Thinking Critically: The Case of Health Policy Research

In this paper, we focus upon the recent work of one of health policy's leading academics. We then explore policy developments and show that where 'mainstream' health policy analysis implicitly supports the managerialization of health services, our critical perspectives reveal the existence of four male power blocs: management, medicine as science, medicine as practice, and the academic discipline of political science. Finally we suggest how the use of our perspectives enhances the possibility for bringing about meaningful change in health policy.     

Willingness to pay for QALY: perspectives and contexts in Japan

Abstract

Objectives: Theoretically, willingness-to-pay (WTP) for quality-adjusted life years (QALY) can vary depending on social and personal preferences and on ex-ante and ex-post settings. However, empirical investigations into the theoretical differences are lacking. In Japan, setting the threshold has been controversial since a pilot project to implement health technology assessments (HTA) launched in 2016. The study aim is to estimate WTP values for one additional QALY from different perspectives, health statuses, and contexts to confirm the difficulty in setting a uniform price threshold using WTP.

Methods: More than 1,000 respondents representing a cross-section of the Japanese population answered each of nine questionnaire decks in an online panel. WTP values were estimated on three different perspectives (personal, social, and socially inclusive) and on two contexts (ex-ante and ex-post). This study primarily used the non-parametric spike model based on double-bounded dichotomous choice (DBDC) settings to obtain the conditional WTP values.

Results: WTP per QALY was higher in the severe health status than in the moderate health status from all perspectives. Respondents from the socially inclusive perspective estimated the highest WTP value for a new drug. Respondents were also asked about life-threatening diseases in ex-post and ex-ante. The WTP value in ex-ante was higher than in ex-post, and demographic factors affecting the WTP were different in both situations. The various WTP values were obtained from these surveys.

Limitations: The analysis was based on data collected from an internet panel, which could be biased. There is also a risk that respondents answered the questionnaire differently if asked in everyday situations.

Conclusion: Use of a uniform price threshold may not be appropriate in policy settings, because it may not reflect diverse preferences based on different situations, such as disease type and severity. Setting a price threshold as Japan institutes an HTA system requires further research.     

The Five-Year Outlook as a policy document: Historical and comparative perspectives

The article reflects on the role played by policy analysis in the development of national science policies. Its thesis is that science policy, for coherence as a policy function and its impact on policy making, depends on analysis of goals, strategies, issues, and programs; policy crystallizes, to the extent it does, through the medium of policy analysis. First, a number of United States science policy reports prepared between 1945 and 1980 are reviewed. Next, recent science policy reports from predominantly western countries are examined. Taken together, these historical and comparative perspectives make it possible to appreciate the policy potential of future Five-Year Outlook reports.     

Fisher and Wicksell on money: A reconstructed conversation

Abstract

The paper offers a reconstruction of the ‘conversation’ between Irving Fisher and Knut Wicksell on money as shown by references they made to each other's works. The first phase corresponded largely to the period between 1897 and 1911, when they proposed different explanations of the interaction between interest and prices, and incorporated aspects of each other's approaches into their own respective frameworks. This was followed by Wicksell's extended criticism of Fisher's compensated dollar plan and his bewilderment at its apparent lack of relation with the quantity theory of money (1912–1919). Finally, especially after Wicksell's death, Fisher came to support a significant part of Wicksell's monetary policy proposals, particularly in connection with the Swedish stabilisation experiment in the early 1930s. Fisher and Wicksell were both heirs of Böhm-Bawerk's interest theory, but interpreted and criticised the Austrian from different perspectives, which helps to explain the differences in their approaches to monetary dynamics.     

