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Moving North or South: Corporate Responses to Rising Health Care Costs in the U.S.
Abstract
Health care has become a core competitive issue in North America. On the one hand, Americans are worried about the impact of their privately financed system on business interests. On the other hand, Canadians are capitalizing on US problems in an attempt to attract investment away from the United States through their public health insurance system. This paper seeks to evaluate whether these views and actions are justified. This is done by examining, through close dialogue and case study, how the two systems interact with firms' ability to compete. While the findings in this paper do not give empirical backing to those calling for a nationalization of US health care on the basis of competitiveness, our research does suggest that health care reform will be necessary to preserve individual and corporate welfare in the global economy.
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Once an integral component of company-sponsored compensation schemes in many Western economies, private defined benefit (DB) pensions are in decline. For many, DB schemes (and their related healthcare liabilities, depending on the jurisdiction) have hobbled the financial well being of plan sponsors and even whole sectors of industry. If a constraint on shareholder value in the short-term, these schemes threaten long-term corporate survival in the emerging global economy. While there remains considerable debate over the ability of financial markets to adequately price DB liabilities, there is a growing industry devoted to estimating their long-term risks with respect to longevity, inflation and cost. In this two-part paper, we begin by surveying the nature and significance of the problem, focusing upon UK and US private employer-sponsored plans. It is suggested that the ‘crisis’ was apparent, for those willing to look, a decade ago. Its significance was papered-over by the 1990s stock market bubble and high interest rates but has returned through what many analysts identify as a ‘perfect storm’. Having documented the nature and scope of the ‘perfect storm’ in part I, we then evaluate the proffered solutions to the crisis in part II, focusing on financial engineering, government intervention and private sector negotiation. In the final sections of the paper, we set out the principles that should guide the design of new kinds of employer-sponsored plans noting that if, as suggested by many experts, Western economies are entering an era of increasing labour shortage, private pensions will continue to have an important role in managing human capital.Pensions (2006) 12, 43–54. doi:10.1057/palgrave.pm.5950041
Does Canada's publicly funded, single payer health care system deliver better health outcomes and distribute health resources more equitably than the multi-payer heavily private U.S. system? We show that the efficacy of health care systems cannot be usefully evaluated by comparisons of infant mortality and life expectancy. We analyze several alternative measures of health status using JCUSH (The Joint Canada/U.S. Survey of Health) and other surveys. We find a somewhat higher incidence of chronic health conditions in the U.S. than in Canada but somewhat greater U.S. access to treatment for these conditions. Moreover, a significantly higher percentage of U.S. women and men are screened for major forms of cancer. Although health status, measured in various ways is similar in both countries, mortality/incidence ratios for various cancers tend to be higher in Canada. The need to ration resources in Canada, where care is delivered "free", ultimately leads to long waits. In the U.S., costs are more often a source of unmet needs. We also find that Canada has no more abolished the tendency for health status to improve with income than have other countries. Indeed, the health-income gradient is slightly steeper in Canada than it is in the U.S.
Once an integral component of company-sponsored compensation schemes in many Western economies, private defined benefit (DB) pensions are in decline. For many, DB schemes (and their related healthcare liabilities, depending on the jurisdiction) have hobbled the financial wellbeing of plan sponsors and even whole sectors of industry. If a constraint on shareholder value in the short term, these schemes threaten long-term corporate survival in the emerging global economy. While there remains considerable debate over the ability of financial markets to adequately price DB liabilities, there is a growing industry devoted to estimating their long-term risks with respect to longevity, inflation and cost. In part I of this two-part paper, we surveyed the nature and significance of the problem, focusing upon the UK and the US private employer-sponsored plans. We suggested that the ‘crisis’ was apparent, for those willing to look, a decade ago. Its significance was papered over by the 1990s stock market bubble and high interest rates but has returned through what many analysts identify as a ‘perfect storm’. Having documented the nature and scope of the ‘perfect storm’, we now evaluate in part II the proffered solutions to the crisis, such as financial engineering, government intervention and private sector negotiation. In the final sections of the paper, we set out the principles that should guide the design of new kinds of employer-sponsored plans noting that if, as suggested by many experts, Western economies are entering an era of increasing labour shortage, private pensions will continue to have an important role in managing human capital.Pensions (2007) 12, 68–81. doi:10.1057/palgrave.pm.5950045
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Do regions compete, as firms do? How does one deal with the fact that regions, unlike organizations, are entities that do not act? Does it make sense to talk about the ability of regions to generate new variety? This paper aims to address these questions from an evolutionary perspective. It is meaningful to talk about regional competitiveness when the region affects the performances of local firms to a considerable degree. This is especially true when the competitiveness of a region depends on intangible, non-tradable assets based on a knowledge and competence base embedded in a particular institutional setting that are reproduced and modified through the actions and repeated interactions of actors. Although regions are increasingly becoming collective players actively responding to an increasing exposure to extra-regional competition, the paper explains why there are serious limits in enhancing the competitiveness of regions. By doing so, it questions the usefulness of benchmarking practices with the purpose of improving regional competitiveness: there exists no 'optimal' development model, it is difficult to copy or imitate a successful model from elsewhere, and new trajectories often emerge spontaneously and unexpectedly in space.
