Has DRG payment influenced the technical efficiency and productivity of diagnostic technologies in Portuguese public hospitals? An empirical analysis using parametric and non‐parametric methods

The use of Diagnosis Related Groups (DRG) as a mechanism for hospital financing is a currently debated topic in Portugal. The DRG system was scheduled to be initiated by the Health Ministry of Portugal on January 1, 1990 as an instrument for the allocation of public hospital budgets funded by the National Health Service (NHS), and as a method of payment for other third party payers (e.g., Public Employees (ADSE), private insurers, etc.). Based on experience from other countries such as the United States, it was expected that implementation of this system would result in more efficient hospital resource utilisation and a more equitable distribution of hospital budgets. However, in order to minimise the potentially adverse financial impact on hospitals, the Portuguese Health Ministry decided to gradually phase in the use of the DRG system for budget allocation by using blended hospitalspecific and national DRG casemix rates. Since implementation in 1990, the percentage of each hospitals budget based on hospital specific costs was to decrease, while the percentage based on DRG casemix was to increase. This was scheduled to continue until 1995 when the plan called for allocating yearly budgets on a 50% national and 50% hospitalspecific cost basis. While all other nonNHS third party payers are currently paying based on DRGs, the adoption of DRG casemix as a National Health Service budget setting tool has been slower than anticipated. There is now some argument in both the political and academic communities as to the appropriateness of DRGs as a budget setting criterion as well as to their impact on hospital efficiency in Portugal. This paper uses a twostage procedure to assess the impact of actual DRG payment on the productivity (through its components, i.e., technological change and technical efficiency change) of diagnostic technology in Portuguese hospitals during the years 1992–1994, using both parametric and nonparametric frontier models. We find evidence that the DRG payment system does appear to have had a positive impact on productivity and technical efficiency of some commonly employed diagnostic technologies in Portugal during this time span.

Assessing pupil and school performance by non-parametric and parametric techniques

Often observations are nested within other units. This is particularly the case in the educational sector where school performance in terms of value added is the result of school contribution as well as pupil academic ability and other features relating to the pupil. Traditionally, the literature uses parametric (i.e. it assumes a priori a particular function on the production process) Multi-Level Models to estimate the performance of nested entities. This paper discusses the use of the non-parametric (i.e. without a priori assumptions on the production process) Free Disposal Hull model as an alternative approach. While taking into account contextual characteristics as well as atypical observations, we show how to decompose non-parametrically the overall inefficiency of a pupil into a unit specific and a higher level (i.e. a school) component. By a sample of entry and exit attainments of 3017 girls in British ordinary single sex schools, we test the robustness of the non-parametric and parametric estimates. We find that the two methods agree in the relative measures of the scope for potential attainment improvement. Further, the two methods agree on the variation in pupil attainment and the proportion attributable to pupil and school level.

A preliminary study into emergent behaviours in a lattice of interacting nonlinear resonators and oscillators

Future sensor arrays will be composed of interacting nonlinear components with complex behaviours with no known analytic solutions. This paper provides a preliminary insight into the expected behaviour through numerical and analytical analysis. Specically, the complex behaviour of a periodically driven nonlinear Duffing resonator coupled elastically to a van der Pol oscillator is investigated as a building block in a 2D lattice of such units with local connectivity. An analytic treatment of the 2-device unit is provided through a two-time-scales approach and the stability of the complex dynamic motion is analysed. The pattern formation characteristics of a 2D lattice composed of these units coupled together through nearest neighbour interactions is analysed numerically for parameters appropriate to a physical realisation through MEMS devices. The emergent patterns of global and cluster synchronisation are investigated with respect to system parameters and lattice size.

Longitudinal parametric oscillation in photorefractive sillenites: comparison between theory and experiment

By using an alternative setup for photorefractive parametric oscillation in which wave mixing between the recording beams is avoided it has become possible to make more detailed comparisons with the space-charge wave theory. In the present paper we compare the experimental features of longitudinal parametric oscillation observed in a crystal of Bi12SiO20 with the theoretical predictions.

The effect of corruption on FDI:a parametric and non-parametric analysis

This paper analyses the effect of corruption on Multinational Enterprises' (MNEs) incentives to undertake FDI in a particular country. We contribute to the existing literature by modelling the relationship between corruption and FDI using both parametric and non-parametric methods. We report that the impact of corruption on FDI stock is different for the different quantiles of the FDI stock distribution. This is a characteristic that could not be captured in previous studies which used only parametric methods. After controlling for the location selection process of MNEs and other host country characteristics, the result from both parametric and non-parametric analyses offer some support for the ‘helping-hand’ role of corruption.

Fiber optical parametric amplifier performance in a 1-Tb/s DWDM communication system

We have reduced signal-signal four-wave mixing crosstalk in a fiber optical parametric amplifier (OPA) by using a short nonlinear fiber for the gain medium and a high-power pump. This allowed us to obtain less than 1 dB penalty for amplification of 26 dense wavelength-division multiplexed (WDM) channels modulated at 43.7Gb/s return to zero-differential phase-shift keying, with the OPA placed between transmitter and receiver. We then used the same OPA in several different roles for a long-haul transmission system. We did not insert the OPA within the loop, but investigated this role indirectly by using equivalent results for small numbers of loop recirculations. We found that standard erbium-doped fiber amplifiers currently hold an advantage over this OPA, which becomes negligible for long distances. This paper shows that at this time OPAs can handle amplification of WDM traffic in excess of 1 Tb/s with little degradation. It also indicates that with further improvements, fiber OPAs could be a contender for wideband amplification in future optical communication networks.

