Specialty pharmaceuticals and the quest for better outcomes

Over the past decade, the healthcare system has seen significant growth in the number of products, pathways, and modes of treatment administration for a number of costly conditions. Many of these products are biologic agents, classified as specialty pharmaceuticals, and are distributed through specialty pharmacies. The increasing use of these expensive medications and their growing costs raise the simple question, can payers and purchasers afford to keep doing business as usual? In addition, confusion exists as to what “outcomes” are relevant for these conditions treated using specialty medications. Available information on outcomes, treatments, and pathways from multiple sources can overload clinicians and the treatment team, making it difficult to select – and receive reimbursement for – the most appropriate regimens. This article offers an approach to understanding some of the unique challenges posed in evaluating the value of specialty pharmaceuticals.     

China and Japan: Culture,economics, and geopolitics in the quest for a leading international role

The Western view of China and Japan is often based on a perception that they are both Confucian and, therefore, are more similar than is actually the case. Although both do share some fundamental characteristics of Asian culture, certain unique features of each, particularly at the level of social relationships and cultural landmarks, make them quite different. Analysing what these features are allows us to understand what influence they have on personal choices and on the decisions of leaders on important issues in these countries. The Asian financial crisis of 1997–99 can be taken as a useful acid test for evaluating the different decision‐making capacities of the Chinese and Japanese leaders. Currency devaluation, exchange rate intervention, banking system restructuring, economic reforms, and responses to international pressure were the main areas in which government action took place. Interpreting the decisions made in these areas from a geographical‐cultural perspective provides a solid basis for analysing geopolitical dynamics and the ‘global’ prospects of the two most important nations of the Far East.     

Visibility estimates of budgetary burden and benefit in European countries

Intermediate territorial levels of government in Austria, Germany, Switzerland, and Spain are different regarding their basic institutions, devolved powers, revenue and public expenditure systems, public revenue equalization mechanisms, accountability, public performance management, and financial control bodies. In spite of the complexity derived from these different characteristics, this paper presents some indicators which permit the creation of time and space fiscal visibility measurements and comparisons. It also advances systematic estimates on visibility for intermediate subsystems of public revenue and expenditure now in force in these European countries. Policy implications seem straightforward. That is, current values are low in general, and allocation improvements could be obtained by implementing changes and reforms that aim to raise both public revenue and expenditure visibility.An earlier version of this paper was presented at the Forty-Seventh International Atlantic Economic Conference, Vienna, Austria, March 16–23, 1999. The author is indebted to the participants of this conference and an anonymous referee for helpful comments. The author is responsible for any errors or shortcomings.     

Challenging the dominant logic in the healthcare industry: the case of precision medicine

The study on the impact of precision medicine (PM) in its surrounding political and business milieu has burgeoned in recent years. Recent advances in biomedical sciences suggest that PM has the potential to fundamentally alter the existing business logic in the healthcare landscape and the relationship between how medical care is delivered and organised. While barriers and policy challenges to the introduction of pharmacogenomics into healthcare system are widely noted, relatively little is known about whether and to what extent PM alters or even destroys the dominant logics of the pharmaceuticals and diagnostics industry, which constitute the core segment of the PM. In this paper, the shifting nature of dominant logic in the field of PM is studied by means of qualitative analysis. Several dimensions are identified to help develop a better understanding of changing business models and collaborative network structures.     

Financial innovation in the UK

This study employs a national survey of over 1100 British financial firms to ascertain the determinants of financial innovation and their sales success using the logit and the generalized Tobit models. We find that the likelihood of financial innovation rises with the size of financial firms, employee education, greater expenditure on research and development, the availability of finance and the extent to which firms cooperate with each other. Perceptions of economic risk and innovation costs are also influential. R&D, cooperation and human capital are the main variables driving the success of financial innovation, measured by the percentage share of innovations sold. Firms in London/the south have a significantly greater tendency to innovate, though Scotland also does well. Stock broking, fund management and related activities are more innovative than firms in the financial intermediation and pension/insurance sectors.     

Knowledge Management Capabilities for Steel Makers: A British-Japanese Corporate Alliance for Organizational Learning

