Health spending in Italy: The impact of immigrants

The welfare impact of immigration is a highly debated issue especially for countries on the external borders of the European Union. This paper studies how immigrants affect public health expenditure across Italian regions during the period 2003–2016 using NUTS II level data. Identification strategy is based on shift–share instruments, which are made robust to pull factors that might attract immigrants in Italy and to internal migration of natives. We find that a 1 percentage point increase in immigrants over total resident population leads to a decrease in public health expenditure per capita by about 3.8% (i.e. around 69 euro per capita). Among possible channels, we find no support for any crowding out effect from public to private health services by natives due to increasing immigration or for any role played by different levels of efficiency across regional health systems. Our results are driven by immigrants' demographic structure: they are mostly males and younger workers that call for less health spending, according to a positive selection mechanism. Moreover, linguistic barriers contribute to limiting the immigrants' reliance on public healthcare, which is confirmed also by the use of the European Health Interview Survey microdata.     

US state health expenditure convergence: A revisited analysis

This paper studies the evolution of US state health expenditure for a sample that covers 1966–2014. Our results provide evidence against the existence of a single pattern of behavior of personal health care expenditure across the US states. Rather, we can observe the existence of two statistically different convergence clubs. We cannot find evidence of convergence when we disaggregate health expenditure into its three main payers: Medicare, Medicaid and private health insurance expenditure, whilst we again find evidence of convergence clubs. However, the estimated clubs for Medicaid and private health insurance expenditure are statistically different that estimated for total health expenditure. Consequently, our results offer strong evidence of heterogeneity in the evolution of US health expenditure. The analysis of the forces that drive club creation shows that economic situation and some supply-side factors are important. We can also appreciate that some healthcare outcome variables are only related to private insurance health expenditure. The other health expenditures, thus, show a certain lack of efficiency which may be due to practices that have little benefit for patient health.     

PUBLIC CAPITAL, PRODUCTIVE EFFICIENCY AND CONVERGENCE IN THE SPANISH REGIONS (1964–93)

This paper analyses the behaviour of productive efficiency in the Spanish regions for the period 1964–93. From a growth accounting approach, it describes the regional evolution of total factor productivity (TFP'), based on a private inputs production function. A stricter measure of efficiency is then quantified, which is not equivalent to Solow's residual, since public capital is included in the production function and constant returns to scale are not imposed. Finally, on the basis of the measures of total factor productivity and efficiency, the study discusses the existence of technological convergence among Spanish regions and the role played in it by public capital. The renewed interest in the analysis of the process of growth reflected in economic literature in recent years has also occurred in the case of the Spanish economy, with some peculiarities which are worth mentioning. In the 1980s, two important institutional changes took place: a profound political and administrative decentralization, the regions now being autonomous in many decisions on public expenditure, and the incorporation of Spain into the European Community, which as it is well known has a powerful regional policy. Both changes have meant that the analysis of regional economies, and especially their growth paths, have received much more attention from politicians and economists, and even from the population in general. In particular, intense discussion has taken place regarding the effects of development policies and on criteria for geographical distribution of infrastructures. In both cases, much attention has been paid to discussing their capacity to contribute to convergence among the different regions. As a consequence of this greater interest in the analysis of growth from a regional perspective, efforts have also been made to improve the relevant statistical information. In particular, statistical series have been drawn up for investment and accumulated capital stock in each region, both private and public.' This information, only recently available and the first of its kind, as far as we know, in the European regions, substantially broadens the possibilities of research into the Spanish case in this field, where before not even the simplest exercises in growth accounting could be attempted. Further-more, since the series now available allow the time dimension of growth analysis to be combined with the regional dimension, it is possible to work with a panel of data and apply the corresponding techniques. This article analyses the growth of the Spanish economy over the period 1964–93, during which it can be observed that the per capita income levels of the Spanish regions converged. The objective of the study is to evaluate this process of convergence in income from the perspective of the productive efficiency of the regions, in three different ways. First, Section I considers the importance of the contributions of the private factors of production and of improvements in total factor productivity to the growth of output. Secondly, section II studies the existing relationship between the standard measure of efficiency (Solow's residual or TFP') and a stricter measure when the endowments of public capital are considered. Section III analyses whether or not the convergence in per capita income     

