asset transformation and the challenges to servitize a utility business model abstract the traditional energy utility business model is under pressure and energy services are expected to play an important role for the energy transition experts and scholars argue that utilities need to innovate their business models and transform from commodity suppliers to service providers the transition from a product oriented capital intensive business model based on tangible assets towards a service oriented expense intensive business model based on intangible assets may present great managerial and organizational challenges little research exists about such transitions for capital intensive commodity providers and particularly energy utilities where the challenges to servitize are expected to be greatest this qualitative paper explores the barriers to servitization within selected swiss and german utility companies through a series of interviews with utility managers one of them is asset transformation the shift from tangible to intangible assets as major input factor for the value proposition which is proposed as a driver for the complexity of business model transitions managers need to carefully manage those challenges and find ways to operate both new service and established utility business models aside policy makers can support the transition of utilities through more favorable regulatory frameworks for energy services and by supporting the exchange of knowledge in the industry

aversion to health inequalities and priority setting in health care traditionally aversion to health inequality is modelled through a concave utility function over health outcomes bleichrodt et al bleichrodt h diecidue e quiggin j 2004 equity weights in the allocation of health care the rank dependent qaly model journal of health economics 23 157 171 have suggested a dual approach based on the introduction of explicit equity weights the purpose of this paper is to analyze how priorities in health care are determined in the framework of these two models it turns out that policy implications are highly sensitive to the choice of the model that will represent aversion to health inequality

public private partnerships for energy efficiency projects a win win model to choose the energy performance contracting structure abstract to stimulate private sector investments and promote energy efficiency in recent years through public private partnership arrangements the public sector uses private companies the energy service company esco to perform one or more activities related to the provision of energy services and the contractual arrangements defining the contracting parties obligations and rights are traditionally based on energy performance contracting epc although epc is a valuable model for delivering public energy efficiency projects the adoption is still far from its vast potential mainly because of two unresolved issues the dilemma of equally sharing the benefits between the public and private parties so as assuring a win win condition and the lack of adequate public procedures that support the selection of the most appropriate epc schema given certain circumstances and projects characteristics the existing literature have analyzed the advantages of epc mechanism for delivering energy efficiency projects and explored the critical success factors of epc however it does not provide any solution to address the issues that hamper the adoption of epcs in public sector to fill this gap this paper proposes a model for assessing and benchmarking the net benefits of the different epc structures so as choosing the epc schema that creates a win win solution for both the esco and the government by balancing the private sector s profitability needs and the public sector s economic interests the assessment of the benefits of the epc schema for contractual parties and the benchmark among the contracts are based on an economic approach which expresses the net benefit gained by each party through the three epc contracts in monetary terms and benchmarks the three epc schema through the net present value npv method the win win condition is ensured by the contract that minimizes the difference between the net profits npv gained by the contractual parties this will support the public authority in the decision making process about the epc structure to be adopted to develop an energy efficiency project as a ppp to demonstrate the applicability of the proposed model we apply it to an energy efficiency project launched by the municipality of noci southern italy

pressure and the division of a public budget this paper considers the division of a public budget among competing interests the planner determines the optimal allocation by maximizing a weighted social welfare function these weights reflect society s attitudes to different recipient groups and are not constrained to be constant by exerting pressure the recipients can attempt to manipulate the weights and hence influence the division of the budget the amount of resources used on pressure and the effects on the preference weights are calculated an important parameter in the model is the elasticity of pressure for which an appropriate estimate is presented from the case of competition for a share of a health services budget in norway

a note on the estimation of the equity efficiency trade off for qalys abstract in this note the veil of ignorance approach is tested as a basis for empirically determining the shape of the social welfare function for qalys an experiment is carried out where the participants choose between different societies that differ with respect to per capita qalys and the distribution of qalys the answers are analyzed using logistic regression analysis according to the results the respondents are willing to give up 1 qaly in the group with more qalys to gain 0 45 qalys in the group with fewer qalys but this trade off is independent of the size of the difference in qalys between the groups

theories of justice and their implications for priority setting in health care abstract the paper aims to show how three theories of distributive justice utilitarianism egalitarianism and maximin can provide a clearer understanding of the normative basis of different priority setting regimes in the health service the paper starts with a brief presentation of the theories followed by their prescriptions for distribution as illustrated with their respective preferred points on a utility possibility frontier after this general discussion attention is shifted from utils to health the paper discusses how the recent norwegian guidelines for priority setting can be understood in the light of the theories

