Human Capital, the Structure of Production, and Growth

Recent decisions by the Spanish national competition authority (TDC) mandate payment systems to include only two costs when setting their domestic multilateral interchange fees (MIF): a fixed processing cost and a variable cost for the risk of fraud. This artificial lowering of MIFs will not lower consumer prices, because of uncompetitive retailing; but it will however lead to higher cardholders fees and, likely, new prices for point of sale terminals, delaying the development of the immature Spanish card market. Also, to the extent that increased cardholders fees do not offset the fall in MIFs revenue, the task of issuing new cards will be underpaid relatively to the task of acquiring new merchants, causing an imbalance between the two sides of the networks. Moreover, the pricing scheme arising from the decisions will cause unbundling and underprovision of those services whose costs are excluded. Indeed, the payment guarantee and the free funding period will tend to be removed from the package of services currently provided, to be either provided by third parties, by issuers for a separate fee, or not provided at all, especially to smaller and medium-sized merchants. Transaction services will also suffer the consequences that the TDC precludes pricing them in variable terms.

Investigation of County Treasurers' Tax-Sale Registration Fees, June 2007

On January 2, 2007, the Ombudsman received a complaint regarding the fee that county treasurers charge registrants at annual tax sales. The complainant said generally that many of the state’s counties, especially larger ones, appeared to be charging higher fees than was thought to be allowed by law. Investigation The investigation was conducted by Assistant Ombudsman Bert Dalmer. For purposes of this report, all investigative actions are ascribed to the Ombudsman. In early 2007, the Ombudsman surveyed tax-sale registration fees in 10 of the state’s 99 counties. Interviews of 10 county treasurers and/or some of their deputies were conducted. In addition, the Ombudsman researched the Iowa Code and relevant case law. The Ombudsman also consulted with the Iowa State Auditor and the president of the Iowa State County Treasurers Association.

¿Es posible reducir el gasto sanitario a través del subsidio a los seguros sanitarios privados? La doble cobertura sanitaria en Catalunya. Estimación de patrones de utilización de servicios sanitarios y simulación de costes asociados a la asistencia

The objective of this study consists in quantifying in money terms thepotential reduction in usage of public health care outlets associatedto the tenure of double (public plus private) insurance. In order to address the problem, a probabilistic model for visits to physicians is specified and estimated using data from the Catalonian Health Survey. Also, a model for the marginal cost of a visit to a physician is estimated using data from a representative sample of fee-for-service payments from a major insurer. Combining the estimates from the two models it is possible to quantify in money terms the cost/savings of alternative policies which bear an impact on the adoption of double insurance by the population. The results suggest that the private sector absorbs an important volumeof demand which would be re-directed to the public sector if consumerscease to hold double insurance.

Transfers, social safety nets and economic growth

The role of social safety nets in the form of redistributional transfersand wage subsidies is analyzed using a simple model of criminal behavior. Itis argued that public welfare programs act as a crime--preventing ordisruption--preventing devices because they tend to increase the opportunitycost of engaging in crime or disruptive activities. It is shown that, in thepresence of a leisure choice, wage subsidies may be better than pure transfers. Using a simple growth model, it is shown that it is not optimal for the governmentto try to fully eliminate crime. The optimal size of the public welfare programis found and it is argued that public welfare should be financed with income(not lump--sum) taxes, despite the fact that income taxes are distortionary.The intuition for this result is that income taxes act as a user fee oncongested public goods and transfers can be thought of as {\it productive}public goods {\it subject to congestion}. Finally, using a cross-section of 75 countries, the partial correlation betweentransfers and growth is shown to be significantly positive.

