Unseen Costs Research Articles

Treating chronic wounds in an acute care setting: the forgotten diagnosis.

Chronic wounds include lower extremity ulcers, diabetic foot ulcers, and pressure injuries, and can take months or years to heal. Wounds place a high burden on outpatient and inpatient care settings. This burden is expected to increase markedly in the United States as the population ages and with increased rates of diabetes, obesity, and COVID-19. To articulate the effect of chronic, hard-to-heal wounds on acute care facilities, and how a few days of inpatient care can have a significant effect on the healing trajectory. An expert panel of 7 members, all with extensive knowledge and experience in the assessment and treatment of chronic wounds in an acute care setting, was convened in March 2022. The panel discussed the role of hospitals as part of the longer-term healing pathway of chronic wounds. Chronic wounds have a significant effect on hospitals that includes unseen costs, bed occupancy, demands on bedside nurses, and wound complications that lead to extended stays or readmissions. A successful inpatient wound program offers appropriate identification of previously undiagnosed wounds, elevation of bedside care through simplified protocols, quickly and easily understood education and easy dressing selection, and comprehensive discharge planning with a multidisciplinary team for continuity of care and reduced risk of readmission. Hospitals can play a key role in the management of chronic wounds, thus reducing the effect on each facility and the wider care network.

The Perils of Regulating COVID–19: Insights from Kirznerian Entrepreneurship and Ostromian Polycentricity

During the COVID-19 pandemic, governments at every level in the United States made various policies to reduce the spread of the disease and to mitigate pandemic-related economic impacts. Such policies included stay-at-home orders that shuttered “non-essential” businesses and economic stimulus programs that provided financial assistance. Using Israel Kirzner’s insights from “The Perils of Regulation,” we argue that local, state, and federal COVID-19 policies have had and will continue to have long-run spillover effects and other negative unintended consequences. Pandemic policies have stifled entrepreneurial discovery and created opportunities for superfluous discovery, thus directing entrepreneurial efforts in directions that would not have existed otherwise. The normative implications of this analysis are that policymakers should better account for the wide variety of seen and unseen costs of policies that are likely to have many negative unintended consequences, regardless of the intentions behind such policies. One of the most effective ways to limit the perils of regulation is polycentric governance systems. With multiple, overlapping decision-making centers, polycentric systems allow for policymakers to experiment with different policy approaches and learn from other jurisdictions. Polycentric systems also limit the spillover effects of negative unintended consequences onto other jurisdictions.

Unseen Costs: The Direct and Indirect Impact of U.S. Immigration Policies on Child and Adolescent Health and Well-Being.

Shifts in migration and border control policies may increase the likelihood of trauma exposure related to child–parent separation and result in costs to the health system and society. In the present study, we estimated direct and indirect costs per child as well as overall cohort costs of border control policies on migrant children and adolescents who were separated from their parents, detained, and placed in the custody of the United States following the implementation of the 2018 Zero Tolerance Policy. Economic modeling techniques, including a Markov process and Monte Carlo simulation, based on data from the National Child Traumatic Stress Network's Core Data Set (N = 458 migrant youth) and published studies were used to estimate economic costs associated with three immigration policies: No Detention, Family Detention, and Zero Tolerance. Clinical evaluation data on mental health symptoms and disorders were used to estimate the initial health state and risks associated with additional trauma exposure for each scenario. The total direct and indirect costs per child were conservatively estimated at $33,008, $33,790, and $34,544 after 5 years for No Detention, Family Detention, and Zero Tolerance, respectively. From a health system perspective, annual estimated spending increases ranged from $1.5 million to $14.9 million for Family Detention and $2.8 million to $29.3 million for Zero Tolerance compared to baseline spending under the No Detention scenario. Border control policies that increase the likelihood of child and adolescent trauma exposure are not only morally troubling but may also create additional economic concerns in the form of direct health care costs and indirect societal costs.

