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

Doutoramento em Economia.

Dental Service Utilization, Dental Health Production and Equity in Dental Care: the Finnish Experience

This thesis is grounded on four articles. Article I generally examines the factors affecting dental service utilization. Article II studies the factors associated with sector-specific utilization among young adults entitled to age-based subsidized dental care. Article III explores the determinants of dental ill-health as measured by the occurrence of caries and the relationship between dental ill-health and dental care use. Article IV measures and explains income-related inequality in utilization. Data employed were from the 1996 Finnish Health Care Survey (I, II, IV) and the 1997 follow-up study included in the longitudinal study of the Northern Finland 1966 Birth Cohort (III). Utilization is considered as a multi-stage decision-making process and measured as the number of visits to the dentist. Modified count data models and concentration and horizontal equity indices were applied. Dentist s recall appeared very efficient at stimulating individuals to seek care. Dental pain, recall, and the low number of missing teeth positively affected utilization. Public subvention for dental care did not seem to statistically increase utilization. Among young adults, a perception of insufficient public service availability and recall were positively associated with the choice of a private dentist, whereas income and dentist density were positively associated with the number of visits to private dentists. Among cohort females, factors increasing caries were body mass index and intake of alcohol, sugar, and soft drinks and those reducing caries were birth weight and adolescent school achievement. Among cohort males, caries was positively related to the metropolitan residence and negatively related to healthy diet and education. Smoking increased caries, whereas regular teeth brushing, regular dental attendance and dental care use decreased caries. We found equity in young adults utilization but pro-rich inequity in the total number of visits to all dentists and in the probability of visiting a dentist for the whole sample. We observed inequity in the total number of visits to the dentist and in the probability of visiting a dentist, being pro-poor for public care but pro-rich for private care. The findings suggest that to enhance equal access to and use of dental care across population and income groups, attention should focus on supply factors and incentives to encourage people to contact dentists more often. Lowering co-payments and service fees and improving public availability would likely increase service use in both sectors. To attain favorable oral health, appropriate policies aimed at improving dental health education and reducing the detrimental effects of common risk factors on dental health should be strengthened. Providing equal access with respect to need for all people ought to take account of the segmentation of the service system, with its two parallel delivery systems and different supplier incentives to patients and dentists.

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.

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.

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.

Equity management strategies in the Australian private sector

This paper outlines the methods and outcomes of a study into equity management strategies in Australian private sector organisations reporting to the Equal Opportunity for Women in the Workplace Agency. Reports from 1976 organisations indicate eleven key factors characterising equity management in Australia. The study highlights differences within previously identified social structural policies, temperamental and opportunity policies and identifies a further policy type, categorised as “support policies”. Differences have also been identified in relation to distribution structures, suggesting that gender is not the sole consideration in determining equity management strategies. The principle of distribution also figures strongly in equity management implementation.

Applying an equity lens to tobacco-control policies and their uptake in six western-european countries

We identified policies that may be effective in reducing smoking among socioeconomically disadvantaged groups, and examined trends in their level of application between 1985 and 2000 in six western-European countries (Sweden, Finland, the United Kingdom, the Netherlands, Germany, and Spain). We located studies from literature searches in major databases, and acquired policy data from international data banks and questionnaires distributed to tobacco policy organisations/researchers. Advertising bans, smoking bans in workplaces, removing barriers to smoking cessation therapies, and increasing the cost of cigarettes have the potential to reduce socioeconomic inequalities in smoking. Between 1985 and 2000, tobacco control policies in most countries have become more targeted to decrease the smoking behaviour of low-socioeconomic groups. Despite this, many national tobacco-control strategies in western-European countries still fall short of a comprehensive policy approach to addressing smoking inequalities.

Australian Indigenous students: addressing equity issues in assessment

This article provides the background and context to the important issue of assessment and equity in relation to Indigenous students in Australia. Questions about the validity and fairness of assessment are raised and ways forward are suggested by attending to assessment questions in relation to equity and culture-fair assessment. Patterns of under-achievement by Indigenous students are reflected in national benchmark data and international testing programmes like the Trends in International Mathematics and Science Sstudy and the Program for International Student Assessment. The argument developed views equity, in relation to assessment, as more of a sociocultural issue than a technical matter. It highlights how teachers need to distinguish the "funds of knowledge" that Indigenous students draw on and how teachers need to adopt culturally responsive pedagogy to open up the curriculum and assessment practice to allow for different ways of knowing and being.

A-REIT seasoned equity offerings : determinants and market reaction

The paper examines the decision by Australian Real Estate Trusts (A-REITs) to issue seasoned equity offerings from 2000 - 2008 and stock market reaction to the offerings using panel data and event study methodologies, respectively. The global financial crisis has resulted in freezing of the Australian bond markets, with several A-REITs left with seasoned equity issuance and asset sales as the only viable modes of raising additional capital. The findings review that leverage and operating risk are negative significant determinants of seasoned equity offerings; profitability and growth opportunities are positive significant determinants. Of the structure and type of properties held by the A-REIT, only stapled management structure and international operations are significant determinants. Type of properties held by A-REITs show inconsistent results. Similar to previous studies of seasoned equity offerings, we find a significant negative abnormal return associated with their announcement and no evidence of excessive leakage of information. Cross-sectional regressions show that the issued amount raised and leverage are significant factors affecting abnormal returns.

Equal employment opportunity and diversity management : can either live up to the promise of achieving gender equity?

This paper examines the extent to which women movement into management positions. Like many other countries, this progress in Australia is slow. The paper includes discussion of the theoretical explanations for this and the extent to which these are borne out in Australia. We are aware this group represents only a minority of Australian women workers, and there are many other groups of women workers for whom constraints to women’s access to senior management may not be the most pressing issue. We have, however, chosen to focus on women in management in this paper, as while there was considerable research and public policy attention directed towards this group in the 1980s and early 1990s, over the past decade there seems to have been a reluctance to continue to address this group, despite the numerical evidence that women continue to be disproportionately represented in senior management positions. We believe it’s timely to refocus on women in management.

Race and equity in higher education : A harder path for Indigenous academics

Our experiences as Indigenous academics within universities often reflects the experiences we have as Indigenous people in broader society, yet I am still surprised and angered when it is others working in higher education who espouse notions of justice and equity with whom we experience tension and conflict in asserting our rights, values and cultural values. At times it is a constant struggle even when universities have Reconciliation Statements as most of them do now, Indigenous recruitment or employment strategies and university wide anti-racism and anti-discrimination policies and procedures.