"Let's Talk Cash": Cantons' Interests and the Reform of Swiss Federalism

In 2004 the Swiss people accepted a new equalization scheme and a new distribution of competences between the federal state and the cantons. It was argued that the reform was successful because of the capacity of veto-players to overcome their interests and adopt a ‘problem-solving’ interaction mode. We propose a different interpretation and argue that distributive issues and the accommodation of actors' interests crucially mattered. We identify three mechanisms that contribute to a successful reform, i.e. package-deals, side-payments and the downsizing of the reform. Our in-depth, mainly qualitative study of both the content of the reform and related decision-making process supports the pertinence of these strategies for the explanation of the successful reform of Swiss federalism.

Pay for performance does not always increase performance

Pay for performance can have a positive or a negative influence on actual performance. The aim of this study was to give an explanation for this contradiction.We demonstrated that the variability of the payment can act as a stressor. According to the transactional model of stress, the influence on performance depends on the subjective interpretation of the variability as challenge or threat. Therefore we manipulated the degree of variability. The data showed decreasing performance for participants who preferred less-variable payments. They performed better under a less-variable rather than more-variable payment. The participants who preferred more-variable payment schemes showed the opposite pattern. These participants showed a higher performance under a more-variable rather than less-variable payment scheme.

Alpine Common Property Institutions under Change: Conditions for Successful and Unsuccessful Collective Action by Alpine Farmers in the Canton of Grisons, Switzerland

The protection and sustainable management of alpine summer pastures has been stated as a goal in Swiss national law since 1996, and direct payments from the state for summer pasturing have been tied to sustainability criteria since 2000. This reflects the increasing value of the alpine cultural landscape as a public good. However, provision of this public good remains in the hands of local farmers and their local common pool resource (CPR) institutions for managing alpine pastures. These institutions are increasingly struggling to maintain their institutional arrangements, particularly regarding the work needed to maintain the pastures. This paper examines two cases of local CPR institutions for managing alpine pastures in the Swiss Canton of Grisons that manifest different institutional developments in light of changing conditions. The differences in how these institutions reacted to change and the impacts this has had on the provision of the CPR are explained by focusing on relative prices, bargaining power, and ideology as drivers of institutional change that are often neglected within common property research. Key words: summer pasture management, institutional change, bargaining power, ideology

Forests and water: Managing interrelations

Due to their biodiversity, forests generate a range of products and services that are of economic, social or cultural value to human beings. Natural resource management provisions should ensure the creation and maintenance of these goods and services in the long term. However, unsustainable management practices of forests do not only generate short-term benefits but also considerable costs for society. Payment by the beneficiaries of the services would enable us to internalise external costs and promote sustainable management. Two days of conferences on ”Forest and water”, on the multifunctionality of forests, on interactions between forests and water, on sustainable resource management, on payments for environmental services, their institutional and economic perspectives, were the basis of this brochure which presents an in-depth analysis of the information exchanged among conference participants and the public. It is intended for readers who work in international development cooperation and assistance in Switzerland and abroad. It offers additional information for local programmes in the field and at policy level.

Game Theoretic Bidding Strategies for Auctions in Green Electricity Markets

Electricity markets in the United States presently employ an auction mechanism to determine the dispatch of power generation units. In this market design, generators submit bid prices to a regulation agency for review, and the regulator conducts an auction selection in such a way that satisfies electricity demand. Most regulators currently use an auction selection method that minimizes total offer costs ["bid cost minimization" (BCM)] to determine electric dispatch. However, recent literature has shown that this method may not minimize consumer payments, and it has been shown that an alternative selection method that directly minimizes total consumer payments ["payment cost minimization" (PCM)] may benefit social welfare in the long term. The objective of this project is to further investigate the long term benefit of PCM implementation and determine whether it can provide lower costs to consumers. The two auction selection methods are expressed as linear constraint programs and are implemented in an optimization software package. Methodology for game theoretic bidding simulation is developed using EMCAS, a real-time market simulator. Results of a 30-day simulation showed that PCM reduced energy costs for consumers by 12%. However, this result will be cross-checked in the future with two other methods of bid simulation as proposed in this paper.