wages and employment in a segmented labor market this paper analyzes the impact of business cycle fluctuations on a labor market segmented into a unionized primary sector and a competitive secondary sector either permanent or temporary changes in real aggregate demand are shown to widen the intersectoral wage differential in recession and under reasonable specifications of key parameters to cause greater fluctuations of primary sector employment than secondary sector employment this pattern agrees with the stylized facts of the u s economy

on the intergenerational allocation of natural resources it is known hartwick and others that under standard assumptions a society that invests in reproducible capital the competitive rents on its current extraction of exhaustible resources will enjoy a consumption stream constant in time it is shown here that this result can be interpreted as saying that an appropriately defined stock of capital including the initial endowment of resources is being maintained intact and that consumption can be interpreted as the interest on that patrimony this seems like a useful rule of thumb for policy

implications of spillover effects within the family for medical cost effectiveness analysis medical cost effectiveness analyses traditionally treat patients as isolated individuals and neglect the effects of improvement in patients health on the welfare of their family members we use a model based on a family utility function with altruistic linkages to show that there can be direct and indirect effects on the welfare of all family members we focus specially on a model of how the spillover effects to the spouse in a two person family might affect choice of treatments for prostate cancer we then test the predictions of this model by analyzing treatment choices of prostate cancer patients using the linked seer medicare database we find that our results are consistent with the model s predictions we conclude that cost effectiveness analyses may better reflect the full costs and benefits of medical interventions if they incorporate these family effects however concerns about equity present a dilemma for the practice of cea from the societal perspective

bibliography of robert m solow s publications 1950 1987 1952 6 an econometric model of interindustry flows with k j arrow and r shephard abstract econometrica july 1952 7 on the structure of linear models econometrica january 1952 8 review of w e deming some theory of sampling review of econometrics and statistics may 1952 9 review of r dorfman application of linear programming to the theory of the firm journal of american statistical association june 1952 10 review of t c koopmans ed activity analysis of production and allocation journal of american statistical association june 1952 11 review of r roy ed cahiers dii seminaire deconometrie no 1 journal of american statisticalassociation december 1952

optimal medical treatment under asymmetric information a model is developed of patient doctor interaction under asymmetric information it examines how both the probability of consulting and initial health status are semi endogenously determined by a potential patient determining a threshold health level below which he demands a consultation it is shown that the demand elasticity with respect to socio economic variables is lower the more severe the illness the paper also offers a model of the supply side a distinction is established between uncertainty and asymmetric information between the patient and the doctor after deriving the conditions for an equilibrium of the patient doctor interaction payment systems for achieving medical adequacy and pareto efficiency are analysed

inequality aversion health inequalities and health achievement this paper addresses two issues the first is how health inequalities can be measured in such a way as to take into account policymakers attitudes towards inequality the gini coefficient and the related concentration index embody one particular set of value judgements by generalising these indices alternative sets of value judgements can be reflected the other issue addressed is how information on health inequality can be used together with information on the mean of the relevant distribution to obtain an overall measure of health achievement

municipal scale scenario analysis of an italian seaside town with markal times this work presents three 25 year energy scenarios developed with the times model generator for pesaro a seaside municipality in central italy it evaluates the effectiveness of local scale energy policies in three sectors households transport and the public sector ps since the local energy demand is affected by summer tourism seasonal consumption by holiday homes was also studied three scenarios were hypothesized business as usual bau exemplary public sector eps and exemplary municipality em the eps scenario models the exemplary role that recent european directives attribute to the ps in setting energy efficiency and technology penetration targets for itself the em scenario extends these targets to the household sector in particular the study underscores the potential of micro cogeneration technologies in achieving local environmental targets even though their diffusion would involve an increase in local energy consumption due to internalization of the primary energy used to produce electricity which would no longer be wholly imported from outside municipal boundaries the study provides information to local decision makers by estimating the cost of implementing a number of energy policies finally the study discusses the adequacy of times as a tool to analyse municipal scale scenarios