Market Exchanges, Negative Externalities and Sustainability

Lusch (2017), in an insightful article published posthumously, enumerated and elaborated on four macro observations concerning Homo sapiens and exchange. He noted that Homo sapiens massively (1) engage in exchanges with each other, (2) create tools to facilitate exchanges, (3) engage in exchanges with the vast majority of costs being unseen, and (4) create institutions to efficiently coordinate exchanges and interactions among the parties to the exchanges. Lusch also proposed a number meta-questions pertaining to the above macro views on Homo sapiens and exchange for future research. This article focuses on the following questions highlighted by Lusch in reference to the unseen costs of market exchanges from an economic, environmental and social sustainability perspective: (1) Do any of the theories that are currently in vogue shed light into unseen costs of market exchanges, or is there a need for new theories? (2) Can some or most unseen costs of market exchanges be quantified? (3) How important is it for individuals, organizations and governments to consider the unseen costs of market exchanges? In reference to the last question, the article proposes manifestos for Citizen Consumer Environmental Oath, Company Manager Environmental Oath, and Country Leader Environmental Oath, highlights the need to develop guiding consensus principles on Government Sustainability Responsibility, Corporate Sustainability Responsibility and Consumer Sustainability Responsibility, and proposes a principle in respect of each.

Cleaning up unseen practice costs

Steve Nurdin explains how an excellent hygiene strategy can help practice managers comply with legal requirements, protect staff and patients' health and safety and keep costs to a minimum

Robert F. Lusch—One of a Kind Scholar and a Macromarketer

Robert F. Lusch spoke in a plenary session at the 2015 Macromarketing Conference in Chicago and shared four ideas he felt will have importance to macromarketing scholars in the future. His essay “The Long Macro View” follows. In it, he highlights humans’ innate propensity for 1) engaging in exchange, 2) creating technology, 3) encountering choices with unseen costs, and 4) developing institutions to coordinate interactions with each other. Four macromarketers offer their own comments on this essay: 1) Gene R. Laczniak (who also organized the set of commentaries on “The Long Macro View”), 2) Olga Kravets, 3) Clifford J. Shultz, II, and 4) Roger A. Layton. These commentaries were authored and edited shortly before Bob Lusch passed away.

The Hidden Costs of Hidden Costs

This brief comment expands on the “long macro view” observation of Prof. Robert Lusch that human choices, including market choices, have massive and unseen costs. It is argued here that a central challenge for macromarketing scholars is to make transparent the hidden costs embedded in macromarketing systems and sub-systems so that their true complexity and heterogeneity are better understood. Distributive Justice demands such consideration.