Attributing inpatient care to diabetes: The case of Medicare for the elderly in Texas, 1995

Specific aims. This study estimated the accuracy of alternative numerator methods for attributing health care utilization and associated costs to diabetes by comparing findings from those methods with findings from a benchmark denominator method. ^ Methods. Using Medicare's 1995 inpatient and enrollment databases for the elderly in Texas, the researcher developed alternative estimates of costs attributable to diabetes. Among alternative numerator methods were selection of all records having diabetes as a principal or secondary diagnosis, and a complex ICD-9-CM sorting routine as previously developed for study of diabetes costs in Texas. Findings from numerator methods were compared with those from a benchmark denominator method based on attributable risk and adapted from a study of national diabetes costs by the American Diabetes Association. This study applied age, gender and ethnicity specific estimates of diabetes prevalence taken from the 1987–94 National Health Interview Surveys to person-months of Medicare Part A, non-HMO enrollment for Texas in 1995. Outcome measures were number of persons identified as having diabetes using alternative definitions of the disease; and number of hospital stays, patient days, and costs using alternative methods for attributing care and costs to diabetes. Cost estimates were based on Medicare payments plus deductibles, co-pays and third party payments. ^ Findings. Numerator methods for attributing costs to diabetes produced findings quite different than those from the benchmark denominator method. When attribution was based on diabetes as principal or secondary diagnosis, the resulting estimates were significantly higher than those obtained from the denominator method. The more complex sorting routine produced estimates near the lower boundary for the confidence interval associated with estimates from the benchmark method. ^ Conclusions. Numerator methods employed by previous researchers poorly estimate the costs of diabetes. While crude mathematical adjustment can be made to the respective numerator approaches, a more useful strategy would be to refine the complex sorting routine to include more hospitalizations. This report recommends approaches to improving methods previously employed in study of diabetes costs. ^

Nonpoint Pollution Control: Inducing First-best Outcomes through the Use of Threats

In this paper we develop a simple economic model to analyze the use of a policy that combines a voluntary approach to controlling nonpoint-source pollution with a background threat of an ambient tax if the voluntary approach is unsuccessful in meeting a pre-specified environmental goal. We first consider the case where the policy is applied to a single farmer, and then extend the analysis to the case where the policy is applied to a group of farmers. We show that in either case such a policy can induce cost-minimizing abatement without the need for farm-specific information. In this sense, the combined policy approach is not only more effective in protecting environmental quality than a pure voluntary approach (which does not ensure that water quality goals are met) but also less costly than a pure ambient tax approach (since it entails lower information costs). However, when the policy is applied to a group of farmers, we show that there is a potential tradeoff in the design of the policy. In this context, lowering the cutoff level of pollution used for determining total tax payments increases the likely effectiveness of the combined approach but also increases the potential for free riding. By setting the cutoff level equal to the target level of pollution, the regulator can eliminate free riding and ensure that cost-minimizing abatement is the unique Nash equilibrium under which the target is met voluntarily. However, this cutoff level also ensures that zero voluntary abatement is a Nash equilibrium. In addition, with this cutoff level the equilibrium under which the target is met voluntarily will not strictly dominate the equilibrium under which it is not. We show that all results still hold if the background threat instead takes the form of reducing government subsidies if a pre-specified environmental goal is not met.

