How Should An Accumulative Toxic Substance be Banned?

The harmful effects on human health or ecosystems of many toxic substances depend on their cumulative concentration in the carrying medium (water, soil, or air), not just on the annual deposition rates of the substances. Accumulative toxic substances pose challenges to regulatory policy that are not faced when controlling pollutants whose damaging effects are though to depend primarily on annual emission flows. An increasingly common response is to phase out offending uses or production of the substance. In this paper we take as given the goal of phasing out an accumulative pollutant and examine different ways this could be done using a simple, partial-equilibrium dynamic model. We focus on phaseout measures in which the cumulative production and release of the offending substance over the transition period is fixed. Once this cumulative volume is reached, users must convert to a known but higher-cost substitute that is assumed to be benign. The key to the analysis is the observation that the quota on cumulative production makes production of the toxic substance during the transition analogous to extraction of an exhaustible resource with a higher-cost, nonexhaustible ‘backstop’ technology. Using this framework, we first describe the cost-effective outcome when the ‘sunset’ date is chosen to maximize product market surplus subject to the cumulative production constraint. This outcome is compared to one in which the regulator fixes the sunset date, and one in which the regulator limits annual production as well as cumulative production out of concern for acute exposure effects. Finally, we discuss the kinds of market-based policy instruments that would be appropriate for supporting a cost-effective outcome.     

Cost-effectiveness of foreign aid programs in the baltics

After the upheavals in Central and Eastern Europe in the late 1980s and early 1990s, the Western world has given considerable aid to the fledgling democracies. In this paper we draw a summary from Baltic experience in the fields of educational programs, scientific and environmental programs, and commercial projects in banking, taxation, and energy. We analyze the motivation and identify different possible effects of foreign aid. We signal possible inefficiencies arising from the lack of coordination of foreign aid, deal with possible waste as being a form of loss in cost-effectiveness, and address the policies followed by aid-providing agencies. Finally, we suggest ways that can help to achieve cost-effectiveness by assisting the donor and recipient in maximizing benefits gained and possibly reducing costs.     

SCHOOL CHOICE: SUPPORTERS AND OPPONENTS

We examine the attitudes of Ohio homeowners about school choice, which includes open enrollment programs, school vouchers, tuition tax credits, and charter schools. Previous studies examine more limited forms of choice and investigate fewer possible influences. Overall we report at least five new findings and five findings that contradict previous studies. We find the strongest predictors of opposition for school choice are people having graduate degrees and living in high‐performing public school districts. We find people living in blue collar areas and using private schools to be the strongest predictors of support. Males tend to oppose choice and African Americans support it. We find no role for income, the convenience of alternative schools, or the protection of house values in support for school choice. Overall we report at least five new findings and five findings that contradict previous studies. (JEL H44, I22)     

Healthcare costs for Crohn’s disease patients treated with infliximab: a propensity weighted comparison of the effects of treatment adherence

Objective:

The objective for the research was to evaluate the direct healthcare costs for Crohn’s disease (CD) patients categorized by adherence status.

Methods:

Adult patients with ≥1 claim for infliximab and ≥2 claims for CD who were continuously insured for 12 months before and after their first infliximab infusion (index date) were identified in a 2006–2009 US managed care database. Patients were excluded if they had rheumatoid arthritis claims, received infliximab billed as a pharmacy benefit, or received another biologic drug. Patients were categorized as being either adherent or intermittently adherent to infliximab using a pre-defined algorithm. Total and component direct costs, CD-related costs, rates of surgery, and days of hospitalization were estimated for the 360-day post-index period. Propensity weighted generalized linear models were used to adjust the cost estimates for potential confounding variables.

Results:

The total propensity weighted cost for infliximab adherent patients was $40,425 (95% CI?=?[$38,686, $42,242]), compared to $41,082 (95% CI?=?[$38,163, $44,223]) for the intermittently adherent (p?=?0.71). However, adherent patients had lower total direct medical costs, exclusive of infliximab, that were $13,097 (95% CI?=?[$12,141, $14,127]) compared with $20,068 (95% CI?=?[$17,676, $22,784]) for intermittently adherent patients as a result of substantially lower hospital and outpatient costs (p?Conclusions:

Greater drug-related costs for infliximab adherent patients were offset by lower costs from hospitalization and outpatient visits. These findings indicate that adherent patients have improved clinical outcomes, at a similar aggregate cost, than patients who are only intermittently adherent to therapy.     

Protecting the privacy of personal information in employee benefit plans

The United States is not the only country dealing with privacy of health information. In the absence of clear legislative direction, this paper focuses on the common privacy principles that underlie Canadian privacy legislation and recommends a plan of action. The objective is to give plan administrators and trustees sufficient transition time to develop and implement the appropriate privacy strategies, thereby minimizing both the potential burden of compliance and the potential risks of noncompliance.     

Markets for Tradeable Emission and Ambient Permits: A Dynamic Approach

This paper discusses trade mechanisms in pollutionpermit markets. Proofs are given, that sequential,bilateral trade in tradeable emissions permitsconverges to a market equilibrium with minimal totalcosts of pollution control. If ambient or depositionpermits are traded, the convergence of bilateraltransactions occurs only in the case of a singlereceptor. For multiple receptors, the proof ofconvergence for tradeable emissions and ambientpermits is given for two trade mechanisms: sequential,multilateral trade and a Walrasian auction.