Financiación capitativa, articulación entre niveles asistenciales y descentralización de las organizaciones sanitarias

Public organisations are subjected to weak incentivesfor competition. Therefore, institutional Darwinismcannot apply. Regulation and performance monitoring isrequired to protect the public interest. This isparticularly the case of organisations in the healthcare arena, since strong incentives may risk the wholesupply of public health services. Regarding to the pathdependence of the Spanish public health institutionswith respect to the international experience and theobserved health technological changes, this paper triesto ground some theoretical bases for the organisationalchange in our health system. We do this by building ourargument from the very basic public goal: the improvementof the health status of the Spanish population. Thisrequires a better integration of health care services.To this regard, capitation in finance shows somecomparative advantages: it takes an integral view forthe care of the population, it allows for a betterdecentralisation ('deconcentration') of risks to healthproviders and favours managed care under a globalperspective, replacing partial payment to differentproviders. However, the paper shows some potentiallimitations for this purpose and the need of a gradualstrategy for its implementation.

Population based resource allocation: The use of hybrid risk adjustment

The emphasis on integrated care implies new incentives that promote coordinationbetween levels of care. Considering a population as a whole, the resource allocation systemhas to adapt to this environment. This research is aimed to design a model that allows formorbidity related prospective and concurrent capitation payment. The model can be applied inpublicly funded health systems and managed competition settings.Methods: We analyze the application of hybrid risk adjustment versus either prospective orconcurrent risk adjustment formulae in the context of funding total health expenditures for thepopulation of an integrated healthcare delivery organization in Catalonia during years 2004 and2005.Results: The hybrid model reimburses integrated care organizations avoiding excessive risktransfer and maximizing incentives for efficiency in the provision. At the same time, it eliminatesincentives for risk selection for a specific set of high risk individuals through the use ofconcurrent reimbursement in order to assure a proper classification of patients.Conclusion: Prospective Risk Adjustment is used to transfer the financial risk to the healthprovider and therefore provide incentives for efficiency. Within the context of a National HealthSystem, such transfer of financial risk is illusory, and the government has to cover the deficits.Hybrid risk adjustment is useful to provide the right combination of incentive for efficiency andappropriate level of risk transfer for integrated care organizations.

Price regulation of plastic money: A critical assessment of Spanish rules

Recent decisions by the Spanish national competition authority (TDC) mandate paymentsystems to include only two costs when setting their domestic multilateral interchange fees(MIF): a fixed processing cost and a variable cost for the risk of fraud. This artificiallowering of MIFs will not lower consumer prices, because of uncompetitive retailing; but itwill however lead to higher cardholders fees and, likely, new prices for point of saleterminals, delaying the development of the immature Spanish card market. Also, to the extent that increased cardholders fees do not offset the fall in MIFs revenue, the task of issuing new cards will be underpaid relatively to the task of acquiring new merchants, causing an imbalance between the two sides of the networks. Moreover, the pricing scheme arising from the decisions will cause unbundling and underprovision of those services whose costs are excluded. Indeed, the payment guarantee and the free funding period will tend to be removed from the package of services currently provided, to be either provided by third parties, by issuers for a separate fee, or not provided at all, especially to smaller and medium-sized merchants. Transaction services will also suffer the consequences that the TDC precludes pricing them in variable terms.

La gestión sanitaria: orientaciones a futuro para el cambio organizativo, del control y la financiación

This paper offers a general view of changes in health care management in theSpanish Health System. We focus on the organisational, financing andaccountability aspects of health care provision. We do this by encompassingmanagerial changes and social change and well-grounded in theory health economicsliterature. In this way we try to link applied economics and management issues,as we did in a former paper, ten years ago on the same basis(López-Casasnovas, 2002). We emphasise mistakes and milestones in the wayforward to improve health systems by better understanding the public natureof health policies. Key aspects of this are to achieve a better allocation ofresponsibilities to providers on patients health, to incentive the organisationof medical self-managed health care institutions and to build global budgets onrisk-adjusting capitation and better integrated health care providers on acommunity basis.

The provision on non-audit services by auditors: Let the market evolve and decide

The provision of non-audit services by auditors to their auditclients reduces total costs, increases technical competence and motivates more intense competition. Furthermore, theseservices do not necessarily damage auditor independence nor the quality of non-audit services. This assessment leads to recommending that legislative policy should aim at facilitating the development and use of the safeguardsprovided by the free action of market forces. Regulation should thus aim to enable the parties-audit firms, self-regulatory bodies and audit clients-to discover through competitive market interaction both the most efficient mix of services and the corresponding quality safeguards, adjusting for the costs and benefits of each possibility. Particular emphasis is placed on the role played by fee income diversification and the enhancement, through disclosurerules, of market incentives to diversify.

