Technological change in health care: Why are opinions so divided?

This paper purports to explain the widespread scepticism towards technological change in health care in general and pharmaceutical innovation in particular in the face of very high estimated rates of social return. These estimates are based on observable market prices and quantities, which are used for measuring the additional consumer surplus induced by an innovation. They grossly overstate true surplus due to the effect of insurance, however. For true demand for health care services and hence true surplus depends on the net price a patient is willing to pay, which is a rather small fraction of observed market price. The paper also outlines the conditions under which a health insurer would welcome a pharmaceutical innovation.     

Competition in Regulated Markets with Sluggish Beliefs about Quality

We investigate the effect of competition on quality in regulated markets (e.g., health care, higher education, public utilities), using a Hotelling framework, in the presence of sluggish beliefs about quality. We take a differential‐game approach, and derive the open‐loop solution (providers choose the optimal quality investment plan based on demand at the initial period) and the feedback closed‐loop solution (providers observe demand in each period and choose quality in response to current demand). If variable costs are strictly convex, and the degree of cost complementarity between quality and output is not too strong, the steady‐state quality is higher under the open‐loop solution than under the feedback solution. In both solutions, quality and demand move in opposite directions over time on the equilibrium path to the steady‐state. While lower transportation costs or less sluggish beliefs lead to higher quality in both solutions, the quality response is weaker when players use feedback strategies.     

Hospital performance standards and medical pricing: The impact of information disclosure in cardiac care

A policy concern is that the initiation of Hospital Compare (HC) reporting in Medicare provided leverage to insurers in price negotiations for lowering private sector prices without regard to hospital performance. Using the sequential Nash bargaining framework we provide economic intuition to the contrary: while average hospital prices decline under quality disclosures, hospitals with above‐average quality are able to exert a stronger bargaining position, consequently capturing prices above the market rate. To explore this issue empirically we estimate variants of difference‐in‐difference models, examining the effects of the three main scores (heart attack, heart failure, and combined mortalities) on transaction prices of related hospital procedures. States which had similar mandated reporting systems in place before the initiation of HC form the control group. Analyzing claims data of privately insured patients, we find that HC exerted downward pressure on prices. However, hospitals rated “above‐average” captured higher prices, thereby offsetting the overall policy effect fully or partially. Leads and lags analysis lends further support for our difference‐in‐difference approach. We find that highly ranked hospitals received a quality premium of 8–14%, comparable to price effects found in other health care markets. We conclude that HC was effective at constraining prices without penalizing high performers.     

Diverging trends in health care use between 2010 and 2016: Evidence from three groups of transition countries

This paper investigates changes in health care use in 28 transition countries using data on more than 60,000 households from the “Life in Transition” surveys II and III conducted in 2010 and 2016. Following the literature, the transition countries are divided into three groups – Eastern Europe, Southern Europe and the non-Baltic states of the former Soviet Union with Mongolia – based on the speed of their transformation. Regressions based on Andersen’s conceptual framework show no difference in public health care use between the three groups in 2010. By 2016, however, the share of households using the public health care system dropped by remarkable 17.1–22.2% points in Southern Europe and 13.5–27.1% points in the former Soviet Union with Mongolia compared to Eastern Europe. Moreover, by 2016, the probability of a household using the private health care system (with no use of public health care) in Southern Europe and the former Soviet Union was 7.5–18.7% points higher than in Eastern Europe, whereas it was 2.9–6.8% points lower than in Eastern Europe back in 2010. The analyses indicate that differences in household characteristics, as well as perceived corruption and quality of public health care, help to understand these diverging trends in health care use in the three groups of transition countries between 2010 and 2016.     

Concordat or contract

The New Labour Government in England is seeking to promote public/private partnerships in health and social care as a key component of its political project. This article reports the findings from the first phase of an ongoing qualitative research study exploring the relationship between a private sector company and their public sector partners at four study sites. These findings indicate that organizations within the NHS do not view the development of public/private partnerships as a priority and furthermore currently have a limited ability to engage in strategic planning with the private sector. The findings are explored in the broader context of the evolution of ‘managed competition’ in health care systems and the role of partnership in that process.     

Shifting from Undersupply to Oversupply: Does NHS Workforce Planning Need a Paradigm Shift?

The National Health Service in England is currently halfway through the most austere decade in its history. Finding ways to improve health care efficiency is crucial to ensure the sustainability of the health system. While evidence of supply‐induced demand (SID) has often been used as an economic argument to restrict labour supply, in the UK the risks of SID may be much less than in health care systems with more deregulated entry into the market post‐qualification and with fee‐for‐service payment systems. This article focuses on the problem of staff shortages in nursing. We argue that, although an oversupply of some types of labour can add to cost pressures by increasing demand for health care services and that the cost of training staff is high, undersupply and poor labour planning lead to unintended consequences such as poor labour productivity. As a result there is a case for public policy to target an oversupply of nurses in the future. If government reforms to nurse funding help, they are to be welcomed.     

Opt Out or Top Up? Voluntary Health Care Insurance and the Public vs. Private Substitution

We investigate whether in a mixed insurance system, people enrolled into voluntary health care insurance (VHI) substitute public consumption with private (opt out) or just enlarge their private consumption without reducing reliance upon public provisions (top up). We specify a joint model for public and private specialist visits counts, allowing for different degrees of endogenous supplementary insurance coverage. We find evidence of opting out: richer and wealthier individuals consume more private services and concomitantly reduce those services publicly provided through selection into for‐profit VHI. Accounting for VHI endogeneity in the joint model of the two counts is crucial to this conclusion.     

浅谈民营医院的声誉问题

民营医院作为公立医院的补充,其存在是必要的。但是随着医疗市场的发展,民营医院的经营出现了问题,民众对于其信任感大大降低,声誉面临极大的挑战。本文分析了民营医院存在的一些声誉问题,并提出了一些解决措施。     

A low quality–high cost–low satisfaction trap in public health care: a model and an efficiency-quality-welfare improving stochastic resolution

This paper develops an applied stochastic model of public health care and shows that the public health care sector in Turkey is plagued by a low quality–high cost–low satisfaction trap which has been persistent over time. The values in question are shown to be stochastically stable. We formulate an efficiency-quality-welfare improving stochastic policy rule, which helps the sector to reach a selected target and which stabilizes quality, cost and welfare around that target.     

The Effect of Performance Standards on Health Care Provider Behavior: Evidence from Kidney Transplantation

Performance standards are designed to ensure a basic level of quality, and through public reporting of firm performance, encourage firms to compete on quality thus allowing the market to determine the optimal level of quality. In markets with substantial excess demand, however, demand effects may be insufficient to induce any change in firm behavior and enforcement may be required to ensure high quality. Even with enforcement, quality still may not improve at underperforming firms if gaming the system is less costly than improving quality. We test whether information alone or with regulatory enforcement improves outcomes or elicits gaming behavior in our study of 266 kidney transplant centers between 2001 and 2012. In a context of excess demand induced by price controls, we show that information alone has no impact and enforcement may actually increase market inefficiencies; firms respond to costly quality requirements, not by improving quality, but by reducing supply, which exacerbates the disequilibrium between supply and demand, and by cream‐skimming, which reduces access to transplantation among sicker patients.     

Share,price and category expenditure—geographic market effects and private labels

Focusing on the interaction between national brands and private labels, this paper has two main empirical contributions: (i) a simultaneous system of demand (share), price and expenditure equations is estimated, and (ii) differences in the structure of the local geographic market are incorporated into the analysis. The former represents an important step in understanding the complete nature of private label and national brand interaction, while the latter is important for understanding the impact of the local retail environment on market behaviour. IRI scanner data from 1991 and 1992 are used to estimate a five‐equation system across 135 food product categories and 59 geographic markets. The results suggest that concentration at both the manufacturer and retailer level can significantly affect private label and national brand price. However, while increased retailer concentration is associated with higher national brand and private label prices, higher manufacturer concentration is associated with higher national brand but lower private label prices. Increases in national brand advertising has the effect of raising national brand price and share, but lowering private label price and share. This is consistent with previous research and suggests that advertising and local market conditions play a significant role in the ability of national brands to price at a premium over private labels. Finally, marketing decision variables, such as display activity and private label distribution, can have an important impact on total category expenditure. Copyright © 1999 John Wiley & Sons, Ltd.     

EFFECT OF CROSS‐BORDER HEALTH CARE ON QUALITY AND PROGRESSIVITY OF FINANCING

In this study, we examine the effect of cross‐border health care in terms of public health insurance. We consider its effect on healthcare quality and progressivity of financing. We use a two‐country Hotelling model in which consumers are divided into two groups: high and low innate‐talent consumers. Aiming to maximize social welfare, governments impose a progressive income tax on consumers to provide healthcare services. Assuming that a payment scheme for healthcare services is based on diagnosis‐related group pricing, which has been adapted in many countries, we obtain the following results. The promotion of cross‐border health care does not influence healthcare quality or the progressivity of financing in patient‐importing countries, but does reduce healthcare quality and influence the progressivity of financing in patient‐exporting countries.     

重大突发公共卫生事件背景下企业捐赠对股价的影响——基于企业异质性的分组检验

以2020年沪深A股上市公司为样本,探讨在重大突发公共卫生事件暴发后企业捐赠对股票价格的影响,并分别从公司自身性质（产权性质、行业性质）、内部特征（内部控制质量、信息披露质量）、外部环境（产品市场竞争、所在地区疫情严重程度）三个维度研究捐赠发挥的作用效果是否会因企业异质性而存在显著差异。实证结果显示,在重大突发公共卫生事件背景下,企业捐赠对股票价格有显著正向影响。进一步研究发现,此关系会受到企业异质性的影响。具体而言,国有企业、受疫情负面影响严重行业的企业、内部控制质量低的企业、信息披露质量低的企业、疫情严重地区所在企业、产品市场竞争度高的企业,捐赠对股价的提升作用不显著。     

The Macro Impacts of Public Resold Dwellings on Private Housing Prices in Singapore

In Singapore, the public resale housing market is an actively traded public owner occupier housing market succeeding to the heavily regulated new public owner occupier housing sector, in which the new public housing units are sold at a heavily subsidized price. The resale market was originally aimed at facilitating consumer housing choices and harnessing the greater efficiency of market mechanism in the delivery of public housing. However, it also became a vehicle for many Singaporeans to upgrade to private housing. This raises the concerns of its impacts on the private housing market as well as the equitable distribution of public resources. This paper first analytically reviews the retrospect of Singapore housing system, then empirically studies the impacts of public resold dwellings on the private housing prices, probing the links between the public resale market and the private housing market as well as the implications on the equitable distribution of public resources.     

Diaries from the front line—Formal supervision and job quality among social care workers during austerity

Focusing on social care workers in public, private and voluntary sectors, this article contributes to research on the impact of austerity on public service human resource management (HRM). The article uses an innovative diary method to highlight the importance of intrinsic elements of job quality such as supervision practice in mitigating degradation in extrinsic elements as austerity dismantles public service HRM. The article also reports that supervision has itself come under pressure due to resource shortages. The results regarding sub‐sector differences have implications for policy‐makers and practitioners in terms of rebuilding the standard employment relationship in social care so that they are more sensitive to differences across private, public and voluntary sectors.     

Under pressure: community water systems in the United States—a production model with water quality and organization type effects

This paper examines the interaction of productive efficiency, water quality and organizational type. A water quality index is constructed employing various contaminants which are then treated together with variables including organizational type as endogenous in an input distance function model. The cost of drinking water quality and inefficiency are derived and hypothesis tests estimated concerning their variation by location, organization type and water quality. The key findings are that more technically efficient water utilities deliver higher quality drinking water and that private firms distribute higher quality water at a higher price and at a higher implicit cost than public utilities despite no overall inefficiency differences between the two organizational types.     

The utilization of diagnostic tests among the elderly: Evidence from Malaysia

Diagnostic test plays a major role in reducing the prevalence of non-communicable diseases (NCDs). The present study examines the relationships between the utilization of diagnostic tests and socioeconomic, insurance, lifestyle, and health factors among the elderly in Malaysia. Analyses based on the National Health and Morbidity Survey 2011 (NHMS 2011) suggest that high income and having private insurance are associated with a higher likelihood of utilizing diagnostic tests. However, low education levels, being employed and smoking are associated with a lower propensity to utilize. These results provide public health administrators with useful information on policy development. In particular, the proposed policies include providing the poor with nominal price of basic diagnostic tests, introducing various health education programmes to the public, creating health awareness campaigns to encourage elders who do not own private insurance to utilize diagnostic tests, as well as making basic diagnostic tests compulsory for all elders owning government insurance.     

城市经济与交通结构互动关系研究

经济总量和居民收入的提高,一方面为城市加快交通建设提供了必要的物质基础:另一方面也引发交通需求在数量和质量上均发生了深刻的变化。现阶段居民用于交通方面的支出逐年提高,通勤以外非基本出行的需求迅速增加,对交通服务的要求也越来越高。本文通过对经济发展与私人交通、经济发展与公共交通两方面阐明城市经济与交通结构的互动关系,为寻求城市发展与交通发展之间的协调机制,逐步建立适宜的交通结构目标奠定理论基础和可能的技术途径。     

Optimal road capacity in the presence of unpriced congestion

This paper studies how the optimal capacity of a road is affected by a pricing constraint which keeps the toll fixed below its optimal value. The answer is found to depend on the value of the price elasticity of travel demand at the second-best optimum. The pricing constraint lowers the optimal capacity, if the price elasticity is sufficiently high. But under reasonable assumptions, the pricing constraint raises the optimal capacity, if the price elasticity is less than the ratio of the consumer price of travel to the private congestion cost at the second-best optimum. This ratio cannot be less than one.     

Performance Indicators for Quality with Costly Falsification

Performance indicators are increasingly used to regulate quality in health care and the public sector. We develop a model of contracting between a purchaser and a provider under the following assumptions: (a) providers have private information about their own ability and (b) they can engage in costly manipulation of quality measures. If the contract is separating, manipulation reduces the optimal quality effort but increases the quality targets. If the purchaser's benefit from quality is sufficiently concave, then pooling of high-ability types (or all types) turns out to be optimal. (Partial) pooling provides a rationale for quality ceilings and minimum quality standards.