ALBERT

Description: In many enterprises and other types of organizations, decision making is both a crucial and a challenging task. Despite their importance, many decisions are still made based on experience and intuition rather than on evidence supported by rigorous approaches. Decisions are often made this way because of lack of data, unknown relationships between data and goals, conflicting goals, and poorly understood risks. This research presents a goal-oriented, business intelligence-supported methodology for decision making. The methodology, which is iterative, allows enterprises to begin with limited data, discover required data to build their models, capture stakeholders goals, and model threats, opportunities, and their impact. It also enables the aggregation of Key Performance Indicators and their integration into goal models. The tool-supported methodology and its models aim to enhance the user’s experience with common business intelligence applications. Managers can monitor the impact of decisions on the organization's goals and improve both decision models and business processes. The approach is illustrated and evaluated through a retail business scenario, from which several lessons were learned. One key lesson is that once an organization has a goal model, data can be added iteratively. The example, tool support, and lessons suggest the feasibility of the methodology.

Description: The developing and least developed countries in the South and Southeast Asia have emerged as dynamic hosts of foreign direct investment; and inbound FDI growth surpassed that of the developing world during the decade 2001–2010. Yet foreign investment continues to flow quite unevenly into individual countries in the region, although majority of the Asian countries do emphasize liberalization unilaterally, bilaterally under the bilateral investment treaty (BIT) and the bilateral trade agreement (BTA), and regionally under the regional trade agreement (RTA). Under such scenarios, this study empirically assesses FDI determinants with a specific focus on the FDI effects of BIT, BTA, and RTA as well as of factors pertaining to institutional quality. Gravity-type econometric results of unbalanced panel data uncover that BIT, BTA, and RTA promote FDI insignificantly. It appears that the role of bilateral instruments in stimulating the inflow of foreign capital diminishes if liberal FDI policies already exist in the host country. Under such circumstances, the quality of the host country’s legal and regulatory environment exerts a profound influence on firms’ investment decisions. Nonetheless, core gravity variables are found to be important determinants of FDI.JEL Classification: C33, F21, F23.

Description: ObjectivesThis article aims to assess the relationship between the monetary value of informal care - approximated with the caregiver's willingness to pay to reduce caregiving time - and the caregiver's need of three types of support services: care training, respite care and support group. Developing such services may be the only way to provide sustainable informal care in the future, along with efficient allocation.Data & MethodsData used stemmed from two representative national surveys conducted by French National Institute of Statistics and Economic Studies and the French Head Office of Research, Studies, Evaluation and Statistics of the Social Affairs Ministry in 2008. The contingent valuation method was used to approximate the monetary value of informal care. The model was run on 223 informal caregivers of people with Alzheimer's Disease. Statistical analyses were performed using Heckman's two-step estimation strategy, which is known to correct selection bias. Results: On average, one hour of informal care was estimated at €12.1. Monetary value of informal care was influenced by the caregiver's need of care training (p

Description: This paper extends the classical Samuelson multiplier–accelerator model for national economy. Actually, this new modeling structure removes the basic shortcoming of the original model producing stable business cycles when realistic values of the parameters (multiplier, accelerator) are entered into the system of equations. Under this new approach, we introduce some kind of randomness and memory into the system. We assume that consumption, private investment and governmental expenditure depend upon the national income values of the last n ( n 〉 1 ) years and further assume that multiplier and accelerator factors are stochastic variables. Then stochastic delayed difference equations of higher order are employed to describe the model, while the respective solutions of higher order polynomials for the expectation of national income variables correspond to the typical observed business cycles of real economy. Stability and controllability conditions are investigated while numerical examples provide further insight and better understanding as regards the control actions, system design, and produced business cycles.

Description: Recent increases in U.S. immigration enforcement at the local and state level may be impacting remittance flows to developing countries by curtailing undocumented immigration, restricting the cyclicality of migration flows and limiting employment opportunities for the undocumented. We examine how the remitting patterns of Mexican migrants in the United States are being impacted by two types of immigration enforcement policies: police-based initiatives, such as 287(g) agreements and Secure Communities, and employment-based programs, as is the case with employment verification mandates. We find that increased enforcement reduces the share of migrants sending money home. However, legal migrants remitting money home increase their money outflows enough to offset any reductions in remittance payments from their undocumented counterparts. As a result, the average dollar amount remitted per Mexican migrant rises in the midst of increased uncertainty, safeguarding remittances as one of the least volatile sources of income in the developing world.

Description: Immigrants experience substantial disadvantages in employment in the host country. “Ethnic capital” (e.g. the ethnic network) is argued to provide a niche for immigrants. Previous international studies adopt either ethnic concentration or language as proxy for immigrants’ network in host country. In this paper we introduce a new “spatial autoregressive network approach” to construct a dynamic network variable from micro-data to capture the effects of social and resource networks for immigrants. This approach allows each individual’s self-employment decision to be geographically and ethnically correlated with that of other individuals. We further show that there are three advantages of this approach: it captures a more accurate effect of networks; it provides a better estimation of the impact of other socio-economic variables on self-employment; and it provides a better data fit. The empirical findings of this study strongly suggest that ethnic capital plays a vital role in relation to immigrants’ self-employment decisions.JEL classification codes: J23, J61, Z13

Description: Do more risk loving migrants opt for self-employment? We use a novel vignette-adjusted measure of risk preferences to investigate the link between risk aversion and entrepreneurship in migrant communities. Using an original representative household survey of the migrant population in the Greater Dublin Area, we find a significant negative relationship between risk aversion and entrepreneurship. Our results show that the use of vignettes improves the significance of the results, as they simultaneously correct for differential item functioning (where respondents interpret the self-evaluation scale in different ways) between entrepreneurs and non-entrepreneurs, and correct for variation in the use of self-evaluation scales between migrants from different countries of origin. This finding may help explaining the variability in results on the correlation between risk preferences and entrepreneurship reported in previous studies.JEL: F22; J01; J15; J61; L26

Description: ObjectivesMany European countries regulate the markets for prescription drugs in order to cope with rising health expenditures. On the other hand, regulation distorts incentives to invest in pharmaceutical R&D. This study aims at empirically assessing the impact of regulation on pharmaceutical R&D expenditures. Methods: We analyze a sample of 20 leading pharmaceutical companies between 2000 and 2008. The share of sales in Europe serves as a proxy for the degree of pharmaceutical regulation. We control for other firm specific determinants of R&D such as cash flow, company size, leverage ratio, growth rate, and Tobin’s q. Results: Our results suggest a nonlinear relationship between European sales ratio and R&D intensity. Beyond a threshold of 33% of sales generated in Europe, a higher presence in Europe is associated with lower R&D investments. Conclusion: The results can be interpreted as further evidence of the deteriorating effect of regulation on firm’s incentives to invest in R&D.

Description: Biologic drugs, as with all other medical technologies, are subject to a number of regulatory, marketing, reimbursement (financing) and other demand-restricting hurdles applied by healthcare payers. One example is the routine use of cost-effectiveness analyses or health technology assessments to determine which medical technologies offer value-for-money. The manner in which these assessments are conducted suggests that, holding all else equal, the economic value of biologic drugs may be determined by how much is spent on administering these drugs or trade-offs between drug acquisition and administration costs. Yet, on the supply-side, it seems very little attention is given to how manufacturing and formulation choices affect healthcare delivery costs. This paper evaluates variations in the administration costs of biologic drugs, taking care to ensure consistent inclusion of all relevant cost resources. From this, it develops a regression-based algorithm with which manufacturers could possibly predict, during process development, how their manufacturing and formulation choices may impact on the healthcare delivery costs of their products.