Receipt by Karen Leona Anderson

Reviewed by: Receipt by Karen Leona Anderson Alyse Bensel (bio) Karen Leona Anderson. Receipt. Milkweed Editions, 2016. Karen Leona Anderson’s Receipt is an interrogation of the domestic that draws from cookbooks, shopping receipts, and the physical space of the home. While initially organized to reflect an orderly kept home, this poetry collection’s three marked sections catalogue and complicate the meaning of home and the implications of housekeeping. Household tasks and chores break down and reveal their sparest parts: a gathering of objects, desires, and bodies. Anderson resituates the domestic goddess myth as one not of mastery over the home but of a figure full of contradictory needs that extend beyond the realm of the kept household. The collection’s first-person speakers, who inhabit most of these poems, continue through daily existence. These figures situate their lives within consumerist impulses that demand consumption in order to achieve personal, physical, and household perfection. Rather than hover at the surface, though, these poems strive to uncover what lurks underneath, what is hidden under dust-free corners, pedicured feet, and costly dresses. The collection’s title section, “Receipt,” serves as a drawer full of past purchases, ranging from clothing to an epidural, that talk back to monetary value. In “Lacy ($292.06 modcloth.com),” a bridesmaid dress from the well-known online vintage fashion store turns seething and brutal: “I sew you to your shadow, crude / and machine made, torque your honeymoon, // bad fairy at the wedding.” The dress elicits a curse. Any sugar-coated and carefully planned matrimonial bliss is interrupted at every turn while the speaker mocks the bride: “I look / forward to your indoor tan, your SUV, / and your fertility kit.” The home turns toxic, as even macramé becomes “ozoney” and [End Page 29] dangerous to live on. With these receipts, the costs are not solely monetary—rather, cultural expectations and emotional costs accrue among these poems, seeking an outlet beyond the mute object. Interspersed among these sharp receipts are complementary poems titled after common and usually un-romanticized birds. In “Pigeon,” the speaker embodies a pigeon preparing its nest for offspring. During this act, the speaker claims, “I’m all throat: all mother: fiery / blue-green: I’ll make oppression bitter: / I’ll feed them all there is.” The mother’s sacrifice culminates in the desperate need to cling onto what persists through her offspring and fellow birds. Unlike the receipts, however, these birds have no monetary value placed on them. Rather, their worth comes from how the speaker inhabits the birds, projecting desires through them. The interspersed bird and receipt poems in this section serve as commentary on cultural assumptions and the costs associated with inhabiting a particular body. These underlying, unseen costs, as pointed out in these poems, go far beyond a price tag. The failure to live up to cultural expectations is addressed in Receipt’s opening section, which is filled with recipes and cookery books. In many of these poems, the speaker fails to live up to domestic standards; instead, she becomes consumed by the recipes, which have their own particular flavor of wildness. In “Venison,” a poem, as the epigraph notes, after The Wild Game Cookbook (1972), the deer are simultaneously artificial and untamed, “built on stripling legs or the sun strained divine / through their ears’ big pink shells—.” The poem’s neat tercets begin to break apart as the speaker turns feral: “I’m gone // from wolf to bad fawn for them, men: / trash tin at the heart of silver, picked off […].” The speaker searches for scraps, becoming animal and disorderly. But when the speaker stays within the home, even pie baking is tainted by the thought of men. In “Pie,” the speaker works through the familiar act of making the crust and building up the dessert. Crust becomes flesh as the speaker tells the addressed you: now cool, you’ll see through slicks and sheers of juice the sign I pieced from crust through red, through cover, through sugar, your name, you stitched to it. Baking as bodily nourishment and domestic task becomes an incantation, calling the wrongdoer to atone for their mistakes within the home. These moments of breakdown...

Tonsillectomy is not a procedure of limited value - the unseen costs of tonsillitis and quinsy on hospital bed consumption.

To assess the impact of the introduction of the SIGN Clinical guidelines in 1999 and subsequent revision in 2005 on tonsillectomy, hospital admission with tonsillitis and peritonsillar abscess rates in four countries. Retrospective analysis using English, Welsh, Australian and New Zealand National healthcare hospital admission databases between 2000 and 2013. Primary outcomes measures included tonsillectomy rates and hospital admission rates for tonsillitis and peritonsillar abscess. Secondary outcome measures included bed-day usage in England and Wales. Linear forecasting was used to identify the potential impact of any trends. Following guideline introduction for tonsillectomy, a significant decline in tonsillectomy rates in England (P < 0.01) and Wales (P < 0.05) was seen. Hospital admissions for acute tonsil infections increased in England (P < 0.01) and Wales (P < 0.01). In Australia and New Zealand, tonsillectomy and admission for tonsillitis rates both increased (P < 0.01). During this time, the increased rate of admission for tonsillitis in England and Wales was significantly greater than Australasia (P < 0.01). Following the introduction of these Clinical guidelines, there was a decrease in the rate of tonsillectomy in England and Wales and a presumed associated increase in admissions with tonsillitis. This did not occur in Australasia where tonsillectomy rates rose over time. If these trends continue, it is likely that they will have a significant deleterious impact on healthcare spending in the future.

Worry and time: the unseen costs of informal care.

