The cost of inappropriateness of coagulation testing [I costi dell'inappropriatezza in coagulazione]

Background. Laboratory utilization has steadily increased with a corresponding increase in overall costs; several authors have attempted to measure the impact of inappropriateness on clinical outcomes but data are insufficient. The aim of the study is to assess the cost of inappropriateness of test-ordering behaviour for second-level coagulation tests (hemorrhagic diathesisand thrombophilia). Methods. We reviewed all second-level coagulation testrequests received by our department during a six months period. Clinicians must fill out a specific order form for these kind of tests, containing all informations deemed necessary for the laboratory specialist to evaluatethe appropriateness of the request. We identified all inappropriate requests and counted the numbers and types of all coagulation tests that were not performed during the period. An analysis of the laboratory activity costs was done in order to calculate the global costof each test in our department and to estimate the savings achieved. Results. On a total of 1664 second-level coagulationtest requests, we estimated 150 as completely inappropriate. We found an overall of 295 inappropriate testswhich were not performed. This resulted in an economic saving of 20.000 euro in 6 months. Conclusions. The analysis of cost of our intervention shows the urgent need for a definite and sustained reduction in inappropriate requests of second-level coagulation tests. Even though we estimated only the economic aspect of inappropriate testing, this is also associated with the overuse of diagnostic tests which entailsthe risk of generating erroneous results with potentialnegative consequences on patients' health.

Deute públic europeu : els Eurobons

En el següent Treball de Fi de Carrera, s’explicarà l’origen i les causes de la crisi de deute sobirà europeu. Observarem també la situació de cada un dels 17 països que composen la unió monetària i veurem possibles solucions a adoptar en el curt, mig i llarg termini. Un cop vistes les possibles solucions, ens centrarem amb els Eurobons, un instrument innovador, el qual s’està valorant la seva implantació a la zona euro. Analitzarem les seves característiques, si seria convenient i quines propostes s’han fet perquè s’implantin.

Sovereign debt markets in turbulent times: Creditor discrimination and crowding-out effects

In 2007, countries in the Euro periphery were enjoying stable growth, low deficits, and lowspreads. Then the financial crisis erupted and pushed them into deep recessions, raising theirdeficits and debt levels. By 2010, they were facing severe debt problems. Spreads increased and,surprisingly, so did the share of the debt held by domestic creditors. Credit was reallocatedfrom the private to the public sectors, reducing investment and deepening the recessions evenfurther. To account for these facts, we propose a simple model of sovereign risk in which debtcan be traded in secondary markets. The model has two key ingredients: creditor discriminationand crowding-out effects. Creditor discrimination arises because, in turbulent times, sovereigndebt offers a higher expected return to domestic creditors than to foreign ones. This providesincentives for domestic purchases of debt. Crowding-out effects arise because private borrowingis limited by financial frictions. This implies that domestic debt purchases displace productiveinvestment. The model shows that these purchases reduce growth and welfare, and may lead toself-fulfilling crises. It also shows how crowding-out effects can be transmitted to other countriesin the Eurozone, and how they may be addressed by policies at the European level.

Rate, type, and cost of adverse drug reactions in emergency department admissions.

Background: Adverse drug reactions (ADRs) are a threat to patients' health and quality of life, and can generate significant expenses. They are generally underreported, with different rates in different health care systems. Methods: We conducted a 6-month survey of all primary admissions to the medical emergency department of a university hospital and assessed the rate, characteristics, avoidability, and marginal costs of ADRs. Results: A total of 7% of all admissions were mainly caused by ADRs. The most frequent were gastrointestinal bleeding (22.3%) and febrile neutropenia (14.4%). Anticancer drugs were involved in 22.7% of the cases, and anticoagulants, analgesics, and non-steroidal anti-inflammatory drugs in 8% each. Physicians had prescribed 70% of these drugs. Patients were predominantly treated in intermediate care units and ordinary wards. The mean cost per case amounted to CHF 3586+/-342, or a total of CHF 821204 over the 6-month-period (1 CHF=0.56 US$=0.87 Euro). A total of 67% were considered definitely imputable to drug effects and 32% were retrospectively regarded as avoidable. Conclusions: Interventions aimed at reducing the incidence of ADRs should be directed towards both patient education and physician training. This could save hospitals admissions and money, and could be used as an indicator of prescription quality.

