capital structure ownership and capital payment policy the case of hospitals this study examines effects of pertinent features of hospital capital payment policies on hospital capital structure decisions in a one period stochastic value maximization model separate models are developed for for profit and not for profit hospitals hospital debt to assets ratios are analyzed empirically using a cross section of data from the american hospital association although the effect on capital structure of hospital reliance on cost based reimbursement cannot be signed theoretically in both for profit and not for profit cases a higher cost based share leads to higher leverage factors associated with high bankruptcy risk e g earnings volatility cause hospitals to take on less debt the hospital industry exhibits two prominent characteristics that have unique implications for its capital structure first the majority of hospitals are organized as private not for profit nfp institutions since there is no applicable corporate income tax any risk of bankruptcy might imply that the nfp hospital would select an all equity hospital structure yet it is a stylized fact that almost all nfp hospitals have debt obligations at the same time there exists a sizeable minority of hospitals operated by government or as for profit organizations forprofit hospitals are subject to all tax privileges and obligations applicable to forprofit enterprises in other sectors thus the industry provides a laboratory for analysis of the effect of ownership on organizations capital structures a second unique feature of the industry is that almost all hospital revenue is derived from public and private insurers waldo et al 21 at least until very recently insurers in this industry paid hospitals on either a retrospective cost or

the growing supply of physicians has the market become more competitive the stock of u s physicians at any point in time is modeled as a weighted average of the supply that a perfect cartel would produce and that would prevail under perfect competition estimation of a system of stock and income equations over the post world war ii period shows that after holding constant demand and marginal cost conditions and accounting for gradual adjustment to changes in equilibrium the weighting parameter has moved toward the competitive extreme since 1965 this rise in the degree of competition is estimated to have increased physician stock by 6 20 and concomitantly decreased medical incomes by 19 45

efficiency growth and concentration an empirical analysis of hospital markets taking an evolutionary view of markets harold demsetz hypothesized that firms differ persistently in efficiency and that industry concentration results from growth of efficient firms at the expense of inefficient ones we test the hypothesis with high quality microdata from the us hospital industry an industry of keen policy and scientific interest we measure efficiency by firm in the early 1980s and relate it to subsequent growth of efficient firms to the persistence of profit differences and to changes in the concentration of markets initial hospital efficiency and subsequent growth and profitability are significantly and positively related also greater initial variation in hospital efficiency within local markets is positively related to subsequent growth in market concentration these findings support the logic of demsetz s evolutionary efficiency hypothesis though they cannot confirm the stronger idea that variation in firm efficiency is the dominant explanation for changes in concentration

the design of the university system abstract this paper compares the organisation of the university sector under unregulated private provision with the structure which would be chosen by a welfare maximising government it studies a general equilibrium model where students attend university to earn higher incomes in the labour market and universities teach them and carry out research each university chooses its tuition fee to maximise the amount of resources it can devote to research research bestows an externality on society government intervention needs to balance labour market efficiency considerations which would tend to equalise the number of students attending each university with considerations of efficiency on the production side which suggest that the most productive universities should teach more students and carry out more research we find that government concentrates research more that the private market would but less than it would like to do if it had perfect information about the productivity of universities it also allows fewer universities than would operate in a private system

the analytics of the pricing of higher education and other services in which the customers are inputs many services provide outputs that depend partially on the customers as inputs the presence of other customers often contributes to the output experienced by each purchaser higher education is the premier example others are legion we provide a simple model that addresses the questions of competitive pricing and allocative efficiency for these types of services prices that charge customers for what they get on net output minus input from the firm both are competitive and support efficient allocations these prices internalize the apparent external effects of customers on each other few examples of such prices exist in the real world

the supply of charity services by nonprofit hospitals motives and market structure this article studies provision of charity care by private nonprofit hospitals we demonstrate that in the absence of large positive income effects on charity care supply convex preferences for the nonprofit hospital imply crowding out by other private or government hospitals extending our model to include impure altruism rivalry provides a possible explanation for the previously reported empirical result that both crowding out and income effects on indigent care supply are often weak or insignificant empirical analysis of data for hospitals in maryland provides evidence of rivalry on the supply of charity care

the political economy of higher education admission standards and participation gap we build a political economy model allowing us to shed light on the empirically observed simultaneous increase in university size and participation gap parents differ in income and in the ability of their unique child they vote over the minimum ability level required to attend public universities which are tuition free and financed by proportional income taxation parents can invest in private tutoring to help their child pass the admission test a university participation gap emerges endogenously with richer parents investing more in tutoring a unique majority voting equilibrium exists which can be either classical or ends against the middle in which case parents of both low and high ability children favor a smaller university four factors increase the university size larger skill premium enjoyed by university graduates smaller tutoring costs smaller university cost per student larger minimum ability of students but only the former two also increase the participation gap a more unequal parental income distribution also increases the participation gap but barely affects the university size

hospital ownership and performance this study compares the performance of three ownership forms of hospitals for profit private nonprofit and public further classified according to whether or not the hospital is run by a hospital chain data come from a 1979 national survey of u s hospitals the authors find that hospital cost is quite similar among alternative ownership forms as is profitability the results do not provide much empirical support for standard property rights theory several reasons are suggested why this may be so

incentives and careers in academia theory and empirical analysis we study career concerns in italian academia we mould our empirical analysis on the standard model of contests formalised in the multi unit all pay auction the number of posts the number of app

