Reimbursement schemes for hospitals: the impact of case and firm characteristics

We contribute to the debate on high-powered versus low-powered incentives in regulation by studying their heterogeneous impacts on different subpopulations, using data from the introduction of a high-powered prospective payment system (PPS) for hospital reimbursement in Germany. While no overall effect on quality or cost saving is found, our results support hypotheses drawn from an incentive and selection perspective: PPS reduces the length of stay of older relative to younger patients, of more severe relative to less severe cases, and in smaller relative to larger hospitals. Hospitals which adopted PPS earlier provide higher quality under PPS as proxied by the case-specific readmission rate. Our study also contributes to the health economic literature on hospital reimbursement as our data permits us to identify the treatment effect via different timings of adoption of PPS and to use a more accurate quality measure by following patients even when readmitted to other hospitals.     

Energieeffizienznetzwerke – beschleunigte Emissionsminderungen in der mittelständischen Wirtschaft

The reduction of energy-related CO₂ emissions by more efficient enery use in medium sized companies is one of the most profitable options. However, these opportunities are scarcely realised because of many obstacles and market failures. High transaction cost and decision routines play an important role for decision making and procurement of the companies. A network concept being developed in Switzerland and covering an initial consulting of each participating company, targets for the network, regular and moderated meetings of the energy managers for mutual exchange of experiences and a yearly monitoring alleviates many of these obstacles. It doubles the energy efficiency progress relative to the average progress of industry. This network concept can be fully realised by industry itself. Average energy savings per site and year are 100,000 € and average CO₂ emission reduction about 500 t CO₂ per year and site. Assuming a maximum potential of 700 Networks, additional emission reductions of some 10 Mio. t CO₂ seem to be possible in Germany by 2020. A network management system for consulting engineers and moderators allows a minimum performance standard of how to start and operate those efficiency networks.     

Information-seeking behaviour in interactive videotex. Training effects in an experimental investigation

First, we present a conceptual framework designed to measure information-seeking behaviour of non-professional users of Bildschirmtext, the German version of interactive videotex. A training programme is conceived with the aim of improving high school students' information-seeking behaviour in videotex by means of three consumer education lessons. Second, a laboratory investigation is described which set out to measure the influence of user training and the impact of three antecedents (sex, age, and school mark) upon four constructs of information-seeking behaviour, viz., precision of the information goal, user efficiency, content and amount of retrieved information, and satisfaction with the system. We found (a) that the training increased the ability to formulate precise information goals, (b) that the more precise the information goal the less the user efficiency and the less the satisfaction with the system, and (c) that there exist substantial sex-specific differences in information-seeking behaviour.

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Zusammenfassung Um Bildschirmtext (Btx) wirkungsvoll nutzen zu können, muß der Teilnehmer sein Informationsverhalten den Speicherstrukturen dieses interaktiven Systems anpassen, die vom Suchbaum-Menue-Prinzip geprägt sind. Da das alltägliche Informationsverhalten des durchschnittlichen Verbrauchers nicht derart strengen Regeln folgt, ist fraglich, ob Btx eine erfolgreiche Karriere als Verbraucherinformationssystem beschieden sein wird. Für Zwecke der Untersuchung wird zunächst ein Konzept entwickelt, um das Informationsverhalten nicht-professioneller Nutzer an Btx messen zu können. Weiterhin wird ein Trainingsprogramm entwickelt, das geeignet scheint, Schüler/innen im Rahmen der Verbrauchererziehung in dem wirkungsvollen Gebrauch von Bildschirmtext zu unterweisen. Die Wirkung dieses Programms und der Einfluß dreier Antezedenzvariablen (Alter, Geschlecht und Schulnote) wird im Hinblick auf vier Größen des Informationsverhaltens (Präzision des Informationsziels, Effizienz des Nutzerverhaltens, Art und Inhalt der abgerufenen Informationen und Zufriedenheit mit der Btx-Nutzung) bei Jugendlichen zwischen 13 und 16 Jahren gemessen. Zur Analyse wurde das LISREL Programm eingesetzt, das die kausalen Strukturen zwischen beobachtbaren und latenten Variablen abbildet und überprüft. Es zeigt sich, daß (a) das Nutzertrainung die Präzision des Informationsziels erhöht, daß (b) präzisere Informationsziele die Nutzereffizienz und die Zufriedenheit mit dem System reduzieren, und daß (c) die Bildschirmtextnutzung starke geschlechtsspezifische Unterschiede aufweist. Die Ergebnisse unterstreichen, daß rechnergestützte, interaktive Informationssysteme für den Verbraucher erst dann von Nutzen sein können, wenn das Informationsangebot konsequent seinen Informationsfähigkeiten und -bedürfnissen angepaßt wird.

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Eberhard Kuhlmann is Professor of Consumer Economics and Ingo Balderjahn Assistant Professor of Quantitative Methods in Economics at the Technical University of Berlin. Mailing address: Technische Universität Berlin, Franklinstr. 28/29; D-1000 Berlin 10, FRG.     

Competitive Product Development in the Financial Services Industry—A Knowledge-Based Approach

The development of innovative products and the ability to quickly adapt to changes is important for financial institutions in today's highly competitive environment. The information system department has to create the required information technology support (IT support) for these tasks. A model that allows the characterization of bank products by means of parameter sets and integrity constraints that in most cases may be viewed as business rules will be presented. Based on this parameter model a prototype system was developed to verify the approach used. This system also provides support for the areas of risk and yield management and may be used as a basis for systems providing counselling services. The prototype was implemented by coupling PROLOG and a relational database system. Arguments will be presented against the use of object-oriented database systems and in favour of the currently less popular deductive database approach. The approach presented may be extended such that products related to the life insurance business may also be covered.     

Quo vadis, FAO?

The present recession in aid funding and the ongoing transformation of the United Nations development programme and project management approach calls for fresh ideas, particularly from within the UN specialized agencies. In the largest of these, PAO, a process of self-reflection and intellectual fermentation seems to be taking place to some extent in response to the important November 1993 biennial FAO Conference. The Conference marks the end of the third consecutive six-year electoral term of the organization's Director-General. This article presents for debate some critical issues and opportunities which appear timely for consideration by those working within and outside FAO on the design of realistic development policies.     

Strategic Environmental Policy, Clean Technologies and the Learning Curve

In the political discussion, it is often emphasized that the environmental service industry (which produces a clean factor of production) benefits from an early and strong environmental policy. This is especially likely if the costs of production are decreasing over time due to learning curve effects. Surprisingly, the environmental service industry has not been integrated into the theory of strategic environmental policy yet. Our main question is whether a national leadership in environmental policy can pay off if profits of the environmental service industry are taken into account. We consider a two-period model with one firm in each country competing on a third market. Emissions can be substituted by the clean factor when deciding upon the production technology. The unit costs of producing the clean factor in the second period are decreasing in the quantity produced in the initial period. We derive the optimal environmental policy for both periods from a national point of view and show that the presence of the environmental service industry can indeed lead to a national leadership in pollution control.     

Reforming local public services

Abstract

The following article is aimed at analysing reforms in public service delivery and management at the local level of government in Germany and France from a cross-countries comparative perspective. Particular attention is paid to the results and effects these reform initiatives have caused with regard to the administrative organization, steering capacities, and output performance. Two major approaches of reform will be addressed: privatization, contracting-out, and ‘corporatization’ of local services on the one hand and public management reforms on the other. Proceeding from the distinct ‘starting conditions’ of reforms in the two local government systems, the question will be pursued, as to whether there has been an increasingly convergent or divergent development in French and German local service provision, and how these evolutions can be explained.