Reforming Social Security in a Transition Economy: The Case of Lithuania

This paper points out a number of problems associated with the existing pension system in Lithuania. Reforms are proposed, including (i) a substantial increase in the basic pension benefit rate, financed on a pay-as-you-go basis, provided universally, and regulated according to wage/price indexation; (ii) a significant cut in the tax contribution rate to the public pension system matched by a rise in the VAT; (iii) a rise in the retirement age to 65 for both men and women; and (iv) a gradual conversion to a private, funded, mandatory pension system to replace the earnings-related part of the current pension system.     

New ventures in Cleantech: Opportunities,capabilities and innovation outcomes

Facing the challenge of climate change, innovations that imply environmental benefits create business opportunities for entrepreneurs. This paper analyzes innovation capabilities of startups in Cleantech and how the innovation outcomes of those startups develop over time. Based on the Mannheim Foundation Panel and applying propensity score matching, a cohort of 567 Cleantech startups is analyzed and compared with a control cohort of non‐Cleantech startups. We find that startups in Cleantech have, on average, higher technological capabilities compared with all other startups. Our econometric evidence shows that Cleantech startups are more likely to combine existing technology in a novel way. Finally, we find that Cleantech startups develop more market novelties in subsequent years when compared with their control group peers.     

Projecting total costs and health consequences of increasing mt-sDNA utilization for colorectal cancer screening from the payer and integrated delivery network perspectives

Abstract

Aims: To evaluate total costs and health consequences of a colorectal cancer (CRC) screening program with colonoscopy, fecal immunochemical tests (FIT), and expanded use of multitarget stool DNA (mt-sDNA) from the perspectives of Integrated Delivery Networks (IDNs) and payers in the United States.

Materials and methods: We developed a budget impact and cost-consequence model that simulates CRC screening for eligible 50- to 75-year-old adults. A status quo scenario and an increased mt-sDNA scenario were modeled. The status quo includes the current screening mix of colonoscopy (83%), FIT (11%), and mt-sDNA (6%) modalities. The increased mt-sDNA scenario increases mt-sDNA utilization to 28% over 10 years. Costs for both the IDN and the payer perspectives incorporated diagnostic and surveillance colonoscopies, adverse events (AEs), and CRC treatment. The IDN perspective included screening program costs, composed of direct nonmedical (e.g. patient navigation) and indirect (e.g. administration) costs. It was assumed that IDNs do not incur the costs for stool-based screening tests or bowel preparation for colonoscopies.

Results: In a population of one million covered lives, the 10-year incremental cost savings incurred by increasing mt-sDNA utilization was $16.2 M for the IDN and $3.3 M for the payer. The incremental savings per-person-per-month were $0.14 and $0.03 for the IDN and payer, respectively. For both perspectives, increased diagnostic colonoscopy costs were offset by reductions in screening colonoscopies, surveillance colonoscopies, and AEs. Extending screening eligibility to 45- to 75-year-olds slightly decreased the overall cost savings.

Limitations: The natural history of CRC was not simulated; however, many of the utilized parameters were extracted from highly vetted natural history models or published literature. Direct nonmedical and indirect costs for CRC screening programs are applied on a per-person-per modality basis, whereas in reality some of these costs may be fixed.

Conclusions: Increased mt-sDNA utilization leads to fewer colonoscopies, less AEs, and lower overall costs for both IDNs and payers, reducing overall screening program costs and increasing the number of cancers detected while maintaining screening adherence rates over 10 years.     

Costs of complying with quality requirements in meal services for older adults

ABSTRACT

Care of older adults, including meal service to home-dwelling individuals is under pressure for improving its resource utilization. There is concern for potential meal quality impacts of this development – and subsequently for the users’ food intake and nutritional status. The objective of the study is to examine the municipalities’ additional costs of initiatives to improve quality in the supply of meal services for the home-dwelling elderly. An economic optimization model was developed and used to determine the cost-minimizing meal production scheme under alternative specifications regarding production methods, ingredient sourcing, composition of dishes, menu variation, and delivery frequency for each municipality in Denmark, while taking heterogeneity of users into account. Alternative modifications to the quality standards within these dimensions have been analyzed. Results suggest that except for higher delivery frequency, the additional costs of the considered quality improvements are modest (1–5% of the current cost), whereas daily delivery would increase the cost by 10–15% in several municipalities. Despite relatively low additional costs, Danish municipalities may lack the economic incentive to undertake such quality improvements, because the additional costs cannot be passed on to the users; thus, municipalities will need to finance these costs by savings on other municipal services.     

Exporting and Productivity in the USA

Exporting is often touted as a way to increase economic growth.This paper examines the interaction between exporting and productivitygrowth in US manufacturing. While exporting plants have substantiallyhigher productivity levels, there is no evidence that exportingincreases plant productivity growth rates. The higher productivityof exporters largely predates their entry into exporting. However,within the same industry, exporters do grow faster than non-exportersin terms of both shipments and employment. Exporting is associatedwith the reallocation of resources from less efficient to moreefficient plants. In the aggregate, these reallocation effectsare quite large, making up over 40 per cent of total factorproductivity growth in the manufacturing sector. Half of thisreallocation to more productive plants occurs within industriesand the direction of the reallocation is towards exporting plants.     

Innovative leadership: First-mover advantages in new product adoption

Summary. This paper analyzes innovation adoption when uncertainty about its profitability cannot be resolved immediately. Firms begin with a common estimate of the probability of high demand. If any adopts, all observe realized demand. An increase in the initial estimate can decrease the equilibrium number of initial adopters, because it results in higher updated estimates that can induce future adoption by additional firms that reduces the initial adoption payoff. Moreover, innovative leadership does not imply initial adoption because leadership implies a greater waiting payoff as well as a greater adoption payoff. Leadership does, however, still provide a higher expected payoff. Received: July 16, 2001; revised version: January 13, 2002     

Multiplant Firms and Innovation Adoption and Diffusion

A new theoretical explanation is provided for the empirical observation that large firms usually adopt sooner, although there are notable exceptions. The analysis focuses on the adoption of an innovation of uncertain profitability by a large firm with two plants and a small firm with one. Marginal production costs are increasing in each plant, and economies of multiplant operation are possible. These have conflicting effects on the incentive to adopt. The large firm benefits more from adopting a success. However, if an adopter must shut down a plant to learn about the innovation, the loss of multiplant economies reduces the large firm's incentive to adopt. Absent multiplant economies, the large firm is more likely to lead a diffusion because its greater return from a success dominates. However, the small firm is more likely to lead a diffusion if there are multiplant economies and the large firm's learning cost disadvantage dominates.