Evaluating the impact of vertical integration on health system peformance

Vertical integration is grounded in economic theory as a corporate strategy for reducing cost and enhancing efficiency. There were three purposes for this dissertation. The first was to describe and understand vertical integration theory. The review of the economic theory established vertical integration as a corporate cost reduction strategy in response to environmental, structural and performance dimensions of the market. The second purpose was to examine vertical integration in the context of the health care industry, which has greater complexity, higher instability, and more unstable demand than other industries, although many of the same dimensions of the market supported a vertical integration strategy. Evidence on the performance of health systems after integration revealed mixed results. Because the market continues to be turbulent, hybrid non-owned integration in the form of alliances have increased to over 40% of urban hospitals. The third purpose of the study was to examine the application of vertical integration in health care and evaluate the effects. The case studied was an alliance formed between a community hospital and a tertiary medical center to facilitate vertical integration of oncology services while maintaining effectiveness and preserving access. The economic benefits for 1934 patients were evaluated in the delivery system before and after integration with a more detailed economic analysis of breast, lung, colon/rectal, and non-malignant cases. A regression analysis confirmed the relationship between the independent variables of age, sex, location of services, race, stage of disease, and diagnosis, and the dependent variable, cost. The results of the basic regression model, as well as the regression with first-order interaction terms, were statistically significant. The study shows that vertical integration at an intermediate health care system level has economic benefits. If the pre-integration oncology group had been treated in the post-integration model, the expected cost savings from integration would be 31.5%. Quality indicators used were access to health care services and research treatment protocols, and access was preserved in the integrated model. Using survival as a direct quality outcome measure, the survival of lung cancer patients was statistically the same before and after integration. ^

A Note on US Royalty Relief, Rent Sharing and Offshore Oil Production

This paper offers an economic analysis explaining why royalty relief under US Federal legislation is expensive in terms of revenue foregone, but is largely ineffective in increasing US offshore oil production. Repeal of royalty relief is therefore justified.

The Geographic Distribution of the Size and Timing of Monetary Policy Actions

This paper examines the magnitude and timing of the effects of changes in the monetary base on the aggregate and regional changes in bank loans within the United States. We consider both Bureau of Economic Analysis (BEA) regions, and individual states and the District of Columbia for our regional analysis. The empirical analysis provides some insight on the bank-lending channel of monetary policy. We find strong evidence of a 4-quarter lag in the effect of changes in the monetary base on bank loans. That finding proves robust across all regions and nearly all states.

Has implementation of integrated mental health services in primary care programs positively impacted health outcomes among the mentally ill in developing countries?

Objective. The World Health Organization (WHO) estimates that nearly 450 million people suffer from a mental disorder in the world. Developing countries do not have the health system structure in place to support the demand of mental health services. This study will conduct a review of mental health integration in primary care research that is carried out in low-income countries identified as such from the World Bank economic analysis. The research follows the standard of care that WHO has labeled appropriate in treatment of mental health populations. Methods. This study will use the WHO 10 principles of mental health integration into primary care as the global health standard of care for mental health. Low-income countries that used these principles in their national programs will be analyzed for effectiveness of mental health integration in primary care. Results. This study showed that mental health service integration in primary care did have an effect on health outcomes of low-income countries. However, information did not lead to significant quantitative results that determined how positive the effect was. Conclusion. More ethnographic research is needed in low-income countries to truly assess how effective the program is in integrating with the health system currently in place.^ ^

Fundamentos y límites de una economía de la justicia

The Economic Analysis of Law should be considered the most important bridge between Law and Economics at the present time. We can find its foundations in 1960’s, mainly since the publication of two great economists’ works: Ronald Coase (University of Chicago) and Guido Calabresi (University of Yale). Furthermore, several works of Richard Posner (University of Chicago Law School) have contributed to its diffusion beyond the frontiers of the american universities. In this paper, we show the internal structure of the Economic Analysis of Law, based upon the neoclassical model in Economics, and the main critics adressed to it from Institutional Economics as well as from Legal Theory.

