Choice of Contracts in the British National Health Service: An Empirical Study

Following major reforms of the British National Health Service (NHS) in 1990, the roles of purchasing and providing health services were separated, with the relationship between purchasers and providers governed by contracts. Using a mixed multinomial logit analysis, we show how this policy shift led to a selection of contracts that is consistent with the predictions of a simple model, based on contract theory, in which the characteristics of the health services being purchased and of the contracting parties influence the choice of contract form. The paper thus provides evidence in support of the practical relevance of theory in understanding health care market reform.

The Effect of Activity-Based Payment on Dentists’ Activity: Evidence from a Natural Experiment in the UK National Health Service

The extent to which remuneration systems affect the behaviour of health care professionals is of considerable importance in the administration of publicly funded heath care systems. Using data across two jurisdictions in the United Kingdom, in only one of which remuneration was changed, we compare the extent of measured dental activity at the dentist level in order to ascertain the impact of moving to activity-based remuneration. We find that there are large and statistically significant increases in activity as dentists moved to the activity-based system and that a dentist’s previous form of contract is an important determinant of the magnitude of the effect. We also explore the extent to which dentists’ professional attitudes can explain differences in their activity and find that some aspects of self-reported attitudes are associated with observable differences in activity.

The Relative Efficiency of Automatic and Discretionary Industrial Aid

For the last two decades, the primary instruments for UK regional policy have been discretionary subsidies. Such aid is targeted at “additional” projects - projects that would not have been implemented without the subsidy - and the subsidy should be the minimum necessary for the project to proceed. Discretionary subsidies are thought to be more efficient than automatic subsidies, where many of the aided projects are non-additional and all projects receive the same subsidy rate. The present paper builds on Swales (1995) and Wren (2007a) to compare three subsidy schemes: an automatic scheme and two types of discretionary scheme, one with accurate appraisal and the other with appraisal error. These schemes are assessed on their expected welfare impacts. The particular focus is the reduction in welfare gain imposed by the interaction of appraisal error and the requirements for accountability. This is substantial and difficult to detect with conventional evaluation techniques.

Un groupe d'accueil pour la fratrie lors d'une naissance à risque dans un service de néonatalogie

Cet article a pour objectif de décrire l'expérience d'un groupe d'accueil pour les frères et soeurs d'enfants hospitalisés en néonatoloyie. Cet événement représente un facteur de stress et suscite d'importantes angoisses chez les parents. Sensibles et perméables au vécu parental, les frères et soeurs peuvent éprouver une difficulté à se représenter ce qui se déroule autour d'eux. Leur offrir un lieu de parole avec leurs parents se révèle important et permet de préparer la rencontre avec le nouveau-né hospitalisé. Il s'agit d'un espace permettant de nouvelles représentations du bébé, pour la fratrie et pour les parents.

Industrial Structure, Trade and Regional Economics : Market Segmentation

We consider a general equilibrium model a la Bhaskar (Review of Economic Studies 2002): there are complementarities across sectors, each of which comprise (many) heterogenous monopolistically competitive firms. Bhaskar's model is extended in two directions: production requires capital, and labour markets are segmented. Labour market segmentation models the difficulties of labour migrating across international barriers (in a trade context) or from a poor region to a richer one (in a regional context), whilst the assumption of a single capital market means that capital flows freely between countries or regions. The model is solved analytically and a closed form solution is provided. Adding labour market segmentation to Bhaskar's two-tier industrial structure allows us to study, inter alia, the impact of competition regulations on wages and - financial flows both in the regional and international context, and the output, welfare and financial implications of relaxing immigration laws. The analytical approach adopted allows us, not only to sign the effect of policies, but also to quantify their effects. Introducing capital as a factor of production improves the realism of the model and refi nes its empirically testable implications.

Financial liberalisation and industrial development in Malawi

It has been suggested that financial liberalisation may be a key policy to promote industrialisation as it removes the credit access constraint on firms, especially small and medium ones. We investigate the effect of credit expansion in the wake of liberalisation on the structure of the industrial sectors in Malawi and find that, in contrast to the hypothesis above, it resulted in an increase in industrial concentration and a decrease in net firm entry, especially in sectors that are more finance dependent. The case of Malawi is interesting because financial liberalisation has been justified precisely as a means for industrial development and because the implementation of the policy has been regarded as relatively successful.

