Hospital district viability and Medicaid /market changes

Hospital districts (HD) that serve the uninsured and the needy face new challenges with the implementation of Medicaid managed. The potential loss of Medicaid patients and revenues may affect the ability to cost-shift and subsequently decrease the ability of the HD to meet its legal obligation of providing care for the uninsured. ^ To investigate HD viability in the current market, the aims of this study were to: (1) describe HD's environment, (2) document the HDs strategic response, (3) document changes in the HD's performance (patient volume) and financial status, and (4) determine whether relationships or trends exist between HD strategy, performance and financial status. ^ To achieve these aims, three Texas HDs (Fort Worth, Lubbock, and San Antonio) were selected to be evaluated. For each HD four types of strategic responses were documented and evaluated for change. In addition, the ability of each HD to sustain operations was evaluated by documenting performance and financial status changes (patient volume and financial ratios). A pre-post case study design method was used in which the Medicaid managed care “rollout'” date, at each site, was the central date. First, a descriptive analysis was performed which documented the environment, strategy, financial status, and patient volume of each hospital district. Second, to compare hospital districts, each hospital district was: (i) classified by a risk index, (ii) classified by its strategic response profile, and (iii) given a performance score based upon pre-post changes in patient volume and financial indicators. ^ Results indicated that all three HDs operate in a high risk environment compared to the rest of the nation. Two HDs chose the “Status Quo” response whereas one HD chose the “Competitive Proactive” response. Medicaid patient volume decreased in two of three HDs whereas indigent patient volume increased in two of the three (an indication of increasing financial risk). Total patient revenues for all HDs increased over the study period; however, the rate of increase slowed for all three after the Medicaid rollout date. All HDs experienced a decline in financial status between pre-post periods with the greatest decline observed in the HD that saw the greatest increase in indigent patient volume. ^ The pre-post case study format used and the lack of control study sites do not allow for assignment of causality. However, the results suggest possible adverse effects of Medicaid managed care and the need for a larger study, based on a stronger evaluation research design. ^

韓国のソーシャル・セーフティネット

アジア通貨危機後、韓国はIMFの構造調整を受け入れた。不況とマクロ緊縮政策があいまって、失業率が急激に上昇した。その対策として、政府はソーシャル・セーフティネットの整備に力を入れた。雇用保険の適用者拡大などの政策は、IMFのコンディショナリティに従ったものである。しかし、実際に実施された政策はIMFの勧告を超え、広く社会保障の整備につながるものであった。

The Production Technology of Philippine Domestic Banks in the Pre-Asian Crisis Periods: Estimation of Cost Function in the 1990-96 Period

This is to analyzes the operational behavior and technical progress among Philippine domestic banks, using micro-level data on individual banks. First, we summarize their major business activities and gain insight on how the structure is changing. Then, we formally estimate the cost function of Philippine domestic banks using panel data covering a seven-year period (1990-96). The presence of economies of scale and economies of scope is investigated and technical progress in the banking industry is measured. In addition, the results of analysis for the Philippines are compared with those of similar studies on Thailand conducted by the author previously.

Related Lending and Bank Performance: Evidence from Indonesia

After the Asian financial crisis of 1997, it was confirmed that banks lend to their related parties in many countries. The question examined in this article is whether related lending functions to alleviate the problems of asymmetric information or transfers profits from depositors and minority shareholders to related parties. The effects of related lending on the profitability and risk of banks in Indonesia are examined using panel data from 1994 to 2007 comprising a total of 74 Indonesian banks. The effects on return on asset (ROA) varied at different periods. Before and right after the crisis, a higher credit allocation to related parties increased ROA. In middle of the crisis, it turned to negative; and this has also been the case in the most recent period as the Indonesian economy has normalized. Effects of related lending on bank risk measured by the Z-score and non-performing loan is not clear. After undergoing bank restructuring, related lending has decreased and the profit structure of banks has changed.

