The aim of this work was to carry out a cost evaluation of the home care programme for terminally ill cancer patients run by the Istituto Oncologico Romagnolo (I.O.R.) in the areas of Forlì, Cesena, Ravenna and Rimini (Romagna, Italy). To determine effective home care direct costs, we first selected 1 week of care as an observation unit. We then proceeded to assess the medical and nursing care units together with the clinical protocols administered for each patient. The Karnofsky Performance Status (KPS) was also assessed weekly. In this way, we calculated care costs for each patient and for each week as the sum of medical costs, nursing costs, treatment costs and other costs. A consecutive series of 574 patients were involved in the study from 1 April 1994 to 31 March 1995. A total of 5164 patient-weeks of care was provided, with an average cost per week of 177.6 Ecu. This weekly cost increased in the last 100 days of life (week -15 = 179.5 Ecu; week -8 = 188.3 Ecu; week -2 = 221.0 Ecu; P < 0.001). When single components were analysed in relation to total cost (treatment protocols, physician and nursing care) the increased global cost was found to be mainly attributable to the intensification in nursing care (21.8% of costs in week -15 vs 27.3% of costs in week -2). Examination of the relation between the cost of 1 week of care and KPS values clearly shows that healthcare costs increased as KPS decreased (from 152.2 Ecu with KPS > or = 60 to 292.6 Ecu with KPS < or = 20; P < 0.001). Home care costs were also seen to vary with some clinical characteristics and symptoms present when patients entered the study: asthenia, anorexia, nausea/vomiting, bedsores. Given the good results of home care for cancer patients in terms of quality of life, this method of cost accounting for home-care providers can help to monitor the rising cost of assistance and confirm the cost effectiveness of this type of care.

This research investigates what happens to sustainability disclosure in the light of an industrial disaster. Drawing from legitimacy theory, the disaster is treated as a moment of crisis, in which the relationship of trust between the company and its stakeholders suffers and has to be reconstructed to legitimise the company's operations once more. While past studies revealed an increase in corporate disclosure after a disaster, the authors' results highlight a different behaviour. The analysis focuses on six companies involved in industrial disasters with a global media coverage, before and after the event. The sample includes, among others, Tepco for the leakage of nuclear material from the Fukushima power plant and Carnival Cruise Corporation in relation to the sinking of the Costa Concordia. Findings obtained using text mining techniques suggest that there is a tendency to reduce the quantity of information provided in the year of the disaster, which represents a precise managerial strategy aiming to avoid further drops in corporate legitimacy.

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Abstract:Social Enterprise is increasingly becoming a pressing area of study in European faculties, and likewise, a broad range of literature has been produced on the various, relating arguments.One of the aspects least focused upon, however, regards the issue of governance; which is a fundamental aspect when defining a type of governing system that could lead to an improvement in the efficiency and effectiveness of social enterprises. The need to combine both social and economic aims in the decision making process also emphasizes the importance of stakeholder participation.Furthermore, seeing as how social enterprises work in an environment of high public involvement, whether it be with public entities or with the community as a whole, issues such as business administration and activity supervision, come to be of high importance. The production of social utility goods and/or services is directed toward a plurality of local actors, which are to be furthermore guaranteed a high level of accountability and transparency. This paper explores governance through an in-depth analysis and comparison of the legislation of eleven countries on social enterprise or social cooperatives

Direct mental health costs are concentrated among a small fraction of patients who receive intensive socio-rehabilitation in community services. One limitation includes the unavailability of hospital costs. Our methodology is replicable and useful for national and cross-national benchmarking.

The main aim of this paper is to analyse company sustainability disclosure in case of a legitimacy crisis. This work sets out to investigate how the negative externalities of an event reported widely in the media, such as the sinking of the Costa Concordia class cruise ship, have affected sustainability communication, for not only Carnival Corporation & PLC (the parent company of Costa) but also its most direct competitor Royal Caribbean Cruises Ltd. The paper relies on text analysis focusing on the sustainability reports of the two major companies (in terms of market share) in the cruise sector. Authors compared the reports of Carnival Corporation & PLC and its most direct competitor for a five-year period using text mining techniques. Results indicate that an event with social and environmental negative externalities, dominating international media and capable to bring discredit in the eyes of stakeholders, generates a change in the sustainability communication of both companies. Thus, repercussions are larger than one might suppose. Companies reduced the amount of information disclosed as a strategy to influence the perception of their audience, demonstrating that the provision of justifications, explanations and announcements of new sustainable policies (which increase the quantity of information) is not a predictable reaction. This paper undertakes empirical research on the sustainability reports of cruise line companies - which have been largely overlooked - and contributes to better understand company sustainability reporting praxis after an industrial disaster.

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Background and Objectives Many studies and systematic reviews have estimated the healthcare costs of diabetes using a cost-of-illness approach. However, in the studies based on this approach patients' heterogeneity is rarely taken into account. The aim of this study was to stratify patients with type 2 diabetes into homogeneous cost groups based on demographic and clinical characteristics. Methods We conducted a retrospective cost-of-illness study by linking individual data on health services utilization retrieved from the administrative databases of Emilia-Romagna Region (Italy). Direct medical costs (either all-cause or diabetesrelated) were calculated from the perspective of the regional health service, using tariffs for hospitalizations and outpatient services and the unit costs of prescriptions for drugs. The determinants of costs identified in a generalized linear regression model were used to characterize subgroups of patients with homogeneous costs in a classification and regression tree analysis. Results The study population consisted of a cohort of 101,334 patients with type 2 diabetes, followed up for 1 year, with a mean age of 70.9 years. Age, gender, complications, comorbidities and living area accounted significantly for cost variability. The classification tree identified ten patient subgroups with different costs, ranging from a median of €483 to €39,578. The two subgroups with highest costs comprised dialysis patients, and the largest subgroup (57.9%) comprised patients aged ≥ 65 years without renal, cardiovascular and cerebrovascular complications. Conclusions Classification of patients into homogeneous cost subgroups can be used to improve the management of, and budget allocation for, patients with type 2 diabetes.