heterogeneity and the evaluation of efficiency the case of italian universities a random parameters stochastic frontier model is applied to italian data in order to evaluate the cost function and efficiency of higher education institutions the method yields useful information about inter institutional variation in cost structure and technical efficiency returns to scale and scope are evaluated for the typical university and it is found that these returns are almost ubiquitously decreasing a finding with clear policy implications

a fresh look at the productivity and efficiency changes of uk airlines this article uses the bootstrapped malmquist index methodology to measure and test the extent of efficiency and productivity changes in the uk airline sector the aim of the bootstrap method is to overcome the statistical limitations of the data envelopment analysis dea method generally used to measure the distance functions of the malmquist index in applying the method we use input output data on a sample of major uk airlines for the period 2004 2007 results showed that most airlines have witnessed significant decrease in their productivity efficiency scale and technology measures using a second stage tobit regression this article attributed the sources of productivity and efficiency changes to factors such as stage length load factor and airline size this article also discussed the negative impacts of oil price using illustrations from the uk and other international airlines

contestability in bus markets evidence from the british de regulated market following the 1985 transport act in great britain reforms in the provision of bus services continue across europe and other parts of the world to this day the british experience however remains a key point of study in informing these continuing developments this article looks at the issue of contestability in bus markets and tests for the existence of the contestable market in britain through an examination of fare levels profit margins and technical efficiencies in 90 identifiable bus markets the main conclusion is that there is evidence of the contestable market in britain however it can hardly be described as widespread only found to be present in 15 of the 90 markets identified in the sample the real issue however particularly with regard to continuing reforms elsewhere in europe is the ability of regulatory authorities to maintain competitive and contestable free markets and the research suggests that in the face of market forces this is simply not possible the only conclusion therefo

efficiency heterogeneity and cost function analysis empirical evidence from pathology services in the national health service in england pathology services are increasingly recognized as key to effective healthcare delivery underpinning diagnosis long term disease management and research to the extent that pathology services affect a patient s treatment pathway significant healthcare costs are influenced directly by the performance of these services given pressures on the uk department of health to make efficiency savings and that little is known about the efficiency of pathology laboratories this area offers unlocked potential for efficiency gains we adopt a time varying inefficiency model with laboratory specific time paths for inefficiency to identify potential savings in pathology services based on a panel of 57 english laboratories over a 5 year period we apply a range of approaches to account for observable and unobservable heterogeneity between laboratories we find potential efficiency savings of 13 in pathology services in this sample which implies the potential for an annual saving of 390m in pathology across the nh

some models for estimating technical and scale inefficiencies in data envelopment analysis in management contexts mathematical programming is usually used to evaluate a collection of possible alternative courses of action en route to selecting one which is best in this capacity mathematical programming serves as a planning aid to management data envelopment analysis reverses this role and employs mathematical programming to obtain ex post facto evaluations of the relative efficiency of management accomplishments however they may have been planned or executed mathematical programming is thereby extended for use as a tool for control and evaluation of past accomplishments as well as a tool to aid in planning future activities the ccr ratio form introduced by charnes cooper and rhodes as part of their data envelopment analysis approach comprehends both technical and scale inefficiencies via the optimal value of the ratio form as obtained directly from the data without requiring a priori specification of weights and or explicit delineation of assumed functional forms of relations between inputs and outputs a separation into technical and scale efficiencies is accomplished by the methods developed in this paper without altering the latter conditions for use of dea directly on observational data technical inefficiencies are identified with failures to achieve best possible output levels and or usage of excessive amounts of inputs methods for identifying and correcting the magnitudes of these inefficiencies as supplied in prior work are illustrated in the present paper a new separate variable is introduced which makes it possible to determine whether operations were conducted in regions of increasing constant or decreasing returns to scale in multiple input and multiple output situations the results are discussed and related not only to classical single output economics but also to more modern versions of economics which are identified with contestable market theories