General and multiplicative non-parametric corporate performance models with interval ratio data

The increasing intensity of global competition has led organizations to utilize various types of performance measurement tools for improving the quality of their products and services. Data envelopment analysis (DEA) is a methodology for evaluating and measuring the relative efficiencies of a set of decision making units (DMUs) that use multiple inputs to produce multiple outputs. All the data in the conventional DEA with input and/or output ratios assumes the form of crisp numbers. However, the observed values of data in real-world problems are sometimes expressed as interval ratios. In this paper, we propose two new models: general and multiplicative non-parametric ratio models for DEA problems with interval data. The contributions of this paper are fourfold: (1) we consider input and output data expressed as interval ratios in DEA; (2) we address the gap in DEA literature for problems not suitable or difficult to model with crisp values; (3) we propose two new DEA models for evaluating the relative efficiencies of DMUs with interval ratios, and (4) we present a case study involving 20 banks with three interval ratios to demonstrate the applicability and efficacy of the proposed models where the traditional indicators are mostly financial ratios. © 2011 Elsevier Inc.

A study of the properties and applications of electrostatic charged particle oscillators

This investigation originated from work by Dr. A.H. McIlraith of the National Physical Laboratory who, in 1966, described a new type of charged particle oscillator. This makes use of two equal cylindrical electrodes to constrain the particles in such a way that they follow extremely long oscillatory paths between the electrodes under the influence of an electrostatic field alone. The object of this work has been to study the principle of the oscillator in detail and to investigate its properties and applications. Any device which is capable of creating long electron trajectories has potential application in the field of ultra high vacuum technology. It was therefore considered that a critical review of the problems associated with the production and measurement of ultra high vacuum was relevant in the initial stages of the work. The oscillator has been applied with a considerable degree of success as a high energy electrostatic ion source. This offers several advantages over existing ion sources. It can be operated at much lower pressures without the need of a magnetic field. The oscillator principle has also been applied as a thermionic ionization gauge and has been compared with other ionization gauges to pressures as low as 5 x 10- 11 torr.. This new gauge exhibited a number of advantages over most of the existing gauges. Finally the oscillator has been used in an evaporation ion pump and has exhibited fairly high pumping speeds for argon gas relative to those for nitrogen. This investigation supports the original work of Dr. A.H. McIlraith and shows that his proposed oscillator has considerable potential in the fields of vacuum technology and electron physics.

Longitudinal parametric oscillation in photorefractive sillenites: comparison between theory and experiment

By using an alternative setup for photorefractive parametric oscillation in which wave mixing between the recording beams is avoided it has become possible to make more detailed comparisons with the space-charge wave theory. In the present paper we compare the experimental features of longitudinal parametric oscillation observed in a crystal of Bi12SiO20 with the theoretical predictions.

The impact of pump phase-modulation and filtering on WDM signals in a fibre optical parametric amplifier

WDM signal degradation from pump phase-modulation in a one-pump 20dB net-gain fibre optical parametric amplifier is experimentally and numerically characterised for the first time using 10x59Gb/s QPSK signals.

Suppression of WDM four-wave mixing crosstalk in fibre optic parametric amplifier using Raman-assisted pumping

We perform an extensive numerical analysis of Raman-Assisted Fibre Optical Parametric Amplifiers (RA-FOPA) in the context of WDM QPSK signal amplification. A detailed comparison of the conventional FOPA and RA-FOPA is reported and the important advantages offered by the Raman pumping are clarified. We assess the impact of pump power ratios, channel count, and highly nonlinear fibre (HNLF) length on crosstalk levels at different amplifier gains. We show that for a fixed 200 m HNLF length, maximum crosstalk can be reduced by up to 7 dB when amplifying 10x58Gb/s QPSK signals at 20 dB net-gain using a Raman pump of 37 dBm and parametric pump of 28.5 dBm in comparison to a standard single-pump FOPA using 33.4 dBm pump power. It is shown that a significant reduction in four-wave mixing crosstalk is also obtained by reducing the highly nonlinear fibre interaction length. The trend is shown to be generally valid for different net-gain conditions and channel grid size. Crosstalk levels are additionally shown to strongly depend on the Raman/parametric pump power ratio, with a reduction in crosstalk seen for increased Raman pump power contribution.

Polarisation phenomena in mode locked fibre lasers and fibre Raman amplifiers griffon tutorial

For a fibre Raman amplifier with randomly varying birefringence, we provide insight on the validity of previously explored multi-scale techniques leading to polarisation pulling of the signal state of polarisation to the pump state of polarisation. Unlike previous study, we demonstrate that in addition to polarisation pulling a new random birefringence-mediated phenomenon that goes beyond existing multi-scale techniques can boost resonance-like gain fluctuations similar to the Stochastic Anti-Resonance. For mode locked fibre lasers we report on fast and slow polarisation dynamics of fundamental, bound state, and multipulsing vector solitons along with stretched pulses. We demonstrate that tuning cavity anisotropy and birefringence along with parameters of an injected signal with randomly varying state of polarisation provides access to the variety of vector waveforms previously unexplored.

On the theory of the modulation instability in optical fiber and laser amplifiers

The modulation instability (MI) in optical fiber amplifiers and lasers with anomalous dispersion leads to CW beam breakup and the growth of multiple pulses. This can be both a detrimental effect, limiting the performance of amplifiers, and also an underlying physical mechanism in the operation of MI-based devices. Here we revisit the analytical theory of MI in fiber optical amplifiers. The results of the exact theory are compared with the previously used adiabatic approximation model, and the range of applicability of the latter is determined. The same technique is applicable to the study of spatial MI in solid state laser amplifiers and MI in non-uniform media. © 2011 SPIE.