A vision for Nicaragua : Health services in the new century

Nicaragua is facing a crisis in health and health care, and a health futures programme has been initiated to focus concern and mobilize key actors. Two national scenario workshops have been held at which participants constructed several scenarios describing alternative health futures for the country, with particular emphasis on the organization of health services. One or these, a scenario of profound change, was selected by the participants as their vision of the preferred future. It involves more emphasis on health promotion, decentralization of health-care services, broader participation in health matters, improved training for health professionals, and a stronger role for universities and other educational and research centres. Implications of the selected scenario regarding health policies and actions have been identified, among them being the adoption and implementation of the Ottawa Charter on Health Promotion, the organization of local health service networks, and the more active involvement of health professionals in the designing of health systems.     

Dynamic Equilibrium with Liquidity Constraints

This article studies an intertemporal economy with liquidityconstrained and unconstrained individuals. We use a stoppingtime approach to solve the finite horizonconstrained consumptionportfolio problem with constant relative risk aversion and toexamine the structure of equilibrium. The impact of the constrainton the optimal consumption and the financing portfolio is assessed.The equilibrium state price density is related to the exerciseboundary of an American-style contingent claim with nonlinearpayoff. This stopping time characterization enables us to provethe existence of an equilibrium and can be implemented numerically.Properties of equilibrium bond and stock returns are examined.     

Combining Discrete and Continuous Representations of Preference Heterogeneity: A Latent Class Approach

Unobserved preference heterogeneity has been widely recognized as a critical issue not only for modelling choice behaviour, but also for policy analysis. This paper examines alternative approaches for incorporating heterogeneity in recreational demand. We apply a hybrid model combining discrete and continuous heterogeneity representations of tastes to capture the defining features of both the latent class and the random parameter logit specifications. This model allows for the joint estimation of discrete segments and within segment heterogeneity providing a richer interpretation of preference heterogeneity. A database of recreational trips to forest sites in Mallorca has been used to compare the empirical performance of this hybrid approach with common specifications such as the conditional logit, the random parameter logit, and the latent class model.     

Insights on endogenous money and the liquidity preference theory of interest

It is argued that the debate between “structuralist” and “horizontalist” has long been obscured because of inadequate treatment, in both approaches, of the credit-money supply and of the total money supply. As a result, endogenous money models still have serious limitations today. On the one hand, the bank loan markup and the loan interest rate are exogenous in the horizontalist model, which supposes that they do not depend on the money/liquidity market conditions (as if bank loans did not compete with the existing liquidity). On the other hand, although interest rates are endogenous in the structuralist model, they result from inappropriate treatment of the loan supply and money/liquidity supply. This article aims to remove these shortcomings. It offers a theoretical framework and formal modeling where the creditworthy demand for loans determines the bank loan supply, given the central bank refinancing interest rate, while the total supply and demand for liquidity-money determines the markup and the market rate of interest in accordance with Keynes’s liquidity preference theory. In this framework, the post Keynesian theory of endogenous money and Keynes’s “verticalist” view prove to be analytically complementary.     

Measuring Productive Efficiency in Input–Output Models by Means of Data Envelopment Analysis

The goal of the present research is to evaluate productive efficiency in an input–output framework by means of data envelopment analysis (DEA). This mathematical programming technique allows researchers to assess potential efficiency improvements in the form of input requirements reduction. By constructing envelopment unitary isoquants corresponding to comparable sectors across different local, regional or national economies, e.g. agriculture and manufacturing, DEA identifies as productive benchmarks those economies that exhibit the lowest technical coefficients, i.e. lowest input amount to produce one unit of output. Once these reference frontiers have been defined, it is possible to assess what would be the potential efficiency improvements available to the inefficient economies if they were to produce according to the best practice technologies of their benchmark peers. From an equivalent perspective, these simulations identify the necessary changes that each productive sector needs to undertake in order to reach the efficiency levels of the most successful economies. Finally, within Leontief’s analytical construction, these calculations allow us to assess what would have been the economy‐wid,e benefits for the inefficient economies—in terms of intermediate consumption reductions and final demand increases—of producing with best practice technologies. The model is empirically illustrated using the input–output tables for a set of OECD countries.     