Electronic Payments for Driver's Licensing Transactions,December 31, 2008

House File 2196 required the Department of Transportation (DOT) to study the acceptance of electronic payments at its customer service sites and sites operated by county treasurers. Specifically the legislation requires the following: “The department of transportation shall review the current methods the department employs for the collection of fees and other revenues at sites operated by county treasurers under chapter 321M and at customer service sites operated by the department. In conducting its review, the department, in cooperation with the treasurer of state, shall consider providing an electronic payment option for all of its customers. The department shall report its findings and recommendations by December 31, 2008, to the senate and house standing committees on transportation regarding the advantages and disadvantages of implementing one or more electronic payment systems.” This review focused on estimating the costs of providing an electronic payment option for customers of the DOT driver’s license stations and those of the 81 county treasurers. Customers at these sites engage in three primary financial transactions for which acceptance of electronic payments was studied: paying for a driver’s license (DL), paying for a non-operator identification card (ID), and paying certain civil penalties. Both consumer credit cards and PIN-based debit cards were reviewed as electronic payment options. It was assumed that most transactions would be made using a consumer credit card. Credit card companies charge a fee for each transaction for which they are used. The amount of these fees varies among credit card companies. The estimates for credit card fees used in this study were based on the State Treasurer of Iowa’s current credit card contract, which is due to expire in September 2009. Since credit card companies adjust their fees each year, estimates were based on the 2008 fee schedule. There is also a fee for the use of PIN-based debit cards. The estimates for PIN-based debit card transactions were based on information provided by Wells Fargo Merchant Services for current fees charged by debit card networks. Credit and debit card transactions would be processed through vendor-provided hardware and software. The costs would be determined through the competitive bidding process since several vendors provide this function; therefore, these costs are not reflected in this document.

Multinationals, technology networks and international takeovers

We formulate a knowlegde--based model of direct investment through mergers and acquisitions. M&As are realized to create comparative advantages by exploiting international synergies and appropriating local technology spillovers requiring geographical proximity, but can also represent a strategic response to the presence of a multinational rival. The takeover fee paid tends to increase with the strength of local spillovers which can thus work against multinationalization. Seller's bargaining power increases the takeover fee, but does not influence the investment decision. We characterize losers and winners from multinationalization, and show that foreign investment stimulates research but could result in a synergy trap reducing multinationals' profits.

Audit quality: Attributes, private safeguards and the role of regulation

This article examines the private mechanisms used to safeguard quality in auditing, with a view to defining rules capable of facilitating the performance of market forces. An outline is given of a general theory of private quality assurance in auditing, based on the use of quasi-rents to self-enforce quality dimensions. Particular attention is paid to the role of fee income diversification as the key ingredient of private incentives for audit quality. The role of public regulation is then situated in the context defined by the presence of these safeguard mechanisms. This helps in defining the content of rules and the function of regulatory bodies in facilitating and strengthening the protective operation of the market. By making sense of the interaction between regulation, quality attributes and private safeguards, the analysis helps to evaluate the relative merits of different regulatory options.

State of Iowa Department of Administrative Services Human Resource Enterprise: Review of State Hiring Practices, April 30, 2007

The State of Iowa and the Hiring Practices Working Group commissioned this review of the State’s hiring practices in response to recent concerns about these practices involving racial discrimination claims against the Departments of Human Services, Transportation, and Iowa Workforce Development. The State of Iowa should be commended for undertaking this review. The State has a longstanding Affirmative Action Program and commitment to diversity – they instituted their Affirmative Action Program in 1973, and continue their commitment to its success by making the changes necessary to ensure the program is viable and sustainable. Iowa Department of Administrative Services In July 2003, the State created the Iowa Department of Administrative Services (DAS) as a way to manage and coordinate the major resources of state government. DAS provides human resource services through an entrepreneurial management model. Entrepreneurial management is a customer-focused approach to delivering services. The customer departments have input about what services and products they want from DAS and in turn DAS is funded by the customer departments through purchases of DAS services and products. DAS looks to offer new and additional services (for example recruitment support and coordination) to various customers on a fee-for-service basis. A customer council is charged with approving the DAS business plan, establishing the rate for services, and reviewing service delivery and complaints. Under this entrepreneurial model, human resource services are provided by DAS-HRE (Human Resources Enterprise) central staff, 12 DAS-HRE Personnel Officers located at the customer departments, and customer agency staff. The majority of the recruitment and hiring functions are done by the customer (hiring) departments and their staff. Applications for employment are submitted using the BrassRing system with applicants being qualified by DAS-HRE employees. Since the creation of Human Resources Enterprise, DAS-HRE has strived to provide human resource tools to the departments. The Screening Manual and the Supervisor’s Manual are just two examples of the resources created for the hiring departments. They also provide Supervisor Training for newly appointed supervisors. Larger departments have dedicated staff assigned to human resource activities. The staff at the departmental level may or may not have a human resources background. Iowa Population and Workforce The 2000 U.S. Census indicated that Iowa’s population was 2,926,324. According to this census, 92.6 percent of Iowa’s population identified their race as white (alone). The nonwhite alone or minority population (including Black or African American, Asian, Native Hawaiian or Pacific Islander, Hispanic or Latino, American Indian or Alaska Native, two or more races, or some other race) was 7.4 percent.

Disseny i implementació d'una pàgina web de subhastes

Amb la situació econòmica actual pot ser interessant poder vendre objectes que ja no s’utilitzen i també poder-ne comprar de segona mà. Amb aquesta idea sorgeix el projecte de crear una pàgina de subhastes online on la gent pugui comerciar amb les coses que ja no necessita. Tenint en compte el concepte inicial, el propietari de la pàgina no rebrà cap retribució ni percentatge de cada subhasta, tot l’import serà pel venedor. L’objectiu principal és el de poder oferir un lloc on després de registrar-se, els usuaris puguin veure i pujar per els articles que altres persones estan subhastant i també la possibilitat de crear les seves pròpies subhastes. Cada usuari disposarà d’un espai personal on veure les subhastes amb les que ha interactuat i així no perdre-les de vista i també on poder veure en cada moment l’estat de les subhastes que ha creat. La vista d’una subhasta s’actualitzarà automàticament sense haver de recarregar la pàgina i si algú puja durant l’últim minut la subhasta s’allargarà un minut més per evitar puges a l’últim moment i així maximitzar el preu final. Hi haurà un administrador que serà l’encarregat de gestionar el bon funcionament de la pàgina amb permís per afegir, editar, consultar i eliminar tota la informació disponible. Per portar a terme el projecte s’ha utilitzat PHP per la part de programació i MySQL com a sistema gestor de bases de dades.

The effect of non-medical factors on variations in the performance of colonoscopy among different health care settings

BACKGROUND: Previous published studies have shown significant variations in colonoscopy performance, even when medical factors are taken into account. This study aimed to examine the role of nonmedical factors (ie, embodied in health care system design) as possible contributors to variations in colonoscopy performance. METHODS: Patient data from a multicenter observational study conducted between 2000 and 2002 in 21 centers in 11 western countries were used. Variability was captured through 2 performance outcomes (diagnostic yield and colonoscopy withdrawal time), jointly studied as dependent variables, using a multilevel 2-equation system. RESULTS: Results showed that open-access systems and high-volume colonoscopy centers were independently associated with a higher likelihood of detecting significant lesions and longer withdrawal durations. Fee for service (FFS) payment was associated with shorter withdrawal durations, and so had an indirect negative impact on the diagnostic yield. Teaching centers exhibited lower detection rates and longer withdrawal times. CONCLUSIONS: Our results suggest that gatekeeping colonoscopy is likely to miss patients with significant lesions and that developing specialized colonoscopy units is important to improve performance. Results also suggest that FFS may result in a lower quality of care in colonoscopy practice and highlight the fact that longer withdrawal times do not necessarily indicate higher quality in teaching centers.