Hospital competition under pay‐for‐performance: Quality,mortality, and readmissions

Health outcomes, such as mortality and readmission rates, are commonly used as indicators of hospital quality and as a basis to design pay‐for‐performance (P4P) incentive schemes. We propose a model of hospital behavior under P4P where patients differ in severity and can choose hospital based on quality. We assume that risk‐adjustment is not fully accounted for and that unobserved dimensions of severity remain. We show that the introduction of P4P which rewards lower mortality and/or readmission rates can weaken or strengthen hospitals' incentive to provide quality. Since patients with higher severity have a different probability of exercising patient choice when quality varies, this introduces a selection bias (patient composition effect) which in turn alters quality incentives. We also show that this composition effect increases with the degree of competition. Critically, readmission rates suffer from one additional source of selection bias through mortality rates since quality affects the distribution of survived patients. This implies that the scope for counterproductive effects of P4P is larger when financial rewards are linked to readmission rates rather than mortality rates.     

Comparison of Hypothesis Testing and Bayesian Model Selection

The main goal of both Bayesian model selection and classical hypotheses testing is to make inferences with respect to the state of affairs in a population of interest. The main differences between both approaches are the explicit use of prior information by Bayesians, and the explicit use of null distributions by the classicists. Formalization of prior information in prior distributions is often difficult. In this paper two practical approaches (encompassing priors and training data) to specify prior distributions will be presented. The computation of null distributions is relatively easy. However, as will be illustrated, a straightforward interpretation of the resulting p-values is not always easy. Bayesian model selection can be used to compute posterior probabilities for each of a number of competing models. This provides an alternative for the currently prevalent testing of hypotheses using p-values. Both approaches will be compared and illustrated using case studies. Each case study fits in the framework of the normal linear model, that is, analysis of variance and multiple regression.     

Integrating local ecological services into intergovernmental fiscal transfers: The case of the ecological ICMS in Brazil

Local conservation efforts are often related to benefits at higher governmental levels. On the one hand, these efforts are strongly connected to local land-use decisions. On the other hand, activities such as sustainable water management or biodiversity conservation are associated with regional, national or even global public goods. Therefore, spatial externalities or spillovers exist, which—if not adequately compensated for—lead to an underprovision of the public goods and services concerned. This article investigates intergovernmental fiscal transfers as an innovative instrument for compensating local jurisdictions for the ecological goods and services they provide across local boundaries. From a public finance perspective, fiscal transfers are a suitable instrument for internalising spatial externalities. However, most federal states use this instrument predominantly for social and economic public sector functions rather than for ecological ones. This article investigates the case of the ecological “ICMS” that was first introduced by a few states in Brazil during the 1990s. Part of the revenue from this value-added tax is redistributed to the local level on the basis of ecological indicators. In this way, the state level uses fiscal transfers to compensate municipalities for the existence of protected areas and other ecological services provided within their territories. The Brazilian experience illustrates that such fiscal transfers can represent both a compensation for land-use restrictions and an incentive to value and engage in more conservation activities at the local level.     

The income effect and supplier induced demand. Evidence from primary physician services in Norway

A much debated issue within the health economic literature is whether physicians can induce demand for their services. The relationship between physicians' ‘nonpractice income’ and supply of primary physician services in Norway is examined. It is argued that, if inducement exists, physicians with a low nonpractice income who work in municipalities where competition for patients is high, compensate for lack of patients by inducing demand. This model is adapted to the institutional setting of the Norwegian primary physician services, where there is a fixed fee schedule. The analyses were performed on a large set of data, encompassing all primary care physicians in Norway who are remunerated per item of treatment. Data on output in practice were merged with information about nonpractice income from the tax forms of the physician and her/his spouse. In municipalities with high physician density, nonpractice income had no effect on the number of consultations per physician, or on the number of treatment items per consultation. The results are interpreted as evidence against the inducement hypothesis.     

