Traditional Medicare does not cover routine dental care, but little is known about transitions in dental outcomes upon reaching Medicare eligibility at age sixty-five. Using data from the 2010-19 ...Medical Expenditure Panel Surveys, we examined dental insurance, utilization, and outcomes among US adults before and after age sixty-five, using a regression discontinuity design and segmented regression analysis. Among 97,108 US adults representing a weighted population of 104,787,300 people, complete edentulism, or the loss of all teeth, increased by 4.8 percentage points at age sixty-five, and the percentage of people receiving restorative dental care decreased by 8.7 percentage points. Enrollment in Medicare Advantage, which may offer a dental benefit, was not associated with greater use of dental services relative to traditional Medicare, and Medicare Advantage enrollees had a significantly larger drop in dental spending from private insurance at age sixty-five than traditional Medicare enrollees. Expanding Medicare to cover dental services may help counteract these effects among all enrollees.
Real options reasoning assumes timely and effective managerial decision making yet does not address managers' ability to provide it. An attention-based view describes managerial behavior under ...varying structural conditions. I examine real options reasoning from an attention-based view. I develop several testable propositions regarding the effects of a firm's particular concrete and contextual attention structures on the ways in which its managers notice, champion, acquire, maintain, exercise, and abandon the various real options within its portfolio. I conclude with implications for future empirical research on real options reasoning.
A central and contentious debate in many literatures concerns the relationship between financial and social performance. We advance this debate by measuring the financial--social performance link ...within mutual funds that practice socially responsible investing (SRI). SRI fund managers have an array of social screening strategies from which to choose. Prior studies have not addressed this heterogeneity within SRI funds. Combining modern portfolio and stakeholder theories, we hypothesize that the financial loss borne by an SRI fund due to poor diversification is offset as social screening intensifies because better-managed and more stable firms are selected into its portfolio. We find support for this hypothesis through an empirical test on a panel of 61 SRI funds from 1972 to 2000. The results show that as the number of social screens used by an SRI fund increases, financial returns decline at first, but then rebound as the number of screens reaches a maximum. That is, we find a curvilinear relationship, suggesting that two long-competing viewpoints may be complementary. Furthermore, we find that financial performance varies with the types of social screens used. Community relations screening increased financial performance, but environmental and labor relations screening decreased financial performance. Based on our results, we suggest that literatures addressing the link between financial and social performance move toward in-depth examination of the merits of different social screening strategies, and away from the continuing debate on the financial merits of either being socially responsible or not.
Despite the central role of primary care in improving health system performance, there are little recent data on how use of primary care and specialists has evolved over time and its implications for ...the range of care coordination needed in primary care.
To describe trends in outpatient care delivery and the implications for primary care provider (PCP) care coordination.
Descriptive, repeated, cross-sectional study using Medicare claims from 2000 to 2019, with direct standardization used to control for changes in beneficiary characteristics over time.
Traditional fee-for-service Medicare.
20% sample of Medicare beneficiaries.
Annual counts of outpatient visits and procedures, the number of distinct physicians seen, and the number of other physicians seen by a PCP's assigned Medicare patients.
The proportion of Medicare beneficiaries with any PCP visit annually only slightly increased from 61.2% in 2000 to 65.7% in 2019. The mean annual number of primary care office visits per beneficiary also changed little from 2000 to 2019 (2.99 to 3.00), although the mean number of PCPs seen increased from 0.89 to 1.21 (36.0% increase). In contrast, the mean annual number of visits to specialists increased 20% from 4.05 to 4.87, whereas the mean number of unique specialists seen increased 34.2% from 1.63 to 2.18. The proportion of beneficiaries seeing 5 or more physicians annually increased from 17.5% to 30.1%. In 2000, a PCP's Medicare patient panel saw a median of 52 other physicians (interquartile range, 23 to 87), increasing to 95 (interquartile range, 40 to 164) in 2019.
Data were limited to Medicare beneficiaries and, because of the use of a 20% sample, may underestimate the number of other physicians seen across a PCP's entire panel.
Outpatient care for Medicare beneficiaries has shifted toward more specialist care received from more physicians without increased primary care contact. This represents a substantial expansion of the coordination burden faced by PCPs.
National Institute on Aging.
Multiple Sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system (CNS). There is currently no single definitive test for MS. Circulating exosomes represent ...promising candidate biomarkers for a host of human diseases. Exosomes contain RNA, DNA, and proteins, can cross the blood-brain barrier, and are secreted from almost all cell types including cells of the CNS. We hypothesized that serum exosomal miRNAs could present a useful blood-based assay for MS disease detection and monitoring. Exosome-associated microRNAs in serum samples from MS patients (n = 25) and matched healthy controls (n = 11) were profiled using small RNA next generation sequencing. We identified differentially expressed exosomal miRNAs in both relapsing-remitting MS (RRMS) (miR-15b-5p, miR-451a, miR-30b-5p, miR-342-3p) and progressive MS patient sera (miR-127-3p, miR-370-3p, miR-409-3p, miR-432-5p) in relation to controls. Critically, we identified a group of nine miRNAs (miR-15b-5p, miR-23a-3p, miR-223-3p, miR-374a-5p, miR-30b-5p, miR-433-3p, miR-485-3p, miR-342-3p, miR-432-5p) that distinguished relapsing-remitting from progressive disease. Eight out of nine miRNAs were validated in an independent group (n = 11) of progressive MS cases. This is the first demonstration that microRNAs associated with circulating exosomes are informative biomarkers not only for the diagnosis of MS, but in predicting disease subtype with a high degree of accuracy.
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