Description: Background: This contribution seeks to measure preferences for health insurance in Germany and the Netherlands, using two Discrete Choice Experiments (DCE). Since the Dutch DCE was carried out right after the 2006 health reform, which made citizens explicitly choose a health insurance contract, two research questions naturally arise. First, are the preferences with regard to contract attributes (such as Managed Care-type restrictions of physician choice), incentives (such as bonus options for no claims, deductibles, and a bonus for preventive behavior), and extra services provided by the health insurer (such as patient counseling) similar between the two countries? Second, was the requirement to explicitly choose imposed by the Dutch government in the context of the reform effective in reducing status quo bias with respect to future reforms? Results: Based on random-effects Probit estimates, these two questions can be answered as follows. First, there is resistance against Managed Care-type attributes in both populations, but Germans would have to be compensated more for giving up free physician choice. Second, their status quo bias is twice as important as among their Dutch counterparts, who apparently learned to bear the cost of information associated with future choices concerning their health insurance.JEL codesC25, D12, I18

Description: Background: Experimental designs constitute a vital component of all Stated Choice (aka discrete choice experiment) studies. However, there exists limited empirical evaluation of the statistical benefits of Stated Choice (SC) experimental designs that employ non-zero prior estimates in constructing non-orthogonal constrained designs. This paper statistically compares the performance of contrasting SC experimental designs. In so doing, the effect of respondent literacy on patterns of Attribute non-Attendance (ANA) across fractional factorial orthogonal and efficient designs is also evaluated. The study uses a ‘real’ SC design to model consumer choice of primary health care providers in rural north India. A total of 623 respondents were sampled across four villages in Uttar Pradesh, India. Methods: Comparison of orthogonal and efficient SC experimental designs is based on several measures. Appropriate comparison of each design’s respective efficiency measure is made using D-error results. Standardised Akaike Information Criteria are compared between designs and across recall periods. Comparisons control for stated and inferred ANA. Coefficient and standard error estimates are also compared. Results: The added complexity of the efficient SC design, theorised elsewhere, is reflected in higher estimated amounts of ANA among illiterate respondents. However, controlling for ANA using stated and inferred methods consistently shows that the efficient design performs statistically better. Modelling SC data from the orthogonal and efficient design shows that model-fit of the efficient design outperform the orthogonal design when using a 14-day recall period. The performance of the orthogonal design, with respect to standardised AIC model-fit, is better when longer recall periods of 30-days, 6-months and 12-months are used. Conclusions: The effect of the efficient design’s cognitive demand is apparent among literate and illiterate respondents, although, more pronounced among illiterate respondents.This study empirically confirms that relaxing the orthogonality constraint of SC experimental designs increases the information collected in choice tasks, subject to the accuracy of the non-zero priors in the design and the correct specification of a ‘real’ SC recall period.

Description: In the past three decades, farm families have relied on government payments and off-farm income to reduce income risk and increase total household income. Many studies have analyzed the role of government payments; however, little is known about the impact of health insurance coverage on labor allocation. This study builds on previous literature by using copulas to test for dependence in the labor allocation, addressing the importance of fringe benefits to the farm household, and determining how these considerations affect our knowledge of the impact of fringe benefits on off-farm labor. The results indicate that the off-farm hours worked by the operator and spouse are jointly determined; health insurance coverage is an endogenous variable. Using the predicted probability of insurance coverage and joint estimation techniques, we find a positive and highly significant relationship with the hours worked off-farm. Further, we find that both coupled and decoupled payments are negatively correlated with the hours worked off-farm.Keywords:Health insurance coverage, Endogeneity, Copula, Off-farm labor supply, Dependence, Bivariate tobit, Coupled farm programs payments, Decoupled farm program payments.

Description: Background: Diabetes Mellitus Type II (T2DM) is a major and growing medical, social and economic burden in the East-Asian country of Cambodia. However, no economic modelling has been done to predict the number of cases and the budget impact.ObjectiveThis paper forecasts the epidemiological and economic consequences of T2DM in Cambodia. The Ministry of Health and related donor agencies are supported to select the most cost-effective interventions against the disease. At the same time this paper demonstrates the relevance and potential of health economic modelling for least developed countries. Methods: We developed a Markov-Model for the specific situation of Cambodia. Data was taken from the scientific literature, grey literature in Cambodia and key-informant interviews. Results: The number of people living with T2DM is steadily increasing from 145,000 in the year 2008 to 264,000 in the year 2028 (+82 %). In the year 2008 the diagnosed T2DM patients would incur costs of some 2 million US$ to cover all of diabetes treatment. 57 % of this amount would have to be spent for OAD-therapy, the rest for insulin therapy. In the year 2028 this amount will have grown to some 4 million US$. If all patients (incl. non-diagnosed) had to be paid-for the respective figure would be 5.5 million and 11 million US$.Screening for T2DM is only cost-effective if the sensitivity of the test is high while the unit price is low. The results of this simulation call for targeting the high-risk groups. However, an increased availability of Oral Anti-Diabetic and Insulin Therapy is highly cost-effective.DiscussionType 2 Diabetes Mellitus is a major public health challenge in Cambodia. The simulations clearly indicate that prevention and treatment of this disease is highly cost-effective. However, not everything that is cost-effective might be affordable in Cambodia. This country will require external support to ease the growing burden of T2DM.

Description: During the 2000s Arab and Islamic American racial identity selection was subjected to an exogenous racializing event, viz., public and private reaction to the Al Qaeda attacks of September 11, 2001. The Al Qaeda attacks clearly demarcate a period in which there was a structural increase in the intensity of US stigmatization of persons with Islamic religious affiliation and Arab ethnicity. This stigmatization created an exogenous reduction in the expected payoff to acculturation relative to non-acculturation. This paper uses self-identification as white as its measure of acculturation and the fraction of all hate crimes directed at Muslims as its measure of stigmatization after 9/11. Comparing 2002–2012 to 1996–2001, there is a statistically significant and substantively large decrease in the unconditional and conditional probabilities that Arab and Islamic Americans will self-identify as white. The data are combined cross sections of the Current Population Survey Annual Social and Economic Supplement.Keywords:Race, Identity, Arab, Muslim, Islam, September 11.

Description: The next generation of artificial vision devices (AVDs), which is currently developed in pre-clinical settings, has the potential to improve the vision of blind patients with retinitis pigmentosa (RP) in a manner that they will be categorized as visual impaired but no more as blind. This unprecedented vision improvement will result in a mentionable quality of life gain which poses the question at which costs the next generation AVDs are to be regarded as cost-effective, from a German healthcare payer perspective. In order to answer this research question a Markov model was developed to simulate and to compare the costs and effects of next generation AVDs versus best supportive care (BSC). Applying the base case settings resulted in incremental costs of €107,925, in 2.03 incremental quality-adjusted life years (QALYs) and in a cost-effectiveness ratio of €53,165 per QALY gained. Probabilistic and deterministic sensitivity analyses as well as scenario analyses for the effect size and the AVD costs were performed in order to investigate the robustness of results. In these scenario analyses a strong variation of the cost-effectiveness results was obtained ranging from €23,512 (best case) to €176,958 (worst case) per QALY gained by AVD therapy. This early health economic evaluation has to handle with three main uncertainty factors: the effect size of next generation AVDs, the costs of next generation AVDs and the WTP threshold that might be applied in RP patients, which reflect the main limitations of the presented assessment. In conclusion the presented early cost-effectiveness evaluation has obtained that next generation AVDs have the potential to be a cost-effective therapy option in patients with RP in Germany. The innovative nature, the high unmet medical need and the expected unprecedented efficacy of next generation AVDs will highly likely lead to the case that even relatively high incremental cost-effectiveness ratios, that have been obtained when simulating various effect and pricing scenarios, will be regarded as acceptable from a German healthcare payer perspective.

Description: Background: EQ-5D-3L valuation studies continue to employ the MVH protocol or variants of MVH. One issue that has received attention is the selection of the states for direct valuation by respondents. Changes in the valuation subset have been found to change the coefficients of the utility function. The purpose of this study was to test the performance of valuation subsets based on orthogonal experiment designs. The design of the study also allowed a comparison of models based on raw or untransformed VAS values with values transformed at the level of the respondent and at the aggregate level. Methods: Two different valuation subsets were developed based on orthogonal arrays. A VAS elicitation was undertaken with two groups of similar respondents and the resulting utility functions based on the valuations of the two different valuation subsets were compared using mean absolute errors between model and observed values, and by correlation with values in and out of sample. The impact of using untransformed versus VAS values transformed at the level of the individual and at aggregate level and the inclusion of a constant term in the utility functions were also investigated. Results: The utility functions obtained from the two valuation subsets were very similar. The models that included a constant and based on raw VAS values from the two valuation studies returned rank correlation coefficients of 0.994 and 0.995 when compared with respective observed values. MAEs of model values with observed values were 2.4% or lower for all models that included a constant term. Several models were developed and evaluated for the combined data (from both valuation subsets). The model that included the N3 term performed best. Conclusions: The finding that two very different valuation subsets can produce strikingly similar utility functions suggests that orthogonal designs should be given some attention in further studies. The impact of rescaling VAS values at the level of the individual versus at aggregate level had minimal impact on the performance of the models when compared to models based on the raw VAS values.

