Essays on Environmental and Health Economics

Thesis (Ph.D.)--University of Washington, 2016-06

A Comparison of Paediatric Occupational Therapy University Program Curricula in New Zealand, Australia, and Canada

Comparisons were made of the paediatric content of professional entry-level occupational therapy university program curricula in Australia, New Zealand, and Canada using an ex post facto surveymethodology. The findings indicated that in Australia/New Zealand, paediatrics made up 20% of the total curriculum, but only 13% in Canada. Canadian reference materials were utilized less often in Canadian universities than in Australia/New Zealand. Theories taught most often in Australia/New Zealand were: Sensory Integration, Neurodevelopmental Therapy, Client-Centered Practice, Playfulness, and the Model of Human Occupation. In Canada, the most frequent theories were: Piaget’s Stages ofCognitive/Intellectual Development, Neurodevelopmental Therapy, Erikson’s Eight Stages of Psychosocial Development and Sensory Integration. The most frequently taught paediatric assessment tools in both regions were the Bruininks-Oseretsky Test of Motor Proficiency and Miller Assessment for Preschoolers. Paediatric interventionmethods taught to students in all three countries focused on activities of daily living/self-care, motor skills, perceptual and visual motor integration, and infant and child development. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: Website: ©2006 by The Haworth Press, Inc. All rights reserved.]

Some economic dimensions of the mental health jigsaw in Australia

The purpose of this paper is to demonstrate that, although there are some unique features associated with mental illness, such special features do not preclude economic analysis. As a mechanism for understanding how individual economic studies fit into the mental health sector, a conceptual framework of the components of mental health service provision is outlined. Emphasis is placed on, not simply institutional and market resources, but also on the services provided by relatives, self-help groups, etc. Australian data on parts of the mental health sector are employed to illustrate that some (and different) economic analyses can be undertaken in mental health. First, time-series data on public psychiatric hospitals are employed to demonstrate trends associated with deinstitutionalisation. Other data (for Queensland alone) indicate that there are state-based differences in the provision of such services. Second, attention is then directed to the analysis of time-series data on private fee-for-service psychiatric services. Various concepts and measures from industrial economics are applied to analyse the relative size of this service industry, the pricing behaviour of the profession, the service-mix of "the psychiatry firms" operating in Australia.

O PAPEL DO GESTOR ESCOLAR NO PROCESSO DE QUALIFICAÇÃO PROFISSIONAL DOS ALUNOS NO ENSINO MÉDIO UM ESTUDO DE CASO EM UMA ESCOLA PÚBLICA ESTADUAL PAULISTA

A presente dissertação trata do papel da gestão escolar no Ensino Médio, no processo de qualificação profissional dos alunos em uma escola pública estadual na periferia do município de Osasco São Paulo. Observa-se que um novo modelo de gestão na educação é discutido nos últimos anos no Brasil. Os Governos Federais junto com o Ministério da Educação têm apresentado programas sociais com o objetivo de que o jovem brasileiro possa se profissionalizar e estar apto a enfrentar um mercado de trabalho competitivo. Entre os programas do Governo destaca-se o Prouni, (Programa de Universidade para todos), representa um programa do Ministério da Educação criado em 2004 com a finalidade de conceder bolsas de ensino integral e parcial em instituições privadas de ensino superior, em cursos de graduação, destinada a estudantes brasileiros que não tenham cursado o ensino superior. Essas bolsas são concedidas aos alunos que participaram do Exame Nacional do Ensino Médio (ENEM). Em 2011, o Ministério da Educação criou o Programa Nacional de Acesso ao Ensino Técnico e Emprego (Pronatec) com o propósito de ampliar a oferta de cursos de educação profissional e tecnológica. Com esses e outros programas oferecidos pelo Governo pretende-se preparar os jovens para o mercado de trabalho. A pergunta norteadora deste estudo é: qual o papel do gestor escolar do Ensino Médio e suas ações visando a qualificação profissional do aluno? A pesquisa busca analisar a gestão escolar no Ensino Médio, tendo como foco o papel do gestor de uma escola pública no processo de escolha da qualificação profissional dos alunos do Ensino Médio. Para auxiliar o alcance desse objetivo, foram delimitados dois aspectos para estudo: a) analisar as ações e concepções políticas da gestão escolar pela percepção do corpo docente e de funcionários da escola; b) analisar as ações da gestão escolar visando à qualificação profissional por meio da visão de alunos em curso e de egressos. Trata-se de uma pesquisa que será qualitativa exploratória- descritiva. A pesquisa documental e as entrevistas semiestruturadas fazem parte da coleta de dados que irão subsidiar a análise final. A contribuição científica e social que se discute neste trabalho é a reflexão sobre a gestão da escola no Ensino Médio no processo de qualificação profissional dos alunos.