Geopolitical fantasies,national strategies and ordinary Russians in the post‐communist Era

New geopolitical writings that have developed in the post‐Soviet period are predicated on different ideological and historical perspectives and against the formal statements of Russia's place in the world from President Vladimir Putin and enshrined in the document ‘Concept of the Foreign Policy of the Russian Federation’. Four geopolitical schools can be identified, ranging from the fantastic notions of extreme Eurasianism to the reformers’ goal of tying Russia firmly to the West. Formal statements concentrate on Russia's regional prominence in Eurasia and on close integration into the world economic and political systems. However, ordinary Russians display little interest in these geopolitical writings or in the foreign policy actions of the Russian state, except in special cases where the Russian military are actively involved on Russian territory or the ‘near abroad’. In this regard, Russian public opinion has increasingly become like that of the Western democracies, generally disinterested in foreign policy and focused on their personal day‐to‐day lives.     

The Economic Contributions of James J. Heckman and Daniel L. McFadden

This paper analyzes the economic contributions of Daniel L. McFadden and James J. Heckman, who were awarded the Nobel Prize in economic science in 2000. McFadden's analytical work on discrete choices and related theory brings economic tools to bear on policy questions that previously had not been empirically investigated. The multinomial logit and similar models developed by McFadden enable researchers to empirically model factors that affect individual choices (e.g. of travel mode, occupation or employment, and residential location) with discrete outcomes. Heckman's research on selective samples demonstrates the difficulty of achieving generalizable results in analyses of choice-based behavior. In addition, his work on the evaluation of social programs has challenged conventional beliefs about the infallibility of experimental evaluation results and explored the limits and potential of non-experimental methodologies in a range of social science applications.     

Measurement,incentives and constraintsin Stigler's economics of science *

Abstract

George J. Stigler's seminal role as one of the founders of the economics of science is summarized and evaluated. His main contribution rests in his asking an array of important questions and arguing persuasively for the application of empirical, and especially statistical, techniques to the answering of those questions. He asks whether and how science progresses; whether a scientist's biography is important in understanding his science; what characteristics of a scientist are most complementary to success in science; and how the professionalization of science redirects the attention of scientists more toward internal puzzle-solving, and less toward applied relevance.     

The political economy of preferential trade arrangements: The case of Japan

ABSTRACT

Support for open trade regimes varies. We analyze Japanese survey data on individuals' preferences for TPP, unilateral import liberalization, and East Asian economic integration, and compare factors influencing policy preferences. First, despite the massive negative campaigns against TPP, 42.8% of individuals support Japan’s participation in TPP, vs. 21.1% against. Second, economic factors do matter for an individual in determining his/her policy preference over TPP. Third, noneconomic factors such as gender, age, access to accurate information, and attachment to hometown also feature as determinants. Fourth, although preferences over TPP and other policy options are positively correlated, some factors decrease TPP support but do not undermine support for two other less-politicized policy options: lack of access to accurate information and some industry and regional TPP-specific factors. Criticism impacts negatively on FTA policy preferences. Finally, we discuss economic policy implications for relationships between China, Japan, and Korea.

Abbreviations: FTA: Free trade agreement; JA: Japan agricultural cooperative; TPP: Trans-Pacific partnership agreement.     

The impact of pain on labor force participation,absenteeism and presenteeism in the European Union

Abstract

Objectives:

The aims of this paper are to generate estimates of the association between the experience and burden of pain, by severity and frequency, with (1) labor force participation and workforce status in five EU countries (the UK, France, Spain, Germany and Italy) and (2) patterns of absenteeism and presenteeism for the employed workforce.

Methods:

Data are from the internet-based 2008 National Health and Wellness Survey (NHWS). This survey covers both those who report experiencing pain in the last month as well as the no pain population. A series of regression models are developed with the no pain group as the reference category. The impact of pain, categorized by severity and frequency reported, is assessed within a labor supply framework for (1) labor force participation and (2) absenteeism and presenteeism. In the former case both binomial and multinomial logistic models are estimated; in the latter case ordered logit models are estimated.

Results:

The results demonstrate that, in the context of health status, the experience of frequent severe and moderate pain has a dominant, independent and negative association with labor force participation and employment status as well as absenteeism and presenteeism. The presence of severe daily pain is associated with a 20-point reduction in the probability of being employed full-time; with moderate daily pain associated with a 10-point reduction. The impact of pain is far greater than the potential impact of other health status measures (e.g., chronic comorbidities and BMI). The experience of pain, notably severe and frequent pain, also outstrips the impact of other health status factors in absenteeism and presenteeism.