a local independence condition for characterization of walrasian allocations rule abstract the purpose of this paper is to characterize walrasian resource allocations in terms of social choice axioms we prove that the walras rule is the only social choice rule satisfying individual rationality pareto principle non discrimination and local independence in the last part of this paper we discuss the relation between our result and nash implementation we introduce a new condition called nash implementation with strong star shapedness around nash equilibria and show that it is equivalent to the local independence

catalysing the energy service market the role of intermediaries the uk market for energy service contracts is expanding owing in part to the emergence of intermediaries for those contracts in different parts of the public sector these intermediaries combine a legal framework for establishing contracts with an organisational framework that facilitates contract negotiation and execution this paper examines the nature and operation of these intermediaries in more detail including their achievements to date and their similarities and differences it uses ideas from transaction cost economics to develop a theoretical model of the contracting decision and shows how intermediary organisations can lower the transaction costs incurred by both clients and contractors thereby increasing the viability of contracting the paper argues that intermediaries can play an important role in expanding the market for energy service contracts and hence in delivering cost effective energy efficiency improvements throughout the public sector

scaling up the energy service company business market status and company feedback in the russian federation abstract many energy efficiency professionals have proposed using energy performance contracts epcs as a mechanism to improve public sector energy efficiency in countries with restrictive government budgets however in practice most middle income countries have used this mechanism only in a limited way russia offers an interesting case study because of its huge energy savings opportunities increasing energy prices robust political backing for public sector energy efficiency and evolving legislation that supports epcs in 2009 the russian federation initiated reductions in the country s energy intensity including of the large public sector which accounts for 9 percent of russia s total energy consumption to achieve energy efficiency goals in the public sector russia experimented with its public procurement rules adjusting them to encourage epcs we reviewed the russian government s official public database conducted structured interviews with energy service companies escos in russia and supplemented them with online research even though this process might not have captured all of the epcs signed in russia as of mid 2013 we estimate that nearly 50 escos signed about 150 contracts in public facilities most esco contracts in russia are for 5 years and they generally are small under 100 000 escos in russia face a challenging environment which leads to smaller projects escos also are concerned about costly and risky tender procedures uncertainty regarding repayment from public facilities the inability to expand projects and financing we discuss these challenges and propose potential solutions at policy and company levels the escos feedback regarding russia s experimental model can inform the country s program for public sector energy efficiency and offer lessons for other countries attempting to develop the epc mechanism

a snapshot of the european energy service market in 2010 and policy recommendations to foster a further market development abstract as of 2010 the energy service market in europe is still far from utilising its full potential wide scale peer reviewed studies investigating the development and up to date status of the european esco market are scarce this article presents a comprehensive insight of the european esco industry based on the results from a large scale survey carried out 2009 2010 in 39 european countries the observed market development during the period 2007 2010 trends in business practices and factors influencing the esco industry evolution are described finally having considered the remaining barriers and the supporting factors as well as the successful experiences in europe policy measures that could further promote esco activities are proposed

priority setting in health care and higher order degree change in risk this paper examines how priority setting in health care expenditures is influenced by the presence of uncertainty about the severity of the illness and the effectiveness of medical treatment we provide necessary and sufficient conditions on social preferences under which a social planner will allocate more health care resources to populations at higher risk changes in risk are defined by the concept of stochastic dominance up to order n the shape of the social utility function and an equity weighting function are used to model the inequality aversion of the social planner we show that for higher order risk changes the usual conditions on preferences such as prudence or relative risk aversion are not necessarily required to prioritise health care when there are different levels of uncertainty associated with otherwise similar patient groups

cost effectiveness utility analyses do current decision rules lead us to where we want to be despite the growing literature on economic evaluation of health care programmes little attention has been paid to the theoretical foundations of cost effectiveness and cost utility analyses and the validity of the decision rules adopted as methods of achieving the stated goals we show that although applications of the techniques can be used to pursue some managerial objectives in the context of highly constrained environments such applications are inconsistent with both welfare economic objectives and the interpretations of the findings of these applications alternative strategies are identified as potential and practical methods for pursuing welfare economic objectives

