Horizontal fiscal equity: a theoretical contribution with an application to the portuguese municipalities.

Doutoramento em Economia.

Desigualdades socioeconómicas na utilização de cuidados de saúde na população com 65 ou mais anos de idade em Portugal : dados do 4.º Inquérito Nacional de Saúde 2005-2006

RESUMO - INTRODUÇÃO: A equidade em cuidados de saúde constitui uma prioridade das políticas de saúde, tendo vários estudos descrito uma iniquidade que geralmente favorece os indivíduos com maior rendimento e nível educacional. Este estudo visa caracterizar as desigualdades socioeconómicas na utilização de cuidados de saúde na população com 65 ou mais anos de idade, dadas as suas características, maior vulnerabilidade e crescente peso demográfico na população. METODOLOGIA: Através de dados do INS, procedeu-se à análise univariada e multivariada por regressão linear múltipla para avaliação das desigualdades socioeconómicas na utilização de cuidados de saúde em 8698 indivíduos. RESULTADOS: Identifica-se um padrão de desigualdade na utilização de cuidados de saúde – indivíduos com maior rendimento e nível de escolaridade utilizam em média mais consultas de especialidade; ocorrendo o inverso nas consultas de CSP. Com ajustamento pela necessidade, através do estado de saúde auto-reportado, observa-se um padrão de iniquidade no sexo masculino relativamente às consultas em geral e consultas de CSP. DISCUSSÃO E CONCLUSÕES: A iniquidade na utilização de cuidados de saúde, apesar de não constituir a única causa, pode determinar maior iniquidade em saúde, pelo que é relevante o seu estudo. Os resultados alcançados podem ser justificados pelas características do SNS, assim como pelas isenções de taxas moderadoras, rede social, outros indicadores económicos, ou ainda pelo próprio contexto de vida do individuo. Torna-se fundamental prosseguir a investigação acerca da equidade, assim como promover uma ampla reflexão sobre os desafios futuros do sistema de saúde, que permitam preservar a sua sustentabilidade e princípios fundadores.

El Sistema de financiación de las comunidades autónomas de régimen común: un análisis crítico y algunas propuestas de reforma

We identify a number of elements of the current Spanish system of regional financing that do not conform satisfactorily to the principles of equity, autonomy and efficiency that should inspire its design. Our main conclusion is that although the system presents a series of shortcomings that would require an in-depth reform, its basic focus on the equalization of the service provision capacity of all regional governments should be preserved because it is in accordance with the constitutional guarantee of equal rights for all citizens and with notions of horizontal equity that are widely shared in our country. In fact, the main shortcoming of the system is, in our opinion, that it does not fully guarantee such equality in practice. Additional weaknesses of the system are its lack of transparency, the absence of mechanisms to maintain vertical equilibrium across the different levels of the administration and a significant deficit of fiscal autonomy and responsibility on the pa

Hallintoelinten oikeudenmukainen palkitseminen - toimialavertailu osuustoiminnallisissa organisaatioissa

Työn tarkoituksena oli lähteä tutkimaan palkitsemisen, vaativuuden ja tehtävien eroavaisuuksia kolmen osuustoiminnallisen organisaation hallintoelinten välillä. Tavoitteena oli selvittää, miten palkitsemisen horisontaalista oikeudenmukaisuutta voitaisiin kehittää osuustoiminnallisten organisaatioiden hallintoelimissä. Tutkimus toteutettiin kvantitatiivisena kyselylomaketutkimuksena, ja analysointimenetelmänä käytettiin regressioanalyysiä. Tutkimuksen teoreettinen viitekehys koostui palkitsemisesta ja sen oikeudenmukaisuudesta keskittyen horisontaaliseen ulottuvuuteen, työn vaativuudesta sekä aiempien tutkimusten perusteella palkitsemiseen vaikuttavista tekijöistä muun muassa rakenteen, toimialan ja strategian näkökulmista. Tutkimuksessa havaittiin, että tilaajaorganisaatiossa X palkkiot olivat vertailuorganisaatiota Y ja Z korkeammat. Erot vaativuuden ja tehtävien osalta eivät olleet yhtä suuria kuin palkkioissa, mutta organisaatiossa X nämäkin olivat pääasiassa korkeammalla tasolla. Regressioanalyysissä kävi ilmi, että työn vaativuus selittää suurimman osan palkitsemisen kertymästä ja muut tilastollisesti merkittävät selittävät muuttujat olivat huomattavasti vähäisempiä. Organisaation X korkeamman palkkiotason voitiin nähdä johtuvan erilaisesta palkkiorakenteesta sekä siitä, että se otti palkitsemisessa organisaation koon huomioon; palkkiot vaihtelivat huomattavasti enemmän alueorganisaatioiden kesken kuin organisaatiossa Y ja Z. Johtopäätöksenä voidaan sanoa, että työn vaativuusarviointi palkkioiden horisontaalista oikeudenmukaisuutta arvioitaessa on merkittävimmässä asemassa. Muiden tarkasteltujen muuttujien osalta tulokset eivät olleet aivan odotetun kaltaisia tai täysin yhdenmukaisia aiempien tutkimusten kanssa, vaikka samansuuntaisiakin havaintoja saatiin. Työn tärkein anti oli kuitenkin työn vaativuusarvioinnin tärkeyden havaitseminen hallintoelintyön palkitsemisen yhteydessä horisontaalisella tasolla.