coordination problems in local level resource management starting from the observation of important returns to scale effects in conservation of common property resources we identify some of the factors that impinge upon the chances of success of a decentralized group based management of local natural resources particular attention is paid to the influence of asset inequality among resource users in particular it is shown that by redistributing incentives among landowners land reform has an ambiguous impact on the latter s willingness to undertake conservation investments

access based consumption the case of car sharing access based consumption defined as transactions that can be market mediated but where no transfer of ownership takes place is becoming increasingly popular yet it is not well theorized this study examines the nature of access as it contrasts to ownership and sharing specifically the consumer object consumer consumer and consumer marketer relationships six dimensions are identified to distinguish among the range of access based consumptionscapes temporality anonymity market mediation consumer involvement the type of accessed object and political consumerism access based consumption is examined in the context of car sharing via an interpretive study of zipcar consumers four outcomes of these dimensions in the context of car sharing are identified lack of identification varying significance of use and sign value negative reciprocity resulting in a big brother model of governance and a deterrence of brand community the implications of our findings for understanding the nature of exchange consumption and brand community are discussed

environmental externalities in traditional agriculture and the impact of trade liberalization the case of ghana abstract this paper provides a framework for the evaluation of trade policies that explicitly considers the effects of such policies on the environmental resources biomass in doing this we estimate the effects of biomass as a factor of agricultural production and test the hypothesis that farmers efficiently exploit biomass a resource held in common property the main findings are i biomass is an important factor of production in ghanian agriculture ii the biomass resource is exploited beyond the socially optimal level iii a deepening of trade liberalization is likely to induce further losses of biomass and deforestation and iv national income is likely to fall in response to further trade liberalization

are hospitals seasonally inefficient evidence from washington state efficiency measurement has been one of the most extensively explored areas of health services research over the past two decades despite this attention few studies have examined whether a provider s efficiency varies on a monthly quarterly or other sub annual basis this article presents an empirical study that looks for evidence of seasonal inefficiency using a quarterly panel of general acute care hospitals from washington state we find that hospital efficiency does vary over time however the nature of this dynamic inefficiency depends on the type of efficiency being measured our results suggest that technical and cost efficiency vary by quarter allocative and scale efficiency also vary on a quarterly basis but only if the data are jointly disaggregated by quarter and another firm specific factor such as size or operating status thus future research corporate decisions and government policies designed to improve the efficiency of hospital care need to account for seasonal trends in hospi

green entrepreneurship in the sharing economy utilising multiplicity of institutional logics the green potential of the sharing economy to exploit underutilised or redundant resources has generated a considerable interest and expectations on the part of government institutions investors and consumers alongside the emerging green logic more established economic and social logics appear to be critical for growth of sharing platforms applying an institutional logics approach this paper investigates how entrepreneurial teams in the sharing economy deal with this complexity of expectations of various constituents and institutions based on 30 semi structured interviews with founders and executives of uk sharing platforms we examine the strategies used by entrepreneurial teams to utilise and combine the green logic with other institutional logics present the results demonstrate that sharing platforms are able to grow via utilising the green logic together with the economic and social logics in a flexible manner applying complexity reducing and complexity absorbing strategies as well as temporal adjustments in the use of logics

using panel data analysis to estimate confidence intervals for the dea efficiency of individual decision making units this article demonstrates a methodology using panel data analysis to estimate confidence intervals for the data envelopment analysis efficiency of individual decision making units dmus and the statistical significance of trends in individual dmu efficiency the procedure accounts for stochastic variations of the inputs and outputs of the target dmu as well as stochastic variations of the inputs and outputs of its efficient benchmark peers the procedure is demonstrated using 9 years of data from 34 canadian paratransit agencies

