Analysis of different public policies through simulation to increase total social utility in a healthcare system

Public and private hospitals are seen to co-exist in several countries and they have different levels of service, waiting times and prices. Public hospitals, in general, are cheaper, but more crowded and offer lower quality service than private ones while private ones are underutilized because of the higher payments required for their services. These differences among hospitals affect patients’ choices in hospital selection and result in different levels of satisfaction in the community. Appropriate subsidy mechanisms can be developed to balance the capacity utilization of both sectors and to improve overall access to healthcare. The objective of this study is to develop an estimate of the magnitude of this improvement and differential effectiveness of various policies in achieving this improvement. For this purpose, we develop a simulation model that includes all the emergency departments of main public and private hospitals in a certain region of Turkey. We analyze the effects of different public policies on patients’ preferences regarding hospital choices and the results of these choices on social utility and public healthcare spending. Different capacity decisions, contracting and subsidy mechanisms are proposed and the optimal system parameters are determined under these mechanisms over this simulation model. After the validation and verification of the simulation model, several scenarios are designed and executed to increase social utility, decrease government expenses, improve patient satisfaction level and decrease waiting times. We compare the proposed scenarios based on multiple objective functions and present numerical results for different scenarios in this system.     

Waiting Time and Production Uncertainty in Medical Services

To focus on office waiting time, the behavior of a medical practice is analyzed under a perfectly competitive setting where office waiting time is the only choice variable in the short-run. The optimum waiting time is determined for both the certainty and the uncertainty cases. Comparative statics are drawn with respect to the opportunity cost of waiting time, physician fee, capacity, and standard deviation of waiting time. Empirical analysis of waiting time is made based on questionnaires distributed among physicians and patients. The results are consistent with the majority of the theoretical findings.     

Hospitals’ strategic behaviours and patient mobility: Evidence from Italy

This study explores the behaviour of hospitals in Lombardy in attracting patients from outside the region and investigates the effects on the quality of care to regional patients, where treatment of the latter is constrained by a budget cap while extra-regional patients represent an unconstrained source of revenue. The data suggest that hospitals use waiting time and length of stay to attract extra-regional patients. Regional patients in both private and public hospitals with higher proportions of extra-regional patients are characterized by lower mortality rates and reimbursement costs. These results suggest that the market for extra-regional patients has no negative effects on resident patients. Finally, the pattern of reimbursement for extra-regional care generates a financial flow in favour of wealthier regions, exacerbating the North–South divide in the National Health Service. Some form of regulation for extra-regional mobility is advisable to reduce the gap.     

Selling to Socially Responsible Consumers: Competition and The Private Provision of Public Goods

We model firms as competing for socially responsible consumers by linking the provision of a public good (environmentally friendly or socially responsible activities) to sales of their private goods. In many cases, too little of the public good is provided, but under certain conditions, competition leads to excessive provision. Further, there is generally a trade-off between more efficient provision of the private and the public good. Our results indicate that the level of private provision of the public good varies inversely with the competitiveness of the private-good market and that the types of public goods provided are biased toward those for which consumers have high participation value.     

Issues in the Industrial Organization of the Market for Physician Services

What is the nature of the industrial organization of the market for physician services? Is the market “competitive?” Are there pareto-relevant market failures, such that there is room for welfare-improving policies? Economists have devoted a great deal of attention to this market, but it remains relatively poorly understood. The key features of this market are that the product being sold is a professional service, and the pervasive presence of insurance for consumers. A professional service is inherently heterogeneous, nonretradable, and subject to an asymmetry of information between buyers and sellers. These characteristics are what bestow market power on sellers, further strengthened by the fact that consumers face only a small fraction of the price of any service due to insurance. This paper considers the implications of these characteristics for agency relationships between patients and physicians, and insurers (both private and public) and physicians. Agency relationships within physician firms are also considered. Both theoretical and empirical modeling of contracting between insurers and physicians and of the joint agency problems between patient and physician and insurer and physician are recommended as areas for future research. Because failures in this market are seen to derive largely from the structure of information, the potential gains from government intervention may be sharply circumscribed. Nonetheless, careful consideration of the competitive implications of contracting between physicians, insurers, and other health care providers is an important area for antitrust policy.     

Public–private innovation: barriers in the case of mobility as a service in West Sweden

Departing from open innovation (OI), this case study explores the development of Mobility as a Service (MaaS) in West Sweden. An analysis of 19 interviews reveals how representatives from involved actors perceive internal and external barriers as hampering the regional public transport authority’s attempts to collaborate with private actors, and that the perception of barriers is incongruent across public and private actors. Transferability to other cases of public–private OI is discussed, and implications for public actors are proposed. The paper expands the knowledge of preconditions for MaaS’ development and of the unique conditions for OI in public–private settings.     

Political contestability and public contract rigidity: An analysis of procurement contracts

Are public contracts less adaptable than private contracts? Using a comprehensive set of contracts for a standard product, we compare procurement contracts in which the procurer is either a public administration or a private corporation. We find that public‐to‐private contracts feature more rigidity clauses than private‐to‐private contracts and that the use of rigidity clauses in public contracts rises when political risks are more salient. We argue that a significant part of the increased rigidity of public contracts is a contractual adaptation to limit political hazards from political opponents and interested third parties.     