On the Evolution of the Spatial Economy with Multi-unit/Multi-plant Firms: The Impact of IT Development

This paper examines how the decline of communication costs between management and production facilities within firms and the decrease in trade costs of manufactured goods affect the spatial organization of a two-region economy with multi-unit/multi-plant firms. The development of information technology decreases the costs of communication and trade costs. Thus, the fragmentation of firms is promoted. Our result indicates that, with decreasing communication costs, firms producing low trade-cost products (such as consumer electronics) tend to concentrate their manufacturing plants in low wage countries. In contrast, firms producing high trade-cost products (such as automobiles) tend to have multiple plants serving to segmented markets, even in the absence of wage differentials.

Globalization and the Evolution of the Supply Chain: who gains and who loses?

This paper focuses on two distinct facets of globalization: the decrease in the trade costs of goods and the decline of communication costs between headquarters and production facilities within firms. When the unskilled have about the same wage in the two regions, the decrease of these costs fosters the gradual agglomeration of plants in the core region accommodating the headquarters. By contrast, when the wage gap is significant, the process of integration eventually triggers the re-location of plants into the periphery. In particular, when the process of re-location is driven by falling communication costs, the welfare of all workers living in the core goes down whereas the welfare of those who reside in the periphery rises.

Transport Sector and Regional Price Differentials: A SCGE Model for Chinese Provinces

With regression formulas replaced by equilibrium conditions, a spatial CGE model can substantially reduce data requirements. Detailed regional analyses are thus possible in countries where only limited regional statistics are available. While regional price differentials play important roles in multi-regional settings, transport does not receive much attention in existing models. This paper formulates a spatial CGE model that explicitly considers the transport sector and FOB/CIF prices. After describing the model, performance of our model is evaluated by comparing the benchmark equilibrium for China with survey-based regional I-O and interregional I-O tables for 1987. The structure of Chinese economies is summarized using information obtained from the benchmark equilibrium computation. This includes regional and sectoral production distributions and price differentials. The equilibrium for 1997 facilitates discussion of changes in regional economic structures that China has experienced in the decade.

Trade Coefficients and the Role of Elasticity in a Spatial CGE Model Based on the Armington Assumption

The Armington Assumption in the context of multi-regional CGE models is commonly interpreted as follows: Same commodities with different origins are imperfect substitutes for each other. In this paper, a static spatial CGE model that is compatible with this assumption and explicitly considers the transport sector and regional price differentials is formulated. Trade coefficients, which are derived endogenously from the optimization behaviors of firms and households, are shown to take the form of a potential function. To investigate how the elasticity of substitutions affects equilibrium solutions, a simpler version of the model that incorporates three regions and two sectors (besides the transport sector) is introduced. Results indicate: (1) if commodities produced in different regions are perfect substitutes, regional economies will be either autarkic or completely symmetric and (2) if they are imperfect substitutes, the impact of elasticity on the price equilibrium system as well as trade coefficients will be nonlinear and sometimes very sensitive.

Tax differentials and inflow of foreign direct investments : evidence from foreign operations of U.S. multinational companies

This paper concerns the measurement of the impact of tax differentials across countries on inflow of Foreign Direct Investment (FDI) by using comprehensive data on the foreign operations of U.S. multinational corporations that has been collected by the Bureau of Economic Analysis (BEA), the U.S. Department of Commerce. In particular, this research focuses on examining: (1) how responsive FDI locations are to tax differentials across countries, (2) how different the tax effect on FDI inflow is between developed and developing countries, and (3) whether investment location decisions have become more or less sensitive to tax differences between countries over time ranging from the late 1990s to the early 2000s. Estimation results suggest that high rates of corporate income taxation are associated with reduced foreign assets of U.S. multinational firms in all industries by decreasing the return to foreign asset investment. Further, foreign assets of U.S. multinationals in all industries have become more responsive to non-income tax differentials across countries than to income tax differences from 1999 to 2004. Empirical estimates also indicate that foreign investment by American firms is associated with higher tax sensitivity more in developed countries than in those that are developing.

