Cyril F. Chang

A Methodology for Measuring the Financial Vulnerability of Charitable Nonprofit Organizations

This article defines a charitable nonprofit organization as financially vulnerable if it is likely to cut service offerings immediately when a financial shock occurs. It discusses why the vulnerability of the nonprofit sector is of interest to researchers, explores the destabilizing role of third-party finance, considers the reasons for the lack of research on vulnerability, and presents a conceptual framework for identifying finan cially vulnerable nonprofits. Four vulnerability criteria are defined and applied to a 1983 national sample of tax returns filed by 4,730 U.S. charitable nonprofits. The financial data of at-risk organizations are then analyzed to discern the characteristics of vulnerable and other nonprofit organizations.

Impact of adherence to interferons in the treatment of multiple sclerosis: a non-experimental, retrospective, cohort study.

AbstractBackground: Relapsing-remitting multiple sclerosis (RRMS) is a chronic disease affecting about 400 000 people in the US characterized by increasing patient disability and burden on society. While there is no cure for multiple sclerosis (MS), pharmaceutical treatments exist that can limit the number of relapses a patient experiences, and slow disease progression. One such class of agents used to treat RRMS are the interferons: interferon-β-1a (Rebif® and Avonex®) and interferon-β-1b (Betaseron® and Extavia®). Patients must take these injectable medications regularly to achieve the optimal outcomes. However, patient issues and potential adverse effects of the medication may prevent the patient from taking the medication as directed and lower adherence. To date, limited evidence exists regarding the effect of patient adherence to interferon-β therapies on clinical and economic outcomes. Objective: The purpose of this study was to explore the impact of patient adherence to interferon-β therapy on MS relapse rates and healthcare resource utilization. Methods: Using a non-experimental, retrospective cohort design, a sample population (n= 1606) was drawn from patients identified in a database that includes both pharmacy and medical claims data. The study population was separated into two groups based on a measure of medication possession ratio (MPR)-adherent and non-adherent patients, and adherence was defined as MPR ≥85% in a given year during the study period (2006–8). Key outcome variables included MS relapses and healthcare resource utilization. Data were analysed using parametric and non-parametric statistics, and regression modeling. Results: During the study period, the average MPR for all patients on interferon-β therapy varied from 72% to 76%. Only 27–41% of patients in each year were considered adherent (i.e. MPR ≥85%) and only 4% of patients had an MPR of ≥85% throughout the 3-year study period (2006–8). Patients who were adherent tended to have a lower risk of relapses over 3 years than non-adherent patients. A significantly lower risk of relapses was found in 2006 (risk ratio [RR] 0.89; 95% CI 0.81, 0.97). Furthermore, an increasingly larger effect emerged between adherence and relapses when comparing adherent patients (MPR ≥85%) with subgroups of non-adherent patients (<80%, <75%, <70%, <65% and <60%). The impact of adherence on emergency room (ER) visits also tended to suggest a lower risk during 2006, 2007 and 2006–8. During 2008, the risk for an ER visit was significantly lower for patients adherent in 2007 (RR 0.78; 95% CI 0.61, 0.99). Inpatient admissions followed the ER trends, as patients considered adherent in 2006 and 2007 tended to have a lower risk over 3 years. This result was significant for patients adherent in 2007 (RR 0.79; 95% CI 0.65, 0.98). Conclusion: The findings of low patient adherence and the impact of adherence on relapses and healthcare resource utilization strongly suggest opportunities to reduce healthcare resource utilization and healthcare costs among RRMS patients taking interferon-β therapy. Efforts should be undertaken to understand and improve medication-taking behaviour in this population so as to minimize the negative impacts of RRMS on patients while reducing unnecessary direct and indirect costs to treat disease exacerbations.

The Cost-Effectiveness of a Behavior Intervention with Caregivers of Patients with Alzheimer's Disease

OBJECTIVES: To examine the cost‐effectiveness of a randomized, clinical trial of a home‐based intervention for caregivers of people with dementia.

