risk adjustment and prevention widespread integration of market based incentives into healthcare systems calls for and has elicited increasing adoption of risk adjustment by deterring selection risk adjustment helps to assure fair and efficient payments among health insurers or capitated provider groups however since conventional risk adjustment allocates funds among regions or insurers according to current population health status it does not reward indeed it penalizes preventive efforts that improve population health this prevention penalty of risk adjustment represents a hidden cost of unclear magnitude undermining provider incentives for health promotion we develop a theoretical model of selection and prevention demonstrating this problem with conventional risk adjustment and suggesting a simple alternative risk adjustment should be linked to pay for performance for prevention l integration generalisee d incitatifs mercantiles dans les systemes de soins de sante appelle et a engendre l adoption croissante d ajustements au risque en decourageant la selection l ajustement au risque aide a assurer des paiements justes et equitables entre les assureurs ou les groupes de fournisseurs finances par capitation cependant comme les ajustements conventionnels au risque allouent des fonds entre les regions ou les assureurs selon le statut sanitaire present de la population ils ne recompensent pas et meme penalisent les efforts de prevention qui ameliorent la sante des populations cette penalisation de la prevention dans les ajustements au risque represente un cout cache d une magnitude mal etablie qui mine l incitation des fournisseurs a s occuper de promotion de la sante on developpe un modele theorique de selection et de prevention mettant en lumiere ce probleme dans l utilisation de l ajustement au risque conventionnel et on suggere une solution de rechange ou l ajustement au risque est reliea une remuneration a la performance pour la prevention

a neo schumpeterian model of health services innovation the paper presents and empirically applies a neo schumpeterian model of innovation capable of studying interactions between service providers patients and policy makers and how these complex interactions determine the timing direction and success of innovations in the public sector the model is tested using a case study that traces the introduction and development of ambulatory surgery in a spanish hospital the multi agent model applies the ideas of schumpeter to services encompassing schumpeter s five types of innovation and re introducing the policy maker as a key agent in the innovation process the model has a number of advantages over previous reduced form models first it can analyse the interactions between the economic social and political spheres that make up the complex selection environment of innovations second it captures the recursive impact of radical innovations on agents competences and preferences and their relative power this brings politics power and rhetorical persuasion to the fore third it provides an improved set of definitions for radical and incremental innovation these are not only important for understanding the sources and drivers of innovation but also for the accurate measurement of innovation

rationing by waiting and the value of time results from a natural experiment the authors analyze data from a natural experiment with rationing by waiting in the situation motorists were confronted with a choice between waiting in line for low priced gasoline or purchasing at a higher price without waiting they view this as a revealed preference experiment and use their choices to estimate the value of time spent waiting as a function of individual characteristics in most cases the estimates of the value of time are quite similar to individuals after tax wages 13 references 7 tables

weather shocks and cropland decisions in rural mozambique abstract economic development in low income settings is often associated with an expansion of higher value agricultural activities since these activities often bring new risks an understanding of cropland decisions and how these interact with shocks is valuable this paper uses data from mozambique to examine the effect of weather shocks on cropland decisions we account for the bounded nature of land shares and estimate a pooled fractional probit model for panel data our results show that crop choice is sensitive to past weather shocks farmers shift land use away from cash and permanent crops one year after a drought and from horticulture and permanent crop after a flood however this reallocation seems temporary as farmers devote less land to staples after two periods this is consistent with the aim of maintaining a buffer stock of staples for home consumption

cash crop liberalization and poverty alleviation in africa evidence from malawi this article uses the case of burley tobacco liberalization in malawi to investigate the efficacy of cash crop liberalization as an instrument for poverty alleviation in sub saharan africa the principal justification for cash crop liberalization is that markets allow farm households to increase their incomes by producing that which provides the highest return to their productive resources and use the cash to buy consumption goods using a latent welfare model we find that households that selected to grow cash crops had higher incomes than those that did not grow cash crops however we also find that due to the lumpiness and seasonality of cash crop incomes higher household incomes while increasing food purchases did not significantly affect per capita food intake irrespective of participation in cash crops for much of the cropping season rural households seem to rely more on nonfarm income for expenditure and consumption smoothing

a money demand system for euro area m3 in order to assess the importance of monetary and financial developments for key macroeconomic variables in the euro area a money demand system for m3 is estimated adopting a structural cointegrating var approach while maintaining a good statistical representation of the data long run relationships are based on economic theory by using generalized response profiles the dynamics of the money demand system is investigated without any further identifying assumptions error bounds of the profiles are derived using bootstrap simulations