hospital costs and competition for services a multiproduct analysis the authors estimate the effects of market structure on hospital costs using a translog multiproduct cost function recognizing the multiplicity of services provided by hospitals the results show that costs are substantially determined by service configuration and that there are distinct economies of size and sco pe the model also distinguishes market concentration measures by servic e type including obstetrics radiation therapy diagnostic imaging a nd surgery estimates show that after controlling for the other determinants of cost the degree of competition has only modest cost increasing effects copyright 1992 by mit press

measuring hospital performance a non parametric approach abstract in this paper a technique for assessing the relative performance of firms is introduced and applied to a sample of hospitals in california hospitals are compared on the basis of their relative technical efficiency the reference technology is constructed from observed outputs and inputs including physicians using programming techniques and efficiency is assessed relative to the frontier of the technology using measures similar to those suggested by farrell the technique used here imposes no prespecified functional form allows for multiple outputs and inputs allowing for differences in case mix and yields information on the productive performance of individual hospitals this technique can also be used to determine whether different types of hospitals use different technologies our results although illustrative rather than definitive suggest that ownership affects efficiency as measured here public and nfp hospitals have different best practice frontiers and public hospitals appear to use relatively fewer resources these results could reflect differences in quality of care by ownership

efficiency analysis for exogenously fixed inputs and outputs we evaluate by means of mathematical programming formulations the relative technical and scale efficiencies of decision making units dmus when some of the inputs or outputs are exogenously fixed and beyond the discretionary control of dmu managers this approach further develops the work on efficiency evaluation and on estimation of efficient production frontiers known as data envelopment analysis dea we also employ the model to provide efficient input and output targets for dmu managers in a way that specifically accounts for the fixed nature of some of the inputs or outputs we illustrate the approach using real data for a network of fast food restaurants

is ecommerce boundary less effects of individualism collectivism and uncertainty avoidance on internet shopping from publicly available data we identified two national culture dimensions individualism collectivism and uncertainty avoidance and their interaction that influences internet shopping rates across a wide spectrum of countries together these factors accounted for 14 of the explained variance on top of the combined variance of 63 explained by national income level educational level economic growth rate unemployment rate and crime rate in predicting internet shopping rates for countries lower in uncertainty avoidance individualist cultures show higher internet shopping rates than do collectivist cultures implications for national and internet firm level web design strategies are discussed

consumer information and competition between nonprofit and for profit nursing homes this paper develops implications of arrow s hypothesis that nonprofit organizations are prevalent in health care because of quality uncertainty the model analyzes the ability of nonprofits to mitigate market failures created by asymmetric information in an environment characterized by potential competition from both explicitly for profit firms and for profits in disguise profit motivated firms who obtain nonprofit status in order to exploit the perceived trustworthiness of the nonprofit sector under certain conditions it is shown that nonprofit status can serve as a credible signal of quality and that nonprofits can decrease the underprovision of quality both by providing high quality services and indirectly via a spillover effect on quality in the for profit sector applicability to long term care and implications for empirical research and policy towards nonprofits in health care are discussed

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

measuring efficiency in education an analysis of different approaches for incorporating non discretionary inputs measuring efficiency in the education sector is a highly complex task one of the reasons is that the main resource of schools the type of students they have lie outside of their control which means that it must be treated differently to other factors in analysis this study examines the different options available in the literature for incorporating non controllable inputs in a data envelopment analysis in order to determine the most appropriate model for evaluating schools our empirical study presents the results obtained using the model proposed by fried et al 1999 though we use bootstrap techniques to avoid problems of bias in the estimations

hospital profits the effects of reimbursement policies this paper provides a theoretical and empirical analysis of the effect of cost based reimbursement cbr on hospital costs and charges it takes issue with previous analyses which have treated cbr as paying economic costs plus a mark up and have concluded that the mark up is too small to significantly distort hospital decision making the basic thesis here is that if reimbursement is based on costs accounting costs become a price to cost paying patients and will be optimized to maximize revenue a hospital serving both cost and charge paying private patients can set two price schedules accounting profits ratio of charges to costs are not a measure of economic profit but of relative prices to these two groups of patients in the absence of constraints from regulation or patient co payment the optimum level of accounting costs would be infinite in practice the medicare reimbursement formula links allowable costs to charges received from charge paying patients this formula creates incentives for the hospital to raise charges above the single price profit maximizing monopoly level this inflationary effect of the medicare formula does not presuppose that medicare pays less than full cost the empirical analysis of hospital laboratory costs and charges generally supports the predictions for other departments the conclusions are consistent but more tentative because of data limitations overall evidence suggests minimal cross subsidy between cost and charge paying patients comparisons of cost and charge levels in for profit voluntary non profit and government hospitals are presented but it is emphasized that inferences about relative efficiency and profitability cannot be drawn from accounting data given the incentives created by cbr

international entrepreneurship in internet enabled markets abstract despite the increasing numbers of businesses that are already using the internet to pursue international opportunities and the latent potential for such activity from rising internet adoption levels the international entrepreneurship literature has paid limited attention to the phenomenon to address this gap we review past research in international entrepreneurship as well as the broader fields of entrepreneurship international business marketing management and management information systems to identify firm level resources that are associated with the successful pursuit of international opportunities in internet enabled markets we identify three such internet related firm level resources online reputation online technological capabilities and online brand communities we develop a propositional inventory of the expected relationships identify measures expected to be useful to future scholars in this area and present the implications of our review for future international entrepreneurship research

