11 de maig 2017

from "third sector" to "plural sector"

Henry Mintzberg born in Canadà in 1939 is an internationally renowned academic, author and researcher and professor of Management Studies at the Desautels Faculty of Management of McGill University in Montreal, Quebec, Canada.

He published an article in 2015 where he explained that a "A healthy society requires a respected public sector, a responsible private sector, and a robust plural sector".

He defended the name of "plural sector" instead labels like "nonprofit sector" or "third sector". In his opinion the name "plural" will help this sector take its rightful place alongside the other two (public vs private) and also help us to appreciate the unique role it has to play in restoring that balance.

Main ideas:
  • Why "plural": The plurality of the sector: we can find cooperatives, foundations, clubs, religious orders, think tanks, activist NGO's, services NGO's, voluntary, social economy. He divides in four groups: mutual associations, benefit associations, protection associations and activists associations. There is a variety of this sector's associations and a wide range forms of ownership.
  • Radical renewal: The plural sector has to lead the radical renewal "in communities on the ground, with groups of people who exhibit the inclination, independence and resourcefulness to tackle difficult problems head on".
  • The plural sector has to leave form its obscurity. They have to have their own acts together, collectively, enabling pluralism but not dispersion of their efforts. It has to focus on its distinctiveness and partnership with each other.
  • It's time to rebalance the power: Each sector needs to maintain sufficient influence in a society to be able to check the excesses of the other two.

Access full article (pdf): Time for the plural sector (2015)

photo: (*) Photosolde "The world begins with every kiss. photo-mosaic designed by Joan Fontcuberta"


29 d’abr. 2017

the effect of competition on the quality of health care

In 2016 Martin Gaynor with Rodrigo Moreno-Serra and Carol Propper were awarded the American Economic Association Prize for the best paper published in the American Economic Journal: Economic Policy in 2012-15.

In their article they examined the impact of the introduction of a pro-competition policy, in 2006, on hospital outcomes in England. They found strong evidence that under the regulated price regime hospitals within the NHS engaged in activities that increased quality of patient care.

The NHS reforms resulted in significant improvements in mortality and reductions in length of stay without changes in total expenditure or increases in expenditure per patient. .

In 2006 the NHS mandated that all patients requiring treatment be given the choice of five different hospitals (Choose and Book) and adopted a payment system in which hospitals were paid fixed, regulated prices for treating patients (payment by results based, PbR on DGR's). The reform gave patients more choice (via the mandated five alternatives and the end of selective contracting), increased the incentive for hospitals to win business and moved hospitals from a market determined price environment to a regulated price environment.

The introduction of competition can be an important mechanism for enhancing the quality of care patients receive even in a set up where hospitals are not profit maximizers. Attracting patients becomes very important. Given that price is fixed, the only way managers can do this is by undertaking effort to increase quality. The reforms made attracting patients tougher in less concentrated markets and so managers had greater incentives to improve quality in these markets. This increases managerial incentives to improve quality effort as competition grows stronger.

This is one empirical study on "yardstick competition (competence by comparison)" among health care organizations.

Access full article and data sets: Death by Market Power: Reform, Competition, and Patient Outcomes in the National Health Service (2013)

Related post:  some controversies about competition in health care

photo: (*) Photosolde

14 d’abr. 2017

health technology/expenditure relationship

The effect of insurance expansion on the diffusion of new technologies is not a well-understood phenomenon.

Burton A. Weisbrod published in 1991 in the Journal of Economic Literature: The Health Care Quadrilemma: An Essay on Technological Change, Insurance, Quality of Care, and Cost Containment. The Weisbrod proposition in his article is that the expansion in health care insurance produces a cost increasing in new technologies and how new technologies induces demand for insurance. There is an inexorable link between the broadening and deepening of health insurance coverage and the development of new health-care technologies.

Joan Costa-Font and Alistair McGuire  and Victoria Serra-Sastre published in 2012 The “Weisbrod Quadrilemma” Revisited: Insurance Incentives on New Health Technologies

In their study, they attempted to produce empirical tests of Weisbrod thesis and find supportive evidence. The paper presents evidence of a link between insurance and technology diffusion using OECD panel data and taking advantage of a dynamic specification structure. The empirical estimates indicate that higher degrees of private expenditure on health care correlate with higher levels of R&D in health care, consistent with the hypothesis forwarded by Weisbrod that increasing insurance coverage boosts technology adoption. However, their findings also suggest that increasing public funding of health care appears to lower technological adoption, which is consistent with the exercising of monopsony power and an objective of cost containment.

photo: (*) Photosolde

26 de març 2017

Women 20 (W20): Gender disparities

Gender equality contributes to strong, sustainable and balanced economic growth.

