Health systems futures: The challenges of technology,prevention and insurance

This article argues that the futures of health systems depend on how countries address three wider challenges that include: (a) the adoption of health innovations and quality improvements, (b) responses to new non-communicable and preventable global diseases, as well as (c) adjusting financial models to current insurance constraints. Future trends point towards an increasing dependence on productive quality improvements, the personalisation of health care and the organisation of delivery and finance to take advantage of existing knowledge. Prevention, and disease avoidance, particularly that of non-communicable diseases, will aim to reduce pressure on “care components” of the health system whilst global control of communicable risks will become apparent. Finally, trends suggest an increase in patient participation and personalisation of insurance contracts will help to realign risk sharing with cost containment and financial sustainability. Other potential challenges such as ageing are regarded as second order issues to be addressed through these aforementioned future trends.     

Is There Market Discipline in the European Insurance Industry? An Analysis of the German Insurance Market

Economists often argue in favour of market discipline as a means to distribute resources effectively and efficiently. These same arguments likely influence decision-makers as they incorporate market discipline as the third pillar of Solvency II, the European insurance regulatory scheme currently being implemented. Success for Solvency II, then, is dependent in part on the strength of influence found in market discipline. Our research indicates that the German insurance market demonstrates the existence of such discipline, although the actual effect appears smaller than previously found in the U.S. insurance market. Solvency II, therefore, seems to be following an appropriate path, although further research is needed to evaluate whether or not enhancements to market discipline within the European market are warranted.     

THE GOVERNANCE OF CEO INCENTIVES IN ENGLISH NHS HOSPITAL TRUSTS

Institutional arrangements for the governance of CEO pay and turnover in English NHS Hospital Trusts replicate best practice for listed companies but with the additional feature of centrally imposed performance measurement. In this paper we investigate the impact of this unique combination of incentives on the relationship between CEO pay/turnover and Trust financial and operating performance in the period 1998–2005. We identify a strong association between poor Trust performance and CEO turnover but find little evidence that remuneration committees relate pay to performance in the best performing Trusts. Our findings raise questions about the economic rationale for remuneration committees in the governance of NHS Hospital Trusts.     

Redealing the cards: How an eco-industry modifies the political economy of environmental taxes

This article presents a combined economic–political model of environmental taxation setting. The model introduces a third lobby group – the lobby of an eco-industry – in addition to the traditional lobbies of polluting firms and environmentalists. Pressure groups interact to influence the environmental tax chosen by a regulator maximizing its chances of being reelected. The eco-industry lobby adds a new political contribution toward a higher environmental tax. The imperfectly competitive structure of the eco-industry also modifies the incentives of the usual lobbies. When the foreign environmental policy is constant, environmentalists can be in favor of a decrease in the local tax in order to reduce foreign pollution. We also discuss the formation of alliances between the eco-industry and one of the other lobbies and their potential impact. In general, the impact of lobbying activities on the politically optimal tax is ambiguous and depends on the relative concentration of each pressure group.     

Agri-environmental schemes: Adverse selection, information structure and delegation

This work analyzes alternative designs of agri-environmental schemes and how different incentive mechanisms impact on their overall efficiency. It focuses on spatial targeting and delegation in an asymmetric information context. First, the optimal contract under adverse selection is modeled. This model underlines the trade-off between information rents and allocative efficiency. The impact of spatial targeting is then addressed. Disaggregated information structures increase the optimal efforts asked of the farmers. It may also involve higher information rents and may reduce the net contributions of some farmers. Finally, the consequences of delegating authority within the principal-agent relationship are investigated. The results illustrate that spatial targeting and delegation, when combined, have asymmetric impacts on farmers' payoffs.     

