An integrated approach to measuring potential spatial access to health care services

In recent years there have been several attempts to develop quantitative measures of potential spatial access to health care services which, despite their limitations, offer many positive ideas that can perhaps be integrated into a logically consistent and generally acceptable index. It is in this vein that the current paper presents an integrated approach, drawing partially from past contributions, to measuring potential spatial access to health care services. The final access index is derived as the culmination of a series of individual measures, starting with an initial gravity formulation and progressing through successive stages as new elements, consistent with the definition and conceptualization of potential spatial access, are introduced. Application of the proposed index to the ambulatory medical care system of the Akron, Ohio SMSA, demonstrates the validity of the measure, and its suitability as a potential health care planning tool.     

A quantitative index of access to primary medical care for health planning

The emphasis of Public Law 93–641 on numerical goals of health care, as elaborated upon by the National Health Planning Council in its guidelines, foreshadows the emergence of quantitative indices in many areas of health resources utilization and health outcomes. In the area of access to primary medical care, the guidelines spell out in detail what is considered the reasonable waiting period for an appointment, travelling time to the source of care, and in-office waiting time for individuals seeking care. An index of access is developed on the basis of these reasonable limits of waiting for health services research and planning purposes. An example of hypothesis-testing with hypothetical data is given, along with a caveat in the interpretation of the results.     

Bank efficiency and access to credit: International evidence

This paper examines the impact of bank efficiency on access to credit. We test the hypothesis that higher bank efficiency, meaning a better ability of banks to operate at lower costs, favors access to credit for firms. To this end, we perform a cross-country analysis with firm-level data on access to credit and bank-level data to compute bank efficiency, using a sample of about 54,000 firms from 76 countries. We find that greater bank efficiency improves access to credit for firms. The beneficial impact of bank efficiency to alleviate credit constraints takes place through the demand channel by reducing borrower discouragement to apply for a loan. Whereas the positive impact of bank efficiency on credit access is observed for firms of all sizes, the effect tends to be more pronounced in countries with a better economic and institutional framework. Our results therefore support policies favouring bank efficiency to enhance access to credit.     

追逐效率与安全——访联邦快递亚太区信息技术部副总裁莲达·柏勤

多年来,联邦快递(FedEx Express)始终坚持为客户提供优质的、个性化服务.在联邦快递集团全球网络支持下,通过采用反应更迅速、更安全、更灵活的物流系统,提高了快件的送达效率和安全性能,联邦快递亚太区信息技术部副总裁莲达·柏勤(Linda C.Brigance)这样表示.在强大的货运量和经济增长的背景下,联邦快递对中国快递市场的未来非常乐观.     

Improving access to health facilities in Nouna district,Burkina Faso

The Nouna health district in Burkina Faso, has a population of approximately 275,000 people living in 281 villages, and is served by 25 health facilities, as of 2006. For many people, the time and effort required in traveling to a health facility, which may demand a journey of many kilometers over poor roads on foot, is a deterrent to seeking proper medical care. In this study we examine how access to health facilities in Nouna may be improved by considering the configuration of the road network in addition to the locations of the facilities. We model the situation as a facility location–network design problem and draw conclusions about how best to improve the physical access of the health facilities. Our model shows the extent to which access can be improved when the road network is considered along with facility locations, in contrast to facility locations considered alone.     

Creditor rights,financial health,and corporate investment efficiency

This paper analyzes the influence of creditor rights on investment efficiency and how firms’ financial health shapes this influence. Using time-series changes within a country and cross-country variations in creditor rights, I find that stronger protection of creditors improves investment efficiency in healthy firms but worsens it in distressed firms. The impact on investment efficiency operates more through changes in overinvestment than in underinvestment. Alternative proxies for creditor rights control for both contractual and enforcement rights. The results are robust to alternative model specifications and to controls for omitted variables.     

Hospital efficiency and equity in health care delivery: A study based in China

Hospital efficiency and equity in health care delivery are two enduring research topics. Yet little research has been done to examine the relationship between them. This paper studies the impact of hospital efficiency on equity in health care delivery based on a proprietary dataset of hospital characteristics and 630,000 inpatient records from 149 public hospitals in a representative Chinese city. To measure the hospitals' efficiencies, this study takes the hospitals' operational features and case-mix indexes into account, and computes the efficiency levels using data envelopment analysis with bootstrapping. Through regressions that control for a variety of the patients’ personal characteristics (e.g., age, disease, residence, hospital visit frequency), this study shows that the gap between hospitalization expenses of urban and rural inpatients in more efficient hospitals is smaller than those in less efficient hospitals. Thus efficiency enhances equity in expenditure between urban and rural patients. But the dwindling urban-rural gap in expenditure is achieved by raising the spending of rural patients, thereby undermining their access to health care. This pattern is more conspicuous in large and sophisticated high-tier hospitals. Further analysis shows that hospital efficiency impacts equity of health care delivery by inducing different lengths of stay and uncovered parts of total expenditure for urban and rural groups. The findings imply that an efficiency-oriented health care policy may lead to social benefit loss.     

Scheduling food bank collections and deliveries to ensure food safety and improve access

Food banks are privately-owned non-profit organizations responsible for the receipt, processing, storage, and distribution of food items to charitable agencies. These charitable agencies in turn distribute food to individuals at risk of hunger. Food banks receive donated food from national and local sources, such as The Emergency Food Assistance Program (TEFAP) and supermarkets. Local sources with frequent high-volume donations justify the use of food bank vehicles for collection. Food bank vehicles are also used to deliver food to rural charitable agencies that are located beyond a distance safe for perishable food to travel without spoilage. Due to limited funds, food banks can only afford to sparingly use their capital on non-food items. This requires exploring more cost effective food delivery and collection strategies. The goal of this paper is to develop transportation schedules that enable the food bank to both (i) collect food donations from local sources and (ii) to deliver food to charitable agencies. We identify satellite locations, called food delivery points (FDPs), where agencies can receive food deliveries. A set covering model is developed to determine the assignment of agencies to an FDP. Both vehicle capacity and food spoilage constraints are considered during assignment. Using the optimal assignment of agencies to FDPs, we identify a weekly transportation schedule that addresses collection and distribution of donated food and incorporates constraints related to food safety, operator workday, collection frequency, and fleet capacity.     