an evaluation of medicaid selective contracting in california this study used 1982 1986 data on 262 private community hospitals to evaluate the effects of selective contracting for inpatient services by california s medicaid program selective contracting by medicaid significantly reduced the rate of inflation in average costs per admission and per patient day while slightly increasing average lengths of patient stays private sector contracting also reduced cost inflation rates significantly and caused small non significant reductions in lengths of stays hospital savings in 1986 due to medicaid selective contracting were 836 million 7 6 of what hospital expenditures would have been in the absence of contracting

the cost structure of american research universities 1597 this study estimates translog variable cost functions for 147 american doctorate granting universities accounting for three major products of these institutions undergraduate and graduate instruction and research explicit measures of research output and quality are employed evidence is found for considerable economies of scale for the average institution as well as economies of scope related to the joint production of undergraduate and graduate instruction the public or private ownership of an institution is not significant for the explanation of variable costs the intensity of state regulation in the public sector does not have a significant impact on production efficiency copyright 1991 by mit press

enter at your own risk hmo participation and enrollment in the medicare risk market we examine hmo participation and enrollment in the medicare risk market for the years 1990 to 1995 we develop a profit maximization model of hmo behavior which explicitly considers potential linkages between an hmo s production decision in the commercial enrollee market and its participation and production decisions in the medicare risk market our results suggest that the payment rate is a primary determinant of hmo participation while the price of a supplemental medicare insurance policy positively affects hmo medicare enrollment we also find empirical support for the existence of complementarities in the joint production of an hmo s commercial and medicare products

optimal prices and costs for hospitals with excess bed capacity this paper analyses theoretically and empirically issues in optimal pricing with excess hospital capacity and then applies the analysis to the issue as to whether medicare and medicaid payments cover the marginal costs of treating patients of each type the primary innovation of this paper lies in incorporating appropriate theoretical measures of hospital excess capacity to a multiproduct empirical hospital cost function and in showing how proper measures of marginal cost can be applied to the examples of medicare and medicaid reimbursement in california with a standard translog specification that ignores hospital excess capacity the estimated marginal costs of medicare and medicaid patients are higher than the reimbursement however correctly incorporating excess capacity into our model leads to considerably lower estimates of short run marginal costs suggesting that medicare hospital reimbursement is more than adequate in the short run we also develop a third marginal cost concept that of what l

institutions of higher education as multi product firms economies of scale and scope a multiple output cost function is estimated for institutions of higher education in the united states employing data for 1981 82 the authors flexible fixed cost quadratic function includes three outputs undergraduate teaching graduate teaching and research grants and one input price average faculty salaries results indicate the existence of scope economies at least up to a point for both public and private institutions of higher education ray economies of scale are more pronounced in the private sector and product specific economies of scale are observed only in the public sector for research and graduate teaching copyright 1989 by mit press

the impact of hospital market structure on patient volume average length of stay and the cost of care a variety of recent proposals rely heavily on market forces as a means of controlling hospital cost inflation sceptics argue however that increased competition might lead to cost increasing acquisitions of specialized clinical services and other forms of non price competition as means of attracting physicians and patients using data from hospitals in 1972 we analyzed the impact of market structure on average hospital costs measured in terms of both cost per patient and cost per patient day under the retrospective reimbursement system in place at the time hospitals in more competitive environments exhibited significantly higher costs of production than did those in less competitive environments

is dumping socially inefficient abstract this paper investigates an efficiency implication of medicare s prospective payment system pps on the utilization of united states veterans affairs va hospital inpatient services by elderly veterans there is empirical evidence to suggest that non va hospitals are reacting to pps by increasingly shifting veterans they expect may be high cost to va hospitals we define as efficient allocations that would occur if hospitals acted as perfect agents of the patient then we show that some shifting would still occur if allocations were efficient this is because va and non va hospitals operate under different budget regimes and within each diagnosis related group veterans with different levels of illness severity and different non va insurance packages will self select into va and non va hospitals we derive conditions of severity under which different hospital types become attractive to particular patients

regulating a monopolist with unknown costs we consider the problem of how to regulate a monopolistic firm whose costs are unknown to the regulator the regulator s objective is to maximize a linear social welfare function of the consumers surplus and the firm s profit in the optimal regulatory policy prices and subsidies are designed as functions of the firm s cost report so that expected social welfare is maximized subject to the constraints that the firm has nonnegative profit and has no incentive to misrepresent its costs we explicitly derive the optimal policy and analyze its properties in their classic papers dupuit 2 and hotelling 5 considered pricing policies for a bridge that had a fixed cost of construction and zero marginal cost they demonstrated that the pricing policy that maximizes consumer well being is to set price equal to marginal cost and to provide a subsidy to the supplier equal to the fixed cost so that a firm would be willing to provide the bridge this first best solution is based on a number of informational assumptions first the demand function is assumed to be known to both the regulator and to the firm while the assumption of complete information may be too strong the assumption that information about demand is as available to the regulator as it is to the firm does not seem unnatural a second informational assumption is that the regulator has complete information about the cost of the firm or at least has the same information about cost as does the firm this assumption is unlikely to be met in reality since the firm would be expected to have better information about costs than would the regulator as weitzman has stated an essential feature of the regulatory environment i am trying to describe is uncertainty about the exact specification of each firm s cost function in most cases even the managers and engineers most closely associated with production will be unable to precisely specify beforehand the cheapest way to generate various hypothetical output levels because they are yet removed from the production process the regulators are likely to be vaguer still about a firm s cost function 12 p 684 as this observation suggests it is natural to expect that a firm would have better information regarding its costs than would a regulator the purpose of this paper is to develop an optimal regulatory policy for the case in which the regulator does not know the costs of the firm one strategy that a regulator could use in the absence of full information about costs is to give the firm the title to the total social surplus and to delegate the pricing decision to the firm in pursuing its own interests which would then be to maximize the total social surplus the firm would adopt the same marginal cost pricing strategy that the regulator would have imposed if the regulator had