Chapter 2 Equilibrium locations of upstream and downstream firms

This paper explores the interaction between upstream firms and downstream firms in a two-region general equilibrium model. In many countries, lower tariff rates are set for intermediate manufactured goods and higher tariff rates are set for final manufactured goods. The derived results imply that such settings of tariff rates tend to preserve a symmetric spread of upstream and downstream firms, and continuing tariff reduction may cause core-periphery structures. In the case in which the circular causality between upstream and downstream firms is focused as agglomeration forces, the present model is fully solved. Thus, we find that (1) the present model displays, at most, three interior steady states, (2) when the asymmetric steady-states exist, they are unstable and (3) location displays hysteresis when the transport costs of intermediate manufactured goods are sufficiently high.

Compilation, application and challenge of IDE-JETRO's International Input-Output tables

International input-output tables are among the most useful tools for economic analysis. Since these tables provide detailed information about international production networks, they have recently attracted considerable attention in research on spatial economics, global value chains, and issues relating to trade in value-added. The Institute of Developing Economies at the Japan External Trade Organization (IDE-JETRO) has more than 40 years of experience in the construction and analysis of international input-output tables. This paper explains the development of IDE-JETRO’s multi-regional input-output projects including the construction of the Asian International Input-Output table and the Transnational Interregional Input-Output table between China and Japan. To help users understand the features of the tables, this paper also gives examples of their application.

Propuesta metodológica para la identificación de medidas de adaptación al cambio climático en sistemas de recursos hídricos

