The NHS: Quasi-market, Quasi-hierarchy and Quasi-network?

It has been argued that the British National Health Service (NHS) has moved from a hierarchical and bureaucratic organization to a market and, more recently, towards a network. The authors believe that this view is too simplistic: the three organizational forms have co-existed and continue to do so. It is more accurate to view moves over time as a changing mix between quasi-hierarchies, quasi-markets and quasi-networks.     

Do foreign institutional investors destabilize China’s A-share markets?

This paper investigates the effect of foreign institutional investors on the stability of Chinese stock markets. Previous literature views this investor group as destabilizing feedback traders. We use the abolition of ownership restrictions on A shares as a natural experiment. There is strong evidence that foreign institutions have a stabilizing effect on Chinese stock markets and contribute to market efficiency. This finding is robust across exchanges, sample periods, size quintiles and alternative model specifications. By contrast, domestic investors appear to engage in positive feedback trading. Our results have important implications for market regulation.     

Economic modeling to evaluate the impact of chronic myeloid leukemia therapy management on the oncology care model in the US

Abstract

Objective: To develop an economic model to evaluate changes in healthcare costs driven by restricting usage of branded tyrosine kinase inhibitors (TKIs) through substitution with generic imatinib among chronic myeloid leukemia (CML) patients in a typical Oncology Care Model (OCM) practice, and examine the impact on Performance-Based Payment (PBP) eligibility.

Methods: An Excel-based economic model of an OCM practice with 1,000 cancer patients during a 6-month episode of care was developed. Cancer types and proportions of patients treated in the practice were estimated from an OCM report. All-cause healthcare costs were obtained from published literature. It was assumed that if a practice restricts usage of branded TKIs for newly-diagnosed CML patients, 80% of the market share of branded imatinib and 50% of the market shares of 2^nd-gen TKIs would shift to generic imatinib. Among established TKI-treated patients, it was assumed that 80% of the market share of branded imatinib and no patients treated with 2^nd-gen TKIs would shift to the generic.

Results: Four CML patients were estimated for a 1,000-cancer patient OCM practice with a total baseline healthcare cost of $51,345,812 during a 6-month episode. If the practice restricts usage of branded TKIs, the shift from 2^nd-gen TKIs to generic imatinib would reduce costs by $12,970, while shifting from branded to generic imatinib lowers costs by $25,250 during a 6-month episode. Minimum reductions of $3,013,832 in a one-sided risk model and $2,372,010 in a two-sided risk model are required for PBP eligibility; the shift from 2^nd-gen TKIs to generic imatinib would account for 0.4% and 0.5% of the savings required for a PBP, respectively.

Conclusions: This analysis indicates that the potential cost reduction associated with restricting branded TKI usage among CML patients in an OCM setting will represent only a small proportion of the cost reduction needed for PBP eligibility.     

Victim or Victimizer: Firm Responses to Government Corruption

What is the relationship between government corruption and firm performance? To address this question, I conduct a review of articles published in the leading management journals on government‐business interactions pertaining to rent‐seeking activities and integrate findings from the fields of international business, social issues in management, public organization, institutional change, and corporate political activity. I find that while much empirical work corroborates the earlier findings suggesting a corrosive impact of government corruption on firm performance in general, management research also points to the heterogeneous impact of government corruption on individual firm performance, driven by the strategic activities conducted by firms in response to corruption. I propose an integrative model of firm strategy vis‐à‐vis corruption that predicts the activity choice of the firm as predicated by its organizational structure, political resources, industry regulation, and surrounding political and social institutions.     

Reform der Pflegeversicherung

Im Juli will das Bundesministerium für Gesundheit Eckpunkte zur Reform der Pflegeversicherung vorlegen. Inwieweit ist die Pflegeversicherung reformbedürftig? In welchem Umfang ben?tigt sie zus?tzliche Finanzmittel? Sollte das System auf ein Kapitaldeckungsverfahren umgestellt werden? Welcher Reformbedarf und welche Reformoptionen sind auf der in der Diskussion vernachl?ssigten Leistungsseite zu sehen? Die Autoren unseres Zeitgespr?chs: Prof. Dr. Bernd Raffelhüschen, 49, ist Direktor des Forschungszentrums Generationenvertr?ge und lehrt Volkswirtschaftslehre am Institut für Finanzwissenschaft I an der Albert-Ludwigs-Universit?t Freiburg; Jasmin H?cker, 27, Dipl.-Volkswirtin, ist wissenschaftliche Mitarbeiterin am Forschungszentrum Generationenvertr?ge der Albert-Ludwigs-Universit?t Freiburg. PD Dr. Markus Lüngen, 41, ist Leiter des Instituts für Gesundheits?konomie und Klinische Epidemiologie der Universit?t zu K?ln; Guido Büscher, 26, Dipl.-Statistiker, ist dort wissenschaftlicher Mitarbeiter. Dr. Martin Gasche, 36, ist Senior Economist bei der Allianz Dresdner Economic Research und war wissenschaftlicher Mitarbeiter im Stab des Sachverst?ndigenrates zur Begutachtung der gesamtwirtschaftlichen Entwicklung. Er vertritt hier seine pers?nliche Auffassung. Prof. Dr. Heinz Rothgang, 44, ist Professor für Gesundheits?konomie im Fachbereich Human- und Gesundheitswissenschaften der Universit?t Bremen und Direktor der Abteilung Gesundheits?konomie, Gesundheitspolitik und Versorgungsforschung am Zentrum für Sozialpolitik.     

State and County Incarceration Rates:

ABSTRACT This study examines the direct and indirect effects of race and income inequality on imprisonment rates across states. The analysis is designed to: 1) investigate whether race and income inequality are significantly related to imprisonment when controlling for crime , 2) assess the relative magnitudes of the direct and indirect effects; and 3) assess the relative magnitudes of race and income inequality. Crime is found to be the strongest predictor of incarceration rates in five of the six equations estimated. Income inequality is significantly related to incarceration rates in two of the six equations. There was no clear evidence of a direct race effect. The indirect effect of race was greater than the direct effect in four of the six equations.     

Intermediation Can Replace Certification

We consider a market in which consumers do not have perfect information about product quality. Producers can perfectly reveal that a good is of high quality through certification, which entails socially wasteful costs. Firms can choose whether to sell through an intermediary or to sell independently (vertical integration). We show that multibrand retailing, which leads to a redistribution of profits but not to social costs, can fully or partially replace certification by signaling product quality. Renting the image of a competing high-quality brand is shown to be an outcome that can be sustained through intermediation.     

Environmental Change, Leadership Succession and Incrementalism in Local Government

A theoretical model of strategic budgetary choices in local government is developed and tested. The model assumes that expenditure decisions are a function of changes in environmental circumstances and the characteristics of local leaders. Environmental change is operationalized through measures of workload, munificence and regulatory controls. Leadership succession is defined as the turnover in managerial and political élites. These environmental and leadership variables are included in a multivariate statistical model of budgetary incrementalism. The model is tested on the spending decisions of 402 English local authorities from 1981 to 1996. The empirical results suggest that the extent of budgetary change is influenced strongly by environmental change but weakly by leadership succession. Furthermore, environmental constraints became tighter during the study period. The characteristics of public sector organizations that impose limits on the strategic choices of new leaders are identified.