This paper draws on a detailed case-study of a technical alliance between British Steel Strip Products (BSSP) and a leading Japanese steel company which was established to help the UK producer improve its product quality, its production control management and its customer links with Japanese car company transplants in the UK. The study is one of a series of comparisons of leading UK and Japanese manufacturing companies, from the steel, aerospace, telecoms and chemical industries. The overall project has been funded under the ESRC Innovation Programme. Evidence of the success of the alliance is illustrated in a series of graphs depicting the reduction in scrap and steel losses from particular BSSP mill sites and clear improvements in quality and productivity levels at these sites. The case-study traces these improvements back to specific management practices transferred from the Japanese producer as part of the alliance. Detailed evidence comes from the activities of 'Task Teams' which were assembled, with engineers from the Japanese companies as team members, to identify key quality problems at the mill sites and initiate procedural changes to overcome them. Using this empirical foundation the paper explores and develops a number of key concepts believed to be increasingly important within the broader analysis of organisational change and innovation at the firm level. The corporate 'capabilities' approach and 'knowledge-based' theories of the firm are brought together to help identify differences between the two firms and explain the resulting effects on company performance. The main focus in on 'knowledge management practices', including practices and procedures governing project management, inter-divisional coordination, management roles, budgeting and resource allocation, networking and information exchange, human resource development, employee motivation and so on, in each of the firms. The study highlights important differences between the two firms in terms of how specialist knowledge is developed, deployed, integrated and exploited or 'leveraged' for manufacturing innovation (quality control improvements at the mill sites). This also encourages intra-firm knowledge flows between technical support departments, R&D and production sites. The case study of the alliance represents an unusually clear illustration of how some knowledge management practices are more difficult to transfer between firms because they are more deeply 'embedded', that is, highly dependent on broader contextual factors (knowledge resources, organisational structure, culture etc.,) to operate effectively. Broader changes are more difficult to implement and usually take much longer. Moreover, as shown by other studies looking at the transferability of Japanese management practices, some changes, though leading to performance improvements, are probably not possible and/or desirable. The study therefore provides some insights into the capacity for and limits of various kinds of organisational innovation in the British firm.     

Too big to fail — Lessons for today and the future from British industrial policy, 1960–1990

British industrial policy for two sectors (automotive and aerospace manufacture) in the period the 1960–1990 is considered and compared with the challenges facing the United Kingdom following the financial crisis of 2008. The history of the period 1960–1990 is informed by interviews with well-placed policy-makers of the time. These observations complement the historical record to confirm that British industrial policy was then more often a pragmatic response to events than the consequence of political ideology. Four particular phases of policy are observed: consolidation, investment, nationalisation and privatisation. During the decade 2000–2009 several British companies in banking, transport and energy have been subject to similar state interventions. In 2010 these companies are at various stages on the four step journey considered by the paper. The paper provides four lessons from the past for twenty-first century policy makers tasked with taking forward the companies with state investment and ensuring a return to economic prosperity.     

Financial Integration and Market Efficiency: Some International Evidence from Cointegration Tests

This study investigates whether the globalization of financial markets enhances the efficiency of national stock markets. To this end, we have developed a dynamic representation of cointegration which is consistent with hypothesis that stock prices reflect the efficient discounting of new information on market fundamentals and testes for market efficiency in five industrialized markets (the United States, Canada, Japan, the United Kingdom, and Germany) over the last two decades. Our empirical analysis indicates that the U.S. and Canadian stock markets obey the long-run equilibrium path implied by our dynamic cointegration model, but the Japanese, British, and German markets do not exhibit such characteristics. Thus, it can be claimed that the stock markets of the United States and Canada are informationally efficient, whereas those of Japan, the United Kingdom, and Germany are not. [G15, G14]     

Financial development, the structure of capital markets, and the global digital divide

This paper examines the extent to which financial development and financial structure may explain cross-country diffusion of information communication technology (ICT). Using panel data for 76 emerging and advanced countries for the period 1990–2003, it finds that credit and stock market development tends to foster ICT diffusion, but financial structure does not appear to have any significant relationship with it. The conclusions, which are consistent with what theory might predict, highlight the role of financial development in the market for knowledge-based products. The finding that financial development is an important determinant of ICT diffusion implies that countries with underdeveloped financial markets may sink even further to the information-poor and noncommunicating side of the global digital divide.     

‘Icarian Geography’: Air Power,Closed Space,and British Decolonisation

Through the first half of the twentieth century, strategists and statesmen in Britain struggled reconcile the advent of intercontinental air power with the geopolitical logic of the British Empire. This article explores how, and to what extent, their efforts might have catalysed the onset of British decolonisation.     

Policy uncertainty and international financial markets: the case of Brexit

ABSTRACT

This study assesses the impact of the Brexit probability on both the UK and on international financial markets, for the first and the second statistical moments. As financial markets are by nature highly interlinked, one might expect that the uncertainty engendered by Brexit also has an impact on financial markets in several other countries. We first estimate the time-varying interactions between UK policy uncertainty, which to a large extent is attributed to uncertainty about Brexit and UK financial market volatilities. Second, we use two other measures of the perceived probability of Brexit before the referendum, namely daily data released by Betfair and results of polls published by Bloomberg. Based on these data sets, and using both panel and single-country SUR estimation methods, we analyse the Brexit effect on levels of stock returns, sovereign CDS, 10-year interest rates in 19 predominantly European countries, and those of the British pound and the euro. We show that Brexit-induced policy uncertainty will continue to cause instability in key financial markets and has the potential to damage the real economy in both the UK and other European countries. The main losers outside the UK are the ‘GIIPS’ economies: Greece, Ireland, Italy, Portugal and Spain.     

