Health and finance: exploring the parallels between health care delivery and professional financial planning

This article compares the role of risk and uncertainty discourse across two rather disparate areas of expertise: personal financial planning and health care delivery. On the basis of 42 semi-structured interviews and eight recorded meetings between planners and their clients, as well as a comprehensive review of extant health literature, it is argued that three points of convergence – the discursive management of uncertainty, the temporalization of risk, and the use of images – offer a modicum of certainty which functions ultimately to legitimize expertise and facilitate courses of remedial action while simultaneously assuaging laypeople’s existential anxieties. The article concludes with a number of reflections on the importance of agency and trust.     

New Jersey's health care system reforms

As New Jersey grappled with the huge burden of uncompensated hospital care, a diverse group of organizations banded together to develop a unique private sector response to the immediate crisis and a long-term strategy for comprehensive reform of the state's health care system.     

New approaches to measuring welfare

Economics has traditionally understood ‘welfare’ (what makes a life go well) as the satisfaction of preference. This conceptualisation of welfare is typically measured using revealed preferences, proxied through income and prices or stated in willingness-to-pay surveys. Recent decades have seen growing challenges to this paradigm. The climate crisis, among other phenomena, has called into question whether income and price data effectively proxy preferences, and willingness-to-pay surveys continue to struggle with accurately pricing important items such as biodiversity, digital goods, privacy and social connections. Preference satisfaction as a welfare criterion has also been challenged conceptually by psychologists and scholars working in the development space, among others. In this article, we review recent innovations in alternate ways of conceptualising and measuring welfare for the purposes of economic welfare analysis. We focus on using stated preferences over aspects of well-being, life-satisfaction scales and the WELLBY approach, and well-being frameworks such as Bhutan's Gross National Happiness Index. While not without weaknesses, these approaches also have marked strengths relative to the traditional approach.     

新金融需要银行家精神

银行风险问题应归咎于商业模式而不是银行家 对于新金融,人们可能会有一种误解,觉得新金融就是互联网金融或者P2P以及众筹.实际上,中国人民银行牵头十部委发布的《关于互联网金融指导意见》中已经给了这个问题一个明确解答,《意见》中指出:“互联网金融是传统金融机构与互联网技术、信息通信技术实现资金融通、支付、投资和信息中介服务的新型服务模式.”互联网与金融深度融合是大势所趋,所以已经把银行部门,也就是传统的金融机构定义为互联网金融的一部分,也算新金融的一部分.     

New Zealand finance companies and risk premiums

This article uses the recent implosion of the finance company sector in New Zealand to examine a number of questions. In the period between the upsurge in the default rate in 2006 and the implementation of a Government Guarantee Scheme in October 2008, we find that the debt risk premiums within the deposit rates of these institutions were grossly inadequate to compensate for default risk, that depositors continued to make significant new deposits even into firms that failed shortly afterwards and that the failure of the companies to increase the risk premiums was likely out of concern that this would aggravate perceptions of default risk.     

FTA and equity: New approaches to governance

FTA and equity addresses the need for multiple stakeholders’ participation in public policy and corporate decision making thus leading to more democratic societies. The need for more participative and inclusive decision making is due to the move from the technocratic nature of decision making towards more democratic processes, which is a result of the transformation of societies and situations as a result of various factors including globalisation, environmental concerns, more knowledge intensive work and lifestyle.The current paper addresses Future-oriented Technology Analyses (FTA) in the context of a better understanding of issues that ought to be considered by the FTA community so that it can support the quest for new forms of governance. The paper has been structured on the discussion of governance around three pillars: socio-cultural evolution, corporate industrial activity and government.Analysis of the relationship between governance and each of the three pillars poses a number of questions to the FTA community that reflect on the potential impacts of FTA activities in governance. Setting a new landscape for the FTA, the paper concludes with those issues where the FTA community is starting to devote attention, as well as those it still ought to consider.     

Improving the delivery of clinic care

There has been an increasingly widespread movement toward the delivery of health care in outpatient settings. Hospitals must start to prepare for the shift from inpatient to outpatient services. Reductions in reimbursement and increasing costs will force hospitals to collect and obtain more data on outpatient services. Projecting future demands and assessing current utilization rates are two of the key factors in maintaining stability. This article is a case study of a major urban medical center's outpatient clinic. It includes a summary of observations on the clinic's daily operations and several recommendations for improvement. While the original analysis was highly specific to the actual facility observed, this article has been structured so that it may be applied to other institutions.     

Fintech and access to finance

This article surveys research on the effects of digitalization on access to finance. We focus the review on access through fintech. We review the growth of three main fintech technologies, fintech lending (incl. peer-to-peer lending), crowdfunding and initial coin offerings. We discuss existing evidence on how fintech affects access to finance for firms and investors and consider the regulatory challenges it poses. We incorporate the papers in this special issue, underlining their significant contributions to our understanding of the digitalization of finance and its effects. Finally, we discuss the challenges of research in the digital finance area and propose some new avenues for future research.     

