Resource use in general anaesthesia: a comparison of practice in Germany,France and the UK

Summary

This study reports the results of a study of anaesthetic resources used before, during and after various surgical procedures performed in the United Kingdom, Germany and France. A total of 1787 patients undergoing general anaesthesia for daycase knee arthroscopy, daycase laparoscopic gynaecological procedures, inpatient major non-gynaecological abdominal surgery or inpatient knee arthroscopy in a range of hospital settings were included in the study. The objective was to compare the use of anaesthetic agents, adjunct drugs and times spent in the various stages of surgery and recovery. An audit of the incidence of emesis in the postoperative recovery room and on the hospital ward was also undertaken. Results showed that the UK had the shortest median procedure times for induction, surgery and recovery. The pattern of drug use was generally similar for the main classes of anaesthetic agents and adjunct drugs, although the use of specific drugs in each class differed from country to country. Between 7% and 10% of patients suffered from one or more episodes of emesis. Practice differences between countries were apparent and differences in resource use indicate considerable scope for institutional cost savings on anaesthesia-related activities, beyond drug acquisition costs, in both France and Germany compared with the UK.     

A dynamic general equilibrium model of driving,gasoline use and vehicle fuel efficiency

The paper constructs a dynamic general equilibrium model to study the endogenous determination of gasoline use, driving and vehicle fuel efficiency. Before vehicles are produced, their fuel efficiency can be chosen optimally. Once produced, their fuel efficiency cannot be changed. The model generates endogenously different short-run and long-run price elasticities of gasoline use, with their magnitudes well within the region of plausible estimates in the empirical literature. The paper shows that although raising gasoline taxes and tightening the CAFE standard both reduce gasoline use in the long run, they are different in terms of the transmission mechanism, magnitudes of responses and dynamic paths of key endogenous variables.     

Time-inconsistent preferences in a general equilibrium model

This paper introduces time-inconsistent preferences in a multicommodity general equilibrium framework with incomplete markets. The standard concept of competitive equilibrium is extended in order to allow for changes in intertemporal preferences. Depending on whether or not agents recognize that their intertemporal preferences change, agents are called sophisticated or naïve. This paper presents competitive equilibrium notions for economies with naïve agents and economies with sophisticated agents and provides assumptions under which both types of equilibria exist. Surprisingly, the set of naïve equilibria in societies populated by time-consistent households is not allocationally equivalent to the set of competitive equilibria. For sophisticated equilibria, the equivalence holds. Time-inconsistency also raises conceptual issues about the appropriate concept of efficiency. Choices have to be made concerning the incorporation of future preferences and the appropriate instruments to create Pareto improvements. For both naïve and sophisticated societies, we present four possible efficiency concepts. Suitable conditions are specified for which both naïve and sophisticated equilibria satisfy appropriate efficiency concepts.     

Carbon leakages: a general equilibrium view

The effectiveness of unilateral action to curb carbon emissions has been dismissed because of possible “carbon leakages”, this referring to the rise of emissions in non-participating countries. This paper offers a general equilibrium (GE) exploration of the key mechanisms and factors underlying the size of carbon leakages. We developed a two-region, two-goods simplified GE framework, incorporating three types of fossil fuels (coal, oil and low-carbon energy), international trade and capital mobility. The model was designed to make tractable extensive multidimensional sensitivity analysis. The results suggest that the coal supply elasticity plays a critical role, while substitution elasticities between traded goods and international capital mobility appear relatively less influential. The shape of the production function also matters for the size of the leakages. Confirming the results obtained with large computable GE models, for a wide range of parameters’ values, carbon leakages appear to be small. Therefore, the argument that unilateral carbon abatement action taken by a large group of countries (such as the Annex 1 group) is flawed by significant carbon leakages is not supported by our sensitivity analysis. The likelihood of small leakages favours in fact the formation of a worldwide coalition to stabilise climate change.