Impact of seasonality-adjusted flexible microcredit on repayment and food consumption : experimental evidence from rural Bangladesh

The mismatch between credit repayments and income seasonality poses a challenge for microfinance institutions (MFIs) working in developing countries. For instance, in northern Bangladesh, income and consumption downfalls during the lean season after the transplanting of major paddy crops are a serious threat to a household's economy. Poor landless agricultural wage laborers suffer the most owing to this seasonality as they face difficulties in smoothing their consumption. However, in designing microcredit products, MFIs do not usually provide flexibility or seasonal adjustment during the lean season. This is mainly because MFIs are afraid that such flexibility might break the repayment discipline of borrowers, resulting in higher default rates. We thus conducted a randomized controlled trial in 2011-12 in northern Bangladesh to empirically test whether seasonality-adjusted flexible microcredit leads to an increase in repayment problems for MFIs as well as whether it can increase and stabilize consumption of borrower households. Our results suggest no statistically discernible difference among the treatment arms in case of default, overdue amount, or repayment frequency. On the other hand, we find no positive impact of repayment flexibility on immediate food consumption during the period of seasonality, except for in-kind full moratorium treatment group. After a year of initial intervention, however, we see positive changes in food intake during the lean season. Thus, our preliminary results are in favor of seasonality-adjusted flexible microcredit.

How does contract design affect the uptake of microcredit among the ultra-poor? : experimental evidence from the river islands of Northern Bangladesh

Despite the professed claims of microcredit alleviating poverty, little is known about what kind of credit contract is suitable for extremely poor households, also called the ultra-poor. To fill this knowledge gap, we initiated a field experiment in the river islands of northern Bangladesh, where a substantial portion of dwellers could be categorized as ultra-poor due to cyclic floods. We randomly offered four types of loans to such dwellers: regular small cash loans with one-year maturity, large cash loans with three-year maturity both with and without a one-year grace period, and in-kind livestock loans with three-year maturity and a one-year grace period. We compared uptake rates as well as the determinants of uptake and found that the uptake rate is the lowest for the regular contract, followed by the in-kind contract. Contrary to prior belief, we also found that the microcredit demand by the ultra-poor is not necessarily small, and in particular the ultra-poor are significantly more likely to join a microcredit program than the moderately poor if a grace period with longer maturity is attached to a large amount of credit, irrespective of whether the credit is provided in cash or in kind. This paper provides evidence that a typical microcredit contract with one-year maturity and without a grace period is not attractive to the ultra-poor. Microfinance institutions may need to design better credit contracts to address the poor's needs.

Modelización de series temporales complejas: de las redes de telecomunicación a los mercados financieros

