AN EVALUATION OF FINANCIAL INCENTIVE POLICIES FOR ORGAN DONATIONS IN THE UNITED STATES

This paper examines the association between financial incentives and organ donations. Although the National Organ Transplant Act of 1984 prohibits financial compensation for organs for transplant, we focus on the impact of laws that influence the relative cost of deceased and live organ donations on the supply of organs for transplant. First, we hypothesize that states that have relatively stringent funeral regulations, which have been associated with higher whole‐body donations, will have fewer organ donations. Second, we examine the impact of two common state laws that offer financial compensation to live donors: one that allows a tax deduction for costs incurred and the other which entitles government employees up to 30 days of paid leave. We find no evidence to support that these laws affect organ donations. (JEL I11, I18)     

Cost-effectiveness achieved through changing the composition of renal replacement therapy in Japan

Abstract

Objective:

The cost-effectiveness of renal replacement therapy (RRT) is affected by the composition of treatment. This study aimed to estimate the costs and outcomes associated with changing the composition of RRT modality over time.

Methods:

By using clinical and cost data from a systematic review, a Markov model was developed to assess the costs and benefits of the four main treatments available for RRT in Japan. The model included direct health service costs and quality-adjusted life years (QALY). Sensitivity analyses were performed to assess the robustness of the results.

Results:

Over the 15-year period of the model, the current composition of RRT (i.e., the base composition of RRT) was $84,008/QALY. The most cost-effective treatment was when the likelihood of a living donor transplant was increased by 2.4-times ($70,581/QALY). Compared with the base composition of RRT, dominant treatments with respect to cost-effectiveness were when the likelihood of a deceased donor transplant was increased by 22-times and when the likelihood of a pre-emptive living donor transplant was increased by 2.4-times. Little difference was found between these two treatments. One-way sensitivity analysis did not change the cost effectiveness except for costs of chronic hemodialysis and a living donor transplant in subsequent years.

Limitations:

It is difficult to increase the rate of transplant overall in the shorter term nationally and internationally.

Conclusions:

Appropriate distribution of all transplant options and hemodialysis is necessary to achieve the most cost-effective solution.     

Kidney exchange: An egalitarian mechanism

Kidney exchange programs utilize both deceased-donor and live-donor kidneys. One of these programs, a two-way kidney paired donation (KPD), involves two patients exchanging their live donors? kidneys. Another possibility is a list exchange (LE): a living incompatible donor provides a kidney to a candidate on the deceased-donor waitlist and in return the intended recipient of this donor receives a priority on the waitlist. By taking into consideration the fact that transplants from live donors have a higher chance of success than those from cadavers, we characterize the set of efficient and egalitarian exchanges involving the KPD?s and LE?s.     

A time-series analysis of the U.S. kidney transplantation and the waiting list: donor substitution effects

This article provides an econometric analysis of the relationship between live and deceased (cadaveric) kidney donations in the United States for the period 1992:IV–2006:II. Utilizing a cointegration representation and impulse-response analysis, we find strong evidence for deceased donor kidneys “crowding out” living donations, potentially undermining conventional efforts to reduce the shortage.     

KIDNEY TRANSPLANTS AND THE SHORTAGE OF DONORS: IS A MARKET THE ANSWER?

This article examines the problem of kidney shortages for transplant in the United States. Following a study by Kaserman and Barnett, we reexamine the viability of allowing a market for cadaveric kidneys and estimate the implied equilibrium price based on our survey responses. In sharp contrast to the findings of Kaserman and Barnett, we estimate that a market equilibrium price for cadaveric kidneys may be prohibitively high. Consequently, we support other policy alternatives to increase supply, particularly presumed consent and mandated choice. Our findings also highlight the importance of obtaining data through experiments, rather than a survey, to estimate the impact of financial incentives. ( JEL I18, I12, I00)     

Optimal production of transplant care services

Most organ transplants are from dead donors. National transplant organizations exhibit considerable differences in terms of their donor population rates. Spain's organization is by far the most efficient in this respect. We argue that much of the productivity advantage of Spain's transplant organization proceeds from an efficient organization of the production chain, from organ procurement to transplantation. Transplants from dead donors are analogous to a common resource for the transplant community. Their circulation through the national transplant organization creates public good externalities between the care units in charge of organ retrieval and those in charge of transplantation. A socially efficient production of transplant care services obtains through an optimal control, by the national transplant agency, of both the circulation and the production of transplants. In particular, transplant shortage makes the rotten kid theorem fail in this context. The analysis also produces a natural measure of public good externalities, evaluated from the standpoint of care units.     