Local development and business creation. The role of local development workers in project management

The participation of social inclusion workers in project management is to a large extent aimed at setting up businesses and mainly entails working with businessmen and women and entrepreneurs. Policies formulated to this end involve four lines of action: improving infrastructure; managing local businesses; supporting and managing the creation of micro-businesses and small and medium-sized enterprises; and carrying out socio-economic studies which aid the economic and social development of a particular local community. This study includes an analysis of the characteristics of the service provided by local development workers with regard to the development areas concerned, the nature of the work carried out and the groups involved, the characteristics of the service offered to entrepreneurs and groups of entrepreneurs and the characteristics of the projects managed. Field work was carried out during the 2004 which entailed the use of a questionnaire intended for all local development workers included in our own directory.     

A dynamic heterogeneous labour demand model for German manufacturing

There is currently general agreement amongst economists that the discount rate to compute the present value of benefits and costs in the economic evaluation of public policies is defined according to the social time preference approach. However, whether this rate has to be used for the discount of non-monetary health consequences is a question for which there is no satisfactory reply. In this paper, it is argued that such a reply rests on the estimation of the relationship between the individual time preference for health and money in the contexts of private and social choice. In support of this argument an empirical analysis has been carried out in which the individuals making-up a representative sample of the population of Zaragoza (Spain) have been faced with a series of hypothetical inter-temporal choices. Their replies have implicitly revealed their temporal preference rates and have led to the conclusion that health consequences are discounted at a higher rate than monetary consequences. This would appear to be contrary to the standard practice applied in the economic valuation of health programmes.     

Business model innovation and competitive imitation: The case of sponsor‐based business models

This paper provides the first formal model of business model innovation. Our analysis focuses on sponsor‐based business model innovations where a firm monetizes its product through sponsors rather than setting prices to its customer base. We analyze strategic interactions between an innovative entrant and an incumbent where the incumbent may imitate the entrant's business model innovation once it is revealed. The results suggest that an entrant needs to strategically choose whether to reveal its innovation by competing through the new business model, or conceal it by adopting a traditional business model. We also show that the value of business model innovation may be so substantial that an incumbent may prefer to compete in a duopoly rather than to remain a monopolist. Copyright © 2012 John Wiley & Sons, Ltd.     

Micro-Entrepreneurship in Niger: Factors Affecting the Success of Women Street Food Vendors

Micro-entrepreneurship in the informal sector plays a vital role in generating employment and income in West Africa. In this article, the authors examine business success factors for micro-entrepreneurs involved in the production and sale of street foods in Niger, drawing on the resource-based view theory. Business success was measured by size of firm and vendor's perception of enterprise growth. Their results indicate that business experience is an important success factor, while the need for cash is a constraint for business success. A rare resource, limited access to financial assets translates into limited opportunities for growth of these informal micro-enterprises into viable businesses.     

Feasibility of routine collection of injured worker occupational information in hospital emergency departments

The aim of this study was to examine injury events and risk-factors among Swedish adult eventing athletes. A cross-sectional study design with retrospective recording of 1-year sports-specific exposure and injury data was used. The invited study population consisted of all members of the Swedish Equestrian Federation with eventing as their primary discipline (n = 513). The participation rate was 70.0%. The total 1-year injury prevalence was 26.6%; the specific 1-year prevalence of traumatic injury was 19.3% and of overuse injury 10.9%. The incidence of traumatic injury events was 0.54 injury events/1000 eventing hours (95% confidence interval (CI), 0.35–0.73 injury events/1000 eventing hours) for novices and 0.35 injury events/1000 eventing hours for qualified riders (95% CI, 0.21–0.49 injury events/1000 eventing hours). A total of 27.9% of the traumatic injury events led to severe injuries (causing more than 3 weeks absence from riding). Attitude to risk-taking was the only factor predicting an athlete becoming injured (p = 0.023), and qualification level was the only risk factor for additional injuries among injured riders (p = 0.003). Our results suggest that injury prevention programs in eventing should also give attention to overuse injuries and that care should be taken when eventing athletes are licensed into higher qualification groups.