The import of hospital rate setting programs on hospital and health care expenditures, 1975–85

To reduce hospital expenditures, many jurisdictions now regulate hospital rates. Prior theoretical work has demonstrated, however, that the effect of rate regulation on total expenditures is a priori unclear. Empirical research has found that hospital rate setting programs have reduced expenditures per diem and per admission, but not necessarily hospital expenditures or total health care expenditure per capita. This study extends this empirical research. It employs pooled cross section-time series data on state level expenditure, regulatory, and demographic variables obrserved annually for 1975–85. The analysis provides little evidence that hospital rate setting programs have reduced hospital expenditures. Some rate setting programs actually are positively and significantly related to hospital expenditures. Overall, this study does not suggest that regulatory programs will reduce hospital expenditures.     

Strategic environmental policy and the accumulation of knowledge

In dealing with a transnational pollutant-emitting duopoly welfare-maximising policy makers face two negative externalities: imperfect competition and unpriced emissions. Strategic environmental policy models show that these externalities involve a trade-off between reducing pollution and allowing for rent-seeking of the respective firm. This dilemma usually results in a suboptimal internalisation of the negative externality emerging from emissions. Indeed, the conventional model setup includes an R&D stage that enables the firms to mitigate regulation costs. But the typical one period configuration ignores that R&D expenditures create knowledge capital which is, due to its inherent cumulativeness, also effective in following periods. Our model analyses the established trade-off in a two period setting and therefore allows for an investigation of intertemporal knowledge accumulation. We find that the intertemporal effects provide an incentive for a policy maker to set a higher tax rate compared to a one-period setup which lessens the magnitude of the suboptimal internalisation of emissions. Under certain conditions even a tax rate above the Pigouvian level is possible in period 1.     

Competitive diffusion of new prescription drugs: The role of pharmaceutical marketing investment

We investigate the impact of marketing interventions on the diffusion of new products in a competitive setting. We develop a family of trial–repeat diffusion models to identify the longitudinal effects of marketing efforts, and complement this with a cross-sectional analysis to identify the between-drug effects. We believe that we are the first to consider both longitudinal and cross-sectional marketing effects in a trial–repeat diffusion context. The models are calibrated on 34 drugs in three therapeutic categories using monthly data. Our longitudinal analyses demonstrate that the trial rate responds positively to increases in own marketing expenditures but is affected negatively by competitors' expenditures. We show how these within-drug analyses provide opportunities for accelerating the diffusion process by reallocating marketing expenditures over time. The cross-sectional analyses demonstrate that pharmaceutical marketing has both an informative and a persuasive influence on the diffusion of new drugs. We find that direct-to-consumer advertising does not affect the trial nor repeat rates during the first months after introduction. We illustrate the managerial relevance of our results and find that a reallocation of marketing budgets does not alter the saturation level, but can help in attaining this level faster. We show that this has a great effect on sales, market share and ROI.     

高科技企业R&D支出资本化的动机研究

文章以2007-2009年在深圳交易所上市的高科技企业为样本,实证研究了R&D支出资本化动机的影响因素。研究结果表明,高科技企业R&D支出资本化的比例受到债务契约和资本市场动机的影响,企业的财务杠杆越高,越倾向于把R&D支出进行资本化处理;在经营状况不好时,企业为保持上市资格、扭亏为盈而趋于把R&D支出进行资本化处理。薪酬契约和收益平滑尚不能很好地解释R&D支出资本化的选择动机。     

Dynamics of Government revenues and expenditures in industrial economies

The sources of growth in government revenues and expenditures in 22 OECD countries is addressed. The question of whether the revenue constraint is binding on the growth of government expenditures, or whether the ‘displacement’ effect of expenditure growth is binding is considered. Controls for the effects of the output gap and inflation rate on government revenues and expenditures in each of the 22 countries are presented. A major conclusion is that reductions in spending are essential to reducing budget deficits and controlling government size.     

Perioperative outcomes and hospital costs associated with flowable gelatin hemostatic matrix for lumbar surgeries in real world hospital setting

Abstract

Background: Efficient hemostasis during lumbar surgery (LS) is associated with better perioperative outcomes. Flowable gelatin hemostatic matrix (FGHM) is a new type of absorbable hemostatic agent, which is effective to control bleeding during spinal surgery. This study aimed to assess the impact of FGHM on perioperative outcomes and hospital costs associated with LS.

Methods: This study retrospectively analyzed medical and billing records of patients who underwent LS for spinal degenerative disease in a Chinese tertiary care hospital from 2014 to 2016. The identified patients were further stratified into a FGHM group (n?=?108) (using the combination of FGHM and gelatin sponge) and a historical control group (using oxidized cellulose and/or collagen, n?=?82) for the adjusted comparisons of the perioperative outcomes using a propensity score matching method. Multiple generalized linear regression was conducted to assess the impact of using FGHM on total hospitalization costs.

