Reforming the Financial Health Care System： The Case of the Republic of Albania

The Albanian health care system is currently in a period of deep transformation as well as the country is reflecting the future reforms after the turbulent development of the most recent years. The admission of Albania among future members of the European Union requires also an innovation in the health care system in order to build a model more compliant with the European performance and standards. These innovations are required also in the managerial approach to the health care and in its financing system. The aim of this paper is to analyze the actual financing model of the Albanian health care sector while highlighting the possible future managerial development. First of all, this article presents a history review of the Albanian health-care system, analyzing the current governance model. The goal of this approach is to describe the starting point of the reform paths for the future policy makers. Afterwards the research underlines the transition from a financing model based on historical public expenditure to a system based on the performance as one of the main innovation in the managerial approach to the health care. The introduction of management thinking will then allow developing a cost-based financing model, an accounting system in the teaching hospital and, finally, a financing system able to pay for services provided by private health care entities. The article then offers also a contribution to policy makers in order to define the ＂paths＂ of the Albanian health care system in the next years.     

Political and Economic Inequities and the Shaping of Institutions and Redistribution

This article studies the joint effect of political and economic inequalities on redistributive taxation and institutional quality. The theoretical model suggests that income inequality, coupled with political bias in favor of the rich, decreases redistribution and lowers institutional quality. The effect of the former is to increase productive investment, and the effect of the latter is to decrease it—with resulting ambiguous implications for economic growth. Testing these predictions empirically in a panel of countries, we find that inequality has a negative effect on both institutional quality and redistribution.     

Economy-wide reform and agricultural recovery: Observations of economic Darwinism among transition economies

The fitness of an economy and its prospects for continued prosperity will be measured and determined by its robustness and its ability to adapt to changing circumstances. Some countries in transition are adapting much more easily than others to rapid changes in the orientation of their economy, the common objective of which is to achieve economic growth through the adoption of a range of characteristics generally associated with a market economy. Economic growth does not have to be very fast, but it must be efficient and sustainable. Policy adjustments must address political economy concerns, while seeking to achieve macroeconomic equilibrium and price stabilization, competitiveness, efficiency and flexibility, and the protection of the living standards of the most vulnerable population The process of agricultural sector reform will be determined both by economy-wide policies and sector-specific policies. This paper first outlines a taxonomy of the objectives of agricultural sector reform, and then discusses the way in which indirect price interventions (specifically exchange rate and interest rate policies, expansive fiscal policies and industrial protection policies), influence agricultural growth. Lessons of experience drawn from the UNDP/World Bank Trade Expansion Program structural and sectoral adjustment operations in Poland, and the cases of New Zealand and Chile are employed to illustrate not only the constraints that countries face in this regard, but also in identifying targets for further action. The third section presents what is called the architecture of incentives for agriculture'. In defining a strategy of agricultural sector reform, experience has shown that a structure of incentives can be developed that creates an environment ripe for agricultural growth-incentives relating, for example, to taxation, prices, foreign investment, privatization and demonopolization, decentralization and institutional reform. Special considerations that will require additional attention by policy-makers outside of this structure include the maintenance of GATT-legal principles in trade policies, issues relating to tariffication (including concerns about price risk management, food supply, and the role of food aid), input and credit subsidies as a means to correct for market failures, and the role of regional trading blocks in world trade.     

Exports,imports and growth: New evidence on Italy: 1863–2004

The nexus between trade and economic growth in Italy has been widely debated by historiography. However, there are no long run analyses on this topic that cover the whole span from Unification to present days. This paper contributes to fill this gap by investigating the relationship between real exports, imports and GDP in Italy from 1863 to 2004 by using cointegration analysis and causality tests. The outcome suggests that these variables comove in the long run but the direction of causality varies across time. In the period prior to the First World War import growth led GDP growth that in turn led export growth. Conversely, in the post-Second World War period we have a strong bidirectionality between imports and exports consequent on the increase in intra-industry trade. We also find a weak support for export-led growth and growth-led imports. This suggests that exports were not the only or the main driver of economic growth. There was probably a multiplicity of factors at work, among which high rates of capital formation and the expansion of internal demand probably stood out.     

MACROECONOMIC POLICY AND ELECTIONS IN OECD DEMOCRACIES*

The purpose of this paper is to test for evidence of opportunistic “political business cycles” in a large sample of 18 OECD economies. Our results can be summarized as follows: 1) We find very little evidence of pre-electoral effects on economic outcomes, in particular, on GDP growth and unemployment; 2) We see some evidence of “political monetary cycles,” that is, expansionary monetary policy in election years; 3) We also observe indications of “political budget cycles,” or “loose” fiscal policy prior to elections; 4) Inflation exhibits a post-electoral jump, which could be explained by either the pre-electoral “loose” monetary and fiscal policies and/or by an opportunistic timing of increases in publicly controlled prices, or indirect taxes.     