nonprofit hospital mergers and the exercise of market power government challenges to mergers within the hospital industry have become more frequent many of those mergers involve nonprofit organizations rather than the for profit firms that are the norm in most other industries this difference in ownership has made no apparent difference in the antitrust agencies approach to proposed hospital mergers in this article i test the proposition that nonprofit and for profit hospitals price differently in response to the structure of the markets in which they compete based on a cross sectional analysis of california hospitals i find that estimated merger effects on hospital prices do vary by type of ownership in response to either higher market share or to the joint combination of higher share and higher market concentration private nonprofit hospital prices are statistically significantly lower than for profit hospital prices and on balance in this sample there is no evidence of any systematic price increasing effect on private nonprofit hospitals

hospital competition spillovers and provision of uncompensated care using data for california from 2005 until 2010 we investigate to what extent market competition and the presence of non profits in the area may play a role in equilibrium uncompensated care uc l

is there a competitive market for hospital services this paper focuses on the price elasticity of hospital specific demand curves each hospital is assumed to practice price discrimination with respect to medicare medicaid and other patients among the third group patients covered by blue cross are analyzed separately from those who pay their own bills or are covered by commercial insurance or a health maintenance organization hmo we use two different methods to estimate the price elasticity of demand first a pricing rule is developed from which hospital specific price elasticities may be inferred second the distribution of each payer s admissions at specific hospitals is examined to determine if low priced hospitals attract more patients data for the analysis are taken from 31 hospitals in the minneapolis st paul metropolitan area in 1981 results of the first analytic method indicate that hospitals had monopoly power in their markets for blue cross and self pay commercial insurance hmo patients these results are confirmed and extended to medicare patients by the hospital demand analysis

measuring hospital efficiency with frontier cost functions this paper uses a stochastic frontier multiproduct cost function to derive hospital specific measures of inefficiency the cost function includes direct measures of illness severity output quality and patient outcomes to reduce the likelihood that the inefficiency estimates are capturing unmeasured differences in hospital outputs models are estimated using data from the aha annual survey medicare hospital cost reports and medpar we explicitly test the assumption of output endogeneity and reject it in this application we conclude that inefficiency accounts for 13 6 percent of total hospital costs this estimate is robust with respect to model specification and approaches to pooling data across distinct groups of hospitals

pareto optimal redistribution and private charity abstract when private charity exists and is motivated by utility interdependence a non pareto optimal outcome the free rider problem typically arises nevertheless incremental fiscal redistribution cannot achieve a paretian welfare improvement so long as private charity continues at positive levels donors respond to incremental fiscal redistribution by reducing their voluntary contributions by exactly a dollar for every dollar transferred in this way no net transfer is achieved unless incremental fiscal redistribution is pursued to the point where private contributions have been driven to zero alternatively a net transfer may be achieved by fiscal measures which affect donors marginal incentives to donate

altruism or moral hazard the impact of hospital uncompensated care pools abstract empirical evidence from new jersey supports theories of hospital altruism from 1987 to 1992 new jersey reimbursed hospitals for uncompensated care through the uncompensated care trust fund the trust fund reduced the shadow price of charity care inducing hospitals to increase their provision of uncompensated care hospitals increased inpatient uncompensated care by an average of 14 8 and statewide uncompensated care increased by 360 million during 1987 1990 empirical evidence suggests that the state effectively addressed the moral hazard problem created by the trust fund by auditing uncompensated care and regulating hospital collection procedures

payer type and the returns to bypass surgery evidence from hospital entry behavior in this paper we estimate the returns associated with the provision of coronary artery bypass graft cabg surgery by payer type medicare hmo etc because reliable measures of prices and treatment costs are often unobserved we seek to infer returns from hospital entry behavior we estimate a model of patient flows for cabg patients that provides inputs for an entry model we find that ffs provides a high return throughout the study period medicare which had been generous in the early 1980s now provides a return that is close to zero medicaid appears to reimburse less than average variable costs hmos essentially pay at average variable costs though the return varies inversely with competition

price and concentration in hospital markets the switch from patient driven to payer driven competition perhaps the most widely accepted paradigm of industrial organization i o is that competition lowers prices or alternatively that price cost margins are lower in less concentrated markets 1 the applicability of this paradigm for hospital markets has been questioned for example in united states vs carilion health system and roanoke valley hospital the district and appellate courts accepted evidence that hospital prices are lower in more concentrated markets and thereby approved a merger between the two largest hospitals in a three hospital market 2 the view that competition has a weak or perverse effect on hospital prices is shared by a number of researchers 3 is a common theme in newspaper stories

pricing behavior of non profit agencies the case of blood products abstract in this study we examine the pricing behavior of a non profit agency the american national red cross blood service units two alternative hypotheses are presented one in which the agency maximizes profits and one in which output is maximized subject to a breakeven constraint following a general approach developed by eckstein and fromm pricing equations for separate blood products are applied to cross sectional data from red cross blood centers to determine the impact of demand cost competition and subsidy variables the impact of these variables in particular the impact of the fixed subsidy on price is shown to be consistent with the output maximizing model

hospital efficiency and indigent care 1990 hospital efficiency and indigent care applied economics vol 22 no 11 pp 1597 1610