equity in health the importance of different health streams this paper develops a conceptual framework in which preferences about the distribution of future health gains depend on differences in four health streams these are as follows 1 the amount of health to be gained 2 the no treatment profiles 3 the amount of health experienced thus far and 4 the amount of health gained previously as a result of public health interventions this classification puts the well established concerns for severity stream 2 and age weights stream 3 into a more complete analytical framework stream 4 has not been discussed to date and the paper suggests some moral arguments about the distributive relevance of this stream of health

insiders and outsiders in wage determination a firm starts with a group of insiders or seasoned workers there is also a large pool of outsiders who are initially less productive but are transformed into insiders after one period of employment the firm gains from having a large pool of insiders some of whom may be laid off in bad years insiders gain from keeping their numbers small if the insiders set their wage unilaterally they will choose a path that in this extreme case prevents employment of outsiders even if future employment prospects are good if the wage path is set by bilateral bargaining the extra advantage to the firm permits employment of some outsiders in some situations

nash solution and uncertain disagreement points abstract we analyze bargaining problems with known feasible sets but uncertain disagreement points we investigate the existence of solutions such that under reasonably restricted circumstances all agents be as well off by reaching an agreement today as they would be by waiting until the uncertainty is resolved we use this requirement together with a few other commonly used conditions to characterize the nash solution

priority setting in health care an axiomatic bargaining approach abstract this paper examines how axiomatic bargaining theory can be used to analyze different rules for dividing the health care budget between two patients this approach allows an explicit statement of the assumptions underlying the division rules and also provides a general characterization of the consequences of using these rules when the opportunity set or number of patients changes jel 118

on the efficiency fairness trade off this paper deals with a basic issue how does one approach the problem of designing the right objective for a given resource allocation problem the notion of what is right can be fairly nebulous we consider two issues that we see as key efficiency and fairness we approach the problem of designing objectives that account for the natural tension between efficiency and fairness in the context of a framework that captures a number of resource allocation problems of interest to managers more precisely we consider a rich family of objectives that have been well studied in the literature for their fairness properties we deal with the problem of selecting the appropriate objective from this family we characterize the trade off achieved between efficiency and fairness as one selects different objectives and develop several concrete managerial prescriptions for the selection problem based on this trade off finally we demonstrate the value of our framework in a case study that considers air traffic management this paper was accepted by yossi aviv operations management

a note on eliciting distributive preferences for health while in theory the strength of preferences for equity in health can be expressed in an inequality aversion parameter in practice analysts would have to obtain them from people s choices we are faced with a number of methodological problems when turning to this type of empirical research this note investigates which types of preference could explain the choices people make when responding to equity efficiency questions of this kind respondents may be heavily influenced by concerns that are not related to their equity preferences something which may lead them to choose distributions that are not consistent with models on the equity efficiency trade off specifically a threshold effect is identified which could explain why some people would rather prefer to concentrate than to diffuse health gains the second aim of this note is to offer some lessons from a survey which was designed for eliciting people s distributive preferences for health gains

aversion to health inequalities in healthcare prioritisation a multicriteria optimisation perspective abstract in this paper we discuss the prioritisation of healthcare projects where there is a concern about health inequalities but the decision maker is reluctant to make explicit quantitative value judgements and the data systems only allow the measurement of health at an aggregate level our analysis begins with a standard welfare economic model of healthcare resource allocation we show how under the assumption that the healthcare projects under consideration have a small impact on individual health the problem can be reformulated as one of finding a particular subset of the class of efficient solutions to an implied multicriteria optimisation problem algorithms for finding such solutions are readily available and we demonstrate our approach through a worked example of treatment for clinical depression

what encourages local authorities to engage with energy performance contracting for retrofitting evidence from german municipalities municipalities aiming at mitigating climate change by implementing new energy efficiency technologies face budgetary and capacity constraints outsourcing through energy service contracting could provide a solution this paper reports results from a survey of 1298 municipalities concerning barriers to retrofitting public street lighting and the possible role of energy service contracting to overcome these barriers using a logistic regression analysis the authors investigate determinants of opting for energy service contracts in the specific context of led retrofits results point to an advantage of outsourcing in a financially and capacity constrained environment which corresponds with the main reasons for engaging in contracting minimising investments and financial risks however municipalities often do not fully grasp the risks associated with retrofitting especially using a novel technology such as led in relation to that they underestimate the risk reduction potential of energy performance contracts epc previous experience with outsourcing increases the probability to engage in servitization although certain existing partnerships particularly with utilities prevent municipalities from considering energy performance contracts interestingly engaging an energy consultant has a negative propensity to use energy service contracts while pre negotiated standardised contracts for energy performance contracts have a positive influence