Intégration des villes par les réseaux des firmes multinationales: le cas du secteur agroalimentaire en Méditerranée

Face aux questions urgentes de marginalisation des villes méditerranéennes, nous nous interrogeons sur les modalités de l'intégration économique des territoires méditerranéens par les firmes multinationales, et sur la manière d'envisager leurs développements dans un contexte économique néo-libéral où le développement passe avant tout par l'investissement privé. Les firmes multinationales, grâce à leur organisation en réseaux à l'échelle de la planète, participent à ces processus d'intégration et se voient confier un rôle fondamental dans les politiques publiques d'intégration des territoires. Par une approche multi-échelles et multi-niveaux, nous avons observé l'intégration des villes par les réseaux de firmes multinationales en approfondissant en particulier les villes des pays du sud de la Méditerranée par les firmes multinationales du secteur agroalimentaire. Au niveau micro, nous avons analysé les stratégies des firmes multinationales selon une approche structurelle de leurs réseaux d'organisation financière, qui combine une approche élaborée par les gestionnaires selon le degré d'intégration internationale des activités au sein des groupes, avec l'analyse quantitative des réseaux sociaux. Au niveau macro, afin d'étudier le réseau de villes, nous avons effectué une agrégation de ces stratégies micro d'entreprises par agglomérations urbaines représentant des villes comparables. Nous avons confronté ces résultats à des études monographiques afin de souligner les processus locaux d'intégration des territoires par les firmes multinationales. D'après nos résultats, nous pouvons suggérer que les processus de métropolisation du système de villes sont le résultat à la fois d'attractivités internationales multiples, et de logiques sectorielles cumulées, conformément à la théorie des économies d'agglomération. La forte différenciation des modes de gouvernance des réseaux d'entreprises au niveau micro et la faible différenciation des réseaux de villes par ces mêmes firmes au niveau macro, nous a donc conduit à penser que les différences de mode de gouvernance observées au niveau micro des firmes multinationales vont se traduire par une différenciation au niveau de la mise en réseau des firmes à l'échelle intra-urbaine. Cette mise en réseau à l'échelle intra-urbaine est déterminante puisque nous avons observé que la connectivité intra-urbaine est fortement corrélée au pouvoir relatif de la ville sur les autres villes. Ceci peut s'expliquer par le fait que les villes qui ont des fonctions de siège ont besoin de s'appuyer sur un ensemble de services dans la ville, donc de fortes économies d'urbanisation. Nous avons observé que les villes méditerranéennes appartiennent à la région européenne mais la dissysmétrie des relations entre le nord et le sud témoignent de processus de périphérisation liées aux structures internationales des accords bilatéraux entre l'union européenne et les pays du sud de la Méditerranée. Cependant, nous avons pu vérifier au niveau local que la firme participe à des processus de développement plus larges à l'échelle du pays en participant à la restructuration des filières locales. Parce qu'elles appliquent le même modèle d'implantation où qu'elles soient, ce sont les acteurs institutionnels qui jouent un rôle déterminant dans les processus de développement en protégeant les filières locales, en réglementant les marchés nationaux, et en soutenant au niveau local les acteurs de la filière. Ces observations appliquées au cadre euro-méditerranéen suggèrent qu'il faudrait soutenir davantage les structures internationales pour accroître la compétitivité des territoires méditerranéens, et ce à tous les niveaux : renforcer les partenariats régionaux sud-sud pour l'émergence d'une région sud-méditerranéenne plus intégrée, et soutenir et réglementer davantage les filières locales avec une attention particulière accordée aux processus intra-urbains.