Este trabajo aborda el problema de modelizar sistemas din´amicos reales a partir del estudio de sus series temporales, usando una formulaci´on est´andar que pretende ser una abstracci´on universal de los sistemas din´amicos, independientemente de su naturaleza determinista, estoc´astica o h´ıbrida. Se parte de modelizaciones separadas de sistemas deterministas por un lado y estoc´asticos por otro, para converger finalmente en un modelo h´ıbrido que permite estudiar sistemas gen´ericos mixtos, esto es, que presentan una combinaci´on de comportamiento determinista y aleatorio. Este modelo consta de dos componentes, uno determinista consistente en una ecuaci´on en diferencias, obtenida a partir de un estudio de autocorrelaci´on, y otro estoc´astico que modeliza el error cometido por el primero. El componente estoc´astico es un generador universal de distribuciones de probabilidad, basado en un proceso compuesto de variables aleatorias, uniformemente distribuidas en un intervalo variable en el tiempo. Este generador universal es deducido en la tesis a partir de una nueva teor´ıa sobre la oferta y la demanda de un recurso gen´erico. El modelo resultante puede formularse conceptualmente como una entidad con tres elementos fundamentales: un motor generador de din´amica determinista, una fuente interna de ruido generadora de incertidumbre y una exposici´on al entorno que representa las interacciones del sistema real con el mundo exterior. En las aplicaciones estos tres elementos se ajustan en base al hist´orico de las series temporales del sistema din´amico. Una vez ajustados sus componentes, el modelo se comporta de una forma adaptativa tomando como inputs los nuevos valores de las series temporales del sistema y calculando predicciones sobre su comportamiento futuro. Cada predicci´on se presenta como un intervalo dentro del cual cualquier valor es equipro- bable, teniendo probabilidad nula cualquier valor externo al intervalo. De esta forma el modelo computa el comportamiento futuro y su nivel de incertidumbre en base al estado actual del sistema. Se ha aplicado el modelo en esta tesis a sistemas muy diferentes mostrando ser muy flexible para afrontar el estudio de campos de naturaleza dispar. El intercambio de tr´afico telef´onico entre operadores de telefon´ıa, la evoluci´on de mercados financieros y el flujo de informaci´on entre servidores de Internet son estudiados en profundidad en la tesis. Todos estos sistemas son modelizados de forma exitosa con un mismo lenguaje, a pesar de tratarse de sistemas f´ısicos totalmente distintos. El estudio de las redes de telefon´ıa muestra que los patrones de tr´afico telef´onico presentan una fuerte pseudo-periodicidad semanal contaminada con una gran cantidad de ruido, sobre todo en el caso de llamadas internacionales. El estudio de los mercados financieros muestra por su parte que la naturaleza fundamental de ´estos es aleatoria con un rango de comportamiento relativamente acotado. Una parte de la tesis se dedica a explicar algunas de las manifestaciones emp´ıricas m´as importantes en los mercados financieros como son los “fat tails”, “power laws” y “volatility clustering”. Por ´ultimo se demuestra que la comunicaci´on entre servidores de Internet tiene, al igual que los mercados financieros, una componente subyacente totalmente estoc´astica pero de comportamiento bastante “d´ocil”, siendo esta docilidad m´as acusada a medida que aumenta la distancia entre servidores. Dos aspectos son destacables en el modelo, su adaptabilidad y su universalidad. El primero es debido a que, una vez ajustados los par´ametros generales, el modelo se “alimenta” de los valores observables del sistema y es capaz de calcular con ellos comportamientos futuros. A pesar de tener unos par´ametros fijos, la variabilidad en los observables que sirven de input al modelo llevan a una gran riqueza de ouputs posibles. El segundo aspecto se debe a la formulaci´on gen´erica del modelo h´ıbrido y a que sus par´ametros se ajustan en base a manifestaciones externas del sistema en estudio, y no en base a sus caracter´ısticas f´ısicas. Estos factores hacen que el modelo pueda utilizarse en gran variedad de campos. Por ´ultimo, la tesis propone en su parte final otros campos donde se han obtenido ´exitos preliminares muy prometedores como son la modelizaci´on del riesgo financiero, los algoritmos de routing en redes de telecomunicaci´on y el cambio clim´atico. Abstract This work faces the problem of modeling dynamical systems based on the study of its time series, by using a standard language that aims to be an universal abstraction of dynamical systems, irrespective of their deterministic, stochastic or hybrid nature. Deterministic and stochastic models are developed separately to be merged subsequently into a hybrid model, which allows the study of generic systems, that is to say, those having both deterministic and random behavior. This model is a combination of two different components. One of them is deterministic and consisting in an equation in differences derived from an auto-correlation study and the other is stochastic and models the errors made by the deterministic one. The stochastic component is an universal generator of probability distributions based on a process consisting in random variables distributed uniformly within an interval varying in time. This universal generator is derived in the thesis from a new theory of offer and demand for a generic resource. The resulting model can be visualized as an entity with three fundamental elements: an engine generating deterministic dynamics, an internal source of noise generating uncertainty and an exposure to the environment which depicts the interactions between the real system and the external world. In the applications these three elements are adjusted to the history of the time series from the dynamical system. Once its components have been adjusted, the model behaves in an adaptive way by using the new time series values from the system as inputs and calculating predictions about its future behavior. Every prediction is provided as an interval, where any inner value is equally probable while all outer ones have null probability. So, the model computes the future behavior and its level of uncertainty based on the current state of the system. The model is applied to quite different systems in this thesis, showing to be very flexible when facing the study of fields with diverse nature. The exchange of traffic between telephony operators, the evolution of financial markets and the flow of information between servers on the Internet are deeply studied in this thesis. All these systems are successfully modeled by using the same “language”, in spite the fact that they are systems physically radically different. The study of telephony networks shows that the traffic patterns are strongly weekly pseudo-periodic but mixed with a great amount of noise, specially in the case of international calls. It is proved that the underlying nature of financial markets is random with a moderate range of variability. A part of this thesis is devoted to explain some of the most important empirical observations in financial markets, such as “fat tails”, “power laws” and “volatility clustering”. Finally it is proved that the communication between two servers on the Internet has, as in the case of financial markets, an underlaying random dynamics but with a narrow range of variability, being this lack of variability more marked as the distance between servers is increased. Two aspects of the model stand out as being the most important: its adaptability and its universality. The first one is due to the fact that once the general parameters have been adjusted , the model is “fed” on the observable manifestations of the system in order to calculate its future behavior. Despite the fact that the model has fixed parameters the variability in the observable manifestations of the system, which are used as inputs of the model, lead to a great variability in the possible outputs. The second aspect is due to the general “language” used in the formulation of the hybrid model and to the fact that its parameters are adjusted based on external manifestations of the system under study instead of its physical characteristics. These factors made the model suitable to be used in great variety of fields. Lastly, this thesis proposes other fields in which preliminary and promising results have been obtained, such as the modeling of financial risk, the development of routing algorithms for telecommunication networks and the assessment of climate change.