Regional convergence clubs in Europe: Identification and conditioning factors

The aim of this paper is to empirically identify convergence clubs in per capita incomes of European regions and to investigate whether initial conditions − as suggested by the club convergence hypothesis − are responsible for club formation. To tackle this issue, we propose a two-step procedure in which we first endogenously identify groups of regions that converge to the same steady state level, and in a second step we investigate the role of starting conditions and structural characteristics for a region's club membership. Our sample comprises 206 European NUTS2 regions between 1990 and 2002. The results strongly support the existence of convergence clubs, indicating that European regions form six separate groups converging to their own steady state paths. Moreover, estimates from an ordered logit model reveal that the level of initial conditions such as human capital and per capita income plays a crucial role in determining the formation of convergence clubs among European regions.     

Converging trends in national health services and social health insurance systems

Despite the difficulties in comparing the problems and solutions in the European healthcare system reforms, this paper will emphasise that there are signs of convergence among them given the way that they respond to similar challenges. By observing recent developments in national health services and social health insurance systems the focus will be on common trends. They both appear to favour models of (i) greater decentralisation of responsibilities in managing insurance coverage, (ii) population-based mechanisms to finance providers and (iii) more extensive consumer choice and additional private finance.     

Risk adjustment and prevention

Abstract Widespread integration of market‐based incentives into healthcare systems calls for – and has elicited – increasing adoption of risk adjustment. By deterring selection, risk adjustment helps to assure fair and efficient payments among health insurers or capitated provider groups. However, since conventional risk adjustment allocates funds among regions or insurers according to current population health status, it does not reward – indeed, it penalizes – preventive efforts that improve population health. This prevention penalty of risk adjustment represents a hidden cost of unclear magnitude, undermining provider incentives for health promotion. We develop a theoretical model of selection and prevention demonstrating this problem with conventional risk adjustment and suggesting a simple alternative: risk adjustment should be linked to pay‐for‐performance for prevention.     

Estimating the speed of adjustment of European banking efficiency under a quadratic loss function

This paper investigates the speed of adjustment of cost efficiency to equilibrium level in the European banking industry. Our analysis provides for the first time insights into the process of convergence across European banking markets as measured by the speed of adjustment of cost efficiency. In particular, we employ a quadratic loss function specification based on forward-looking rational expectations to model the underlying dynamics of efficiency scores in the banking industry of the EU-15 region over the period 1998–2005. Results show that there is considerable variation in the speed of adjustment across banking systems, while over time it appears that continuing efforts to advance financial integration have led to some improvement in the speed of adjustment to the long-run equilibrium.     

基于空间效应的科技企业孵化器运营效率俱乐部收敛研究

科技企业孵化器在区域间的互动既有利于孵化器运营效率提升,同时又给各地孵化器运营带来新机遇和新挑战。在考虑空间效应情形下,科技企业孵化器运营效率是愈发极化还是更加趋同值得探究。构建Super-SBMDEA模型,测量中国内地29个省份2016—2019年国家级科技企业孵化器运营效率,采用探索性空间分析法探究科技企业孵化器运营效率的空间分布收敛情况。结果发现：中国大多数省份科技企业孵化器运营处于有效状态,效率分布呈现“东高西低”特征。中国整体组和L—L组运营效率呈收敛趋势,但空间效应不显著;H-H组和H-L组运营效率呈收敛趋势,且空间效应显著;L-H组收敛趋势不明显。研究结论表明在空间效应情形下,科技企业孵化器运营效率呈现整体收敛和多稳态趋同的特点。     

Club convergence analysis of regional ecological efficiency in China

This paper adopts a network data envelopment analysis (DEA) model combined with a window analysis approach to evaluate the ecological efficiency (eco‐efficiency) of 30 regions in China over 2000–2015. We also investigate the existence of eco‐efficiency convergence clubs among these regions and analyse the important factors that drive eco‐efficiency club formation. Our results reveal that, overall, Chinese regional eco‐efficiency deteriorated from 2000 to 2015. We find that there is a significant regional disparity in eco‐efficiency. Our convergence analysis indicates that Chinese regions converge into three eco‐efficiency clubs, suggesting that common economic and environment policies might have a limited impact on promoting regional eco‐efficiency and regionally‐tailored policies need to be designed. Finally, we find that forest coverage, R&D expenditure and pollution punishment are important determinants of convergence club membership.     