Auditor's engagement risk and audit fees:the role of the audit firm alumni

This study explores the effect of the association of audit firm alumni with their alma mater on audit prices. The tests indicate that there is a moderate reduction of up to 21% in the level of audit fee when alumni (i.e., former employees) of the incumbent audit firm sit on the client board of directors which is consistent with the engagement risk theory. This suggests that there is an 'alumni effect' in the market for audit services. The findings hold only in the large company segment of the market. The results are robust to different model specifications and alternative samples. The sample comprises all executive and non-executive directors who run the UK quoted companies and are simultaneously ICAEW qualified chartered accountants. The study's implications for the accounting profession and the regulators are also discussed. © 2007 The Author Journal compilation © 2007 Blackwell Publishing Ltd.

An empirical investigation of price competition and industry specialisation in NHS audit services

The NHS audit market is regulated by the Audit Commission (AC) and has unique features. We develop a model for audit fees that includes rigorous analysis of the type of auditor. Poor financial standing does not give rise to higher audit fees. Despite regulation the study supports the existence of a Big Five price premium on the audit fee, but only one firm has a premium. We found no premium due to industry specialisation. The removal of performance audit from AC regulation will require improved audit fee reporting and control.

The market for professional services in Indonesia

This paper reports the results of a study which investigates the market for professional services in Indonesia, a country which has not been investigated in the by audit fee literature prior. A well-developed research model used in the prior literature has also been applied in this study, and the empirical findings suggest broad similarities in the pricing of professional services in Indonesia and other countries previously studied. In addition to extending the results of prior research to a country not previously studied, this paper examines whether the large auditors fee premium documented in other countries exists in Indonesia, especially after the major Asian financial crisis of 1997/98, since then almost all companies in this geographical area exercise tight budget controls. The results suggest that no audit fee premium is accrued to Indonesian Big 5 auditors, in contrast to the large audit firm fee premium documented in many other countries.

Dispensing activity in a community pharmacy-based repeat dispensing pilot project

Objective: To measure changes in dispensing activity in a UK repeat dispensing pilot study and to estimate any associated cost savings. Method: Patients were provided with two successive three-monthly repeat prescriptions containing all of the items on their "repeat medicines list" and valid at a study pharmacy. Pharmacists consulted with patients at the time of supply and completed a patient-monitoring form. Prescriptions with pricing data were returned by the UK Prescription Pricing Authority. These data were used to calculate dispensing activity, the cost of dispensed items and an estimate of cost savings on non-dispensed items. A retrospective identification of items prescribed during the six months prior to the project was used to provide a comparison with those dispensed during the project and thus a more realistic estimate of changes. Setting: 350 patients from two medical practices in a large English City, with inner city and suburban locations, and served by seven pharmacies. Key findings: There were methodological challenges in establishing a robust framework for calculating changes. Based on all of the items that patients could have obtained from their repeat list, 23.8% were not dispensed during the intervention period. A correction was then made to allow for a comparison with usage in the six months prior to the study. Based on the corrected data, there was an estimated 11.3% savings in drug costs compared with the pre-intervention period. There was a marked difference in changes between the two practices, the pharmacies and individual patients. The capitation-based remuneration method was acceptable to all but one of the community pharmacists. Conclusion: The repeat dispensing system reduced dispensing volume in comparison with the control period. A repeat dispensing system with a focus on patients' needs and their use of medicines might be cost neutral.

Waste to power

ABSTRACT: There has been a growing trend towards the use of biomass as a primary energy source, which now contributes over 54% of the European pulp and paper industry energy needs [1]. The remaining part comes from natural gas, which to a large extent serves as the major source of energy for numerous recovered fiber paper mills located in regions with limited available forest resources. The cost of producing electricity to drive paper machinery and generate heat for steam is increasing as world demand for fossil fuels increases. Additionally, recovered fiber paper mills are also significant producers of fibrous sludge and reject waste material that can contain high amounts of useful energy. Currently, a majority of these waste fractions is disposed of by landspreading, incineration, or landfill. Paper mills must also pay a gate fee to process their waste streams in this way and the result of this is a further increase in operating costs. This work has developed methods to utilize the waste fractions produced at recovered fiber paper mills for the onsite production of combined heat and power (CHP) using advanced thermal conversion methods (pyrolysis and gasification) that are well suited to relatively small scales of throughput. The electrical power created would either be used onsite to power the paper making process or alternatively exported to the national grid, and the surplus heat created could also be used onsite or exported to a local customer. The focus of this paper is to give a general overview of the project progress so far and will present the experimental results of the most successful thermal conversion trials carried out by this work to date. Application: The research provides both paper mills and energy providers with methodologies to condition their waste materials for conversion into useful energy. The research also opens up new markets for gasifier and pyrolysis equipment manufacturers and suppliers.

