Willingness to pay for publicly-financed health care: how should we use the numbers?

This paper addresses the question of how willingness to pay (WTP) values in health care evaluation can be used by policy makers. The way in which WTP values are used depends on from whom values are elicited and whether the good concerned is privately-financed or publicly-financed through taxation. Thus, four possible uses of WTP values are identified. The focus is on the two uses which arise in the publiclyfinanced situation. ‘Conventional’ use of WTP values, where the decision as to whether or not to provide a service depends upon whether or not WTP values are greater than total cost, applies only in the privately-financed, and not publiclyfinanced situations. The situations with publicly-financed goods are more complex. The use of WTP values for publicly-financed goods is justified and illustrated.     

Prospective utility study of patients with multiple cardiovascular events

Objectives: The effects of acute coronary syndrome (ACS) events on health-related quality-of-life (HRQoL) and the time dependency of these effects are unknown. This study aimed to characterize health utilities in ACS patients to aid development of future economic models estimating the cost per quality-adjusted life-year impact of ACS events and potential treatments.

Methods: Multi-center, non-interventional, longitudinal evaluation of health utility in patients experiencing ACS or stroke events. EuroQol-5 dimension 3 level (EQ-5D-3L) surveys were sent to patients (≥18 years) from three UK centers, 1 month after hospital discharge for myocardial infarction (MI), unstable angina (UA), or stroke. Patient demographics, lifestyle, and baseline utility score were collected in the first survey. Follow-up surveys were sent at 6, 12, 18, and 24 months to prospectively capture utility and subsequent health events. Two methods of patient identification were adopted—prospective, where the patient’s qualifying events occurred after the study index date, and retrospective, where the patient’s qualifying event occurred prior to the study index date. General healthy population utility values were assumed for pre-event HRQoL.

Results: Between January 2011 and March 2014, 2,103 prospectively (n?=?1,350)/retrospectively (n?=?753) identified patients (mean age?=?68.3 years; 67.9% male) responded: MI?=?55.9% (n?=?1,176), UA?=?42.7% (n?=?898), stroke?=?1.4% (n?=?29); 24% had type 2 diabetes. Post-event utility values were lower than general healthy population values, although significant differences in utility between subsequent 6 (n?=?1,031, change?=?–0.002), 12 (n?=?1,096, change?=?–0.008), 18 (n?=?1,246, change?=?–0.007), and 24 (n?=?1,277, change?=?–0.004) month timepoints were not detected. Through multivariate regression analyses, wheelchair use, current smoking, and secondary mental and joint health events were associated with the greatest statistically significant utility decrements.

Conclusions: This study indicates that health utility decreases following a cardiovascular event and, although some improvement occurs over the subsequent 24 months, general healthy population utility is not necessarily attained.     

The Impact of the Berlin Accord and European Enlargement on Dairy Markets

Journal paper No. J-18684 of the Iowa Agriculture and Home Economics Experiment Station, Ames, Iowa, Project No. 3566, and supported by Hatch Act and State of Iowa funds. Using a world agricultural model, we analyze the impact on dairy markets of the Berlin Accord on the European Union (EU) Common Agricultural Policy (CAP) Reforms. We also investigate the consequences of enlargement of the EU to include the Czech Republic, Hungary and Poland for the same markets. We produce a market outlook up to 2010 for these two scenarios. The Berlin Accord induces lower EU milk and dairy prices. A change in relative prices between cheese and butter-skim milk powder (SMP) occurs after 2005 and induces an expansion of cheese production, consumption and exports at the expense of the butter–SMP sector. Accession of the three central and eastern European countries (CEECs) leads to a permanent but moderate decrease in EU prices of milk and dairy products. For the three acceding CEECs, domestic prices increase dramatically. Their final consumption of milk decreases and dairy product consumption drops considerably. The derived demand of milk in dairy production increases, however, because of the higher prices for dairy products, benefiting dairy producers in these CEECs. Dairy exports of the three acceding countries to the EU–15 increase by one to three orders of magnitude, despite building large inventories. The impact of accession on world markets is small. À l'aide d'un modèle agricole à l'échelle mondiale, nous analysons l'impact des accords de Berlin sur la réforme de la Politique agricole commune (PAC) de l'Union Européenne, en ce qui touche les marchés laitiers. Nous examinons aussi les conséquences éventuelles de l'élargissement de l'Union Européenne à la République Tchèque, à la Hongrie et à la Pologne. Ces deux scénarios nous ont servi de base d‘élaboration de perspectives du marché jusqu'en 2010. Les accords de Berlin déclenchent une hausse duprix du lait et desproduits laitiers dans l'UE. Selon nos prédictions, on assiste après 2005 à un changement du prix relatif du fromage par rapport à celui de la poudre de lait écremé (PLE). II s‘ensuit une expansion de la production et de la consommation et des exportations defromage aux dépens du segment de la PLE. L'entrée des trois pays de l'Europe, du centre et de l'est (PECE) conduit à une baisse permanente, encore que modeste, des prix du lait et des produits laitiers dans l'UE. Chez les trois nouveaux arrivés, les prix intérieurs grimpent de façon spectaculaire, ce qui entraîne une chute de la consommation du lait particulièrement de celle des produits laitiers transformés. En revanche, la demande de lait industriel augmente à cause des prix plus élevés des produits dérivés, ce qui profite aux producteurs laitiers des trois pays. Les exportations laitières de ces pays augmentent de 1 à 3 ordres de grandeur, ce qui n'empèche pas la constitution de stocks importants. L'impact de l'accession sur leur marchés mondiaux devrait être de peu d'importance.     