Recent years have witnessed considerable academic debate with regard to the ways in which urban competitiveness can best be conceptualised and measured. In this paper we draw on these theoretical discussions in an attempt to interrogate the dynamics of competitiveness. We report on research to develop indicators to explore the relationship between sources (the initial stock of assets in a city) and outcomes of competitiveness (the result of attempts to exploit these assets by firms) across a sample of urban areas. We argue that urban asset bases provide a strong predictor of competitive performance in English cities, but that this general pattern is interrupted by some cities for which competitive outcomes are stronger or weaker than might be expected in light of underlying asset bases. The study findings provide some tentative methodological suggestions, augmenting the limited volume of empirically focused work regarding the means by which different aspects of the contested concept of competitiveness might best be measured. The findings also illustrate the differing competitive fortunes of major English cities and provide pointers with regard to priorities for policymakers in moulding and managing urban asset bases.
Flexibility is identified as the hallmark of recent modelling of the multinational enterprise. The focus on flexibility is a response to the rationalization and restructuring of international business, which has occurred since the end of the “golden age” of Western economic growth. Flexibility has been south in factor markets, intermediate product markets and markets for final products. It has been sought by both governments and firms. Flexible firms are attracted to locations with flexible host governments. This article contrasts the modern research agenda based on flexibility with the more traditional research agenda which predominates in the literature reviewed by Caves (1996).© 1998 JIBS. Journal of International Business Studies (1998) 29, 21–44
The pressures for the harmonization of labour laws and policies under trade liberalization are outlined, with particular attention to inter-jurisdictional competition for investment and jobs. This is followed by an analysis of the linkages that are necessary for there to be downward harmonization, with some discussion of the empirical evidence (and lack of evidence) on those linkages. Opposing pressures towards divergence and away from convergence and harmonization are also discussed. The paper concludes with some observations on the advantages and disadvantages of harmonization and the appropriate policy responses.
A key issue facing researchers of economic, political, social, and cultural change is the dialectical tension between globalizing and localizing processes. From an economic geography perspective, a major question concerns the relationship between the globalizing tendencies of many business firms and the prospects for a genuinely local economic development, particularly in light of the organizational and technological changes associated with the alleged transition to a post-Fordist world. This paper addresses a specific aspect of the "global-local nexus" that has not been well developed in the geographic literature: the relationships between transnational corporations and nation-states. Each can be conceptualized as highly embedded interacting networks. Firms and states are locked in competitive struggles. The competitive strategies they employ are both diverse and the outcome of contested power relations, internal and external. Increasingly, too, they involve various forms of collaborative relationship. Concrete spatial outcomes, therefore, reflect complex competitive and bargaining relationships between and within firms, between and within states, and between firms and states.
