the internal market and hospital efficiency a stochastic distance function approach the uk internal market was one of the first european attempts to introduce a competitive mechanism in the provision of hospital services the assumption was that competition would have led hospitals to increase efficiency in the use of their resources the aim of this paper is to analyse the effectiveness of this kind of reform by measuring the changes in technical efficiency of a panel of 52 acute scottish hospitals observed from 1991 92 to 1996 97 the time period covers the whole duration of the internal market and the sample contains a different mix of both trusts and non trusts where the former embed the proper working of the reform the selected model is a stochastic output distance function that includes an interaction dummy variable to allow for parameters to change over time the results show a structural break after which hospitals change not only the way in which they provide their services but also the kind of services they provide favouring the quicker treatment of patients on a day basis

socially responsible products what motivates consumers to pay a premium abstractthe motivation to pay a premium for socially responsible products is partly an expression of consumer concern for the well being of those involved in the production process buying a product with a socially responsible label and donating to a charity are similarly motivated actions while there is an extensive literature on the economics of charitable giving that examines motivations to donate as well as on the impacts of labelling on consumer demand there is little overlap between the two literatures we bridge these two literatures by investigating whether consumers have heterogeneous motivations for paying a premium through a laboratory experiment that auctions coffee with hypothetical socially responsible labels that put different weights on in kind versus cash transfers we find that those consumers who prefer an in kind transfer paternalistic altruists are willing to pay a 52 5 price premium over standard coffee those who prefer that most of the premium is paid as cash strong altruis

cash transfer programs with income multipliers procampo in mexico abstract cash transfer programs create multiplier effects when recipients put the money they receive to work to generate further incomes when this is the case the ultimate income effects are multiples of the amounts transferred we analyze the procampo program in mexico that was introduced to compensate farmers for the anticipated negative effect of nafta on the prices of basic crops the transfer rules and the timing of the panel data collected allow unique control of biases in this impact analysis we find that the multiplier among ejido sector recipients is in the range 1 5 2 6 multipliers are higher for households with medium and large farms low numbers of adults in the household nonindigenous backgrounds and located in the center and gulf regions high multipliers reflect income opportunities that had remained unrealized due to liquidity constraints that are relaxed by the transfers opportunities come from the asset endowments that these households received through the land reform particularly irrigated land and they are enhanced by access to technical assistance

the ambivalent impact of coffee certification on farmers welfare a matched panel approach for cooperatives in central kenya certification is promoted to improve rural welfare through better market access and improved agricultural practices we compare net effects of fairtrade and utz certified coffee production in central kenya using a matched panel from 218 farm households that belong to three cooperatives and were visited twice in 2009 and 2013 we distinguish between effects at field farm household cooperative community and market levels both certification regimes improved coffee returns but fairtrade was more effective in coffee processing whereas utz contributed to productivity under stagnating coffee prices fairtrade farmers increased their coffee specialization while utz farmers reduced coffee areas but increased yield

the impact of fair trade certification for coffee farmers in peru smallholder farmers producing for fair trade market outlets are usually considered to benefit from better prices and stable market outlets however many empirical studies verifying this impact suffer from strong selection bias this study uses a balanced sample of fair trade farmers and likewise nonfair trade producers of organic and conventional coffee from peru to compare the net effects on production income and expenditures wealth and investments and attitudes and perceptions after careful matching we find only modest direct income and production effects but significant changes in organization input use wealth and assets and risk attitudes moreover important differences between farmers with early and more recent ft affiliation are registered

the mystery of the vanishing benefits this article provides an introduction to the concepts and methods of impact evaluation the author provides an intuitive explanation in the context of a concrete application the article takes the form of a short story about a fictional character s on the job training in evaluation ms speedy analyst is an economist in the ministry of finance in the fictional country of labas in the process of figuring out how to evaluate a human resource program targeted to the poor ms analyst learns the strengths and weaknesses of the main methods of ex post impact evaluation

the supply and demand for exports in israel abstract using annual data for israel over the period 1960 1989 we estimate an econometric model for the supply and demand for exports a novel feature is that domestic absorption crowds out export supply exports are imperfect substitutes in world markets for tradeables produced abroad the price elasticity of demand is about 1 3 while the price elasticity of supply is about 1 5 the model is simulated to calculate the effects of policy instruments and other exogenous variables on exports and export prices

the role of market forces in assuring contractual performance the conditions under which transactors can use the market repeat purchase mechanism of contract enforcement are examined increased price is shown to be a means of assuring contractual performance a necessary and sufficient condition for performance is the existence of price sufficiently above salvageable production costs so that the nonperforming firm loses a discounted steam of rents on future sales which is greater than the wealth increase from nonperformance this will generally imply a market price greater than the perfectly competitive price and rationalize investments in firm specific assets advertising investments thereby become a positive indicator of likely performance

valuing school quality using boundary discontinuities abstract existing research shows that house prices respond to local school quality as measured by average test scores however higher test scores could signal higher academic value added or higher ability more sought after intakes in our research we show that both school value added and student prior achievement linked to the background of children in schools affect households demand for education in order to identify these effects we improve the boundary discontinuity regression methodology by matching identical properties across admissions authority boundaries by allowing for boundary effects and spatial trends by re weighting our data towards transactions that are closest to district boundaries by eliminating boundaries that coincide with major geographical features and by submitting our estimates to a number of novel falsification tests our results survive this battery of tests and show that a one standard deviation change in either school average value added or prior achievement raises prices by around 3