qalys and the equity efficiency trade off as the volume of research on quality adjusted life years qalys has increased concern has begun to be expressed about the equity aspects of resource allocation decisions based on the results of this research this paper suggests that a common theme running through the criticisms of the qaly approach is a concern about inequality it also suggests that the method for incorporating distributional concerns which is currently being pursued by advocates of the qaly approach will only ever capture concerns other than a concern about inequality the paper suggests a method for incorporating both sets of concerns into resource allocation decisions

economic history and economics i have in the back of my mind a picture of the sort of discipline economics ought to be or at least the sort of discipline i wish it were if economics were practiced in that way there would be nothing problematical about its reciprocal relationship with economic history it would be pretty clear what it is that economic theory offers to economic history and what economic history offers to economic theory i will try to describe what i mean below for better or worse however economics has gone down a different path not the one i have in mind one consequence not the most important one but the one that matters for this discussion is that economic theory learns nothing from economic history and economic history is as much corrupted as enriched by economic theory i will come to that too later on you will notice that i am using strong language i am prepared to admit right away that i may be dead wrong in my judgements but there is no point in pussyfooting bluntness may lead to an interesting discussion after all no one would remember the old german historical school if it were not for the famous methodenstreit actually no one remembers them anyway there must be a lesson in that to get right down to it i suspect that the attempt to construct economics as an axiomatically based hard science is doomed to fail there are many partially overlapping reasons for believing this but since that is not the topic under discussion today i do not have to lay them out in an orderly way i hope the following hodgepodge will convey what i mean a modern economy is a very complicated system since we cannot conduct controlled experiments on its smaller parts or even observe them in isolation the classical hardscience devices for discriminating between competing hypotheses are closed to us the main alternative device is the statistical analysis of historical time series but then another difficulty arises the competing hypotheses are themselves complex and subtle we know before we start that all of them or at least many of them are capable of fitting the data in a gross sort of way then in order to make more refined distinctions we need long time series observed under stationary conditions unfortunately however economics is a social science it is subject to damon runyon s law that nothing between human beings is more than three to one to express the point more formally much of what we observe cannot be treated as the realization of a stationary stochastic process without straining credulity moreover all narrowly economic activity is embedded in a web of social institutions customs beliefs and attitudes concrete outcomes are indubitably affected by these background factors some of which change slowly and gradually others erratically as soon as time series get long enough to offer hope of discriminating among complex hypotheses the likelihood that they remain stationary dwindles away and the noise level gets correspondingly high under these circumstances a little cleverness and persistence can get you almost any result you want i think that is why so few econometricians have ever been forced by the facts to abandon a firmly held belief indeed some of fortune s favorites have been known to write scores of empirical articles without once feeling obliged to report a result that contradicts their prior prejudices if i am anywhere near right about this the interests of scientific economics would be better served by a more modest approach there is enough for us to do without pretending to a degree of completeness and department of economics massachusetts institute of technology cambridge ma 02139

unemployment getting the questions right in my opinion the form and conception of this conference exemplifies the right instinct for modern macroeconomics there is a fact a big unmistakable unsubtle fact essentially everywhere in the modern industrial capitalist world unemployment rates are much higher than they used to be two or three decades ago why is that if macroeconomics is good for anything it ought to be able to understand and explain that fact we should be able to produce a fairly convincing analytical account of the occurrence and persistence of unusually high unemployment rates you might think that to be a mere commonplace to what other sort of end would anyone organize a conference my experience however is that most high powered academic conferences are stimulated by purely technical developments or less often by ideological or political promotion rather than by the need to deal with an outstanding fact i do not blame anyone for this state of affairs we may not be blessed with many significant observations too big to be quibbled over and technical innovations do need to be thrashed out by experts anyway it is good to be faced by a brute fact that needs explanation it is what macroeconomics ought to be about i compliment the organizers also on a second aspect of the agenda the country by country organization of the papers we can all hope to learn something from cross country comparisons one of the few good ways we have to test analytical ideas is to see whether they can make sense of international differences in outcomes by appealing to international differences in institutional structure and historical environment the right place to start is within each country separately studied by someone who knows the peculiarities of its history and its data you might think that this too ought to be obvious but in fact the usual approach is just the opposite more often than not we fail to take institutional differences seriously one model is supposed to apply everywhere and always each country is just a point on a cross section regression or one among several essentially identical regressions leaving only grumblers to worry about what is exogenous and what is endogenous and whether simple parametrizations do justice to real differences in the way the economic mechanism functions in one place or another i have no way of knowing whether this organized effort will get anywhere in explaining high unemployment but it seems to be set up to give itself the best chance for better or worse probably for the better theoretical and empirical work are closely intertwined in macroeconomics scratch a macro theorist and you find a casual econometrician scratch a macro econometrician and you find a casual theorist usually you do not have to scratch very hard thus the discussion of the issues central to the conference has already hardened into certain characteristic forms there are questions already lying on the table that the individual country papers will be trying to answer i suspect that some