Infrastructure Finance and Industrial Takeoff in England

That financial matters did not constrain industrial takeoff in the UK is generally accepted in the historical literature; in contrast, contemporary empirical analyses have found evidence that financial development can be a causal determinant of economic growth. We look to reconcile these findings by concentrating on a particular aspect of industrialising UK where inefficiencies in finance could have had bite: The finance of physical infrastructures. We document the historical record and develop the importance of spatial disaggregation and spillovers in both technological and financial development. We develop a simple model that captures the nature of infrastructure finance within a theory of endogenous growth where financial costs are endogenous. We argue that the conception of the finance-growth nexus as a largely static, aggregative phenomenon misses out a good deal of complexity and we relate that complexity to a number of implications for regulation of both financial systems and the emergence of infrastructures

The Significance of Identifying Industrial clusters The Case of Scotland

Industrial clustering policy is now an integral part of economic development planning in most advanced economies. However, there have been concerns in some quarters over the ability of an industrial cluster-based development strategy to deliver its promised economic benefits and this has been increasingly been blamed on the failure by governments to identify industrial clusters. In a study published in 2001, the DTI identified clusters across the UK based on the comparative scale and significance of industrial sectors. The study identified thirteen industrial clusters in Scotland. However the clusters identified are not a homogeneous set and they seem to vary in terms of their geographic concentration within Scotland. This paper examines the spatial distribution of industries within Scotland, thereby identifying more localised clusters. The study follows as closely as possible the DTI methodology which was used to identify such concentrations of economic activity with particular attention directed towards the thirteen clusters identified by the DTI. The paper concludes with some remarks of the general problem of identifying the existence of industrial clusters.

Eye Care Service in Scotland: Did the Scots Get it Right?

In March 2004, the Scottish government announced a review of eye care services in Scotland, which culminated in the introduction of free eye examinations from 1st April 2006. This free eye examination is not just a sight test; it is a thorough examination to check the health of the patient’s eyes and to look for signs of other health problems. The Scottish government commissioned private ophthalmic optician practices to perform these eye examinations. Consequently, since April 2006 individuals in Scotland could walk into any high street optometry practice and get a ‘free’ eye examination funded under the NHS.

Anatomy of contaminated aquifers of an industrial site: insights from the stable isotope compositions of waters and dissolved inorganic carbon

The hydrogen and oxygen isotopes of water and the carbon isotope composition of dissolved inorganic carbon (DIC) from different aquifers at an industrial site, highly contaminated by organic pollutants representing residues of the former gas production, have been used as natural tracers to characterize the hydrologic system. On the basis of their stable isotope compositions as well as the seasonal variations, different groups of waters (precipitation, surface waters, groundwaters and mineral waters) as well as seasonably variable processes of mixing between these waters can clearly be distinguished. In addition, reservoir effects and infiltration rates can be estimated. In the northern part of the site an influence of uprising mineral waters within the Quaternary aquifers, presumably along a fault zone, can be recognized. Marginal infiltration from the Neckar River in the cast and surface water infiltration adjacent to a steep hill on the western edge of the site with an infiltration rate of about one month can also be resolved through the seasonal variation. Quaternary aquifers closer to the centre of the site show no seasonal variations, except for one borehole close to a former mill channel and another borehole adjacent to a rain water channel. Distinct carbon isotope compositions and concentrations of DIC for these different groups of waters reflect variable influence of different components of the natural carbon cycle: dissolution of marine carbonates in the mineral waters, biogenic, soil-derived CO2 in ground- and surface waters, as well as additional influence of atmospheric CO2 for the surface waters. Many Quaternary aquifer waters have, however, distinctly lower delta(13)C(DIC) values and higher DIC concentrations compared to those expected for natural waters. Given the location of contaminated groundwaters at this site but also in the industrially well-developed valley outside of this site, the most likely source for the low C-13(DIC) values is a biodegradation of anthropogenic organic substances, in particular the tar oils at the site.

