Schizophrenia is a chronic and debilitating disease that affects approximately one percent of the US population and exerts a disproportionately high financial burden on the society. The objective of this study was to estimate the direct and indirect costs of schizophrenia among community-dwelling US residents and identify patient characteristics associated with high schizophrenia-related direct costs. Patients with a diagnosis of schizophrenia (ICD-9 code 295) or other non-organic psychoses (ICD-9 code 298) between January 1, 2005 and December 31, 2008 were identified from the Medical Expenditure Panel Survey (MEPS). To estimate direct costs, the following cost categories were identified: inpatient hospitalizations, outpatient visits, emergency department visits, office-based physician visits, home healthcare visits, and prescription medications. The following cost categories were identified to estimate indirect costs: caregivers’ costs and cost of lost productivity due to missed work days, reduced employment, and suicide. Logistic regression was used to compare patients belonging to the high-cost group and to the low-cost group. All analyses were carried out using SAS version 9.2 (SAS Institute Inc., Cary, North Carolina). The weighted average number of patients with schizophrenia identified for each year was 757,893. The annual direct and indirect costs were estimated at $3.96 billion and $15.35 billion, respectively. The mean annual direct medical schizophrenia-related cost per patient was $5,586. For each one-year increase in age, patients were 5.7% less likely to be in the high-cost group. Patients with a spouse were 77.7% less likely than patients without a spouse to be in the high-cost group. Healthcare providers and policymakers can use these cost estimates to better understand the economic burden of schizophrenia and identify services and subgroups of patients associated with the highest costs. This would help in the provision of healthcare services to patients with schizophrenia and in the optimization of patient outcomes. / text

The economic burden of prescription opioid abuse is believed to be substantial, however it is not known whether total and per-event hospital (ED and inpatient) costs associated with opioid abuse or misuse differ by insurance status. We also wanted identify predictors of charges. We used the 2006, 2007, and 2008 files of the Healthcare Cost and Utilization Project's Nationwide Emergency Departments Sample (HCUP-NEDS) to identify events and charges assigned opioid abuse, dependence, or poisoning ICD-9-CM diagnosis codes (304.0X, 304.7X, 305.5X, 965.00, 965.02, 965.09). Using methods to account for the sampling design of the NEDS, we estimated national total and mean charges -- overall and by insurance status (Medicare, Medicaid, private insurance, or self-payment). Charges were adjusted using the 2010 Medical Consumer Price Hospital Services index. We used a log-linked gamma regression model to assess potential predictors of charges. The number of opioid abuse-related events was 515,896; 506,837; and 564,559 for 2006, 2007, and 2008, respectively. Approximately 55% visits in each year resulted in inpatient admissions. Total charges billed for opioid abuse-related events were US$9.8; 9.6; and 9.5 billion for 2006, 2007, and 2008, respectively. Medicaid patients had the highest charges in each years followed by Medicare patients. Approximately 93% of total charges were due to subsequent inpatient admission. Overall unadjusted mean charges were $20,651; $20,373; and $18,384 for 2006, 2007, and 2008, respectively. Compared to events paid for by private insurance, Medicaid-covered events had significantly higher mean charges, and self-paid events had significantly lower charges (p < 0.001 for each year). Inpatient admissions resulted in significantly higher mean charges compared to treat-and-release ED visits (p < 0.001 for each year). We found similar results after adjusting for clinical and demographic factors. Age, number of diagnoses, inpatient admission, presence of cardiac tissue disorders, respiratory infections or failure, gastrointestinal hemorrhage, and acute pancreatitis were significantly positively associated with total charges billed (p < 0.001 for all). This study helps in determining differences in hospital costs of opioid abusers by insurance status and in identifying potential predictors of such costs, resulting in better understanding the economic burden of opioid abuse on the healthcare system. / text

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In this paper, I will explore the hidden costs and risks of IT offshoring and how to manage those costs so that realistic expectations can be set. Establishing a baseline of such expectations will help companies understand and follow best practices in planning, executing, and managing the full offshore lifecycle. While details will vary with each project, offshore vendor, and company, these costs are seen across most offshore ventures and, if understood, will help explain why so many offshoring attempts fail, help IT managers and decision makers anticipate potential problems, and help CIOs more accurately predict cost savings. / text

