Essays in health economics: Volume-Outcome Effect, upcoding behaviour and the evaluation of a short-term intervention program

Evidence in the literature suggests a negative relationship between volume of medical procedures and mortality rates in the health care sector. In general, high-volume hospitals appear to achieve lower mortality rates, although considerable variation exists. However, most studies focus on US hospitals, which face different incentives than hospitals in a National Health Service (NHS). In order to add to the literature, this study aims to understand what happens in a NHS. Results reveal a statistically significant correlation between volume of procedures and better outcomes for the following medical procedures: cerebral infarction, respiratory infections, circulatory disorders with AMI, bowel procedures, cirrhosis, and hip and femur procedures. The effect is explained with the practice-makes-perfect hypothesis through static effects of scale with little evidence of learning-by-doing. The centralization of those medical procedures is recommended given that this policy would save a considerable number of lives (reduction of 12% in deaths for cerebral infarction).

Improving retail banking staff incentive systems

This Work Project seeks to analyze the viability, utility and best way of implementing mechanisms of double accounting and of insertion of low (or null) sales objectives in an incentives program. The main findings are that both processes are possible and to a certain extent advisable, although in very specific ways and with some limitations. Double accounting processes are especially effective between different segments and networks and should have a greater impact in the first evaluation periods of each case and the null objectives, albeit usable, are recommended to be always substituted by positive objectives, even if quite small. Moreover, it is concluded that the formal structure of the incentives program influences significantly these concepts, namely concerning the duration of the evaluation periods and the interaction of the objectives of different entities for both the vertical (hierarchic) and horizontal (individual and collective) levels.