Reputation and performance in large law firms

Reputation is a signalling device that serves as a proxy for the quality of a firm’s products, strategies and employees relative to its competitors, when communicating with clients and other stakeholders. It is especially important for professional service firms because of the complex and intangible nature of their service and because of the advantages it confers in the market for high-quality professional staff. This paper extends and refines existing research on reputation which shows positive returns to reputation for professional service firms. We use different rankings of the top 50 law firms in the UK to measure reputation and examine their relationship with financial performance as expressed in firm revenue and profits. We find positive but diminishing returns to reputation even within this group and we find a stronger relationship between reputation and profits than fee income. We conclude that reputation may be an important source of competitive advantage for leading firms but it seems to offer little leverage for others. If these results are generalizable across other professional sectors this raises the question of how the majority of firms can differentiate themselves.

Customer loyalty among daily disposable contact lens wearers

Background: Optometric practices offer contact lenses as cash sale items or as part of monthly payment plans. With the contact lens market becoming increasingly competitive, patients are opting to purchase lenses from supermarkets and Internet suppliers. Monthly payment plans are often implemented to improve loyalty. This study aimed to compare behavioural loyalty between monthly payment plan members and non-members. Methods: BBR Optometry Ltd offers a monthly payment plan (Eyelife™) to their contact lens wearers. A retrospective audit of 38 Eyelife™ members (mean. ±. SD: 42.7. ±. 15.0 years) and 30 non-members (mean. ±. SD: 40.8. ±. 16.7 years) was conducted. Revenue and profits generated, service uptake and product sales between the two groups were compared over a fixed period of 18 months. Results: Eyelife™ members generated significantly higher professional fee revenue ( P<. 0.001), £153.96 compared to £83.50, and profits ( P<. 0.001). Eyelife™ members had a higher uptake of eye examinations ( P<. 0.001). The 2 groups demonstrated no significant difference in spectacle sales by volume ( P= 0.790) or value ( P= 0.369). There were also no significant differences in contact lens revenue ( P= 0.337), although Eyelife™ members did receive a discount. The Eyelife™ group incurred higher contact lens costs ( P= 0.037), due to a greater volume of contact lens purchases, 986 units compared to 582. Conclusions: Monthly payment plans improve loyalty among contact lens wearers, particularly service uptake and volume of lens purchases. Additionally the greater professional fees generated, render monthly payment plans an attractive business model and practice builder.

A techno-economic comparison of power production by biomass fast pyrolysis with gasification and combustion

This paper presents an assessment of the technical and economic performance of thermal processes to generate electricity from a wood chip feedstock by combustion, gasification and fast pyrolysis. The scope of the work begins with the delivery of a wood chip feedstock at a conversion plant and ends with the supply of electricity to the grid, incorporating wood chip preparation, thermal conversion, and electricity generation in dual fuel diesel engines. Net generating capacities of 1–20 MWe are evaluated. The techno-economic assessment is achieved through the development of a suite of models that are combined to give cost and performance data for the integrated system. The models include feed pretreatment, combustion, atmospheric and pressure gasification, fast pyrolysis with pyrolysis liquid storage and transport (an optional step in de-coupled systems) and diesel engine or turbine power generation. The models calculate system efficiencies, capital costs and production costs. An identical methodology is applied in the development of all the models so that all of the results are directly comparable. The electricity production costs have been calculated for 10th plant systems, indicating the costs that are achievable in the medium term after the high initial costs associated with novel technologies have reduced. The costs converge at the larger scale with the mean electricity price paid in the EU by a large consumer, and there is therefore potential for fast pyrolysis and diesel engine systems to sell electricity directly to large consumers or for on-site generation. However, competition will be fierce at all capacities since electricity production costs vary only slightly between the four biomass to electricity systems that are evaluated. Systems de-coupling is one way that the fast pyrolysis and diesel engine system can distinguish itself from the other conversion technologies. Evaluations in this work show that situations requiring several remote generators are much better served by a large fast pyrolysis plant that supplies fuel to de-coupled diesel engines than by constructing an entire close-coupled system at each generating site. Another advantage of de-coupling is that the fast pyrolysis conversion step and the diesel engine generation step can operate independently, with intermediate storage of the fast pyrolysis liquid fuel, increasing overall reliability. Peak load or seasonal power requirements would also benefit from de-coupling since a small fast pyrolysis plant could operate continuously to produce fuel that is stored for use in the engine on demand. Current electricity production costs for a fast pyrolysis and diesel engine system are 0.091/kWh at 1 MWe when learning effects are included. These systems are handicapped by the typical characteristics of a novel technology: high capital cost, high labour, and low reliability. As such the more established combustion and steam cycle produces lower cost electricity under current conditions. The fast pyrolysis and diesel engine system is a low capital cost option but it also suffers from relatively low system efficiency particularly at high capacities. This low efficiency is the result of a low conversion efficiency of feed energy into the pyrolysis liquid, because of the energy in the char by-product. A sensitivity analysis has highlighted the high impact on electricity production costs of the fast pyrolysis liquids yield. The liquids yield should be set realistically during design, and it should be maintained in practice by careful attention to plant operation and feed quality. Another problem is the high power consumption during feedstock grinding. Efficiencies may be enhanced in ablative fast pyrolysis which can tolerate a chipped feedstock. This has yet to be demonstrated at commercial scale. In summary, the fast pyrolysis and diesel engine system has great potential to generate electricity at a profit in the long term, and at a lower cost than any other biomass to electricity system at small scale. This future viability can only be achieved through the construction of early plant that could, in the short term, be more expensive than the combustion alternative. Profitability in the short term can best be achieved by exploiting niches in the market place and specific features of fast pyrolysis. These include: •countries or regions with fiscal incentives for renewable energy such as premium electricity prices or capital grants; •locations with high electricity prices so that electricity can be sold direct to large consumers or generated on-site by companies who wish to reduce their consumption from the grid; •waste disposal opportunities where feedstocks can attract a gate fee rather than incur a cost; •the ability to store fast pyrolysis liquids as a buffer against shutdowns or as a fuel for peak-load generating plant; •de-coupling opportunities where a large, single pyrolysis plant supplies fuel to several small and remote generators; •small-scale combined heat and power opportunities; •sales of the excess char, although a market has yet to be established for this by-product; and •potential co-production of speciality chemicals and fuel for power generation in fast pyrolysis systems.