productivity in public services abstract this paper discusses issues arising in the measurement of productivity in public services compared to measuring productivity in the private sector difficulties arise because the output of public services is often unpriced and because some public services are consumed collectively a key problem is measuring the full range of outputs and quality improvements delivered by public sector organizations that are valued by society without comprehensive measures of output productivity statistics may be misleading i outline methods used in the measurement of both private and public sector productivity and discuss the measurement of public sector productivity in practice finally i discuss studies that examine factors underlying productivity differences and productivity growth in public and private sector organizations public sector reforms and the use of pilot schemes in public sector organizations present opportunities for research to identify causal effects on productivity

the effects of regulation and competition in the nhs internal market the case of general practice fundholder prices the 1989 reforms of the uk national health service introduced competition in supply within a tightly regulated framework the paper examines whether this competition affects the prices posted by sellers of medical services we argue that despite regulation market forces may have an impact on price we test this using the posted prices for one of the two types of buyer general practice fundholders we find the regulatory rules are not observed and some evidence of the impact of market forces on price

credibility of propensity score matching estimates an example from fair trade certification of coffee producers abstractpropensity score matching psm is an increasingly popular method for evaluation studies in agricultural and development economics however statisticians and econometricians have stressed that results rely on untestable assumptions and therefore guidelines for researchers on how to improve credibility have been developed we follow one of these guidelines with a data set analysed by other authors to evaluate the impact of fair trade certification on the income of coffee producers we provide thereby a best practice example of how to evaluate the credibility of psm estimates we find that a thorough assessment of the assumptions made renders the data we use not suitable for a credible psm estimation of the effects of treatment we conclude that the debate about the impact of fair trade certification would greatly benefit from a detailed reporting of credibility checking

tracking the quality premium of certified coffee evidence from ethiopia summary certification of voluntary sustainability standards vss is rapidly increasing in global value chains while consumers mostly in developed countries are willing to pay significant premiums for the certification of such standards it is not well understood how effectively these incentives are transmitted to producing countries we study vss more in particular fair trade and organic certification in ethiopia s coffee sector the country s most important export commodity using a unique census of transaction data at the export level and large scale data at the production level we find that transmission of export quality premiums to coffee producers is limited with only less than one third of this premium being passed on and we find limited evidence of effects due to communal investments moreover as quality premiums are small and average production levels in these settings are low we estimate that these premiums would only lead to an increased income for coffee farmers of 22 usd per year even with a perfect transmission scenario and therefore would have little impact on the welfare of the average coffee farmer given that the vss studied are characterized by the highest premiums among vss schemes it can be assumed that even lower benefits from other vss certification schemes trickle down to producers

rice farmers preferences for fairtrade contracting in benin evidence from a discrete choice experiment abstract private standards such as fairtrade have emerged as a response to consumer civil society and corporate concerns about the production conditions of imported food many studies have investigated the welfare implications of smallholder participation in fairtrade schemes and consumers willingness to pay for fairtrade and other labelled products on the other hand no study has yet investigated farmers preferences for fairtrade and other private standards such insights would be valuable to improve the efficiency of certification schemes and ensure that they are tailored to farmers needs using a choice experiment this study investigates the preferences of smallholder rice farmers in benin for fairtrade and organic standards and compares the value of three types of contracts domestic fairtrade and fairtrade organic the results indicate that farmers positively value contracts but prefer domestic over fairtrade contracts because the former involve fewer requirements at current market prices farmers are willing to accept a fairtrade contract that includes fertiliser and child labour restrictions and a social premium but they are not willing to accept a fairtrade organic contract that completely prohibits chemical input use the results imply that adding organic requirements to fairtrade contracts may undermine the adoption and spread of fairtrade certification in the beninese rice sector

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

equality efficiency and market fundamentals the dynamics of international medical care reform public opinion surveys uniformly show low support for medical care systems in developed countries the longstanding conflict between equal access to care and efficient service provision partly explains this dissatisfaction but the trade off is particularly acute in medical care as new technologies developed over time have increased the cost of care and made the equity commitment even more expensive countries first dealt with rising costs by maintaining equal access and restricting total spending efficiency suffered however as a result many countries are considering a move away from spending controls and toward incentive based medical care reform

