Childhood preventive care,adult healthcare and economic growth: The role of healthcare financing

We analyze the impact of healthcare financing on economic growth, focusing on the issue of the joint public–private financing of healthcare (co-payment). We use an overlapping-generations model with endogenous growth based on health human capital accumulation, where families pay for childhood preventive care and the government can either fully finance or co-finance adulthood curative care. From a growth maximizing perspective, distortionary taxes give an advantage to co-financing. Nevertheless, we prove that, if agents are assumed to be heterogeneous in preferences, full financing can become the best option.     

Comparing Regulations to Protect the Commons: An Experimental Investigation

In a laboratory experiment we test three regulations imposed on a common-pool resource game with heterogeneous users: an access fee and subsidy scheme, transferable quotas and non-transferable quotas. We calibrate the game so that all regulations improve users’ profits compared to free-access extraction. We compare the regulations according to five criteria: resource preservation, individual profits, profit difference, Pareto-improvement from free-access and sorting of the most efficient users. One of the main findings is that, even though it performs better in sorting out the most efficient subjects, the fee and subsidy scheme is not more profitable than tradable quotas.     

Global Drivers of and Local Resistance to French Shareholder Activism

Shareholder activism in France has made significant advances during the past 25 years even as it continues to face formidable sources of local resistance. But if the list of corporate governance improvements since 1989 described by the authors might lead one to conclude that France now has minority shareholder protection and shareholder activism comparable to those of the U.S. or U.K., powerful local interests, including much of French management, labor, and government, continue to mount effective resistance to such forces for change. The French government still works closely with French business elites and unions to manage both individual companies and the general economy. And government officials continue to speak publicly of “protecting” French firms from “illegitimate” foreign shareholders. Accordingly, the authors characterize French corporate governance as a “hybrid” model of shareholder activism, one that incorporates the perspectives and interests of the classic French stakeholder model as well as an emerging shareholder value movement. Although foreign institutional investors have increased their shareholdings in French companies and promoted “best practice” governance rules, particularly with respect to voting rights, local forces will continue to resist aggressive shareholder activism. Such a hybrid model makes the outcomes of shareholder activism less predictable, a risk that foreign investors and companies often respond to by seeking alliances with local proxy advisers and investor associations to gain “legitimacy.”     

Cooperation in R&D through a network,an ‘organizational gamble’? an empirical analysis of rhône poulenc rorer-gencell

This paper is based on the empirical analysis of innovation challenges to Rhône Poulenc Rorer-Gencell (RPR-Gencell) resulting from development of biotechnology in the pharmaceutical industy. These we identify as an organizational innovation involving the development of a network of partners following and/or inducing a technological innovation. RPR-Gencell represents a ‘style of innovation’ since it is based on various factors specific to the firm and corresponds to a new organizational form, the ‘tight network’ of partners. We argue that this organizational from, in the context of the development of biotechnology in the pharmaceutical industry, can be likened to an ‘organizational gamble’ associated with a ‘technological gamble’ Altogether, this ‘gamble’ dimension means that the network of partners in R&D is still a marginal organizational form. After an introduction we show that the specficities of the pharmaceutical industry especialy since the emergence of biotechnohgy have led to the emergence of a multiplicity of institutional arrangements governing cooperation in R&D. We take as a specific example that of gene therapy. Later on, we present some stylized facts to emphasize the diversity among the network organizational forms. The network of partners is an alternative to the other complex but ‘clarsical’ forms of cooperation (R&D agreements, cross-licensing, joint-ventures, mergers/acquisilions). We propose a new definition of the network based on the case of RPR-Gencell: the ‘tight network’. We distinguish between the ‘tight network’ and all the other approaches, focusing in particular on the ‘loose network’ of cooperative relationship (mostly multifirm alliances implemented with several bilateral contracts). Only two pharmaceutical companies have adopted the ‘tight network’ to govern their cooperation in R&D. We present the network ofpartners as an organizational innovation governing a technological innovation. We argue that this organizational innovation could be likened to an ‘organizational gamble’ in the case of the pharmaceutical industry. Finally, we show that the network raises several organizational issues since it short-circuits traditional strategic operations in the pharamaceutical industry. We argue that among many different reasons, RPR's technological choices (especially the priorig given to gene therapy) have influenced the creation of its network of partners. As a conclusion, we discuss the link between the organizational innovation and the technological innovation focusing on the ‘gamble’ dimension of such an innovation.     

Use and abuse of regulated prices in electricity markets: “How to regulate regulated prices?”

We consider the regulation of the tariffs charged by a public utility in the electricity sector. Consumers differ in terms of their privately known demands. When regulating a firm's tariffs, the government is concerned by the redistribution across consumer classes. A conflict between redistribution and screening induces pricing distortions when the firm is a monopoly. Introducing competition with an unregulated fringe improves efficiency but jeopardizes redistribution. In response to this problem, the government may now want to manipulate information about the incumbent's cost to restrict entry and better promote its own redistributive objective. To prevent such obstacle to entry, the government's discretion in fixing the incumbent's regulated tariffs should be restricted by imposing floors or caps on those tariffs and/or by controlling the market share left to the competitive fringe. We highlight the determinants of such limits on discretion and unveil to what extent they depend on the government's redistributive concerns.     

The Definition and Diffusion of Expert Systems: An Empirical Survey of Belgian External Audit Firms

This paper reports empirical results on the definition and diffusion of expert systems (ESs). The findings are based on a questionnaire that was sent to Belgian external audit firms in June 1993. Audit firms were chosen as the questionnaire's target group because another part of the survey was aimed at gathering information concerning the audit of ESs. The definition section deals with the importance of several ES characteristics as seen by the sample of practitioners. Results are compared with opinions from theoretical literature and reveal significant differences. The section on diffusion of ESs is intended to provide an indication of the extent of development and usage of ESs in todays business life. On the basis of the sample of audit firms that reported on their auditees' situations, diffusion rates are rather low. Each of these sections is introduced by a short literature review. As both sections are largely based on the results of a survey, relevant details are included in the first section.     

How to Regulate Heterogeneous Hospitals?

In many areas of health care financing, there is controversy over the sources of cost variability and about the respective roles of inefficiency versus legitimate heterogeneity. This paper proposes a payment system that creates incentives to increase hospital efficiency when hospitals are heterogeneous, without reducing the quality of care. We consider an extension of Shleifer's yardstick competition model and apply an econometric approach to identify and evaluate observable and unobservable sources of cost heterogeneity. Moral hazard can be seen as the result of two components: long‐term moral hazard (hospital management can be permanently inefficient) and transitory moral hazard. The latter is linked to the manager's transitory cost‐reducing effort. For instance, he or she can be more or less rigorous each year when bargaining prices for supplies delivered to the hospital by outside firms. The use of a three‐dimensional nested database makes it possible to identify transitory moral hazard and to estimate its effect on hospital cost variability. Econometric estimates are performed on a sample of 7,314 stays for acute myocardial infarction observed in 36 French public hospitals over the period 1994–1997. We obtain two alternative payment systems. The first takes all unobservable hospital heterogeneity into account, provided that it is time invariant, whereas the second ignores unobservable heterogeneity. Simulations show that substantial budget savings—at least 20%—can be expected from the implementation of such payment rules. The first method of payment has the great advantage of reimbursing high‐quality care. It leads to substantial potential savings because it provides incentives to reduce costs linked to transitory moral hazard, whose influence on cost variability is far from negligible. This payment rule could be extended to other areas of health care financing, such as Adjusted Average Per Capita Cost to calculate Medicare Managed Care reimbursements in the United States.