ECONOMIC ANALYSIS OF THE DEMAND FOR PRESCRIPTION MEDICINE IN THE UNITED STATES

The purpose of this study was to understand the role of principle economic, sociodemographic and health status factors in determining the likelihood and volume of prescription drug use. Econometric demand regression models were developed for this purpose. Ten explanatory variables were examined: family income, coinsurance rate, age, sex, race, household head education level, size of family, health status, number of medical visits, and type of provider seen during medical visits. The economic factors (family income and coinsurance) were given special emphasis in this study.^ The National Medical Care Utilization and Expenditure Survey (NMCUES) was the data source. The sample represented the civilian, noninstitutionalized residents of the United States in 1980. The sample method used in the survey was a stratified four-stage, area probability design. The sample was comprised of 6,600 households (17,123 individuals). The weighted sample provided the population estimates used in the analysis. Five repeated interviews were conducted with each household. The household survey provided detailed information on the United States health status, pattern of health care utilization, charges for services received, and methods of payments for 1980.^ The study provided evidence that economic factors influenced the use of prescription drugs, but the use was not highly responsive to family income and coinsurance for the levels examined. The elasticities for family income ranged from -.0002 to -.013 and coinsurance ranged from -.174 to -.108. Income has a greater influence on the likelihood of prescription drug use, and coinsurance rates had an impact on the amount spent on prescription drugs. The coinsurance effect was not examined for the likelihood of drug use due to limitations in the measurement of coinsurance. Health status appeared to overwhelm any effects which may be attributed to family income or coinsurance. The likelihood of prescription drug use was highly dependent on visits to medical providers. The volume of prescription drug use was highly dependent on the health status, age, and whether or not the individual saw a general practitioner. ^

Geographic variation in the utilization and survival associated with oxaliplatin chemotherapy in patients with stage III colon cancer

Background: Overall objectives of this dissertation are to examine the geographic variation and socio-demographic disparities (by age, race and gender) in the utilization and survival of newly FDA-approved chemotherapy agents (Oxaliplatin-containing regimens) as well as to determine the cost-effectiveness of Oxaliplatin in a large nationwide and population-based cohort of Medicare patients with resected stage-III colon cancer. Methods: A retrospective cohort of 7,654 Medicare patients was identified from the Surveillance, Epidemiology and End Results – Medicare linked database. Multiple logistic regression was performed to examine the relationship between receipt of Oxaliplatin-containing chemotherapy and geographic regions while adjusting for other patient characteristics. Cox proportional hazard model was used to estimate the effect of Oxaliplatin-containing chemotherapy on the survival variation across regions using 2004-2005 data. Propensity score adjustments were also made to control for potential bias related to non-random allocation of the treatment group. We used Kaplan-Meier sample average estimator to calculate the cost of disease after cancer-specific surgery to death, loss-to follow-up or censorship. Results: Only 51% of the stage-III patients received adjuvant chemotherapy within three to six months of colon-cancer specific surgery. Patients in the rural regions were approximately 30% less likely to receive Oxaliplatin chemotherapy than those residing in a big metro region (OR=0.69, p=0.033). The hazard ratio for patients residing in metro region was comparable to those residing in big metro region (HR: 1.05, 95% CI: 0.49-2.28). Patients who received Oxalipaltin chemotherapy were 33% less likely to die than those received 5-FU only chemotherapy (adjusted HR=0.67, 95% CI: 0.41-1.11). KMSA-adjusted mean payments were almost 2.5 times higher in the Oxaliplatin-containing group compared to 5-FU only group ($45,378 versus $17,856). When compared to no chemotherapy group, ICER of 5-FU based regimen was $12,767 per LYG, and ICER of Oxaliplatin-chemotherapy was $60,863 per LYG. Oxaliplatin was found economically dominated by 5-FU only chemotherapy in this study population. Conclusion: Chemotherapy use varies across geographic regions. We also observed considerable survival differences across geographic regions; the difference remained even after adjusting for socio-demographic characteristics. The cost-effectiveness of Oxaliplatin in Medicare patients may be over-estimated in the clinical trials. Our study found 5-FU only chemotherapy cost-effective in adjuvant settings in patients with stage-III colon cancer.^

Effects of overweight and obesity on economic outcomes among U.S. adults with kidney disease