Quantifying the Economics of Medical Malpractice - A View from a Civil Law Perspective

Life is full of uncertainties. Legal rules should have a clear intention, motivation and purpose in order to diminish daily uncertainties. However, practice shows that their consequences are complex and hard to predict. For instance, tort law has the general objectives of deterring future negligent behavior and compensating the victims of someone else's negligence. Achieving these goals are particularly difficult in medical malpractice cases. To start with, when patients search for medical care they are typically sick in the first place. In case harm materializes during the treatment, it might be very hard to assess if it was due to substandard medical care or to the patient's poor health conditions. Moreover, the practice of medicine has a positive externality on the society, meaning that the design of legal rules is crucial: for instance, it should not result in physicians avoiding practicing their activity just because they are afraid of being sued even when they acted according to the standard level of care. The empirical literature on medical malpractice has been developing substantially in the past two decades, with the American case being the most studied one. Evidence from civil law tradition countries is more difficult to find. The aim of this thesis is to contribute to the empirical literature on medical malpractice, using two civil law countries as a case-study: Spain and Italy. The goal of this thesis is to investigate, in the first place, some of the consequences of having two separate sub-systems (administrative and civil) coexisting within the same legal system, which is common in civil law tradition countries with a public national health system (such as Spain, France and Portugal). When this holds, different procedures might apply depending on the type of hospital where the injury took place (essentially whether it is a public hospital or a private hospital). Therefore, a patient injured in a public hospital should file a claim in administrative courts while a patient suffering an identical medical accident should file a claim in civil courts. A natural question that the reader might pose is why should both administrative and civil courts decide medical malpractice cases? Moreover, can this specialization of courts influence how judges decide medical malpractice cases? In the past few years, there was a general concern with patient safety, which is currently on the agenda of several national governments. Some initiatives have been taken at the international level, with the aim of preventing harm to patients during treatment and care. A negligently injured patient might present a claim against the health care provider with the aim of being compensated for the economic loss and for pain and suffering. In several European countries, health care is mainly provided by a public national health system, which means that if a patient harmed in a public hospital succeeds in a claim against the hospital, public expenditures increase because the State takes part in the litigation process. This poses a problem in a context of increasing national health expenditures and public debt. In Italy, with the aim of increasing patient safety, some regions implemented a monitoring system on medical malpractice claims. However, if properly implemented, this reform shall also allow for a reduction in medical malpractice insurance costs. This thesis is organized as follows. Chapter 1 provides a review of the empirical literature on medical malpractice, where studies on outcomes and merit of claims, costs and defensive medicine are presented. Chapter 2 presents an empirical analysis of medical malpractice claims arriving to the Spanish Supreme Court. The focus is on reversal rates for civil and administrative decisions. Administrative decisions appealed by the plaintiff have the highest reversal rates. The results show a bias in lower administrative courts, which tend to focus on the State side. We provide a detailed explanation for these results, which can rely on the organization of administrative judges career. Chapter 3 assesses predictors of compensation in medical malpractice cases appealed to the Spanish Supreme Court and investigates the amount of damages attributed to patients. The results show horizontal equity between administrative and civil decisions (controlling for observable case characteristics) and vertical inequity (patients suffering more severe injuries tend to receive higher payouts). In order to execute these analyses, a database of medical malpractice decisions appealed to the Administrative and Civil Chambers of the Spanish Supreme Court from 2006 until 2009 (designated by the Spanish Supreme Court Medical Malpractice Dataset (SSCMMD)) has been created. A description of how the SSCMMD was built and of the Spanish legal system is presented as well. Chapter 4 includes an empirical investigation of the effect of a monitoring system for medical malpractice claims on insurance premiums. In Italy, some regions adopted this policy in different years, while others did not. The study uses data on insurance premiums from Italian public hospitals for the years 2001-2008. This is a significant difference as most of the studies use the insurance company as unit of analysis. Although insurance premiums have risen from 2001 to 2008, the increase was lower for regions adopting a monitoring system for medical claims. Possible implications of this system are also provided. Finally, Chapter 5 discusses the main findings, describes possible future research and concludes.