Building a global database: consequences for the national I–O data

ABSTRACT

Global economic analysis requires consistent and balanced data, which necessitates the reconciliation of datasets from both national and international sources. In the case of the Global Trade Analysis Project Data Base, datasets supplied by international sources are considered preferable to national input–output (I–O) tables. As a result, the national I–O data can experience significant adjustments during the reconciliation process due to differences between the national and international datasets. The purpose of this paper is to examine the extent to which national I–O data change during reconciliation. The results demonstrate that the I–O data are altered by the construction process, particularly from the reconciliation of the national I–O data to the international trade and energy datasets. Closer examination reveals potential issues with both the trade and energy datasets, as well as the national I–O data – illustrating the challenges associated with reconciling data from multiple sources.     

Modelling conditional heteroskedasticity: Application to the “IBEX-35” stock-return index

This paper compares alternative time-varying volatility models for daily stock-returns using data from Spanish equity index IBEX-35. Specifically, we estimate a parametric family of models of generalized autoregressive heteroskedasticity (which nests the most popular symmetric and asymmetric GARCH models), a semiparametric GARCH model, the generalized quadratic ARCH model, the stochastic volatility model, the Poisson Jump Diffusion model and, finally, a nonparametric model. Those models which use conditional standard deviation (specifically, TGARCH and AGARCH models) produce better fits than all other GARCH models. We also compare the within sample predictive power of all models using a standard efficiency test. Our results show that the asymmetric behaviour of responses is a statistically significant characteristic of these data. Moreover, we observe that specifications with a distribution which allows for fatter tails than a normal distribution do not necessarily outperform specifications with a normal distribution.     

The use of Zostavax in Spain: the economic case for vaccination of individuals aged 50 years and older

Background Population aging brings up a number of health issues, one of which is an increased incidence of herpes zoster (HZ) and its complication, post-herpetic neuralgia (PHN). Zostavax vaccine has recently become available to prevent HZ and PHN. This study evaluates the cost-effectiveness of vaccination against HZ in Spain considering a vaccination of the population aged 50 years and older and comparing this to the current situation where no vaccination is being administered.

Methods An existing, validated, and published economic model was adapted to Spain using relevant local input parameters and costs from 2013.

Results Vaccinating 30% of the Spanish population aged 50 years and older resulted in €16,577/QALY gained, €2025/HZ case avoided, and €5594/PHN case avoided under the third-party payer perspective. From a societal perspective, the ICERs increased by 6%, due to the higher price of the vaccine. The number needed to vaccinate to prevent one case was 20 for HZ, and 63 for PHN3. Sensitivity analyses showed that the model was most sensitive to the HZ and PHN epidemiological data, the health state utilities values, and vaccine price used.

Conclusion Considering an acceptable range of cost-effectiveness of €30,000–€50,000 per QALY gained, vaccination of the 50+ population in Spain against HZ with a new vaccine, Zostavax, is cost-effective and makes good use of the valuable healthcare budget.     

Lancaster's characteristics approach revisited: product selection using non‐parametric methods

In consumer theory, the principles of Lancaster's characteristics approach and hedonic pricing appear to offer the most promising insight into choice when qualitative aspects are important. The paper reconciles these principles with the family of non‐parametric frontier estimation methods known as data envelopment analysis. It is shown that, with some straightforward adjustments, DEA is entirely consistent with the characteristics view of consumer choice found in the economics literature. In making Lancaster's ideas operational, the paper also addresses the theoretical concern voiced by Lancaster about combining indivisible products. The principles are illustrated with a case study involving the comparison of diesel cars. The paper concludes that the user will ultimately have to apply some judgement in choosing between competing efficient products. However, the analysis should help to restrict the number of products to be assessed to manageable proportions. Copyright © 2002 John Wiley & Sons, Ltd.