Drága-e a megújuló? – A hazai megújuló villamosenergia-termelés hatása a villamos energia árára (Is the renewable energy expensive? – Impact of the Hungarian renewable based power generation on electricity price)

A tanulmány arra keresi a választ, hogy a megújuló alapú áramtermelők támogatása csökkentőleg hathat- e a villamos energia nagykereskedelmi és kiskereskedelmi árára. Ez utóbbi tartalmazza a megújulók támogatásának összegét is. Számos elméleti cikk rámutatott arra, hogy nemcsak a nagykereskedelmi árak, hanem a kiskereskedelmi villamosenergia-árak is csökkenhetnek a drágább, megújuló alapú áramtermelők támogatása révén. A tanulmány során egy villamosenergia-piacokat szimuláló modell segítségével modellezi a szerző, hogy a különböző mennyiségű szélerőművi és fotovoltaikus kapacitás támogatása hogyan hat a magyarországi nagykereskedelmi és kiskereskedelmi árakra. _____ Impact of the Hungarian renewable based power generation on electricity price The aim of this paper is to answer the question whether the support of renewable power generation could decrease the wholesale and retail electricity prices. The latter one includes the support of renewables. Several studies point out that not only the wholesale, but the retail electricity prices could decrease when supporting the more expensive, renewable power generation. A model, which simulates the electricity markets, is used in order to analyse the impact of different level of wind and photo voltaic power generator support fee on Hungarian wholesale and retail electricity prices.

Managerial work roles of health care executives in the changing environment of academic medical centers

The current U.S. health care system faces numerous environmental challenges. To compete and survive, health care organizations are developing strategies to lower costs and increase efficiency and quality. All of these strategies require rapid and precise decision making by top level managers. The purpose of this study is to determine the relationship between the environment, made up of unfavorable market conditions and limited resources, and the work roles of top level managers, specifically in the settings of academic medical centers. Managerial work roles are based on the ten work roles developed by Henry Mintzberg, in his book, The Nature of Managerial Work (1973). ^ This research utilized an integrated conceptual framework made up of systems theory in conjunction with role, attribution and contingency theories to illustrate that four most frequently performed Mintzberg's work roles are affected by the two environment dimensions. The study sample consisted of 108 chief executive officers in academic medical centers throughout the United States. The methods included qualitative methods in the form of key informants and case studies and quantitative in the form of a survey questionnaire. Research analysis involved descriptive statistics, reliability tests, correlation, principal component and multivariate analyses. ^ Results indicated that under the market condition of increased revenue based on capitation, the work roles increased. In addition, under the environment dimension of limited resources, the work roles increased when uncompensated care increased while Medicare and non-government funding decreased. ^ Based on these results, a typology of health care managers in academic medical centers was created. Managers could be typed as a strategy-formulator, relationship-builder or task delegator. Therefore, managers who ascertained their types would be able to use this knowledge to build their strengths and develop their weaknesses. Furthermore, organizations could use the typology to identify appropriate roles and responsibilities of managers for their specific needs. Consequently, this research is a valuable tool for understanding health care managerial behaviors that lead to improved decision making. At the same time, this could enhance satisfaction and performance and enable organizations to gain the competitive edge . ^