Surgery in High-Quality Hospitals

Although dual eligibility (DE) status for Medicare and Medicaid has been used for social risk stratification in value-based payment programs, little is known about the interplay between hospital quality and disparities in outcomes and spending by social risk. To assess whether treatment at high-quality hospitals mitigates DE-associated disparities in outcomes and spending for cancer surgery. Retrospective cohort study from January 1, 2014, to December 31, 2018, evaluating inpatient surgery at acute care hospitals. A total of 119 757 Medicare beneficiaries aged 65 years or older who underwent colectomy, rectal resection, lung resection, or pancreatectomy were evaluated. Data were analyzed between November 1, 2020, and April 30, 2021. Medicare and Medicaid DE status and hospital quality. Postoperative complications, readmission, and mortality by DE status and hospital quality. Overall, 119 757 Medicare beneficiaries underwent colectomy, rectal resection, lung resection, or pancreatectomy. The mean (SD) age was 75.3 (6.7) years, 61 617 (51.5%) were women, 7677 (6.4%) were Black, 106 099 (88.6%) were White, and 5981 (5.0%) identified as another race or ethnicity; 11.3% had DE status. Dually eligible patients were more likely to be discharged to a facility (colectomy, 15.0% [95% CI, 14.7%-15.3%] vs 23.9% [95% CI, 22.9%-24.9%]; proctectomy, 18.7% [95% CI, 18.0%-19.3%] vs 26.9% [95% CI, 24.9%-28.9%]; lung resection, 11.0% [95% CI, 10.7%-11.3%] vs 17.9% [95% CI, 16.8%-18.9%]; pancreatectomy, 23.5% [95% CI, 22.5%-24.4%] vs 30.0% [95% CI, 26.5%-33.5%]). Differences in postacute care use persisted even after accounting for postoperative complications and contributed to variation in spending. Compared with the lowest-quality hospitals, DE patients had improved rates of discharge to a facility (22.7% vs 19.3%) and spending ($22 577 vs $20 100) but rates remained increased compared with Medicare patients even at the highest-quality hospitals. The findings of this study indicate that, even among the highest-quality hospitals, DE patients had poorer outcomes and higher spending. Dually eligible patients were more likely to be discharged to a facility and therefore incurred higher postacute care costs. Although treatment at high-quality hospitals is associated with reduced differences in outcomes, DE patients remain at high risk for adverse postoperative outcomes and increased readmissions and postacute care use.

Determinants of selection behavior in online distribution channels for fresh food

AbstractThis study examines the core factors that determine consumer choices of distribution channels for fresh food during the COVID‐19 pandemic, focusing on online distribution channels and the substitution patterns between online and offline distribution channels. Using 1436 responses to a survey conducted by Gallup Korea, a specialized survey agency in Korea, we adopted a multivariate probit model for the empirical analysis. The results show that consumers who pursued ease of use or had high awareness of online food delivery tended to choose online distribution channels for fresh food, unlike consumers who were sensitive to high quality or low prices. Consumers with high consumer spending, who are living in Seoul or a metropolitan area, have children of 10 years old or younger, and have a high educational level had positive relationships with the choice of an online distribution channel. Additionally, the estimates of the variance‐covariance matrix showed a complementary relationship between large markets and small and medium‐sized markets, with the possibility of a weak substitution effect between small and medium‐sized markets and online distribution channels.

How to deal with persistently low/high spenders in health plan payment systems?

Health insurance markets with community‐rated premiums typically include risk adjustment (RA) to mitigate selection problems. Over the past decades, RA systems have evolved from simple demographic models to sophisticated morbidity‐based models. Even the most sophisticated models, however, tend to overcompensate people with persistently low spending and undercompensate those with persistently high spending. This paper compares three methods that exploit spending‐level persistence for improving health plan payment systems: (1) implementation of spending‐based risk adjustors, (2) implementation of high‐risk pooling for people with multiple‐year high spending, and (3) indirect use of spending persistence via constrained regression. Based on incentive measures for risk selection and cost control, we conclude that a combination of the last two options can substantially outperform the first, which is currently used in the health plan payment system in the Netherlands.

Análisis de la contribución del gasto público de seguridad en la mitigación de la delincuencia de las entidades federativas de México

The objective of this article is to analyze the contribution that public spending for security has in mitigating crime in the states of Mexico. From the empirical theory, the debate remains as to whether the higher spending on security actually contributes to the decrease in crime. To reach the objective, a balanced micro panel is used. Multiple crime variables are used to contrast the results and strengthen the conclusions. Likewise, salary, education and unemployment are used as control variables and explanatory of crime. The results suggest that there is a negative and statistically significant relationship between public spending on security and the decrease in criminal activity. Likewise, a higher salary contributes to the mitigation of crimes, crimes against property and crimes against personal freedom.