New approaches to the finance and delivery of health care

Radical reform of the financing of health care has emerged onto the political agenda in recent months. Any new proposals must, however, be judged in terms of their impact on the fundamental public policy objectives of efficiency, equity and choice. How do the new proposals measure up?     

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.     

Improving the Health of Healthcare Companies

The healthcare sector has been extremely effective in improving human health while at the same time delivering outstanding returns to shareholders, at least on average. But averages can hide a lot of poor performance, and careful examination of the sector shows a sizable disparity between the long‐run productivity and value added of the top companies and the rest. To better understand the reasons for this disparity, the authors undertook a comprehensive study of how differences in capital deployment strategies, financial policies, and measures of corporate operating performance such as sales growth and return on capital are associated with returns to shareholders. Perhaps the most striking finding is the strong positive correlation in the healthcare industry between higher rates of reinvestment, especially in the form of spending on R&D and acquisitions, and stock price performance. And given the importance of such reinvestment, it is not surprising that maintaining financial flexibility by paying down net debt and otherwise limiting corporate leverage—and even issuing significant equity—are all associated with higher stock returns. When it comes to operating performance, moreover, it's not enough just to be good; it takes growth and improvement in cash flow and earnings to drive share prices higher. Measures of changes in performance such as increases in EBIT and ROIC, and high rates of growth in sales, all show consistently strong and positive relationships with stock returns while measures of levels of performance, especially EBIT margins and EBITDA margins, demonstrate relationships that are weak and in some cases even negative. Last, and consistent with the findings reported above, despite often vocal investor demands to pay dividends and buy back shares, in the case of healthcare as a whole such distributions have a clearly inverse relationship with share price performance. That is to say, the larger the payouts to shareholders, the lower the shareholder returns.     

完善金融信用体系

金融的本质是社会信用,银行的基本特征是以比较低的资本金来运营大量的负债,没有社会信用的支持就寸步难行。金融业在某种程度上说是经济状况的集中反映点以及经济发展中矛盾和风险的反映点。金融信用在社会信用体系中非常重要,金融信用缺失对经济造成极大的危害。金融信用环境的恶化在严重影响金融业发展的同时,也直接阻碍了社会经济的正常、快速发展,重建金融信用环境、整治金融秩序迫在眉睫。     

对提高图书馆工作人员素质的思考

对提高图书馆工作人员素质的重要意义和图书馆工作人员应具备的素质进行了探讨,并提出了如何提高图书馆工作人员素质的方法。     

固有风险评估方法及其改进

固有风险是指在不考虑内部控制结构的前提下,由于内部因素和客观环境的影响,企业的账户、交易类别和整体财务报表发生重大错误的可能性.     

关于完善我国银行业突发事件应急管理的思考

银行作为现代经济的枢纽,与经济社会的各个方面紧密相连,一旦银行业突发事件处置不当,很有可能上升为经济危机,影响社会安定和经济发展,并给人民财产带来损失.为此,本文着重对我国银行业突发事件应急管理的"预防和监测、响应与应对和评估与恢复"等重点和难点问题进行了探索研究,并结合实际提出了相应的解决办法,以期进一步深化我国银行业突发事件应急管理的研究.     

增强审计判断有效性初探

审计判断是审计学研究的重点,审计师的审计判断能够影响到审计服务质量,提高审计服务的效率。本文以审计判断的有效性为出发点。首先通过文献研究分析了审计判断的两个重要命题“主体有效性假设”和“过程有效性假设”,在此基础上分析了审计假设的框架效应、锚定效应、肯定效应和稀释效应等,有针对性地提出相关对策建议,以便改善审计师判断的准确性。     

如何提高宏观财政政策的有效性?——宏观政策与微观政策协调的视角

问题的起源——扩张的财政政策,以应对突发的外部冲击 当前,全球经济都面临突发的疫情冲击,这种冲击远比一般的技术冲击或者石油冲击更具有负面影响,甚至战争带来的影响也不如这种疫情冲击,它对社会的总供给和总需求都带来了显著影响.首先影响的是总供给,直接减少了厂商的生产,特别是劳动力投入,这种对劳动力的影响一般的外部冲击都很少...     

社会需要完善个人信用系统

推广和完善个人信用系统是与时俱进的需要,更是规范道德,约束行为的需要。推广和完善个人信用系统要分阶段分步骤推广,同时要借鉴国内外的经验,完善个人信用的职能部门。     

提高教学质量的经济学分析

当前影响教学质量的内在原因是教师教学研究的机会成本大于教学研究的总收益,这促使资源从教学研究向非教学研究活动转移.应采取有效措施,更好地为教师提高教学质量创造条件、提供机会,增加教师教学研究收益.     

提高信用卡营销渠道效率研究

本文用经济学原理来分析信用卡营销渠道行为。文章指出销渠道是一串合约,分析渠道行为应该站在合约关系的角度上来分析。在目前各大国有商业银行内部市场没有充分建立这一市场环境下,这种合约关系主要表现为一种考核关系。目前信用卡市场上存在的大量的机会主义行为实质上是信息不对称下的败德行为。因为缺乏准确的考核信息,对一线客户经理的考核指标与集体的目标不一致,造成营销渠道效率降低。应通过更加精确的考核,来解决信息不对称的问题,提高渠道效率。本文给出了具有实质意义的方案来解决目前信用卡市场上存在的大量无效卡、睡眠卡的问题,并对该方案做了深入探讨。     

提升中国金融“软实力”问题

转变金融增长方式关键在于提升金融"软实力" "金融实力"包括金融"硬实力"和金融"软实力".金融"硬实力"主要包括金融资产规模、经济金融化程度、经济货币化程度、股票市值、资本实力,金融机构数量,金融从业人数、外汇储备、金融市场交易量、金融业增加值等等.金融"软实力"主要包括金融创新水平、金融市场体系发育程度、金融企业治理机制、金融社会环境、金融监管能力、金融开放度,金融人才配置、金融文化、金融理论建设、金融国际环境等等.金融"硬实力"的平面扩张是金融大国的标志,金融"软实力"的立体提升是金融强国的标志.中国转变金融增长方式的关键在于变金融"硬实力"的平面扩张为金融"软实力"的立体提升.     

提高海南省金融监管有效性的思考

作在对海南省金融监管工作状况进行评估的基础上，针对金融监管所面临的问题就如何加强金融监管、提高金融监管有效性提出了见解。如更新观念完善监管机制，强化监管手段，完善法规等。     

论我国税收激励制度的完善

税收激励主要通过收益调节、现金流量的可获性和风险分担这三种方式发挥其作用。我国目前的税收激励的主要不足在于，缺乏一种系统的、一以贯之的政策取向。从知识经济的大背景看，完善我国的税收激励制度应紧紧围绕促进科技创新这一主线来进行。     

Managed care,technology adoption,and health care: the adoption of neonatal intensive care

Managed care may influence technology diffusion in health care. This article empirically examines the relationship between HMO market share and the diffusion of neonatal intensive care units. Higher HMO market share is associated with slower adoption of mid-level units, but not with adoption of the most advanced high-level units. Opposite the common supposition that slowing technology growth will harm patients, results suggest that health outcomes for seriously ill newborns are better in higher-level units and that reduced availability of mid-level units may increase their chance of receiving care in a high-level center, so that slower mid-level growth could have benefitted patients.