Conclusions:

The experience of pain, in particular severe daily pain, has a substantial negative association with labor force participation in these five European countries as well as reported absenteeism and presenteeism. As a measure of health status, it clearly outweighs other health status measures. Whether or not pain is considered as a disease in its own right, the experience of chronic pain, as defined here, presents policy makers with a major challenge. Programs to relieve the burden of pain in the community clearly have the potential for substantial benefits from societal, individual and employer perspectives.     

Policy mix to foster innovation in the Dominican Republic: attempts from an empirical perspective

ABSTRACT

This paper aims to understand firms’ preferences for incentives to foster innovation in Dominican firms. A key research question arises: What are the most preferred science, technology, and innovation (STI) policy options to support innovation in Dominican firms? This research relies on the concept of policy mix and the conjoint analysis to support the empirical approach. Over 300 firms were surveyed across the country, and we discovered that Dominican firms prefer more complex STI policy options, including at the same time research grants, guarantee funds, and tax incentives to support several kinds of innovative activities. But also, firms need to understand the potential of available options such as tax credit and other monetary instruments, including guarantee funds. It is concluded that in the medium and long term, the STI policy mix approach could support as part of the Dominican policy agenda, an economic transition toward a more resilient and competitive economy.     

Class Debates in Intermediate Microeconomics: Social Economics and Pluralist Perspectives

Abstract

This paper proposes the use of class debates in an intermediate-level microeconomics course to introduce early to mid-career undergraduate students to socially embedded and pluralist perspectives, political-economic processes, and policy analyses. Using data from three semesters of class debates in an intermediate microeconomics course, we argue that this activity is a beneficial way to stimulate student interest in social economics, especially in the ethical, political economy, and economic justice aspects of economics and policy. We carried out three allied activities: participation in the debate, a learning self-assessment survey, and a five-page memo providing a balanced analysis of the policy conundrums surrounding the issue under discussion. We discuss three aspects of these class debates relevant to social economists: student attention to processes of knowledge construction, cognizance of power in socioeconomic life, and engagement with economic justice and ethics.     

Creativity-enhancing technological change in the production of scientific knowledge

ABSTRACT

We view scientific publications as a measure of technical knowledge. Using the Solow method of functional decomposition and scientific publication data from the National Institute of Standards and Technology, we find that 79% of the increase in scientific publications per unit of scientific personnel is explained by an increase in federal R&D capital per unit of scientific personnel. We describe the unexplained or residual 21% as a measure of creativity-enhancing technological change, a phenomenon that offers a way to reverse the perceived slowing of the productivity of science. The explained 79% offers a possible metric for federal laboratories’ mandated reporting of a ROI to federal R&D. Understanding the drivers of the residual 21% could enable public policy to mitigate the resource constraints caused by the breakdown of exponential growth of the resources devoted to science.     

TACKLING THE ENDOGENEITY OF FERTILITY IN THE STUDY OF WOMEN'S EMPLOYMENT IN DEVELOPING COUNTRIES: ALTERNATIVE ESTIMATION STRATEGIES USING DATA FROM URBAN BRAZIL

Abstract

Opinions differ about whether family structure, especially fertility, should be considered endogenous in models of behavior in developing countries. Faced with a dearth of good instruments, mainstream researchers often urge working in reduced form and, therefore, losing variables of policy interest or limiting the type of questions they ask to those where good instruments are available. Rather than treating endogeneity as a yes or no characteristic, we suggest instead that researchers consider the likely magnitude of endogeneity bias before moving to reduced form. Facing a situation where endogeneity bias is often presented as a concern but where we expect little endogeneity bias, we tackle endogeneity using multiple econometric techniques not available to the average researcher. We find support for our hypothesis that little bias arises due to the assumption of exogeneity of recent fertility in a model of women's employment.     