The Economic Case for Fiscal Federalism in Scotland

In this paper we consider the case for assigning tax revenues to Scotland, by which we mean that taxes levied on Scottish tax bases should be returned to the Scottish budget. The budget, however, would continue to be supplemented by transfers from the Westminster budget. This arrangement differs from the current situation whereby public spending is largely financed by a bloc grant from Westminster. Our suggestion falls short of full fiscal federalism for Scotland . meaning that Scotland had control over choice of tax base and of tax rates, and fiscal transfers from Westminster would be minimal. We use propositions drawn from the theory of fiscal federalism to argue for a smaller vertical imbalance between taxes retained in Scotland and public spending in Scotland. A closer matching of spending with taxes would better signal to beneficiaries the true costs of public spending in terms of taxes raised. It would also create more complete incentives for politicians to provide public goods and services in quantities and at qualities that voters are actually willing to pay for. Under the current bloc grant system, the marginal tax cost of spending does not enter into political agents. calculations as spending is out of a fixed total budget. Moreover, the Scottish electorate is hindered in signaling its desire for local public goods and services since the size of the total budget is determined by a rigid formula set by Westminster. At the present time we reject proposals for full fiscal federalism because in sharply reducing vertical imbalance in the Scottish budget, it is likely to worsen horizontal balance between Scotland and the other UK regions. Horizontal balance occurs where similarly situated regions enjoy the same per capita level of public goods and services at the same per capita tax cost. The complete removal of the bloc grant under full fiscal federalism would remove the mechanism that currently promotes horizontal equity in the UK. Variability in own-source tax revenues creates other problems with full fiscal federalism. Taxes derived from North Sea oil would constitute a large proportion of Scottish taxes, but these are known to be volatile in the face of variable oil prices and the pound-dollar exchange rate. At the present time variability in oil tax revenue is absorbed by Westminster. Scotland is insulated through the bloc grant. This risk sharing mechanism would be lost with full fiscal federalism. It is true that Scotland could turn to financial markets to tide itself over oil tax revenue downturns, but as a much smaller and less diversified financial entity than the UK as a whole it would probably have to borrow on less favorable terms than can Westminster. Scotland would have to bear this extra cost itself. Also, with full fiscal federalism it is difficult to see how the Scottish budget could be used as a macroeconomic stabilizer. At present, tax revenue downturns in Scotland - together with the steady bloc grant - are absorbed through an increase in vertical imbalance. This acts as an automatic stabilizer for the Scottish economy. No such mechanism would exist under full fiscal federalism. The borrowing alternative would still exist but on the less favorable terms - as with borrowing to finance oil tax shortfalls.

Classical horizontal inequity and reranking: an integrated approach

The last 20 years have seen a significant evolution in the literature on horizontal inequity (HI) and have generated two major and "rival" methodological strands, namely, classical HI and reranking. We propose in this paper a class of ethically flexible tools that integrate these two strands. This is achieved using a measure of inequality that merges the well-known Gini coefficient and Atkinson indices, and that allows a decomposition of the total redistributive effect of taxes and transfers in a vertical equity effect and a loss of redistribution due to either classical HI or reranking. An inequality-change approach and a money-metric cost-of-inequality approach are developed. The latter approach makes aggregate classical HI decomposable across groups. As in recent work, equals are identified through a nonparametric estimation of the joint density of gross and net incomes. An illustration using Canadian data from 1981 to 1994 shows a substantial, and increasing, robust erosion of redistribution attributable both to classical HI and to reranking, but does not reveal which of reranking or classical HI is more important since this requires a judgement that is fundamentally normative in nature.