monopolistic competition when price and quality are imperfectly observable consider the symmetric equilibrium of a monopolistically competitive industry in which manufacturers select price and quality to maximize expected profit and consumers maximize utility by conducting costly search among sellers using an optimal sequential search rule consumers search among sellers because i each consumer idiosyncratically evaluates each seller s quality and ii a retailing sector generates variation in the prices consumers pay consumers are handicapped in their search because their observations of firms price and quality levels are noisy an improvement in price information is represented by an increase in the precision with which consumers observe sellers prices similarly an improvement in quality information is represented by an increase in precision with which consumers observe sellers quality levels an improvement of either type of information may increase or decrease welfare the perverse case in which improved price information decreases welfare occurs when price competition among firms becomes so intense relative to quality competition that firms select severely suboptimal levels of quality a consumer searching among monopolistically competitive sellers may have difficulty accurately observing the price and quality of each seller s product he must infer from his prior beliefs and noisy observations the true values of the product s price and quality attributes we show that increasing the precision with which consumers observe an attribute of a product makes the inference problem easier and causes the demand the seller faces with respect to that attribute to become more elastic the equilibrium level of that attribute changes accordingly and since the equilibrium levels of price and quality interact the equilibrium level of the other attribute changes as well these equilibrium effects can be perverse in two ways first if the precision of quality observation is fixed then improvement in the precision of price observation can reduce welfare the chain of causation is this increasing the precision of price observation causes price to fall the resulting smaller price cost margin induces sellers to reduce quality de

using regional variation in wages to measure the effects of the federal minimum wage the imposition of a national minimum wage standard provides a natural experiment in which the treatment effect varies across states depending on the fraction of workers initially earning less than the new minimum the author exploits this fact to evaluate the effect of the april 1990 increase in the federal minimum wage on teenagers wages employment and school enrollment comparisons of grouped and individual state data confirm that the rise in the minimum wage increased teenagers wages there is no evidence of corresponding losses in teenage employment or changes in teenage school enrollment

does competition from private surgical centres improve public hospitals performance evidence from the english national health service abstract this paper examines the impact of a government programme which facilitated the entry of for profit surgical centres to compete against incumbent national health service hospitals in england we examine the impact of competition from these surgical centres on the efficiency measured by pre surgery length of stay for hip and knee replacement patients and case mix of incumbent public hospitals we exploit the fact that the government chose the broad locations where these surgical centres independent sector treatment centres or istcs would be built based on local patient waiting times not length of stay or clinical quality to construct treatment and control groups that are comparable with respect to key outcome variables of interest using a difference in difference estimation strategy we find that the government facilitated entry of surgical centres led to shorter pre surgery length of stay at nearby public hospitals however these new entrants took on healthier patients and left incumbent hospitals treating patients who were sicker this paper highlights a potential trade off that policymakers face when they promote competition from private for profit firms in markets for the provision of public services

comparing the profitability of organic and conventional production in family farming empirical evidence from brazil abstract several studies have compared the profitability of organic and conventional producers but present very conflicting results although in the majority of these papers selection bias due to observables is accounted for the possibility of selection based on unobservables has been largely overlooked in this paper we compare these two types of producers using a large and unique data of about 4 2 million family farmers in brazil standard propensity score matching techniques are used together with the procedure recently developed by oster forthcoming to address concerns about omitted variables our results confirm the working hypothesis that organic producer s profits are lower than conventional ones

does hospital competition harm equity evidence from the english national health service increasing evidence shows that hospital competition under fixed prices can improve quality and reduce cost concerns remain however that competition may undermine socio economic equity in the utilisation of care we test this hypothesis in the context of the pro competition reforms of the english national health service progressively introduced from 2004 to 2006 we use a panel of 32 482 english small areas followed from 2003 to 2008 and a difference in differences approach the effect of competition on equity is identified by the interaction between market structure small area income deprivation and year we find a negative association between market competition and elective admissions in deprived areas the effect of pro competition reform was to reduce this negative association slightly suggesting that competition did not undermine equity

product quality and competition evidence from the broadband industry abstractaccess to high quality broadband internet is important in many different respects such as in communication education commerce and information acquisition we investigate the relationship

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

modelling export prices and quantities in a small open economy volvement by u s manufacturing industry oxfjord economic papers 32 mar 1980 102 122 lindenberg eric b and stephen a ross tobin s q ratio and industrial organization journal of business 54 jan 1981 1 32 marvel howard p foreign trade and domestic competition economic inquiry 18 jan 1980 103 122 thomadakis stavros b a value based test of profitability and market structure this review 59 may 1977 179 185

decoupling standards from practice the impact of in house certifications on coffee farms environmental and social conduct in this paper we investigate whether coffee farms that have been granted in house socio environmental certification from a global buyer display better social and environmental conduct compared to non certified farms we perform an econometric analysis using data from an original cross country survey covering 575 farms in various regions of brazil colombia costa rica guatemala and mexico we find that farms that have been granted in house certification demonstrate better environmental but not better social conduct than non certified farms we find also that the positive relationship between in house certification and environmental conduct is stronger if the farm sells to a cooperative and if it is located in an institutionally weak country finally we find that the institutional strength of the farm s home country has a positive influence on its social conduct we discuss how our analysis contributes to the literature on the social and environmental impacts of certifications and to scholarship in global value chains social and environmental upgrading

the economics of quality in the specialty coffee industry insights from the cup of excellence auction programs this study estimates price determinants for specialty green coffee auctions using records from the 2004 2010 cup of excellence programs hosted by the alliance for coffee excellence while some literature on coffee has focused on certifications and sustainability labels the discussion of price determinants has been limited this article replicates one of the first publications on price determinants and formulates a new model to more accurately describe the market we include the necessary additional variables and estimate the model using a truncated maximum likelihood estimation technique while sensory quality has a strong effect on price the highest premiums stem from obtaining a top rank compared to other coffees from the same country and north american buyers are more responsive to sensory quality than buyers in asian and european markets jel classifications c24 d44 q13