The objective of this study is to examine the experiences of informal carers in terms of how their time spent caring is related to worry. Is worry about a care recipient a care practice, and if so, to what extent it can be understood temporally? Classical phenomenology underpinned this study. Three qualitative studies of people living with chronic illness in Australia were conducted between 2009 and 2013. Semi-structured interviews were conducted. Interviews were audio recorded and transcribed verbatim. Phenomenological thematic analysis of the data was undertaken. Twenty-five informal carers participated. The findings pivot around three interconnected themes: time, worry and cost. Worry was identified as a temporally bound unseen cost to carers that informs carer identity irrespective of culture, ethnicity, or social status. Worry is a practice that most carers report engaging in and it is one that comes with a temporal cost-it keeps people busy looking after the needs of others during the day and it keeps some people awake when they would rather be sleeping. Worry takes time and effort, it informs people's construction of their own sense of self, motivates acts of care, and informs carers' imaginings of what their future and that of their loved one(s) may entail.

The unseen costs of flexible working

Purpose To examine the impact of employing temporary contract workers (“temps”) alongside permanent employees on the social capital of the organization. Design/methodology/approach Uses discourse analysis to analyze data from semi-structured interviews with both temporary workers and permanent employees in a range of occupations at seven companies in different industries in Finland. Findings Agency workers, temporary workers or just “temps” – call them what you like, but reliance on individuals employed on a short-term contract basis appears to be here to stay. Since the 1990s, the use of temps has doubled across Europe and is still rising. The argument is that this provides the employer with a cheaper, more flexible workforce. But asking temporary and permanent employees to work together has a significant impact on the social fabric of the organization. Practical implications Suggests that human resource managers review contracts with agencies providing temporary workers. Notes that practices that leave temps feeling like “second-class citizens” can damage the social fabric of the workgroup and undermine team effectiveness. Social implications Highlights potentially harmful effects on social capital and organizational performance resulting from an unequal treatment of temps and permanent employees doing the same job within a workgroup. Originality/value A qualitative study focusing on the feelings and emotions evoked by the growing use of temporary contract workers from the viewpoint of both the temps and the permanent employees they work with.

Does metabolic rate and evaporative water loss reflect differences in migratory strategy in sexually dimorphic hoverflies?

A typical explanation for ecologically stable strategies that apply to only a proportion of a population, is bet hedging, where increased reproductive success offsets reduced reproductive rate. One such is partial migration, where only a proportion of a population moves seasonally to avoid inclement climatic conditions. Bet hedging may overlook unseen costs to maintain broad physiological resilience, implied by encountering a breadth of environmental conditions. We investigated the physiological correlates of partial migration by measuring standard metabolic rates, and rates of evaporative water loss, and then estimating upper and lower thermal tolerance in males and females of two hoverfly species, Episyrphus balteatus and Eristalis tenax. In central Europe, females of these species may either migrate or overwinter, whereas males may migrate south to the Mediterranean, but have not been found overwintering. Both species were sexually dimorphic; female Ep. balteatus were lighter than males, but female Er. tenax were heavier than males. While allometrically- corrected metabolic rate in both species increased with temperature, the most parsimonious models included no sex-specific differences in metabolic rate for either species. Evaporative water loss of both species also increased with temperature, but was higher for females of both species than males. Assuming that resting metabolism is congruent with the activity requirements of migration, highly consistent thermal tolerance and metabolic rate suggests that any given fly could migrate, although water loss patterns suggest that females may be less well-adapted to Mediterranean climates. We infer that partial migration probably results from the imperatives of their reproductive strategies.