The Impact of Monetary Union on EU-15 Sovereign Debt Yield Spreads

With European Monetary Union (EMU), there was an increase in the adjusted spreads (corrected from the foreign exchange risk) of euro participating countries' sovereign securities over Germany and a decrease in those of non-euro countries. The objective of this paper is to study the reasons for this result, and in particular, whether the change in the price assigned by markets was due to domestic factors such as credit risk and/or market liquidity, or to international risk factors. The empirical evidence suggests that market size scale economies have increased since EMU for all European markets, so the effect of the various risk factors, even though it differs between euro and non-euro countries, is always dependent on the size of the market.

Monetary integration and the cost of borrowing

With the beginning of the European Monetary Union (EMU), euro-area sovereign securities¿ adjusted spreads over Germany (corrected from the foreign exchange risk) experienced an increase that caused a lower than expected decline in borrowing costs. The objective of this paper is to study what explains that rising. In particular, if it took place a change in the price assigned by markets to domestic (credit risk and/or market liquidity) or to international risk factors. The empirical evidence supports the idea that a change in the market value of liquidity occurred with the EMU. International and default risk play a smaller role

Three essays in financial economics: asset pricing, optimal portfolio selection and financial integration

Executive Summary The unifying theme of this thesis is the pursuit of a satisfactory ways to quantify the riskureward trade-off in financial economics. First in the context of a general asset pricing model, then across models and finally across country borders. The guiding principle in that pursuit was to seek innovative solutions by combining ideas from different fields in economics and broad scientific research. For example, in the first part of this thesis we sought a fruitful application of strong existence results in utility theory to topics in asset pricing. In the second part we implement an idea from the field of fuzzy set theory to the optimal portfolio selection problem, while the third part of this thesis is to the best of our knowledge, the first empirical application of some general results in asset pricing in incomplete markets to the important topic of measurement of financial integration. While the first two parts of this thesis effectively combine well-known ways to quantify the risk-reward trade-offs the third one can be viewed as an empirical verification of the usefulness of the so-called "good deal bounds" theory in designing risk-sensitive pricing bounds. Chapter 1 develops a discrete-time asset pricing model, based on a novel ordinally equivalent representation of recursive utility. To the best of our knowledge, we are the first to use a member of a novel class of recursive utility generators to construct a representative agent model to address some long-lasting issues in asset pricing. Applying strong representation results allows us to show that the model features countercyclical risk premia, for both consumption and financial risk, together with low and procyclical risk free rate. As the recursive utility used nests as a special case the well-known time-state separable utility, all results nest the corresponding ones from the standard model and thus shed light on its well-known shortcomings. The empirical investigation to support these theoretical results, however, showed that as long as one resorts to econometric methods based on approximating conditional moments with unconditional ones, it is not possible to distinguish the model we propose from the standard one. Chapter 2 is a join work with Sergei Sontchik. There we provide theoretical and empirical motivation for aggregation of performance measures. The main idea is that as it makes sense to apply several performance measures ex-post, it also makes sense to base optimal portfolio selection on ex-ante maximization of as many possible performance measures as desired. We thus offer a concrete algorithm for optimal portfolio selection via ex-ante optimization over different horizons of several risk-return trade-offs simultaneously. An empirical application of that algorithm, using seven popular performance measures, suggests that realized returns feature better distributional characteristics relative to those of realized returns from portfolio strategies optimal with respect to single performance measures. When comparing the distributions of realized returns we used two partial risk-reward orderings first and second order stochastic dominance. We first used the Kolmogorov Smirnov test to determine if the two distributions are indeed different, which combined with a visual inspection allowed us to demonstrate that the way we propose to aggregate performance measures leads to portfolio realized returns that first order stochastically dominate the ones that result from optimization only with respect to, for example, Treynor ratio and Jensen's alpha. We checked for second order stochastic dominance via point wise comparison of the so-called absolute Lorenz curve, or the sequence of expected shortfalls for a range of quantiles. As soon as the plot of the absolute Lorenz curve for the aggregated performance measures was above the one corresponding to each individual measure, we were tempted to conclude that the algorithm we propose leads to portfolio returns distribution that second order stochastically dominates virtually all performance measures considered. Chapter 3 proposes a measure of financial integration, based on recent advances in asset pricing in incomplete markets. Given a base market (a set of traded assets) and an index of another market, we propose to measure financial integration through time by the size of the spread between the pricing bounds of the market index, relative to the base market. The bigger the spread around country index A, viewed from market B, the less integrated markets A and B are. We investigate the presence of structural breaks in the size of the spread for EMU member country indices before and after the introduction of the Euro. We find evidence that both the level and the volatility of our financial integration measure increased after the introduction of the Euro. That counterintuitive result suggests the presence of an inherent weakness in the attempt to measure financial integration independently of economic fundamentals. Nevertheless, the results about the bounds on the risk free rate appear plausible from the view point of existing economic theory about the impact of integration on interest rates.