In the complex set of economic, social, political and cultural processes which interact to create a continuously changing and uneven geographical structure of economic activity the role of the business enterprise remains central. This paper first addresses Walker's (1989) critique of "corporate geography' and argues that business organization does matter. Particular emphasis is placed upon the need to take a broader socio-organizational view of the business enterprise in which transactional relationships between, and within, business organizations are conceptualized in terms of differential power relationships within interdependent production systems. Both intra- and inter-firm structures are best seen as complex networks of enormous diversity. Business organizations organize production systems but are themselves produced through an historical process of embedding. Geographical industrialization needs to be seen not only in terms of changing industry trajectories but also in terms of dynamic webs of power relationships. -Authors
Improved competitiveness, as we all know, is the path to economic nirvana. Plainly, it is a sought after property of any economy: the term trips frequently off the lips of politicians and commentators on economic and business matters. As cities increasingly engage in competition with one another at different levels, the determinants of competitive advantage are coming under intense scrutiny. Many
Canadian Medicare, the government financed national health care system, is seen by many as enhancing both social welfare and competitiveness. If true, this will broaden and further existing conceptions of competitiveness in Canada and beyond. Moreover, it will have important implications for the ongoing debate in the social sciences about institutional convergence and path dependence. The central focus of this paper is to evaluate this claim: Medicare’s impact on competitiveness, evaluated by using investment attraction as a proxy, is determined through reference to detailed case analysis and the insight into investment behavior gained from interviews. This paper concludes that Medicare makes a difference for certain reinvestment decisions but no difference for location and initial investment decisions. Several implications are drawn from this finding: Medicare’s impact on reinvestment decisions may stop certain Canadian firms from investing elsewhere but likely would not attract new investment into Canada from abroad. Industries with high labor costs will extract a disproportionately large benefit from Medicare; so, this type of institution is a source of competitiveness to certain industries if not an overarching source of regional competitiveness for Canada. I conclude that, no matter the size and scope of the competitive benefit, social institutions such as Medicare must be considered when evaluating regional competitiveness, having thus far been ignored by mainstream academic competitiveness theories.
In 1999, slightly more than half of all employees in Canada enjoyed employer-sponsored medical, dental, or life/disability insurance coverage. The coverage rate for pensions was slightly lower (about 43%). Coverage rates in the three insurance plans for unionized employees were approximately double those for nonunionized (about 80% versus 40%). The union advantage in pension plan coverage was much larger (80% versus 27%). The 1999 rates and differentials were generally unchanged from 1995. A majority of unionized employees enjoyed coverage under all three insurance plans; a majority of non-unionized workers had no coverage under any plan. For unionized workers, the chances of being covered were almost the same in both the public and private sectors. For the non-unionized, the chances were much higher in the public sector. The overall union advantage resulted primarily from low coverage in small-and medium-sized firms (less than 100 employees) in the private sector. In both Canada and the U.S., unionized workers enjoyed higher coverage rates for these non-wage fringe benefits than their non-unionized counterparts. However, the union advantage tended to be less in the U.S.
The view that nations compete against each other like big corporations has become pervasive among Western elites--many of whom are in the Clinton administration. As a practical matter, however, the doctrine of "competitiveness" is flatly wrong. The world's leading nations are not, to any important degree, in economic competition with each other. Nor can their major economic woes be attributed to "losing" on world markets. This is particularly true in the case of the United States. Yet Clinton's theorists of competitiveness--from Laura D'Andrea Tyson to Robert Reich to Ira Magaziner--make seemingly sophisticated arguments, most of which are supported by careless arithmetic and sloppy research. Competitiveness is a seductive idea, promising easy answers to complex problems. But the result of this obsession is misallocated resources, trade frictions and bad domestic economic policies.
A case study of the Hong Kong watch industry demonstrates the adaptive flexibility of labor-intensive industrial clusters. The study describes the evolution of industry in Hong Kong, and highlights the unique attributes of the country's economic history which have influenced the structure of production systems in the country. Focusing on the role of global competition, the case study identifies the constraints posed by a labor-intensive flexible production system in the face of continuous technological change in the industry.
Burdensome past commitments are currently threatening a concentrated group of industries and communities, predominantly in the US Midwest. Beginning with reference to the bankruptcy of Delphi Corporation, this paper documents the crisis for 'old economy firms' with significant legacy costs. In order to understand the root causes of this legacy crisis, the analysis builds on previous economic geography research and the results of a widely subscribed and unique 'expert opinion' survey highlighting the corporate impacts of defined benefit pensions in the private sector. The result is a conceptual framework that describes the corporate geography of legacy costs; the 'knot of contracts'. Specifically, the 'knot of contracts' conceptualizes the role of intergenerational commitments in restricting corporate evolution and innovation, while underscoring 'time' as a central component of the nature of the firm. Developing this framework requires linking microeconomic theories of the firm with the institutional aspects of firms' geographies. While referring to specific cases and proprietary data throughout, this paper is principally concerned with understanding legacy costs. Additionally, the intent is to uncover managerial and governmental behavior that tightened this knot of contracts, and, subsequently, to expose the current managers' attempts at managing their firms through the adverse affects of the knot of contracts. The explanations in this paper serve as a useful bridge between the realities faced by firms and their surrounding communities, and the more abstract notions of the firm and competitiveness in the context of globalization.A subsequent version of this paper appears in Economic Geography, 84(2).