Congressional Intransigence and Executive Power

In NLRB v. Noel Canning, the Solicitor General argued that the President’s novel reading of the recess appointment power was justified as a “safety valve” in response to “congressional intransigence.” All nine Justices emphatically rejected this position, finding the President’s three appointments, made during a three-day break, could not be saved because of an obstructionist Senate. Yet, the reliance on “congressional intransigence” as a rationale for broadly interpreting inherent executive powers has been a hallmark of the Obama Presidency. As part of his “We Can’t Wait” platform, President Obama routinely cites Congress’s obstinacy to his agenda as a justification to engage in a series of executive actions that suspend, waive, and even rewrite statutes. The lesson from Noel Canning is clear — gridlock does not allow the president to flex his Article II powers, as a means to release a safety valve of pressure in Congress. This article places the Court’s unanimous holding in Noel Canning in the context of the President’s unilateral action with respect to modifying the Affordable Care Act, Deferred Action immigration policy, as well as the detainee release for Sgt. Bowe Bergdahl, and the “hostilities” in Libya. For each action, in the face of congressional opposition, the President executes at his “lowest ebb,” and warrants the closest scrutiny. In the domestic affairs context, the President can rely only on his “corrective powers,” which allow him to correct the political process, and achieve what a reasonable congress would have done. This novel constitutional philosophy, while defensible in theory, falls apart in practice, with unseen costs to the separation of powers.

Judging the Constitutionality of Social Cost

The tiers of judicial scrutiny represent the Supreme Court’s attempts to balance three important concerns–individual liberty, collective safety, and social cost. The relationship between liberty and safety has been ably explored; however, considerations of social cost — a factor that has been integral in the Supreme Court’s balancing of liberty and security — has been neglected. Understanding the interaction between liberty, safety, and social costs, reveals insight into how the Supreme Court has fashioned the tiers of scrutiny, and judicial review more broadly.The Supreme Court has recognized two types of social cost, that I have labeled liberty costs and security costs. First, liberty costs, refer to the risk of negative externalities to society as a whole that can result from individuals exercising liberty. Second, safety costs, refer to the risk of negative externalities to individual liberty that can result from the state providing for collective safety. The Supreme Court employs the tiers of scrutiny when the liberty interests of an individual (or group of individuals) are weighed against the interests of the state to provide for collective safety (defined broadly as the police powers — health, safety, and morals). Scrutiny is effectively a question of burdens — which party’s interests receive judicial deference, and which party’s interests are met with judicial skepticism. Or, to state it differently, which party bears the burden of justifying its high social costs. These relationships are plotted on a graph I labeled the Social Cost Frontier. The frontier depicts judicial review and the relationship between the tiers of scrutiny and social cost, with respect to Miranda, the exclusionary rule, the overbreadth doctrine, unprotected speech, and commercial speech.Social cost further explains how the court shifts between the counter-majoritarian difficulty and representation reinforcement. Which branch of government is in the better position to assess social costs — the legislature, or the courts? Or more precisely, should the court defer to the state’s assessment of social cost, or defer to the individual’s assessment, or engage in an independent inquiry. Ultimately, this determination is largely informed by a given Justice’s view of liberty and safety costs with respect to Footnote Four of United States v. Carolene Products, and Professor John Hart Ely’s “representation reinforcement” theory of the Constitution. Even with the judiciary’s assumption of this role, certain cognitive and confirmation biases dictate that, in the words of Frederic Bastiat, there are seen, and unseen costs by the Justices. The costs that are unseen, are often the costs that the Justice is inclined to disregard. How a Justice choose to see, and not see, certain social costs — rather than abstract terms like tiers of scrutiny, or equal protection, or due process — explains how some of the most important constitutional issues of our time can be so divisive.The Supreme Court’s reliance on social cost, without ever fully defining it, illustrates the normative appeal of this rubric. No one likes costs, they’re bad. Identifying costs, and using them as a rationale for a judicial decision is quite attract. Yet, by failing to define these costs — and what considerations go into calculating them — the Court, and the academy, has unfortunately elided over an important jurisprudential step in numerous cases involving the Constitution. Further, by assuming the role of assessing social cost, and either grating the costs deference or skepticism, the Court has succeeded at its institutional aim at minimizing social cost in the absence of judicial intervention. For when either cost grows too large, the role — and need — of courts disappears. In their efforts to keep this balance in check, courts aim to maintain their legitimacy, and indeed relatedly, their need for existence. If courts step too far in either direction, their legitimacy, and place in society decreases