reimbursing health plans and health providers efficiency in production versus selection the tradeoff between an insurer s or medical provider s incentives to select good risks and to produce efficiently is governed by the supply price analog to the demand price tradeoff between moral hazard and risk aversion under a variety of models the optimum supply price is a mixture of capitation and fee for service payments empirical literature shows that pure capitation payment leaves strong incentives for selection that are acted upon the presence of contracting costs in a rothschild stiglitz model means a limited pooling equilibrium can exist and that poor risks will not be at their preferred outcome

ideals versus dollars donors charity managers and government grants this paper demonstrates how changes in untied lump sum government grants or income from unrestricted endowments will affect the behavior of charities operated by managers with strong philosophical or professional commitments an increase in such funds will reduce the charity s accountability to private donors and lower its fund raising activities the grant will not be spent entirely on raising the quantity of output instead it will permit the charity manager to reduce his or her dependence on the costly solicitation of donors who do not completely share the manager s preferences in order to understand nonprofit charities one must recognize both their diversity and the independent role of their managers in furthering this diversity we will miss much of their special character if we view them as mere conduits seeking faithfully to reify the wishes of their contributors in this paper i demonstrate how an increase or a fall in untied lump sum government grants or income from unrestricted endowments will affect the behavior of charities operated by managers with strong philosophical or professional commitments to some service mixes rather than others an increase in such funds will reduce the charity s accountability to private donors and lower its fund raising activities the grant will not be spent entirely on raising

the changing effects of competition on non profit and for profit hospital pricing behavior abstract has the nature of hospital competition changed from a medical arms race in which hospitals compete for patients by offering their doctors high quality services to a price war for the patients of payors this paper uses time series cross sectional methods on california hospital discharge data from 1986 1994 to show the association of hospital prices with measures of market concentration changed steadily over this period with prices now higher in less competitive areas even for non profit hospitals regression results are used to simulate the price impact of hypothetical hospital mergers

what matters most teaching or research empirical evidence on the remuneration of british academics this paper examines the impact of productivity on pay within academia drawing upon a detailed dataset of academics from five old established universities results outline the importance of publication grant receipt and teaching quality in the determination of pay a large financial penalty to time out of the profession is revealed which with productivity variables explains away the gender salary gap the relationship between teaching and research is investigated and we find some evidence in support of the hypothesis that productive researchers are successful teachers results on reservation salary suggest that the best academics are willing to stay within the profession

profiles of internet buyers in 20 countries evidence for region specific strategies the prospect of an emerging global internet consumer entices many internationalizing organizations as it would enable standardization of internet strategies on a worldwide basis a sample of advanced internet users from 20 countries shows differences in beliefs attitudes perceptions and internet buying behavior depending on user experience and home country or region there were important differences after controlling for social cultural and macro economic variables implications for a regional approach to global e commerce strategies are discussed

assessing school efficiency in portugal using fdh and bootstrapping this study explores a new data set that contains information both on inputs and outputs for a sample of portuguese secondary schools an fdh reference technology is used to determine radial technical efficiency scores and slacks although it is known that there is no reason to assume convexity in the study of education efficiency frontiers this is the first study ever to use fdh at the school level effectively relaxing the convexity assumption a two stage approach is used whereby the significant environmental variables that explain fdh efficiency scores and slacks are identified for the purpose of statistical inference the first application of the bootstrapping algorithms suggested by simar and wilson 2003 is conducted the study concludes that the unemployment rate access to health care services adult education and living infrastructures are determinants of school efficiency the differences between the coast and the interior of portugal seem to be more relevant as far as school efficiency is

the governance and performance of universities evidence from europe and the us we test the hypothesis that universities are more productive when they are both more autonomous and face more competition using survey data we construct indices of university autonomy and competition for both europe and the united states we show that there are strong positive correlations between these indices and multiple measures of university output to obtain causal evidence we investigate exogenous shocks to us universities expenditures over three decades these shocks arise through the political appointment process which we use to generate instrumental variables we find that an exogenous increase in a university s expenditure generates more output measured by either patents or publications if the university is more autonomous and faces more competition exploiting variation over time in the stakes of competitions for us federal research grants we also find that universities generate more output for a given expenditure when research competitions are high stakes we draw lessons arguing that european universities could benefit from a combination of greater autonomy and greater accountability greater accountability might come through increased reliance on competitive grants enhanced competition for students and faculty promoted by reforms that increase mobility and yardstick competitions which often take the form of assessment exercises philippe aghion mathias dewatripont caroline hoxby andreu mas colell and andre sapir

voluntary donations and public expenditures in a federal system proponents of the new federalism argue that nonprofit organizations and local governments will fully offset federal social service expenditure cutbacks the author analyzes this proposition as a competitive game in which donations are motivated by private and public good considerations the author characterizes the response of political economic equilibrium to exogenous changes in federal expenditures when local voters are cognizant of donor reactions partial replacement is the most likely outcome though others are possible copyright 1987 by american economic association

quality and outside capacity in the provision of health services abstract this paper studies the effects of non contractibility of investment on the choices made by a health authority and a hospital which supplies a specific service non contractibility determines inefficiencies compared with any pareto efficient outcome the quality of the service chosen by the hospital is too low and the health authority relies too much on outside providers

using cost observation to regulate firms the paper emphasizes the use of accounting data in regulatory or procurement contracts when the supplier 1 has superior information about the cost of the project and 2 invests in cost reduction the main result states that under risk neutrality the supplier announces an expected cost and is given an incentive contract linear in cost overruns this optimal contract moves toward a fixed price contract as the announced cost decreases an investment choice is then introduced and the use of a rate of return regulation is studied