organic agriculture and fair trade a happy marriage a case study of certified smallholder black pepper farmers in india summary this study examines whether the joint adoption of organic and fair trade systems adds additional benefits to smallholders in developing countries we use panel data collected from 300 smallholder rural black pepper growers in kerala india to assess household welfare impacts we apply a multinomial endogenous switching regression model along with a counterfactual analysis to estimate certification effects results show that both certification systems have a significant impact on income compared to conventional black pepper farming however membership in fair trade marketing systems does not increase income of organic farmers but has positive effects on asset accumulation of smallholder farmers

fair trade organic coffee production in nicaragua sustainable development or a poverty trap abstract this article assesses the impact of fair trade organic coffee production on the well being of small scale farmers in nicaragua studying the results of organic management is crucial for evaluating the advantages of fair trade because approximately half of all fair trade coffee is also organically certified a wide range of farmers representatives of cooperatives and export companies in nicaragua were interviewed during seven months of field work between 2005 and 2008 fair trade organic production raises farmer income when low intensity organic farming is an alternative to low intensity conventional farming however low intensity farming produces very little coffee in the case of the most marginalized farmers keeping these farmers in poverty with higher intensities of management the economic advantages of fair trade organic production largely depend on prices in the mainstream market

fair trade organic coffee rural livelihoods and the agrarian question southern mexican coffee families in transition summary we use a random sample of coffee producing households in southern mexico to compare opportunities associated with government subsidies and migration to the role of fair trade organic coffee in household livelihoods although land and labor returns among fair trade organic coffee growers are higher than for conventional growers differences in yields are more important than price premiums moreover investment in education and labor opportunities outside coffee dominate those in fair trade organic coffee the results highlight the value of an integrated approach to the agrarian question that improves productivity and prices and supports other pathways for improving incomes

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

the industrial organization of health care markets the u s health care sector is large and growing health care spending in 2011 amounted to 2 7 trillion and 18 percent of gdp approximately half of health care output is allocated via markets in this paper we analyze the industrial organization literature on health care markets focusing on the impact of competition on price quality and treatment decisions for health care providers and health insurers we conclude with a discussion of research opportunities for industrial organization economists including opportunities created by the u s patient protection and affordable care act

the effect of specialty coffee certification on household livelihood strategies and specialisation abstract farm certification is rapidly becoming a sine qua non for access to specialty coffee markets at the centre of these changes are smallholder coffee producers responsible for 80 of global coffee production although rural households are known to depend on more than agricultural production alone the literature on specialty coffee and certification has rather narrowly focused on coffee income and production in this study broader impacts are explicitly taken into account household income was decomposed into categories corresponding to specific income generating activities and coffee income was broken down into price yield and area effects results show that coffee certification encourages farmers to specialise in coffee production increasing coffee income but not total household income at least not in the short run the time and effort required to attain the higher coffee income offered by certified production means farmers have to give up other activities this substitution effect cancels out the income effect such that there is no increase in total household income the lack of an effect on total household income suggests the return to the additional labour effort required for certified coffee production is not higher than in other activities questioning the benefits of certification for small scale producers

the changing role of government in financing health care an international perspective this paper explores the changing role of government involvement in health care financing policy outside the united states it provides a review of the economics literature in this area to elucidate the implications of recent policy changes on efficiency costs and quality our review reveals that there has been some convergence in policies adopted across countries to improve financing incentives and encourage efficient use of health services in the case of risk pooling all countries with competing pools experience similar difficulties with selection and are adopting more sophisticated forms of risk adjustment in the case of hospital competition the key drivers of success appear to be what is competed on and measurable rather than whether the system is public or private in the case of both the success of performance related pay for providers and issues resulting from wait times evidence differs within and across jurisdictions however the evidence does suggest that some governments have effectively reduced wait times when they have chosen explicitly to focus on achieving this goal many countries are exploring new ways of generating revenues for health care to enable them to cope with significant cost growth but there is little evidence to suggest that collection mechanisms alone are effective in managing the cost or quality of care jel h51 i11 i18

the price ain t right hospital prices and health spending on the privately insured we use insurance claims data for 27 6 percent of individuals with private employer sponsored insurance in the us between 2007 and 2011 to examine the variation in health spending and in hospitals transaction prices we document the variation in hospital prices within and across geographic areas examine how hospital prices influence the variation in health spending on the privately insured and analyze the factors associated with hospital price variation four key findings emerge first health care spending per privately insured beneficiary varies by a factor of three across the 306 hospital referral regions hrrs in the us moreover the correlation between total spending per privately insured beneficiary and total spending per medicare beneficiary across hrrs is only 0 14 second variation in providers transaction prices across hrrs is the primary driver of spending variation for the privately insured whereas variation in the quantity of care provided across hrrs is the primary driver of medicare spending variation consequently extrapolating lessons on health spending from medicare to the privately insured must be done with caution third we document large dispersion in overall inpatient hospital prices and in prices for seven relatively homogenous procedures for example hospital prices for lower limb mris vary by a factor of twelve across the nation and on average two fold within hrrs finally hospital prices are positively associated with indicators of hospital market power even after conditioning on many demand and cost factors hospital prices in monopoly markets are 15 3 percent higher than those in markets with four or more hospitals

