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Tim Benson 《Journal of medical economics》2017,20(2):107-113
Background: QALYs are widely used in health economic evaluation, but remain controversial, largely because they do not reflect how many people behave in practice. This paper presents a new conceptual model (Load Model) and illustrates it in comparison with the QALY model.Methods: Load is the average annual weight attributed to morbidity and mortality over a defined period, using weightings based on preference judgements. Morbidity Load is attributed to states of illness, according to their perceived severity. When people are in full health, Load is zero (no morbidity). Death is treated as an event with negative consequences, incurred in the year following death. Deaths may be weighted equally, with a fixed negative weight such as ?100, or differ according to the context of death. After death, Load is zero. In a worked example, we use the standard gamble method to obtain a weighting for an illness state, for both Load and QALY models. A judge is indifferent between certainty of 1.5 years’ illness followed by death, or a 50/50 chance of 1.5 years’ full health or 1-year illness, each followed by death. The weightings calculated are applied to a hypothetical life, 72 years in full health followed by 3 years with illness then death, using both models. Three other hypothetical outcomes are also compared.Results: For an example life, the relative size of the morbidity component compared with the mortality component is much higher in the Load model than in the QALY model. When comparing alternative outcomes, there are also substantial differences between the two models.Conclusions: In the Load model the weight of morbidity, relative to mortality, is very different from that in the QALY model. Given the role of the QALYs in economic evaluation, the implications of an alternative, which generates very different results, warrant further exploration. 相似文献
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This study assesses the potential impact of rising world food prices on the welfare of Ugandan households. While Uganda experienced sharply higher food prices in 2008, as a landlocked, food‐exporting country the causes of those price changes were mainly regional and indirect rather than directly transmitted from global markets. Using trade volumes, food prices, and household survey data we describe how Uganda, unlike some other countries, is partially shielded from direct impacts of global food price movements. Although the majority of Ugandans are net food buyers, the adverse impact at household‐level of rising global prices is moderated by the relatively large quantity and range of staples consumed that come from home production. Moreover, several of these are not widely traded. Some population groups in Uganda are vulnerable to rising food prices, however, primarily those for whom maize is an important staple, including those dependent upon humanitarian relief and the urban poor. Only a relatively small group of Ugandan households will benefit directly and immediately from rising food prices—the significant net sellers of food crops constituting between 12% and 27% of the population. In this assessment we do not estimate the level and extent of wider second round effects from these higher prices. 相似文献
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Burning bluegrass seed stubble is an important production practice that, among other benefits, increases production and stand life of this perennial crop. Despite economic forecasts that higher production costs from the 1996 state ban on seed stubble burning would reduce Washington production by up to 30%, output in the years 1998–2005 was nearly two-thirds higher than in any previous eight-year period. This study seeks to explain why that paradoxical behavior occurred. This study puts forward and systematically tests several hypotheses. The only hypothesis with any support, innovation offsets, is examined by an assessment of contemporaneous innovations and by corroborative statistical evidence. 相似文献
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John Benson 《The Economic history review》2014,67(3):852-853
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Whether firms pursue shareholder value maximization or the maximization of stakeholder welfare is a controversial issue whose outcomes seem irreconcilable. We propose that firms are likely to compensate their executives for pursuing the firm's goal be it shareholder value maximization or the maximization of stakeholder welfare. In this paper, we examine the correlation between firm value, stakeholder management, and compensation. We find that stakeholder management is positively related to firm value. However, firms do not compensate managers for having good relationships with its stakeholders. These results do not support stakeholder theory. We also find an endogenous association between compensation and firm value. Our results are consistent with Jensen's (2001) enlightened value maximization theory. Managers are compensated for achieving the firm's ultimate goal, value maximization. However, managers optimize interaction with stakeholders to accomplish this objective. 相似文献