An empirical analysis of wealth taxation: equity Vs.tax compliance

Capital taxation is currently under debate, basically due to problems of administrative control and proper assessment of the levied assets. We analyze both problems focusing on a capital tax, the annual wealth tax (WT), which is only applied in five OECD countries, being Spain one of them. We concentrate our analysis on top 1% adult population, which permits us to describe the evolution of wealth concentration in Spain along 1983-2001. On average top 1% holds about 18% of total wealth, which rises to 19% when tax incompliance and under-assessment is corrected for housing, the main asset. The evolution suggests wealth concentration has risen. Regarding WT, we analyze whether it helps to reduce wealth inequality or, on the contrary, it reinforces vertical inequity (due to especial concessions) and horizontal inequity (due to the de iure and to de facto different treatment of assets). We analyze in detail housing and equity shares. By means of a time series analysis, we relate the reported values with reasonable price indicators and proxies of the propensity to save. We infer net tax compliance is extremely low, which includes both what we commonly understand by (gross) tax compliance and the degree of under-assessment due to fiscal legislation (for housing). That is especially true for housing, whose level of net tax compliance is well below 50%. Hence, we corroborate the difficulties in taxing capital, and so cast doubts on the current role of the WT in Spain in reducing wealth inequality.

Estratégias de escopo em empresas que foram a IPO no Brasil : uma comparação entre empresas investidas e não investidas por private equity

Esta dissertação teve o objetivo de estudar as semelhanças e diferenças básicas de estratégia de negócios de empresas investidas por Private Equity comparadas às empresas não investidas. A pesquisa foi feita por meio de análise comparativa da estratégia de escopo de empresas brasileiras do segmento de consumo-cíclico que foram a IPO de 2007 a 2012, utilizando-se informações públicas (fontes secundárias). Foram avaliados o escopo horizontal (escala e variedade de bens e serviços), o escopo vertical (nível de integração vertical da cadeia de produção ou serviço), o escopo geográfico e a diversificação das empresas. Como principais resultados, foram identificados que ambos grupos de empresas tinham estratégias semelhantes de economia de escala e escopo geográfico e a diversificação estava sempre atrelada à economia de escopo. No entanto, a estratégia de diversificação diferia entre os grupos. Enquanto as empresas não investidas por Private Equity tinham estratégias de longo prazo, as empresas investidas focavam em estratégias de diversificação com ganhos de curto prazo.

[principles Of Universality, Comprehensiveness And Equity In A Hearing Health Care Service].

This article analyzed whether the practices of hearing health care were consistent with the principles of universality, comprehensiveness and equity from the standpoint of professionals. It involved qualitative research conducted at a Medium Complexity Hearing Health Care Center. A social worker, three speech therapists, a physician and a psychologist constituted the study subjects. Interviews were conducted as well as observation registered in a field diary. The thematic analysis technique was used in the analysis of the material. The analysis of interviews resulted in the construction of the following themes: Universality and access to hearing health, Comprehensive Hearing Health Care and Hearing Health and Equity. The study identified issues that interfere with the quality of service and run counter to the principles of Brazilian Unified Health System. The conclusion reached was that a relatively simple investment in training and professional qualification can bring about significant changes in order to promote a more universal, comprehensive and equitable health service.

Equity Of Access To Pap Smears: Population-based Study In Campinas, São Paulo, Brazil.

To determine the prevalence of the Papanicolaou exam among women aged 20 to 59 years in the city of Campinas (state of São Paulo, Brazil) and to analyze associations between this test and affiliation to private health insurance plans as well as socioeconomic/demographic variables and health-related behavior. To do so, a population-based, cross-sectional study was carried out. Statistical analyses took the study design into account. Despite the significant socioeconomic differences between women with and without private health plans, no differences between these groups were found regarding having been submitted to the Papanicolaou test. In fact no differences were found as to socioeconomic and health variables analyzed. Among all variables analyzed, only marital status was significantly associated with having undergone the test. The Brazilian public health system accounted for 55.7% of the exams. The present findings indicate social equity in the city of Campinas regarding the preventive exam for cervical cancer in the age group studied.

A SEARCH FOR FIELD HORIZONTAL-BRANCH STARS NEAR THE SOUTH GALACTIC POLE

Searches for field horizontal-branch (FHB) stars in the halo of the Galaxy in the past have been carried out by several techniques, such as objective-prism surveys and visual or infrared photometric surveys. By choosing adequate color criteria, it is possible to improve the efficiency of identifying bona fide FHB stars among the other objects that exhibit similar characteristics, such as main-sequence A-stars, blue stragglers, subdwarfs, etc. In this work, we report the results of a spectroscopic survey carried out near the south Galactic pole intended to validate FHB stars originally selected from the HK objective-prism survey of Beers and colleagues, based on near-infrared color indices. A comparison between the stellar spectra obtained in this survey with theoretical stellar atmosphere models allows us to determine T(eff), log g, and [Fe/H] for 13 stars in the sample. Stellar temperatures were calculated from measured (B-V)(o), when this measurement was available (16 stars). The color index criteria adopted in this work are shown to correctly classify 30% of the sample as FHB, 25% as non-FHB (main-sequence stars and subdwarfes), whereas 40% could not be distinguished between FHB and main-sequence stars. We compare the efficacy of different color criteria in the literature intended to select FHB stars, and discuss the use of the Mg II 4481 line to estimate the metallicity.