market structure and prices the responses of hospitals in the uk national health service to competition abstract the internal market reforms to the uk national health service nhs are a model adopted in many health care systems they introduce competition in supply little is known about the impact of these reforms this paper examines the pricing responses of nhs suppliers to competition the incentives of the reformed system are analysed these indicate that prices should differ between buyers and markets these hypotheses are tested using data on spot market transactions between hospitals and health care buyers the results indicate considerable price variability but offer broad support for the hypotheses

a game theoretic model of the relationship between prices and waiting times abstract issue the role of prices charged to patients as a policy instrument for altering waiting times method a game theoretic model is used to examine the determinants of waiting times results under certain circumstances an increase in the price charged to patients at some institutions will lower the waiting times at all institutions conclusions the results provide a set of policy implications and testable predictions that arise under a certain set of assumptions alternative assumptions as well as the policy implications and testable predictions associated with them are also examined

do doctors respond to financial incentives uk family doctors and the gp fundholder scheme abstract the 1991 reforms to the uk nhs created a group of buyers of hospital care from amongst primary care physicians the implementation of the reforms was such that these buyers had incentives to increase their use of hospital services prior to entering the scheme in order to inflate their budgets it has been argued that non financial motives would limit such behaviour the paper shows that these health care providers did respond to the financial incentives offered by the scheme increasing hospital based activity prior to entry and so inflating their budgets upwards for the duration of the fundholding scheme

cash crop production food price volatility and rural market integration in the third world large farmers in the third world often devote to cash crops a larger share of their land than do small farmers this paper suggests a possible explanation even in the presence of food markets third world farmers food security is best assured by food self sufficiency a model of crop portfolio choice under multivariate risk is used to show that reasonable assumptions regarding risk and preferences reproduce the observed pattern simulations further indicate that food market integration reduces the need for food self sufficiency policy implications are drawn regarding domestic trade liberalization and agricultural technology

insurance market efficiency and crop choices in pakistan this paper tests the efficiency of insurance markets in the pakistan punjab by examining how crop choices are affected by the presence of price and yield risk we estimate reduced form and structural models of crop choices although we cannot reject the hypothesis that village members efficiently share risk among themselves production choices are shown to depend on risk existing risk sharing and selfinsurance mechanisms thus imperfectly protect punjab farmers against village level shocks results also indicate that households respond to consumption price risk thereby suggesting that empirical and theoretical work on risk should avoid putting an exclusive emphasis on yield and output price risk

risk crop choice and savings evidence from tanzania rural households engaged in agricultural activities face considerable risks in their income process these income risks are especially important if they result in consumption fluctuations this is likely if insurance and credit markets are absent one possible strategy for household is to take up low risk activities even if they imply lower returns such response cannot be viewed independently from the other options available to households to reduce consumption fluctuations this paper focuses on the importance of liquid asset formation for risk taking behaviour by households an intertemporal model of consumption under liquidity constraints is developed in which households can choose between income activities with different returns and riskiness it shows that if liquid asset holdings are large providing a buffer for consumption shortfalls then households will be more willing to take up high risk activities evidence based on survey data from shinyanga district tanzania is presented consistent with this prediction this abstract was borrowed from another version of this item

agricultural technology risk and gender a cge analysis of mozambique abstract interactions between agricultural technology improvements risk reducing behavior and gender roles in agricultural production in mozambique are examined the analysis employs a computable general equilibrium cge model that explicitly incorporates key features of the economy these include detailed accounting of marketing margins home consumption risk and gender roles in agricultural production our results show that agricultural technology improvements benefit both male and female occupants of rural households due to economic interactions agricultural technology improvements are particularly compelling when combined with marketing system improvements moreover technological change in cassava appears to be a particularly strong lever for increasing female and overall household welfare especially when risk is considered

rationing by waiting lists an implication in a recent article cotton lindsay and bernard feigenbaum 1984 present and test a model of rationing by waiting lists its novel feature is the recognition that being on some types of waiting list involves no opportunity cost and that consumers surplus cannot be dissipated by waiters undertaking costly activities that will help secure the good or service in question in this sense time does not act as a price although it imposes costs although lindsay s earlier version 1980 of this model has already been misinterpreted by some commentators 1 its heart is a waiting list that is equilibrated by attacking the assumption that the demand curve remains unchanged throughout the wait waiting time matters because the value of the good or service decays the longer it is delivered after order day while not wishing to take issue with this insight there are a number of points that need to be borne in mind when assessing the significance of the model especially in relation to the authors application to britain s national health service nhs

