Search results

The purpose of this paper is to examine whether high-cost-sharing ambulatory care policies affect non-urgent emergency department (ED) care utilization differently among individuals with and without chronic conditions.

This retrospective cohort study used 2010–2011 US Medical Expenditure Panel Survey data. Difference-in-difference methods, multivariate logit model and survey procedures were employed. Time lag effect was used to address endogeneity concerns.

The sample included 4,347 individuals. Difference in non-urgent ED visits log odds between high- and low-cost-sharing policies was not significantly different between chronically ill and non-chronically ill individuals (β=−0.48, p=0.42). Sensitivity analysis with 15 and 25 percent cost-sharing levels also generated consistent insignificant results (p=0.33 and p=0.31, respectively). Ambulatory care incidence rates were not significantly different between high- and low-cost-sharing groups among chronically ill people (incidence rate ratio=0.849, p=0.069).

High-cost-sharing ambulatory care policies were not associated with increased non-urgent ED care utilization among chronically ill and healthy people. The chronically ill patients may have retained sizable ambulatory care that was necessary to maintain their health. Health plans or employers may consider low-level cost-sharing policies for ambulatory care among chronically ill enrollees or employees.

Findings contribute to insurance benefit design; i.e., whether high-cost-sharing ambulatory care policies should be implemented among chronically ill enrollees to maintain their health and save costs for health plans.

Purpose – To assess the claim of moral hazard proponents that individuals insulated from paying for the health care they use tend to demand more, often unnecessary, services, or engage in unhealthier behaviors than they otherwise would, collectively driving up demand and increasing health care spending (HCS).

Methodology/Approach – To test the hypothesis that moral hazard increases rather than decreases HCS, I apply a multivariate analysis to examine data from 21 OECD countries over a 20-year period, using out-of-pocket spending (OPS) as a proxy for moral hazard and as the key variable predicting HCS, controlling for other potential drivers of spending.

Findings – OPS is independently associated with HCS, yet in the direction opposite to what moral hazard theory predicts – about $13 higher HCS per additional $10 OPS (p = 0.000).

Research limitations – As with other cross-national studies, limitations include (1) inability to assess differences in health care delivery and quality within and across countries; (2) differences in the measurement and availability of variables across countries; (3) lack of access to data of potential significance, and (4) hard to evaluate cross-national political and cultural differences with implications for health policy.

Policy implications – At least in the United States, unless a fully publicly financed system to cover medically necessary services is implemented, the policy goals of extending adequate health insurance to a national population and controlling HCS nationally will not be met.

Originality/Value of Paper – Most research on moral hazard in US health care has drawn from comparisons within rather than among national health systems. Therefore, the originality and value of this cross-national study lies in its ability to identify variables that could not be included in single nation studies and which have the ability to inform policy and political action.

Contaminated food is a major source of illnesses around the world. This research seeks to learn how people assign responsibility for two food contamination risks and how they allocate costs to reduce these risks to four members of the food supply chain. The aims are to identify differences between countries and test options to control for cultural differences.

A random sample of online panellists from six countries (N = 6,090) was surveyed on how they assigned responsibility for controlling natural and accidental food contamination (traditional food safety) and for controlling intentional contamination (food defense) to farmers, transporters/distributors, retailer grocery stores/restaurants and consumers. They were also asked how they would allocate food safety and defense costs to the four groups. Differences between countries were tested with dummy variables and cultural measures.

In nearly every country, respondents assigned the least responsibility and allocated the smallest cost shares to consumers. In multivariate models, responsibility and cost-share results differed, suggesting that preferences varied by country and that respondents did not allocate costs the same way they assessed responsibility. The food safety and defense models also differed, implying that the respondents believed the two sources of contamination represented different risks.

This is the first study to examine how adults allocate the responsibility and costs for food safety and defense to farmers, transporters/distributors, retailer grocery stores/restaurants and consumers. Other research did not differentiate between these two food risks. This study also compared Hofstede's cultural measures with the recently developed Minkov's cultural measures.

The purpose of this paper is, for English acute NHS hospitals, to investigate how they operate their governance systems in the area of secondary care contracting and identify the key determinants of relationship building within the contacting/commissioning of secondary care focusing upon non‐price competitive behaviour.

A survey instrument was designed and mailed to a sample of all acute NHS hospitals in England of whom 35 per cent responded. This survey was then analysed using logit techniques.