HOW ENDAs EXTEND THE WORKWEEK: LEGAL PROTECTION AND THE LABOR SUPPLY OF BEHAVIORALLY GAY MEN

Employment Nondiscrimination Acts (ENDAs) have received much political attention in the recent past. Despite the political attention, very little research has investigated the impact of ENDAs. I analyze the impact of ENDAs on labor supplies, which is under‐researched in the policy analysis literature. My work is the first to investigate the labor supply patterns of behaviorally gay men using data that are representative of the entire behaviorally gay population. I show that ENDAs motivate behaviorally gay men to work roughly 15–20 h more per week and increase the probability that behaviorally gay men will supply any labor by approximately 7%. These results suggest that ENDAs increase the labor supply of behaviorally gay workers by increasing workplace tolerance of homosexuality. (JEL J2, J7, J1)     

Transplant quality and patients? preferences in paired kidney exchange

Paired Kidney Exchange (PKE) programs solve incompatibility problems of donor-patient pairs in living donor kidney transplantation by arranging exchanges of donors among several pairs. Further efficiency gains may emerge if the programs consider the quality of the matches between patients and donors. Limitations on the number of simultaneous required operations imply that every efficient PKE program introduces incentives for the patients to misreport how they rank the option of remaining in dialysis with respect to the available kidneys. Truthfully revealing their preferences is however, the unique protective (lexicographic maximin) strategy for patients under pairwise exchange maximizing PKE programs.     

Pairwise kidney exchange

The literature on exchange of indivisible goods finds natural application in the exchange of live donor kidneys for transplant. However, in kidney exchange, there are constraints on the size of exchanges. Initially, kidney exchanges are likely to be between just two patient-donor pairs. We show that, although this constraint eliminates some potential exchanges, there is a wide class of constrained-efficient mechanisms that are strategy-proof when patient-donor pairs and surgeons have 0-1 preferences. This includes deterministic mechanisms that accommodate the priority setting that organ banks currently use to allocate cadaver organs, and stochastic mechanisms that allow distributive justice issues to be addressed.     

FACTORS AFFECTING THE LABOR SUPPLY DECISIONS OF REGISTERED NURSES

We estimate the labor force participation and the full‐time and part‐time work decisions of female registered nurses (RNs) and find higher wages are not a significant factor to (a) increase the likelihood of working nor (b) to encourage full‐time work. Another key factor is age which, given the aging of the RN population, foreshadows dwindling labor supply. This, while demand for RNs is predicted to continue to rise, will exacerbate labor shortages in the market for RNs. The results also offer insight to explain the reduction in labor supply wage elasticities for female workers in general in the United States. (JEL I11, J22, J44)     

THE ASSOCIATION BETWEEN PHYSICIAN SUPPLY AND THE MIX OF GENERALIST AND SPECIALIST SERVICES USED

Variations in physician supply, and the impact on a patient's use of physicians, remains a concern. This article asks how the supply of physicians is associated with both the number of visits and the dollar value of services received from general practitioners and specialists. Ontario respondents in the Canadian Community Health Survey 2000/2001 are linked to their Ontario Health Insurance Program claims for 3 years (1999–2002). A geographic weighting method is employed to account for physician supply in surrounding jurisdictions. The results are consistent with the conclusion patients substitute one physician type for another when physician supply is constrained. (JEL I10, I12, C29, C39, C52)     

Need,Merit, or Self‐Interest—What Determines the Allocation of Aid?

Previous studies of aid allocation have concluded that foreign aid is allocated not only according to development needs but also according to donor self‐interest. We revisit this topic and allow for donor‐ as well as recipient‐specific effects in our analysis. In addition to comments on the statistical significance of our results we assess the relative economic importance of recipient need, merit, and donor self‐interest. Our results indicate that all bilateral donors allocate aid according to their self‐interest and recipient need. However, most bilateral donors seem to place little importance on recipient merit. Less than 1% of the variance of aid is accounted for by merit, ceteris paribus. The UK and Japan are exceptions: they allocate more aid to countries with higher growth, higher democracy scores, and fewer human rights abuses.     

Income splitting, specialization, and intra-family distribution

Abstract Income splitting for tax purposes results in more specialization of wives, but does this in turn generate more gender inequality? In my dynamic bargaining model with a divorce threatpoint, I find that who controls the couple's labour supply plays a crucial role in establishing this link. If spouses choose their labour supply non‐cooperatively, only the husband's increase – but not her own decrease – in labour supply introduces a negative term in the wife's change in welfare. If the wife does not control her own labour supply, a decrease in her own labour supply introduces an additional negative term.     

The Comparative Statics of Effective Demand

Keynes introduces the term ‘effective demand’ in Chapter 3 of the General Theory as designating the point of intersection of two functions: the ‘aggregate demand function’ (D) and the ‘aggregate supply function’ (Z). For the first time in the literature, I here use specific functional forms for the D and Z functions and run numerical simulations which allow study of the comparative statics of the model in the face of various ‘shocks’. The demonstration of how the D/Z model actually works will hopefully prove useful for future students of the economics of Keynes.     