investigating the social value of health changes this survey has demonstrated that the danish public is concerned with distributional aspects of health gains they have a strong inclination to give priority to those in a more severe health state provided their expected benefits are large enough to bring them to the health level where their rival patients are without treatment results also indicated that the equity argument may not apply with equal force on all health dimensions respondents did to some extent trade off equity for greater health gains a nouvelle finding is that the valuations of health increments per se seem to be affected by whether questions are framed as individual or social choices if social decision making is the issue health gains which involve relieving patients of extreme problems are valued more highly than relief of minor ailments these discrepancies between individual and social valuations suggest that the use of qaly values elicited from an individual s perspective may not be valid in social decision making

a critical review of china s rapidly developing renewable energy and energy efficiency policies renewable energy and energy efficiency reee policies have far reaching implications for energy security climate change economic competitiveness pollution and human livelihood for these reasons reee has become a national priority for the chinese government particularly since 2005 this paper aims to critically review china s reee policies in six sectors electricity industry transportation buildings and local government in addition to examining the progress china has made in the development and implementation of reee policies this review also identifies limitations and room for improvement finally five policy recommendations are presented

accounting for future costs in medical cost effectiveness analysis most medical cost effectiveness analyses include future costs only for related illnesses but this approach is controversial this paper demonstrates that cost effectiveness analysis is consistent with lifetime utility maximization only if it includes all future medical and non medical expenditures estimates of the magnitude of these future costs suggest that they may substantially alter both the absolute and relative cost effectiveness of medical interventions particularly when an intervention increases length of life more than quality of life in older populations current methods overstate the cost effectiveness of interventions which extend life compared to interventions which improve the quality of life

economic evaluation of health care programmes is cea better than cba it has been noted earlier that during the same period that the contingent valuation cv method evolved and became the most commonly used method of valuing environmental projects the development in health economics was instead been towards cost effectiveness analysis cea recently there has been a growing interest in the use of cea where qalys quality adjusted life years are used as a measure of effectiveness as the method of evaluation for environmental projects the purpose of this paper is to answer the question is cea a superior method to cba both theoretically and empirically to provide information to decision makers for use in decisions on resource allocation in health the paper deals with the following topics the underlying theoretical foundation for cea is cea free of income distribution considerations is qaly a superior measure to wtp the usefulness of incremental ce ratio icer to determine resource allocation the paper concludes that there is neither theoretical nor practical support for the claim about the superiority of cea

analysis of esco activities using country indicators energy service companies escos are private sector instruments that offer energy emission improvement energy saving energy efficiency energy conservation emission reduction projects in the developed and in some developing countries literature reveals that energy emission improvements of countries may be related to their innovation and r d activity levels in this work we use a literature data on the activities and the sectors targeted by escos in 38 countries summarized in terms of the age of esco market aem number of esco companies ne and total value of esco projects ve along with the global innovation index gii data of the countries we investigate the relationships among the esco indicators eis aem ne ve sectors targeted by escos and the country indicators cis gii and per capita gdp energy consumption co2 emission we observe noteworthy dependencies between the eis and cis using the simple trend equations we estimate the missing ves in the original data we also project as a hint for the size and orientation of the upcoming turkish esco market the set of eis and the distribution of the sectors that are likely to be targeted by escos in turkey