Revenue diversification among non-profits

Although the non-profit literature has grown substantially, the issue of how revenue diversification affects non-profits has not been fully explored. This paper presents several disciplinary perspectives regarding the financing of non-profits, what determines their ability to diversify, and the consequent effects on their behaviour. It first develops an index for measuring revenue diversification and applies it to a national sample of charitable non-profits. The results indicate that, while the perception that most non-profits rely on a single revenue source is exaggerated, the institutions in our sample have somewhat concentrated revenue. Our findings also suggest that the activity of a non-profit and the proportion of its expenditures that it devotes to fund-raising affect its ability to diversify its revenues concentration. While a number of anomalies exist, the weight of our evidence suggests that diversified revenue sources are more likely to be associated with a strong financial position than are concentrated revenue sources. Researchers interested in studying the life-cycle of non-profits, the factors that give rise to stability and growth, and the constraints on non-profit behaviour would do well to consider the diversification index presented in this paper.

The association of smoking and the cost of military training

OBJECTIVE To determine if premature discharge from the US Air Force was associated with the smoking status of recruits. DESIGN AND SETTING A total of 29 044 US Air Force personnel recruited from August 1995 to August 1996 were administered baseline behavioural risk assessment surveys during basic military training. They were tracked over a 12 month period to determine those who were prematurely discharged. MAIN OUTCOME MEASURES Excess training costs as a result of premature discharge. RESULTS In this 12 month period, 14.0% of those entering the US Air Force were discharged at a one year follow up. In both univariate and multivariate models, the best single predictor of early discharge was smoking status. Overall, 11.8% of non-smokers versus 19.4% of smokers were prematurely discharged (relative risk 1.795). CONCLUSIONS Using US Department of Defense data on the cost of military training, recruits who smoke in the US Air Force are associated with

Nonprofit equity: A behavioral model and its policy implications

18 million per year in excess training costs. Applied to all service branches, smoking status, which represents a constellation of underlying behaviours and attitudes that can contribute to early discharge, is associated with over

Impact of High-Deductible Health Plans on Health Care Utilization and Costs

130 million per year in excess training costs.

Informal caregivers' leisure time and stress

This article assumes that nonprofit decisionmakers have an incentive to earn and accumulate surpluses, and it suggests six reasons for this being the case. Based on the assumption that both the program outputs and the equity of a nonprofit yield satisfaction to its decisionmakers, a behavioral model is developed. This is used to derive a demand function for equity, which is then applied to a national sample of 6168 charitable nonprofits drawn by the Internal Revenue Service for the 1985 taxable year. The results substantiate the hypothesis that nonprofit decisionmakers consciously plan to increase their organizations equity. Currently, evidence of continued equity buildup is not sufficient to call into question a nonprofits exempt status, because federal tax laws assume that surplus accumulations will ultimately be used in support of program mission. However, equity accumulation can become excessive. We present several criteria to define excessive equity accumulation and discuss why large equity accumulations may not be in the best interest of society.

Cost‐effectiveness of post‐transplantation quality of life intervention among kidney recipients

BACKGROUND High-deductible health plans (HDHPs) are of high interest to employers, policy makers, and insurers because of potential benefits and risks of this fundamentally new coverage model. OBJECTIVE To investigate the impact of HDHPs on health care utilization and costs in a heterogeneous group of enrollees from a variety of individual and employer-based health plans. DATA Claims and member data from a major insurer and zip code-level census data. STUDY DESIGN Retrospective difference-in-differences analyses were used to examine the impact of HDHP plans. This analytical approach compared changes in utilization and expenditures over time (2007 versus 2005) across the two comparison groups (HDHP switchers versus matched PPO controls). RESULTS In two-part models, HDHP enrollment was associated with reduced emergency room use, increases in prescription medication use, and no change in overall outpatient expenditures. The impact of HDHPs on utilization differed by subgroup. Chronically ill enrollees and those who clearly had a choice of plans were more likely to increase utilization in specific categories after switching to an HDHP plan. CONCLUSIONS Whether HDHPs are associated with lower costs is far from settled. Various subgroups of enrollees may choose HDHPs for different reasons and react differently to plan incentives.

Potentially Avoidable Pediatric Hospitalizations as Defined by the Agency for Healthcare Research and Quality: What Do They Tell Us About Disparities in Child Health?

This article explores the disruption informal caregiving creates in the caregivers family life and the relationship between leisure and stress caused by caregiving. The study finds that the caregiving setting, caregivers sociodemographic characteristics, and economic variables (i.e., wage rate, nonwage income, and Medicaid coverage) significantly affect the caregivers leisure. Additionally, reducing leisure leads to emotional and physical stress and less satisfaction with life overall. The article concludes with implications for public policy.