Drug prescribing patterns in the General Medical Services Scheme in Ireland and projected costs to 2026

The primary objective is to investigate the main factors contributing to GMS expenditure on pharmaceutical prescribing and projecting this expenditure to 2026. This study is located in the area of pharmacoeconomic cost containment and projections literature. The thesis has five main aims: 1. To determine the main factors contributing to GMS expenditure on pharmaceutical prescribing. 2. To develop a model to project GMS prescribing expenditure in five year intervals to 2026, using 2006 Central Statistics Office (CSO) Census data and 2007 Health Service Executive{Primary Care Reimbursement Service (HSE{PCRS) sample data. 3. To develop a model to project GMS prescribing expenditure in five year intervals to 2026, using 2012 HSE{PCRS population data, incorporating cost containment measures, and 2011 CSO Census data. 4. To investigate the impact of demographic factors and the pharmacology of drugs (Anatomical Therapeutic Chemical (ATC)) on GMS expenditure. 5. To explore the consequences of GMS policy changes on prescribing expenditure and behaviour between 2008 and 2014. The thesis is centered around three published articles and is located between the end of a booming Irish economy in 2007, a recession from 2008{2013, to the beginning of a recovery in 2014. The literature identified a number of factors influencing pharmaceutical expenditure, including population growth, population aging, changes in drug utilisation and drug therapies, age, gender and location. The literature identified the methods previously used in predictive modelling and consequently, the Monte Carlo Simulation (MCS) model was used to simulate projected expenditures to 2026. Also, the literature guided the use of Ordinary Least Squares (OLS) regression in determining demographic and pharmacology factors influencing prescribing expenditure. The study commences against a backdrop of growing GMS prescribing costs, which has risen from e250 million in 1998 to over e1 billion by 2007. Using a sample 2007 HSE{PCRS prescribing data (n=192,000) and CSO population data from 2008, (Conway et al., 2014) estimated GMS prescribing expenditure could rise to e2 billion by2026. The cogency of these findings was impacted by the global economic crisis of 2008, which resulted in a sharp contraction in the Irish economy, mounting fiscal deficits resulting in Ireland's entry to a bailout programme. The sustainability of funding community drug schemes, such as the GMS, came under the spotlight of the EU, IMF, ECB (Trioka), who set stringent targets for reducing drug costs, as conditions of the bailout programme. Cost containment measures included: the introduction of income eligibility limits for GP visit cards and medical cards for those aged 70 and over, introduction of co{payments for prescription items, reductions in wholesale mark{up and pharmacy dispensing fees. Projections for GMS expenditure were reevaluated using 2012 HSE{PCRS prescribing population data and CSO population data based on Census 2011. Taking into account both cost containment measures and revised population predictions, GMS expenditure is estimated to increase by 64%, from e1.1 billion in 2016 to e1.8 billion by 2026, (ConwayLenihan and Woods, 2015). In the final paper, a cross{sectional study was carried out on HSE{PCRS population prescribing database (n=1.63 million claimants) to investigate the impact of demographic factors, and the pharmacology of the drugs, on GMS prescribing expenditure. Those aged over 75 (ẞ = 1:195) and cardiovascular prescribing (ẞ = 1:193) were the greatest contributors to annual GMS prescribing costs. Respiratory drugs (Montelukast) recorded the highest proportion and expenditure for GMS claimants under the age of 15. Drugs prescribed for the nervous system (Escitalopram, Olanzapine and Pregabalin) were highest for those between 16 and 64 years with cardiovascular drugs (Statins) were highest for those aged over 65. Females are more expensive than males and are prescribed more items across the four ATC groups, except among children under 11, (ConwayLenihan et al., 2016). This research indicates that growth in the proportion of the elderly claimants and associated levels of cardiovascular prescribing, particularly for statins, will present difficulties for Ireland in terms of cost containment. Whilst policies aimed at cost containment (co{payment charges, generic substitution, reference pricing, adjustments to GMS eligibility) can be used to curtail expenditure, health promotional programs and educational interventions should be given equal emphasis. Also policies intended to affect physicians prescribing behaviour include guidelines, information (about price and less expensive alternatives) and feedback, and the use of budgetary restrictions could yield savings.

US Asset-Backed Securities – Regulatory Reform, Dodd-Frank and Final Rules

This chapter examines the new rules proposed under regulatory reform since the credit crisis of 2008-09, including the major proposals of the Dodd-Frank Act of 2010 and some of the Final Rules thereto.