Description: The correct definition of the product market and of the geographic market is a prerequisite for assessing market structures in antitrust cases. For hospital markets, both dimensions are controversially discussed in the literature. Using data for the German hospital market we aim at elaborating the need for differentiating the product market and at investigating the effects of different thresholds for the delineation of the geographic market based on patient flows. Thereby we contribute to the scarce empirical evidence on the structure of the German hospital market. We find that the German hospital sector is highly concentrated, confirming the results of a singular prior study. Furthermore, using a very general product market definition such as “acute in-patient care” averages out severe discrepancies that become visible when concentration is considered on the level of individual diagnoses. In contrast, varying thresholds for the definition of the geographic market has only impact on the level of concentration, while the correlation remains high. Our results underline the need for more empirical research concerning the definition of the product market for hospital services.Keywords:Hospital market, Concentration, Product market, Geographic market, Germany.

Description: ObjectiveTo obtain detailed real-world data on persistence and dosing patterns in the utilisation of the TNF inhibitors adalimumab, etanercept, and infliximab in rheumatoid arthritis (RA) patients treated in Germany. Methods: In this retrospective observational study claims data of a major German health insurance fund between 2005 and 2008 were analysed. Patients receiving at least one prescription of adalimumab, etanercept or infliximab were identified and categorised as “TNF inhibitor naive" or “TNF inhibitor continuing”. For the calculation of TNF inhibitor persistence a survival analysis with the Kaplan–Meier estimator was used. A Cox regression was used to analyse, if any relevant factors were influencing persistence. Dosage increase rates were analysed for adalimumab, etanercept and infliximab. Sensitivity analyses based on variations in gap length were conducted. Results: A total of 2,201 RA patients were identified. 1,468 of these patients were TNF inhibitor naive patients and 733 were defined as TNF inhibitor continuing patients. There were no significant differences in the treatment persistence rates between adalimumab, etanercept and infliximab for TNF inhibitor naive and continuing patients. The persistence rate after three years was 22.47% for adalimumab, 24.27% for etanercept and 21.49% for infliximab naive patients. For continuing patients, the persistence rate after three years was 32.88% for adalimumab, 30.95% for etanercept, and 33.90% for infliximab, respectively. Gender, medication and Charlson Comorbidities Index did not influence the persistence significantly. Dosage increase occurred in 7.3% adalimumab, 1.4% etanercept, and 17.2% infliximab naive patients and 5.8%, 1.1% and 11.9% respectively in the continuing patients. Conclusions: In this study, there were no significant differences in persistence among adalimumab, etanercept and infliximab treated patients. Consistent with previous research, there was a higher dose escalation for infliximab than for the two subcutaneous treatments, adalimumab or etanercept.

Description: The paper investigates the effect of adequate use of prenatal care on birth weight in Kenya using data from the Kenya Demographic and Health Survey of 2008–2009 together with additional administrative data. Both a single–level model and a multi–level model are estimated. The estimation strategy controls for potential sample selection bias, potential endogeneity of prenatal care, and potential unobserved heterogeneity. The results indicate that adequate use of prenatal care increases birth weight, holding other factors constant. We further observe that the single–level model overstates the effect of prenatal care on birth weight. The results imply that infant health can be improved by using prenatal care adequately. The study calls for the pursuit of policies that encourage adequate use of prenatal care by expectant mothers such as ensuring availability of skilled health care providers such as doctors and nurses at prenatal care clinics, reducing the average distances mothers have to cover when seeking prenatal care services, intensifying education of females as a way of empowering them to be able to make the right choices regarding when to seek prenatal care and from whom, and increasing income opportunities for households.

Description: Early benefit assessment in Germany under the legislative framework of AMNOG (Arzneimittelmarktneuordnungsgesetz) requires direct comparisons of the new drug with appropriate comparators determined by the Federal Joint Committee (G-BA). In case no head-to-head studies are available for direct comparisons, the submission of indirect comparisons is permitted to assess the additional benefit of the new drug. However, the Institute for Quality and Efficiency in Health Care (IQWiG) states a clear preference for head-to-head trials and defines strict requirements for indirect comparisons to be considered in the benefit assessment. Similar requirements also exist in other countries with mandatory health technology assessments (HTA), like France, England and Scotland. Our evaluation shows that a comparison of the different HTA regarding indirect comparisons is difficult. Overall, external preconditions and methodological requirements are demanding and hardly to fulfill by pharmaceutical companies for implementation of indirect comparisons in early benefit assessment. The determination of the appropriate comparators, outcomes, patient subgroups and study choice are the main target within indirect comparisons for the future. To compare and assess submitted indirect comparisons it would be desirable that a transparent process was established, including the mandatory publication of HTA-reports within Europe and international guidelines, accepted by a large number of HTA-agencies.JEL classification:I18.

Description: Background: Child malnutrition remains widespread in many developing countries. Malnutrition during infancy may substantially increase vulnerability to infection and disease, and the risk of premature death. Malnutrition in children may also lead to permanent effects and to their having diminished health capital later in life as adults. These negative consequences of child malnutrition entail that the reduction of child malnutrition is vital for the social-economic development of countries. Urban children generally have better nutritional status than rural children. Malawi is no exception in this regard. The objective of this paper is to explore how much of the rural-urban nutrition gap in Malawi is explained and how much is unexplained by differences in characteristics.MethodUsing data from the 2006 multiple indicator cluster survey (MICS), the paper used the Nopo decomposition method to decompose the rural-urban malnutrition gap. This nonparametric method takes into account the fact that the supports of the distributions of characteristics between the two areas can be different. Results: The results show that 90% and 89% of the stunting and underweight gaps respectively would be eliminated if there were no urban children with combinations of characteristics which positively influence child nutrition that remain entirely unmatched by rural children. Further to that, 4% and 6% of the stunting and underweight gaps respectively would disappear if there were no rural children with combinations of characteristics which negatively affect child nutrition that remain entirely unmatched by urban children. Conclusions: These findings suggest that the characteristics which negatively affect child nutrition in rural areas play a small role in the gap, and that most of the gap is largely due to the favourable characteristics such as better parental education and better household economic status among others that urban children have. The findings imply that in order to reduce the malnutrition gap policy interventions should focus more on ensuring that the favourable characteristics that urban children have such as better parental education, better household economic status among others are also available to rural children.

Description: Background: BRAC, a large Bangladeshi NGO, recently has been using female volunteer community health workers (CHWs) in Dhaka urban slums to provide maternal and child health services. Due to erratic performance-based income and higher opportunity cost the urban CHWs lose motivation which contributes to high dropout and poor performance. This results challenges for the cost effectiveness and sustainability of the urban health program. CHWs also consider their performance-based income very low compare to their work load. So, CHWs raise their voice for a fixed income. In order to understand this problem we explored fixed income for CHWs and the correlates that influence it. We surveyed a sample of 542 current CHWs. We used bidding game approach to derive the equilibrium reservation wage for CHWs for providing full-time services. Then, we performed ordered logit models with bootstrap simulation to identify the determinants of reservation wage. Results: The average reservation wage of CHWs to continue their work as full-time CHWs rather than volunteer CHWs was US$24.11 which was three times higher than their current performance-based average income of US$ 8.03. Those CHWs received additional health training outside BRAC were 72% and those who joined with an expectation of income were 62% more likely to ask for higher reservation wage. On the contrary, CHWs who were burdened with household loan were 65% and CHWs who had alternative income generating scope were 47% less likely to ask for higher reservation wage. Other important factors we identified were BRAC village organization membership, competition with other health services providers, performance as a CHW, and current and past monthly CHW income. Conclusions: The findings of this study are relevant to certain developing countries such as Bangladesh and Tanzania which commonly use volunteer CHWs, and where poor retention and performance is a common issue due to erratic and performance-based income. So, the study has implications in improving retention of health workers as well as their level of performance. The study also suggests that the financial incentives provided to CHWs should be clearly based on their qualifications and opportunity cost to ensure a high performing and motivated health workforce.

