Globalization with a human face

This paper has six parts. The first part defines globalization. The second discusses globalization eras. The third discusses the irreversibility and inevitability of globalization. The fourth section discusses the benefits and costs of globalization. The fifth section asks what is to be done. The sixth section contains my conclusions.     

基于新公共管理视角的瓦格纳定律之现实评析

伴随着公共管理的不断发展,尤其是新公共管理运动的滥觞及其在全世界范围内的衍化,使得瓦格纳定律不仅从理念上而且从实践上都遭遇了严峻挑战.一方面,新公共管理运动通过实施政府职能优化、分权化改革、公共人事制度改革以及社会保障制度改革等一系列措施,直接削减了财政支出规模;另一方面,由工业化(或所谓后工业化)所衍生的经济、政治、社会需求的持续扩张,在新公共管理理念之下催生了多元化的供给主体和多种形式的供给方式(体现为公共产品供应机制改革),客观上间接缓解了政府财政的压力.以上两方面力量共同作用,为限制财政支出规模或者弱化财政支出冲动提供了相当巨大的空间,瓦格纳定律的神话将被打破.     

失地农民参与新型农村合作医疗影响因素探析——基于江阴市临港新城H小区失地农民的调查

基于对发达地区江阴市临港新城H小区的调查,从微观视角关注失地农民群体中个体特征对新型农村合作医疗制度运行的影响,探讨失地农民群体对新型农村合作医疗制度的认知程度与其参与新型农村合作医疗的具体选择行为之间的相关性,深入考察新型农村合作医疗制度实施现状,探寻新型农村合作医疗制度在失地农民群体中实施存在的问题,以期对完善新型农村合作医疗保障制度建设提供参考。     

新就业大学生员工离职动因及其管理之浅见

如何降低新就业大学生员工的主动离职率,是那些接受大量大学生就业,处于高速发展阶段的高新技术企业迫切需要解决的问题。本文通过分析新就业大学生员工的群体特征,结合国内外离职动因理论,探讨了新就业大学生员工离职率居高不下的主要动因,并提出了有针对性的离职管理方略。     

中国式"荷兰病"影响中国财政收支格局的实证分析

中国式荷兰病来源于中国入世后外向型劳动力密集型产业的空前繁荣。本文从实证角度分析了中国式荷兰病通过体制惰性效应对中国财政收支体制与财政收支政策的诸多影响。研究发现,在中国整体财政能力增强和财政收支状况改善的同时,不仅我国外债结构、中央与地方财政关系明显恶化,而且社会财富加速向公共部门集中,国富民穷现象突出,经济增长方式转变受到较大制约。文章最后建议及时对个人、企业进行实质性减税,积极扩大政府公共服务范围及领域,增加环境保护、社会保障、医疗卫生、教育、科学技术以及农业的财政支出比重,进一步规范中央与地方政府的财政税收权利与义务,从而确保中国经济健康、稳定与可持续发展。     

Innovation and antibiotic use within antibiotic classes: Market incentives and economic instruments

We analyze a monopolist's incentive to innovate a new antibiotic which is connected to the same pool of antibiotic treatment efficacy as is another drug produced by a generic industry. We outline the differences of antibiotic use under market conditions and in the social optimum. A time- and state-dependent tax-subsidy mechanism is proposed to induce the monopolist and generic industry to exploit antibiotic efficacy optimally.     

Region,Regionness and Regionalism in Latin America: Towards a New Synthesis

Latin American regional governance today represents a conglomerate of commercial, political and trans-societal welfarist integration projects. In this overlapping and sometimes conflicting scenario what Latin Americanness should mean, and how integration projects should respond to current challenges of global political economy are being redefined. The focus of the paper is twofold: to better understand current regional transformations and to discuss what new developments mean for how we theorise non-European regionalism. Looking at the Bolivarian Alliance for the Americas and the Union of South American Nations we ask: How are we to understand regional agreements that are grounded in different systems of rules, alternative ideas and motivations that contest ‘open regionalism’? We argue that Union of South American Nations (UNASUR) and Bolivarian Alliance for the Americas (ALBA) represent different pathways to regional building, creating foundations for post-hegemonic and post-trade regional governance. We thus challenge New Regionalist approaches that assume regionalism as taking place within and modelled by neoliberal economics, establishing the debate around ‘old’ vs. ‘new’ regionalism. As these categories are limited in grasping the full meaning and implications of post-hegemonic regional orders, we discuss UNASUR and ALBA as ‘arenas for action’ to understand divergent practices, outcomes and types of regionness emerging in alternative regional spaces in South America.     

Evaluating the length of stay and value of time in a pediatric emergency department with two models by comparing two different albuterol delivery systems

Abstract

Objective:

Asthma is one of the most common childhood illnesses and accounts for a substantial amount of pediatric emergency department visits. Historically, acute exacerbations are treated with a beta agonist via nebulizer therapy (NEB). However, with the advent of the spacer, the medication can be delivered via a metered dose inhaler (MDI?+?S) with the same efficacy for mild-to-moderate asthma exacerbations. To date, no study has been done to evaluate emergency department (ED) length of stay (LOS) and opportunity cost between nebulized vs MDI?+?S. The objective of this study was to compare ED LOS and associated opportunity cost among children who present with a mild asthma exacerbation according to the delivery mode of albuterol: MDI?+?S vs NEB.