financial incentives in health new evidence from india s janani suraksha yojana this paper studies the health effects of one of the world s largest demand side financial incentive programmes india s janani suraksha yojana our difference in difference estimates exploit heterogeneity in the implementation of the financial incentive programme across districts we find that cash incentives to women were associated with increased uptake of maternity services but there is no strong evidence that the jsy was associated with a reduction in neonatal or early neonatal mortality the positive effects on utilisation are larger for less educated and poorer women and in places where the cash payment was most generous we also find evidence of unintended consequences the financial incentive programme was associated with a substitution away from private health providers an increase in breastfeeding and more pregnancies these findings demonstrate the potential for financial incentives to have unanticipated effects that may in the case of fertility undermine the programme s own objective of reducing mortality

limitations of contract farming as a pro poor strategy the case of maize outgrower schemes in upper west ghana summary contract farming cf arrangements have the potential to address market failures and improve technology adoption productivity and welfare in ghana government and donors use cf as a strategy for increasing adoption of new agricultural technologies and developing value chains yet to date there has not been a rigorous assessment of these cf schemes the focus in this paper is on different maize based cf schemes in the poorest and most remote region in ghana it assesses the profitability and potential impact of these cf schemes utilizing a unique plot level dataset that covers two periods of data and two maize plots scheme and non scheme per household and employing matching techniques and an instrumental variable approach to address selection bias and unobserved heterogeneity across farmers these are complemented by a community level survey in depth interviews with scheme operators and a series of key informant interviews results show that these schemes led to improved technology adoption and yield increases in addition a subset of maize farmers with high yield improvements due to cf participation have high profits maize cf schemes also enabled market coordination and consistent supply of quality maize to downstream industries however on average the impact of the cf schemes on profitability is negative even when input diversion is accounted for yield increases are not high enough to compensate for higher input requirements and the cost of capital under the schemes despite higher yields the costs to produce one metric tonne of maize under cf schemes are higher than on maize farms without cf schemes twice that of several countries in africa and more than seven times higher than that of major maize exporting countries the united states brazil and argentina sustainability of these cf schemes will largely depend on developing and promoting much improved varieties and technologies that boost yields in order to compensate for the high input and credit costs

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

do financial incentives trump clinical guidance hip replacement in england and scotland following devolution in 1999 england and scotland s national health services diverged resulting in major differences in hospital payment england introduced a case payment mechanism from 2003 4 while scotland continued to pay through global budgets we investigate the impact this change had on activity for hip replacement we examine the financial reimbursement attached to uncemented hip replacement in england which has been more generous than for its cemented counterpart although clinical guidance from the national institute for clinical excellence recommends the later in scotland this financial differential does not exist we use a difference in difference estimator using scotland as a control to test whether the change in reimbursement across the two countries had an influence on treatment our results indicate that financial incentives are directly linked to the faster uptake of the more expensive uncemented hip replacement in england which ran against the clinical guidance

does competition between hospitals improve the quality of care hospital death rates and the nhs internal market payer driven competition has been widely advocated as a means of increasing efficiency in health care markets the 1990s reforms to the uk health service followed this path we examine whether competition led to better outcomes for patients as measured by death rates after treatment following heart attacks using data that until 1999 was not publicly available in any form on hospital level death rates we find that the relationship between competition and quality of care appears to be negative greater competition is associated with higher death rates controlling for patient mix and other observed characteristics of the hospital and the catchment area for its patients however the estimated impact of competition is small jel classification i1 l8 h4

a dynamic model of quality competition with endogenous prices abstract we develop a dynamic model of price and quality competition in order to analyze the effects of competition on quality provision and to which extent an unregulated market is able to provide a socially optimal quality level our model combines a differential game approach with a hotelling spatial competition framework and our analysis applies in particular to industries such as long term care health care child care and education if providers nursing homes hospitals schools nurseries use closed loop decision rules which imply strategic interaction over time we show that although increased competition leads to higher quality in the steady state quality provision is nevertheless lower than under open loop rules and also suboptimally low from a welfare perspective thus our analysis identifies dynamic strategic interaction between competing providers as a potential source of inefficiency in quality provision

social security and private transfers in developing countries the case of peru do social security systems crowd out private transfers from younger to older generations this question has generated much theoretical discussion but little empirical work exists to confirm or refute this crowding out hypothesis we investigate the connection between social security and private transfers in peru using the peruvian living standards survey and find that private transfers from young to old would have been nearly 20 percent higher without social security benefits this indicates that the peruvian social security system is less effective at delivering benefits to the elderly than a simple assignment of government expenditures would suggest social security s displacement of private transfers while significant is less than that predicted by models with widespread altruistic transfers

competition and the incentive to produce high quality previous literature indicates that when quality is a choice variable firms have an incentive to produce high quality to maintain their reputations with consumers the strategic interaction among firms and competition for market share is not considered this paper finds that when firms compete for market share perfect equilibria in which firms produce high quality goods need not exist competition for customers can eliminate the price premium needed to induce firms to maintain a reputation for high quality production in this case economists and policy analysts should pay greater attention to the interaction among firms and the institutions such as professional associations that structure interfirm relations when considering whether firms have an incentive to produce high quality goods

