Health expenditures in the OECD: A political economy analysis using structural breaks

A Masters Thesis, presented as part of the requirements for the award of a Research Masters Degree in Economics from NOVA – School of Business and Economics

Needs assessment of people with severe mental illnesses and their families in Azerbaijan

RESUMO: Os indivíduos com doença mental grave, assim como os seus familiares, podem ser caracterizados como uma população em que ocorre uma combinação complexa de necessidades médicas e psicossociais, nomeadamente a nível do diagnóstico e do acesso aos serviços de saúde mental. A avaliação de necessidades pode fornecer informações importantes para o desenvolvimento de intervenções eficazes, tanto a nível da população como a nível individual. Este estudo teve como objetivo determinar as diferentes necessidades reportadas pelos pacientes com doença mental grave e seus familiares , assim como investigar as possíveis relações entre o estado de necessidades e as variáveis sócio-demográficas e clínicas. Simultaneamente, o estudo teve como objetivo avaliar a sobrecarga familiar e a satisfação dos utentes com os serviços de saúde mental. Foi elaborado um estudo transversal, realizado numa amostra de conveniência de cinquenta díades de paciente/membro da família, seguidos em regime de ambulatório no Centro Nacional de Saúde Mental. Foram utilizados como instrumentos de avaliação um questionário sociodemográfico, a Escala Breve de Avaliação Psiquiátrica (BPRS), o questionário de Avaliação de Necessidades de Camberwell (CAN), o Questionário de Avaliação do Envolvimento (IEQ) e a Escala de Verona de Satisfação com os Serviços (VSSS). As mais frequentes necessidades não-satisfeitas foram o ‘sofrimento psicológico’, as ‘atividades sociais’ e os ‘benefícios sociais’. O estudo mostrou uma sobrecarga significativa nas famílias que cuidam de pessoas com doença mental grave, que se correlacionou com as suas opiniões sobre as necessidades dos pacientes e teve um impacto negativo sobre o bem-estar psicológico. Os três mais importantes predictores de sofrimento psíquico em familiares foram o sexo, a situação laboral e a relação com o paciente. A avaliação da satisfação com os serviços revelou a existência de um hiato significativo entre os serviços prestados e os serviços desejados, reportados pelos pacientes e seus familiares. A maioria dos participantes do estudo desejavam ter um trabalho protegido, ou receber ajuda para encontrar emprego. Os resultados deste estudo poderão ser usados para fins de planeamento desenvolvimento e avaliação de serviços de saúde mental no Azerbeijão. Algumas recomendações sobre a melhoria dos serviços de saúde mental para pacientes com doença mental grave e suas famílias são feitas na secção final do trabalho.----------ABSTRACT: Patients suffering from severe mental illness, in addition to their family members, may be characterized as a population with a complex combination of medical and psychosocial needs, which are under-recognized and under-addressed by mental health services. At the same time, needs assessment provides important information necessary for developing effective interventions at both population and individual level. The study was aimed to determine various needs perceived by patients with SMI and their family members, as well as to find out possible relations between the needs and socio-demographic and clinical variables. Similarly the study was intended to evaluate family burden and users’ satisfaction with services. This was a cross-sectional study conducted on a convenience sample. Fifty dyads of a patient and family member applying for out-patient services to the National Mental Health Centre participated in the study. Sociodemographic questionnaire, Brief Psychiatric Rating Scale, Camberwell Assessment of Need, Involvement Evaluation Questionnaire, and Verona Service Satisfaction Scale were used as assessment tools. The most prominent unmet needs reported by people with SMI and their relatives were psychological distress, social activities and welfare benefits. The study showed significant burden in families caring for people with SMI, which correlated with their views about patients’ needs and had a negative impact on the psychological well-being. The three most important predictors of psychological distress in family members were gender, employment status and relationship to patient. Evaluation of satisfaction with services pointed out the gap between provided and desired services reported by patients and their relatives. Most of study participants wished to have sheltered work, or receive help in finding employment. The results of this study may be used for the purposes of mental health service planning, development and evaluation in our country. Some recommendations on improvement of mental health services for patients with SMI and their families have been made in the conclusion.

