1,721,040 research outputs found
Measuring economies of scale and scope in the english secondary care
No full textOBJECTIVES: In 2000 the English government announced a ten-year programme of reforms to increase value for money in a health system shaped around patient choice and population needs. This programme included the shift in the reimbursement system from cost-based to fixed-tariff (termed Payment by Results, PbR, and implemented in 2003) and the creation of new providers enjoying new freedoms and flexibilities (Foundation Trusts, FTs introduced in 2004).
One of the aims of the FT reform is to increase efficiency in production and delivery of health care: FTs’ freedoms combined with PbR provide the ground for efficiency improvement.
The FT reform has been implemented in a phased manner with only the best performing trusts being able to apply for foundation status. Since non-FTs generally have a higher installed capacity with guaranteed levels of activity, they might exploit scale economies and be able to produce at lower costs. On the other hand, non-FTs are expected to offer a broader mix of services than FTs, which implies investing on services with a volatile demand.
Being locked on their capacity, non-FTs might either supply care far below their capacity, and therefore incur into high costs for unused capacity, or produce
unnecessary care by inducing demand. FTs, on the other hand, are able to choose the mix of services to be provided and therefore can profit from scope economies.
Estimating cost functions and testing for the existence of economies of scale and scope for FTs and non-FTs is therefore relevant for policy design as it could have an impact on the future developments of PbR. Namely it could affect the design of the tariff payable to different types of providers in order, not only to better achieve PbR efficiency targets, but also to avoid discrimination and inequitable treatment between providers.
METHODS: We use a unique dataset of English hospitals from 1994/95 to 2006/07, which includes variables on activity, expenditure and staffing from numerous sources (e.g., the Department of Health, the Hospital Episodes Statistics).
We address some methodological shortcomings affecting the measurement of scale and scope economies (existence of weak cost complementarities, choice of the functional form, output measurement and output aggregation) and design a hybrid multi-product function (Pulley and Braunstein, 1992) for hospital costs.
This function has the advantage to decompose scope economies into the component arising from the spread of fixed costs and the component arising from complementarity. Moreover, whether heteroskedastic disturbances were found in the empirical analysis, it would be the only function suitable for unbiased cost estimates (Preyra and Pink, 2006). We use Maximum Likelihood estimation.
RESULTS & CONCLUSIONS: We find that only FTs experience economies of scale. We also find that FTs experience scope economies by operating jointly outpatient visits and inpatient admissions or emergency and inpatient admissions, while non-FTs experience scope economies by operating any kind of hospitalisation.
The methodology developed in this paper is quite powerful and general enough to be applied to systems where hospitals have achieved more freedom and are being reimbursed according to the activity they deliver (e.g., USA, Italy, Australia).
REFERENCES:
Preyra, C., Pink., G., 2006. Scale and scope efficiencies through hospital consolidations. Journal of Health Economics 25, 1049-1068.
Pulley, L.B., Braunstein, Y.M., 1992. A Composite cost function for multiproduct firms with an application to economies of scope in banking. Review of Economis and Statistics 74, 221--230
What do we really know about Reference Pricing for pharmaceuticals?Evidence from a systematic review of the literature
No full textHealth policy-makers worldwide have adopted different Reference Pricing (RP) systems for pharmaceuticals. Systems may differ concerning their effects on pharmaceutical prices, firms’ strategies, market structure, public and private expenditure, health outcomes and R&D investments. We present evidence from a recent systematic review of the effects of RP across different systems. Evidence suggests RP successfully decreases drugs’ prices and expenditures in the short-run. Prices drop more where generics have more market power. There is no evidence of negative health effects associated with patients’ switching between drugs. More research is needed on the long-term effects of RP and its impact on R&D
Giving greater financial independence to hospitals-does it make a difference? The case of English NHS Trusts
No full textIn 2003 a new type of provider organisation, the Foundation Trust (FT), was introduced in England, and the best performing NHS hospitals were able to apply for 'Foundation status'. FTs enjoy greater financial flexibility and are subject to less central monitoring and control. The phased introduction of FTs represents an opportunity to examine whether the new financial structures facing FTs have produced any differences in financial performance compared with non-FTs. We use difference in difference methods to examine whether Foundation status had a significant effect on financial management. We find that Foundation status has had a limited impact in terms of acting as an instrument to signal strong financial management of FTs. This result may reflect the relatively early stage of the FT process or may be due to the fact that all types of Trusts are experiencing a challenging financial environment, including the introduction of a prospective payment system. However, we explore the nature of the trends emerging over time and discuss the implications of our findings for policy. Copyright © 2007 John Wiley & Sons, Ltd.
Giving greater financial independence to hospitals – does it make a difference? The case of English NHS Trusts
No full textIn 2003 a new type of provider organisation, the Foundation Trust (FT), was introduced in England, and the best performing NHS hospitals were able to apply for “Foundation status”. FTs enjoy greater financial flexibility and are subject to less central monitoring and control. The phased introduction of FTs represents an opportunity to examine whether the new financial structures facing FTs have produced any differences in financial performance compared to non-FTs. We use difference in difference methods to examine whether Foundation status had a significant effect on financial management. We find that Foundation status has had a limited impact in terms of acting as an instrument to signal strong financial management of Foundation Trusts. This result may reflect the relatively early stage of the FT process or may be due to the fact that all types of Trusts are experiencing a challenging financial environment, including the introduction of a prospective payment system. However, we explore the nature of the trends emerging over time and discuss the implications of our findings for policy
Effects of Reference Pricing in Pharmaceutical Markets: a Review
No full textThis work aims to provide a systematic and updated survey of original scientific studies on the effect of the introduction of reference pricing (RP) policies in Organisation for Economic Co-operation and Development (OECD) countries. We searched PubMed, EconLit and Web of Knowledge for articles on RP. We reviewed studies that met the inclusion criteria established
in the search strategy. From a total of 468 references, we selected the 35 that met all of the inclusion criteria.
Some common themes emerged in the literature. The first was that RP was generally associated with a decrease in the prices of the drugs subject to the policy. In particular, price drops seem to have been experienced in virtually every country that implemented a generic RP (GRP) policy. A GRP policy applies only to products with expired patents and generic competition, and clusters drugs according to chemical equivalence (same form and active compound).
More significant price decreases were observed in the sub-markets in which drugs were already facing generic competition prior to RP. Price drops varied widely according to the amount of generic competition and industrial strategies: brand-named drugs originally priced above RP values decreased
their prices to a greater extent. A second common theme was that both therapeutic RP (TRP) and GRP have been associated with significant and consistent savings in the first years of application. A third general result is that generic market shares significantly increased whenever the firms producing brand-named drugs did not adopt one of the following strategies:
lowering prices to RP values; launching new dosages and/or formulations; or marketing substitute drugs still under patent protection. Finally, concerning TRP, although more evidence is needed, studies based on a large number of patient-level observations showed no association between the RP policy and
health outcomes
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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