Performance signals in the public sector: the case of health care

Although there are no traditional markets and money prices inthe public sector, consumers and providers may respond to signalsof organisational performance. We present a simple dynamic modelof the demand and supply for elective surgery in the UK NationalHealth Service in which waiting time acts as the prime indicatorof performance. The model is tested using a panel of quarterlydata for 123 English health authorities over an eight-year period.We find that supply is increasing and demand is decreasing inmeasures of the previous period waiting time. The results implythat health care systems which are rationed by waiting do respondto indicators of waiting times. The paper adds to the smallbut consistent body of research which demonstrates that publicsector systems respond to important aspects of reported performance.     

The value of changes in individual risk in a large mixed economy

Changes in an individual's risk will affect all other individuals in the economy because of the interdependence created by the government's budget constraint. If government policy is optimal, these spillover benefits are measured by the change in the expected government budget surplus.     

Competition,Prices and Quality in the Market for Physician Consultations

Prices for consultations with General Practitioners (GP's) in Australia are unregulated, and patients pay the difference between the price set by the GP and a fixed reimbursement from the national tax‐funded Medicare insurance scheme. We construct a Vickrey‐Salop model of GP price and quality competition and test its predictions using individual GP‐level data on prices, the proportion of patients who are charged no out‐of‐pocket fee, average consultation length, and characteristics of the GP's, their practices and their local areas. We measure the competition to which the GP is exposed by the distance to other GP practices and allow for the endogeneity of GP location decisions with measures of area characteristics and area fixed‐effects. Within areas, GP's with more distant competitors charge higher prices and a smaller proportion of their patients make no out‐of‐pocket payment. GP's with more distant competitors also have shorter consultations, though the effect is small and statistically insignificant.     

Measuring systemic importance of financial institutions: An extreme value theory approach

This paper proposes a set of market-based measures on the systemic importance of a financial institution or a group of financial institutions, each designed to capture different aspects of systemic importance of financial institutions. Multivariate extreme value theory approach is used to estimate these measures. Using six big Canadian banks as the proxy for Canadian banking sector, we apply these measures to identify systemically important banks in Canadian banking sector and major risk contributors from international financial institutions to Canadian banking sector. The empirical evidence reveals that (i) the top three banks, RBC Financial Group, TD Bank Financial Group, and Scotiabank, are more systemically important than other banks, while we also find that the size of a financial institution should not be considered as a proxy of systemic importance; (ii) compared to the European and Asian banks, the crashes of the U.S. banks, on average, are the most damaging to Canadian banking sector, while the risk contribution to the Canadian banking sector from Asian banks is quite lower than that from banks in the U.S. and euro area; (iii) the risk contribution to Canadian banking sector exhibits “home bias”, that is, cross-country risk contribution tends to be smaller than domestic risk contribution.     

Corporate taxation and the efficiency gains of the 1986 Tax Reform Act

Summary The 1986 Tax Reform Act (TRA) had little effect on the overall U. S. effective capital income tax rate. However, TRA significantly reduced differences in effective taxation of corporate and noncorporate capital for a number of U. S. industries. The Mutual Production Model developed in Gravelle and Kotlikoff (1989) can be used to study the efficiency gains from the reduction in corporate tax wedges within industries. Unlike the Harberger Model, the Mutual Production Model permits both corporate and noncorporate firms to produce the same goods and, therefore, to coexist within a given industry.This paper develops an 11-industry-55-year dynamic life cycle version of the Mutual Production Model. We use this model to study the steady-state efficiency gains associated with the new law. While we do not simulate the economy's transition path, our steady-state welfare changes are those that arise from compensating transitional generations for the first-order redistribution of income associated with the Tax Reform.We find that the 1986 Tax Reform law reduces excess burden by 85 percent of our model's economy's present value of consumption. This efficiency gain reflects the Tax Reform's reduction in corporate-noncorporate tax wedges, particularly in those industries with significant noncorporate production. Measured as a flow the 1988 estimated efficiency gain from the Tax Reform Act is $31 billion.The opinions expressed in this paper are those of the authors and do not necessarily reflect the views of The Congressional Research Service of the Library of Congress, Boston University, or The National Bureau of Economic Research. We are particularly grateful to Alan Auerbach, Oldrich Kyn, and an anonymous referee for very extensive and critical comments. We also thank Don Fullerton, Yolanda Henderson, Tom Woodward, and a referee for their very helpful suggestions.     

Health and income inequality: attempting to avoid the aggregation problem

Attempts to test the relative deprivation hypothesis, that income inequality affects individual health, are subject to the aggregation problem. Waldmann (Quarterly Journal of Economics 107, 1992) ingeniously attempts to overcome the difficulty by using income data for the poor and the share of income accruing to the rich. The study finds that his results do not hold for a more recent data set and it suggests that his method may not overcome the aggregation problem.