Out-of-pocket spending and financial burden among low income adults after Medicaid expansions in the United States: quasi-experimental difference-in-difference study.

OBJECTIVE:To examine the association between expansion of the Medicaid program under the Affordable Care Act and changes in healthcare spending among low income adults during the first four years of the policy implementation (2014-17). DESIGN:Quasi-experimental difference-in-difference analysis to examine out-of-pocket spending and financial burden among low income adults after Medicaid expansions. SETTING:United States. PARTICIPANTS:A nationally representative sample of individuals aged 19-64 years, with family incomes below 138% of the federal poverty level, from the 2010-17 Medical Expenditure Panel Survey. MAIN OUTCOMES AND MEASURES:Four annual healthcare spending outcomes: out-of-pocket spending; premium contributions; out-of-pocket plus premium spending; and catastrophic financial burden (defined as out-of-pocket plus premium spending exceeding 40% of post-subsistence income). P values were adjusted for multiple comparisons. RESULTS:37 819 adults were included in the study. Healthcare spending did not change in the first two years, but Medicaid expansions were associated with lower out-of-pocket spending (adjusted percentage change -28.0% (95% confidence interval -38.4% to -15.8%); adjusted absolute change -122 (£93; €110); adjusted P<0.001), lower out-of-pocket plus premium spending (-29.0% (-40.5% to -15.3%); -442; adjusted P&lt;0.001), and lower probability of experiencing a catastrophic financial burden (adjusted percentage point change -4.7 (-7.9 to -1.4); adjusted P=0.01) in years three to four. No evidence was found to indicate that premium contributions changed after the Medicaid expansions. CONCLUSION:Medicaid expansions under the Affordable Care Act were associated with lower out-of-pocket spending and a lower likelihood of catastrophic financial burden for low income adults in the third and fourth years of the act's implementation. These findings suggest that the act has been successful nationally in improving financial risk protection against medical bills among low income adults

Supplying Innovation?: Investigating Impact of Suppliers on Innovation in IT Firms

Although IT has been widely recognized as one of the most important determinants of the innovation in firms,the determinants of innovation within IT firms are very poorly understood. Cooperation with various players is widely believed to be an important determinant of innovation productivity. These include suppliers, clients, competitors etc. Amongst these supplier is most intriguing more so because of its importance for manufacturing firms and almost a negligible presence in IT literature. We attempt to understand what impact a closer cooperation with suppliers has in innovation productivity in IT firms. Literature from traditional manufacturing firms’ domain indicates that suppliers are very integral to innovation processes at a firm. Our research drawing from data of Chinese firms finds that suppliers are indeed a very critical determinant of IT innovation as well. The results from this paper sheds considerable light on suppliers and their integral role for IT firms’ innovation development

Influencing the Influencers: Analyzing Impact of Prior Review Sentiments on Product Reviews

Extant research has widely studied the impact of online product review on sales and most studies have found a significant impact of these reviews as an e-WOM tool. Given the importance of the online reviews, we study a hitherto understudied area of antecedents of sentiments in user reviews. We assess the impact of contagion effect of past review sentiments on reviewers\u27 choice to write a review. We analyze the impact of emotional response of users while writing product reviews triggered by the appraisal response to prior online reviews. A short selection of reviews, which most e-commerce websites show, along with the numerical product rating (if any) could strongly bias the sentiments in a review being written under their influence. Through a mix of experimental methods and text analysis of online reviews, we find that review writers tend to veer towards extreme reviews in absence of any benchmark or prior review

Conflict and Development: A Headquarter Intervention View of IT Subsidiary Evolution

In this paper, we examine the impact that headquarter interventions have on how subsidiaries evolve in the Indian IT offshoring industry. We analyze how a subsidiary evolved in the presence of a rare phenomenon: a negative headquarter intervention. Such an evolution has nuances and theoretical implications that existing frameworks cannot fully explain. Although researchers have often studied the relationship between a subsidiary and its headquarters through a headquarter-intervention lens, they have not employed it to examine how subsidiaries evolve. In this paper, we present a generalized model of subsidiary evolution using three constructs: value potential, headquarter intervention, and headquarter control of the subsidiary. In line with our study’s exploratory nature, we conducted an in-depth case study of a multinational firm and its Indian subsidiary over several years. We found that, in the presence of high potential value in the subsidiary ecosystem, certain headquarter interventions can lead to a conflict between the headquarters and the subsidiary. If not aligned with the subsidiary’s interests and values, a headquarter intervention can negatively affect the subsidiary’s growth even if the headquarters has good intentions