Estimating the switching costs in wireless telecommunication market

PurposeSwitching cost is an important concept in the study of consumer loyalty which has implications for organizational business strategy and regulatory policies. Much research has already examined the formation and influence of switching costs on the consumers' repeated purchase intentions, but little research has focused on quantitative measurement of the switching cost itself. This paper aims to address this issue.Design/methodology/approachBy game theory, a complete Nash‐Bertrand model is proposed to accurately estimate consumer switching costs considering price compensation and transport costs in a duopoly. The relationship between switching costs and market structure is then analyzed by using the example of Hong Kong's wireless telecommunication market. From the observed data of China's wireless telecommunication industry, the model calculates switching costs per year of China Mobile and China Unicom's users respectively, as well as other variables.FindingsThe results demonstrate that reducing consumer switching costs will benefit small operators and increase competition in a winner‐take‐all market.Originality/valueThe model is valuable in calculating unseen switching costs and studying the impact of switching costs on market structure, especially for a duopoly in telecommunication.

Prior Authorization for Medication: Unseen Costs

Healthcare payers are increasingly using restricted formularies and requiring prior authorization for new or expensive medications. Presumably, these

Survival math for marketers

Chapter 1. Your Credibility It's Absolute and Definite (Maybe) A Few Definitions Why is This Important to Me? A Short True-False Quiz Reality and Perception The Numbers Control Us I Thought This Was a Math Book Chapter 2. Figures Never Lie, but Liars Figure It's Absolute and Definite (Maybe), Part II Is Actual actually Actual? Debits and Credits The Chart of Accounts Double Entry Sales and Expenses It's an Accrual, Accrual World Chapter 3. Making a (Financial) Statement How Are We Doing? The Balance Sheet The Income Statement Fiscal Years Chapter 4. Organizations, Measurements, and Standards What Are We, Anyway? Different Purposes, Different Rulers Percentage of What? The Pitfalls of Precision Why Are We Looking Here? The Unseen Costs of Saving Money Too High? Too Low? What Standards? Chapter 5. An Economics Excursion Economics, Science, Markets, and Demand Utility Is Not Just Gas The Economists' Curve Marketing and Elasticity Chapter 6. Pricing and Profitability Pricing: Theory and Practice A True-False Quiz on Pricing What a Really Is There's More Than Price Involved in Price A Small digression on Quality Price vs. Cost Markups and Break-even Sensitive Pricing for Profit What is the Company's Objective? Pricing Policies You Should Have Pricing for Services Chapter 7. Costs and Profitability Costs, Real and Imagined Cost Allocation Variable, Fixed, and Somewhere in Between Why a Toilet Seat Costs $600 Over Whose Head? Is Overhead a Burden? Sunk and Avoidable Costs Marginal Costs Inventory and Stockturn LIFO and FIFO A Cost Control Fallacy Fun with Depreciation and Amortization Chapter 8. Strategy: Break-Even and Profitability Profit is Why We're Here Break Even Must Everything Break Even? Chapter 9. Cash Cash Flow Source and Use of Funds Receivables and Payables: A/R and A/P Cash Flows and Cash Gaps Net Present Value Chapter 10. Budgets What is a Budget? Basis for Budgets: Last Year, Percentage or Zero? The Fantasy Factor Cost Fudge and Revenue Cotton Candy Don't Just Divide By 12 Revenues and Strategy Chapter 11. Just Look at the Statistics Mean Stuff and Deviations That Average Just Moved! Trends Appendix A - A Summary of Non-Magic Formulae Appendix B - Sample Chart of Accounts

Ground‐Water Development in Western River Basins: Large Economic Gains with Unseen Costsa

AbstractIn river basins where aquifers are closely interrelated with a stream, large‐scale ground‐water development can lower water tables near the stream and diminish stream flows. Junior surface right holders are adversely affected. A digital computer simulation of the hydrologic‐economic system on the lower South Platte River in Colorado is employed to study economic impacts of two water management policies. Open access management is found to yield high income benefits but imposes substantial costs on surface‐water users when water supplies are limited. Incorporation of ground water into the appropriation system can help avoid the losses to surface‐water users, but greatly reduces the income of ground‐water users.