Population based resource allocation: The use of hybrid risk adjustment

The emphasis on integrated care implies new incentives that promote coordinationbetween levels of care. Considering a population as a whole, the resource allocation systemhas to adapt to this environment. This research is aimed to design a model that allows formorbidity related prospective and concurrent capitation payment. The model can be applied inpublicly funded health systems and managed competition settings.Methods: We analyze the application of hybrid risk adjustment versus either prospective orconcurrent risk adjustment formulae in the context of funding total health expenditures for thepopulation of an integrated healthcare delivery organization in Catalonia during years 2004 and2005.Results: The hybrid model reimburses integrated care organizations avoiding excessive risktransfer and maximizing incentives for efficiency in the provision. At the same time, it eliminatesincentives for risk selection for a specific set of high risk individuals through the use ofconcurrent reimbursement in order to assure a proper classification of patients.Conclusion: Prospective Risk Adjustment is used to transfer the financial risk to the healthprovider and therefore provide incentives for efficiency. Within the context of a National HealthSystem, such transfer of financial risk is illusory, and the government has to cover the deficits.Hybrid risk adjustment is useful to provide the right combination of incentive for efficiency andappropriate level of risk transfer for integrated care organizations.

Financing local development: Quasi-experimental evidence from municipalities in Brazil, 1980-1991

This paper uses a regression discontinuity design to estimate the impact of additional unrestrictedgrant financing on local public spending, public service provision, schooling, literacy, andincome at the community (municipio) level in Brazil. Additional transfers increased local publicspending per capita by about 20% with no evidence of crowding out own revenue or otherrevenue sources. The additional local spending increased schooling per capita by about 7% andliteracy rates by about 4 percentage points. The implied marginal cost of schooling -accountingfor corruption and other leakages- amounts to about US$ 126, which turns out to be similar tothe average cost of schooling in Brazil in the early 1980s. In line with the effect on human capital,the poverty rate was reduced by about 4 percentage points, while income per capita gains werepositive but not statistically significant. Results also suggest that additional public spending hadstronger effects on schooling and literacy in less developed parts of Brazil, while poverty reductionwas evenly spread across the country.

A non-quasi-competitive Cournot oligopoly with stability

This paper presents a classical Cournot oligopoly model with some peculiar features: it is non--quasi--competitive as price under N-poly is greater than monopoly price; Cournot equilibrium exists and is unique with each new entry; the successive equilibria after new entries are stable under the adjustment mechanism that assumes that actual output of each seller is adjusted proportionally to the difference between actual output and profit maximizing output. Moreover, the model tends to perfect competition as N goes to infinity, reaching the monopoly price again.

The quasi-judicial role of large retailers: An efficiency hypothesis of their relation with suppliers

The paper explores an efficiency hypothesis regarding the contractual process between large retailers, such as Wal-Mart and Carrefour, and their suppliers. The empirical evidence presented supports the idea that large retailers play a quasi-judicial role, acting as "courts of first instance" in their relationships with suppliers. In this role, large retailers adjust the terms of trade to on-going changes and sanction performance failures, sometimes delaying payments. A potential abuse of their position is limited by the need for re-contracting and preserving their reputations. Suppliers renew their confidence in their retailers on a yearly basis, through writing new contracts. This renovation contradicts the alternative hypothesis that suppliers are expropriated by large retailers as a consequence of specific investments.

When are layoffs acceptable? Evidence from a quasi-experiment

Many authors have discussed a decline in internal labor markets and an apparent shift to a new employment contract, characterized by less commitment between employer and employee and more portable skills. These discussions occur without much evidence on what employment contract employees currently feel is fair. We perfomed quasi-experimental surveys to study when employees in the U.S. andCanada feel that layoffs are fair.Layoffs were perceived as more fair if they were due to lower product demand than if the result of employee suggestions. This result appears to be solely due to norms of reciprocity (companiesshould not punish employees for their efforts), rather than norms of sharing rents, as new technology was also considered a justification for layoffs.Consistent with theories of distributive and procedural equity, layoffs were perceived as more fair if the CEO voluntarily shared the pain. CEO bonuses due to layoffs lowered their reported fairness only slightly.Respondents in Silicon Valley were not more accepting of layoffsthan were those in Canada on average, although the justificationsconsidered valid differed slightly.