The ‘New Agenda’ and Human Resource Management: A Roundtable Discussion With John Edmonds

John Storey and Nick Bacon discuss trade union reactions to HRM initiatives with John Edmonds and Phil Wyatt. John Storey and Nick Bacon are respectively Senior Lecturer in Human Resource Management and Research Fellow at Loughborough University Business School. John Edmonds is General Secretary and Phil Wyatt Research Director of the General, Municipal and Boilermakers’ Union.     

Internet Adoption by Travel Agents: a Case of Egypt

Current collaborative and rapid developments in tourism and information and communication technologies (ICTs) make it difficult to imagine that tourism existed before ICTs. Communication technology is one main reason for the existence of the Internet. Travel agents (TAs) are among service providers whom their Internet adoption could be the best marketing device for their business and a tool for their competitive advantages. The study explores the Internet adoption of the Egyptian TAs, patterns of usage and perceived benefits and barriers of e‐commerce adoption. It is found that the majority of TAs use the Internet to provide TA's information, find out about customers and competitors. Sales and revenue growth, increasing competitive advantages and marketing activities are the agents’ perceived benefits of adopting e‐commerce. Limited resources, unskilled labour, lack of readiness of public infrastructure and customers are among the main obstacles for not adopting the Internet technologies. Copyright © 2012 John Wiley & Sons, Ltd.     

Emerging organizations' characteristics as predictors of human capital employment mode: A theoretical perspective

Entrepreneurship is important to capitalistic economies, and in management studies. Additionally, organizations recognize that human resources are imperative to survival. Although human resources is an important field, sparse theory has been applied to human resources in emerging organizations. Recognizing that emerging organizations are different from established organizations, we expand prior work in human resources and emerging organizations to introduce a human resource architecture of emerging organizations. We introduce a model for the employment mode of emerging organizations based on intentionality, resources, boundary, and exchange. We present propositions drawn from our theory, and conclude with implications and suggestions for research.     

The Carbon Neutral Public Sector

Abstract

This paper argues for research into the effectiveness of government strategies for a ‘carbon neutral public sector’. We review initiatives in three OECD countries: New Zealand, Australia and the UK. In all jurisdictions, government agencies have consistently stressed ‘leading by example’ as a rationale for adoption. ‘Direct mandate’ by the Prime Minister (NZ); ‘organic development’ from wider central government sustainability initiatives (UK); and a more ‘laissez faire’ approach by Australian Federal and State Governments, were identified as the general pathways leading to implementation. Our assessment indicates: a lack of understanding of the implementation process for carbon neutrality; a need to identify and critically examine the ‘offset threshold’ at which mitigation efforts cease and offsetting is adopted; an absence of any evaluation of the ‘leading by example’ rationale; a lack of inter-country comparisons; a gap in understanding the relationship with economic and social aspects of sustainability; and a need to evaluate the utility of core government departments as the focus of carbon accounting. We urge colleagues to consider research in this area with a view to contributing to the interdisciplinary solutions which we believe are required.     

Intra-regional variation in land use and livelihood change during a forest transition in Costa Rica's dry North West

The work reported here examined intra-regional differences in land use and livelihood changes made by landholders during a forest transition in a dry region of North-West Costa Rica. It drew on the Sustainable Livelihoods Analysis framework to evaluate a qualitative, comparative study of landholders’ access to livelihood resources in two key landholder groups across five communities. Research findings show that while forest outcomes were similar across the two landholder groups and the five communities (net forest recovery), the livelihood dynamics leading to these outcomes varied. One important factor influencing this was small differences in the geographic location of the five communities, which shaped the effect of mediating institutions and policies on the accessibility and deployment of livelihood resources. The findings point to the importance of locally tailored interventions that reach beyond the field of forest conservation and management. These would include interventions to strengthen rural peoples’ access to resources needed to adapt livelihoods to changing socio-economic conditions. They would also include programs to reduce locally felt trade-offs between conservation and development. The findings also raise doubts that Costa Rica's payments for environmental services (PES) program, as it is currently structured, is an effective mechanisms for linking forest recovery and sustainable rural livelihoods in this particular region.