the impact of competition on management quality evidence from public hospitals in this paper we examine the causal impact of competition on management quality we analyze the hospital sector where geographic proximity is a key determinant of competition and english public hospitals where political competition can be used to construct instrumental variables for market structure since almost all major english hospitals are government run closing hospitals in areas where the governing party has a small majority is rare due to fear of electoral punishment we find that management quality measured using a new survey tool is strongly correlated with financial and clinical outcomes such as survival rates from emergency heart attack admissions ami more importantly we find that higher competition as indicated by a greater number of neighboring hospitals is positively correlated with increased management quality and this relationship strengthens when we instrument the number of local hospitals with local political competition adding another rival hospital increases the index of management quality by one third of a standard deviation and leads to a 10 7 reduction in heart attack mortality rates

hospital competition and quality with regulated prices we analyse the effect of competition on quality in hospital markets with regulated prices considering the effect of both introducing competition monopoly versus competition and increasing competition through either lower transportation costs increased substitutability or a higher number of hospitals with semi altruistic providers and a fairly general cost structure we show that the relationship between competition and quality is generally ambiguous in contrast to the received body of theoretical literature this is consistent with and potentially explains the mixed empirical evidence

walk the talk private sustainability standards in the ugandan coffee sector abstractwe investigate the welfare and productivity implications of private sustainability standards in the coffee sector in uganda we use cross sectional household survey data and an instrumental variable method with instruments that pass weak identification and over identification restrictions we find that triple utz rainforest alliance 4c certification increases income and land and labour productivity and reduces poverty double fairtrade organic certification is found to be associated with higher producer prices but results in lower land and labour productivity and thereby fails to increase producer income and contribute to poverty reduction we conclude that private sustainability standards do not always live up the expectations they create towards consumers

motives for private transfers over the life cycle an analytical framework and evidence for peru abstract this paper tests for the motives for private income transfers we consider two motives altruism and exchange the question of private transfer motives is important because such motivation can influence the effects of public income transfers on the distribution of income using a household survey for peru we find that transfer amounts received increase with recipient pre transfer income which contradicts a key prediction of the strong form of the altruism hypothesis but is consistent with exchange we also find that capital market imperfections are likely to be an important cause of private transfers and that social security benefits crowd out the incidence of private transfers

competition among hospitals the traditional view of hospital competition has posited that hospitals compete primarily along quality dimensions in the form of fancy equipment to attract admitting physicians and pleasant surroundings to entice patients price competition among hospitals is thought to be non existent this paper estimates the effects of various hospital market characteristics on hospital prices and expenses in an attempt to determine the form of hospital competition the results suggest that both price and quality competition are greater in markets that are less concentrated although the net effect of the two on prices is insignificant it appears therefore that despite important distortions hospital markets are not immune to standard competitive forces

quality signaling through certification in developing countries this paper studies how signaling the credence attributes of consumer goods distorts their market equilibrium in developing countries costs of certification sunk in order to achieve credibility play a key role in producing an oligopolistic market leading to high prices that form a barrier for consumers in the south to lower the cost certification is better achieved by a single independent body which can be financed either by end consumers through a fee or by public subsidies the paper identifies the conditions under which each funding mechanism is most efficient taking into account the government s budget constraint the theoretical analysis is motivated with reference to agricultural seed certification

does hospital competition save lives evidence from the english nhs patient choice reforms recent substantive reforms to the english national health service expanded patient choice and encouraged hospitals to compete within a market with fixed prices this study investigates whether these reforms led to improvements in hospital quality we use a difference in difference style estimator to test whether hospital quality measured using mortality from acute myocardial infarction improved more quickly in more competitive markets after these reforms came into force in 2006 we find that after the reforms were implemented mortality fell i e quality improved for patients living in more competitive markets our results suggest that hospital competition can lead to improvements in hospital quality

is hospital competition socially wasteful we study the consequences of hospital competition for medicare beneficiaries heart attack care from 1985 to 1994 we examine how relatively exogenous determinants of hospital choice such as travel distances influence the competitiveness of hospital markets and how hospital competition interacts with the influence of managed care organizations to affect the key determinants of social welfare expenditures on treatment and patient health outcomes in the 1980s the welfare effects of competition were ambiguous but in the 1990s competition unambiguously improves social welfare increasing hmo enrollment over the sample period partially explains the dramatic change in the impact of hospital competition