Prise en charge par une équipe pluridisciplinaire des patients avec multiples vulnérabilités dans un service d'urgence

Introduction: Les centres d'urgence se trouvent régulièrement confrontés à des patients avec de multiples vulnérabilités médico-sociales qui recourent préférentiellement aux urgences pour y recevoir des soins de bases. Leurs fréquentes consultations contribuent à encombrer les urgences : dans notre service d'urgence entre avril 2008 et mars 2009, une étude ayant pour but de caractériser ces patients a montré que 14 % de l'ensemble des consultations ont été causées par 5 % des patients admis > 4 x/an.Matériel et méthode: Cohorte prospective des patients admis aux urgences et présentant des critères touchant > 3 axes de vulnérabilités sur les 5 axes reconnus habituellement (déterminants somatiques, de santé mentale, comportemental, social, de consommation de soins). Les patients inclus ont été soit signalés par le personnel médico-infirmier des urgences, soit dépistés par une équipe pluridisciplinaire (2 infirmières, 1 assistant social, 1 médecin) durant les jours ouvrables du 1.9.2010 au 14.12.2010.Résultats: 75 patients ont été inclus (65 % d'hommes). La moyenne d'âge était de 43 ans. 59 % étaient des migrants en provenance de : Europe (22 %), Afrique (22 %), Asie (12 %), Amériques du Sud (6 %) et du Nord (1 %). Les vulnérabilités les plus fréquentes étaient: somatiques 76 % (maladies aiguës/chroniques sévères 50 %, mauvaise adhérence thérapeutique 40 %), liées à la santé mentale 65 % (troubles anxieux et dépressifs 54 %), comportementales 80 % (addictions aux substances 73 %), sociales 93 % (absence de domicile fixe 31 %, absence d'assurance-maladie 15 %, barrières linguistiques 24 %, à l'assistance sociale 46 %) et consommation de soins (> 4 visites aux urgences/an 57 %, absence de médecin de premier recours 33 %). La charge de travail moyenne pour orienter ces patients vers des structures de santé primaire était de 3 heures/cas. Les interventions ont été d'évaluer le réseau de soins déjà impliqué (98 %), de réorienter dans le réseau ambulatoire (64 %) ou vers les services sociaux (37 %).Conclusion: Les vulnérabilités multiples sont relativement peu fréquentes dans notre service d'urgence mais leur complexité requiert des ressources qui dépassent ce que peuvent offrir des équipes de soins habituelles aux urgences. Une prise en charge individuelle par une équipe pluridisciplinaire est susceptible de fournir ces ressources et de réorienter ces patients vers des structures ambulatoires adaptées à leurs besoins.

Spatial Takeoff in the First Industrial Revolution

Using the framework of Desmet and Rossi-Hansberg (forthcoming), we present a model of spatial takeoff that is calibrated using spatially-disaggregated occupational data for England in c.1710. The model predicts changes in the spatial distribution of agricultural and manufacturing employment which match data for c.1817 and 1861. The model also matches a number of aggregate changes that characterise the first industrial revolution. Using counterfactual geographical distributions, we show that the initial concentration of productivity can matter for whether and when an industrial takeoff occurs. Subsidies to innovation in either sector can bring forward the date of takeoff while subsidies to the use of land by manufacturing firms can significantly delay a takeoff because it decreases spatial concentration of activity.

Spatial Takeoff in the First Industrial Revolution

Using the framework of Desmet and Rossi-Hansberg (forthcoming), we present a model of spatial takeoff that is calibrated using spatially-disaggregated occupational data for England in c.1710. The model predicts changes in the spatial distribution of agricultural and manufacturing employment which match data for c.1817 and 1861. The model also matches a number of aggregate changes that characterise the first industrial revolution. Using counterfactual geographical distributions, we show that the initial concentration of productivity can matter for whether and when an industrial takeoff occurs. Subsidies to innovation in either sector can bring forward the date of takeoff while subsidies to the use of land by manufacturing firms can significantly delay a takeoff because it decreases spatial concentration of activity.