Less Risk, More Effort : Demand Risk Allocation in Incomplete Contracts

This article investigates the allocation of demand risk within an incomplete contract framework. We consider an incomplete contractual relationship between a public authority and a private provider (i.e. a public-private partnership), in which the latter invests in non-verifiable cost-reducing efforts and the former invests in non-verifiable adaptation efforts to respond to changing consumer demand over time. We show that the party that bears the demand risk has fewer hold-up opportunities and that this leads the other contracting party to make more effort. Thus, in our model, bearing less risk can lead to more effort, which we describe as a new example of âeuro~counter-incentivesâeuro?. We further show that when the benefits of adaptation are important, it is socially preferable to design a contract in which the demand risk remains with the private provider, whereas when the benefits of cost-reducing efforts are important, it is socially preferable to place the demand risk on the public authority. We then apply these results to explain two well-known case studies.

Monetary integration and the cost of borrowing

With the beginning of the European Monetary Union (EMU), euro-area sovereign securities¿ adjusted spreads over Germany (corrected from the foreign exchange risk) experienced an increase that caused a lower than expected decline in borrowing costs. The objective of this paper is to study what explains that rising. In particular, if it took place a change in the price assigned by markets to domestic (credit risk and/or market liquidity) or to international risk factors. The empirical evidence supports the idea that a change in the market value of liquidity occurred with the EMU. International and default risk play a smaller role

The Impact of Monetary Union on EU-15 Sovereign Debt Yield Spreads

With European Monetary Union (EMU), there was an increase in the adjusted spreads (corrected from the foreign exchange risk) of euro participating countries' sovereign securities over Germany and a decrease in those of non-euro countries. The objective of this paper is to study the reasons for this result, and in particular, whether the change in the price assigned by markets was due to domestic factors such as credit risk and/or market liquidity, or to international risk factors. The empirical evidence suggests that market size scale economies have increased since EMU for all European markets, so the effect of the various risk factors, even though it differs between euro and non-euro countries, is always dependent on the size of the market.

¿La sobreeducacion de los padres afecta al rendimiento academico de sus hijos?

El objetivo del trabajo consiste en analizar si el desajuste educativo de los progenitores afecta a los resultados educativos de los hijos. Para ello, se utilizan los microdatos de PISA-2009 para España, dado que facilita información detallada sobre el rendimiento educativo de los estudiantes, sus características personales y la de su entorno escolar y familiar lo que la hace idónea para llevar a cabo el estudio planteado. Los resultados obtenidos muestran que los estudiantes con progenitores sobreeducados tienen una penalización en su rendimiento académico en las tres materias analizadas, siendo ésta más intensa para los estudiantes con peores resultados educativos.