Frontiers of finance: Evolution and efficient markets

In this review article, we explore several recent advances in the quantitative modeling of financial markets. We begin with the Efficient Markets Hypothesis and describe how this controversial idea has stimulated a number of new directions of research, some focusing on more elaborate mathematical models that are capable of rationalizing the empirical facts, others taking a completely different tack in rejecting rationality altogether. One of the most promising directions is to view financial markets from a biological perspective and, specifically, within an evolutionary framework in which markets, instruments, institutions, and investors interact and evolve dynamically according to the “law” of economic selection. Under this view, financial agents compete and adapt, but they do not necessarily do so in an optimal fashion. Evolutionary and ecological models of financial markets is truly a new frontier whose exploration has just begun.

Testing co-volatility spillovers for natural gas spot, futures and ETF spot using dynamic conditional covariances

There is substantial empirical evidence that energy and financial markets are closely connected. As one of the most widely-used energy resources worldwide, natural gas has a large daily trading volume. In order to hedge the risk of natural gas spot markets, a large number of hedging strategies can be used, especially with the rapid development of natural gas derivatives markets. These hedging instruments include natural gas futures and options, as well as Exchange Traded Fund (ETF) prices that are related to natural gas stock prices. The volatility spillover effect is the delayed effect of a returns shock in one physical, biological or financial asset on the subsequent volatility or co-volatility of another physical, biological or financial asset. Investigating volatility spillovers within and across energy and financial markets is a crucial aspect of constructing optimal dynamic hedging strategies. The paper tests and calculates spillover effects among natural gas spot, futures and ETF markets using the multivariate conditional volatility diagonal BEKK model. The data used include natural gas spot and futures returns data from two major international natural gas derivatives markets, namely NYMEX (USA) and ICE (UK), as well as ETF data of natural gas companies from the stock markets in the USA and UK. The empirical results show that there are significant spillover effects in natural gas spot, futures and ETF markets for both USA and UK. Such a result suggests that both natural gas futures and ETF products within and beyond the country might be considered when constructing optimal dynamic hedging strategies for natural gas spot prices.