The location decisions of foreign multinational corporations (FMNCs) are analyzed using a conditional logit model with states as the choice set. We consider the establishment of new manufacturing plants and separately analyze the site selection of all MNCs, Japanese MNCs, and European MNCs. The results indicate that access to markets, labor market conditions, state promotional efforts to attract foreign investment, and state and local personal taxes are significant fadors in the location decision. The decision determinants for Japanese and European MNCs are found to be different.
In this paper we argue that far from being surpassed by globalization, the nation-state remains a key space for organized labour. However, labour geographers’ focus on patterns of union organization and strategies of ‘internationalism’ underplays the enduring role of national institutions. Moreover, while labour geographers have recognized the significance of new forms of work organization, such as just in time and lean production, with some exceptions they have not examined how unions both formally and informally determine the trajectory of workplace change. Based on case studies of unions in the Canadian and German auto industries, we stress that the linkage between national and workplace scales remains critical to understanding how unions are responding to the challenges being presented by lean and just in time production. Finally, while there is a re-scaling of bargaining in the automobile industry to the firm or enterprise scale, the outcomes of decentralization depend largely on the national regulatory context.
One difference between economists and geographers is the significance attached by the former to stylized facts and the very different significance attached by the latter to the diversity of economic life. The paper begins with this distinction and argues that Krugman's theory-enslaved stylized facts may impoverish theoretical innovation in economic geography just as the efficient-markets hypothesis has had severe consequences for research in finance. An alternative to theory-enslaved stylized facts is suggested, noting the inevitable and antagonistic relationship between theory and empirical observation. My philosophical perspective is neither foundational nor postmodern, but is, rather, a version of philosophical skepticism. Having reviewed recent developments in economic geography, the claimed virtues of objectivity and the supposed dangers of subjectivity are disputed. I suggest that the former is compromised by its reliance upon a ready-made world, while the dangers of the latter are exaggerated by an implied commitment to an uncontested truth. This is the basis for arguing the virtues of close dialogue in economic geography and in the geography of finance in particular.
This book is about the demographic and funding crises that threaten continental European systems of pension and retirement income. The author argues that state-sponsored social security will not deliver promised retirement incomes for the baby-boom generation; European monetary union and the imperatives of global finance has made such promises untenable thereby undercutting nation-state social solidarity. Globalization has set many challenges for European countries, not least of which is providing pension security for their citizens. At the same time, global finance has opened-up options for corporations and individuals seeking alternatives to the past; but exercising those opportunities will come at a high cost for European notions of social justice. Drawing upon original research, the author considers (1) the dimensions of the pending European retirement income funding crisis, noting the economic and political forces involved in debates over possible solutions; (2) Current country-specific models of pensions provision, making the connection between social security and supplementary pensions; (3) The allocation of risks between individuals, markets, and institutions emphasizing the tensions between social solidarity and the market in France, Germany, the Netherlands, and the United Kingdom; (4) And finally, the prospects for a pan-European approach to retirement income provision. Available in OSO: http://www.oxfordscholarship.com/oso/public/content/management/9780199253647/toc.html
It has become common to say that social cohesion and economic competitiveness go together, indeed to claim that cohesion actually promotes prosperity. This is a reversal of the previous belief in economic determinism and individualism. The shift in perspective stems partly from concerns about a growing malaise in society with the potential for unrest. Social stability and trust are thought to encourage long-term investment decisions, while conflict and crime may deter productive activity and make growth less secure. The notion that a strong society supports and sustains a successful economy has begun to influence government policy. It also coincides with a more positive view of the economic potential of cities in the contemporary economy. Yet, the arguments linking cohesion and competitiveness are typically couched in very general terms. They conflate different kinds of phenomena in fuzzy concepts and can confuse the underlying causal relationships.