Description: Recent empirical evidence links migrant remittances, savings and return migration, and stresses the inaccuracy of return migration plans. This paper presents a model of endogenous remittances, savings and return decisions under uncertainty. In our framework, migrants make remittance and saving decisions at an early stage of migration, when their long term economic performance in the host country is still uncertain. Over time, information about professional prospects is acquired, and conditionally on past decisions, migrants adjust their return plans. We show that when migrants expect large gains from migration and face relatively low wage risks in the host country, they tend to remit less, save more and are less likely to return migrate. These results are in line with recent empirical evidence and provide a rationale for the support by relatives in the sending country of low-skill, illegal migration.JEL codes D13; D80; JE

Description: By examining the preferences over migration destinations of those revealing a desire to permanently leave their country, this paper provides new evidence on the relevance of subjective measures for cross country comparisons. While hard statistics such as GDP per capita and unemployment rates are commonly used to measure a country’s success, this analysis reveals that people’s preferences over alternative migration destinations are better explained by average levels of life satisfaction in the destination country. Aggregated measures of subjective well-being are, therefore, useful for international comparisons as they better reflect what makes some countries more attractive than others.JEL:F22; I30

Description: This paper applies the framework for pro-poor analysis to welfare changes from a CGE-microsimulation model to analyze what are the better or worse models for agriculture modernization, and to estimate the contribution of growth and redistribution to changes in poverty in DRC. The findings indicate that labor-using technological change generates absolute and relative pro-poor effects whereas capital-using technological change leads to immiserizing growth. More importantly, the results suggest that labor-using technological change can be independently sufficient for reducing poverty via the income growth effects. This study also highlights how developing input supply networks, securing tenure among smallholders, and improving access to land for women are important for pro-poor agricultural modernization.JEL Classification:C68, D33, O33, Q10, Q18.

Description: We focus on high school dropout rates among male and female immigrant children. We consider the relationship between the dropout rate and age at arrival of the immigrants. Using repeated cross sectional data from the Israeli Labor Force Surveys of 1996-2011 we show that the share of high school dropouts among immigrant children who arrived from the Former Soviet Union during 1989-1994 is at least double that of natives in the same age group. Further, we show that among immigrant youth there is a negative relation between age at arrival and the share of high school dropouts. To understand our results we present a theoretical framework that links between age at arrival in the host country, language proficiency, quality of education and wages.Keywords:Immigrants, Age at arrival, High-school dropouts.

Description: Over the past decade or so, there has been widespread recognition that a large and growing proportion of the global workforce is employed in informal sector enterprises. To explain this, neo-liberals contend that enterprises operate in the informal sector due to high taxes, public sector corruption and too much state interference in the free market and that the remedy is therefore to reduce taxes, public sector corruption and the regulatory burden via minimal state intervention. To evaluate critically this neo-liberal policy approach, this paper explores whether cross-national variations in the share of the workforce in informal sector enterprises are associated with cross-national variations in the level of tax rates, corruption and state interference. To do this, International Labour Organisation data on the share of the workforce in informal sector enterprises in 43 developing and transition economies is compared with cross-national variations in tax rates, corruption and levels of state intervention using World Bank development indicators. The finding is that there is little or no evidence to support the neo-liberal policy approach that decreasing tax rates, public sector corruption and the regulatory burden via minimal state intervention, reduces the share of the workforce in informal sector enterprises. Instead, higher tax rates and levels of regulation and state intervention are found to be associated with lower (not higher) levels of employment in informal sector enterprise. The paper concludes by discussing the theoretical and policy implications.

Description: This paper studies the respective influences of intergenerational transmission and the environment in shaping individual trust. Focusing on second generation immigrants in Australia and the United States, we exploit the variation in the home country and in the host country to separate the effect of cultural transmission from that of the social and economic conditions on individual trust. Our results indicate that trust in the home country contributes to the trust of second generation immigrants in both of the host countries, and marginally more in the United States. Social and economic conditions in the host country also affect individual trust.JEL classificationJ15, O15, Z10

Description: Addiction has attracted considerable attention in health and behavioral economics, and economists have attempted to understand addiction from the viewpoint of decision making over time. This paper investigates whether two time preference parameters can successfully predict smoking status, including cigarette dependence. Both the present bias and the constant time preference parameters account for smoking behavior status and cigarette dependence.

Description: This paper analyses the impact that diversity has on life satisfaction of people living in England. In England, and in many other countries, local communities are becoming more diverse in terms of country of birth, ethnicity and religion of residents, with unclear consequences on the well-being of people living in these communities. The results suggest that white British people living in diverse areas have on average lower levels of life satisfaction than those living in areas where diversity is low, while there is no correlation on average between diversity and life satisfaction for non-white British people and foreign born.JEL codesJ31, J61, R23

Description: The rationalization of the healthcare processes and organizations is a task of fundamental importance to grant both the quality and the standardization of healthcare services, and the minimization of costs. Clinical Practice Guidelines (CPGs) are one of the major tools that have been introduced to achieve such a challenging task. CPGs are widely used to provide decision support to physicians, supplying them with evidence-based predictive and prescriptive information about patients' status and treatments, but usually on individual pathologies. This sets up the urgent need for developing decision support methodologies to assist physicians and healthcare managers in the detection of interactions between guidelines, to help them to devise appropriate patterns of treatment for comorbid patients (i.e., patients affected by multiple diseases).We identify different levels of abstractions in the analysis of interactions, based on both the hierarchical organization of clinical guidelines (in which composite actions are refined into their components) and the hierarchy of drug categories. We then propose a general methodology (data/knowledge structures and reasoning algorithms operating on them) supporting user-driven and flexible interaction detection over the multiple levels of abstraction. Finally, we discuss the impact of the adoption of computerized clinical guidelines in general, and of our methodology in particular, for patients (quality of the received healthcare services), physicians (decision support and quality of provided services), and healthcare managers and organizations (quality and optimization of provided services).

Description: Entrepreneurs allocate resources among different activities that generates a profit; in particular, in this paper entrepreneurs consider at each instant of time both innovation and rent-seeking as alternative sources of profit. The consequences in terms of economic growth are obviously quite different: the higher the amount of innovations in the economy the higher the rate of economic growth and vice versa. What are the determinants of these different entrepreneurial behavior? Is there anything in the nature of entrepreneurs that essentially distinguishes between innovators and rent seekers? A main claim of this paper is that differences among entrepreneurs are not essential but of degree: all of them are in fact profit-seekers and the only difference is to be found in their attitude towards innovation as a source of profit. In this sense entrepreneurial effort is defined and modelled for each entrepreneur according to its propensity to innovate and the corresponding Entrepreneurial Problem (EP) is posed and solved both analytically and via simulation in terms of profit maximization. The individual decisions measured in units of innovation are then aggregated to calculate the innovation quantity for a given population based on the distribution of heterogeneous entrepreneurs. The entrepreneurship rate and the implications for economic growth are also modelled. Consequently, policy makers should focus on reducing the entry barriers and the costs of production in order to stimulate the entrepreneurial activity and maximize the innovation quantity.

Description: Correspondence studies can identify the extent of discrimination in hiring as typically defined by the law, which includes discrimination against ethnic minorities and females. However, as Heckman and Siegelman (1993) show, if employers act upon a group difference in the variance of unobserved variables, this measure of discrimination may not be very informative. This issue has essentially been ignored in the empirical literature until the recent methodological development by Neumark (2012). We apply Neumark’s method to a number of already published correspondence studies. We find the Heckman and Siegelman critique relevant for empirical work and give suggestions on how future correspondence studies may address this critique.JEL classificationJ71

Description: This paper studies the individual-level relationship between immigration and property crime in England and Wales using crime self-reports from the Crime and Justice Survey. Models that account for underreporting are used, since this is a major concern in crime self-reports. The results indicate that the reported crime is substantially underreported, but if anything, immigrants are less likely to underreport than natives. More importantly, controlling for underreporting and basic demographics, the estimates across all model specifications, although imprecise, indicate that immigration status and property crime are negatively associated. We finally find that the estimated relationship between immigration status and property crime differs across regions and ethnic groups.JEL CodesK42, J15, J22, C25, C51

Description: Background: The prospective reimbursement of hospitals through the grouping of patients into a finite number of categories (Diagnosis Related Groups, DRGs), is common to many European countries. However, the specific categories used vary greatly across countries, using different characteristics to define group boundaries and thus those characteristics which result in different payments for treatment. In order to assist in the construction and modification of national DRG systems, this study analyses the DRG systems of 10 European countries.AimsTo compare the characteristics used to categorise patients receiving a coronary artery bypass graft (CABG) surgery into DRGs. Further, to compare the structure into which DRGs are placed and the relative price paid for patients across Europe.MethodPatients with a procedure of CABG surgery are analysed from Austria, England, Estonia, Finland, France, Germany, Ireland, Poland, Spain and Sweden. Diagrammatic algorithms of DRG structures are presented for each country. The price in Euros of seven typical case vignettes, each made up of a set of a hypothetical patient’s characteristics, is also analysed for each country. In order to enable comparisons across countries the simplest case (index vignette) is taken as baseline and relative price levels are calculated for the other six vignettes, each representing patients with different combinations of procedures and comorbidities. Results: European DRG payment structures for CABG surgery vary in terms of the number of different DRGs used and the types of distinctions which define patient categorisation. Based on the payments given to hospitals in different countries, the most resource intensive patient, relative to the index vignette, ranges in magnitude from 1.37 in Poland to 2.82 in Ireland. There is also considerable variation in how much different systems pay for particular circumstances, such as the occurrence of catheterisation or presence of comorbidity. Conclusion: Past experience of the construction of DRG systems for CABG patients demonstrates the variety of options available. It also highlights the importance of updating systems as frequently as possible, to incentivise best practice.