A Viable Alternative to Basel III Prudential Capital Rules. CEPS Policy Brief No. 291, May 2013

Stefano Micossi argues in this paper that the Basel framework for bank prudential requirements is deeply flawed and that the Basel III revision has failed to correct these flaws, making the system even more complicated, opaque and open to manipulation. In practice, he finds that the present system does not offer regulators and financial markets a reliable capital standard for banks and its divergent implementation in the main jurisdictions of the European Union and the United States has broken the market into special fiefdoms governed by national regulators in response to untoward special interests. The time is ripe to stop tinkering with minor adjustment and revisions in order to rescue the system, because the system cannot be rescued. In response to the current situation, Micossi calls for abandoning reference to risk-weighted assets calculated by banks with their internal risk management models for the determination of banks’ prudential capital, together with the preoccupation with the asset side of banks in correcting for risk exposure. He suggests that the alternative may be provided by a combination of a straight capital ratio and a properly designed deposit insurance system. It is a logical, complete and much less distortive alternative; it would serve better the cause of financial stability as well as the interest of the banks in clear, transparent and level playing field.

Mellowing Meroni: Hows ESMA can help build the single market. CEPS Commentaries, 18 February 2014

In examining the long-awaited opinion given January 22nd by the CJEU in the case concerning the European Securities and Markets Authority (ESMA), this Commentary argues that the ruling is important for the insights it yields into the modern understanding of the Meroni non-delegation doctrine. The authors, Jacques Pelkmans and Marta Simoncini, aim to extract the potential implications of the ESMA case for the place and significance of the Meroni doctrine in building up the single market. They demonstrate that the ESMA case is yet another manifestation of a slow process of “mellowing Meroni’, which is a critical condition for a new single market strategy aiming to end the remaining fragmentation of the single market – not only in financial markets but also in network industries – and to ensure its ‘proper functioning’.

Discretion and Accountability: The ESMA Judgment and the Meroni Doctrine. Bruges European Economic Research (BEER) Papers 30/2014

This paper assesses the effectiveness of the Meroni doctrine in the light of the recent judgment in the ESMA case. The first part explains in detail the problem of delegation of powers in the EU from the perspective of the principal-agent theory and complements it with the analysis of the trade-off between different levels of independence and accountability of agencies. A simple economic model is developed to illustrated the relationship between the independence and accountability of an agency. It shows that it is the accountability mechanism that induces the agent to act, rather than the extent of his independence. The paper also explains the inter-temporal interactions between the principal and the agent on the basis of the incentives in place for the different players. The second part is devoted to analysis of the functioning of ESMA in the context of its delegated powers. After the presentation of main aspects of the regulatory framework establishing ESMA, the paper continuous with an analysis and interpretation of the discretionary powers of ESMA. The rather rigid position of the Court of Justice in relation to the Meroni doctrine seems to be unsuitable to delegation of complex regulatory tasks. This is particularly evident in the case of financial markets. Finally, the judgment does not examine in any detail whether and how the principals - i.e. the EU and Member States - are best able to evaluate the quality of ESMA decisions and regulations and whether there are different but more effective accountability mechanisms.

British Balance of Competence Reviews, Part III: More reform than renegotiation or repatriation. EPIN [Working] Paper No. 42/December 2014. [see Abstract for I and II]

This paper, the third in a series for a CEPS project on the ‘The British Question’, is pegged on an ambitious exercise by the British government to review all the competences of the European Union on the basis of evidence submitted by independent stakeholders. The reviews considered in this paper cover the following EU policies: the single market for services, financial markets, the free movement of people, cohesion, energy, agriculture, fisheries, competition, social and employment policies, and fundamental rights. The declared objective of Prime Minister Cameron is to secure a ‘new settlement’ between the UK and the EU. From political speeches in the UK one can identify three different types of possible demand: reform of EU policies, renegotiation of the UK’s specific terms of membership, and repatriation of competences from the EU back to the member states. As most of the reviews are now complete, three points are becoming increasingly clear: i) The reform agenda – past, present or future - concerns virtually every branch of EU policy, including several cases reviewed here that are central to stated UK economic interests. The argument that the EU is ‘unreformable’ is shown to be a myth. ii) The highly sensitive cases of immigration from the EU and social policies may translate into requests for renegotiation of specific conditions for the UK, but further large-scale opt-outs, as in the case of the euro and justice and home affairs, are implausible. iii) While demands for repatriation of EU competences are voiced in general terms in public debate in the UK, no specific proposals emerge from the evidence as regards competences at the level at which they are identified in the treaties, and there is no chance of achieving consensus for such ideas among member states. Michael Emerson and Steven Blockmans, “British Balance of Competence Reviews, Part I: ‘Competences about right, so far’”, CEPS/EPIN Working Paper No. 35, October 2013 (www.ceps.eu/book/british-balance-competence-reviews-part-i-%E2%80%98competences-about-right-so-far%E2%80%99)(http://aei.pitt.edu/45599/); Michael Emerson, Steven Blockmans, Steve Peers and Michael Wriglesworth, “British Balance of Competence Reviews, Part II: Again, a huge contradiction between the evidence and Eurosceptic populism”, CEPS/EPIN Working Paper No. 40, June 2014 (www.ceps.eu/book/british-balance-competence-reviews-part-ii-again-huge-contradiction-between-evidence-and-eurosc)(http://aei.pitt.edu/52452/).