efficiency of hospitals in germany a dea bootstrap approach various attempts to assess the performance of german hospitals have generated a wide range of estimates regarding their efficiency these attempts were based on different often rather small data sets consisting of heterogeneous hospitals the techniques applied range from simple benchmarking approaches to studies which employ data envelopment analysis dea some studies report dramatic differences in efficiency and propose savings potentials of 50 others find an average efficiency in excess of 95 and characterize almost 75 of their observations as fully efficient this study presents results for two datasets representative of two segments of the german hospital system these segments comprise all hospitals that have one internal medicine and one surgery department the hospitals are located in the old federal states of germany none of the hospitals provides tertiary care dea can be applied because all hospitals offer a comparable quality and range of services the results were estimated with a d

comparing french and us hospital technologies a directional input distance function approach french and us hospital technologies are compared using directional input distance functions the aggregation properties of the directional distance function allow comparison of hospital industry level performance as well as standard firm level performance with regard to productive efficiency in addition the underlying constituents of efficiency in the short run congestion and technical inefficiency and in the long run scale inefficiency are analysed by decomposing the overall measure by virtue of using the directional distance function it is also possible to obtain an estimate of a lower bound on allocative inefficiency it is found that french and us hospitals use quite different technologies long run scale inefficiencies cause most of the french hospitals inefficiency while short run technical inefficiency is the main source of overall productive inefficiency in the us hospitals

does it matter who your buyer is the role of nonprofit mission in the market for corporate control of hospitals abstract the hospital industry is one of this country s largest mixed industries with for profit nonprofit and government hospitals operating in the same local markets but how do ownership types differ previous studies have compared costs among different hospitals however these studies have not been entirely successful because costs cannot be meaningfully compared without controlling for hard to measure quality of service in this study we look to the market for corporate control or takeovers for evidence of ownership related differences we find that nonprofit and for profit firms pay different prices and that these differences relate to the nonprofit s mission specifically nonprofits and for profits pay the same price when buying for profits but nonprofits pay less when buying a like minded nonprofit so religious nonprofits pay less for other religious nonprofits for example the resulting dual price equilibrium suggests that nonprofits have a different objective than do for profits but

efficient tuition fees and examinations we assume that students observe only a private noisy signal of their ability and that universities can condition admission decisions on the results of noisy tests if the university observes a private signal of each student s ability which is soft information then asymmetries of information are two sided and the optimal admission policy involves a mix of pricing and pre entry selection based on the university s private information in contrast if all test results are public knowledge then there is no sorting on the basis of test scores tuition alone does the job of implementing an optimal degree of student self selection these results do not depend on the existence of peer effects the optimal tuition follows a classic marginal social cost pricing rule jel d82 h42 i22 j24

resolving the impasse on hospital scale economics a new approach the existence of scale economies in hospitals in important for both public and managerial policy yet production and cost function studies have found conflicting evidence more recently more sophisticated studies have typically found scale diseconomies which is inconsistent with the views of industry participants and observers in the early 1980s california deregulated both private and public health insurance medical which provides a natural laboratory for examining hospital efficiency using stigler s original and multivariate survivor analysis we resolve the conflict in favour of scale economies and reconcile the controversy the survivorship methodology in simple to apply and a useful tool in conjunction with statistical cost and production studies

strategic integration of hospitals and physicians a striking development in the healthcare market place has been the formation of strategic relationships between hospitals and physicians hospital physician integration appears to be a response to rapidly expanding managed care health insurance we examine whether integration lead to efficiency gains from transaction cost economies thereby allowing providers to offer managed care insurance plans lower prices or whether integration is really a strategy to improve bargaining power and thereby increase prices we find that integration has little effect on efficiency but is associated with an increase in prices especially when the integrated organization is exclusive and occurs in less competitive markets

toward a service oriented growth strategy abstract this article suggests that the linkage between industrial modernization and significant service sector employment gains has not been adequately considered and that such consideration might lead to a re evaluation of the labour absorption argument which calls for more appropriate technologies with higher labour intensity this paper reviews the literature on labour absorption and appropriate technology it then examines the experience of the service sector in both dcs and ldcs the key relationships between the service sector and the economy are then developed leading up to possible implications for ldc growth strategies

behavioural differences among hospitals it is ownership or location by about 1988 the consensus among leading health economists was that no meaningful differences existed among hospitals of differences owernership form and this position was embraced by the antitrust division of the us department of justice but behavioural differences among hospitals of different among hospitals of different owernership has continued to be a matter of both academic and judicial interest recent empirical studies have concluded that real differences do exist while many earlier studies reached the opposite conclusion this contradiction in finding over time as competition intensified is exactly opposite to what expense preference theory would predict we examine this apparent paradox using a very general test of behavioural differences by hospital ownership we find that the omission of location specific variables can lead to biased estimates of ownership effects and that no significant behavioural differences exist among private california hospitals in 1986 90 when this source of o

neoliberalism and income distribution in latin america abstract this paper reviews the principal neoliberal policy measures instituted in latin america in the last decade and their impact on equity it first emphasizes the difficulty of separating the impact of liberalization measure from the necessary fiscal adjustments of the 1980s and their transitional vs longrun effects and then places the observed movements in distribution in global and historical context the second part places several innovations of neoliberal regimes in historical perspective and argues that their overall impact is unlikely to be regressive and that previous regimes were probably not especially progressive over the long run developments in factor markets the demand side driven by reoriented industrial growth and the increasing importance of the service sector interacting with the relative supplies of skilled and unskilled labor are likely to be of overriding importance in determining the evolution of the distribution of income