At their summit in Brisbane in 2014, G20 leaders agreed to focus on gender equality challenges at the strategic level. They committed to ‘women’s full economic and social participation' to reducing the gender gap in participation by 25 per cent by 2025; and to bringing more than 100 million women into the labour force.

To make the world’s premier economic forum accountable for progress on this crucial front, the engagement group known as the ‘Women 20’ (W20) was created in early 2015.

Progress towards gender equality at work has been slow. Contrary to conventional wisdom, global rates of female labour force participation have stagnated, or even fallen, in recent decades.

This paper-brief seeks to inform the work of the W20 in expanding women’s economic opportunities. It begins by outlining the origins and objectives of the W20, then highlights the key gaps in economic opportunities for women and girls in G20 countries, identifying common challenges as well as distinguishing features and constraint

Main conclusions:
  1. To close labour force participation gaps is to change legal rules and institutions that restrict women’s opportunities, and to review the scope for specific measures and investments to support the expansion of opportunities.
  2. Governments should eliminate all legal discrimination against women and review policies to support their participation in the labour market, including investment in social infrastructure for the care of children and the elderly.
  3. Governments can also lead by example, including by undertaking gender audits of their own workforces, and increasing the share of public procurement sourced to companies that meet specified gender criteria.
  4. Private-sector leadership and innovation on gender equality are also needed to promote and support progress.

Research paper (2015) (pdf.) A Profile of Gender Disparities in the G20: What is Needed to Close Gaps in the Labour Market

photo: (*) Photosolde

25 de febr. 2017

Kenneth J. Arrow the "Albert Einstein of economics"

In October 29th of 1990, Kenneth J. Arrow was invited to give the opening lecture ("Exellence and Equality in Education") in the Economics Faculty at the Pompeu Fabra University founded the same year by the Government of Catalonia. He came to Barcelona with with wife Selma Schweitzer. 

A group of Ph.D students organized a route in Barcelona with them. First we went to visit La Pedrera and then we went to have lunch in Els 4 Gats.

For us, a group of 23 years old, recently graduated economists were a great pleasure and an honour to stay with them.

Kenneth J. Arrow is considered one of the most important economists in economic theory .

Ramon Marimon first dean of the Economics Faculty in 1990 has said about him: "Ken Arrow also pioneered endogenous growth theory by showing how far countries can go by the simple process of ‘learning by doing,’ but now I realize he was referring to his own life…he really did an incredible lot!

As Andreu Mas-Colell said "The surprising thing about him is that he only got one Nobel Prize".

Related post about Kenneth J. Arrow: If you'd like to understand what health economics is, don't miss Ken Arrow __________________________________________________________________________

29 de gen. 2017

clinical trails, conflicts of interest

"if professional societies and medical institutions do not demonstrate vigorous self- regulation and a commitment to keeping patients interests paramount, public trust may diminish, and more external regulation may be imposed" (Bernard Lo)

"Particularly attention must be paid when researchers offer some medical benefit that can be integrated easily into a course of treatment. Although subjects in these trials are offered a treatment of unproven efficacy, many mistakenly believe that they are receiving cutting-edge treatment guaranteed to improve their condition. This therapeutic misconception may be reinforced when subjects receive the experimental treatment from the same physician who has administered all of their care in the past, in contrast to being referred to a clinical investigator located in an academic setting with a reputation for conducting research" (Karine Morine, et al)

photo: (*) Photosolde

8 de gen. 2017

winter is coming and there's no bed in hospital that can resist it

The Nuffield Trust is looking closely at some of the big issues behind pressure on the NHS in winter months. Prof John Appleby Director of Research and Chief Economist presents some solutions:
  • For some hospitals, the answer is simple: providing more beds and more staff will help them weather the storm through winter.
  • For most others, recording bed occupancy in real time rather than taking a snapshot each day will help them to better coordinate the flow of patients.
  • And for virtually all, reducing delays once patients are medically fit to leave hospital is essential.
Recent articles to look forward by Nuffield Trust and The Health Foundation in relation to winter pressures:

1) Winter bed pressures (2016)
2) How to help health care flow to winter pressures (different materials) 

and the Report of the Health Committee appointed by the House of Commons to examine the policy, administration and expenditure of the Department of Health and its associated bodies

3) 3rd Report - Winter pressure in accident and emergency department (2016)

Photo: Aaron Harris / Reuters (2014)