The relative lack of flexibility of parametric models has led to the development of nonparametric regression techniques based on the family of generalized additive models. However, despite the ...potential advantages of using Generalized Additive Model (GAM) in practice many models have, until now, not been sufficiently explored in health economics problems. It could be interesting to calculate a new flexible hospital production function by means of a GAM including interactions and to compare it with the classic model Cobb-Douglas in the prediction of the behavior of productive factors.
The flexible model considered has been the AM including the beds-facultative interaction. The covariates "Hospital", being a categorical variable and "Year" being a continuous variable, have also been included in the model. Based on the estimation of the model penalized thin plate splines will be used to represent smoothed functions. In this configuration, the smoothed parameters will be estimated via REML.
Cobb-douglas model fits well for the production functions of the more general clinical and surgical services, while the GAM adjusts better in the case of more specialized medical services.
Generalized Additive Models are more flexible than parametric models, providing a better fit in the presence of non-linear relationships and thus allowing more accurate prediction values. The results of this study suggest that AM is a promising technique for the areas of research and application in health economics.
Companies in general and family businesses in particular engage in local collaborations in rather diverse areas through their corporate social responsibility activities. The COVID-19 pandemic has ...made these contributions to community improvement more apparent, suggesting a paradigm shift. This conceptual paper proposes a reflection about the evolution of the corporate social responsibility activities linked to family businesses in emergencies and from the socioemotional wealth perspective. The contribution of this paper is twofold. Firstly, it provides an in-depth reflection on the evolution of philanthropy, posing the following questions: are we witnessing a reinvention of corporate social responsibility within the framework of family businesses because of the global pandemic; does this new trend deserve support, given the fundamental role that family businesses have played in this situation; and if so, what should such support consist of, and what is the optimal channel for articulating it? Secondly, the paper proposes a theoretical framework from the socioemotional wealth perspective to advance research about corporate social responsibility carried out by family businesses. Business families are more likely to implement strategies that promote ethical behavior and CSR activities in their companies. The pandemic situation has created new possibilities for developing CSR.
ObjectivesThe aim of the study was to answer whether the central government has been more efficient than the regional governments or vice versa. Likewise, through the analysis of the data, the aim ...was to shed light on whether decentralisation has had a positive impact on the efficiency of the hospital sector or not.DesignIn this paper, we have used data envelopment analysis to analyse the evolution of efficiency in the last 10 Autonomous Regions to receive healthcare competences at the end of 2001.ParticipantsFor this study, we have taken into account the number of beds and full-time workers as inputs and the calculation of basic care units as outputs to measure the efficiency of the Spanish public sector, private sector and jointly in the years 2002, 2007, 2012 and 2017 for the last Autonomous Regions receiving healthcare competences.ResultsOf the Autonomous Regions that received the transfers at the end of 2001, the following stand out for their higher efficiency growth: the Balearic Islands (81.44% improvement), the Madrid Autonomous Region, which practically reached absolute efficiency levels (having increased by 63.77%), and La Rioja which, together with the Balearic Islands which started from very low values, improved notably (46.13%).ConclusionIn general, it can be observed that the transfer of responsibilities in the health sector has improved efficiency in the National Health Service.JEL classificationC14; I18; H21.
Introduction. This study assesses the impact of an electronic physician-to-physician consultation program on the waiting list and the costs of a Pulmonology Unit. Materials and Methods. A prepost ...intervention study was conducted after a new ambulatory pulmonary care protocol was implemented and the capacity of the unit was adopted. In the new model, physicians at all levels of healthcare send electronic consultations to specialists. Results. In the preintervention year (2019), the Unit of Pulmonology attended 7,055 consultations (466 e-consultations and 6,589 first face-to-face visits), which decreased to 6,157 (3,934 e-consultations and 2,223 first face-to-face visits; 12.7% reduction) in the postintervention year (all were e-consultations). The mean wait time for the first appointment was 25.7 days in 2019 versus 3.2 days in 2021 (p<0.001). In total, 43.5% of cases were solved via physician-to-physiciane-consultation. A total of 2,223 patients needed a face-to-face visit, with a mean wait time of 7.5 days. The mean of patients in the waiting listing decreased from 450.8 in 2019 to 44.8 in 2021 (90% reduction). The annual time devoted to e-consultations and first face-to-face visits following an e-consultation diminished significantly after the intervention (1,724 hours versus 2,312.8; 25.4% reduction). Each query solved via e-consultation represented a saving of €652.8, resulting in a total annual saving of €827,062. Conclusions. Physician-to-physiciane-consultations reduce waiting times, improve access of complex patients to specialty care, and ensure that cases are managed at the appropriate level. E-consultation reduces costs, which benefits both, society and the healthcare system.