Universities and Welfare States Coping with Permanent Financial Austerity: Pressures on (Competing) Public Institutions

A chapter linking universities and welfare states to permanent financial austerity can take a shorter or a longer historical perspective. This chapter looks further back (to the postwar expansion of European welfare states) to better understand future transformations of both public institutions. Their long-term sustainability problems did not start with the financial crisis of 2008 but have been growing since the 1970s (Schäfer and Streeck 2013; Bonoli and Natali 2012; Hay and Wincott 2012). Financial austerity is not a post-crisis phenomenon. As a concept, it was used in welfare state research at least a decade earlier, although it does not seem to have been used in higher education studies until recently. Two quotations bring us to the heart of the matter: welfare states and universities are currently changing under adverse financial conditions caused by an array of interrelating and mutually reinforcing forces and their long-term financial sustainability is at stake across Europe. The welfare state is a “particular trademark of the European social model” (Svallfors 2012: 1), “the jewel in the crown” and a “fundamental part of what Europe stands for” (Giddens 2006: 14), as are tuition-free universities, the cornerstone of intergenerational social mobility in Continental Europe. The past trajectories of major types of welfare states and of universities in Europe tend to go hand in hand: first vastly expanding following the Second World War, and especially in the 1960s and 1970s, and then being in the state of permanent resource-driven and legitimacy-based “crisis” in the last two decades. Welfare states and universities, two critically important public institutions, seem to be under heavy attacks from the public, the media and politicians. Their long-term sustainability is being questioned, and solutions to their (real and perceived) problems are being sought at global, European, and national levels.

Proces prekaryzacji pracy - nowe kierunki zmian społeczno-gospodarczych w świecie

Wydział Nauk Politycznych i Dziennikarstwa

La paradoja de Maastricht. Los distintos modelos económicos y políticos para el futuro integrador de la UE

La crisis existencial del proyecto de integración europea constituye el principal reto al que debe enfrentarse la Comunidad en su futuro más inmediato puesto que se alza como toda una amenaza para la continuidad del sistema establecido desde el Tratado fundacional de Roma (1957). Las tres crisis acontecidas durante los primeros años del siglo XXI, véase la gran crisis económica del año 2008, la pandemia global de la Covid-19 y la actual intervención de la Federación Rusa en Ucrania, están poniendo constantemente a prueba la firmeza de los cimientos y valores sobre los cuales se ha construido la Comunidad durante todos estos años. Esta tesis doctoral pretende ser una contribución académica al debate abierto en las sociedades comunitarias acerca de por donde debe de transitar la evolución del proyecto de integración europea en los próximos años. Para conseguir alcanzar este objetivo, la investigación se retrotrae hasta los orígenes del proceso de integración y avanza en la línea temporal hasta nuestros días, analizando con ello las posibles causas que pudieran encontrarse detrás de la crisis existencial actual. A su vez, , la investigación estudia con detenimiento los múltiples efectos que está generando la problemática existencial en los Estados miembros en los últimos años, tales como el aumento del apoyo social a favor de actores considerados populistas o el fenómeno de la creciente desafección ciudadana. Esta investigación analiza los distintos escenarios propuestos por la Comisión Europea en su Libro Blanco sobre el futuro de Europa para determinar cuál podría ser el mejor escenario que concordara con la nueva realidad económica y sociopolítica que actualmente impera en los Estados miembro. Lo que se persigue es formular una propuesta que pueda dar por terminada la crisis existencial de la Comunidad abriendo con ello una nueva etapa en la historia de la integración europea.

Análisis de la crisis financiera de estados unidos (2007-2008) y la crisis de deuda (2011): su relación e impacto sobre uno de los fundamentales de la economía colombiana, la tasa de cambio

Este documento presenta una perspectiva de como una economía pequeña y abierta (en temas comerciales y de inversión) como la colombiana, se ve afectada por choques que sufren economías grandes como la estadounidense. Durante el periodo de estudio la economía de Estados Unidos sufrió dos choques: primero la crisis de las hipotecas subprime en los años 2007-2008; luego la crisis de deuda soberana de Estados Unidos en 2011. Estos dos choques afectaron la economía colombiana. En ambos casos, se puede establecer un hecho clave que detonó las crisis. En el primero, la entrada en el capítulo 11 de protección a bancarrotas por parte de Lehman Brothers, el 15 de septiembre de 2008. En el segundo, el detonante fue la baja de la calificación de la deuda soberana de Estados Unidos por parte de Standard and Poor´s el 5 de agosto de 2011. Estos días claves en las crisis, afectaron los principales índices de la bolsa de Estados Unidos, especialmente los relacionados con la actividad financiera, luego es de suponer que posiblemente también afectaron fundamentales de la economía colombiana como lo es la tasa de cambio peso-dólar (USD/COP). Este documento tiene como objeto principal, establecer el impacto de las crisis Norteamericana de 2007-2008 y de 2011, sobre la economía colombiana, específicamente sobre la tasa de cambio USD/COP. El documento también, analiza las causas que generaron dichas crisis en Estados Unidos, haciendo énfasis en la falta de regulación y control por parte de las instituciones del gobierno en la crisis de las hipotecas subprime. De igual forma se analiza el papel de las firmas calificadoras de riesgo, en la crisis de deuda estadounidense.