Choice experiments,site similarity and benefits transfer

Choice experiments are designed to account for variations in environmental resources and site characteristics, as well as potential implications of these variations for willingness to pay. As a result, choice experiment results may be well suited for benefits transfer. It is unclear, however, whether the flexibility of choice experiments renders the similarity of study and transfer sites less critical for transfer validity. Drawing from identical choice experiments conducted in different Rhode Island communities, this model assesses the extent to which error in function-based benefits transfer is related to the similarity of communities across a variety of observable dimensions. Results suggest that site similarity, at least across some dimensions, influences the validity of choice experiment benefits transfers. However, the use of some measures of similarity as indicators of transfer error may provide misleading results.     

XBRL技术对审计的影响及选择模式研究

信息技术的变革给会计环境带来了一定的冲击力,随着XBRL技术的研究应用,实现了网络财务报告在高级阶段的发展,在一定程度上提高了财务报告的效率和质量,然而,基于XBRL技术的实时网络财务报告模式给审计工作带来了一定的挑战,这样的挑战不仅是对审计概念的一种冲击力,也是对审计技术及方法变革的迫切需求。文章在探讨XBRL技术概念特征的基础上,讨论了XBRL技术对审计的影响,并展望了基于XBRL技术的未来审计模武。     

Bidding and Overconfidence in Experimental Financial Markets

Overconfidence is a well-documented phenomenon in psychology. Psychologists define an overconfident individual as one who believes he has more accurate information than he actually does. Recently, behavioral economists have become interested in the implications of trader overconfidence for financial decision-making and the functioning of financial markets. To date, most financial market studies have been analytical in nature. These studies assume that traders are overconfident and model decision-making behavior accordingly. Rather than assuming the presence of overconfidence, we use experimental bidding data to determine the extent to which trader overconfidence exists, and what variables suggested by previous finance and psychology research relate to it. We find approximately 40% of subjects exhibited overconfidence. Variables that distinguish overconfident bidding from risk-averse and risk-neutral bidding include the traditional financial variables that explain bidding (expected value and standard deviation), non-traditional financial variables, and variables relating to the self-attribution bias and feedback. Contrary to what some analysts have suggested, experience did not reduce overconfidence.     

The CNO/CFO partnership: navigating the changing landscape

With increasing pressure to cut costs, both real and immediate, and those forecasted and anticipated, the partnership and collaboration between nursing and finance will continue to take on new challenges. This partnership has historically been strained and does not always come easy due to differences in focus, different priorities, and inadequate communication, listening, and hearing. That needs to change and a strong CNO-CFO partnership is needed. Nursing leaders need to understand and appreciate the financial constraints and balance them with expected outcomes, and financial leaders need to understand and appreciate the core clinical business and what gaps in care mean to the financial viability of the organization and to patient outcomes. One health system developed a platform for change and is dedicated to the hard work involved in continuously working on those partnerships so when it comes to patient quality, safety, and financial performance, nursing and finance leaders are well positioned for future health care challenges.     

依托大科学装置的产业化模式及其对策研究

大科学装置是国家科技创新的重要驱动力,依托大科学装置的技术创新及产业化具有特殊性和稀缺性。以散裂中子源为依托,通过借鉴英国哈维尔创新科技园区实地调研一手资料、关键人物访谈及日本J-PARC、上海光源等国内外典型散裂中子源、光源相关产业化标杆的成功经验,提出4种产业化模式：大学-企业合作、企业自主转化、装置自主转化及大学自主转化。分析4种产业化模式的适用条件及优劣势,结合我国散裂中子源所在地东莞及其周边实际情况,发现大学-企业合作模式更符合我国散裂中子源未来产业化发展方向,并提出相关对策建议。     

Inflation targeting and financial stability in emerging markets

This paper aims at investigating whether emerging market inflation targeters are more financially vulnerable than their non-targeting counterparts. It further assesses the extent to which targeting central banks are less responsive to financial imbalances, compared to those implementing alternative policy strategies. Based on a sample of 26 emerging countries, including 13 targeters, the analysis suggests that monetary policy in targeting countries is relatively more sensitive to financial risks. However, despite stronger central banks’ responses to financial imbalances, the financial sector appears to be more fragile for targeters. Our conclusion therefore challenges the view that central banks, through their policy interest rates, can guarantee the stability of the financial system. It rather suggests that the control of inflation should remain the primary monetary policy objective, while a (macro)prudential authority would be in charge of the financial stability objective.     

A principal components analysis of international financial integration under fixed and floating exchange rate regimes

This paper presents an application of factor analytic techniques, employing principal components analysis, to determine to what extent international financial integration has been enhanced as a result of the move to a floating exchange rate regime by the major industrialized countries in the early 1970s. While several alternative, though related definitions exist, financial integration is viewed here as the extent to which the levels or changes in interest rates in different financial centers move in harmony. The results suggest that there has not been a marked increase in scope for countries to pursue independent interest rate policies since 1973, though Germany would seem to be an exception to this general observation.