The analysis suggests that: those NHS Trusts offering volume discounts, non‐price competitive incentives or having a strong belief in performance being by “payment by results” criteria are significantly more likely to offer augmented services to secondary care purchasers over and above contractual minima; those NHS Trusts strongly believing in the importance of non‐price factors (such as contract augmentation or quality) in the contracting process are more likely to offer customisation of generic services; and those NHS Trusts using cost‐sharing agreements to realign contracts when negotiating contracts or who strongly believe in the importance of service augmentation in strengthening relationships, or that increased hospital efficiency is the most important aspect of recent NHS reform are more likely to utilise default measures to help realign contracts.

This paper fills a gap in the area of non‐price competition in English NHS acute secondary care contracting.

Through political decisions – in the North mostly willed decisions, in the South decisions forced on them by monetary institutions in the North – governments have dismantled national controls with capital movements, profits and foreign investments. By this willed or enforced political choice – the consequences of which has seldom been spelled out to the electorates – political leaders have removed those legal and administrative tools which might have protected local economic and social systems. Directed by Western interests the World Bank and the International Monetary Fund have used and continue to use their creditor powers to pressure first the poor debtor countries of the South and then the collapsing members of the former Soviet Union to turn their own battered economies into the same kind of unrestricted markets. Last but not the least the World Trade Organization (WTO) has become a vehicle for assuring that practically the whole world is opened for the unhindered operations of private capital. This ideology, which I here term globalization, leads to a democratic deficit, increases income differences and forces new groups into poverty.

The purpose of this chapter is to highlight the dichotomous nature of two World Bank educational goals and examine how enrollment growth became prioritized over quality in Tanzania. Nestled within the theoretical framework of developmental discourse, the chapter begins with a historical review of World Bank educational policy, exploring Tanzania's lending relationship with the Bank. The chapter next evaluates the new World Bank 2020 educational strategy using the Tanzanian context to draw attention to policy strengths and weaknesses. Finally, using current research regarding World Bank policy in Tanzania, this chapter explores the implications of the new strategy on the next installment of Tanzania's SEDP policy. By locating the intersections of these policies, one may gauge a better understanding as to why the past trend of flooding Tanzania's classrooms with students has had the effect of eroding educational quality.

The aim is to investigate and group the strategic motives that firms engage in cooperative R&D by exploring a new method.

Four theories are adopted to explain the motives and they are cited as the base to categorize the motives into four factors. A survey questionnaire of participants in the aluminum industry is used to examine the empirical prevalence and clustering of these different categories of strategic motives. Factor analysis is used to test this measurement modeling.

The results of the confirmatory factor analysis support this grouping of strategic motives as reliable and valid method. Research limitations/implications – The techniques used in this study when applied to group other motives or other similar issues could produce useful information in business and management research. Moreover, the theories employed in this research can help in hypothesis development and the relationship test between the factors and the formation of R&D alliances.

The incentives such as strategic motives and the formation of R&D alliances studied in this paper can be used to investigate how they might be related to the aluminum or any other industry characteristics.

This paper contributes to the modeling of measurement model in management by exploring a new method.

This chapter explores how neoliberal higher education reforms in the United Republic of Tanzania (URT) during the 1990s and 2000s were shaped by the history of governance, schooling, and foreign donor involvement in the country following its independence in 1961. Against this backdrop, I examine how concepts of private versus public leadership, individualism, competition, and education’s place in the overall development scheme shifted over time, and the influence these changing conceptualizations had on the role of universities in Tanzania by the end of the first decade of the 21st century. In an international environment in which powerful funding agencies see neoliberal higher education policies and “knowledge societies” as the key to increased national competitiveness and poverty eradication in sub-Saharan Africa, this chapter shows how changes embedded in recent market-centered university reforms – in which the state is said to “steer” rather than “row” – have influenced the quest for equitable development.

Over the last decades, the Czech health care system has undergone significant reforms. Regardless of its good performances in terms of health care spending and improved population's health, the sustainability and functionality of the Czech system still faces important challenges. It is particularly vulnerable to economic shocks and an ageing society; it suffers from inefficiencies in hospital management and experiences profound changes in the health workforce. To tackle these problems, policy makers have been working to reform the system, but these challenges have not yet been overcome. The present chapter provides an overview of selected reforms and their outcomes. First, we describe the main features of the health care system in the Czech Republic. Then, we discuss its main sustainability problems and the policy interventions that have been implemented to tackle these problems with a particular focus on evidence provided by the health economics literature on the actual effects of the reforms.

Examines the training needs of practising professional librarians in the Kenyan public university libraries. There is a general, but false assumption, in this sector that professional librarians who have attained the minimum professional qualifications need no further training on the job. Many changes have taken place and many more are likely to occur, which are likely to affect the working environment of librarians. Librarians must be trained in preparation for managing such changes. Suggestions for sources of funding are given. The specific training needs of practising librarians are described.