Indigenous Peoples’ Health Care: New approaches to contracting and accountability at the public administration frontier

Abstract

This article analyses reforms to contracting and accountability for indigenous primary health care organizations in Canada, New Zealand, and Australia. The reforms are presented as comparative case studies, the common reform features identified and their implications analysed.

The reforms share important characteristics. Each proceeds from implicit recognition that indigenous organizations are ‘co-principals’ rather than simply agents in their relationship with government funders and regulators. There is a common tendency towards more relational forms of contracting; and tentative attempts to reconceptualize accountability. These ‘frontier’ cases have broad implications for social service contracting.     

Economic modelling of costs associated with outcomes reported for type 2 diabetes mellitus (T2DM) patients in the CANVAS and EMPA-REG cardiovascular outcomes trials

Aims: To model direct medical costs associated with reductions in cardiovascular disease (CVD) events in T2DM patients reported in the CANVAS and EMPA-REG trials, which assessed the cardiovascular safety of canagliflozin and empagliflozin, respectively.

Materials and methods: Costs were modeled from a US managed care organization (MCO) perspective for the CVD outcomes included in both trials: three-point major adverse cardiovascular event (MACE) and its components (cardiovascular-related death, nonfatal myocardial infarction, nonfatal stroke), as well as heart failure requiring hospitalization. The rate of CVD events averted (difference between study drug and placebo) was projected to the portion of an MCO T2DM population matching the respective trial’s inclusion criteria. A targeted literature search for paid amounts directly associated with each CVD event provided the unit costs, which were applied to the projected number of events averted, to calculate costs avoided per member per year (PMPY). One-way sensitivity analyses were performed on events averted, unit costs, and percentages of trial-applicable patients.

Results: Based on three-point MACE events averted, costs avoided PMPY of $6.17 (range: $1.27–$10.94) for CANVAS and $2.75 ($0.19–$4.83) for EMPA-REG were estimated. Costs avoided for individual components of MACE ranged from $0.77 to $3.84 PMPY for CANVAS and from -$0.97 (additional costs) to $1.54 for EMPA-REG. PMPY costs avoided for heart failure were $2.72 for CANVAS and $1.32 for EMPA-REG.

Limitations and conclusions: Models assumed independent, non-recurrent outcomes and were restricted to medical costs directly associated with the trial-reported events. The reductions in CVD events in T2DM patients reported for both CANVAS and EMPA-REG project to a positive cost avoidance for these events in an MCO population. The analysis did not include an assessment of the impact on total cost, as the costs associated with adverse events, drug utilization or other clinical outcomes were not examined.     

Wird die Konjunkturkomponente der Schuldenbremse ihrer Aufgabe noch gerecht?

Wirtschaftsdienst - In der Debatte um die Schuldenbremse geht es zumeist um eine Grundgesetzänderung. Dabei ist ein wesentlicher Teil der Schuldenbremse — die Konjunkturkomponente,...     

How resilient is La Réunion in terms of international tourism attractiveness: an assessment from unit root tests with structural breaks from 1981-2015

Even if local policymakers increasingly claim that tourism is one of the key factors of future economic development for the French small island La Réunion, international tourist arrivals are observed to be locked in a stagnation phase since the beginning of the 2000s. Starting from this stylized fact, this article aims to study if this phenomenon results from major external events hurting this economy regularly. Next, by using univariate unit root procedures with structural breaks, we test for evidence of permanent or transitory effects of external shocks on international tourist inflows (total, by source markets, and by category) over the period 1981–2015. Finally, the empirical analysis allows us to reject the null of a unit root. Then, stagnation of tourism arrivals to La Réunion is not due to exogenous shocks but probably results from endogenous impediments within the domestic tourism industry and unsuitable public policies.     

Exploring consumer attitudes to online collaborative consumption: A typology of collaborative consumer profiles

Online collaborative consumption enhances peer networks, members of which communicate, collaborate, and even deliver services to one another via digital sharing platforms. Despite the tremendous increase in collaborative consumption, due in large part to the development of the Internet, the reality of the economic and social movements that underpin this trend is much less visible. Of course, not all consumers seek collaborative consumption or interact through online platforms. Using a qualitative approach, this paper aims to investigate motivational factors and barriers against collaborative consumption and to establish a typology of collaborative consumer profiles, identifying the most suitable type of online sharing platforms for each profile. The findings reveal the following collaborative consumer profiles: committed, pragmatists, intermittent, and skeptical, each demonstrating different preferences for the different type of online sharing platform.     

Bank market power and the intensity of borrower discouragement: analysis of SMEs across developed and developing European countries

Small Business Economics - This paper analyzes the effect of bank market power on the financial constraints of small and medium-sized enterprises (SMEs) through the study of borrower...     

Has the CSR engagement of electrical companies had an effect on their performance? A closer look at the environment

Even though electrical companies attain a top ranking in the publication of CSR reports, they are often accused of 'green‐washing' due to their bad environmental reputation. The current economic crisis is testing their real CSR commitment more than ever, especially when this goes beyond its economic consequences. Based on a worldwide sample of electrical companies, we are going to study why companies are being socially responsible. We wish to know if it is due to the impact on the firms' performance or whether there are other motives (legitimation, improving their reputation) that lead companies to carry out these practices. We will also consider if it changes across the kind of CSR action considered. The results show that there is an economic justification beyond the socially responsible behaviour of the electrical companies. Additionally, most kinds of CSR action (community, diversity, corporate governance, product responsibility) are also carried out looking for economic rewards. However, the CSR actions oriented to the environment are mainly motivated by their need to improve their image and reverse their negative impact. Copyright © 2014 John Wiley & Sons, Ltd and ERP Environment     

THEORY AND EVIDENCE IN PSYCHOLOGY AND ECONOMICS ABOUT MOTIVATION CROWDING OUT: A POSSIBLE CONVERGENCE?

The empirical relevance of motivation crowding out is a controversial issue in economics and psychology. As already pointed out by Frey and Jegen ( 2001 ), this is partly due to the historical development of two distinct and parallel strands of literature that stem from different theoretical traditions, have radically different tenets and therefore, are difficult to reconcile. In this survey, we go back to the details of the debates that took place independently among psychologists and economists, and sketch an integrative interdisciplinary approach likely to favor a more fruitful collaboration between economics and psychology. From this perspective, experimental economics (both field and laboratory) is viewed as a major research field shedding new light on the conditions of relevance of motivation crowding out.