The Quest for Quality: A Quality Adjusted Dynamic Regulatory Mechanism

In situations where quality is fixed, the widely used RPI‐X regulatory mechanism has a number of desirable properties, such as convergence to a second best optimum. Theoretical analysis of this mechanism in the case of endogenous quality is limited and therefore regulators have typically imposed constraints on the firm's quality choice in ad hoc manners, either by mandating quality levels, or by including quality adjustment factors in the RPI‐X mechanism. In this paper, we construct the rigorous theoretical counterpart of these manners of including quality measures in the constraints faced by a regulated firm. This mechanism converges to second best optimum. It works by offering the firm trade‐offs between prices and qualities based on the choice it made in the previous period; however, reflecting the practical problem valuing quality, the informational requirement to select these trade‐offs appropriately is qualitatively stronger than in the fixed quality case. Moreover, even when the informational problem can be overcome, we identify a further potential pitfall in the approach taken in practice by regulators, and show that, in order to avoid it, the regulated firm should be subject to an additional constraint, which we label the distance constraint, and which can be interpreted as requiring the firms to choose prices and qualities within a band in every period.     

Graduate employment: Does the type of higher education institution matter?

The paper analyses whether the type of institution from which students graduate has an impact on their unemployment propensity. It uses official data on the Portuguese higher education system, for 2018, at the program/institution level, which provides information on graduate unemployment, as well as demographic and socioeconomic background information. A fractional probit model on graduates’ propensity for unemployment is estimated. Results suggest that polytechnic graduates face higher unemployment propensity than university graduates, maintaining inequalities present in students’ previous trajectories. Policies targeting socioeconomic segregation need to address not only access to higher education but also the transition to the labor market.     

The Well-Being Cost of Inflation Inequalities

In terms of well-being, how costly is inflation? To answer this question, empirical evaluations have typically studied average inflation rates at the national level, thus disregarding the role of inflation inequalities within a country. In this article, we relax the assumptions that heterogeneous consumers face homogeneous inflation rates, and study the correlation between price changes and self-reported satisfaction with living standards. We use newly available data from France and adopt two approaches. First, we focus on individually perceived inflation and use the internationally harmonized Opinion Price Index as a proxy for experienced inflation. Variations in perceived inflation help predict well-being differences among consumers, even when controlling for relevant sociodemographic factors, personality traits, and common method variance. We estimate their marginal impact to be higher than equivalent variations in nominal income. Second, we compare groups of consumers over time and find that changes in the price of a good disproportionately affect the relative well-being of those who consume it. The study shows that the well-being cost of the inflation crisis would be underestimated if looking at aggregate figures only.     

Medication adherence and persistence in the treatment of rheumatoid arthritis with adalimumab and etanercept. Six years of analysis

Objective:

The aim of this study was to evaluate medication adherence and persistence of patients treated with Etanercept and Adalimumab for Rheumatoid Arthritis, also giving economic evaluations on therapy costs for Received Daily Dose (RDD).

Materials and methods:

This retrospective study took into account 6 years from January 1, 2007 to December 31, 2012. Medication adherence was quantified utilizing the ratio between RDD and Prescribed Daily Dose (PDD). Persistence has been reckoned taking into account the actual days of therapy comparing posology with supplied dose. The persistence has been graphed according to Kaplan-Meier method. The cost per RDD was reckoned starting from the expense incurred by Pescara General Hospital.

Results:

Medication adherence gave results in values between 0.88–0.97 for Etanercept and 0.83–0.90 for Adalimumab. The value of persistence was 100% for Etanercept and 90% for Adalimumab for the first year, and 70% for Etanercept and 80% for Adalimumab for the second year. In the 3rd year the persistence for Etanercept was 50% while for Adalimumab it was 60%. In the fourth year the persistence for Etanercept was 21% while for Adalimumab it was 27%. The statistical analysis was conducted using the Log rank test. The average cost per RDD was €32.97 for Etanercept and for Adalimumab it was €32.00 as an average of 6 years.

Conclusion:

The medication adherence was good for both Etanercept and Adalimumab. The rate of persistence decreased strictly in the fourth year of treatment. This data suggests the need for continuous monitoring of patients in treatment with TNF blockers.