the normative economics of health care finance and provision whereas in many countries the crisis in medical care has been seen in terms of excess spending on health services in the uk it has been seen at least by most of those who manage and work in the nhs as a crisis of underfunding this has come about as the result of the government s successful attempts to restrain the rate of growth of real spending on the nhs which in turn reflects the government s belief that its principal effective weapon against what it perceives to be inefficiency in the nhs is to challenge management itself reformed and to some extent liberated by systematic financial squeezes the same concern has given rise to a host of proposals for reform of the nhs most of which involve a much greater role for private insurance private finance of other kinds such as out of pocket payments and private provision of health care itself

measurement of health state utilities for economic appraisal health status measurement for use in economic appraisal of health care programmes is reviewed in this paper with particular emphasis on utility measurement a framework for economic appraisal is presented displaying the various components that must be measured and showing how the three forms of analysis cost effectiveness analysis cost benefit analysis and cost utility analysis relate to the framework and to each other one of the components in the framework is health status it can be measured using ad hoc numeric scales willingness to pay receive or health state utilities the determination of health state utilities is reviewed covering the following issues alternative sources of utilities health state descriptions multi attribute utility approach determination of appropriate subjects utility aggregation and accuracy three measurement techniques for health state utilities are described in detail rating scale standard gamble and time trade off the use of these methods is described for both chronic and temporary health states and for both health states considered better than death and those considered worse than death

the choice of energy saving modes for an energy intensive manufacturer considering non energy benefits in practice energy intensive manufacturers have two main options when improving their energy efficiency design and implement energy efficiency projects on their own we call this self saving or enter into an energy performance contracting epc which mainly includes shared savings and guaranteed savings in this paper we will discuss an energy intensive manufacturer facing self saving and shared savings options and how this manufacturer chooses the optimal energy saving mode when non energy benefits are considered we only consider costs and profit as non energy benefits and formulate an optimization model of self saving and a stackelberg game model of shared savings from our model analysis when considering only energy savings we find that the optimal unit savings has a monotonic impact on the optimal profit of the manufacturer our results indicate that the manufacturer will prefer the second option to the first when the investment cost factor ratio of the energy service company esco to the manufacturer is small otherwise the manufacturer will prefer the first to the second furthermore when considering non energy benefits we find that the results change in some cases

demand pull government policies to support product service system activity the case of energy service companies escos in the uk product service systems psss constitute a family of service based business models designed to satisfy our societal needs in an economically and environmentally sustainable manner to date however pss application has remained niche due to a variety of critical barriers this paper explores how demand pull national government policies could support pss activity by addressing these barriers and cultivating market demand lessons are drawn from a case study of how regulatory economic incentive informative and procurement policies have supported energy service company esco activity in the uk a sub set of the pss family focused on energy service provision subsequently five policy recommendations are presented to support pss activity 1 balancing economic incentives and regulatory disincentives 2 promoting indirect policy support 3 redesigning existing market structures 4 promoting locally led pss activity and 5 creating stable policy frameworks the paper warns however that national government policy cannot easily address all pss barriers such as customer preferences international developments technological progress and inherent business model weaknesses pointing to the need for other complementary solutions furthermore other governance actors beside national government could also implement pss supporting policies

the bargaining within abstract this short paper shows that intrapersonal bargaining in a dual self model can be used to provide a foundation for quasi hyperbolic discounting model popularized by laibson laibson david 1994 essays in hyperbolic discounting ph d dissertation mit laibson david 1997 golden eggs and hyperbolic discounting quarterly journal of economics 112 443 477

uk local authority engagement with the energy service company esco model key characteristics benefits limitations and considerations abstract this paper explores how some uk local authorities las have opted to engage with the energy service company esco model in a bid to enhance their influence over local energy system change and help them to deliver on their political public good objectives three common approaches to la esco model engagement are outlined including the 1 la owned arm s length model 2 private sector owned concession agreement model and 3 community owned and run model the la s decision to establish its own esco or alternatively enter into a partnership with another predominantly depends on its willingness to expose itself to risk the level of strategic control it desires and the resources it has at its disposal however the business case is contingent on the extent to which the national policy and regulatory framework facilitates and obligates las to play an active energy governance role stronger alignment of local and national energy agendas through communication and coordination between different governance actors could help to remove critical barriers to la esco engagement and their wider energy governance activities