Description: In the majority of children and adolescents with epilepsy, optimal drug therapy adequately controls their condition. However, among the remaining patients who are still uncontrolled despite mono-, bi- or tri-therapy with chronic anti-epileptic treatment, a rescue medication is required. In Western Europe, the licensed medications available for first-line treatment of prolonged acute convulsive seizures (PACS) vary widely, and so comparators for clinical and economic evaluation are not consistent. No European guidelines currently exist for the treatment of PACS in children and adolescents and limited evidence is available for the effectiveness of treatments in the community setting. The authors present cost-effectiveness data for BUCCOLAM® (midazolam oromucosal solution) for the treatment of PACS in children and adolescents in the context of the treatment pathway in seven European countries in patients from 6 months to 18 years. For each country, the health economic model consisted of a decision tree, with decision nodes informed by clinical data and expert opinion obtained via a Delphi methodology. The events modelled are those associated with a patient experiencing a seizure in the community setting. The model assessed the likelihood of medication being administered successfully and of seizure cessation. The associated resource use was also modelled, and ambulance call-outs and hospitalisations were considered. The patient’s quality of life was estimated by clinicians, who completed a five-level EuroQol five dimensions questionnaire from the perspective of a child or adolescent suffering a seizure. Despite differences in current therapy, treatment patterns and healthcare costs in all countries assessed, BUCCOLAM was shown to be cost saving and offered increased health-related benefits for patients in the treatment of PACS compared with the current local standard of care.

Description: In recent years, migrant entrepreneurs have come to occupy a prominent place in the SME sector in many cities in developed countries, with varying degrees of success. The concept of migrant entrepreneurship suggests a homogeneous set of actors, but it remains to be seen whether differences in cultural and ethnic backgrounds, in education, in age and gender, and in motivational profiles lead to contrasting business outcomes. The present paper aims to identify and compare differences in the economic performance of individual migrant business firms on the basis of a quantitative assessment of the drivers of their efficiency profiles. In this context, we will address in particular the drivers and barriers for the heterogeneous business strategies of specific classes of migrant entrepreneurs. After the use of a multivariate statistical analysis, a modern operational approach–originating from organizational theory–that aims to make a comparative study of quantitative efficiency differences between individual decision-making units (DMUs), viz. Data Envelopment Analysis (DEA) is employed. DEA is used here to assess relative performance differences between distinct categories of migrant entrepreneurs in the city of Amsterdam. A wealth of relevant data has been collected by systematic, personally-supervised interviews and questionnaires, and these contain a variety of efficiency-oriented indicators, on both the input and the output side. Several additional analyses ─ using multivariate cross-analysis methods ─ are also carried out to test the robustness of our findings by, inter alia, investigating the influence of specific socio-cultural ethnic groups, levels of education, first-and second-generation migrants, and age. Finally, the paper offers some lessons on entrepreneurship strategies.Jel codesR10, O15, L26.

Description: The degree at which entrepreneurship affects the economy depends on numerous factors, including the quality, gender composition, and type of entrepreneurial activity. Gender equality and female entrepreneurship are key factors in economic development. In order to study the relationship between gender equality and the rate of female entrepreneurship, this paper investigates how gender-related economic development and women entrepreneurial activity are related. We characterize the relationship between gender-related development indices (introduced by the United Nations) and different stages of women entrepreneurial activity (created by Global Entrepreneurship Monitor, GEM) through a correlation analysis. Our results suggest that female entrepreneurial activity is not significantly correlated with gender equality.

Description: ObjectivesTo evaluate the long-term cost-effectiveness of ticagrelor and ASA versus generic and branded clopidogrel and ASA in patients with ACS based on a Thai cost database. Methods: A one-year decision tree and a long-term Markov model were constructed to estimate lifetime costs and quality-adjusted life years (QALYs). For the first year, data from PLATO (NCT00391872) were used to estimate the rate of cardiovascular events, resource use, and QALYs. For year 2 onwards, clinical effectiveness was estimated conditional on individual health states that occurred during the first year. Results: In the base-case analysis, the incremental cost-effectiveness ratio (ICER) with ticagrelor was 292,504 ($9,476) and 60,055 ($1,946) THB($)/QALY compared with generic and branded clopidogrel, respectively. The probability of ticagrelor being cost-effective was above 99% at a threshold of 160,000 THB/QALY compared with branded clopidogrel. Conclusions: This health economic analysis provides cost effectiveness data for ticagrelor compared with both generic and branded clopidogrel in Thailand. Based on this analysis, it appears that ticagrelor is an economically valuable treatment for ACS compared with branded clopidogrel within the Thai context.

Description: Fatalities from illegal immigration from Africa to Europe are a grave reality. The phenomenon represents a major challenge for both home and host countries. Nonetheless, almost nothing is known about how the motivations of potentially illegally migrating individuals are formed. This paper aims to explain the factors behind the formation of the willingness to migrate illegally knowing that death might occur during the trip. I focus on the role of expectations, friends and relatives who have migrated and host countries policies. By using an original survey among Senegalese residing in Dakar in 2006-2007, I show that potential illegal migrants are willing to accept a substantial risk of death. I find that high expectations and migrant networks are positively related with illegal migration motivations. Surprisingly, I find that stricter immigration policies deter potential legal migrants much more than potential illegal migrants.Finally, I find that the price of illegal migration is negatively correlated with the willingness to migrate illegally.JEL Code:F22, O15

Description: Background: Blood collection following nonstandard operations largely increases the risks of infectious diseases through cross-contamination. Commercial plasma donation and the resulting HIV/AIDS and hepatitis C epidemics in central China in the 1990s killed more than one million people. Many blood banks have since moved to more remote southwest provinces, which have become new suppliers of blood plasma. Methods: Utilizing a primary longitudinal survey, this paper documents commercial plasma donation and estimates its negative health impacts in impoverished rural China using individual fixed effect models. Both the linear regression model and generalized linear models are utilized. Results: Attracted by the financial compensation, a majority of plasma donors are poor, and bear grave consequences of malnutrition and worse health status as a result of unhygienic and frequent donations. Donating plasma is associated with a .83 standard deviation (SD) decline in self-rated health, a .54 SD lower self-rated health relative to peers in their age group, a .74 SD higher chance of being infected with hepatitis, lacking of strength to conduct farm work, and experiencing appetite loss, fatigue, nausea, and vomiting.DiscussionResults indicate an urgent need of more comprehensive and effective interventions on hepatitis screening, diagnosis, and treatment among plasma donors in less developed contexts to eliminate cross-infection of infectious diseases and possible widespread epidemic in the future. Besides, we should encourage voluntary plasma donation to gradually crowd out paid donation.