The persistence of innovation: a panel data investigation on manufacturing firms

This paper represents a contribution to empirical debate on the persistence of innovation in the firm, by exploiting an innovative panel database that, for the first time, links three waves of the Italian Community Innovation Survey with an administrative data source providing economic and financial information for firms in the Italian manufacturing sector, 1996–2003. By using both a dynamic logistic model and a Granger causality approach, we show that in order to innovate successfully it is much more important to have an adequate flow of profits during an appropriate time span rather than high profits only during one period before innovation. Our causality tests prove the existence of a dynamic interaction between innovation and profitability: successful innovation can, in the short run, generate the profitability conditions that can then enhance the financial resources needed to reinvest in new technological opportunities, thus causing the firm to persist in its innovative behaviour. We have also shown that another important source of persistence is represented by past innovative experience. A firm with consolidated innovative behaviour would have a higher probability of future successful innovation with respect to a firm that occasionally (or accidentally) innovates. Persistence in innovation enables a firm to take advantage of substantial technological and organizational learning effects, which improve with time.     

Intergenerational earnings mobility in Singapore and the United States

This study compared intergenerational earnings mobility in Singapore and the United States by replicating the sample criteria in the Singapore National Youth Survey on the U.S. Panel Study of Income Dynamics. The mean estimated earnings elasticities are almost identical: 0.26 in Singapore and 0.28 in the United States. Transformed to 0.44 and 0.47 respectively to reflect permanent status, mobility in the two countries is moderately low compared internationally. The finding of similar mobility is not surprising given that the two countries have similar economic realities, welfare systems, education regimes, and labor structures. Policy makers face the daunting challenge of overcoming immobility and inequality while maintaining global competitiveness.     

Fiscal transfers for biodiversity conservation: The Portuguese Local Finances Law

Biodiversity loss is a serious and ongoing global environmental problem. Economic instruments in biodiversity policies can contribute towards reconciling the conservation costs encountered at local level with the benefits of biodiversity conservation at higher levels of governance, from regional and national levels up to the global level. This paper outlines the theoretical foundations of fiscal transfers in conservation policies and also offers a concise account of existing international experience and future prospects. The recently amended Portuguese Local Finances Law (LFL) of 2007, with its groundbreaking new article on the promotion of local sustainability, is analysed in terms of the significance of fiscal transfers for municipal budgets. It is compared with its predecessor law, highlighting changes in fiscal revenues for selected municipalities in the country in relation to their designated conservation areas. The analysis shows that these ecological fiscal transfers can be significant for those municipalities with a large proportion of land under protected status. However, because it also introduces a considerable number of changes to the Portuguese fiscal transfer scheme, the ecological impact of the new LFL is difficult to grasp due to the presence of several crossover effects. The results obtained offer significant insights both for improving the Portuguese LFL and for designing new ecological fiscal transfer schemes.     

Perceptual differences between recruiters and students on the importance of applicant and job characteristics: a research note based on evidence from Singapore

This study compared the perceptions of various important job applicant characteristics, job characteristics and job benefits between 107 corporate recruiters and 191 business undergraduates in Singapore. Results indicated significant incongruence between recruiter and student perceptions of a large number of job characteristics and benefits. However, perceptual differences were less extensive in the case of applicant attributes. The implications of these findings, and suggestions for greater perceptual congruence between recruiters and applicants, are discussed.     

On nonparametric estimation of the Schumpeterian link between innovation and firm size: Evidence from Belgium,France, and Germany

This paper analyses the Schumpeterian link between innovative activity and firm size by means of the nonparametric Nadaraya-Watson estimator and of the partially linear approach by Speckman. Four data sets referring to the manufacturing industries of three European countries are available for the analysis. We demonstrate how nonparametric methods can produce more reliable conclusions than conventional methods. For this purpose, the roles of bandwidth choice, wild bootstrap, density estimation and trimming are studied. For the German data set of 1984 and for the French data set we find that small firms and large firms are more innovative than firms of intermediate size while the relation is rather hump-shaped for Germany 1989 and decreasing for Belgium. Including an additional parametric component into the estimations based on the French data contributes considerably to the explanation of innovative activity without affecting the U-shaped link between innovation and firm size.