Horizontal subsurface flow constructed wetlands for mitigation of ametryn-contaminated water

The feasibility of using constructed wetlands (CWs) for the mitigation of pesticide runoff has been studied in the last decade. However, a lack of related data was verified when subsurface flow constructed wetlands (SSF CWs) are considered for this purpose. In the present work, SSF CWs were submitted to continuous ametryn addition and evaluated during an I I-week period, with the aim of determining the feasibility of these systems for mitigation of contaminated water. Ametryn was not added to one CW cell in order to provide a control for the experiments. Monitoring of treatment performance was executed by standard water quality parameters, ametryn chromatography quantification and macrophyte (Typha latifolia L) nutritional and agronomic property analysis. Results indicated that 39% of the total initially added amount of ametryn was removed, transferred or transformed. Herbicide metabolism and mineralisation were carried out by chemical and biological mechanisms. No statistic differences were observed in nutritional contents found in the T. latifolia crops of the CWs after the experimental period. Moreover, the biomass production (one valuable source of renewable energy) was equal to 3.3 t.ha(-1) (dry matter) in wetland cells. It was concluded that constructed wetland systems are capable of mitigating water contaminated with ametryn, acting as buffer filters between the emission sources and the downstream superficial water bodies.

Treatment of linear alkylbenzene sulfonate in a horizontal anaerobic immobilized biomass reactor

Linear alkylbenzene sulfonate (LAS) is an anionic surfactant widely used to manufacture detergents and found in domestic and industrial wastewater. LAS removal was evaluated in a horizontal anaerobic immobilized biomass reactor. The system was filled with polyurethane foam and inoculated with sludge that was withdrawn from an up flow anaerobic sludge blanket reactor that is used to treat swine wastewater. The reactor was fed with easily degradable substrates and a solution of commercial LAS for 313 days. The hydraulic retention time applied was 12 h. The system was initially operated without detergent and resulted to 94% reduction of demand. The mass balance in the system indicated that the LAS removal efficiency was 45% after 180 days. From the 109th day to the 254th day, a removal efficiency of 32% was observed. The removal of LAS was approximately 40% when 1500 mg of LAS were applied in the absence of co-substrates suggesting that the LAS molecules were used selectively. Microscopic analyses of the biofilm revealed diverse microbial morphologies and denaturing gradient gel electrophoresis profiling showed variations in the total bacteria and sulfate-reducing bacteria populations. 16S rRNA sequencing and phylogenetic analyses demonstrated that members of the order Clostridiales were the major components of the bacterial community in the last step of the reactor operation. (c) 2009 Elsevier Ltd. All rights reserved.

Pentachlorophenol (PCP) dechlorination in horizontal-flow anaerobic immobilized biomass (HAIB) reactors

This study verifies the potential applicability of horizontal-flow anaerobic immobilized biomass (HAIB) reactors to pentachlorophenol (PCP) dechlorination. Two bench-scale HAIB reactors (R1 and R2) were filled with cubic polyurethane foam matrices containing immobilized anaerobic sludge. The reactors were then continuously fed with synthetic wastewater consisting of PCP, glucose, acetic acid, and formic acid as co-substrates for PCP anaerobic degradation. Before being immobilized in polyurethane foam matrices, the biomass was exposed to wastewater containing PCP in reactors fed at a semi-continuous rate of 2.0 mu g PCP g(-1) VS. The applied PCP loading rate was increased from 0.05 to 2.59 mg PCP l(-1) day(-1) for RI, and from 0.06 to 4.15 mg PCP l(-1) day(-1) for R2. The organic loading rates (OLR) were 1.1 and 1.7 kg COD m(-3) day(-1) at hydraulic retention times (HRT) of 24 h for R1 and 18 In for R2. Under such conditions, chemical oxygen demand (COD) removal efficiencies of up to 98% were achieved in the HAIB reactors. Both reactors exhibited the ability to remove 97% of the loaded PCP. Dichlorophenol (DCP) was the primary chlorophenol detected in the effluent. The adsorption of PCP and metabolites formed during PCP degradation in the packed bed was negligible for PCP removal efficiency. (C) 2009 Elsevier Ltd. All rights reserved.