烟花爆竹物流从安全管理到提高效率

在喜庆的节日里，用绚烂的焰火装点节日的气氛是中国人的传统习惯。新年的钟声已经敲响，春节的脚步也逐渐临近。于是，烟花爆竹又成了十分被人关注的一个话题，到处都在“禁改限”，到处都在热火朝天地布设着销售网点。     

Financial health and airline safety

Agency‐cost models suggest that firms may pursue riskier strategies in times of financial distress. For example, stockholders of financially weak firms in industries where quality cannot be observed ex‐ante have an incentive to compromise safety and quality to maximize current period profit. However, there exists only a modest amount of empirical evidence that relates financial health to the risk‐taking behavior of firms. We explore this relationship for the airline industry. Using bond ratings to proxy for financial health and airline mishaps to measure safety, we find a significant correlation: airlines with higher quality bond ratings are less likely to experience mishaps than airlines with lower quality ratings. On average, a whole letter grade better bond rating is associated with a 10% lower probability of a mishap. Copyright © 2004 John Wiley & Sons, Ltd.     

Electoral accountability and local government efficiency: quasi-experimental evidence from the Italian health care sector reforms

This paper evaluates the effect of two policy changes on the efficiency of Italian regional governments in the provision of health care services: first a change in the electoral system, second a process of fiscal decentralisation. The paper provides two main contributions: (1) a comprehensive analysis of the two main reforms that involved Italian regional governments and the health care sector during the 1990s, (2) the evaluation of the impact of the electoral reform in a quasi-experimental setting. Final results are in line with recent theoretical predictions that show a positive relationship between government efficiency and the electoral accountability enhanced by institutions such as electoral rules and fiscal decentralisation.     

Home safety,accessibility, and elderly health: Evidence from falls

This article presents estimates of the impact of home safety and accessibility features on the prevention of serious, non-fatal falls for elderly widowed individuals. As these features are not randomly assigned across homes, we develop an instrumental variable (IV) strategy that relies on the differential decline in the health and functional status of spouses to identify impacts. Specifically, we use the deceased spouse’s functional status when alive, as measured by limits to Activities of Daily Living (ADLs), as an IV for the presence of home safety and accessibility features for the surviving spouse in the years after widowhood, and then estimate the effect of these features on the likelihood of a serious fall for the widow using rich longitudinal data from the Health and Retirement Study. The presence of such features reduces the likelihood of a fall requiring medical treatment by 20 percentage points, a substantial effect. However, falls are not the type of health shock that is a main driver of housing tenure transitions among the elderly. Although somewhat speculative, cost–benefit estimates suggest that investments in home safety for the elderly may generate in the short run as much as a dollar-for-dollar reduction in medical expenditures.     

A location-based comparison of health care services in four U.S. states with efficiency and equity

This paper examines the efficiency and equality in geographic accessibility provided by hospitals. We use the criteria efficiency, availability of the service, and equality. Quantitative measures are defined for all criteria, and are measured using a geographical information system. We then compare existing locations with optimal locations satisfying two objectives, one that minimizes hospital–patient distance, and another that captures as many patients as possible within a pre-specified time or distance. The results of our study indicate that the existing locations provide near-optimal geographic access to health care. Some potential for improvement is indicated.     

The trilemma between accuracy,timeliness and smoothness in real-time signal extraction

The evaluation of economic data and the monitoring of the economy is often concerned with an assessment of the mid- and long-term dynamics of time series (trend and/or cycle). Frequently, one is interested in the most recent estimate of a target signal, a so-called real-time estimate. Unfortunately, real-time signal extraction is a difficult estimation problem that involves linear combinations of possibly infinitely many multi-step ahead forecasts of a series. Here, we address the performances of real-time designs by proposing a generic direct filter approach. We decompose the ordinary mean squared error into accuracy, timeliness and smoothness error components, and we propose a new tradeoff between these competing terms, the so-called ATS-trilemma. This formalism enables us to derive a general class of optimization criteria that allow the user to address specific research priorities, in terms of the accuracy, timeliness and smoothness properties of the corresponding concurrent filter. We illustrate the new methods through simulations, and present an application to Indian industrial production data.     

Occupational health and safety in transitional Lithuania

Using the example of occupational health and safety regulation, this article examines the tensions between neo‐liberalism and social democratic policy approaches in the context of pre‐accession transitional Lithuania. It is argued that attempts to provide a ‘business‐friendly’ investment climate may be creating a ‘race to the bottom’ as legislative failures to provide for employee voice come into conflict with assumptions of the so‐called European social model.     

Strategic management of worker health,safety, and environmental issues in Mexico's Maquiladora industry

Conflict arising from differences in business practices, standards, values, and norms guiding behavior are inherent in international business. These conflicts are evident in Mexico's maquiladora industry, particularly relating to issues of worker health, safety, and environment. This article extends a model of conflict management; illustrates the model's dimensions with case study examples; discusses strategic human resource management implications of the model's various outcomes; offers recommendations for managing worker health, safety, and environment issues; and identifies directions for future research. © 1993 by John Wiley & Sons, Inc.