Creditor committees have been characterized as the “watchdogs” of the bankruptcy reorganization process of large companies. Not only do creditor committees have broad statutory powers to oversee the debtor and its management, but they also play a key role in preventing abuses by professionals and other participants in the often complex corporate bankruptcy process. Furthermore, recent research has provided evidence of abusive fee practices in large corporate bankruptcy cases which point to failures in the oversight mechanisms of the process. This dissertation examines the role of creditor committees in the bankruptcy process and in selected outcomes of this process, with a focus on fees paid to bankruptcy professionals. Based on a unique data set comprised of 1,037 bankruptcy cases over the period 1999-2008, the research first examines committee characteristics along three separate dimensions of analysis: individual characteristics of members serving on committees; changes of committee composition over the life of the committees; and social characteristics of committee interlocks. The Calpine bankruptcy case is used throughout this dissertation to illustrate the research. This research finds a dense network of interlocks that dominates large cases, with financial industry members being significantly more likely to serve on multiple committees than non-financial industry members. Analysis of the data shows that over 50% of creditor committees are never amended and there are no systematic recompositions of the remaining committees. A test of small-world topology in the member creditor committee network fails to show a strong small-world structure in the member social network once it is corrected for imposed network topology. This dissertation then employs econometric models to evaluate whether creditor committee variables help explain professional fees in large bankruptcy cases. It finds a statistically significant and positive relationship between the social centrality measure of the creditor committee case and the professional fees paid. This finding points to potential conflicts of interest among the repeat creditor committee players and their constituents. The research fails to find a significant relationship between the presence of financial firms in creditors’ committees and professional fees paid in the case. The dissertation concludes with policy recommendations and suggestions for further research. / text

The purpose of this study was to estimate the marginal costs of instruction in several types of public colleges and universities in the United States. If marginal costs vary with enrollment size or differ from average costs, then inadvertent changes in the financial status of those institutions are likely to accompany changes in their enrollments, granted current funding patterns. Long-run total cost functions were developed within a microeconomic framework. The unit of analysis was the institution. A variety of additive and multiplicative functions were tested, as no particular functional form was assumed to be correct a priori. The dependent variable was instructional expenditures; the primary independent variables included lower, upper, and graduate division enrollments, while control variables included average faculty salary, a state price index, sponsored research expenditures per faculty, dummy variables for whether the institution is in a formula-funding state and whether it is a traditionally black institution, and a program vector consisting of the proportion of degrees earned in a representative set of curricular areas. The primary data source was the 1977-78 Higher Education General Information Survey published by the National Center for Higher Education Statistics. The cost functions were estimated using ordinary least-squares regression. Four types of institutions offering primarily a baccalaureate or higher degree and three types of two-year institutions were analyzed. The estimated marginal cost curves were interpreted as reflecting average institutional efficiency. Cost behavior differed considerably by type of institution and by student level with respect to the estimated marginal costs at mean enrollment and the variability of estimated marginal costs across the range of observed enrollments, i.e., the shape of the marginal cost curves. Overall, the results of the study support the concern that current funding patterns for public higher education, with their reliance on average costs, may yield other than intended results when enrollments change substantially; but this implied incongruence varied by institutional type and by student level within institutional types.

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The Canadian proceeds of crime provisions, Part XTJ.2 of the Criminal Code, are targeted at enterprises that are motivated by the desire to generate profit and accumulate wealth from criminal activity. The main purpose of Part XII.2 is to provide the police and prosecution with powerful new tools to attach the proceeds of crime, and the courts with the power to forfeit such proceeds. This thesis will examine how, in recognition of the procedural and substantive problems with this legislation and in contrast to American legislation, Parliament included numerous provisions to balance such extensive powers. The balancing mechanisms included a provision that allows reasonable legal fees to be paid out of seized or restrained property that is alleged to be proceeds and another that requires an in camera session to be held without the presence of the Attorney General, to determine the reasonableness of such fees. The Parliamentary record explicitly demonstrates that the balancing provisions were meant to ensure that the pre-trial restraint and potential forfeiture of property would withstand Charter challenges, especially with regard to an accused's rights to counsel, fair trial and full answer and defence. In this thesis I will analyze the complexities of proceeds litigation and demonstrate how this necessitates adequate legal representation to ensure that an accused's Charter rights are protected. This thesis explores in depth how Parliament recognized the need for balancing mechanisms that permit funds to be released for an accused to retain private counsel. However, these mechanisms have been significantly narrowed by subsequent judicial interpretation. A result of this line of authority is that defence work in the proceeds area has become very difficult. If reasonable legal fees are not taken from seized proceeds, provincial legal aid plans will have to provide for appropriate counsel. This may not be a realistic option given the funding of these plans and their stated objection to funding proceeds cases. Therefore, in this thesis I will argue that if private counsel must be retained the right to counsel could be effectively forfeited, unless a portion of the seized or restrained assets are released for reasonable legal fees. This thesis will attempt to provide a coherent basis for future interpretation of the Part XII.2 provisions that affect legal fees. The approach taken will incorporate the competing interests of accused persons and the State without undermining the objectives of the legislation. This thesis will focus on Canadian legislation and jurisprudence, but will also have a comparative component that examines how these issues have been dealt with in Australia, England and the United States.