Historically, political struggles to define the geographical scale at which labour relations and collective bargaining will be conducted have been of crucial significance to the labour movement. Today, workers and their unions face very difficult challenges. In many manufacturing industries changes in the organizational structure of production at different geographical scales have undermined the effectiveness of the organizing and collective bargaining strategies associated with traditional industrial unionism. This paper focuses on collective bargaining strategies developed by North American autoworkers’ unions to respond to the extensive restructuring of the automotive industry that took place during the 1990s. These strategies include innovations in the structure and content of collective bargaining and efforts to redefine the scale at which collective bargaining takes place. Following a brief discussion of the challenge posed by the integration of Mexico into a continent-wide production system, the analysis focuses on the strategies devised by the Canadian Auto Workers (CAW) union during the 1996 and 1999 rounds of collective bargaining to address issues raised by outsourcing and modular manufacturing. With outsourcing, the automakers are not so much eliminating jobs as they are deciding who gets to do them, at what price, and under what working conditions. With modular manufacturing, the organizational boundaries between firms are blurring and the terms and conditions of work in one firm arguably are becoming dependent upon management decisions made in another firm. The CAW’s response has been to develop new collective bargaining strategies including the concepts of ‘work ownership’ and ‘satellite bargaining’ which involves redefining the traditional geographical extent of the bargaining unit. While the empirical focus is on the North American automobile industry, the general issues related to the re-scaling of production, and especially outsourcing and modular manufacturing, are common across a range of manufacturing industries.
In 2005 large U.S. employers spent an average of almost $7,400 per head on health care benefits, a 73% increase in the last five years. If the current trend continues, American companies may find it difficult to compete in a global marketplace where international competitors provide labor with heath care at a fraction of U.S. costs.
This article argues that effective reform of the U.S. health care system will require major efforts from all major “stakeholders,” starting with the federal government and state and local governments and including insurance companies and the “consumers” of health care services. By far the important role, however, is reserved for private-sector employers, which have been the incubator for recent innovations in American health care and are in the best position to coordinate and drive health care reform.
But incremental steps in cost-sharing, small-scale pilot projects of consumer-based designs, and employee awareness campaigns will not be enough. Employers need to take radical steps to break through the inertia that has built up among all stakeholders over the past 50 years. Chief among the author's proposals for employers are the following:
As the author states in closing, “Let these reforms begin with employers as the organizing force to drive needed change across the system. That may very well be the only way to save our employment-based model.”
The realization that places compete for investment has expanded in recent years to encompass competition among places for the attention of migrants, tourists and media glow as well as investment. The most competitive places have been multidimensional in their attractions and have made the transition to the knowledge-based economy. The latest priority is being placed on attracting mobile workers and mobile investment. Creative workers are the core of the knowledge economy and of its geographies such as 'intelligent places' and 'learning regions'. Knowledge metrics, innovation indices and report cards are increasingly common, each seemingly developed to sort the list of places in a different order. Lists or league tables of 'the best places' for business, to live, retire and visit are key features of economies and societies whose factors of success are highly mobile. Competition in a geographical context and entrepreneurial responses are unlikely to go away, reinforced by an industry comprised of consultancies, the trade press, formal education and other means of learning. Consequently, policy-makers need to grasp the nature of place competition and the critical roles of knowledge and of networks in the strategies of the most competitive places. The standard of competition is complex, comprising innovation indices and cooperation within the network of world cities.
Anderson M. and Holmes J. (1995) High-skill, low-wage manufacturing in North America: a case study from the automotive parts industry, Reg. Studies 29, 655–671. The perceived duality between high-wage/high skill and low-wage/low skill industrial strategies underlies many accounts of contemporary industrial change. Within some North American manufacturing sectors a hybrid strategy has taken root, one that combines technologically sophisticated product and process innovation with low-wage production. A case study of Magna International, a highly successful Canadian-based multinational automotive components producer, illustrates this strategy. Magna's competitive success stems from its ability to combine product innovation founded on high-skilled engineering and tool-and-die making, a decentralized and flexible organizational structure, and a distinctive non-union approach to managing relatively low-paid production workers.
In a globalising economy, territories and not just firms increasingly find themselves in competition with each other. In fact, differently from the case of countries, cities and regions compete, on the international market for goods and production factors, on the basis of an absolute advantage principle, and not of a comparative advantage principle; this means that no efficient, automatic mechanism like currency devaluation or prompt flexibility of wages and prices - may grant each territory some role in the inter-national division of labour, whatever its relative performance. