Waiting times for cataract surgery in ten European countries: an analysis using data from the SHARE survey

AIMS: To assess waiting times for cataract surgery and their acceptance in European countries, and to find explanatory, country-specific health indicators. METHODS: Using data from the survey of health, ageing and retirement in Europe (SHARE), waiting times for cataract surgery of 245 respondents in ten countries were analysed with the help of linear regression. The influence of four country specific health indicators on waiting times was studied by multiple linear regression. The influence of waiting time and country on the wish to have surgery performed earlier was determined through logistic regression. Additional information was obtained for each country from opinion leaders in the field of cataract surgery. RESULTS: Waiting times differed significantly (p<0.001) between the ten analysed European countries. The length of wait was significantly influenced by the total expenditure on health (p<0.01) but not by the other country specific health indicators. The wish to have surgery performed earlier was determined by the length of wait (p<0.001) but not by the country where surgery was performed. CONCLUSION: The length of wait is influenced by the total expenditure on health, but not by the rate of public expenditure on health, by the physician density or by the acute bed density. The wish to have surgery performed earlier depends on the length of wait for surgery and is not influenced by the country.

La actividad hidrocarburífera en la Cuenca del Golfo San Jorge : El papel del empresariado regional

La política económica que se implementó en la década de 1990 tuvo como eje, entre las principales medidas, la apertura de la economía, la privatización de las empresas públicas, el desmantelamiento del aparato estatal y sus agentes reguladores, el ajuste fiscal y del gasto público tanto a nivel nacional, como provincial y municipal, la retirada del Estado Nacional como inversor y subsidiador de actividades económicas, la desregulación del mercado de trabajo y la concentración en grupos 'oligopólicos' de las principales actividades productivas, lo que produjo diferentes impactos en las distintas actividades económicas de la Región Patagónica, dependiendo de su inserción en el mercado interno y externo. En este trabajo se pretende, a partir de una descripción de la evolución de la actividad petrolera y de un estudio de caso, analizar los factores que viabilizan el desarrollo económico local y repensar el papel de los actores sociales en relación con el contexto y con las posibilidades de establecimiento de estrategias de innovación en las sociedades locales. En la primera parte del artículo se hace una caracterización socioeconómica de la región de la Cuenca del Golfo San Jorge. A continuación se observa la evolución de la actividad petrolera dentro de la cuenca, su papel en el mercado de trabajo y su requerimiento de mano de obra; se realiza una caracterización de los principales actores y de su relación con el desarrollo local. En la parte final del artículo se intenta mostrar los desafíos que enfrentan los actores públicos y privados vinculados con la actividad petrolera y su proyección en el corto y mediano plazo

La actividad hidrocarburífera en la Cuenca del Golfo San Jorge : El papel del empresariado regional

La política económica que se implementó en la década de 1990 tuvo como eje, entre las principales medidas, la apertura de la economía, la privatización de las empresas públicas, el desmantelamiento del aparato estatal y sus agentes reguladores, el ajuste fiscal y del gasto público tanto a nivel nacional, como provincial y municipal, la retirada del Estado Nacional como inversor y subsidiador de actividades económicas, la desregulación del mercado de trabajo y la concentración en grupos 'oligopólicos' de las principales actividades productivas, lo que produjo diferentes impactos en las distintas actividades económicas de la Región Patagónica, dependiendo de su inserción en el mercado interno y externo. En este trabajo se pretende, a partir de una descripción de la evolución de la actividad petrolera y de un estudio de caso, analizar los factores que viabilizan el desarrollo económico local y repensar el papel de los actores sociales en relación con el contexto y con las posibilidades de establecimiento de estrategias de innovación en las sociedades locales. En la primera parte del artículo se hace una caracterización socioeconómica de la región de la Cuenca del Golfo San Jorge. A continuación se observa la evolución de la actividad petrolera dentro de la cuenca, su papel en el mercado de trabajo y su requerimiento de mano de obra; se realiza una caracterización de los principales actores y de su relación con el desarrollo local. En la parte final del artículo se intenta mostrar los desafíos que enfrentan los actores públicos y privados vinculados con la actividad petrolera y su proyección en el corto y mediano plazo

La actividad hidrocarburífera en la Cuenca del Golfo San Jorge : El papel del empresariado regional

La política económica que se implementó en la década de 1990 tuvo como eje, entre las principales medidas, la apertura de la economía, la privatización de las empresas públicas, el desmantelamiento del aparato estatal y sus agentes reguladores, el ajuste fiscal y del gasto público tanto a nivel nacional, como provincial y municipal, la retirada del Estado Nacional como inversor y subsidiador de actividades económicas, la desregulación del mercado de trabajo y la concentración en grupos 'oligopólicos' de las principales actividades productivas, lo que produjo diferentes impactos en las distintas actividades económicas de la Región Patagónica, dependiendo de su inserción en el mercado interno y externo. En este trabajo se pretende, a partir de una descripción de la evolución de la actividad petrolera y de un estudio de caso, analizar los factores que viabilizan el desarrollo económico local y repensar el papel de los actores sociales en relación con el contexto y con las posibilidades de establecimiento de estrategias de innovación en las sociedades locales. En la primera parte del artículo se hace una caracterización socioeconómica de la región de la Cuenca del Golfo San Jorge. A continuación se observa la evolución de la actividad petrolera dentro de la cuenca, su papel en el mercado de trabajo y su requerimiento de mano de obra; se realiza una caracterización de los principales actores y de su relación con el desarrollo local. En la parte final del artículo se intenta mostrar los desafíos que enfrentan los actores públicos y privados vinculados con la actividad petrolera y su proyección en el corto y mediano plazo

O orçamento como instrumento de intervenção no domínio econômico

Este trabalho versa sobre a utilização do orçamento público como instrumento de intervenção no domínio econômico, demonstrando, em síntese, de que forma o Estado utiliza, ou ao menos deveria utilizar, o orçamento público como instrumento de planejamento de suas ações e de intervenção na atividade desempenhada pela iniciativa privada. Tem-se por objetivo contribuir para a compreensão jurídica de diversas questões atinentes à elaboração e execução da peça orçamentária federal, aos reflexos causados na economia e na atividade desempenhada pela iniciativa privada, especialmente no que toca à realização das receitas e despesas públicas, à elaboração das leis orçamentárias Plano Plurianual (PPA), Lei Orçamentária Anual (LOA) e Lei de Diretrizes Orçamentárias (LDO) e, também, aos interesses, às paixões e ideologias envolvidas em todo o processo financeiro. Para tanto, inicialmente, estuda o papel do Estado, distinguindo os campos de atuação privada e aquele reservado à Administração Pública, os modos de intervenção e aqueles aplicados à hipótese analisada, para, em seguida, proceder à análise da peça orçamentária, sua concepção atual e relevância para a iniciativa privada, o que possibilita, então, tratar de questões que envolvam as receitas públicas, em específico as tributárias e as despesas públicas. Por fim, trata do crédito público e, com isso, procura evidenciar de que forma, sob a ótica do orçamento público e nos limites legais de atuação do Estado, as previsões constantes do orçamento podem funcionar como instrumento de promoção, incentivo e estímulo, ou, em sentido contrário, limitar, frear ou desestimular o crescimento econômico e a atividade desenvolvida pela iniciativa privada.

La migración de retirados europeos al mercado de viviendas español: una evidencia sobre sus efectos

La migración internacional de retirados no es un fenómeno nuevo entre los países de la Unión Europea. Hay un buen número de sociólogos que han descrito el proceso y sus implicaciones en las formas de vida, especialmente en los casos de migración de los hogares de jóvenes retirados desde los países del norte de Europa hacia los soleados del sur. Muchos de estos movimientos afectan al mercado de viviendas desde el mismo momento de la llegada al país de destino y, en muchos casos, los flujos de población generados por esta migración contribuyen al cambio en las tendencias de edificación en los casos en que los destinos tienen bajos niveles de renta. Estos flujos tienen también implicaciones futuras como la necesidad de aumentar los servicios de atención a la tercera edad o en salud lo que, hoy por hoy, implican un elevado gasto público para el sistema español. Este artículo se interesa por las implicaciones en el corto plazo, así como en indagar en el fenómeno en sí. A través de la explotación de parte de los resultados de un proyecto de investigación denominado REVIcVAL (Retirados y vivienda en la Comunidad Valenciana), el artículo muestra algunas características de este flujo migratorio así como la racionalidad a la hora de tomar la decisión de comprar una vivienda. El ejercicio empírico utiliza información primaria recogida a través de un cuestionario recopilando información de retirados ingleses y alemanes en la costa de Alicante durante los años 2005 y 2006, con una base municipal, y estima la racionalidad en la toma de decisión de compra de viviendas.

Assessment of the Association of Health with the Liberalisation of Trade in Services under the World Trade Organisation

Background: The liberalisation of trade in services which began in 1995 under the General Agreement on Trade in Services (GATS) of the World Trade Organisation (WTO) has generated arguments for and against its potential health effects. Our goal was to explore the relationship between the liberalisation of services under the GATS and three health indicators – life expectancy (LE), under-5 mortality (U5M) and maternal mortality (MM) - since the WTO was established. Methods and Findings: This was a cross-sectional ecological study that explored the association in 2010 and 1995 between liberalisation and health (LE, U5M and MM), and between liberalisation and progress in health in the period 1995–2010, considering variables related to economic and social policies such as per capita income (GDP pc), public expenditure on health (PEH), and income inequality (Gini index). The units of observation and analysis were WTO member countries with data available for 2010 (n = 116), 1995 (n = 114) and 1995–2010 (n = 114). We conducted bivariate and multivariate linear regression analyses adjusted for GDP pc, Gini and PEH. Increased global liberalisation in services under the WTO was associated with better health in 2010 (U5M: 20.358 p,0.001; MM: 20.338 p = 0.001; LE: 0.247 p = 0.008) and in 1995, after adjusting for economic and social policy variables. For the period 1995–2010, progress in health was associated with income equality, PEH and per capita income. No association was found with global liberalisation in services. Conclusions: The favourable association in 2010 between health and liberalisation in services under the WTO seems to reflect a pre-WTO association observed in the 1995 data. However, this liberalisation did not appear as a factor associated with progress in health during 1995–2010. Income equality, health expenditure and per capita income were more powerful determinants of the health of populations.

La empresa social en España y en Italia durante la crisis ¿un laboratorio de innovación económica y social?

En este artículo analizamos el desarrollo de empresa social en España e Italia en el marco de la crisis económica y social, en términos de difusión y marco jurídico. De esta manera, definimos los confines del “ecosistema” de la empresa social en los dos países e identificamos elementos comunes y especifidades. La hipótesis es que la empresa social representa una herramienta de generación de respuestas proactivas a la crisis, impulsando trayectorias de innovación económica y social, y contribuyendo a un modelo de desarrollo económica y socialmente sostenible. La innovación surge de la capacidad de las empresas sociales de generar respuestas innovativas a demandas emergentes, de su capacidad de crear al mismo tiempo valor social y económico, de satisfacer necesidades individuales y colectivas, de activar dinámicas de cambio de medio y largo plazo, de estimular dinámicas de emprendimiento, de empoderamiento y de valorización en el territorio. Sin embargo, el carácter innovador de la empresa social no surge simplemente de una empresarializacción del Tercer Sector tradicional, y mucho menos como consecuencia de la transferencia de servicios fundamentales del estado a asociaciones, cooperativas y empresas sociales, si con eso se persigue el simple objetivo de reducción de los gastos públicos. Al contrario, detrás de la retórica de la innovación social se puedan esconder proyectos de reducción de los gastos de servicios a través de la reducción de los salarios y de la cualidad de los servicios. El artículo, a partir de la comparación de la difusión del fenómeno y de las perspectivas de desarrollo en España y en Italia, termina con una reflexión crítica sobre las luces y sombras, los riesgos y las oportunidades, relacionados con la difusión de la empresa social, o sea, de la integración de la acción solidaria y la acción económica en prácticas que son al mismo tiempo empresariales y con finalidades sociales.

Financial assistance to Greece: Three programmes. EPC Discussion Paper, 26 February 2016

There are a lot of myths surrounding the bailout money that was given to Greece. Many people still believe that the money never went to the Greek people, but to the Greek and European banks; that the intervention of the euro-area governments and the IMF dealt almost exclusively with the Greek debt; that very little money was used to finance Greek public expenditure; that most Greek debt was reimbursed; that no cuts were made to the stock of Greek government bonds on the market; and, finally, that so far, no cuts have been made to the debt of the Greek state towards the euro-area countries. In this Discussion Paper, Fabio Colasanti debunks some of those myths by taking stock of the numbers behind the financial support given to Greece by the countries of the euro-area and the IMF. Examining the three bailout programmes in detail, he discusses the reasons for and against a restructuring of the Greek public debt in 2010, its implementation in 2012, the degree in which the Greek debt towards the euro-area countries has already been cut, and the scope for further cuts. Finally, the paper explains how both issues were and are still dominated by internal political considerations, both in the creditor countries and in Greece.

A proposal to revive the European Fiscal Framework. Bruegel Policy Contribution ISSUE 2016/07 MARCH 2016

Pro-cyclical fiscal tightening might be one reason for the anaemic economic recovery in Europe, raising questions about the effectiveness of the EU’s fiscal framework in achieving its two main objectives: public debt sustainability and fiscal stabilisation. • In theory, the current EU fiscal rules, with cyclically adjusted targets, flexibility clauses and the option to enter an excessive deficit procedure, allow for large-scale fiscal stabilisation during a recession. However, implementation of the rules is hindered by the badly-measured structural balance indicator and incorrect forecasts, leading to erroneous policy recommendations. The large number of flexibility clauses makes the system opaque. • The current inefficient European fiscal framework should be replaced with a system based on rules that are more conducive to the two objectives, more transparent, easier to implement and which have a higher potential to be complied with. • The best option, re-designing the fiscal framework from scratch, is currently unrealistic. Therefore we propose to eliminate the structural balance rules and to introduce a new public expenditure rule with debt-correction feedback, embodied in a multi-annual framework, which would also support the central bank’s inflation target. A European Fiscal Council could oversee the system.

Fiscal survey of the State Department of Highways, 1942 to 1947.

Mode of access: Internet.

Spesa pubblica in Sanità, Istruzione e Ricerca: efficienza, efficacia e determinanti

La ricerca intende analizzare l’efficacia della spesa pubblica, l’efficienza e le loro determinanti nei settori della Sanità, dell’Istruzione e della Ricerca per 33 paesi dell’area OCSE. L’analisi ha un duplice obiettivo: da un lato un confronto cross country e dall’altro un confronto temporale, prendendo in considerazione il periodo che va dal 1992 al 2011. Il tema della valutazione dell’efficacia e dell’efficienza della spesa pubblica è molto attuale, soprattutto in Europa, sia perché essa incide di quasi il 50% sul PIL, sia a causa della crisi finanziaria del 2008 che ha spinto i governi ad una riduzione dei bugdet e ad un loro uso più oculato. La scelta di concentrare il lavoro di analisi nei settori della Sanità, dell’Istruzione e della Ricerca e Sviluppo deriva da un lato dalla loro peculiarità di attività orientate al cliente (scuole, ospedali, tribunali) dall’altro dal ruolo strategico che essi rappresentano per lo sviluppo economico di un paese. Il lavoro è articolato in tre sezioni: 1. Rassegna dei principali strumenti metodologici utilizzati in letteratura per la misurazione della performance e dell’efficienza della spesa pubblica nei tre settori. 2. Valutazione e confronto dell’efficienza e della performance della spesa pubblica dal punto di vista sia temporale sia cross-country attraverso la costruzione di indicatori di performance e di efficienza della spesa pubblica (per approfondire l'indice dell'efficienza ho applicato la tecnica DEA "bootstrap output oriented" con indicatori di output ed input non simultanei mentre l’evoluzione dell’efficienza tra i periodi 2011-2002 e 2001-1992 è stata analizzata attraverso il calcolo dell’indice di Malmquist). 3. Analisi delle variabili esogene che influenzano l’efficienza della spesa pubblica nei settori Salute, Istruzione e Ricerca e Sviluppo attraverso una regressione Tobit avente come variabile dipendente i punteggi di efficienza DEA output oriented e come variabili esogene alcuni indicatori scelti tra quelli presenti in letteratura: l’Indicatore delle condizioni socioeconomiche delle famiglie (costruito e applicato da OCSE PISA per valutare l’impatto del background familiare nelle performance dell’apprendimento), l’Indicatore di fiducia nel sistema legislativo del paese, l’Indicatore di tutela dei diritti di proprietà, l’Indicatore delle azioni di controllo della corruzione, l’Indicatore di efficacia delle azioni di governo, l’Indicatore della qualità dei regolamenti, il PIL pro-capite. Da questo lavoro emergono risultati interessanti: non sempre alla quantità di risorse impiegate corrisponde il livello massimo di performance raggiungibile. I risultati della DEA evidenziano la media dei punteggi di efficienza corretti di 0,712 e quindi, impiegando la stessa quantità di risorse, si produrrebbe un potenziale miglioramento dell’output generato di circa il 29%. Svezia, Giappone, Finlandia e Germania risultano i paesi più efficienti, più vicini alla frontiera, mentre Slovacchia, Portogallo e Ungheria sono più distanti dalla frontiera con una misura di inefficienza di circa il 40%. Per quanto riguarda il confronto tra l’efficienza della spesa pubblica nei tre settori tra i periodi 1992-2001 e 2002-2011, l’indice di Malmquist mostra risultati interessanti: i paesi che hanno migliorato il loro livello di efficienza sono quelli dell’Est come l’Estonia, la Slovacchia, la Lituania mentre Paesi Bassi, Belgio e Stati Uniti hanno peggiorato la loro posizione. I paesi che risultano efficienti nella DEA come Finlandia, Germania e Svezia sono rimasti sostanzialmente fermi con un indice di Malmquist vicino al valore uno. In conclusione, i risultati della Tobit contengono indicazioni importanti per orientare le scelte dei Governi. Dall’analisi effettuata emerge che la fiducia nelle leggi, la lotta di contrasto alla corruzione, l’efficacia del governo, la tutela dei diritti di proprietà, le condizioni socioeconomiche delle famiglie degli studenti OECD PISA, influenzano positivamente l’efficienza della spesa pubblica nei tre settori indagati. Oltre alla spending review, per aumentare l’efficienza e migliorare la performance della spesa pubblica nei tre settori, è indispensabile per gli Stati la capacità di realizzare delle riforme che siano in grado di garantire il corretto funzionamento delle istituzioni.

Autonomia de Gestão dos Agrupamentos dos Centros de Saúde

The National Health Service is one of the portuguese social progress pillars and as a key role in terms of health services, organized around a universal service, general and tend to free, provided for the Portuguese Republic Constitution, in order to promote people's access to health care,adequate and adaptively to their needs and expectations, seeking economic efficiency in a control context of public expenditure and budget. Primary Health Care are considered fundamental piece for the National Health Service, as they are the first users accessibility to health care, being the health center a unit to serve and providing the essential first treatments, preventive and/or curative, assuming important functions of promotion of health and prevention of disease, cooperating with other services for continuity of caring. The implementation of the Health Centers Groupings aims to decentralize the management and allow decision making on key resources to the provision of care, absorbing the district offices of the extinct Health Sub-Regions and having the task of ensuring the provision of health care primary the population of a given geographical area, based on a multidisciplinary team with organization and technical autonomy and is guaranteed intercooperation with other functional units. However, these district offices were attached to the Regional Health Administrations following the reverse path, causing dysfunctional positions and making health centers Groupings their dependents. Thus, before the reform of Primary Health Care, all the structural changes were made, except to check the Health Centers Groupings proper management autonomy, currently one of the biggest obstacles to the implementation of such reform. It is intended in this work through a inquiry by forms done at 21 Health Centers Groupings North Regional Health Authority, IP, evidence can the management autonomy in Health Centers Groupings provide greater efficiency in the provision of Primary health Care to citizens and ensure greater sustainability of the National health Service, better managing existing resources, human and financial, showing a growing responsibility in its management and ensuring appropriate practices, more quality in health care and better accessibility, providing the ability to apply more adjusted measures in providing health care to the population of their geographical área.

Measurement of productivity and cost of the direct labour organisation within highways maintenance departments

The objective of this thesis is to investigate, through an empirical study, the different functions of the highways maintenance departments and to suggest methods by means of which road maintenance work could be carried out in a more efficient way by utilising its resources of men, material and plant to the utmost advantage. This is particularly important under the present circumstances of national financial difficulties which have resulted in continuous cuts in public expenditure. In order to achieve this objective, the researcher carried out a survey among several Highways Authorities by means of questionnaire and interview. The information so collected was analysed in order to understand the actual, practical situation within highways manintenance departments, and highlight any existing problems, and try to answer the question of how they could become more efficient. According to the results obtained by the questionnaire and the interview, and the analysis of these results, the researcher concludes that it is the management system where least has been done, and where problems exist and are most complex. The management of highways maintenance departments argue that the reasons for their problems include both financial and organisational difficulties, apart from the political aspect and nature of the activities undertaken. The researcher believes that this ought to necessitate improving the management's analytical tools and techniques in order to achieve the most effective way of performing each activity. To this end the researcher recommends several related procedures to be adopted by the management of the highways maintenance departments. These recommendations, arising from the study, involve the technical, practical and human aspects. These are essential factors of which management should be aware - and certainly should not neglect - in order to achieve its objectives of improved productivity in the highways maintenance departments.

Climate change performance measurement, control and accountability in English local areas

Purpose – This paper aims to consider how climate change performance is measured and accounted for within the performance framework for local authority areas in England adopted in 2008. It critically evaluates the design of two mitigation and one adaptation indicators that are most relevant to climate change. Further, the potential for these performance indicators to contribute to climate change mitigation and adaptation is discussed. Design/methodology/approach – The authors begin by examining the importance of the performance framework and the related Local Area Agreements (LAAs), which were negotiated for all local areas in England between central government and Local Strategic Partnerships (LSPs). This development is located within the broader literature relating to new public management. The potential for this framework to assist in delivering the UK's climate change policy objectives is researched in a two-stage process. First, government publications and all 150 LAAs were analysed to identify the level of priority given to the climate change indicators. Second, interviews were conducted in spring 2009 with civil servants and local authority officials from the English West Midlands who were engaged in negotiating the climate change content of the LAAs. Findings – Nationally, the authors find that 97 per cent of LAAs included at least one climate change indicator as a priority. The indicators themselves, however, are perceived to be problematic – in terms of appropriateness, accuracy and timeliness. In addition, concerns were identified about the level of local control over the drivers of climate change performance and, therefore, a question is raised as to how LSPs can be held accountable for this. On a more positive note, for those concerned about climate change, the authors do find evidence that the inclusion of these indicators within the performance framework has helped to move climate change up the agenda for local authorities and their partners. However, actions by the UK's new coalition government to abolish the national performance framework and substantially reduce public expenditure potentially threaten this advance. Originality/value – This paper offers an insight into a new development for measuring climate change performance at a local level, which is relatively under-researched. It also contributes to knowledge of accountability within a local government setting and provides a reference point for further research into the potential role of local actions to address the issue of climate change.