[Show abstract][Hide abstract] ABSTRACT: For health care, economists have developed cost-effectiveness analysis (CEA) as a "rational," analytic tool to set priorities. Attempts to use CEA to decide how to cut expenditures, however, have been met with stakeholders' resistance. This article presents an illustrative case study of the application of an approach explicitly designed to engage stakeholders with conflicting objectives in confronting tightening budgets. The outcome of this process, which engaged a group of stakeholders including patients, caregivers, clinicians, and managers, was a strategy that reconfigured services to produce more health gain at reduced total cost. I argue that the key factors that led to overcoming resistance to change were (1) the collective character of the deliberations; (2) the analysis of the whole pathway; (3) the presence of patients; (4) the development of a model based on CEA principles, which provided a credible rationale for difficult decisions.
Journal of Health Politics Policy and Law 08/2013;
[Show abstract][Hide abstract] ABSTRACT: This paper examines whether decentralization increases the responsiveness of public investment to local needs using a unique database from Bolivia. Empirical tests show that investment patterns in human capital and social services changed significantly after decentralization. These changes are strongly and positively related to objective indicators of need. Nationally, these changes were driven by the smallest, poorest municipalities investing devolved funds in their highest-priority projects. The findings contradict common claims that local government is too corrupt, institutionally weak, or prone to interest-group capture to improve upon central government’s allocation of public resources.
[Show abstract][Hide abstract] ABSTRACT: We consider dynamic decision making in a legislature, in which in each period legislators vote between the status quo (previous periodʼs policy) and a new bill. However, the agenda formation process is captured by interest groups, that is, the new bill on the agenda is determined by an all-pay auction among these groups. We show that convergence to the median voter of the legislature arises if interest groups are patient enough but not necessarily otherwise. We characterize the bound on the speed of convergence in a family of stationary equilibria in which policy bounces between right-wing and left-wing policies. We also show that convergence may be faster if organized interest groups represent only one side of the policy space, e.g., when only business and not consumer interests are organized.
Journal of Economic Theory. 01/2013; 148(5):1862–1890.
[Show abstract][Hide abstract] ABSTRACT: Findings from neuroimaging are increasingly being cited in policy debates to strengthen the case for early identification of, and intervention with, children at risk of maltreatment and poor outcomes. While agreeing that neuroscientific research into the risks of maltreatment is a very valuable and exciting area of study, this article challenges the confidence with which these findings are used in policy discussions. It critically discusses the reliability and validity of the relevant findings and the contribution they can currently make to our understanding of the causes and consequences of maltreatment. In addition, it is argued that this type of evidence, which is new in policy debates, is often being used in ways that are problematic. Many participants in the relevant policy debates seem to subscribe either to an implicit version of dualism about the relationship between the mind and the body, or to reductionism – the view that the mental can be reduced to the physical. Such assumptions threaten the way we think about human agency and moral responsibility but it is argued that they are misguided for conceptual reasons. It is concluded that neuroscience has the potential to contribute to our understanding of the causes and effects of maltreatment but cannot do so in isolation from the social sciences.
[Show abstract][Hide abstract] ABSTRACT: I examine the distribution dynamics of incomes across Indian states using the entire income distribution. Unlike standard regression approaches, this approach allows us to identify specific distributional characteristics such as polarisation and stratification. The period between 1965 to 1997 exhibits the formation of two convergence clubs: one at 50% and the other at 125% of the national average income. Income disparities across the states declined over the 1960s and then increased from the 1970s to the 1990s. I use the distribution dynamics method to further investigate a neighbours’ effect, i.e., whether states that cluster together are neighbouring states. The evidence obtained suggests that there is none. While this initially comes across as an unusual result, it strongly suggests that India being a developing country is yet to develop the required networks across the states to generate spatial interactions.
[Show abstract][Hide abstract] ABSTRACT: Opportunities for shrouded pricing drive down upfront price as firms compete to capture new customers. Unless the surcharge is sufficiently high, consumers are worse off if the practice is banned, assuming Cournot–Nash equilibrium and isoelastic demand.
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