nonprofit organizations revised theory and new evidence it is apparent that comprehensive analysis requires at least some application of elementary axioms from the economics of politics or public choice one of these implies that because of asymmetric costs of political participation some suppliers of goods and services usually do better for themselves out of lobbying and organization than do others moreover for the same reason dispersed consumers would appear to do worst of all legislation and policy on nonprofit organization seems to be one of many examples of this phenomenon in this case however the supply side lobbyists are aided by an ancient and deep seated popular prejudice against profit making the man in the street has apparently not yet fully grasped the point that so long as competition is possible the profit inducement acts as a continued incentive to minimize costs constantly and indiscriminately to condone pejorative language against profits is to create a climate that results in legislation giving unprecedented new profit opportunities via not for profit organizations and such increased rewards can result in social harm rather than social gain granted there may be cases that justify nonprofits in some circumstances preston 1988 the fact remains that the costs of separating and monitoring these cases at least at federal level would appear to be overwhelming the nonprofit system that is usually advocated calls for a federal general tax exemption yet the value of this advantage is the same to all nonprofit firms whereas we need to know the extent of the particular social benefits generated in each particular case so as to give tailor made government assistance and since in very many instances the social benefits are negative the government s shotgun approach appears highly questionable

a cross country input output analysis of intersectoral relationships between manufacturing and services and their employment implications abstract the paper examines the nature and the evolution of intersectoral relationships between manufacturing and services at different stages of industrialization as revealed by a cross country comparative analysis of input output tables of 26 countries at different income levels this paper suggests among many other findings that the intersectoral relationships between manufacturing and services generally characterize asymmetrical dependence namely service activities tend to depend on the manufacturing sector as a source of inputs to a far greater extent than vice versa moreover the employment absorptive capacity of the manufacturing sector is seriously underestimated when one only measures the direct employment effect of the manufacturing sector and ignores the intersectoral demand of the manufacturing sector for service inputs and its income induced demand for various types of services in effect the capability of the service sector to generate and sustain a high level of employment critically hinges upon its vital linkages with the manufacturing sector

market share and the illusion of power can blue cross force hospitals to discount researchers in health care financing have claimed that large private insurers like blue cross frequently exercise monopsony power to obtain discounts from normal hospital charges they claim that the monopsony power derives from a large blue cross share of a given hospital cost shifting whereby hospitals offset the discount by raising charges to less powerful customers this paper re examines both theoretically and empirically the conditions necessary for a private insurer to extract discounts from a hospital we demonstrate that the theoretical conditions necessary for blue cross to force a discount do not exist in the indiana market using revenue data from 110 indiana hospitals we reject the traditional claim that blue cross pays less than other insurers as a function of market share

the effects of market structure and bargaining position on hospital prices ppos and hmos have gained widespread acceptance due in part to the belief that excess capacity and competitive market conditions can be leveraged to negotiate lower prices with health care providers we investigated prices obtained in different types of markets by the largest ppo in california our findings indicate that greater hospital competition leads to lower prices furthermore as the importance of a hospital to the ppo in an area increases the price rises substantially our testing of alternative methods for defining hospital geographic markets reveals that the common practice of using counties to define the market leads to an underestimate of the price increasing effects of a merger

profit variability in for profit and not for profit hospitals this paper proposes two tests of the hypothesis that not for profit hospitals nfps behave differently than for profit hospitals the profit variability test states that the profits of an nfp will be less variable over time than profits of a for profit hospital if the nfp maximizes utility subject to a profit constraint the second test examines whether nfp profits respond less to change in exogenous factors such as medicare reimbursement rates than profits of for profit hospitals both tests performed on panel data from 1983 to 1988 support the hypothesis that nfps behave differently than for profit hospitals

academic admissions standards implications for output distribution and mobility we examine the trade offs implicit in academic admissions standards when students are charged cost based tuition and offered loans that remove liquidity constraints lowering entry requirements while holding graduation requirements fixed increases aggregate output and promotes a more equal distribution of wages but reduces relative income mobility and diminishes the scope for affirmative action lowering admissions standards while raising graduation requirements so that the number of graduates remains constant has little direct effect on output distribution or mobility but again reduces the scope for affirmative action income based affirmative action offers a better trade off between output and relative mobility than income neutral admissions jel d31 h42 i23 i28 j24

frontier estimation how useful a tool for health economics the journal is pleased to publish in this issue three papers that apply frontier estimation techniques to hospitals and nursing homes together with an exchange over the usefulness of those techniques in the health care context the papers represent the current state of the art with respect to applications of frontier estimation in health care because of the growing popularity of the technique no doubt in part from its availability in standard software packages it seems useful to take this opportunity to appraise its usefulness one might begin by asking usefulness for what assuming one could define a frontier with certainty how would one use such knowledge a straightforward application in health care appears to be to reimbursement because both data envelopment analysis dea and stochastic frontier estimation specify the least cost mix of inputs for a given output both methods can in principle be used to determine whether a given firm hospital or nursing home is efficient and if the answer to that question is no the magnitude of any inefficiency it is not a large step from that information to the notion that a regulator should reduce the firm s budget by the amount of the measured inefficiency indeed vitaliano and toren mention the boren amendment s requirement that the medicaid program reimburse hospitals and nursing homes at the cost incurred by an efficiently operated