Results: Comparisons of 64 propensity score matched pairs showed a significantly lower blood transfusion rate (34.4% vs 64.1%, p?=?0.005), lower blood transfusion volume (182.7?±?312.4 vs 301.3?±?281.0?mL, p?=?0.045), reduced post-surgery drainage tube placement rate (82.8% vs 93.8%, p?=?0.046), and shorter post-operative days on antibiotics (6.0?±?2.6 vs 7.1?±?2.4 days, p?=?0.010) in the FGHM group. Although with a relatively high acquisition price, the use of FGHM for hemostasis in LS did not increase the total hospitalization costs (coefficient = ?0.001, p?=?0.972).

Conclusions: The use of FGHM in LS improved perioperative outcomes related to hemostatic effects without increasing overall hospital costs in a real-world hospital setting.     

Tax Base and Crowding‐in Effects of Balanced Budget Fiscal Policy

A dynamic general equilibrium business cycle model is constructed with staggered price adjustment, monopolistic wage setting and distortionary taxation. The government purchases goods, runs an unemployment benefit system and balances its budget through a proportional tax on labour income. A temporary tax‐financed increase in government expenditures can lower the tax rate through a demand‐induced widening of the tax base. It is shown analytically that this allows private consumption to rise, under realistic conditions, despite the negative wealth effect of increased fiscal spending.     

State regulation and university behavior

The impact of state regulation on the economic behavior of American public research universities is studied, using a unique sample of data on costs, outputs and regulation measures for 98 institutions. The university cost structure is modeled by a multiple output translog cost function, explicitly allowing for the impact of state regulation. Regulating non-faculty salary expenditures and the spending of non-state revenues decreases costs, while regulating faculty salary expenditures increases costs, given the same output levels. The results are interpreted in terms of the principal-agent relationship of state regulators and universities. Efficiency gains and losses depend on the relative accuracy of state information on the production process.     

Using Market Prices to Regulate the Costs of a Utility‘s Inputs

This paper analyzes the problem of determining allowable cost of a utilitys inputs when the price of these inputs may be highly volatile and when hedging and long-term contracting are the norm in the supply of these inputs. In such an environment, benchmarks based upon the observable market price of an input are natural regulatory mechanisms to consider. This paper studies such incentive-based regulation. The first section uses contingent claims analysis to investigate a representative contract currently in place. The analysis indicates that this regulation may impose an important monitoring role on the regulator in order to prevent the utility from taking extremely risky positions in fuel markets. Further investigation of benchmark-based regulation is undertaken in a principal-agent framework in which the utility has the dual role of choosing a fuel portfolio and undertaking expenditures to reduce fuel costs. In this setting, it is shown that benchmark-based compensation is, at best, ineffective. Within the same setting, contracts based upon cost sharing are studied and found to be superior at obtaining a tradeoff between risks and cost reduction.     

PRODUCTIVE GOVERNMENT EXPENDITURE IN MONETARY BUSINESS CYCLE MODELS

This paper assesses the transmission of fiscal policy shocks in a New Keynesian framework where government expenditures contribute to aggregate production. It is shown that even if the impact of government expenditures on production is small, this assumption helps to reconcile the models' predictions about fiscal policy effects with recent empirical evidence. In particular, it is shown that government expenditures can lead to a rise in private consumption, real wages, and employment if the government share is not too large and public finance does not solely rely on distortionary taxation. When government expenditures are partially financed by public debt, unit labor costs fall in response to a fiscal expansion, such that inflation tends to decline. Households are willing to raise consumption if monetary policy is active, i.e. ensures that the real interest rate rises with inflation. Otherwise, private consumption can also be crowded out, as in the conventional case where government expenditures are not productive.     

Economic Growth and Medicare Funding Systems

This article compares the long-run effects of changes in health conditions, population growth, price of medical care, and Medicare indemnity rate on capital formation and medical expenditures under fully funded and pay-as-you-go Medicare. Surprisingly, it is found that population growth, rising medical prices, and increasingly adverse health conditions may or may not raise medical expenditures in the long run. Moreover, the directions of some of these effects under the pay-as-you-go Medicare system are reversed under the fully funded system. Finally, it is shown that fully funded Medicare results in higher steady-state capital than pay-as-you-go Medicare; however, the welfare effect of the former may or may not be higher than that of the latter in general. (JEL H550 , E620 )     

Trade Liberalization and Technology Diffusion

The paper considers the role of technology diffusion and trade liberalization for the catching‐up of structurally backward countries. A New Economic Geography model is presented that accounts for firm entry/exit and international mobility of skilled labor employed in public R&D sectors. This raises the traditional agglomeration effects in a core–periphery setting as firms and mobile factors usually cluster within spatial agglomerations. With international technology diffusion, however, there is a counteracting effect on the traditional agglomeration effects as firms in the periphery also benefit from increasing R&D expenditures in the core lowering entry costs for firms. It is found that the catching‐up of structurally backward countries is spurred not only as a result of trade integration but also because of technology diffusion.     

Do Business Cycles Alter the Composition of Research and Development Expenditures?