foreign direct investment spillovers and technical efficiency in the indonesian pharmaceutical sector firm level evidence the spillovers of foreign direct investment fdi on domestic firms performances have been highly debated for many years this article contributes to this debate by analysing spillovers effects on technical efficiency of indonesian pharmaceutical sector using a unique unbalanced panel of highly disaggregated at five digit international standard industrial classification isic 210 firms over the period 1990 1995 1001 observations the stochastic production frontier spf and the data envelopment analysis dea based on malmquist productivity indices mpi have been used to test the spillovers effects of fdi on technical efficiency the empirical results from the spf show that foreign firms are more efficient than domestic competitors and the presence of the former increases the inefficiency of the latter similarly the results from the mpi demonstrate that fdi has a negative and significant impact on technical efficiency changes in domestic competitors but generate positive spillovers to domestic s

principles for the provision of public goods from agriculture modeling moorland conservation in scotland this paper is concerned with policies for the supply of public environmental goods from the farm sector in particular we characterize the buying of these goods by the public from farmers using the provider gets principle this principle is well established in oecd countries as we demonstrate results from ecological economic modeling of the conservation of heather moorland in northern scotland using this principle are described this model enables us to identify spatially differentiated ecological targets and to calculate the minimum necessary payments needed to achieve these targets

the relevance of commuting zones for regional spending efficiency abstractwe use data envelopment analysis dea efficiency scores to show that clustering municipalities into encompassing regional clusters improves spending efficiency of single stand alone municipalities we propose a new geographic aggregation based on municipalities to municipalities commuting flows defined using hierarchical cluster analysis our example for portugal shows that from an output oriented perspective between 83 and 98 of municipalities would increase their efficiency scores while from an input oriented perspective between 86 and 98 of municipalities would also be better off in terms of efficiency then using a linear regression model we find that population increases positively affects the efficient scores via scale economies also increases in the share of high educated and poorer residents leads to higher efficiency scores

evaluating the operational efficiency of major ports in the asia pacific region using data envelopment analysis in recent years as competition among international ports has intensified the impartial and objective evaluation of port operational efficiency has become increasingly important in enabling each individual port to understand its peculiar strengths and weaknesses as well as any immediate threats or opportunities that may affect its competitive environment this study applies ccr model bcc model and 3 stage dea model to evaluate the changes in efficiency that have taken place between 1998 and 2001 in 10 ports in the asia pacific region using cross period data the empirical results show that different model will lead to different result on average the efficiency estimated by 3 stage dea procedure is the highest while ccr efficiency is the lowest it should be noted that the efficiencies based on ccr and bcc model are somewhat lower than the 3 stage dea approaches because they do not take the environmental factors managerial inefficiency and statistical noises into account

from partial derivatives of dea frontiers to marginal products marginal rates of substitution and returns to scale the characterization of a technology from an economic point of view often uses the first derivatives of either the transformation or the production function in a parametric setting these quantities are readily available as they can be easily deduced from the first derivatives of the specified function in the standard framework of data envelopment analysis dea models these quantities are not so easily obtained the difficulty resides in the fact that marginal changes of inputs and outputs might affect the position of the frontier itself while the calculation of first derivatives for economic purposes assumes that the frontier is held constant we develop here a procedure to recover first derivatives of transformation functions in dea models and we show how we can evacuate the problem of the marginal shift of the frontier we show how the knowledge of the first derivatives of the frontier estimated by dea can be used to deduce and compute marginal products marginal rates of substitution and returns to scale for each decision making unit dmu in the sample

cross country comparisons of technical efficiency of health production a demonstration of pitfalls it has been proposed that cross country comparisons of the technical efficiency of health production estimated using data envelopment analysis dea have useful applications for policy makers in theory such an analysis utilizes measures of the socioeconomic determinants of health relevant to all social policy not just health policy using oecd and who data this article critically analyses a number of outstanding theoretical questions regarding the use of dea in this setting it concludes that until such questions are addressed the resultant implications for policy will be based on misleading information