“From warfare to welfare”: Contextualising Arrow and Schelling's models of racial inequalities (1968–1972)*

ABSTRACT

This paper focuses on Arrow and Schelling's contributions to the study of racial inequality in the late 1960s. We start from the authors’ account of the origin of their work. Then, we locate the “material origin” of the models at the RAND Corporation in the late 1960s and show how it relates to the transfer of the RAND tool-box to the study of welfare issues. Finally, we describe how Arrow's and Schelling's modelling strategies relate to their conception of “science for action,” inherited from their “warfare” work.     

Thinking of Sylos Labini (or Sylos Labini's Thinking)

Abstract

This note reflects upon the methodological principles that Paolo Sylos Labini (1920–2005) brought to his work as a political economist. Sylos Labini drew upon history, political science, sociology and philosophy in order to explain economic processes, and he insisted that an interdisciplinary approach was essential to formulating effective policy responses to modern social problems.     

The Efficiency of Active Labor Market Policies: A Comparative Analysis of Tunisia and OECD Countries’

ABSTRACT

On the third anniversary of the Egyptian revolution and against the backdrop of lingering political instability and deteriorating economic conditions, we diagnose the constraints to sectoral growth in Egypt using the 2011 Egyptian revolution as a natural experiment. We combine quantile regressions to study sector outliers with a difference in difference methodology to capture sectoral behavior before and after revolution. We find that the revolution's effect has been adverse, on average, but heterogeneous across sectors. We identify and characterize sectors most and least impacted. Results reveal that Egypt's fastest growing sectors before Revolution have been the most vulnerable after Revolution. This evidence is supported by our diagnosis approach that shows that faster growing sectors are constrained by continuous increases in prices that threaten export competitiveness (as they erode the benefits accrued to nominal depreciation of currency). Such sectors also benefited from higher monetary growth and fewer constraints on credit availability that have mitigated somewhat the speed of deterioration in the aftermath of the revolution. Our results, which hold under several robustness checks, inform policy priorities as to how to revive investors’ confidence, boost competitiveness, and design priorities in industrial policy to ease structural impediments and align sectoral growth with macro priorities.     

Women and Retirement Pensions: A Research Review

Abstract

The links between women's caring work and access to economic resources are particularly critical in the context of widespread public policy debates about retirement and pensions, many of which neglect care as a key issue for analysis. However, among feminist economists it is widely recognized that women's patterns of care provision have adverse implications for their access to economic resources in later life. The feminist economics literature examines many of the interactions between women's caring roles and their access to resources, particularly women's capacity to access economic resources through publicly mandated or regulated pension schemes. This article reviews research that places women's patterns of work and care at the center of analyses of retirement pension policy in an effort to provide a summary of research on gender and pensions policy and to contrast the extent to which differing institutional and policy frameworks accommodate women's caring roles.     

Three Pillars of Conventional Wisdom

This paper considers three pillars of contemporary economic wisdom that form part of the so-called 'Washington consensus': that free markets work best; that price stability is a good thing; and that deregulated financial markets work best. We argue that these propositions apply in certain circumstances, but do not have general validity. After discussing the circumstances in which these propositions do not hold we suggest how the conventional policy wisdom should be revised.     

Quality upgrading in Ethiopian dairy value chains: dovetailing upstream and downstream perspectives

Abstract

In this article, we analyze opportunities and constraints for upgrading product quality in the dairy value chain in Ethiopia. Our analysis is based on an integrated understanding of supply chain performance both from producer and from consumer perspectives. We outline as main drivers for quality upgrading: (a) factors that influence producers’ willingness to invest toward intensification by smallholder dairy farmers and cooperatives and (b) factors that induce consumer’s willingness to pay for healthy and nutritious dairy products delivered at specific retail outlets. Since there are large gaps between upstream producers incentives and downstream consumers motives, possibilities for dairy quality upgrading remain fairly limited. Given this market structure, decisive policy support is required for better tailoring producer’s investments with consumer preferences.     

Essential medicine policy in China: pros and cons

Abstract

Objective:

To analyze the achievements, issues and policy recommendations for implementing essential medicine system in China after a 3-year effort.