Your development or mine? Effects of donor–recipient cultural differences on the aid-growth nexus

Development aid from the West may lead to adverse growth effects in the global South due to the neglected cultural differences between development aid (paradigm) providers and recipients. I test this hypothesis empirically by augmenting an aid-growth model with proxy variables for cultural differences between donors and recipients. First, I use donor–recipient genetic distance, i.e., blood types, to capture the traditional way of cultural transmission. Second, I use western education of recipient country leaders to capture resource-based transmission of culture. Results of the OLS panel estimation in first differences show that a one unit increase in donor–recipient genetic distance reduces the main effect of aid on growth by 0.2 percentage points when aid is increased by one percentage point. In turn, a one percentage point increase in aid yields on average a 0.3 percentage point increase in growth after a decade for countries with western educated leaders.     

Medical resource utilization and costs among Australian patients with genotype 1 chronic hepatitis C: results of a retrospective observational study

Objective: To evaluate medical resource utilization (MRU) and associated costs among Australian patients with genotype 1 chronic hepatitis C (GT1 CHC), including both untreated patients and those receiving treatment with first-generation protease inhibitor-based regimens (telaprevir, boceprevir with pegylated interferon and ribavirin).

Methods: Medical records were reviewed for a stratified random sample of GT1 CHC patients first attending two liver clinics between 2011–2013 (principal population; PP), supplemented by all GT1 CHC patients attending one transplant clinic in the same period (transplant population; TP). CHC-related MRU and associated costs are reported for the PP by treatment status (treated/not treated) stratified by baseline fibrosis grade; and for the TP for the pre-transplant, year of transplant and post-transplant periods.

Results: A total 1636 patients were screened and 590 patients (36.1%) were included. Comprehensive MRU data were collected for 276 PP patients (F0–1 n?=?59, F2 n?=?58, F3 n?=?53, F4 n?=?106; mean follow-up?=?17.3 months). Thirty-eight (13.8%) were treatment-experienced prior to enrolment; 55 (19.9%) received triple therapy during the study. Data were collected for 112 TP patients (mean follow-up?=?29.9 months), 33 (29.5%) received a transplant during the study, and 51 (45.5%) beforehand. The annual direct medical costs, excluding drug costs, were higher among treated PP vs untreated PP (AU$: $1,954 vs $1,202); and year of transplant TP vs pre-/post-transplant TP (AU$: pre-transplant $32,407, transplant $155,138, post-transplant $7,358).

Limitations: To aid interpretation of results, note that only patients with GT1 CHC who are actively managed are included, and MRU data were collected specifically from liver outpatient clinics. That said, movement of patients between hospitals is rare, and any uncaptured MRU is expected to be minimal.

Conclusions: CHC-related MRU increases substantially with disease severity. These real-world MRU data for GT1 CHC will be valuable in assessing the impact of new hepatitis C treatments.     

DYNAMIC ENTRY WITH DEMAND AND SUPPLY SIDE SPILLOVERS

Supply side spillovers have been used to explain firms' entry behavior in the pharmaceutical industry. In contrast, demand side spillovers have received less attention. This paper identifies supply and demand spillovers using a dynamic model of strategic interaction. The results indicate that demand side spillovers are more significant than the supply side spillovers to generic drug firms, and the demand side spillovers increase a firm's market share by 3%–4% on average in subsequent market entry. In addition, with supply side spillovers alone, lowering entry barriers can increase future entry rates, while in the case of demand side spillovers, lowering entry barriers will have the opposite effect. (JEL L110, L130, D220)     

Wealth and sensibility. The historical outcome of better living conditions for all according to Adam Smith

In this paper, I argue that Smith's commercial society is characterised more by restraint of self-command than by restraint of emotions through self-command, as usually stated. According to Smith, the appropriate degree of self-command varies with historical circumstances: better living conditions for all favour relaxation of self-command and lead people to express their sentiments more freely. I thus highlight a crucial link in Smith's thought between variations in general economic conditions and variations in moral judgement on the expression of emotions, or, in other words, between The Theory of Moral Sentiments and the Wealth of Nations.     

Shortcuts and Signals: An Analysis of the Micro-level Determinants of Aid Allocation, with Case Study Evidence from Brazil

Does the distribution of foreign development assistance depend on the organizational capacity of the recipient organization? I argue that employees at donor agencies seek signals of which recipients will implement aid most effectively, and use these signals to determine the destination of foreign aid on the micro level. Qualitative evidence gathered in the US and Brazil indicates the types of signals donors seek and recipients strive to transmit: signals of a recipient's professionalism, reputation, and sustainability. After developing a signaling game to derive the conditions under which these signals might be credible indicators of implementation effectiveness, I present quantitative evidence of aid recipient organizations in Brazil and score them on the three signals. Statistical tests confirm that organizations with higher levels of these signals are more likely to receive funding, suggesting that donors use these signals to determine the destination of development assistance.     

A modeling framework for enhancing aid effectiveness

ABSTRACT

The development literature lacks consensus about the link between aid effectiveness and governance improvement. A basic rational actor model is introduced to clarify how donors can influence recipient behaviors and more broadly how foreign aid can support or impede governance quality improvement. Adopting the underutilized perspective of donor behavior, this study identifies mechanisms through which aid hinders governance improvement and offers substantive recommendations about how donors can enhance aid effectiveness, including strategies for donors to raise the level of effort recipients devote to project success.