Inpatient bed allocation policy under uncertain capacity

This paper concerns the problem of inpatient bed allocation for two classes of patients (scheduled and non-scheduled) when there is uncertainty about daily available capacity. In the afternoon of each day, patients from the scheduled class, also called backlogged elective admissions, are selected from a waiting list, for the admission on the next day. The non-scheduled class, also called emergent admissions, are new requests that arise randomly each day with emergent needs. The capacity of available beds for a medical specialty to provide hospitalization services is uncertain when backlogged elective patients are chosen. Admitting too many of elective patients may result in exceeding a day’s capacity, which can potentially necessitate “overflowing” or “postponing” some emergent requests that should be performed as soon as possible. Therefore, the problem faced by the medical specialty facility at the decision-making point of each day is how many of the backlogged elective patients can be admitted. We formulate this problem as a Markov decision process (MDP) and study the structural properties of the model to characterize the nature of the optimal policy. We propose easy-to-implement policies (the fixed quota policy and the best fixed quota policy), which perform well under fitted distributions. By reporting numerical analyses using real data from a Chinese public hospital, we finally compare the improvements that our proposed solutions could bring to the hospital with the existing practices under several different cost structures.     

Neighborhood effects on secondary school performance of Latino and African American youth: Evidence from a natural experiment in Denver

We quantify the relationships between measures of neighborhood context and school performance (repeating a grade, grade point average and dropping out before a diploma is earned) for low-income Latino and African American adolescents ages 12–18. We employ administrative and survey data from a natural experiment involving the Denver Housing Authority's public housing program to minimize geographic selection bias and provide wide variation in neighborhood contexts. We use characteristics of the neighborhood initially offered by DHA to waiting list applicants as identifying instruments for the neighborhood context experienced as an adolescent. Cox proportional hazard models (OLS in the case of grades) demonstrate that neighborhoods having less social vulnerability, higher occupational prestige and lower percentages of African American residents robustly predict superior secondary educational performance in one or more dimensions, though magnitudes are typically contingent on ethnicity.     

Total Reward and pensions in the UK in the public and private sectors

Recent controversy has surrounded the relative value of public and private sector remuneration. We propose a comprehensive measure of Total Reward (TR) which includes not just pay, but pensions and other ‘benefits in kind’, evaluate it as the present value of the sum of all these payments over the lifetime and compare it for the highly educated in the UK public and private sectors. Our results suggest that TR is broadly equalised over the lifecycle for highly educated men while highly educated women have a clear TR advantage in the public sector by the end of their career. We suggest that the current controversy over public–private sector pension differentials and the perennial issues of public/private sector pay gaps requires a lifetime perspective and that the concept of TR is appropriate.     

Privatisation and vertical integration under a mixed duopoly

This paper analyses the privatisation of public firms when private firms may be vertically integrated with their suppliers. We consider a mixed duopoly with a vertically integrated public firm. The private firm bargains the price of the input with its supplier if they are not vertically integrated. We find that for a given bargaining power of the private firm, it vertically integrates with its supplier if goods are weak substitutes. We also find that there is less vertical integration in the mixed duopoly than in the private duopoly. Finally, in general, the public firm is privatised when goods are close substitutes and the bargaining power of the private firm is low enough.     

House prices, wealth effects, and the Singapore macroeconomy

This paper examines the effect housing wealth has upon aggregate consumption in Singapore. While past research has focused only on changes in private housing wealth, the residential market in Singapore is dominated by the public housing sector. The massive public housing segment can generate potentially different wealth effects from standard private housing markets given the former’s unique institutional features. In particular, public housing owners who sell their units at market rates can repurchase a public flat at subsidized prices whereas private homeowners typically cannot. We estimate the link between consumption expenditure and both private and public housing wealth using a VARX approach for the Q1:1990–Q4:2002 period. We find that changes in private house prices have no significant effect on aggregate consumption. In contrast, public housing wealth effects are larger and more persistent.     

Presenteeism and burnout among teachers in public and private Portuguese elementary schools

This research aims to study the possible relation between presenteeism and burnout in the public and private education sector. Presenteeism – a groundbreaking concept in organizational behaviour literature – refers to productivity losses that occur when employees come to work but under-perform due to physical and psychological causes. Next, we further clarified the burnout criterion with three groups of predictors: personal, contextual and presenteeism. Results from a sample of 281 elementary school teachers from private and public institutions revealed that personal and contextual characteristics as well as presenteeism were predictive of teacher burnout. We also found that public school teachers exhibited higher levels of both presenteeism and burnout. Finally, the implications of these results are discussed and directions for future research in the field are provided.     

