There is strong evidence on how Medicare Part D and the donut hole coverage gap affect utilization and OOP costs, but weak evidence on how effects vary among dual-eligibles or across diseases. Findings suggest that the Affordable Care Act's provisions to expand coverage and reduce the donut hole should improve patient outcomes.

“Internal controls” refer to organizational rules and procedures used to safeguard assets and to detect fraud, waste, and abuse. This study examines the relationship between internal control deficiencies and municipal bond borrowing costs. The most severe form of internal control deficiencies (i.e., material weaknesses) is associated with higher borrowing costs for municipal bonds, between 10 and 18 basis points. Credit ratings mediate some of the effect of material weaknesses in internal controls but the indirect effect is relatively small. The effect of internal control deficiencies on borrowing costs was consistent in the time period before and after the financial crisis.

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Many nonprofits are multi‐service organizations that provide a range of services. However, how nonprofits manage their service portfolios has not received much scholarly attention in nonprofit management research. In this research note, informed by studies on product diversification in strategic management research in the business management literature, we explore the effect of a nonprofit's service diversification on its service costs, using nonprofit hospitals as an empirical context. Through a longitudinal study of U.S. nonprofit acute care hospitals, we find that a nonprofit hospital's level of service diversification is associated with a decrease in its average service costs. Further, both related diversification and unrelated diversification are associated with a decrease in average service costs, but the association of related diversification is greater. This research note informs an understudied line of inquiry in nonprofit management research and calls for more research attention to nonprofits' service portfolios.

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