Hybrid risk adjustment for pharmaceutical benefits

This paper analyses the application of hybrid risk adjustment versus either prospective orconcurrent risk adjustment formulae in the context of funding pharmaceutical benefits for thepopulation of an integrated healthcare delivery organization in Catalonia during years 2002 and2003. We apply a mixed formula and find that a hybrid risk adjustment model increasesincentives for efficiency in the provision of low risk individuals at health organizations not only asa whole but also at each internal department compared to only prospective models by reducingwithin-group variation of drug expenditures.

A collagen-poly(lactic acid-co-ɛ-caprolactone) hybrid scaffold for bladder tissue regeneration.

Scaffold materials should favor cell attachment and proliferation, and provide designable 3D structures with appropriate mechanical strength. Collagen matrices have proven to be beneficial scaffolds for tissue regeneration. However, apart from small intestinal submucosa, they offer a limited mechanical strength even if crosslinking can enhance their mechanical properties. A more cell-friendly way to increase material strength is to combine synthetic polymer meshes with plastic compressed collagen gels. This work describes the potential of plastic compressed collagen-poly(lactic acid-co-ɛ-caprolactone) (PLAC) hybrids as scaffolds for bladder tissue regeneration. Human bladder smooth muscle and urothelial cells were cultured on and inside collagen-PLAC hybrids in vitro. Scaffolds were analyzed by electron microscopy, histology, immunohistochemistry, and AlamarBlue assay. Both cell types proliferated in and on the hybrid, forming dense cell layers on top after two weeks. Furthermore, hybrids were implanted subcutaneously in the backs of nude mice. Host cell infiltration, scaffold degradation, and the presence of the seeded bladder cells were analyzed. Hybrids showed a lower inflammatory reaction in vivo than PLAC meshes alone, and first signs of polymer degradation were visible at six months. Collagen-PLAC hybrids have potential for bladder tissue regeneration, as they show efficient cell seeding, proliferation, and good mechanical properties.

Elaboració d'indicadors sobre SAGE Logic Class

El treball desenvolupat ha consistit en analitzar el sistema d'informació Logic Class sota la perspectiva de la necessitat de construir un sistema d'indicadors (quadre de comandament operatiu) que integri informació de les diferents fonts de dades.

Modelling of weather radar echoes from anomalous propagation using a hybrid parabolic equation method and NWP model data

Contamination of weather radar echoes by anomalous propagation (anaprop) mechanisms remains a serious issue in quality control of radar precipitation estimates. Although significant progress has been made identifying clutter due to anaprop there is no unique method that solves the question of data reliability without removing genuine data. The work described here relates to the development of a software application that uses a numerical weather prediction (NWP) model to obtain the temperature, humidity and pressure fields to calculate the three dimensional structure of the atmospheric refractive index structure, from which a physically based prediction of the incidence of clutter can be made. This technique can be used in conjunction with existing methods for clutter removal by modifying parameters of detectors or filters according to the physical evidence for anomalous propagation conditions. The parabolic equation method (PEM) is a well established technique for solving the equations for beam propagation in a non-uniformly stratified atmosphere, but although intrinsically very efficient, is not sufficiently fast to be practicable for near real-time modelling of clutter over the entire area observed by a typical weather radar. We demonstrate a fast hybrid PEM technique that is capable of providing acceptable results in conjunction with a high-resolution terrain elevation model, using a standard desktop personal computer. We discuss the performance of the method and approaches for the improvement of the model profiles in the lowest levels of the troposphere.