Low-density lipoprotein cholesterol (LDLc) is the lead effector of atherosclerosis and main treatment target. Bempedoic acid is a novel oral drug in the therapeutic armamentarium which is able to ...reduce LDLc. The objectives of this study were (1) to select the potential patients for administering bempedoic acid such as those with a very high cardiovascular risk in which objectives of LDLc were not achieved despite conventional treatment with PCSK9 inhibitors (PCSK9i) and/or statins and ezetimibe and (2) to estimate the cost-effectiveness of bempedoic acid in different scenarios. The methods used were a multicenter and retrospective study of 652 patients initiating treatment with any PCSK9 inhibitor in 17 different hospitals. Before and on-treatment LDLc cholesterol levels, medical treatments, clinical indication, and baseline characteristics were recorded. The results obtained from 443 subjects in secondary prevention were analyzed. The mean (±) LDLc level at baseline was 142.5 ± 46.4 mg/dL and 61.5 ± 40.5 mg/dL in the follow-up, with a reduction of 55.9% ( P < 0.0001); 71.6% of the patients reached the target of LDL < 55 mg/dL or >50% reduction. Of those patients treated with medium-intensity and low-intensity statins plus PCSK9 inhibitors (with or without ezetimibe), only 5.7% of them were able to reduce LDL below 55 mg/dL and the main LDLc reduction in this group was the lowest (42.9% on average). Patients with TG values >135 mg/dL represented 41.6% of the sample, of which approximately 10% of them were using fibrates. Assuming only LDLc reduction and the UK price, the incremental cost-effectiveness ratio was 88,359€; 83,117€; 82,378€; and 79,015€ for different discount rates. In conclusion, one-third of the patients could achieve the target LDL proposed in the 2019 ESC/EAS guidelines. Approximately 10% of them could also benefit from treating hypertriglyceridemia as indicated in the 2021 ESC guidelines on cardiovascular disease prevention. Patients with medium-intensity and low-intensity statins plus PCSK9i and ezetimibe would be the most benefited. Bempedoic acid could be a not cost-efficacy therapy in all the scenarios, but we need to wait for the CLEAR OUTCOMES Trial results.
PurposeThe purpose of this paper is to find throughout history examples of wealth management of a family or business families that can be assimilated into the current concept of family offices (FOs). ...In such examples, the study identifies characteristics associated with the different dimensions of the concept of socioemotional wealth (SEW).Design/methodology/approachDrawing on the socioemotional perspective, this paper relates significant examples of FOs based on historical stages (ancient history, the middle ages, modern history, the contemporary period and the actual world). Each case is discussed with an effort to identify the dimensions of the SEW that fit and help in understanding the organization studied.FindingsMainly, FOs allow the management of the family legacy, philanthropy, promotion of entrepreneurship and family wealth preservation for future generations. Autonomy in decision-making, privacy and confidentiality and the achievement of more intangible goals make the FO preferable to other institutions. Through the study of historical cases, the FO constitutes a structure with objectives and activities that have remained consistent from Rome to the present, regardless of historical, political or social context. The results also identify four out of five FIBER dimensions of SEW.Originality/valueIn addition to contributing to the scarce literature on FOs, this paper uses various examples of historical periods to better understand its origin, evolution and current state. A selection of examples at different times allows us to verify that FOs undergo a series of changes throughout history but maintain their characteristics regardless of the historical context. This paper is the first to explore the origin and development of the FO as organization. Building on the findings, the authors present a conceptual SEW framework to deepen in the knowledge of FO. This framework could help researchers and practitioners in future researches providing a conceptual link that demonstrates the components of the SEW perspective best fit the objectives pursued by business families when establishing a family office.
The paper proposes a methodology to enhance students' learning experiences by using movie clips to teach business management concepts. We describe the entire management teaching process step by step, ...from film selection to evaluation through questionnaires. In this way, this design can be reproduced by instructors for teaching business management courses. Additionally, we carried out and analyzed questionnaires about student satisfaction and business management concepts acquisition with a quantitative multiple regression. The results suggest that watching movies improves academic results and, in particular, the post-viewing debate. Besides, the more current the movie is for the generation of students, the more impact it has on their learning, as they are more likely to pay attention. On the other hand, we cannot neglect the gender issue, as the content of the film has an important influence. Students may be disinterested in a movie with a marked male or female leading role.
Background: In the debate on the determinants of
social class variation in health, it has been suggested that
social mobility and associated factors play an important
role in this variation. Social ...mobility describes changes
or stability between social class positions. The aim of this
paper was to identify studies on the association between
social mobility and health.