Private and public investment in sub-Saharan Africa: The role of instability risks

This paper explores the impact of public investment on private investment in sub-Saharan Africa using the finite mixture model. We argue that the impact of public investment on private investment differs across groups of countries with similar but unobserved characteristics. Contrary to previous studies, the paper incorporates the potential presence of hidden heterogeneity and tries to explain the group membership. Using a sample of 42 countries, we find that the impact of public investment on private investment differs across three different groups of countries. Moreover, we find that countries with high risk of conflict, terrorism and repatriation of profits are less likely to be in the group where public investment crowds in private investment. The paper underscores the need for sub-Saharan African countries to ensure private investment security by reducing the risks associated with conflicts and terrorism, and preserving contract viability and repatriation of profits.     

论刑法的私权保障及其社会价值

刑法作为公法,首先保障的是公权,也不排除保障私权。问题是刑法在保障私权方面,该做的还远远没有做到。我们应该对受害人的诉讼权利和诉讼地位明确给以法律保障,重视刑法和刑事诉讼法的人性化。在刑事诉讼中推行私法的"自愿、调解"等原则,并以此完善私权的保障。明确公法、公权与私法、私权的关系及其社会价值。     

医院个性化关怀电子商务整体解决方案——以民营医院为例

病人是医院的命脉,只有赢得客户,才能赢得未来。病人就诊,除了关心医院本身的医疗实力,考虑最多,最影响决策的因素,就是医院的服务了。很显然,病人的需求在人满为患的公立医院是无法实现的。本文从电子商务的内涵及发展出发,分析了当今民营医院发展的处境和遇到的问题,并指出了在电子商务发展时代,加强客户关系管理是解决民营医院实际问题的最佳途径;本文还重点提出了民营医院个性化关怀通过电子商务实现的解决方式和发展策略。     

Examining the relationship between strategic HRM and hospital employees’ work attitudes: an analysis across occupational groups in public and private hospitals

Abstract

As human resource challenges have increased, strategic human resource management (SHRM) in hospitals has evolved into an important management task. Accompanying its growing relevance, there is an evolving research stream on the impact of SHRM on organizational and individual-level outcomes in the hospital context. We aim to address two remaining research gaps by investigating variations in the use of SHRM across organizations (public vs. private ownership types) and differences in the relationship between SHRM and employee attitudes within organizations (for the occupational groups of nurses and physicians). This study is based on a sample of 179 German acute care hospitals. We employ ANOVA and logistic regression analyses, and our results corroborate previous research findings showing that SHRM has positive effects on employee attitudes. However, the effects vary in significance and magnitude, depending on whether nurses or physicians are targets. Further, we reveal significant SHRM differences in public- vs. private-sector organizations.     

Public versus private provision of liquidity: Is there a trade-off?

To what extent is public debt private liquidity? Much policy advice given in the aftermath of the financial crisis rests on the assumption that increasing public debt relaxes borrowing constraints of private households. This is the case for ad-hoc debt limits, which are exogenous to public policy. Instead, if debt limits are fully endogenous, as e.g. in the case of the natural borrowing limit, public debt has no impact. We assume that borrowing limits arise because of limited contract enforceability and are therefore determined as equilibrium outcomes. Using an incomplete markets economy in which households are subject to uninsurable earnings shocks, we show that public debt provides some liquidity, but less so than it would if constraints were imposed ad-hoc. We show that generating borrowing constraints as an equilibrium outcome substantially alters the answers to other important questions, such as for the welfare effects of government debt or its impact on real economic activity.     

The dynamic investment and exit decisions of venture capitals

This study develops a continuous time model to examine a complete two-stage decision process for venture capitals (VCs), including investment in the private market at Stage 1 and exit through IPO in the public market at Stage 2. Optimal timings, investment terms, and exit decisions are investigated using the real options game theory under two cases: the same required returns in the public and private markets and a higher required return in the private market than in the public market. Our results indicate that the same required returns in the public and private markets generate an optimal investment decision at Stage 1 without relation to the exit decision in Stage 2. However, when the required return in the private market is higher than that in the public market, the exit decision will influence the investment decision. The size of the initial capital, ownership structure, growth rate and risk of industry, required returns in public and private capital markets, extent of lock-up period price pressure, and transaction costs of financing are important factors influencing the equilibrium results.     

How Governments Promote Monopolies: Public Procurement in India

Government officials exert tremendous power when they buy goods and services from private companies. By setting the terms and conditions under which public procurement takes place, public officials help determine which companies will thrive and which ones will fail. This is one of the important ways governments help create and sustain monopolies in the private sector. But since the bidding process to sell products or services to the government is supposed to be an open and fair competition, how does it become skewed toward businesses that already dominate markets? We examine a particular source of bias: the eligibility criteria for bidding in public procurement tenders. These criteria often allow a few large, private companies to bid on government contracts, but they exclude a large number of small and medium‐sized enterprises. We study the terms by which offers are solicited in India through tenders floated for transportation projects: roads, highways, bridges, and civil construction. We find that the eligibility criteria impose an unnecessarily heavy burden on small firms, potentially knocking them out of the competition and discouraging them from participating in other procurement processes. In this way, the process reinforces monopolies instead of breaking them up. While this study focuses on India, the results also apply to similar economies.