Description: Background: The amount of out-of-pocket (OOP) payments within the German health care system has risen steadily within the last years. OOP payments aim to strengthen patients’ cost awareness and try to restrict the demand on medical necessary treatments. However, besides the intended decline of non-induced health care services there’s a risk that people also forgo necessary treatments because the utilization of health care services depends not only on need-factors but also on the ability to pay for it.Therefore, this paper aims to analyze the determinants of the total amount of OOP payments, the financial burden caused by OOP payments and the relinquishment of health care services due to OOP payments.Data and methodsThe empirical analysis is based on cross-sectional data of the German subsample (n = 2851) of the Survey of Health, Ageing and Retirement in Europe (SHARE). SHARE is a representative panel study among private households with persons above the age of 50 years and covers a wide range of topics, e.g. health behavior, health status and information about the socio-economic status. The analysis of the independent variables “total amount of OOP payments”, “financial burden due to OOP payments” and “forgone care” is carried out by the means of descriptive as well as multivariate regression methods. Results: Individuals with low income as well as people suffering from chronic illnesses face a higher financial burden and forgo health care services more frequently at the same time. E.g. the financial burden of people who belong to the lowest income quintile is about eight times higher compared to individuals who belong to the highest quintile. The probability of forgone care for this group is about 5.6 percentage points higher [95% CI: 5.2 – 6.0]. Conclusion: Especially for the group of people with chronic illnesses and low-income earners it cannot be ruled out that they also forgo necessary medical treatments due to the relatively high financial burden they face. Hence, it is required to facilitate the access to necessary care for these groups.

Description: Background: In the day surgery system are intertwined elements of state health policy, health care payers’ interests, employers of health care system, as well as the interests and wishes of patients. A problem in the health policy is to find a way to regulate ambulatory and short-term surgical procedures, which are hardly distinguishable, and still fulfil the requirements of transparent financing, quality and security. The objective of this paper is to highlight the reasons for the long-term stagnation in Slovakia day surgery and the possibilities of eliminating the structural drivers causing this negative phenomenon. Methods: Due to the nature of the analyzed data and desired outcomes, we selected application of correspondence analysis. Results of correspondence analysis provide valuable information necessary for the projection of specialization of one day surgery clinics for that type of procedure, as well as for the support of the new clinics creation (also with the potential state support), the pricing policy, systemic reduction of beds what is connected with reduction of underutilized departments in hospitals, in order to optimize management processes in the healthcare system. Results: Contribution reveals negative aspects which causing a low level of day surgery in Slovakia. Moreover, it reveals the approaches of the different subjects of day surgery. Presented options for setting optimal strategy supporting its development are based on the results of the analysis. Correspondence analysis provided valuable information of present structure of the day surgery system. The determined similarity of the regions and association of specialized fields indicate specific settings of the day surgery system and its components that are inevitable to analyze in the subsequent analytical process. Conclusions: Results of the analysis are very important in order to set up the system measures in the process of its further development, which should be part of the strategic plan of each health system. On conceptual and methodological issues related with reporting of day surgery performances are highlighting international organizations such as the OECD,WHO.JEL classificationI13, I18, H51

Description: After the introduction of the freedom of movement for Eastern European workers, EU-15 countries were expected to reduce public benefits in order to avoid becoming “welfare magnets”. However, OECD data do not support the prediction of a race to the bottom in benefit levels. Using EU-LFS data, I analyze the determinants of migration flows and do not find evidence that welfare state variables affect migration flows when controlling for temporary political restrictions of the freedom of movement. This explains why the pressure to modify welfare spending is small. Furthermore, evidence is found that the restrictions offset the migration incentive effects of work-related pull factors.

Description: Background: The aim of this study is to estimate the cost of care and treatment for extremely low birth weight (ELBW) neonates admitted to a teaching and referral hospital. This cost estimation project can help health policy makers and planners make decisions and develop plans for perinatal service staging programs and better management of NICUs (Neonatal Intensive Care Units). Methods: This cohort study performed on 50 extremely low birth weight neonates (w ≤ 1000gr) born in Vali-e Asr Hospital, Tehran-Iran in the period of March 2012 to September 2013. This teaching and referral hospital had 15 NICU beds as well as an active neonatal growth and development follow-up clinic with a pediatric neurodevelopment specialist during the period of the study. Cases would undergo initial developmental visits and preventative measures immediately after being admitted to the ward. Also after discharge, they were followed up monthly for six months and then every two months, during first year of life. Results: Overalls, 23 newborns -46% of ELBW and 40% of total neonatal mortality rate (that amounted 55) died during hospital stay. Beside hospitalization, the major part of expenses was related to medication and medical supplies. All neonates needing rehabilitation underwent this type of intervention for one year. The mean cost of rehabilitation in neonates with no insurance coverage was 6700 US Dollars per year, which is reduced by half (3350 US Dollars) when covered by insurance. Conclusion: Medication, medical supplies and equipment cost was significantly high. This is especially due to the fact that the present types of insurances do not cover such expenses very well, forcing parents to pay themselves. Insurance systems are expected to take this issue into immediate account.

Description: ObjectiveTo determine parental willingness-to-pay (WTP) for childhood obesity prevention. Methods: Cross-sectional data from the follow-up measurements (2011) of a health promotion programme in German primary schools. Data collection included anthropometric measurements of children and self-administered questionnaires for parents, including WTP assessment. Mann–Whitney U-Test was used for differences between groups, and regression analysis to identify factors associated with general WTP and amount of WTP. Results: From 1 534 parents, 97.8% considered overweight/obesity to be serious public health problems. A general WTP to reduce the incidence of childhood overweight/obesity by half, was declared by 48.8%. Parents of overweight/obese children showed with 61.4%, significantly more frequently, their general WTP than the others with 47.2% (p = 0.001). Mean WTP was €23.04 (99% confidence interval (CI) [22.45; 23.75]) per month. Parents of centrally obese children showed significantly higher WTP than parents of the other children (p = 0.001). General WTP and the amount of WTP were associated with the central obesity of the child, migration status and household income. Additionally, general WTP was associated with maternal obesity. Conclusions: Nearly half of the parents were willing to invest in prevention of obesity. The general WTP significantly occurs more often and with higher amount in affected parents.

Description: The HIV/AIDS disease represent a priority for all health authorities in all countries and it also represents serious added socioeconomic problems for societies over the world. The aim of this paper is to analize the economic impact associated to the HIV/AIDS in an European context. We conducted a systematic literature review for five different countries (France, Germany, Italy, Spain and United Kingdom) and searched five databases. Three types of analyses were undertaken: descriptive statistics; quantitative analysis to calculate mean costs; and comparison across countries. 26 papers were included in this study containing seventy-six cost estimates. Most of the studies analyzed the health care cost of treatment of HIV/AIDS. Only 50% of the cost estimates provided mean lymphocyte count describing the patients’ disease stage. Approximately thirty percent of cost estimates did not indicate the developmental stage of the illness in the patients included. There is a high degree of variability in the estimated annual cost per patient of the treatments across countries. There is also a great disparity in total healh care costs for patients with lymphocyte counts between 200CD4+/mm3 and 500 CD4/mm3, although the reason of variation is unclear. In spite of the potential economic impact in terms of productivity losses and cost of formal and informal care, few studies have set out to estimate the non-medical costs of HIV/AIDS in the countries selected. Another important result is that, despite the low HIV/AIDS prevalence, its economic burden is very relevant in terms of the total health care costs in this five countries. This study also shows that there are relatively few studies of HIV costs in European countries compared to other diseases. Finally, we conclude that the methodology used in many of the studies carried out leaves ample room for improvement and that there is a need for these studies to reflect the economic impact of HIV/AIDS beyond health care including other components of social burden.

Description: Background: Rheumatoid arthritis (RA) is a chronic, inflammatory disease with severe effects on the functional ability of patients. Due to the prevalence of 0.5 to 1.0 percent in western countries, new treatment options are a major concern for decision makers with regard to their budget impact. In this context, cost-effectiveness analyses are a helpful tool to evaluate new treatment options for reimbursement schemes.ObjectivesTo analyze and compare decision analytic modeling techniques and to explore their use in RA with regard to their advantages and shortcomings. Methods: A systematic literature review was conducted in PubMED and 58 studies reporting health economics decision models were analyzed with regard to the modeling technique used. Results: From the 58 reviewed publications, we found 13 reporting decision tree-analysis, 25 (cohort) Markov models, 13 publications on individual sampling methods (ISM) and seven discrete event simulations (DES). Thereby 26 studies were identified as presenting independently developed models and 32 models as adoptions. The modeling techniques used were found to differ in their complexity and in the number of treatment options compared. Methodological features are presented in the article and a comprehensive overview of the cost-effectiveness estimates is given in Additional files 1 and 2.DiscussionWhen compared to the other modeling techniques, ISM and DES have advantages in the coverage of patient heterogeneity and, additionally, DES is capable to model more complex treatment sequences and competing risks in RA-patients. Nevertheless, the availability of sufficient data is necessary to avoid assumptions in ISM and DES exercises, thereby enabling biased results. Due to the different settings, time frames and interventions in the reviewed publications, no direct comparison of modeling techniques was applicable. The results from other indications suggest that incremental cost-effective ratios (ICERs) do not differ significantly between Markov and DES models, but DES is able to report more outcome parameters. Conclusions: Given a sufficient data supply, DES is the modeling technique of choice when modeling cost-effectiveness in RA. Otherwise transparency on the data inputs is crucial for valid results and to inform decision makers about possible biases. With regard to ICERs, Markov models might provide similar estimates as more advanced modeling techniques.