tax incentives and the demand for private health insurance we analyze the effect of an individual insurance mandate medicare levy surcharge on the demand for private health insurance phi in australia with administrative income tax return data we show that the mandate has several distinct effects on taxpayers behavior first despite the large tax penalty for not having phi coverage relative to the cost of the cheapest eligible insurance policy compliance with mandate is relatively low the proportion of the population with phi coverage increases by 6 5 percentage points 15 6 at the income threshold where the tax penalty starts to apply this effect is most pronounced for young taxpayers while the middle aged seem to be least responsive to this specific tax incentive second the discontinuous increase in the average tax rate at the income threshold created by the policy generates a strong incentive for tax avoidance which manifests itself through bunching in the taxable income distribution below the threshold finally after imposing some plausible assumptions we extrapolate the effect of the policy to other income levels and show that this policy has not had a significant impact on the overall demand for private health insurance in australia

the japanese deflation has it had real effects could it have been avoided has deflation contributed to the long lasting stagnation of the japanese economy could the bank of japan have stopped deflation by implementing a more expansionary monetary policy tentative answers are probably not to the first question and probably yes to the second question it is found that the total cost of deflation over the period 1995 2003 has been close to a 1 1 rate of lost gdp yet on the basis of statistical significance and robustness to specification choices this evidence is not compelling on the other hand the estimated positive linkage between nominal base money growth and inflation is significant and robust even given current economic conditions however in order to be inflationary monetary policy should have been more expansionary than what actually observed even since the launch of the quantitative easing in 2001

rationing by waiting lists an empirical investigation abstract many social systems rely on a waiting list rather than price as a rationing device we present a model of the waiting list for elective surgery in the british national health service waiting time is allowed to influence both supply of and demand for surgery the resulting models of supply and demand are estimated empirically using over 4000 observations the results indicate low elasticity of demand with respect to waiting time suggesting that increased resources may reduce waiting times without greatly stimulating utilization the policy implications are important for the british national government when choosing the level of public expenditure to be devoted to health care

consumption versus asset smoothing testing the implications of poverty trap theory in burkina faso abstract despite solid theoretical foundations for the notion that poor borrowing constrained households will intertemporally manage assets to smooth consumption the consumption smoothing hypothesis has not always withstood empirical scrutiny this paper reassesses the intertemporal asset management problem with a poverty trap model and shows that we would expect to see asset smoothing not consumption smoothing in the neighborhood of critical asset levels at which optimal accumulation behavior bifurcates we then employ threshold estimation techniques to empirically confirm the co existence of consumption and asset smoothing regimes using a household panel data set from west africa households above the estimated threshold almost completely insulate their consumption from weather shocks whereas those below the threshold do not these results not only indirectly provide evidence of the existence of poverty traps but also speak to the level and incidence of the costs of uninsured risk

agricultural land use and asset accumulation in migrant households the case of el salvador abstract this paper examines the effect that international migration and remittances have on agricultural outcomes at the household level in el salvador panel data are used to examine land use allocations agricultural asset accumulation and agricultural input use and returns findings suggest that migration and remittances cause a household to reallocate land away from commercial cash crops toward the production of subsistence food crops there is weak evidence that migration and remittances contribute positively to agricultural asset accumulation in the form of land and livestock holdings further results suggest that migration and remittance do not affect agricultural input use and may decrease the returns to land and labour on farm as migrant households farm their land less intensively than non migrant households

the market for elective surgery joint estimation of supply and demand this paper develops models of the demand for and supply of elective non emergency surgery using a panel of quarterly data for 200 english hospitals over the period 1995 2002 unusually distinct measures of supply outpatients seen and inpatient admissions and demand outpatient referrals and decisions to admit are available for each observation these offer the opportunity to estimate separate empirical models of supply and demand using ordinary least squares ols regression methods however the strong correlation between the residuals of these models suggests some merit in the deployment of seemingly unrelated regression sur methods although both static and dynamic sur estimations leave the results largely qualitatively unchanged sur estimation can have a considerable quantitative effect relative to the ols results for example sur estimation generates a lower elasticity of inpatient demand with respect to waiting time than that obtained via ols the results offer an important justification for more careful econometric modelling of hospital behaviour than has traditionally been employed in the health economics literature

the price stability oriented monetary policy of the ecb an assessment the definition of price stability adopted by the ecb has recently been criticized in the literature particularly for being unable to fully anchor inflation expectations and creating a deflation risk in the paper empirical evidence is provided against these claims despite the unfavourable macroeconomic conditions for the euro area since 2001 monetary policy management has lead to the setting of the policy rate at levels compatible with trend inflation the long run inflation forecast in the range 1 3 and therefore without affecting negatively the inflation outlook