Do business cycles cause firms to alter the composition of research and development (R&D) expenditures? This article uses aggregate data on U.S. firm‐financed R&D expenditures during the 1956–96 period to address this issue. The mix of R&D expenditures changes over the business cycles with firms increasing the amount of basic R&D and reducing the amount of development R&D during recessions. Though the effects are small, the results raise the possibility that business cycles influence the rate of long‐run growth. (JEL E33, O30)     

NATIONAL ACCOUNTS AS AN INSTRUMENT FOR THE ANALYSIS OF THE SOURCES OF STAGFLATION AN EXAMPLE: FRANCE AND GERMANY, 1971–79

Stagflation is a combination of an increasing rate of inflation with a decreasing rate of real growth. It appears when the inflationary gap of production costs raises faster than the inflationary gap of expenditures on Gross Domestic Marketable Product. The decomposition of these two gaps into their main elements gives then the possibility of determining the sources of the inflationary increase in costs and the causes of the relative retardation of the inflationary increase in expenditures. The main cause of stagflation in 1974 for France and Germany was the huge rise in oil prices which had not been immediately followed by an equal rise in prices of their exports. The inflationary rise in wages is an almost permanent factor of stagflation in France; in Germany its responsibility is involved only before 1975. In France the insufficient increase in the inflationary gap of expenditures was mainly due to the restrictive monetary policy and to the official price regulation. In Germany the restrictive monetary policy also contributed to the slowdown in demand in 1974 and 1975. In 1977, on the contrary, the main cause of stagflation was the slackening of export demands due to the world recession and the revaluation of the DM.     

Productivity and R&D: an econometric evidence from Spanish firm-level data

This article analyses the relationship between productivity growth and R&D investments of Spanish manufacturing firms during the 1990s. The theoretical model is a version of the Cobb–Douglas production function in its growth rate form. The purpose is to estimate the rate of return to R&D expenditures. The econometric specification is a distributed lag model. The estimation applies the generalized method of moments method. The main empirical finding is that a positive and significant role is played by R&D expenditures on productivity growth. The rate of return to R&D expenditures is 26.598%.     

Public financing of health expenditures,insurance, and health outcomes

The effects of public financing of health expenditures, insurance coverage and other factors on health outcomes are examined within health production models estimated using 1960–1992 data across 20 OECD countries. Mortality rates are found to depend on the mix of health care expenditures and the type of health insurance coverage. Increases in the publicly financed share of health expenditures are associated with increases in mortality rates. Increases in inpatient and ambulatory insurance coverage are associated with reduced mortality. The effects of GDP, health expenditures and age structure on mortality are similar to those in previous studies. Tobacco use, alcohol use, fat consumption, female labour force participation, and education levels are also significantly related to overall mortality rates. Increases in income inequality are associated with lower mortality rates, suggesting that the negative relationship between inequality and health outcomes suggested by some previous studies does not remain when a more complete model is estimated. The result that increases in public financing increase mortality rates is robust to a number of changes in specifications and samples. Thus, as countries increase the level of their health expenditures, they may want to avoid increasing the proportion of their expenditures that are publicly financed.     

Simultaneous-Equation Regression Analysis of Sales and Advertising

A simultaneous-equation regression model is developed and tested against aggregative time series data. The test involves the model as well as hypotheses regarding the structural parameters. Restrictions on the structural parameters imply limits on the parameters of the reduced-form equations. Estimates of the reduced-form coefficients must fall within the implied intervals in order for the model to be in agreement with the data.     

我国劝诱性医疗的成因:管制、市场结构还是信息不对称?

本文使用一个价格管制背景下的医疗信号博弈模型讨论了我国劝诱性医疗现象的成因,以及管制、市场结构和信息不对称在导致资源配置扭曲中的作用机制和相互关系。研究表明,在无管制市场中,医生存在以价格承诺实现医疗资源最优配置的动机和可能。在政府对各项医疗收费实施全面价格管制的制度背景下,过低的诊断价格上限将使市场自发的事前价格承诺机制失灵,并诱发欺骗性的诊断结果,而药品和医疗器械使用的价格上限管制则诱使医生以增加药品和医疗器械使用量的数量决策来维持自身的垄断抽租能力。这两种机制的共同作用最终导致了双重劝诱性医疗均衡。在此均衡下,由于公立医院的垄断地位未受影响,故价格管制无法改善患者的福利状况,反而会导致社会的净福利损失。     

Spillovers from regulating corporate campaign contributions

Populist clamor and recent Supreme Court decisions have renewed calls for increased regulation of corporate money in politics. Few empirical estimates exist, however, on the implications of existing rules on firms’ political spending. Exploiting within firm-cycle cross-candidate variation and across firm-cycle variation, we demonstrate that the regulation of PAC campaign contributions generates large spillovers into other corporate political expenditures such as lobbying. Using both high dimensional fixed effects and regression discontinuity designs, we demonstrate that firms constrained by campaign contribution limits spend between $549,000 and $1.6M more on lobbying per election cycle, an amount that is more than 100 times the campaign contribution limit. These results demonstrate that, similar to regulations in other domains of the economy, constraining specific corporate political activities often yields unintended effects.