Effects of quantitative easing on the USA economy: A test for policy effectiveness

The catastrophic disruption in the USA financial system in the wake of the financial crisis prompted the Federal Reserve to launch a Quantitative Easing (QE) programme in late 2008. In line with Pesaran and Smith (2014), I use a policy effectiveness test to assess whether this massive asset purchase programme was effective in stimulating the economic activity in the USA. Specifically, I employ an Autoregressive Distributed Lag Model (ARDL), in order to obtain a counterfactual for the USA real GDP growth rate. Using data from 1983Q1 to 2009Q4, the results show that the beneficial effects of QE appear to be weak and rather short-lived. The null hypothesis of policy ineffectiveness is not rejected, which suggests that QE did not have a meaningful impact on output growth.

The new economy: Essays in network economics and two-sided markets

Following the Introduction, which surveys existing literature on the technology advances and regulation in telecommunications and on two-sided markets, we address specific issues on the industries of the New Economy, featured by the existence of network effects. We seek to explore how each one of these industries work, identify potential market failures and find new solutions at the economic regulation level promoting social welfare. In Chapter 1 we analyze a regulatory issue on access prices and investments in the telecommunications market. The existing literature on access prices and investment has pointed out that networks underinvest under a regime of mandatory access provision with a fixed access price per end-user. We propose a new access pricing rule, the indexation approach, i.e., the access price, per end-user, that network i pays to network j is function of the investment levels set by both networks. We show that the indexation can enhance economic efficiency beyond what is achieved with a fixed access price. In particular, access price indexation can simultaneously induce lower retail prices and higher investment and social welfare as compared to a fixed access pricing or a regulatory holidays regime. Furthermore, we provide sufficient conditions under which the indexation can implement the socially optimal investment or the Ramsey solution, which would be impossible to obtain under fixed access pricing. Our results contradict the notion that investment efficiency must be sacrificed for gains in pricing efficiency. In Chapter 2 we investigate the effect of regulations that limit advertising airtime on advertising quality and on social welfare. We show, first, that advertising time regulation may reduce the average quality of advertising broadcast on TV networks. Second, an advertising cap may reduce media platforms and firms' profits, while the net effect on viewers (subscribers) welfare is ambiguous because the ad quality reduction resulting from a regulatory cap o¤sets the subscribers direct gain from watching fewer ads. We find that if subscribers are sufficiently sensitive to ad quality, i.e., the ad quality reduction outweighs the direct effect of the cap, a cap may reduce social welfare. The welfare results suggest that a regulatory authority that is trying to increase welfare via regulation of the volume of advertising on TV might necessitate to also regulate advertising quality or, if regulating quality proves impractical, take the effect of advertising quality into consideration. 3 In Chapter 3 we investigate the rules that govern Electronic Payment Networks (EPNs). In EPNs the No-Surcharge Rule (NSR) requires that merchants charge at most the same amount for a payment card transaction as for cash. In this chapter, we analyze a three- party model (consumers, merchants, and a proprietary EPN) with endogenous transaction volumes and heterogenous merchants' transactional benefits of accepting cards to assess the welfare impacts of the NSR. We show that, if merchants are local monopolists and the network externalities from merchants to cardholders are sufficiently strong, with the exception of the EPN, all agents will be worse o¤ with the NSR, and therefore the NSR is socially undesirable. The positive role of the NSR in terms of improvement of retail price efficiency for cardholders is also highlighted.

Reallocation of resources between the tradable and non-tradable sector in Portugal: Assessing the degree of structural transformation in the Portuguese economy

Portugal implemented a large number of structural reforms in the recent years, which are expected to enhance the allocation of resources in the economy, namely from the non-tradable to tradable sector. We argue that the methodology to identify the tradable sector used by some international institutions is outdated and may hamper an accurate assessment of the progress achieved so far. Based on an enhanced methodology to identify the tradable sector, we are able to provide a more accurate, clearer picture of the recent structural developments of the Portuguese economy.