do doctors charge high income patients more abstract when doctors are unconstrained in setting fees they charge higher fees to high income patients for a standard gp consultation the average fee gap is 25 of a minimum price competition closes this gap but not local area income

socioeconomic inequality of access to healthcare does choice explain the gradient equity of access is a key policy objective in publicly funded healthcare systems however observed inequalities of access by socioeconomic status may result from differences in patients choices using data on non emergency coronary revascularisation procedures in the english national health service we found substantive differences in waiting times within public hospitals between patients with different socioeconomic status up to 35 difference or 43 days between the most and least deprived population quintile groups using selection models with differential distances as identification variables we estimated that only up to 12 of these waiting time inequalities can be attributed to patients choices of hospital and type of treatment heart bypass versus stent residual inequality after allowing for choice was economically significant patients in the least deprived quintile group benefited from shorter waiting times and the associated health benefits were worth up to 850 per person

how can african agriculture adapt to climate change a counterfactual analysis from ethiopia we analyze the impact of different adaptation strategies on crop net revenues in the nile basin of ethiopia we estimate a multinomial endogenous switching regression model of climate change adaptation and crop net revenues and implement a counterfactual analysis households data are combined with spatial climate data we find that adaptation to climate change based upon a portfolio of strategies significantly increases farm net revenues changing crop varieties has a positive and significant impact on net revenues when coupled with water conservation strategies or soil conservation strategies but not when implemented in isolation jel q54 q56

cropland allocation effects of agricultural input subsidies in malawi summary we measure the impacts of malawi s farm input subsidy program on the cropland allocation decisions of farmers in kasungu and machinga districts in central and southern malawi using a two step regression strategy to control for endogenous selection into the program we find positive correlations between participation in the program and the amount of land planted with maize and tobacco furthermore results suggest that participating households simplified crop production by allocating less land to other crops e g groundnuts soybeans and dry beans our findings have implications for policies aimed at promoting both food self sufficiency and crop diversification in low income settings 2011 elsevier ltd all rights reserved

on crop biodiversity risk exposure and food security in the highlands of ethiopia this paper investigates the effects of crop genetic diversity on farm productivity and production risk in the highlands of ethiopia using a moment based approach the analysis uses a stochastic production function capturing mean variance and skewness effects welfare implications of diversity are evaluated using a certainty equivalent measured as expected income minus a risk premium reflecting the cost of risk we find that the effect of diversity on skewness dominates its effect on variance meaning that diversity reduces the cost of risk the analysis also shows that the beneficial effects of diversity

risk preferences and environmental uncertainty implications for crop diversification decisions in ethiopia to the extent that diversifying income portfolio is used as a strategy for shielding against production risk both individual risk aversion and weather uncertainty could affect crop diversification decisions this paper is concerned with empirically assessing the effects of risk aversion and rainfall variability on farm level diversity unique panel data from ethiopia consisting of experimentally generated risk aversion measures combined with rainfall data are employed in the analysis the major contribution of this study is its explicit treatment of individual risk preferences in the decision to diversify simultaneously controlling for environmental risk in the form of rainfall variability covariate shocks from rainfall variability are found to positively contribute to an increased level of diversity with individual risk aversion having a positive but less significant role we find that rainfall variability in spring has a greater effect than rainfall variability summer the major rainy season this finding is in line with similar agronomic meteorological studies these results imply that in situ biodiversity conservation could be effective in areas with high rainfall variability however reduction in risk aversion which is associated with poverty reduction is likely to reduce in situ conservation

household specific food price differentials and high value crop production in rural ghana using panel data from ghana we have examined the relationship between household specific producer consumer price differentials and rural household cropland allocation between food and high value crops we test the hypothesis that cereal price bands induce a shift of resources away from high value crop production making smallholders appear unresponsive to price incentives our results lend support to this hypothesis implying that a policy aiming at increasing farmers income through high value crop production may fail if hard and soft infrastructure does not improve in rural areas and if staple crop productivity does not increase significantly

do central banks act asymmetrically empirical evidence from the ecb and the bank of england the paper attempts to exploit whether monetary authorities have a different behaviour during recession and expansion to this end a multivariate extension of hamilton markov switching model is adopted first regime dependent taylor type rules are estimated for the euro area and the united kingdom in order to capture the systematic behaviour of central banks then impulse response functions that account for the different phases of the business cycle are analysed in addition a comparative analysis concerning the estimated rules as well as the different reaction of real economy to monetary shocks is implemented the study strongly suggests that central banks cannot neglect the regime where the monetary action takes place it follows that the phase of business cycle is an important matter in monetary policy decision process