is the tragedy of the commons likely factors preventing the dissipation of fuelwood rents in zimbabwe although village rules classify fuelwood resources in rural zimbabwe as being open access theory suggests that social norms and or heterogeneity among users prevents rents from being dissipated results from a random utility model suggest that social norms and heterogeneous travel costs significantly influence site choice welfare measures suggest that there are positive site rents and that these rents vary because social norms and or heterogeneity are preventing rent dissipation at some sites more than others given the prevalence of social norms and heterogeneity in costs the tragedy of thecommons is unlikely

efficiency measures and productivity indexes in the context of university library benchmarking data envelopment analysis dea has attracted considerable attention during the last few decades as an intuitively clear method for performance assessment theoretical developments have taken turns with empirical efficiency studies in this paper we empirically analyse performance differences across university libraries from different countries from a cross section and a longitudinal perspective we use the malmquist index approach to disentangle environmental efficiency from technical efficiency te to highlight performance differences eventually induced by environmental factors beyond the control of library management as well as to decompose productivity changes over time into changes in te and changes in technology in our cross section analysis we found that north american na libraries are more productive at higher input levels than the european libraries from germany and austria at which we looked in this contribution moreover the largest na libraries are still able to improve performance as t

drinking and academic performance in high school i investigate the extent to which negative alcohol use coefficients in grade point average regressions reflect unobserved heterogeneity rather than direct effects of drinking using 2001 and 2003 youth risk behaviour survey data on high school students results illustrate that omitted factors are quite important drinking coefficient magnitudes fall substantially in regressions that control for risk and time preference mental health self esteem and consumption of other addictive substances moreover the impact of binge drinking is negligible for students who are less risk averse heavily discount the future or use other drugs however effects that remain significant after accounting for unobserved heterogeneity and are relatively large for risk averse future oriented and drug free students suggest that binge drinking might slightly worsen academic performance consistent with this the relationship between grades and drinking without binging is small and insignificant on the extensive margin and posi

the sharing economy a pathway to sustainability or a nightmarish form of neoliberal capitalism the sharing economy seemingly encompasses online peer to peer economic activities as diverse as rental airbnb for profit service provision uber and gifting freecycle the silicon valley success stories of airbnb and uber have catalysed a vibrant sharing economy discourse participated in by the media incumbent industries entrepreneurs and grassroots activists within this discourse the sharing economy is framed in contradictory ways ranging from a potential pathway to sustainability to a nightmarish form of neoliberalism however these framings share a common vision of the sharing economy a niche of innovation decentralising and disrupting established socio technical and economic structures regimes here i present an analysis of the online sharing economy discourse identifying that the sharing economy is framed as 1 an economic opportunity 2 a more sustainable form of consumption 3 a pathway to a decentralised equitable and sustainable economy 4 creating unregulated marketplaces 5 reinforcing the neoliberal paradigm and 6 an incoherent field of innovation although a critique of hyper consumption was central to emergence of the sharing economy niche 2 it has been successfully reframed by regime actors as purely an economic opportunity 1 if the sharing economy follows this pathway of corporate co option it appears unlikely to drive a transition to sustainability

endogenous provision and appropriation in the commons munity creating the potential of avoiding the tragedy of the commons that characterizes resource use under open access bromley serious difficulties remain however in managing the resource in a way that is socially optimal because of the rival nature of appropriation by individual members achieving the social optimum requires either inducing a noncooperative behavior by individual members that mimics what co

context dependent biodiversity conservation management regimes theory and simulations ecosystem degradation hasmotivated a search for successful conservation approaches the perceived failure of state directed protected areas in the tropics has prompted experimentation with community management and co management strategies numerous case studies suggest that none of these are effective universally there exists however little analytical or empirical work to identify under what conditions one arrangement will be more effective than another this paper develops a model of statedependent equilibrium conservation management design that identifies the comparative advantage of different managers in the interest of appropriately locating authority for conservation tasks as a function of prevailing biophysical economic and sociopolitical conditions