Description: Background: The introduction of the European Working Time Directive (EWTD) has greatly reduced training hours of surgical residents, which translates into 30% less surgical and clinical experience. Such a dramatic drop in attendance has serious implications such compromised quality of medical care. As the surgical department of the University of Heidelberg, our goal was to establish a model that was compliant with the EWTD while avoiding reduction in quality of patient care and surgical training. Methods: We first performed workload analyses and performance statistics for all working areas of our department (operation theater, emergency room, specialized consultations, surgical wards and on-call duties) using personal interviews, time cards, medical documentation software as well as data of the financial- and personnel-controlling sector of our administration. Using that information, we specifically designed an EWTD-compatible work model and implemented it. Results: Surgical wards and operating rooms (ORs) were not compliant with the EWTD. Between 5 pm and 8 pm, three ORs were still operating two-thirds of the time. By creating an extended work shift (7:30 am-7:30 pm), we effectively reduced the workload to less than 49% from 4 pm and 8 am, allowing the combination of an eight-hour working day with a 16-hour on call duty; thus, maximizing surgical resident training and ensuring patient continuity of care while maintaining EDTW guidelines. Conclusion: A precise workload analysis is the key to success. The Heidelberg New Working Time Model provides a legal model, which, by avoiding rotating work shifts, assures quality of patient care and surgical training.

Description: ᅟThere are many existing methodologies on measuring health equity, while seldom has method aiming at health resource allocation. We collected 6 method of measuring equity in health resource allocation. This paper presents key contents of methods on measuring horizontal equity in health service allocation, yet each method has its advantages and disadvantages as well as range of application, which may help researchers or government to make wise decision when choosing appropriate method for measuring equity. Through comparative analysis, we concluded that socioeconomic factors were considered in concentration index; although the Lorenz curve and Gini-coefficient are widely used, which exist uncertainty and incompleteness; overall inequality can be decomposed by Theil index, which is of significance for the planning of urban and rural areas; preferences on a certain class can be set artificially by Atkinson index; it is easy for Chi-square to analyze aided with statistical software; specific regional differences can be calculated by index of dissimilarity.Classification codesI1

Description: Background: In Switzerland, age is the predominant driver of solidarity transfers in risk adjustment (RA). Concerns have been voiced regarding growing imbalances in cost sharing between young and old insured due to demographic changes (larger fraction of elderly 〉65 years and rise in average age). Particularly young adults aged 19–25 with limited incomes have to shoulder increasing solidarity burdens. Between 1996 and 2011, monthly intergenerational solidarity payments for young adults have doubled from CHF 87 to CHF 182, which corresponds to the highest absolute transfer increase of all age groups. Results: By constructing models for age-specific RA growth and for calculating the lifetime sum of RA transfers we investigated the causes and consequences of demographic changes on RA payments. The models suggest that the main driver for RA increases in the past was below average health care expenditure (HCE) growth in young adults, which was only half as high (average 2% per year) compared with older adults (average 4% per year). Shifts in age group distributions were only accountable for 2% of the CHF 95 rise in RA payments.Despite rising risk adjustment debts for young insured the balance of lifetime transfers remains positive as long as HCE growth rates are greater than the discount rate used in this model (3%). Moreover, the life-cycle model predicts that the lifetime rate of return on RA payments may even be further increased by demographic changes.Nevertheless, continued growth of RA contributions may overwhelm vulnerable age groups such as young adults. We therefore propose methods to limit the burden of social health insurance for specific age groups (e.g. young adults in Switzerland) by capping solidarity payments. Conclusions: Taken together, our mathematical modelling framework helps to gain a better understanding of how demographic changes interact with risk adjustment and how redistribution of funds between age groups can be controlled without inducing further selection incentives. Those methods can help to construct more equitable systems of health financing in light of population aging.

Description: ObjectivesExamine how differences in state regulatory environments predict geographic disparities in the utilization of cancer screening.Data sources/setting100% Medicare fee-for-service population data from 2001-2005 was developed as multi-year breast (BC) and colorectal cancer (CRC) screening utilization rates in each county in the US.Study designA comprehensive set of supply and demand predictors are used in a multilevel model of county-level cancer screening utilization in the context of state regulatory markets. States dictate insurance mandates/regulations and whether alternative providers (nurse practitioners) can provide preventive care services supplied by MDs. Controlling statistically for the supply of both types of providers, we study the joint effects of two private insurance regulations: one mandating that insureds with serious or chronic health conditions may receive continuity of care from their established physician(s) after changing health insurance plans, and another mandating that external grievance review is an option for all health plan coverage/denial decisions. These private insurance plan regulations are expected to affect the degree of beneficial spillovers from managed care practices, which may have increased area-wide cancer screening rates.Principal findingsThe two private insurance regulations under study were significant predictors impacted by local market conditions. Managed care spillovers in local markets were significantly associated with higher BC screening rates, but only in states lacking the two forms of regulation under study. Spillovers were significantly associated with higher CRC cancer screening rates everywhere, but much higher in the unregulated states. Area poverty dampened screening rates, but less so for CRC screening in the states with these regulations. Conclusions: Two state insurance regulations that empowered consumers with more autonomy to make informed utilization decisions varied across states, and exhibited significant associations with screening rates, which varied with the degree of managed care penetration or poverty in the state’s counties. Beneficial spillover effects from managed care practices and negative influences from area poverty are not uniform across the United States. Both variables had stronger associations with CRC than BC screening utilization, as did state regulatory variables. CRC screening by endoscopy was more subject to market and regulatory factors than BC screening.

Description: ObjectiveTo assess the impact of reference pricing and extension of generic substitution on the daily cost of antipsychotic drugs in Finland during the first year after its launch. Furthermore, the additional impact of reference pricing on prior implemented generic substitution is assessed. Methods: A retrospective analysis was performed between 2006 and 2010. A segmented linear regression analysis of interrupted time series was used to estimate changes in the levels and trends in the cost of one day of treatment. Of the study drugs, clozapine belonged to generic substitution already at the start of the study period while olanzapine and quetiapine were included in generic substitution alongside with reference pricing in 2009. Risperidone was included in generic substitution in 2008, before reference pricing. Results: A substantial decrease in the daily cost of all four antipsychotic substances was seen after one year of the implementation of reference pricing and the extension of generic substitution. The impact ranged from -29.9% to -66.3%, and it was most substantial on the daily cost of olanzapine. Also in the daily cost of risperidone a substantial decrease of -43.3% was observed. However, most of these savings, -32.6%, were generated by generic substitution which had been adopted prior. Conclusions: Reference pricing and the extension of generic substitution produced substantial savings on antipsychotic medication costs during the first year after its launch, but the intensity of the impact differed between active substances. Furthermore, our results suggest that the additional cost savings from reference pricing after prior implemented generic substitution, are comparatively low.

Description: Our study is one of the first to take search friction and cross-firm differences in factor productivity into account when investigating firm behavior towards second-generation immigrants in Denmark. We ensure sub-sample homogeneity in search models by matching second-generation immigrants to their ethnic Danish twins according to parental characteristics and informal network quality. We find that second-generation immigrants with a high-school or primary school education, in particular females, perform as well or better than their ethnic counterparts. Second generation immigrants with vocational education, in particular males, face lower arrival rates when unemployed and higher layoff rates than those of their twins.