output the stock market and interest rates this paper develops a simple model of the determination of output the stock market and the term structure of interest rates the model is an extension of the is lm model and borrows from it the assumption that output is determined by aggregate demand and that the price level can only adjust over time to its equilibrium value however whereas the is lm emphasizes the interaction between the interest rate and output this model emphasizes the interaction between asset values and output asset values rather than the interest rate are the main determinants of aggregate demand and output current and anticipated output and income are in turn the main determinants of asset values it is this interaction that the model intends to capture its goal is to characterize the joint response of asset values and output to changes in the environment such as changes or announcement of changes in monetary and fiscal policy as the above brief description makes clear anticipations are central to the story the assumption made in this paper will be one of rational expectations the paper is organized as follows section i describes the model and sections ii iv characterize the behavior of the economy under the extreme but convenient assumption that prices are fixed forever sections v and vi extend the analysis to the case where prices adjust over time to their equilibrium value

using weather variability to estimate the response of savings to transitory income in thailand this paper measures the extent to which farmers are able to use savings and dissavings to smooth consumption in response to unexpected shocks to income time series information on regional rainfall is used to construct estimates of transitory income due to rainfall shocks the relationship between these measures of transitory income and savings indicates that farm households save a significantly higher fraction of transitory income than nontransitory income jel d91 016 the incomes of farm households in developing countries are notorious for being both low and uncertain policies that increase the incomes of farmers may well be different

explaining the evolution of poverty the case of mozambique we provide a comprehensive approach for analyzing the evolution of poverty using mozambique as a case study bringing together data from disparate sources we develop a novel back casting framework that links a dynamic computable general equilibrium model to a micro simulation poverty module this framework provides a new approach to explaining and decomposing the evolution of poverty as well as to examining rigorously the coherence between poverty economic growth and inequality outcomes finally various simple but useful and rarely applied approaches to considering regional changes in poverty rates are presented copyright 2012 oxford university press

contingent valuation of time spent on nhs waiting lists this paper derives estimates of the consumer bourne costs of waiting lists for nonurgent medical care the methodology used is contingent valuation the paper examines the use of this methodology and presents the experimental context and the estimates derived the estimates indicate the average valuation of a month spent on a waiting list for nonurgent care is approximately 40 pounds but also show that there exist significant interpersonal differences in valuations copyright 1990 by royal economic society

economic behavior under uncertainty a joint analysis of risk preferences and technology a method is developed to estimate jointly risk preferences and technology under general conditions the approach is illustrated in an application to the analysis of u s corn soybean acreage decisions over time the results provide useful information on the nature of farmers risk preferences and on the influence of price risk and production risk on acreage allocation and farmers welfare copyright 1996 by mit press

dynamic hospital competition under rationing by waiting times abstract we develop a dynamic model of hospital competition where i waiting times increase if demand exceeds supply ii patients choose a hospital based in part on waiting times and iii hospitals incur waiting time penalties we show that whereas policies based on penalties will lead to lower waiting times policies that promote patient choice will instead lead to higher waiting times these results are robust to different game theoretic solution concepts designs of the hospital penalty structure and patient utility specifications furthermore waiting time penalties are likely to be more effective in reducing waiting times if they are designed with a linear penalty structure but the counterproductive effect of patient choice policies is smaller when penalties are convex these conclusions are partly derived by calibration of our model based on waiting times and elasticities observed in the english nhs for a common treatment cataract surgery

career concerns monetary incentives and job design we study optimal incentive contracts when commitments are limited and agents have multiple tasks and career concerns the agent s career concerns are determined by the outside market we show that the principal might want to give the strongest explicit incentives to agents far from retirement to account for the fact that career concerns might induce behavior in conflict with the principal s preferences furthermore we show that maximized welfare might be decreasing in the strength of career concerns that optimal incentives can be positively correlated with various measures of uncertainty and that career incentives have strong implications for optimal job design

stochastic trends and economic fluctuations in a small open economy in this paper we describe how restricted vector autoregressions can be employed to examine the sources of macroeconomic fluctuations we show how cointegration restrictions can be used to identify a var system with common stochastic trends subject to transitory and permanent changes in average growth and how we may investigate the system s responses to permanent shocks i e to innovations to the trends theoretical cointegration vectors are derived from a small open economy growth model for terms of trade real gdp real consumption and real investments applying these methods to swedish annual data 1875 1986 we find that permanent real supply shocks account for most of the fluctuations in gdp even in the short run