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disentangling the effects of fair trade on the quality of malian cotton the increasing importance of premium segments and private labels raise skepticism about the ability of fair trade to help smallholders compete in high value added markets using panel data collected in mali this paper contributes to the debate by estimating the impact of fairtrade certification on the quality of malian cotton controlling for the nonrandom certification of producers results show a significant impact on the quality of cotton produced by both certified and geographically close noncertified growers via spillover effects the analysis suggests that contract farming enforced by third parties and demonstration effects foster the adoption of innovative agricultural practices

does market size matter for charities abstract we analyze implications of market size for market structure in the charity sector while a standard model of oligopolistic for profit competition predicts a positive relationship between market size and firm size our analogous model of competition between prosocially motivated charities predicts no such correlation if charities are biased towards their own provision a positive association between market size and provider size can arise we examine these predictions empirically for six different local charity markets our empirical findings suggest that charities do not solely pursue prosocial objectives and that increased competition in the charity sector can lead to rationalization in provision

sustainability standards gender and nutrition among smallholder farmers in uganda abstractsustainability standards are gaining in importance in global markets for high value foods while previous research has shown that participating farmers in developing countries may benefit through income gains nutrition impacts have hardly been analysed we use survey data from smallholder coffee farmers in uganda certified under fairtrade organic and utz to analyse impacts on food security and dietary quality estimates of instrumental variable models and simultaneous equation systems show that certification increases calorie and micronutrient consumption mainly through higher incomes and improved gender equity in certified households women have greater control of coffee production and monetary revenues from sales

transforming or reproducing conventional socioeconomic relations introducing a regulationist framework for the assessment of fairtrade summary the certification based fair trade initiative is usually described as an alternative form of organizing production trade and consumption with the goal of advancing the situation of marginalized producers and workers while much of the fair trade literature has analyzed the system s direct impacts on its beneficiaries some strands have sought to determine its transformative potential vis a vis capitalist social relations in an attempt to contribute to the latter debate this paper introduces an analytical framework for the assessment of fairtrade built on the basis of the french regulation approach this perspective which focuses on the specific ways in which fairtrade structures and institutionalizes socioeconomic relations seeks to examine this system from a holistic perspective privileging the analysis of the qualitative changes it produces in economic institutions and structures this article presents the main assumptions and concepts developed by the regulation approach and proposes a case based research design that uses them to analyze how transformative fairtrade proves to be and the impacts it produces on specific economic sectors this methodological exposition is illustrated with examples from the case of fairtrade wine produced in argentina and consumed in the united kingdom

fairtrade and labour markets in ethiopia and uganda abstractdrawing on four years of fieldwork in ethiopia and uganda this paper addresses gaps in knowledge about the mechanisms linking agricultural exports with poverty reduction the functioning of rural labour markets and the relevance to the lives of the poorest people of fairtrade statistical analysis of survey evidence complemented by qualitative research highlights the relatively poor payment and non pay working conditions of those employed in research sites dominated by fairtrade producer organisations we conclude that fairtrade is not an effective way to improve the welfare of the poorest rural people

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

can governments do it better merger mania and hospital outcomes in the english nhs the literature on mergers between private hospitals suggests that such mergers often produce little benefit despite this the uk government has pursued an active policy of hospital mergers arguing that such consolidations will bring improvements for patients we examine whether this promise is met we exploit the fact that between 1997 and 2006 in england around half the short term general hospitals were involved in a merger but that politics means that selection for a merger may be random with respect to future performance we examine the impact of mergers on a large set of outcomes including financial performance productivity waiting times and clinical quality and find little evidence that mergers achieved gains other than a reduction in activity given that mergers reduce the scope for competition between hospitals the findings suggest that further merger activity may not be the appropriate way of dealing with poorly performing hospitals

are fair trade goods credence goods a new proposal with french illustrations in the literature fair trade ft goods are usually associated with other products differentiated by process attributes such as organic food genetically modified gm food or child labour free clothing all of these products are regarded as credence goods this classification refers to the simplified definition of credence goods which describes product attributes which consumers cannot evaluate even after having consumed the good focusing on the characteristics of ft goods this article proposes a reassessment of the link between ft goods and credence properties as defined by darby and karni we first demonstrate that 1 the usual classification masks important particularities of ft goods compared to other goods with process attributes and 2 the full definition of credence goods may even provide a better description of the quality of ft goods however and this is our second theoretical contribution the lack of consensus among experts concerning ft standards and their level of efficiency encourage us to consider ft goods as indeterminate goods as defined by lupton this result leads us to suggest a new typology of product attributes summarized in an innovative diagram it sheds light on how competition between the different ft approaches works and why the ft market is still confined to a niche if not threatened with collapse we mainly illustrate our theoretical analysis with observations relating to the french ft market and institutions

trading off nutrition and education a panel data analysis of the dissimilar welfare effects of organic and fairtrade standards millions of smallholder farmers in developing countries participate in different types of sustainability standards a growing body of literature has analyzed the welfare effects with mixed results yet there are important knowledge gaps first most existing studies have looked at the effects of one standard in one country when comparing between studies it is unclear whether dissimilar outcomes are the result of different standards or different local conditions second most studies have used cross section data so that selectivity issues remain a challenge third existing work has primarily analyzed effects in terms of purely economic indicators such as prices and income ignoring other dimensions of household welfare we address these shortcomings using panel data from small scale coffee producers in uganda and comparing the effects of two of the most popular sustainability standards namely organic and fairtrade welfare effects are analyzed in terms of household expenditures child education and nutrition results show that organic and fairtrade both have positive effects on total consumption expenditures however notable differences are observed in terms of the other outcomes organic contributes to improved nutrition but has no effect on education for fairtrade it is exactly the other way around we explore the mechanisms behind these differences