Description: Background: This study compared the methodological requirements for early health technology appraisal (HTA) by the Federal Joint Committee/Institute for Quality and Efficiency in Health Care (G-BA/IQWiG; Germany) and the National Institute for Health and Care Excellence (NICE; England). Methods: The following aspects were examined: guidance texts on methodology and information sources for the assessment; clinical study design and methodology; statistical analysis, quality of evidence base, extrapolation of results (modeling), and generalisability of study results; and categorisation of outcome. Results: There is some degree of similarity regarding basic methodological elements such as selection of information sources (e.g. preference of randomised controlled studies, RCTs) and quality assessment of the available evidence. Generally, the approach taken by NICE seems to be more open and less restrictive as compared with G-BA/IQWiG. Any kind of potentially relevant evidence is requested, including data from non-RCTs. Surrogate endpoints are also accepted more readily, if they are reasonably likely to predict clinical benefit. Modeling is expected to be performed wherever possible and appropriate, e.g. for study duration, patient population, choice of comparator, and type of outcomes. The resulting uncertainty is quantified through sensitivity analyses before making a recommendation regarding reimbursement. By contrast, G-BA/IQWiG bases its assessment and quantification of the additional benefit largely, if not exclusively, on evidence of the highest level and quality and on measurements of “hard” clinical endpoints. This more conservative approach rather firmly dismisses evidence from non-RCTs and measurements of surrogate endpoints that have not or only partly been validated. Moreover, neither qualitative extrapolation nor quantitative modeling of data is done. Conclusions: Methodological requirements differed mainly in the acceptance of low-level evidence, surrogate endpoints, and data modeling. Some of the discrepancies may be explained, at least in part, by differences in the health care system and procedural aspects (e.g. timing of assessment).

Description: Understanding the industrial structure of a national or regional economy is one of the central issues in economics. The triangulation of an input–output table (IOT) can be employed to understand the production structure of an economy. Inter-temporal and inter-regional comparisons of multiple IOTs have addressed interesting and important issues pertaining to international trade, economic growth, and inter-industry relationships in the economy. Rank correlation coefficients between sector rankings obtained by solving optimization problems have been utilized to quantify similarities among production structures. However, it is well known that calculated rank correlations might be weak even if underlying structures are similar because the optimization problem inherently has multiple optimal solutions, thus leading to erroneous interpretations. This paper proposes a new method to triangulate IOTs based on mixed integer programs (MIPs) for comparing the production structures of multiple economies. The proposed new method does not suffer from non-uniqueness of optimal solutions and is consistent with maximization of the Kendall rank correlation coefficient. The application of the proposed method to the Japanese economy demonstrates stability of the Japanese production structure during 1995–2005. Comparisons of triangulated IOTs further reveal similarities in production structures of the Chinese, Japanese, and the U.S. economy for the year 2009.Electronic Supplementary MaterialThe online version of this article (doi:10.1186/2193-2409-3-2) contains supplementary material.JEL Classification: C61, C67, L16.List of AbbreviationsIOT: Input–output tableMIP: Mixed integer programIP: Integer programWIOD: World Input–Output Database

Description: Previous research on the determinants of international migration has largely focused on objective factors, such as income. We instead use subjective well-being (SWB) to explain international migration desires, an expressed willingness to migrate. We find that individuals with higher SWB have lower international migration desires. At the individual level, the SWB-migration relationship appears to be more robust than the income-migration relationship. At the country level, national average SWB better indicates international migration desires for rich countries, while income performs better for poor countries. We thus demonstrate the feasibility of employing subjective measures to study at least one aspect of an important social outcome, migration.JEL codesF22, O15, I31

Description: ObjectiveTo identify associations between market factors, especially relative reimbursement rates, and the probability of surgery and cost per episode for three medical conditions (cataract, benign prostatic neoplasm, and knee degeneration) with multiple treatment options. Methods: We use 2004–2006 Medicare claims data for elderly beneficiaries from sixty nationally representative communities to estimate multivariate models for the probability of surgery and cost per episode of care as a function local market factors, including Medicare physician reimbursement for surgical versus non-surgical treatment and the availability of primary care and specialty physicians. We used Symmetry’s Episode Treatment Groups (ETG) software to group claims into episodes for the three conditions (n = 540,874 episodes). Results: Higher Medicare reimbursement for surgical episodes and greater availability of the relevant specialists are significantly associated with more surgery and higher cost per episode for all three conditions, while greater availability of primary care physicians is significantly associated with less frequent surgery and lower cost per episode. Conclusion: Relative Medicare reimbursement rates for surgical vs. non-surgical treatments and the availability of both primary care physicians and relevant specialists are associated with the likelihood of surgery and cost per episode.

Description: The study primarily verifies whether ORP differs in stages of entrepreneurship and aims at identifying factors that influence ORP in different stages of entrepreneurship. The stages of entrepreneurship include pre-stage (individuals planning to start ventures), early-stage (entrepreneurs with ventures less than 3 years old) and late-stage (entrepreneurs with ventures more than 3 years in existence). The factors that were studied include personal factors (cognitive style, self-efficacy and motivation) and interpersonal factors (bridging social capital and bonding social capital). The results indicate the influence of different factors in different stages of entrepreneurship.

Description: The utilization and reward of the human capital of immigrants in the labor market of the host country has been studied extensively. Using Swedish register data from 2001–2008, we extend the immigrant educational mismatch literature by analyzing incidence, wage effects and state dependence in overeducation among natives and immigrants. In line with previous research we find a higher incidence and a lower return to overeducation among immigrants indicating that immigrants lose more from being overeducated. We find a high degree of state dependence in overeducation both among natives and immigrants, but considerably higher among immigrants.JEL codesJ61, I21, J24, J31, F22

Description: We reconstructed the 2007 Japan–China International Input–Output Table as one that extracts Japanese production activities from China, using microdata of about 3,600 establishments in the METI Statistics “Survey of Overseas Business Activities.” The recompiled input–output table consists of Japan, China (minus Japanese subsidiaries), and Japanese subsidiary activities in China with 30 sectors for each. Using this table, we discuss two topics. One is the regional contribution of value-added and imports against a one-unit increase of final demand in the Japanese subsidiary sector. The other is a simulation analysis of the production shift from Japan to China.

Description: No abstract

Description: We propose a new methodology for analyzing determinants of the wage gap between immigrants and natives. A Mincerian regression framework is extended to include GDP per capita in an immigrant’s country of birth as a proxy for the quality of schooling and work experience acquired in that country. We find that Canadian immigrants’ returns to schooling and work experience significantly increase with the GDP per capita of their country of birth. The contribution of quality of schooling and work experience to the immigrant wage gap is also examined. Lower human capital quality completely negates the endowment advantage that immigrants have in the areas of schooling and work experience. Since data on GDP per capita are available for most countries over long periods, the proposed methodology can be applied to analyze immigrant wage gaps for a large set of countries for which common statistics on natives and immigrants are available.JEL codesJ20, J24, J15, J61

Description: Background: While induced abortion is considered to be illegal and socially unacceptable in Nigeria, it is still practiced by many women in the country. Poor family planning and unsafe abortion practices have daunting effects on maternal health. For instance, Nigeria is on the verge of not meeting the Millennium development goals on maternal health due to high maternal mortality ratio, estimated to be about 630 maternal deaths per 100,000 live births. Recent evidences have shown that a major factor in this trend is the high incidence of abortion in the country. The objective of this paper is, therefore, to investigate the factors determining the demand for abortion and post-abortion care in Ibadan city of Nigeria. Methods: The study employed data from a hospital-based/exploratory survey carried out between March to September 2010. Closed ended questionnaires were administered to a sample of 384 women of reproductive age from three hospitals within the Ibadan metropolis in South West Nigeria. However, only 308 valid responses were received and analysed. A probit model was fitted to determine the socioeconomic factors that influence demand for abortion and post-abortion care. Results: The results showed that 62% of respondents demanded for abortion while 52.3% of those that demanded for abortion received post-abortion care. The findings again showed that income was a significant determinant of abortion and post-abortion care demand. Women with higher income were more likely to demand abortion and post-abortion care. Married women were found to be less likely to demand for abortion and post-abortion care. Older women were significantly less likely to demand for abortion and post-abortion care. Mothers’ education was only statistically significant in determining abortion demand but not post-abortion care demand. Conclusion: The findings suggest that while abortion is illegal in Nigeria, some women in the Ibadan city do abort unwanted pregnancies. The consequence of this in the absence of proper post-abortion care is daunting. There is the need for policymakers to intensify public education against indiscriminate abortion and to reduce unwanted pregnancies. In effect, there is need for effective alternative family planning methods. This is likely to reduce the demand for abortion. Further, with income found as a major constraint, post abortion services should be made accessible to both the rich and poor alike so as to prevent unnecessary maternal deaths as a result of abortion related complications.