Background. Kidney disease is a growing public health phenomenon in the U.S. and in the world. Downstream interventions, dialysis and renal transplants covered by Medicare's renal disease entitlement policy in those who are 65 years and over have been expensive treatments that have been not foolproof. The shortage of kidney donors in the U.S. has grown in the last two decades. Therefore study of upstream events in kidney disease development and progression is justified to prevent the rising prevalence of kidney disease. Previous studies have documented the biological route by which obesity can progress and accelerate kidney disease, but health services literature on quantifying the effects of overweight and obesity on economic outcomes in the context of renal disease were lacking. Objectives . The specific aims of this study were (1) to determine the likelihood of overweight and obesity in renal disease and in three specific adult renal disease sub-populations, hypertensive, diabetic and both hypertensive and diabetic (2) to determine the incremental health service use and spending in overweight and obese renal disease populations and (3) to determine who financed the cost of healthcare for renal disease in overweight and obese adult populations less than 65 years of age. Methods. This study was a retrospective cross-sectional study of renal disease cases pooled for years 2002 to 2009 from the Medical Expenditure Panel Survey. The likelihood of overweight and obesity was estimated using chi-square test. Negative binomial regression and generalized gamma model with log link were used to estimate healthcare utilization and healthcare expenditures for six health event categories. Payments by self/family, public and private insurance were described for overweight and obese kidney disease sub-populations. Results. The likelihood of overweight and obesity was 0.29 and 0.46 among renal disease and obesity was common in hypertensive and diabetic renal disease population. Among obese renal disease population, negative binomial regression estimates of healthcare utilization per person per year as compared to normal weight renal disease persons were significant for office-based provider visits and agency home health visits respectively (p=0.001; p=0.005). Among overweight kidney disease population health service use was significant for inpatient hospital discharges (p=0.027). Over years 2002 to 2009, overweight and obese renal disease sub-populations had 53% and 63% higher inpatient facility and doctor expenditures as compared to normal weight renal disease population and these result were statistically significant (p=0.007; p=0.026). Overweigh renal disease population had significant total expenses per person per year for office-based and outpatient associated care. Overweight and obese renal disease persons paid less from out-of-pocket overall compared to normal weight renal disease population. Medicare and Medicaid had the highest mean annual payments for obese renal disease persons, while mean annual payments per year were highest for private insurance among normal weight renal disease population. Conclusion. Overweight and obesity were common in those with acute and chronic kidney disease and resulted in higher healthcare spending and increased utilization of office-based providers, hospital inpatient department and agency home healthcare. Healthcare for overweight and obese renal disease persons younger than 65 years of age was financed more by private and public insurance and less by out of pocket payments. With the increasing epidemic of obesity in the U.S. and the aging of the baby boomer population, the findings of the present study have implications for public health and for greater dissemination of healthcare resources to prevent, manage and delay the onset of overweight and obesity that can progress and accelerate the course of the kidney disease.^

Policy analysis of shifting to the state-run Texas women's health program

During the 82nd Texas legislature, state leaders passed a provision stating that healthcare providers, who perform, promote, or affiliate with providers who perform or promote elective abortion services may not be eligible to participate in the Texas Medicaid Women's Health Program (WHP). The federal government reacted to this new provision by vowing to eliminate its 90% share of program support on the grounds that the provision violated a patient's freedom to choose a provider; a right protected by the Social Security Act. Texas leaders stated that the Women's Health Program would continue without federal support, financed exclusively with state funds.^ The following policy analysis compares the projected impact of the current Medicaid Women's Health Program to the proposed state-run program using the criteria-alternative matrix framework. The criteria used to evaluate the program alternatives include population affected, unintended pregnancy and abortion impact, impact on cervical cancer rate, and state-level government expenditures. Each criterion was defined by selected measures. The population affected was measured by the number of women served in the programs. Government expenditures were measured in terms of payments for program costs, Medicaid delivery costs, and cervical cancer diagnostic costs. Unintended pregnancy impact was measured by the number of projected unplanned pregnancies and abortions under each alternative. The impact on cervical cancer was projected in terms of the number of new cervical cancer cases under each alternative. Differences in the projections with respect to each criterion were compared to assess the impact of shifting to the state-only policy.^ After examining program alternatives, it is highly recommended that Texas retain the Medicaid WHP. If the state does decide to move forward with the state-run WHP, it is recommended that the program run at its previous capacity. Furthermore, for the purpose of addressing the relatively high cervical cancer incidence rate in Texas, incorporating HPV vaccination coverage for women ages 18-26 as part of the Women's Health Program is recommended.^