Esta tesis realiza una contribución metodológica en el estudio de medidas de adaptación potencialmente adecuadas a largo plazo, donde los sistemas de recursos hídricos experimentan fuertes presiones debido a los efectos del cambio climático. Esta metodología integra el análisis físico del sistema, basándose en el uso de indicadores que valoran el comportamiento de éste, y el análisis económico mediante el uso del valor del agua. El procedimiento metodológico inicia con la construcción de un conjunto de escenarios futuros, que capturan por un lado las características de variabilidad de las aportaciones de diversos modelos climáticos y, por otro, las características hidrológicas de la zona de estudio. Las zonas de estudio seleccionadas fueron las cuencas del Guadalquivir, Duero y Ebro y se utilizaron como datos observados las series de escorrentía en régimen natural estimadas por el modelo SIMPA que está calibrado en la totalidad del territorio español. Estas series observadas corresponden al periodo 1961-1990. Los escenarios futuros construidos representan el periodo 2071-2100. La identificación de medidas de adaptación se apoyó en el uso de indicadores que sean capaces de caracterizar el comportamiento de un sistema de recursos hídricos frente a los efectos del cambio climático. Para ello se seleccionaron los indicadores de calidad de servicio (I1) y de confiabilidad de la demanda (I2) propuestos por Martin-Carrasco et al. (2012). Estos indicadores valoran el comportamiento de un sistema mediante la identificación de los problemas de escasez de agua que presente, y requieren para su cuantificación el uso de un modelo de optimización. Para este estudio se ha trabajado con el modelo de optimización OPTIGES. La determinación de estos indicadores fue realizada para análisis a corto plazo donde los efectos del cambio climático no son de relevancia, por lo que fue necesario analizar su capacidad para ser usados en sistemas afectados por dichos efectos. Para este análisis se seleccionaron tres cuencas españolas: Guadalquivir, Duero y Ebro, determinándose que I2 no es adecuado para este tipo de escenarios. Por ello se propuso un nuevo indicador “Indicador de calidad de servicio bajo cambio climático” (I2p) que mantiene los mismos criterios de valoración que I2 pero que responde mejor bajo fuertes reducciones de aportaciones producto del cambio climático. La metodología propuesta para la identificación de medidas de adaptación se basa en un proceso iterativo en el cual se van afectando diversos elementos que conforman el esquema del sistema bajo acciones de gestión previamente identificadas, hasta llegar a un comportamiento óptimo dado por el gestor. Las mejoras de estas afectaciones son cuantificadas mediante los indicadores I1 e I2p, y de este conjunto de valores se selecciona la que se acerca más al comportamiento óptimo. Debido a la extensa cantidad de información manejada en este análisis, se desarrolló una herramienta de cálculo automatizada en Matlab. El proceso seguido por esta herramienta es: (i) Ejecución del modelo OPTIGES para las diferentes modificaciones por acciones de gestión; (ii) Cálculo de los valores de I1 e I2p para cada una de estas afectaciones; y (iii) Selección de la mejor opción. Este proceso se repite hasta llegar al comportamiento óptimo buscado, permitiendo la identificación de las medidas de adaptación mas adecuadas. La aplicación de la metodología para la identificación de medidas de adaptación se realizó en la cuenca del Guadalquivir, por ser de las tres cuencas analizadas bajo los indicadores I1 e I2p la que presenta los problemas más serios de escasez de agua. Para la identificación de medidas de adaptación se analizaron dos acciones de gestión: 1) incremento de los volúmenes de regulación y 2) reducción de las demandas de riego, primero bajo la valoración del comportamiento físico del sistema (análisis de sensibilidad) permitiendo identificar que la primera acción de gestión no genera cambios importantes en el comportamiento del sistema, que si se presentan bajo la segunda acción. Posteriormente, con la acción que genera cambios importantes en el comportamiento del sistema (segunda acción) se identificaron las medidas de adaptación más adecuadas, mediante el análisis físico y económico del sistema. Se concluyó que en la cuenca del Guadalquivir, la acción de reducción de las demandas de riego permite minimizar e incluso eliminar los problemas de escasez de agua que se presentarían a futuro bajo diferentes proyecciones hidrológicas, aunque estas mejoras implicarían fuertes reducciones en dichas demandas. Siendo las demandas más afectadas aquellas ubicadas en cabecera de cuenca. Los criterios para la reducción de las demandas se encuentran en función de las productividades y garantías con las que son atendidas dichas demandas. This thesis makes a methodological contribution to the study of potentially suitable adaptation measures in the long term, where water resource systems undergo strong pressure due to the effects of climate change. This methodology integrates the physical analysis of the system, by the use of indicators which assess its behavior, and the economic analysis by the use of the value of water. The methodological procedure begins with the building of a set of future scenarios that capture, by one hand, the characteristics and variability of the streamflow of various climate models and, on the other hand, the hydrological characteristics of the study area. The study areas chosen were the Guadalquivir, Ebro and Duero basins, and as observed data where used runoff series in natural regimen estimated by the SIMPA model, which is calibrated in the whole Spanish territory. The observed series are for the 1961-1990 period. The future scenarios built represent the 2071-2100 periods. The identification of adaptation measures relied on the use of indicators that were able of characterize the behavior of one water resource system facing the effects of climate change. Because of that, the Demand Satisfaction Index (I1) and the Demand Reliability Index (I2) proposed by Martin-Carrasco et al. (2012) were selected. These indicators assess the behavior of a system by identifying the water scarcity problems that it presents, and require in order to be quantified the use of one optimization model. For this study the OPTIGES optimization model has been used. The determination of the indicators was made for the short-term analysis where the climates change effect are not relevant, so it was necessary to analyze their capability to be used in systems affected by those these. For this analysis three Spanish basins were selected: Guadalquivir, Duero and Ebro. It was determined that the indicator I2 is not suitable for this type of scenario. It was proposed a new indicator called “Demand Reliability Index under climate change” (I2p), which keeps the same assessment criteria than I2, but responsive under heavy reductions of streamflow due to climate change. The proposed methodology for identifying adaptation measures is based on an iterative process, in which the different elements of the system´s schema are affected by previously defined management actions, until reach an optimal behavior given by the manager. The improvements of affectations are measured by indicators I1 e I2p, and from this set of values it is selected the affectation that is closer to the optimal behavior. Due to the large amount of information managed in this analysis, it was developed an automatic calculation tool in Matlab. The process followed by this tool is: Firstly, it executes the OPTIGES model for the different modifications by management actions; secondly, it calculates the values of I1 e I2p for each of these affectations; and finally it chooses the best option. This process is performed for the different iterations that are required until reach the optimal behavior, allowing to identify the most appropriate adaptation measured. The application of the methodology for the identification of adaptation measures was conducted in the Guadalquivir basin, due to this was from the three basins analyzed under the indicators I1 e I2p, which presents the most serious problems of water scarcity. For the identification of adaptation measures there were analyzed two management actions: 1) To increase the regulation volumes, and 2) to reduce the irrigation demands, first under the assessment of the physical behavior of the system (sensibility analysis), allowing to identify that the first management action does not generate significant changes in the system´s behavior, which there are present under the second management action. Afterwards, with the management action that generates significant changes in the system´s behavior (second management action), there were identified the most adequate adaptation measures, through the physical and economic analysis of the system. It was concluded that in the Guadalquivir basin, the action of reduction of irrigation demands allows to minimize or even eliminate the water scarcity problems that could exist in the future under different hydrologic projections, although this improvements should involve strong reductions of the irrigation demands. Being the most affected demands those located in basins head. The criteria for reducing the demands are based on the productivities and reliabilities with which such demands are meet.