Translating European regulatory approval into healthcare uptake for biosimilars: the second translational gap

ABSTRACT

With 15 biosimilar molecules in 9 different molecular classes and currently marketed under 23 distinct brands, the European pathway for regulatory approval of biosimilars has been demonstrably tried and tested. The gap that now remains is the translation from regulatory assessment and approval to incorporation of biosimilars within our healthcare systems in Europe. Despite many efforts by regulators to reach out to clinicians, there remains a translational gap for biosimilars which need to be incorporated in healthcare pathways and understood by clinicians and patients. Only by bridging this gap will biosimilars fully play their role in healthcare for Europe.     

欧盟《患者跨境医疗权利指令》实施及其借鉴

提升欧盟成员国卫生体系的协同效应,解决共同面临的健康挑战,是欧盟卫生体系一体化发展的重要目标。2013年10月,欧盟所有成员国通过了《患者跨境医疗权利指令》的法律,并在全欧盟范围内正式生效并实施。该指令针对患者的权利做了一些调整,扩大了医疗服务范围,提出了报销原则、成员国职责和创新性措施,如,建立国家联系点,改善各国电子医疗系统,促进各国卫生技术评估,促进各国医疗产品使用和处方的互认,以及促进开发和建立欧洲参考网络等。该指令旨在通过促进成员国合作组织和提供医疗服务,为欧盟公民提供安全、高质的跨境医疗服务。中国与欧盟社会管理体系虽然不同,但该法令在立法过程、实施原则和具体措施等方面,对我国正在实施的医药卫生体制改革有所借鉴。     

Technological change,efficiency gains and capital accumulation in labour productivity growth and convergence: an application to the Spanish regions

The main objective of this article is to analyse labour productivity growth and convergence in the Spanish regions between 1965 and 1995, decomposing total factor productivity gains into technological progress and efficiency change by means of Malmquist productivity indices. On the basis of this decomposition, labour productivity growth is broken down into components attributable to technological change (shifts in the frontier), efficiency gains (movements toward the frontier) and capital accumulation (movements along the frontier). The approach followed in this study is based on work initiated by Färe et al., where a link between the economic growth and convergence literature and the production frontier approach was established. Furthermore, in the spirit of Quah's approach, the evolution of the whole distribution is considered. Thus, the analysis of the dynamics of the entire distribution of labour productivity and the factors behind it – technological progress, efficiency gains and capital accumulation – combine both approaches, yielding new insights into the process of productivity growth and convergence experienced by the Spanish regions over the last 30 years.     

A pair-wise approach to output convergence between European regions

We apply the Pesaran (2007) pair-wise approach of convergence to the per capita outputs of 195 European regions for the period 1980-2006. Pesaran's approach is based on the computation of the percentage ratio of output gaps which fulfil a given convergence criterion. A high ratio will be interpreted in favour of convergence. In a first step, we define stochastic convergence between two regions as level stationarity of their output gap. Deviations from its equilibrium value will only have a temporary effect. Results from several usual unit root or stationarity tests show us that the percentage ratio of level stationary output gaps is low, which stands against this definition of convergence. However, this convergence criterion excludes the possibility of changes in output gap equilibrium value or catching up between regions. To fit these cases, we combine the pair-wise approach with unit root or stationarity tests with structural breaks. Structural breaks are modelled by dummies (Zivot and Andrews, 1992; Kurozumi,2002) or as smooth structural breaks (Christopoulos and León-Ledesma, 2009). Overall results are not changed as convergence is not accepted more often. Finally, we consider the autocorrelation function approach of Caggiano and Leonida (2009). Autocorrelations and their confidence intervals are estimated for each output gap. Convergence between two regions is accepted if their per capita output gap autocorrelations become nonsignificantly different from zero after some lag. Results show that a high percentage of regions satisfy this convergence criterion. Contrary to the conclusions which could be made from previous results, shocks to output gaps seem to disappear as time passes.     

A rank order and efficiency evaluation of the EU regions in a social framework

In this paper, methods of multi-criteria efficiency evaluation are implemented for ranking the socio-economic systems of the EU regions. The socio-economic rank order problem is a multi-criteria non-convex optimization problem that was solved by the implementation of a new efficiency evaluation, AOWI (Absolute Optimal Weights Index). The rank order of the 268 NUTS-2 regions from the 27 European Union countries in the social framework obtained on the basis of 16 socio-economical indicators illustrates social divergence within the European Union and in the new European Union regions.     