Positivism in finance and its implication for the diversification finance research: Diversifying finance research: From financialization to sustainability

This paper is a complementary comment to the article recently published in IRFA by Thomas Lagoarde-Segot on the necessity of diversification of modelling in finance. In his claim, the author explained that financial concepts used by the mainstream are not neutral because they refer to a particular ethical judgement mainly focused on the shareholders' interest. In this comment, I explain that this ethical judgement historically results from the role playing by the Gaussian distribution in finance: while this statistical framework gave the first scientific foundations to finance in the 1960s, its symmetrical configuration implies that negative changes occur with the same probability than positive ones. In this context, all potential intervention (regulation) could only interfere (disturb) this “ethically fair situation” within the only perturbing element is the shareholder whose behaviours are likely to influence the market. After having explained that this reasoning is based on an a priori statement about observational facts (in opposition with positivism), I present this situation as an opportunity for current researchers in finance to clarify their implicit assumptions; which would open the door to a diversification of modelling in finance as Lagoarde-Segot promoted it in his IRFA article.     

Price and income elasticities of demand for modern health care: the case of infant delivery in the Philippines.

In the Philippines most women choose to deliver at home despite the presence of modern facilities. Policy-making requires a knowledge of the factors that determine that choice, especially in terms of variables like price and location, which are amenable to policy intervention. Over 2/3 of the babies born in low-income countries are delivered by traditional birth attendants who are uneducated and have no formal training. They are, however, available in rural areas, whereas 70-90% of the modern practitioners are in the cities. Recently efforts have been made to expand modern obstetrical services in developing countries, but few surveys are available documenting the impact of modern facilities on delivery patterns. The present survey collected data from 3075 women who had singleton births on the island of Cebu between 1983 and 1984, as well as data from 48 modern public and private health facilities and 88 modern and traditional health practitioners. For the analysis of these data an economic demand model was built, using the mixed multinomial logit technic to estimate relationships between delivery characteristics, mothers' characteristics, and delivery choice. Money prices were not a significant factor in the choices, but time prices were a significant consideration for the rural sample. Hours of availability were a significant factor for both urban and rural mothers, and availability of drugs was significant for the urban sample. Both rural and urban women preferred delivery by a midwife, trained or not, to delivery by a combination of doctors, nurses, and midwives. With few exceptions, income was not a significant factor, and having insurance (10% of the sample) increased the probability of choosing a modern private practitioner. Money price effects were inelastic; i.e., a price increase by modern facilities would not have much effect on the choice of these facilities, and lowering the price of modern public delivery services would do little to increase demand for them. Locating more public practitioners and facilities in rural areas could effectively increase the use of modern facilities by rural women. Both urban and rural women would increase their use of modern public away-from-home facilities if these facilities would increase their hours of operation. Having drugs available would also increase the use of the public away-from-home facilities. In both urban and rural samples, trained midwives were the practitioners of choice. Among rural women a rise in income would increase the likelihood of their choosing public and private away-from-home deliveries and home deliveries by private practitioners. From the point of view of public policy, the most significant implications of the study are: 1) decreasing travel time for rural women by locating modern facilities and practitioners in rural areas would increase the use of modern delivery services; 2) increasing hours of operation, increasing the availability of drugs, and providing trained midwives at public facilities would increase the use of modern delivery services; 3) decreasing money prices would not increase use of modern public delivery services; and 4) increasing the price for cost recovery would not decrease the use of modern public delivery services.     

How to solve the cost crisis in health care

U.S. health care costs currently exceed 17% of GDP and continue to rise. One fundamental reason that providers are unable to reverse the trend is that they don't understand what it costs to deliver patient care or how those costs compare with outcomes. To put it bluntly, few health care providers measure the actual costs for treating a given patient with a given medical condition over a full cycle of care, or compare the costs they incur with the outcomes they achieve. What isn't measured cannot be managed or improved, and this is all too true in health care, where poor costing systems mean that effective and efficient providers go unrewarded, and inefficient ones have little incentive to improve. But all this can be remedied by exploring the concept of value in health care and carefully measuring costs. This article describes a new way to analyze costs that uses patients and their conditions--not organizational units or narrow diagnostic treatment groups--as the fundamental unit of analysis for measuring costs and outcomes. The new approach, called time-driven activity-cased costing, is currently being implemented in pilots at the Head and Neck Center at MD Anderson, the Cleft Lip and Palate Program at Children's Hospital in Boston, and units performing knee replacements at Sch?n Klinik in Germany and Brigham & Women's Hospital in Boston. As providers and payors better understand costs, they will be positioned to achieve a true "bending of the cost curve" from within the system, not in response to top-down mandates. Accurate costing also unlocks a whole cascade of opportunities, such as process improvement, better organization of care, and new reimbursement approaches that will accelerate the pace of innovation and value creation.     

Key points to consider in the design and delivery of group long-term care insurance services

Long-term care insurance is a rapidly growing form of risk protection that many employers are beginning to make available to employees and their family members. Benefits managers need to use care in navigating the not yet fully charted waters of this new field of group insurance.     

伴着信息化金融远行

当带着墨香的2008年第1期杂志送到您手中的时候，相信您会像见到思念许久的朋友一样备觉温暖。您是否已经感受到作为编者的我们发自心底的那一份感谢与祝福呢？感谢各界新老朋友，祝福中国金融，祝福中2008，相信信息化将让中国金融业变得更强，行得更远。