common pool resource appropriation under costly cooperation abstract in addition to the usual fixed costs we introduce variable costs in a community s effort to cooperate in extracting from a common pool resource using a standard supervision mechanism these variable costs are shown to be an increasing function of individual members incentives to default the model explains why we frequently observe communities that all cooperate and have relatively similar resource endowments and yet achieve very different levels of extraction

watershed partnerships and the emergence of collective action institutions this paper examines the emergence of local cooperative institutions watershed partnerships that resolve collective action problems involved in the management of natural resources the political contracting approach to institutional supply suggests that watershed partnerships are more likely to emerge when potential benefits outweigh the transaction costs of developing and maintaining new institutions we analyze the impact of social political economic and ecological features of watersheds that affect benefits and transaction costs on the emergence of 958 watershed partnerships in the more than 2 100 watersheds in the united states our findings demonstrate that watershed partnerships are most likely to emerge in watersheds confronting severe pollution problems associated with agricultural and urban runoff with low levels of command and control enforcement and containing the resources to offset transaction costs

non elective c sections in public hospitals capacity constraints and doctor incentives abstractusing administrative records of births from the perinatal surveillance system of the peruvian social security system essalud we test whether high admissions of pregnant women affected non elective caesarean section c section rates in the essalud public hospitals during 2005 2006 we present a basic theoretical model that considers physician preferences for leisure and hospital capacity constraints and test the model predictions we find that physician demand for leisure increases the probability of c sections in small and medium size hospitals while hospital capacity constraints set a limit on them we discuss the policy implications as well as the policies implemented to avoid unnecessary c sections

the efficiency of german universities some evidence from non parametric and parametric methods due to tight public budget constraints the efficiency of publicly financed universities in germany is receiving increasing attention in the academic as well as in the public discourse against this background we analyse the efficiency of 72 public german universities for the years 1998 2003 applying data envelopment and stochastic frontier analysis contrary to earlier studies we account for the faculty composition of universities which proves to be an essential element in the efficiency of higher education our main finding is that east german universities have performed better in total factor productivity change compared to those in west germany however when looking at mean efficiency scores over the sample period west german universities still appear at the top end of relative efficiency outcomes

making the commons work conservation and cooperation in ireland commonage represents land held under common property that incorporates a system of local cooperative arrangements and rules to conserve and manage the irish uplands we analyze the institutional and economic factors that influence the behavior of commonage farmers under a common property regime using a recursive bivariate probit model results show that 1 cooperation has a positive and important impact on commonage conservation 2 agricultural policies by way of livestock premia increase the level of degradation while 3 farm financial support through agrienvironment measures positively affects commonage conservation and encourages cooperation between farmers

evaluating the performance of higher education institutions in europe a nonparametric efficiency analysis of 944 institutions abstractalthough a long tradition exists of studying the economics of education performance comparisons of different kinds have traditionally been difficult to undertake an important impediment has been the lack of comparable data to a large extent this study remedies the shortcomings of earlier studies our contribution is twofold first the current higher education policy of contraction and economizing common to most european countries make knowledge of potential efficiency gains crucial second a unique database allows us to study a broad diversity of organizations as well as organizations located in a number of different european countries the study suggests evaluating higher education institution hei performance in a production theory context applying the well known data envelopment analysis dea method to a cross section of 944 heis in 17 european countries the dea approach is particularly suitable in this context where little is known about production technologies and economic behavio

common property and collective action in economic development abstract a fundamental issue in many ldcs is the degree to which natural resource mismanagement is caused by common property arrangements this view has led to widespread attempts to privatize forests rangelands and water resources many of these efforts have failed to stop overuse and have contributed to inequality in resource distribution this paper seriously questions this approach and describes a number of reasons why common property may continue to be both efficient and equitable complementing and combining with private rights in a way consistent with the resource endowments of village economies a theoretical approach is outlined showing that the tragedy of the commons is an unsatisfactory model of common property an alternative model is presented together with a call for research into institutional alternatives in resource management