Dimensionamiento del proceso de licuación de una planta de gas natural Offshore

Este proyecto consiste en el dimensionamiento del proceso de licuación de una planta offshore para la producción de gas natural licuado, usando únicamente N2 como refrigerante, evitando de este modo riesgos potenciales que podrían surgir con el uso de refrigerantes mixtos compuestos de hidrocarburos. El proceso ha sido diseñado para acomodar 35,23 kg/s (aproximadamente un millón de toneladas por año) de gas natural seco, sin separación de gases licuados de petróleo (GLP) y ajustarlo dentro de los parámetros requeridos en las especificaciones del proceso. Para proceder al dimensionamiento del proceso de licuación de gas natural de la planta se ha empleado el programa Aspen Plus. Los sistemas floating production, storage and offloading para licuar el gas natural (LNG-FPSO), es una nueva unidad conceptual y un modo realista y efectivo para la explotación, recuperación, almacenamiento, transporte y agotamiento de los campos marginales de gas y las fuentes de gas asociadas offshore. En el proyecto se detalla el proceso, equipos necesarios y costes estimados, potencia aproximada requerida y un breve análisis económico. ABSTRACT This project consist of the dimensioning of a liquefaction process in an offshore plant to produce liquefied natural, using only N2 as refrigerant in the cooling cycles to avoid potential hazards of mixed hydrocarbon refrigerants. The process was designed to accommodate 35.23 kg/s (roughly 1 MTPA) of raw natural gas feed without separation of LPG, and fits within all parameters required in the process specifications. The plant has been designed with the computer tool Aspen Plus. The floating production, storage and offloading system for liquefied natural gas (LNGFPSO), is a new conceptual unit and an effective and realistic way for exploitation, recovery, storage, transportation and end-use applications of marginal gas fields and offshore associated-gas resources. The following report details the process, equipment needs and estimated costs, approximated power requirements, and a brief economic analysis.

Información personal: la nueva moneda de la economía digital

Technological progress has profoundly changed the way personal data are collected, accessed and used. Those data make possible unprecedented customization of advertising which, in turn, is the business model adopted by many of the most successful Internet companies. Yet measuring the value being generated is still a complex task. This paper presents a review of the literature on this subject. It has been found that the economic analysis of personal information has been conducted up to now from a qualitative perspective mainly linked to privacy issues. A better understanding of a quantitative approach to this topic is urgently needed.