Methods: The databases consulted were MEDLINE/
PubMed, Cochrane, SciELO, CRD. The keywords used
(in English), through the MeSH methodology, were:
Health (MajorTerm), Class mobility, Vertical mobility,
Social position, Socioeconomic factors, Social class,
Social conditions, Social environment, Poverty and Social
marginalisation (MeSHTerm). The search period was
from January 2010 to December 2019. The STROBE statement
has been used to develop the checklist. Finally, the
evaluation of the studies has been carried out by means of
a qualitative systematic review.
Results: The search identified 1,092 potentially relevant
studies. After analysis, 376 studies were retained
and their full texts were reviewed in depth, resulting in a
final set of 42 studies. Of these, 2 studies were identified
on Class Mobility and Health; 5 studies were also identified
on Poverty and Health, showing evidence of effect on
Health by Social Mobility; 9 studies on Social Class and
Health, showing effect of Social Mobility on Health and 8
studies showing effect of Social Position on Health.
Conclusions: Social mobility measures convey
additional information to that of poverty indices. Using
indices of social position and their impact on health inequalities
could be empirically useful. More research is
needed on this issue.
Fundamentos: En el debate sobre los determinantes
de la variación de la clase social en la salud, se ha
sugerido que la movilidad social y los factores asociados
a ella desempeñan un papel importante en esta variación.
La movilidad social describe los cambios o la estabilidad
entre las posiciones de clase social. El objetivo de este
trabajo fue identificar estudios sobre la asociación entre
movilidad social y salud.
Métodos: Las bases de datos consultadas fueron
MEDLINE/PubMed, Cochrane, SciELO, CRD. Las palabras
clave utilizadas (en inglés), a través de la metodología
MeSH, fueron: Salud (MajorTerm), Movilidad de clase,
Movilidad vertical, Posición social, Factores socioeconómicos,
Clase social, Condiciones sociales, Entorno social,
Pobreza y Marginación social (MeSHTerm). El periodo de
búsqueda fue de enero de 2010 a diciembre de 2019. La
declaración de STROBE se ha utilizado para elaborar la
lista de verificación. Finalmente, la evaluación de los estudios
se ha realizado mediante una revisión sistemática
cualitativa.
Resultados: La búsqueda identificó 1.092 estudios
potencialmente relevantes. Tras el análisis, se retuvieron
376 estudios y se revisaron sus textos completos en profundidad,
resultando un conjunto final de 42 estudios. De
ellos, se identificaron 2 estudios sobre Movilidad de clase
y Salud; también se identificaron 5 estudios sobre Pobreza
y Salud, mostrando evidencia del efecto sobre la Salud
por la Movilidad Social; 9 estudios sobre Clase Social y
Salud, mostrando el efecto de la Movilidad Social sobre
la Salud y 8 estudios que mostraron efecto de la Posición
Social sobre la Salud.
Conclusiones: Las medidas de movilidad social
transmiten información adicional a la de los índices de
pobreza. Utilizar los índices de posición social y su impacto
en las desigualdades en salud podría ser empíricamente
útil. Se necesitan más estudios sobre esta cuestión.
The relevance of family businesses in the world economy has led researchers to study them in various fields and from various perspectives. However, the role played by family businesses in the private ...health care sector has hardly been analyzed. The objective of this research was to focus on the historical evolution of the family business in the field of private health, attempting to determine the variation in its contribution to the sector during 1995- 2018. For this purpose, we constructed a database with the existing private hospitals in Spain, classifying them according to family and non-family ownership for the years 1995 and 2018 and performing a cross-sectional analysis. We observed an almost 60% survival rate for family businesses. We propose implementing the methodology of the case study for future research
The main aim of this work is to achieve reproducing by means of a simulation study the behaviour of the daily inpatient activity and the length of the inpatient stay in Galician public hospitals. ...Another important issue is studying how the number of beds in the hospital affects inpatient activity, the length of the stays and, consequently, the waiting list.
In order to simulate the daily inpatient activity we have fitted a normal distribution to real inpatient activity data observed in 2009, whereas the Parzen–Rosenblatt estimator has been considered for estimating non-parametrically the stay length distribution in the same period. Moreover, the effect of the number of beds on inpatient activity has been modelled by means of a linear regression model where the number of beds is the covariate and the median of daily inpatient activity is the response.
A simulation study is also presented to show the practical behaviour of these procedures in two different scenarios: firstly, assuming that the effect of the number of beds does not exist, and then assuming that the number of hospital beds has a ‘linear’ influence on inpatient activity. In this way, the proposed study turns into an aid for analysing and modifying a complex hospital system, allowing consideration of far more detail and providing more reliable results than would otherwise be possible. Furthermore, it allows us to examine the drop in waiting list numbers due to new-bed allocations in a simple way.
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