Methods:

A structured, retrospective cross-sectional study was conducted. Medical records were reviewed from children aged 1–18 years treated at an urban pediatric ED from July 2007 to June 2008 with a discharge diagnosis International Classification of Disease-9 of asthma. Length of stay was defined: time from initial triage until the time of the guardian signature on the discharge instructions. An operational definition was used to define a mild asthma exacerbation; those patients requiring only one standard weight based albuterol treatment. Emergency department throughput time points, demographic data, treatment course, and delivery method of albuterol were recorded.

Results:

Three hundred and four patients were analyzed: 94 in the MDI?+?S group and 209 in the NEB group. Mean age in years for the MDI?+?S group was 9.57 vs 5.07 for the NEB group (p?<?0.001). The percentage of patients that received oral corticosteroids was 39.4% in the MDI?+?S group vs 61.7% in the NEB group (p?<?0.001). There was no difference between groups in: race, insurance status, gender, or chest radiographs. The mean ED LOS for patients in the MDI?+?S group was 170 minutes compared to 205 minutes in the NEB group. On average, there was a 25.1 minute time savings per patient in ED treatment time (p?<?0.001; 95% CI?=?3.8–31.7). Significant predictors of outcome for treatment time were chest radiograph, steroids, and treatment mode. Opportunity cost analysis estimated a potential cost savings of $213,532 annually using MDI?+?S vs NEB.

Conclusion:

In mild asthma exacerbations, administering albuterol via MDI?+?S decreases ED treatment time when compared to administering nebulized albuterol. A metered dose inhaler with spacer utilization may enhance opportunity cost savings and decrease the left without being seen population with improved throughput.

Limitations:

The key limitations of this study include its retrospective design, the proxy non-standard definition of mild asthma exacerbation, and the opportunity cost calculation, which may over-estimate the value of ED time saved based on ED volume.     

Medical resource use and costs associated with chylomicronemia

Abstract

Background:

The prevalence of severe hypertriglyceridemia (TG?>?1000?mg/dl) is estimated at 150–400 per 100,000 individuals in North America. Severe hypertriglyceridemia in the fasting state is associated with increased acute pancreatitis risk and is a sign of chylomicronemia which reflects the accumulation in the bloodstream of chylomicrons, the large lipoprotein particles produced in the gut after a meal.

Objective:

To assess medical resource use and costs associated with chylomicronemia.

Methods:

Patients with chylomicronemia of different causes (≥2 diagnoses with ICD-9 code 272.3) were identified from a large US claims database (years 2000 to 2009) and matched 1:1 to controls free of chylomicronemia based on age, gender, demographics, comorbidities, and use of lipid lowering drugs. During a 1-year study period, medical resource use and costs associated with chylomicronemia or acute pancreatitis were compared between matched cases and controls.

Results:

Among 6472 matched pairs, annual per-patient medical costs, calculated independently of the occurrence of acute pancreatitis, were significantly greater by $808 for chylomicronemia cases vs controls ($8029 vs $7220, p?<?0.01), half of which was attributable to chylomicronemia-related services (p?<?0.01). Chylomicronemia cases with a history of acute pancreatitis (n?=?46) had greater rates of inpatient visits (p?<?0.05) and greater average costs for subsequent acute pancreatitis or abdominal pain (p?<?0.01) as well as greater total medical costs ($33,587 vs $4402, p?<?0.01) vs matched controls. The average episode of acute pancreatitis (n?=?104 episodes) generated medical costs of $31,820, almost entirely due to inpatient stays.

Limitations:

Triglyceride levels were not available to characterize disease severity.

Conclusions:

Patients with chylomicronemia, and especially those with a history of acute pancreatitis, incurred significantly greater total medical costs compared with individuals without chylomicronemia but with an otherwise comparable health profile.     

Economic evaluation of linaclotide for the treatment of adult patients with irritable bowel syndrome with constipation in the United States

Abstract

Objectives:

To use techniques of decision-analytic modeling to evaluate the effectiveness and costs of linaclotide vs lubiprostone in the treatment of adult patients with irritable bowel syndrome with constipation (IBS-C).

Methods:

Using model inputs derived from published literature, linaclotide Phase III trial data and a physician survey, a decision-tree model was constructed. Response to therapy was defined as (1) a ≥14-point increase from baseline in IBS-Quality-of-Life (IBS-QoL) questionnaire overall score at week 12 or (2) one of the top two responses (moderately/significantly relieved) on a 7-point IBS symptom relief question in ≥2 of 3 months. Patients who do not respond to therapy are assumed to fail therapy and accrue costs associated with a treatment failure. Model time horizon is aligned with clinical trial duration of 12 weeks. Model outputs include number of responders, quality-adjusted life-years (QALYs), and total costs (including direct and indirect). Both one-way and probabilistic sensitivity analyses were conducted.

Results:

Treatment for IBS-C with linaclotide produced more responders than lubiprostone for both response definitions (19.3% vs 13.0% and 61.8% vs 57.2% for IBS-QoL and symptom relief, respectively), lower per-patient costs ($803 vs $911 and $977 vs $1056), and higher QALYs (0.1921 vs 0.1917 and 0.1909 vs 0.1894) over the 12-week time horizon. Results were similar for most one-way sensitivity analyses. In probabilistic sensitivity analyses, the majority of simulations resulted in linaclotide having higher treatment response rates and lower per-patient costs.

Limitations:

There are no available head-to-head trials that compare linaclotide with lubiprostone; therefore, placebo-adjusted estimates of relative efficacy were derived for model inputs. The time horizon for this model is relatively short, as it was limited to the duration of available clinical trial data.

Conclusions:

Linaclotide was found to be a less costly option vs lubiprostone for the treatment of adult patients with IBS-C.