Financial governance: the Brazilian experience on prudential regulation and its impacts on the effects of the 2008 financial crisis

The Brazilian economy was severely hit by the 2008 crisis. In the beginning of the crisis, the vast majorities of the economic agents and authorities thought that Brazil could face some sort of decoupling since some macroeconomic fundamentals were very good. What we saw, however, was that the Brazilian economy was not decoupled, and expectations faced a huge deterioration soon after the bankruptcy of Lehman Brothers in September 15th. Two aspects regarding the impact of crisis in Brazil, however, deserve a great deal of attention: (a) although deep, the impact did not last for a long time. Actually, the GDP growth experienced a good recovery in the second quarter of 2009, showing that the health of the Brazilian economy was good; (b) the Brazilian banking system performed very well during the crisis, although we cannot say the system was not in danger in the worst time of the crisis. In spite of the confidence crisis faced by the banking system 1, it showed a great deal of resilience. In this aspect, we argue that the restructure faced by the banking system in the aftermath of the Real Plan, as well as the development of a solid supervision regulation helped a lot the system to avoid the systemic crisis that was an open possibility to the Brazilian banking system in the end of 2008. These notes, thus, discusse why the Brazilian banking system performed pretty well in the 2008 financial crisis and how the Brazilian banking (and prudential) regulation can be taken as responsible for this good performance. More specifically, the paper back to the middle of the 1990s, when the Real Plan was implemented, in order to understand the role played by the restructuring of the Brazilian financial system in helping to pave the way to the great resilience experienced by the Brazilian banking system during the 2008 crisis. More specifically, the prudential regulation that was implemented in Brazil in the aftermath of the Real Plan seems to play a decisive role in the resilience of the system nowadays.

Preliminary Overview of the Economies of Latin America and the Caribbean 2008

Includes bibliography

A crise financeira de 2008 e seus impactos na economia brasileira: uma análise sob a perspectiva de Minsky

Diante do colapso financeiro de 2008, este trabalho retoma a teoria econômica proposta por Hyman P. Minsky com o objetivo de esclarecer as circunstâncias que propiciaram uma crise financeira tão profunda. A estrutura analítica de Minsky é marcada pela Hipótese da Instabilidade Financeira, a qual aponta para fatores endógenos ao próprio sistema capitalista como o principal causador de instabilidades financeiras. Este processo, caracterizado principalmente por um avanço desfavorável no nível de endividamento dos agentes, constrói um ciclo de estágios que pode se desenvolver para uma crise financeira ou um colapso sistêmico, definidos como “Momento Minsky” e “Colapso Minsky”. Este cenário descrito por Minsky, também analisado à luz de teorias mais recentes como as de Gary A. Dymski e Alessandro Vercelli, é conhecido por “ciclo minskyano”. Ao adotar estes preceitos da análise teórica de Minsky, é possível visualizar como o processo de desregulamentação e fragilização financeira dos Estados Unidos nas décadas de 1980 e 1990 proveram condições para a crise do subprime e, posteriormente, o colapso financeiro de 2008. De maneira similar, é possível observar que a análise teórica de Minsky também é aplicável à crise que afeta a economia brasileira no final de 2008. A fragilização financeira que se inicia no Brasil poucos anos antes da crise, acentuada no setor exportador de commodities, cria a condição para o “momento Minsky brasileiro”, demonstrando que apesar das falhas da análise teórica de Minsky, que supõe uma economia fechada com características da economia estadunidense, é possível visualizar uma relação de causa e efeito da recente crise financeira com a teoria minskyana.

Estudo sobre o efeito de contágio nos mercados financeiros de acções: aplicação aos índices de acções europeus, americanos, asiáticos e brasileiro no período de Janeiro de 1996 a Junho de 2009 e no sub-período da crise subprime

Mestrado em Contabilidade

U.S. subprime financial crisis contagion on BRIC and European Union stock markets

ABSTRACTThe Copula Theory was used to analyze contagion among the BRIC (Brazil, Russia, India and China) and European Union stock markets with the U.S. Equity Market. The market indexes used for the period between January 01, 2005 and February 27, 2010 are: MXBRIC (BRIC), MXEU (European Union) and MXUS (United States). This article evaluated the adequacy of the main copulas found in the financial literature using log-likelihood, Akaike information and Bayesian information criteria. This article provides a groundbreaking study in the area of contagion due to the use of conditional copulas, allowing to calculate the correlation increase between indexes with non-parametric approach. The conditional Symmetrized Joe-Clayton copula was the one that fitted better to the considered pairs of returns. Results indicate evidence of contagion effect in both markets, European Union and BRIC members, with a 5% significance level. Furthermore, there is also evidence that the contagion of U.S. financial crisis was more pronounced in the European Union than in the BRIC markets, with a 5% significance level. Therefore, stock portfolios formed by equities from the BRIC countries were able to offer greater protection during the subprime crisis. The results are aligned with recent papers that present an increase in correlation between stock markets, especially in bear markets.

