Financing medical specialist services in The Netherlands: Welfare implications of imperfect agency

Since 1995 the financing scheme for medical specialist services in the Netherlands has moved from a fee-for-service scheme to a capitation scheme. This paper analyzes the economic and welfare effects of this policy change. The paper adopts a numerical model that integrates demand and supply considerations and that recognizes the potential roles of moral hazard and supplier-induced demand. The paper finds that the shift in financing regime has been welfare-reducing. The policy change induced medical specialists to lower the supply of the health services which was already lower than optimal before the policy reform.     

为品牌注入“能量”

现在,大部分消费品品牌都陷入无法创造价值的困境,少数例外者之所以能找到并发掘品牌的价值潜力,则得益于它们所采用的一套为品牌注入"能量"的策略。     

Exchange or Covenant? The Nature of the Member-Union Relationship

Drawing on a study of members of the U.K. National Union of Teachers, this article considers the extent to which economic exchange, social exchange, and covenantal considerations underpin union members' willingness to continue membership and to participate actively in their union through union citizenship behaviors (UCB). Findings suggest that the more activist forms of UCB were motivated primarily by a perceived covenantal relationship with the union. In contrast, exchange, particularly social exchange, motivations played more of a role in motivating less demanding "rank and file" UCB and intent to quit the union. Union instrumentality appeared to be a necessary but insufficient condition for union viability, having an indirect effect on UCB and intent to quit the union and also moderating the effects of pro-union attitudes. Implications for union strategy are considered.     

The greenhouse effect: Damages,costs and abatement

The buildup of so-called greenhouse gases in the atmosphere — CO₂ in particular-appears to be having an adverse impact on the global climate. This paper briefly reviews current expectations with regard to physical and biological effects, their potential costs to society, and likely costs of abatement. For a worst case scenario it is impossible to assess, in economic terms, the full range of possible non-linear synergistic effects. In the most favorable (although not necessarily likely) case (of slow-paced climate change), however, it seems likely that the impacts are within the affordable range, at least in the industrialized countries of the world. In the third world the notion of affordability is of doubtful relevance, making the problem of quantitative evaluation almost impossible. We tentatively assess the lower limit of quantifiable climate-induced damages at $30 to $35 per ton of CO₂ equivalent, worldwide, with the major damages being concentrated in regions most adversely affected by sea-level rise. The non-quantifiable environmental damages are also significant and should by no means be disregarded.The costs and benefits of (1) reducing CFC use and (2) reducing fossil fuel consumption, as a means of abatement, are considered in some detail. This strategy has remarkably high indirect benefits in terms of reduced air pollution damage and even direct cost savings to consumers. The indirect benefits of reduced air pollution and its associated health and environmental effects from fossil-fuel combustion in the industrialized countries range from $20 to $60 per ton of CO₂ eliminated. In addition, there is good evidence that modest (e.g. 25%) reductions in CO₂ emissions may be achievable by the U.S. (and, by implication, for other countries) by a combination of increased energy efficiency and restructuring that would permit simultaneous direct economic benefits (savings) to energy consumers of the order of $50 per ton of CO₂ saved. A higher level of overall emissions reduction — possibly approaching 50% — could probably be achieved, at little or not net cost, by taking advantage of these savings.We suggest the use of taxes on fossil fuel extraction (or a carbon tax) as a reasonable way of inducing the structural changes that would be required to achieve significant reduction in energy use and CO₂ emissions. To minimize the economic burden (and create a political constituency in support of the approach) we suggest the substitution of resource-based taxes in general for other types of taxes (on labor, income, real estate, or trade) that are now the main sources of government revenue. While it is conceded that it would be difficult to calculate the optimal tax on extractive resources, we do not think this is a necessary prerequisite to policy-making. In fact, we note that the existing tax system has never been optimized according to theoretical principles, and is far from optimal by any reasonable criteria.During the academic year 1989–90 Dr. Ayres was at the International Institute for Applied Systems Analysis (IIASA), Laxenburg, Austria.During the summer of 1989 Mr. Walter was a member of the Young Scientists' Summer Program at IIASA.     

A model for forecasting the substitution of one technology for another

Most technological changes can be described as a substitution of one material, process or product for another. Each such substitution, if successful, normally tends to follow an S-shaped (or “logistic”) curve: that is, it starts slowly as initial problems and resistances have to be overcome; then it proceeds more rapidly as the competition between the new and the old technology grows keener and the new technology gains an advantage; and finally, as the market for the new technology approaches saturation, the pace of substitution slows down. Sometimes, when the process is completed, the old technology continues to retain some specialized portion of the total market (i.e., a sub-market) for which it is particularly well adapted. In forecasting the course and speed of the substitution process especially when it has already begun and partially taken place, the simplest approach is to project a function having the appropriate S-shaped curve, using historical data to determine the free parameters of the function. While useful, especially where data are not available for a more sophisticated study, the simple curve-fitting techniques fail to take into account several important factors that affect economic and management decisions on the part of producers and intermediate users (as well as “final” consumers) and thereby influence the course which the substitution process is likely to take. To overcome this limitation, a simulation model has been developed at IR&T which allows some of these factors to be evaluated and incorporated explicitly and quantitatively. The model is described and its application is illustrated in the case of the substitution of plastic for glass in bottles. It is most applicable where the competing technologies are rather precisely defined, where a good deal of current technical and economic data are available, and where an in-depth analysis is desired. Because this particular forecast was made before the sudden precipitous increase in petroleum prices, which upsets the price relationships assumed in the forecast, there is discussion of the vulnerability of forecasts to political and other contra-economic developments.     

Accelerating New Product Development: A Preliminary Empirical Test of a Hierarchy of Implementation

Although time to market and a product's profitability are closely linked, simply speeding up new product development (NPD) is no guarantee of success. In fact, haphazardly adopting the numerous methods for accelerating NPD may jeopardize the potential success of the new product and the company. An article in a previous issue of The Journal of Product Innovation Management suggests that companies seeking to speed up their NPD process should take a hierarchical approach to implementing the various acceleration techniques. To improve the likelihood that efforts to accelerate NPD will pay off with shorter development time, greater market share, and improved profitability, it is recommended that a company start by focusing on simplification of the NPD process. From there, the company can proceed in sequence through techniques involving the elimination of unnecessary steps in the NPD process, parallel processing (i.e., performing two or more NPD steps at the same time), the elimination of delays, and speeding up of the NPD process. Ed J. Nijssen, Arthur R. L. Arbouw, and Harry R. Commandeur follow up on this earlier work by addressing several key questions regarding the proposed hierarchy of techniques for accelerating NPD. First, do companies that make extensive use of the proposed hierarchy develop new products faster than companies that do not? Second, do companies that make extensive use of the hierarchy enjoy better financial performance than those that do not? Third, regardless of the hierarchy, are products developed faster by companies that make more intensive use of acceleration methods than by companies that use fewer methods of acceleration? Finally, how does financial performance compare among companies that make more intensive use of acceleration methods without following the hierarchy and those that use fewer methods of acceleration? A survey of Dutch companies finds that the proposed hierarchy of techniques has a positive effect on NPD speed. The survey results also suggest that faster NPD is possible through the use of the various acceleration methods without regard for the order in which they are implemented. However, a strong positive relationship is evident between the hierarchy and the profitability of the product and the company. In other words, a random approach to NPD acceleration does not improve financial performance. By trying to accelerate NPD in accordance with the proposed hierarchy of methods, a company can avoid critical mistakes that might otherwise limit financial results.