Holding Hospitals Accountable? Evidence on the Effectiveness of Minimum Charity Care Provision Laws

What can governments do to encourage nonprofit hospitals to provide greater benefits to their communities? Recent efforts by the federal and state governments seek to hold hospitals accountable for community health, in part by incentivizing charity care provision. Laws that set benchmarks for charity care spending are increasingly used, but their efficacy is uncertain. In this study, we examine the extent to which Illinois’ minimum charity care provision (MCCP) law increases nonprofit hospital charity care. Importantly, we differentiate between responses for hospitals required to provide minimal charitable spending (nonprofits) and those that are not (for-profit and public). We use detailed panel (2009-2015) data from Illinois\u27 Annual Hospital Questionnaire and county-level data from the American Community Survey. We exploit a discrete change in charitable care requirements for nonprofit hospitals to identify the effect of the MCCP law on charity care, controlling for hospital characteristics, county demographics, and year and county (or hospital) fixed effects. Employing a differences-in-differences model, we find no evidence that the MCCP law increases charity care on average. Instead, we find some evidence that the law’s effects vary by how much charity care hospitals provided previously – charity care increases for those providing lower levels at baseline, narrowing the gap in charity care provision with those that provide high levels at baseline. The results suggest that setting low benchmarks does not create sufficient incentives for nonprofit hospitals to provide greater charity care on average, but instead may narrow the gap between high and low charity care hospitals

Do Minimum Charity Care Provision Requirements Increase Provision of Charity Care in Nonprofit Hospitals?

Nonprofit hospitals receive significant federal, state, and local tax exemptions, partly based on the rationale that nonprofit hospitals provide public goods and services. Through Minimum Charity Care Provision (MCCP) requirements, nonprofit hospitals are required to spend a certain percentage of their revenues on charity care. However, it is not clear whether these requirements increase spending on charity care. This brief summarizes findings from research examining the differences in provisions of charity care across different hospital market sectors – non-profit, for-profit, and government. Findings suggest that MCCP requirements for nonprofit hospitals do not lead to more charity care. If anything, targeting policies that use external incentives may have crowded out some organizations’ internal motivations to provide public goods and services

Impact and cost-effectiveness of snail control to achieve disease control targets for schistosomiasis

Schistosomiasis is a parasitic disease that affects over 240 million people globally. To improve population-level disease control, there is growing interest in adding chemical-based snail control interventions to interrupt the lifecycle of Schistosoma in its snail host to reduce parasite transmission. However, this approach is not widely implemented, and given environmental concerns, the optimal conditions for when snail control is appropriate are unclear. We assessed the potential impact and cost-effectiveness of various snail control strategies. We extended previously published dynamic, age-structured transmission and cost-effectiveness models to simulate mass drug administration (MDA) and focal snail control interventions against Schistosoma haematobium across a range of low-prevalence (5-20%) and high-prevalence (25-50%) rural Kenyan communities. We simulated strategies over a 10-year period of MDA targeting school children or entire communities, snail control, and combined strategies. We measured incremental cost-effectiveness in 2016 US dollars per disability-adjusted life year and defined a strategy as optimally cost-effective when maximizing health gains (averted disability-adjusted life years) with an incremental cost-effectiveness below a Kenya-specific economic threshold. In both low- and high-prevalence settings, community-wide MDA with additional snail control reduced total disability by an additional 40% compared with school-based MDA alone. The optimally cost-effective scenario included the addition of snail control to MDA in over 95% of simulations. These results support inclusion of snail control in global guidelines and national schistosomiasis control strategies for optimal disease control, especially in settings with high prevalence, "hot spots" of transmission, and noncompliance to MDA

Factor Structure of the Neurocognitive Tests: An Application of the Confirmative Factor Analysis in Stabilized Schizophrenia Patients

The purpose of the present study was to identify the factor structure of neurocognitive tests used on schizophrenia patients by using the confirmative factor analysis, and to assess the factor score differences of schizophrenia patients and healthy controls. Comprehensive neurocognitive tests were administered to stabilized schizophrenia patients (N=114) and healthy controls (N=120). In the results of factor analyses on patients, the multifactorial-6-factor model, which included the speed of processing, working memory, verbal learning and memory, visual learning and memory, attention/vigilance, and reasoning/problem solving as suggested by the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS), showed the better goodness of fit than any of the other models tested. And assessing the group differences of factor scores, we found the patients performed worse than the controls in all factors, but the result showed meaningful variations of impairments across the cognitive factors. Our study identifies the six major domains with multifactorial structure of cognitive abilities in schizophrenia patients and confirms the distinctive impairment patterns of each cognitive domain. These results may have utility in better understanding the pathology of schizophrenia as well as in genetic studies

MSCs derived from iPSCs with a modified protocol are tumor-tropic but have much less potential to promote tumors than bone marrow MSCs

Mesenchymal stem or stromal cells (MSCs) have many potential therapeutic applications including therapies for cancers and tissue damages caused by cancers or radical cancer treatments. However, tissue-derived MSCs such as bone marrow MSCs (BM-MSCs) may promote cancer progression and have considerable donor variations and limited expandability. These issues hinder the potential applications of MSCs, especially those in cancer patients. To circumvent these issues, we derived MSCs from transgene-free human induced pluripotent stem cells (iPSCs) efficiently with a modified protocol that eliminated the need of flow cytometric sorting. Our iPSC-derived MSCs were readily expandable, but still underwent senescence after prolonged culture and did not form teratomas. These iPSC-derived MSCs homed to cancers with efficiencies similar to BM-MSCs but were much less prone than BM-MSCs to promote the epithelial–mesenchymal transition, invasion, stemness, and growth of cancer cells. The observations were probably explained by the much lower expression of receptors for interleukin-1 and TGFβ, downstream protumor factors, and hyaluronan and its cofactor TSG6, which all contribute to the protumor effects of BM-MSCs. The data suggest that iPSC-derived MSCs prepared with the modified protocol are a safer and better alternative to BM-MSCs for therapeutic applications in cancer patients. The protocol is scalable and can be used to prepare the large number of cells required for “off-the-shelf” therapies and bioengineering applications