hospital performance in a noncompetitive environment in this article we perform a quantitative analysis of the performance of hospital services in a nonmarket environment based on a very complete data set evaluating efficiency in a nonmarket system is important since the absence of market mechanisms could yield large inefficiencies in fact we show that hospital performance varies greatly across institutions specifically our results suggest that hospitals with high levels of quasi fixed factors are less efficient than other institutions in general hospitals performed very differently even after controlling for differences in services hospital and patient characteristics all in all increased efficiencies could lead to potential savings for the quebec government in the hundreds of millions of dollars

improving the accuracy of dea efficiency analysis a bootstrap application to the health care foodservice industry this article analyses the efficiency of health care foodservice operations and its determinants using a data envelopment analysis dea bootstrapping approach the purpose of using the bootstrapping approach is two fold first to obtain the bias corrected estimates and the confidence intervals of dea efficiency scores and second to overcome the correlation problem of dea efficiency scores and to provide consistent inferences in explaining the determinants of health care foodservice efficiency the approach was implemented on a sample of 89 health care foodservice operations the results showed the presence of inefficiency in the sample with an average efficiency level of 72 6 further the results from analysing the determinants of health care foodservice operations provided policy implication regarding the factors that might improve the efficiency of health care foodservice operations

measuring the efficiency of health systems of oecd countries by data envelopment analysis abstractthis study aims to assess the efficiency of health sectors of 34 oecd countries by employing input oriented data envelopment analysis dea method both under constant and variable returns to scale assumptions in the analysis the number of doctors number of patient beds and health expenditure per capita were used as input variables and life expectancy at birth and infant mortality rate were used as outputs at the first stage dea analysis was performed for 34 countries and at the second stage outlier 8 countries were eliminated to form a more homogeneous group and to achieve more accurate results 11 of the 26 countries were found to have efficient health systems and there is room for efficiency improvements in health sector in the remaining 15 countries

productivity comparison of european airlines bootstrapping malmquist indices abstractthe study explored the operating efficiency and variability of productivity estimates of european airlines we applied malmquist productivity indices mpi with a bootstrap method to assess the productivities of european airlines in four regions in europe the productivity of small sized airlines lagged further behind that of large sized airlines because of their inferior technological change tc effects derived from inefficient resource allocation to sustain a competitive advantage this study also indicated that the western european airlines were more efficient on average than those in other areas of europe the applications of malmquist productivity techniques in assessing the performance of european airlines are highlighted in their effective resource allocation sustained competitive advantage and optimized operating performance

slacks determinants in brazilian railways a distance friction minimization approach with fixed factors this study investigates the drivers for output increasing input saving potentials in the brazilian railway industry which has undergone significant transformations since its privatization in the mid 1990s the main research objective is to determine whether or not different types of cargoes and geographic regions serviced present a significant impact on railway slacks by applying a distance friction minimization dfm approach with fixed factors based on a balanced panel model secondary data from the period 2004 to 2012 were collected and analysed results support anecdotal evidence regarding a heterogeneous impact of types of cargo and geographic location on input reducing and output increasing potentials besides network length and average speed policy implications for railway authorities are also addressed by focusing on the specifics of each railway operator

small is not that beautiful after all measuring the scale efficiency of tunisian high schools using a dea bootstrap method allocation of resources to schools in a centrally managed state system as the tunisian one should depend on the performance of the individual institutions the optimal size is of crucial importance in this context and we need accurate measurement for sound policies this article discusses and implements a nonparametric statistical test procedure for organization scale efficiency this procedure allows us to test whether the observed scale efficiency is optimal or not using a smooth bootstrap methodology for efficiency measures estimated using data envelopment analysis dea methods because school principals do not control for the size of their institution i e the capital available at decision time the scale efficiency measures are defined so as to include quasi fixed inputs the results show that scale efficiency measures are subject to sampling variation we also found that the schools that are scale efficient are usually mid sized and large schools when size is measured by the number of students