food standards certification and poverty among coffee farmers in uganda summary voluntary standards are gaining in importance in global markets for high value foods we analyze and compare impacts of three sustainability oriented standards fairtrade organic and utz on the livelihoods of smallholder coffee farmers in uganda using survey data and propensity score matching with multiple treatments we find that fairtrade certification increases household living standards by 30 and reduces the prevalence and depth of poverty for the other two certification schemes no significant impacts are found several factors that can explain differential impacts are discussed overly general statements about the effects of sustainability standards on smallholder livelihoods may be misleading

free to choose reform choice and consideration sets in the english national health service choice in public services is controversial we exploit a reform in the english national health service to assess the effect of removing constraints on patient choice we estimate a demand model that explicitly captures the removal of the choice constraints imposed on patients we find that post removal patients became more responsive to clinical quality this led to a modest reduction in mortality and a substantial increase in patient welfare the elasticity of demand faced by hospitals increased substantially post reform and we find evidence that hospitals responded to the enhanced incentives by improving quality this suggests greater choice can raise quality

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

in the market but not of it fair trade coffee and forest stewardship council certification as market based social change summary this paper discusses two well known market based social change initiatives fair trade coffee and forest stewardship council certification which harness market forces to pursue social and environmental objectives a serious challenge for both is to operate in the conventional market without undermining their original objectives a global commodity chain analysis approach is combined with insights from economic sociology embeddedness theory to explore the social cultural and organizational factors shaping the initiatives governance structures both initiatives are seen to move along opposite organizational trajectories but face similar pressures from conventional market logics practices and dominant actors a preliminary framework is proposed for comparative assessment focusing on distribution of benefits how conventional market institutions may be questioned and how internal governance manages diverse stakeholder interests and influence

standards as a new form of social contract sustainability initiatives in the coffee industry abstract in the former age of national capitalism the achievement of market fairness was embedded in a normative framework generated by government labor unions and perhaps religious authority in the current age of global capitalism new actors such as ngos industry associations and public private partnerships provide the normative framework that corporations use for social legitimacy in this context standard setting processes operate as new forms of social contract where the state rather than being directly involved between the parties provides a form of basic guarantee while more or less accountable ngos and firms are in charge of hammering out the bargains this article examines the dynamics of this new configuration through the case study of sustainability initiatives in the coffee sector it addresses four questions 1 are these standards effective in communicating information and creating new markets 2 to what extent do they embed elements of collective and private interests 3 is sustainability content actually delivered to their intended beneficiaries and 4 what is the role of public policy in addressing their shortcomings

the impact of regional competition on the health care industry we investigate factors that determine firm markups by employing data on prices and quantities of various medical procedures at major hospitals in the united states we focus on the impact of hospital quality rival competition and the number of medical procedures upon the health care demand our analysis covers health care markets across the united states with the market definition based upon the hospital referral regions our findings highlight potential implications of the relationship between hospital markups and market structure

an assessment of labour s record on health and healthcare this paper examines the record of the 1997 2010 labour administration on health and healthcare it begins by outlining the policies adopted by the administration with respect to the delivery of healthcare services and population health it then presents a two part assessment in the first part we examine the performance of the administration with respect to improvements in healthcare and population health in the second part we examine the healthcare policy record copyright 2013 oxford university press

confronting the coffee crisis can fair trade organic and specialty coffees reduce small scale farmer vulnerability in northern nicaragua summary this paper links changing global coffee markets to opportunities and vulnerabilities for sustaining small scale farmer livelihoods in northern nicaragua changing governance structures corporate concentration oversupply interchangeable commodity grade beans and low farm gate prices characterize the crisis in conventional coffee markets in contrast certified fair trade and organic are two alternative forms of specialty coffee trade and production that may offer opportunities for small scale producers a research team surveyed 228 farmers to measure the impact of sales on organic and fair trade markets the results suggest that participation in organic and fair trade networks reduces farmers livelihood vulnerability 2004 elsevier ltd all rights reserved

competition and equity in health care markets we provide a model where hospitals compete on quality under fixed prices to investigate how hospital competition affects i quality differences between hospitals and as a result ii health inequalities across hospitals and patient severities the answer to the first question is ambiguous and depends on factors related to both demand and supply of health care whether competition increases or reduces health inequalities depends on the type and measure of inequality health inequalities due to the postcode lottery are more likely to decrease if the marginal health gains from quality decrease at a higher rate whereas health inequalities between high and low severity patients decrease if patient composition effects are sufficiently small we also investigate the effect of competition on health inequalities as measured by the gini and the generalised gini coefficients and highlight differences compared to the simpler dispersion measures

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

market access by smallholder farmers in malawi implications for technology adoption agricultural productivity and crop income abstract in malawi maize is the major crop and food staple given limited off farm employment opportunities much needed increases in household income for improving food security must come from gains in agricultural productivity through better technology and more profitable crops in the past hybrid maize and more recently tobacco were promoted by policy for increasing smallholder income an analysis of determinants of adoption of these two crops and related income effects is presented apart from factor endowment and exposure to agroecological risks differences in the household s access to financial and commodity markets significantly influence its cropping shares and farm income