qalys versus hyes what s right and what s wrong a review of the controversy abstract the paper uses an axiomatic approach to the description of individual preferences for health status sequences to resolve the major issues at stake in the recent controversy over qalys versus hyes while the hye accounts for an individual s time preference for health qaly scores based on the time trade off method will generally differ from the number of hyes hyes do not represent preferences for health under risk unless the utility function for reference flows of health is linear collapsing the two step hye assessment procedure into a single step entails a loss of information as regards the utility of a health status sequence although the procedure does represent preferences for health it fails to supply a description in terms of hyes in the case of risk as a remedy a modified hye approach is proposed

the integration of claims to health care a programming approach the paper contributes to the use of social choice and welfare theory in health economics by developing and applying the integration of claims framework to health care rationing related to sen s critique of neo classical welfare economics the integration of claims framework recognises three primitive sources of claim consequences deontology and procedures a taxonomy is presented with the aid of which it is shown that social welfare functions reflecting these claims individually or together can be specified some of the resulting social choice rules can be regarded as generalisations of health maximisation and all have normative justifications though the justifications may not be universally acceptable the paper shows how non linear programming can be used to operationalise such choice rules and illustrates their differential impacts on the optimal provision of health care following discussion of relations to the capabilities framework and the context in which rationing occurs the paper concludes that the integration of claims provides a viable framework for modelling health care rationing that is technically rigorous general and tractable as well as being consistent with relevant moral considerations and citizen preferences

energy conservation in china s higher educationinstitutions abstract this paper analyzes the energy conservation situation in china s higher education institutions heis a case study was conducted in changchun jilin where eight heis of various types were examined an analysis of government policies was also performed the findings indicate that the heis have implemented comprehensive non technical initiatives to conserve electricity including electricity restrictions and extensions of winter breaks as well as certain technical initiatives the heis are less enthusiastic in conserving thermal energy due to a lack of financial incentives and resources differences between the heis are also noted this paper discusses the role of key players including administrators government agencies networks students and non government organizations ngos challenges to energy conservation are also identified such as the lack of investment by schools lack of government funding quality problems in energy conservation products inadequate heat metering reform underperformance of energy service companies escos and conflicts between energy conservation and student welfare policy recommendations are offered based on the analysis results

the co evolutionary relationship between energy service companies and the uk energy system implications for a low carbon transition abstract the energy service company esco business model is designed to reward businesses by satisfying consumers energy needs at less cost and with fewer carbon emissions via energy demand management and or sustainable supply measures in contrast the revenue of the incumbent energy utility company euco model is coupled with the sale of units of energy which are predominantly sourced from fossil fuels the latter is currently dominant in the uk this paper addresses two questions first why has the esco model traditionally been confined to niche applications second what role is the esco model likely to play in the transition to a low carbon uk energy system to answer these the paper examines the core characteristics of the esco model relative to the euco model the paper then examines how escos have co evolved with the various dimensions of the energy system i e ecosystems institutions user practices technologies and business models to provide insight into how escos might help to shape the future uk energy system we suggest that institutional and technological changes within the uk energy system could result in a more favourable selection environment for escos consequently enabling the esco model to proliferate at the expense of the euco model

modes of governance for municipal energy efficiency services the case of led street lighting in germany energy efficiency retrofits are often impeded by high perceived investment risks long payback periods and a lack of skills at the municipal level these issues are particularly pronounced as procuring implementing and managing retrofits can exceed existing municipal governance capacities the diffusion of municipal led street lighting as a replacement for conventional lighting serves as an example this paper argues that technological e g complexity and maturity economic e g selling services vs products and financing costs institutional e g property situation and contracts and competency barriers to retrofitting e g lack of measurement capacity and qualified facilitators translate into transaction costs we develop a taxonomy of appropriate modes of municipal retrofitting governance based on transaction costs economics the findings indicate that more market based solutions energy performance contracts in particular can facilitate the procurement of innovative energy efficiency retrofitting solutions and associated investments among municipalities if neutral tenders open book accounting municipal ownership and intermediary organisations allow municipalities to choose appropriate governance structures for particular technologies and retrofits