El campesino griego : Sujeto de derecho en la Pólis

El campesinado en la Grecia antigua sufrió transformaciones en su estatus impositivo, desde una ausencia total de tributos en su perjuicio hasta el padecimiento de onerosas cargas fiscales. En ambos extremos de un mismo y único proceso se verifica un idéntico fenómeno, esto es, la incorporación del campesinado antiguo a la comunidad política, como miembro pleno con todos los derechos. El modelo de organización y participación política del campesinado rehúye las categorías sociológicas de sociedad primitiva, sociedad campesina o sociedad industrial. El objetivo del presente trabajo consiste en proponer una mirada de este sujeto que contemple su especificidad política, social y económica, desde una perspectiva cultural

El campesino griego : Sujeto de derecho en la Pólis

El campesinado en la Grecia antigua sufrió transformaciones en su estatus impositivo, desde una ausencia total de tributos en su perjuicio hasta el padecimiento de onerosas cargas fiscales. En ambos extremos de un mismo y único proceso se verifica un idéntico fenómeno, esto es, la incorporación del campesinado antiguo a la comunidad política, como miembro pleno con todos los derechos. El modelo de organización y participación política del campesinado rehúye las categorías sociológicas de sociedad primitiva, sociedad campesina o sociedad industrial. El objetivo del presente trabajo consiste en proponer una mirada de este sujeto que contemple su especificidad política, social y económica, desde una perspectiva cultural

El campesino griego : Sujeto de derecho en la Pólis

El campesinado en la Grecia antigua sufrió transformaciones en su estatus impositivo, desde una ausencia total de tributos en su perjuicio hasta el padecimiento de onerosas cargas fiscales. En ambos extremos de un mismo y único proceso se verifica un idéntico fenómeno, esto es, la incorporación del campesinado antiguo a la comunidad política, como miembro pleno con todos los derechos. El modelo de organización y participación política del campesinado rehúye las categorías sociológicas de sociedad primitiva, sociedad campesina o sociedad industrial. El objetivo del presente trabajo consiste en proponer una mirada de este sujeto que contemple su especificidad política, social y económica, desde una perspectiva cultural

The gap between recognition and the 'compensation business' : the claim against Britain for compensation by Kenya's former Mau Mau fighters

During the first Kibaki administration (2002-2007), a movement by the former Mau Mau fighters demanded recognition for the role that they had played in the achievement of independence. They began to demand, also, monetary compensation for past injustices. Why had it taken over 40 years (from independence in 1963) for the former Mau Mau fighters to initiate this movement? What can be observed as the outcome of their movement? To answer these questions, three different historical currents need to be taken into account. These were, respectively, changing trends in the government of Kenya, progress in historical research into the actual circumstances of colonial control, and a realization, based on mounting experience, that launching a legal action against Britain could turn out to be a lucrative initiative. This paper concludes that, regardless of the actual purpose of the legal case, neither of their objectives was certain to be achieved. Two inescapable realities remain: the doubts cast on the reputation of the government by its decision to lift the Mau Mau‟s outlaw status – a decision that was widely seen as a latter-day example of the „Kikuyu favouritism‟ policy followed by the first Kibaki administration – and the popular interpretation of the involvement of Leigh Day, well known in Kenya ever since the unexploded bombs case for its success in obtaining substantial compensation payments, as a vehicle for squeezing large amounts of money from the British government for the benefit of the Kikuyu people.