Cannabinoid Agonists Inhibit Neuropathic Pain Induced by Brachial Plexus Avulsion in Mice by Affecting Glial Cells and MAP Kinases

Many studies have shown the antinociceptive effects of cannabinoid (CB) agonists in different models of pain. Herein, we have investigated their relevance in neuropathic pain induced by brachial plexus avulsion (BPA) in mice.Mice underwent BPA or sham surgery. The mRNA levels and protein expression of CB(1) and CB(2) receptors were assessed by RT-PCR and immunohistochemistry, respectively. The activation of glial cells, MAP kinases and transcription factors were evaluated by immunohistochemistry. The antinociceptive properties induced by cannabinoid agonists were assessed on the 5(th) and 30(th) days after surgery. We observed a marked increase in CB(1) and CB(2) receptor mRNA and protein expression in the spinal cord and dorsal root ganglion, either at the 5(th) or 30(th) day after surgery. BPA also induced a marked activation of p38 and JNK MAP kinases (on the 30(th) day), glial cells, such as microglia and astrocytes, and the transcription factors CREB and NF-κB (at the 5(th) and 30(th) days) in the spinal cord. Systemic treatment with cannabinoid agonists reduced mechanical allodynia on both the 5(th) and 30(th) days after surgery, but the greatest results were observed by using central routes of administration, especially at the 30(th) day. Treatment with WIN 55,212-2 prevented the activation of both glial cells and MAP kinases, associated with an enhancement of CREB and NF-κB activation.Our results indicate a relevant role for cannabinoid agonists in BPA, reinforcing their potential therapeutic relevance for the management of chronic pain states

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Board Members That Tie: Three Essays on Antecedents and Consequences of Nonprofit Board Interlock

In this dissertation, I bring attention to an understudied question in nonprofit board governance research: board members who link organizations through their board affiliations. Specifically, I focus on board interlock, a phenomenon that occurs between organizations when they are connected via overlapping board members. Board interlock is an important area of research in governance study because of its potential to impact governance outcomes through the flow of information, resources, and status. Despite its potential significance, the role of overlapping board members has not been explicitly discussed in the nonprofit board governance literature.This dissertation consists of three essays that address the issues of board interlock in nonprofit board governance contexts. The goal of this dissertation is to investigate the antecedents of board interlock and the outcomes that are critical to improving board governance accountability. Specifically, it addresses three questions: (1) What are the theoretical orientations and the empirical evidence of board interlock? (2) What are the underlying mechanisms that predict board interlock formation? (3) Does board interlock facilitate the adoption of board governance policies? Each question is addressed in a separate chapter of this dissertation (Chapter 2, 3, 4). In addition to the three essays that address these questions, the dissertation begins with an introduction chapter (Chapter 1) that presents a theoretical framework for the three essays and closes with a conclusion chapter (Chapter 5) that discusses implications of findings from the three essays. The first essay, presented in Chapter 2, provides a synthesis of the literature on antecedents and consequences of board interlock in for-profit and nonprofit context. I integrate research on what we know about board interlock and further propose areas where more research is needed. Specifically, I focus on agenda such as why interorganizational networks occur through overlapping board members and how they influence a variety of governance outcomes. A review suggests scholars have developed three different research traditions in theorizing antecedents of board interlock, including interorganizational perspective, intra-class perspective, and recruitment perspective. Furthermore, a review suggests board interlock influences important board governance outcomes, such as management strategies and practices, financial performance, and acquisition of resources. Finally, I propose suggestions for future research based on identified gaps in the literature. This chapter contributes to scholarship by bringing attention to board interlock through the integration of current literature and making suggestions for future research. The second essay, presented in Chapter 3, investigates mechanisms of board interlock formation. Specifically, I test predictors of board interlock using various characteristics at multiple levels, including organization-level, dyad-level, and structural-level. In doing so, I use a balanced panel of nonprofits in three Central New York cities from 1998 to 2014. I employ a temporal exponential random graph model (TERGM) to assess and control for the interdependent nature of the longitudinal network. In brief, I find that network structural characteristics, such as preferential attachment (e.g., actors\u27 preference to connect with popular actors that are already well-connected) and transitivity (e.g., actors\u27 preference to connect with others with whom they have mutual relationships), are strong predictors of board interlock. These findings inform nonprofit managers about how to bridge to an existing network by recruiting well-connected individuals to the board. This chapter makes a contribution to literature by providing the first empirical examination of nonprofit board linkage in a longitudinal context. The third essay, presented in Chapter 4, examines the relationship between board governance policies, board interlock network characteristics, and institutional pressures. Drawing on network perspectives and institutional theory, this study explores how network characteristics (network presence, network position) and institutional characteristics (external funding, professionalization) are associated with the more extensive use of board governance policies. In doing so, I use a longitudinal panel of nonprofits in three Central New York cities from 2008 to 2014. The analysis from ordinary least squares regression model indicates positive effects of network presence, network position, and professionalization on board governance policy adoption. Results provide useful insights that nonprofit managers can use to encourage the adoption of board policies designed for enhanced governance. This chapter builds on literature through an investigation of board governance policy using a combined theoretical framework to provide a more clear elaboration on network mechanisms and institutional contexts that influence board decision-making over governing practices