An Exercise in Legal Honesty: Re-writing the Court of Justice and the Bundesverfassungsgericht. IHS Political Science Series No. 136, February 2014

At a time of crisis – a true state of emergency – both the Court of Justice of the European Union and the German Federal Constitutional Court have failed the rule of law in Europe. Worse still, in their evaluation of the ersatz crisis law, which has been developed in response to financial and sovereign debt crises, both courts have undermined constitutionality throughout Europe. Each jurisdiction has been implicated within the techocratisation of democratic process. Each Court has contributed to an incremental process of the undermining of the political subjectivity of European Citizens. The results are depressing for lawyers who are still attached to notions of constitutionality. Yet, we must also ask whether the Courts could have acted otherwise. Given the original flaws in the construction of Economic and Monetary Union, as well as the politically pre-emptive constraints imposed by global financial markets, each Court might thus be argued to have been forced to suspend immediate legality in a longer term effort to secure the character of the legal jurisdiction as a whole. Crisis can and does defeat the law. Nevertheless, what continues to disturb is the failure of law in Europe to open up any perspective for a return to normal constitutionality post crisis, as well as its apparent inability to give proper and honest consideration to the hardship now being experienced by millions of Europeans within crisis. This contribution accordingly seeks to reimagine each Judgment in a language of legal honesty. Above all, this contribution seeks to suggest a new form of post-national constitutional language; a language which takes as its primary function, proper protection of democratic process against the ever encroaching powers of a post-national executive power. This contribution forms a part of an on-going effort to identify a new basis for the legitimacy of European Law, conducted jointly and severally with Christian Joerges, University of Bremen and Hertie School of Government, Berlin. Differences do remain in our theoretical positions; hence this individual essay. Nevertheless, the congruence between pluralist and conflict of law approaches to the topic are also readily apparent. See, for example, Everson & Joerges (2013).

Firmer foundations for a stronger European Banking Union. Bruegel Working Paper 2015/13, November 2015

The move to European Banking Union involving the supervision and resolution of banks at euro-area level was stimulated by the sovereign debt crisis in the euro area in 2012. However, the long-term objective of Banking Union is dealing with intensified cross-border banking.The share of the assets of national banking systems that come from other EU countries was rising before the financial and economic crisis of 2007, but went into decline thereafter in the context of a general retrenchment of international banking. Most recent data, however, suggests the decline has been halted. About 14 percent of the assets of banks in Banking Union come from other EU countries, while about a quarter of the assets of the top 25 banks in the Banking Union are held in other EU countries.While a crisis-prevention framework for the euro area has largely been completed, the crisis-management framework remains incomplete, potentially creating instability. There is no governance mechanism to resolve disputes between different levels of crisis-management agencies, and incentives to promote optimum oversight are lacking. Most importantly, risk-sharing mechanisms do not adequately address the sovereign-bank loop, with a lack of clarity about the divide between bail-in and bail-out.To complete Banking Union, the lender-of-last-resort and deposit insurance functions should move to the euro-area level, breaking the sovereign-bank loop. A fully-fledged single deposit insurance (and resolution) fund should be favoured over a reinsurance scheme for reasons of cost and simplicity.