best practice benchmarking in uk higher education new nonparametric approaches using financial ratios and profit efficiency methodologies the neglected issue of using profit efficiency for the best practice benchmarking of uk universities is explored to see whether this supports the policy stance of encouraging more specialized university production the article also investigates whether nonparametric modelling with financial ratios in contrast to nonparametric modelling based on the prices and quantities of each university s inputs and outputs can yield ready insights into this profit efficiency issue the empirical results using two new approaches confirm that more specialized university production yields relatively higher performance on average than less specialized production the results also highlight certain advantages of financial ratios modelling

governance of the commons a role for the state the paper examines property regimes and common pool resources using examples and case studies the relative merits of private community and state based rights are detailed the insights from the case studies and an analysis of institution costs provide a tentative framework for understanding the role of the state in the governance of the commons

effectiveness analysis of quality achievements for university departments of economics when university departments are under pressure to improve the assessed quality of their research and teaching in several different directions simultaneously questions arise as to the nature of the corresponding feasible set and the shape of its frontier when quality is judged by reference to grades whose precise thresholds are subject to stochastic uncertainties both convex and nonconvex regions of the frontier of the feasible set may be present the appropriateness of deploying standard empirical techniques of frontier estimation is then called into question in evaluating the relative effectiveness of individual departments and their scope for improvements the empirical results of frontier estimation here applied to uk university departments of economics are shown to be sensitive to the choice of nonparametric frontier technique deployed with free disposal hull analysis providing an alternative estimation technique that can allow for both convex and nonconvex regions of the possibility frontier i

impact of input substitution and output transformation on data envelopment analysis decisions abstractdata envelopment analysis dea can aid managerial decision making because it offers an opportunity to measure organizational performance in a holistic manner aggregating data from partial indicators into a single comprehensive measure however there are some methodological hazards associated with the use of dea that are especially relevant to managerial decisions but which have been largely ignored in the literature herein we identify and show the impact of a ubiquitous methodological hazard in dea modelling the economic assumptions regarding input substitutions and output transformations

building sustainable hybrid organizations the case of commercial microfinance organizations we explore how new types of hybrid organizations organizations that combine institutional logics in unprecedented ways can develop and maintain their hybrid nature in the absence of a ready to w

efficiency of health care delivery systems effects of health insurance coverage health insurance expansions may increase the demand for care creating incentives for health systems to increase input consumption the possibility remains that added capacity and personnel will have little effect on health outcomes decreasing the technical efficiency of health care delivery systems we estimate that a 1 percentage point increase in health insurance coverage decreases the technical efficiency of health care delivery by 1 3 percentage points translating into approximately 50 billion dollars in additional health expenditures this finding uncovers a previously unexplored consequence of changes in health insurance on the supply side of health care markets suggesting one avenue through which health care costs growth may occur

sharing cities and sustainable consumption and production towards an integrated framework calls for a transformation towards more sustainable consumption and production scp have been intensifying as urban populations swell across the planet cities are faced with increasing pressure on infrastructure economic and ecological systems yet with their high population densities and ubiquity of information and communication technologies cities are becoming breeding grounds for a new circular economy driven by emerging and long standing sharing activities this research provides a comprehensive view of scp systems in cities by integrating and examining sharing economy activities in the context of two continuums i e scp and private public orientation based on these two analytical dimensions the paper evaluates and plots five groups of 18 sharing activities to create a sharing cities scp typology comprised by five ideal types each of these five types represents a unique form of scp activity with the potential to directly impact scp systems in the context of urban environments by enabling diversity and hybridity in the scp analysis we allow for a theoretical expansion of scp models and a new way of understanding how they may play out in cities