Sean Nicholson

The assessment of chronic health conditions on work performance, absence, and total economic impact for employers.

Objective: The objective of this study was to determine the prevalence and estimate total costs for chronic health conditions in the U.S. workforce for the Dow Chemical Company (Dow). Methods: Using the Stanford Presenteeism Scale, information was collected from workers at five locations on work impairment and absenteeism based on self-reported “primary” chronic health conditions. Survey data were merged with employee demographics, medical and pharmaceutical claims, smoking status, biometric health risk factors, payroll records, and job type. Results: Almost 65% of respondents reported having one or more of the surveyed chronic conditions. The most common were allergies, arthritis/joint pain or stiffness, and back or neck disorders. The associated absenteeism by chronic condition ranged from 0.9 to 5.9 hours in a 4-week period, and on-the-job work impairment ranged from a 17.8% to 36.4% decrement in ability to function at work. The presence of a chronic condition was the most important determinant of the reported levels of work impairment and absence after adjusting for other factors (P < 0.000). The total cost of chronic conditions was estimated to be 10.7% of the total labor costs for Dow in the United States; 6.8% was attributable to work impairment alone. Conclusion: For all chronic conditions studied, the cost associated with performance based work loss or “presenteeism” greatly exceeded the combined costs of absenteeism and medical treatment combined.

Biotech-Pharmaceutical Alliances as a Signal of Asset and Firm Quality

Biotechnology companies rely heavily on alliances with pharmaceutical companies to finance their research and development expenditures, and pharmaceutical firms rely heavily on alliances to supplement their internal research and development. Previous studies suggest that asymmetric information may lead to inefficient contracting. We examine the determinants of biotech-pharmaceutical deal prices to determine whether the market for deals between biotech and pharmaceutical companies functions as a well-informed market or whether it is characterized by asymmetric information. We find that inexperienced biotech companies receive substantially discounted payments when signing their first deal. Drugs that are jointly developed are more likely to advance in clinical trials than drugs that are developed by a single company, so the first-deal discount is not consistent with the post-deal performance of these drugs. We also find that biotech companies that sign deals receive substantially higher valuations from venture capitalists and from the public equity market, which implies that the discounts are rational; a biotechnology company that is developing its first product benefits from forming an alliance with a pharmaceutical company because it sends a positive signal to prospective investors.

Reliability and validity of the Stanford Presenteeism Scale.

Objective: This study reports the reliability and validity of the 13-item Stanford Presenteeism Scale (SPS). The SPS differs from similar scales by focusing on knowledge-based and production-based workers. Methods: Data were obtained from administrative and medical claims databases and from a survey that incorporated the SPS, SF-36, and the Work Limitations Questionnaire. Results: Sixty-three percent (7797) of employees responded. Cronbachs alpha (0.83) indicates adequate reliability. Factor analysis identified two underlying factors, “completing work” and “avoiding distraction.” Knowledge-based workers load on “completing work” (&agr; = 0.97), whereas production-based workers load on “avoiding distraction” (&agr; = 0.98). There were significant and positive relationships between the SPS, SF-36, and Work Limitations Questionnaire. Conclusions: The SPS demonstrates a high degree of reliability and validity and may be ideal for employers who seek a single scale to measure health-related productivity in a diverse employee population.

What Does It Cost Physician Practices to Interact with Health Insurance Plans

Physicians have long expressed dissatisfaction with the time they and their staffs spend interacting with health plans. However, little information exists about the extent of these interactions. We conducted a national survey on this subject of physicians and practice administrators. Physicians reported spending three hours weekly interacting with plans; nursing and clerical staff spent much larger amounts of time. When time is converted to dollars, we estimate that the national time cost to practices of interactions with plans is at least

Investing in healthy human capital

23 billion to

Comorbidities and personal burden of urgency urinary incontinence: a systematic review.

31 billion each year.

Autism Prevalence and Precipitation Rates in California, Oregon, and Washington Counties

Although the value of human capital is not captured on company balance sheets, it may account for about half of the gap between a company’s market value and book value. Yet, many companies do not focus comparable scrutiny on human capital management as compared with other large assets, nor do they systematically measure its output (ie, productivity). Methods are emerging to enable employers to assess productivity losses, including absenteeism and presenteeism, and to understand the associated costs (ie, direct medical costs, total productivity loss). This will permit employers to assess the value of programs to enhance health and productivity. We contend that the effective workforce is probably decreased by 5% to 10% because of health problems. We believe that employers who increase their investments in healthy human capital now will emerge tomorrow as the companies leading the gains in US productivity.

US Physician Practices Versus Canadians: Spending Nearly Four Times As Much Money Interacting With Payers

Studies on the burden and comorbidities associated with urgency urinary incontinence (UUI) are difficult to compare, partly because of the evolution of definitions for lower urinary tract symptoms and the various instruments used to assess health‐related quality of life (HRQL). This article summarises published evidence on comorbidities and the personal burden associated specifically with UUI to provide clinicians with a clear perspective on the impact of UUI on patients.

Financing of U.S. biomedical research and new drug approvals across therapeutic areas.

OBJECTIVE To investigate empirically the possibility of an environmental trigger for autism among genetically vulnerable children that is positively associated with precipitation. DESIGN We used regression analysis to investigate autism prevalence rates and counts first in relation to mean annual county-level precipitation and then to the amount of precipitation a birth cohort was exposed to when younger than 3 years, controlling for time trend, population size, per capita income, and demographic characteristics. In some models, we included county fixed-effects rather than a full set of covariates. SETTING Counties in California, Oregon, and Washington. PARTICIPANTS Children born in California, Oregon, and Washington between 1987 and 1999. Main Exposure County-level precipitation. MAIN OUTCOME MEASURES County-level autism prevalence rates and counts. RESULTS County-level autism prevalence rates and counts among school-aged children were positively associated with a countys mean annual precipitation. Also, the amount of precipitation a birth cohort was exposed to when younger than 3 years was positively associated with subsequent autism prevalence rates and counts in Oregon counties and California counties with a regional developmental services center. CONCLUSIONS These results are consistent with the existence of an environmental trigger for autism among genetically vulnerable children that is positively associated with precipitation. Further studies focused on establishing whether such a trigger exists and identifying the specific trigger are warranted.

Improvements in US maternal obstetrical outcomes from 1992 to 2006.

Physician practices, especially the small practices with just one or two physicians that are common in the United States, incur substantial costs in time and labor interacting with multiple insurance plans about claims, coverage, and billing for patient care and prescription drugs. We surveyed physicians and administrators in the province of Ontario, Canada, about time spent interacting with payers and compared the results with a national companion survey in the United States. We estimated physician practices in Ontario spent