Domestic policy responses to the food price crisis: The case of Bolivia

In face of the global food crisis of 2007-2008, severe concerns arose about how developing countries would be affected by the extreme short-term fluctuations in international commodity prices. We examine the effects of the crisis on Bolivia, one of the poorest countries of the Americas. We focus on the effectiveness of the domestic policy interventions in preventing spillovers of the development of international food prices to domestic markets. Using a cointegration model, we study price interdependencies of wheat flour, sunflower oil and poultry. The analysis suggests that the policy measures taken had little effect on food security during the food crisis. Throughout the entire period, perfect price transmission between the Bolivian poultry and sunflower oil markets and the respective international reference markets existed. Bolivian prices were determined by international prices and the policy interventions in the markets of these two commodities were not found to have had an effect. The government's large-scale wheat flour imports did not shield Bolivian consumers from the shocks of international prices.

Derivativos, alavancagem e a crise de 2008

O objeto de estudo deste trabalho foi o subprime, sua origem, evolução e os possíveis contornos à crise financeira do século. O objetivo geral do trabalho foi investigar as razões para a ocorrência do fenômeno, bem como suas consequências. Além disso, as principais causas da crise, suas tendências e algumas possíveis soluções foram investigadas por meio de pesquisa bibliográfica. Para contornar as consequências da crise, seria necessário rever o modelo de regulação das atuais instituições financeiras vigentes, que são as responsáveis pela definição das economias de mercado, de modo a diminuir a instabilidade presente nos mercados financeiros.

Essays on the credit channel of monetary policy: a case study for Brazil

The onset of the financial crisis in 2008 and the European sovereign crisis in 2010 renewed the interest of macroeconomists on the role played by credit in business cycle fluctuations. The purpose of the present work is to present empirical evidence on the monetary policy transmission mechanism in Brazil with a special eye on the role played by the credit channel, using different econometric techniques. It is comprised by three articles. The first one presents a review of the literature of financial frictions, with a focus on the overlaps between credit activity and the monetary policy. It highlights how the sharp disruptions in the financial markets spurred central banks in developed and emerging nations to deploy of a broad set of non conventional tools to overcome the damage on financial intermediation. A chapter is dedicated to the challenge face by the policymaking in emerging markets and Brazil in particular in the highly integrated global capital market. This second article investigates the implications of the credit channel of the monetary policy transmission mechanism in the case of Brazil, using a structural FAVAR (SFAVAR) approach. The term “structural” comes from the estimation strategy, which generates factors that have a clear economic interpretation. The results show that unexpected shocks in the proxies for the external finance premium and the credit volume produce large and persistent fluctuations in inflation and economic activity – accounting for more than 30% of the error forecast variance of the latter in a three-year horizon. Counterfactual simulations demonstrate that the credit channel amplified the economic contraction in Brazil during the acute phase of the global financial crisis in the last quarter of 2008, thus gave an important impulse to the recovery period that followed. In the third articles, I make use of Bayesian estimation of a classical neo-Keynesian DSGE model, incorporating the financial accelerator channel developed by Bernanke, Gertler and Gilchrist (1999). The results present evidences in line to those already seen in the previous article: disturbances on the external finance premium – represented here by credit spreads – trigger significant responses on the aggregate demand and inflation and monetary policy shocks are amplified by the financial accelerator mechanism. Keywords: Macroeconomics, Monetary Policy, Credit Channel, Financial Accelerator, FAVAR, DSGE, Bayesian Econometrics

A note on financial regulation and the brazilian response to the 2008‐09 financial crisis

Brazil was frequently criticized for its interventionist and heavy financial regulation up until the 2008‐09 world financial crisis.  According to the neo‐liberal or pro‐market view that predominated in academic and financial circles during the early 2000s, economic development came together with financial deepening, which in its turn could only be achieved through financial liberalization and deregulation. The currency crises of the 1990s notwithstanding, by the mid‐2000s Brazil’s segmented financial market and its restrictive reserve and capital requirements were seen as a symbol of inefficiency and backwardness by most financial specialists.  To the luck of the Brazilian population, most of the advices of such specialists were ignored by the Brazilian authorities, so that, when the 2008 financial crisis hit the world economy, Brazil still had powerful and efficient instruments to deal with the problem.  The objective of this note is to present the mains aspects of the Brazilian financial regulation and how they helped the economy to deal with the consequences of 2008‐09 financial meltdown.