中国区域绿色创新效率收敛性研究

将环境污染、创新失败因素列为非期望产出指标,运用2006—2016年中国内地30个省份面板数据,构建SBM—DEA模型对中国绿色创新效率及其区域差异进行测算,进而采用σ收敛模型、绝对β收敛模型、条件β收敛模型考察中国区域绿色创新效率的收敛性。结果表明：中国区域绿色创新效率整体上呈现上升趋势,但存在较大区域差异,东部地区绿色创新效率远高于中、西部地区;全国及东、中、西部地区绿色创新效率均不存在明显的σ收敛,但存在显著的绝对β收敛和条件β收敛,且影响收敛的显著性因素各不相同。     

Streamlining regulatory compliance through clinical systems

The Joint Commission states that its mission is "to continuously improve the safety and quality of care provided to the public through the provision of healthcare accreditation and related services that support performance improvement in healthcare organizations.... Accreditation is a risk-reduction activity; compliance with standards is intended to reduce the risk of adverse outcomes" (JCAHO, 2003). The focus of JCAHO is not much different from that of every health care organization. Clinical information systems should be employed to help deliver safer, more efficient patient care, and at the same time ensure that health care organizations achieve regulatory compliance.     

Economic Growth and Convergence of EU Member States: An Empirical Investigation

The aim of this article is to construct a European production frontier using deterministic methods, and to break down growth and convergence during the period 1980–2001. The results show that EU growth is primarily driven by physical and human capital accumulation, the contribution of which is essential for the cohesion of European countries. We find capital accumulation and efficiency change to be important convergence factors within the EU, while technical change has worked against it. The approach used has also enabled us to analyze the differences in growth performance of Member States and highlight the role of human and public capital, supporting the European cohesion and development policies carried out in this period.     

Spatial heterogeneity and interregional spillovers in the European Union: Do cohesion policies encourage convergence across regions?

Using a spatial econometric perspective, the speed of convergence for a sample of 163 regions of the European Union (EU) over the period 1981–1996 is estimated. For this purpose, we use a specification strategy which allows an explicit modeling of both spatial heterogeneity and spatial autocorrelation found in the analyzed sample. The estimated final model combines groupwise heterocedasticity, the identification of two spatial regimes and spatial dependence. Our results show how an appropriate consideration of the role of spatial effects can shed new insights into the European convergence process. We find that regions in the EU cohesion-fund countries (Ireland, Greece, Portugal and Spain) are converging separately from the rest of regions of the EU. Our estimations indicate that over the analyzed period, there was a faster conditional convergence in relative income levels of the regions belonging to Cohesion countries (5.3%) than in the rest of the regions of the EU (3.3%). Therefore, our results contrast with other evidence that points to the fact that the convergence process in Europe has weakened or even has stopped at the beginning of the 1980s. Moreover, our work shows clear evidence of separate spatial convergence clubs among EU regions.     

FISCAL CONVERGENCE IN THE EUROPEAN UNION BEFORE THE CRISIS

This article investigates fiscal convergence attained by EU countries in the period 1991–2008, by employing β‐ and σ‐convergence techniques complemented by a time series analysis. Overall our results highlight a distinctive convergence pattern in the European Union. Fiscal discipline leading to a fast convergence of deficit/GDP ratio over the 1990s markedly weakened in the following decade. Nonetheless, after the Euro debut a pronounced convergence in total revenue and total government spending emerges, with different patterns characterizing each expenditure component. Despite this evidence of fiscal harmonization, European treaties failed to attract countries toward a common share of government debt over GDP. (JEL E61, H11, C23)     

Productivity comparison of European airlines: bootstrapping Malmquist indices

The study explored the operating efficiency and variability of productivity estimates of European airlines. We applied Malmquist productivity indices (MPI) with a bootstrap method to assess the productivities of European airlines in four regions in Europe. The productivity of small-sized airlines lagged further behind that of large-sized airlines because of their inferior technological change (TC) effects derived from inefficient resource allocation to sustain a competitive advantage. This study also indicated that the Western European airlines were more efficient on average than those in other areas of Europe. The applications of Malmquist productivity techniques in assessing the performance of European airlines are highlighted in their effective resource allocation, sustained competitive advantage and optimized operating performance.