an international comparison of hospital efficiency does institutional environment matter the consensus among many health economists is that no meaningful performance differences exist among for profit and non profit hospitals in the us but this topic has continued to be a matter of academic judicial and public policy interest a similar debate has ensued internationally regarding the potential efficiency gains from privatization of public enterprises in this paper we examine empirical evidence from the public highly regulated norwegian hospital sector and the private highly competitive and unregulated california hospital sector to ascertain whether institutional environment and level of market competition significantly affect the degree of productive efficiency in hospitals we compare and discuss the productive efficiency of four similar sets of hospitals operating in different institutional and competitive environments the four samples are carefully matched in the dimensions of sample size hospital size and average lengths of stay heterogeneity in output definition is used to co

the specification of a hospital cost function a comment on the recent literature in the empirical estimation of hospital cost functions two radically different types of specifications have been chosen to date ad hoc forms and flexible functional forms based on neoclassical production theory this paper discusses the respective strengths and weaknesses of both approaches and emphasizes the apparently unreconcilable conflict between the goals of maintaining functional flexibility and keeping the number of variables manageable if at the same time patient heterogeneity is to be adequately reflected in the case mix variables a new specification is proposed which strikes a compromise between these goals and the underlying assumptions are discussed critically

hospital mergers who merges with whom merger pairings are categorized based on the ownership status teaching status hospital size caseload severity and geographical distance of merging hospitals to determine the types of hospitals that tend to merge with each other the results show that mergers between two non teaching nonprofit or for profit hospitals occur more often but that only ownership status not teaching status affects the propensity to merge after controlling for other merger pair characteristics this paper also finds that hospitals are more likely to merge with a partner of similar size and close geographical proximity but not necessarily the closest candidate however ownership status not distance between hospitals is the dominant determinant of merger pairs

sensitivity analysis for dea models an empirical example using public vs nfp hospitals abstract the research presented here applies the data envelopment analysis dea to a sample of public government owned and not for profit hospitals operating in michigan in 1982 the focus of this research is twofold first assessing the relative efficiency between these two ownership types using the dea rather than cost or profit functions can add insights into the production practices of these two ownership forms of hospitals second testing the sensitivity of the dea will add credence to this approach and resulting measures ten different specifications of the dea are employed to test the sensitivity of the model

the social role of not for profit organizations hospital provision of charity care during the 1980s the state of new york shifted from a straight block grant to a matching grant method for reimbursing hospitals with the matching rate varying from 0 to 75 percent across years these changes allow estimation of pure income and price effects for hospitals supply of uncompensated care charity and bad debts the price efrect is positive and significant but no income effect was found hospitals in more concentrated markets provide more charity care as do teaching hospitals and the presence of public hospitals in a market reduces private hospitals provision of charity care

the effects of for profit status and system membership on the financial performance of hospitals this research examines whether for profit status or system membership is significantly related to the financial performance of hospitals panel data containing 573 observations of florida hospitals for 1984 through 1987 are used in a fixed effects regression model the results indicate that it is system membership rather than forprofit status that is significantly related to better financial performance for profit status is unrelated to overall financial performance system hospitals have higher revenues per admission but not higher expenditures per admission than independent hospitals the findings are consistent with the hypothesis that expanding hospital systems target locations and services that are potentially profitable

admission tuition and financial aid policies in the market for higher education we present an equilibrium model of the market for higher education our model simultaneously predicts student selection into institutions of higher education financial aid educational expenditures and educational outcomes we show that the model gives rise to a strict hierarchy of colleges that differ by the educational quality provided to the students we also develop a new estimation procedure that exploits the observed variation in prices within colleges identification is based on variation in endowments and technology it does not rely on observed variation in potentially endogenous characteristics of colleges such as peer quality measures and expenditures we estimate the structural parameters using data collected by the national center for education statistics and aggregate data from peterson s and the national science foundation

participation and study decisions in a public system of higher education we analyze the decision whether to participate and where and what to study in a public system of higher education based on a unique dataset of all eligible high school pupils in an essentially closed region flanders we find that pupils perceive the available institutions and programs as close substitutes relative to the outside option this implies an ambiguous role for travel costs they hardly affect the participation decision but have a strong impact on the decision where and what to study to illustrate how our empirical results can inform the debate on reforming public systems we assess the effects of tuition fee increases uniform cost based tuition fee increases achieve most of the welfare gains the additional gains from fee differentiation are relatively limited these welfare gains are quite large under conservative assumptions on the social cost of public funds and there is a substantial redistribution from students to outsiders copyright 2009 john wiley sons ltd

the effect of competitive pressure on charity hospital responses to price shopping in california abstract since higher charges to private patients are a major source of financing for hospital care to the uninsured increased price shopping by private payers may mean that hospitals are less able to provide such care i study the effect of increased price shopping on california hospital markets over the 1984 1988 period i find that there was a large fall in net private revenues and net income in the least concentrated hospital markets in the state after the advent of price shopping perhaps as a result care to the uninsured fell dramatically in these markets as well relative to more concentrated markets

voluntary and proprietary hospital behavioural response to socio economic stimuli this paper contributes to the literature on the economic aspects of hospital behaviour in the united states in these substantive ways 1 a theoretical basis for incorporating socio economic variables in the form of indices into our analysis of hospital behaviour is presented 2 it is found that hospitals of the same ownership type exhibit different economic behaviour when located in different socio economic environments in fact our results indicate that the prevailing assumption of structural homogeneity among differing ownership types is incorrect 3 findings further suggest that the relative affluence of an urban area is a better determinant of the impact of factor price variation among hospitals than the extent of urbanization alone finally the cost function specified here has broad implications for future empirical studies of hospital behaviour it is found that the flexible form quadratic approximation estimated generally gives theoretically consistent results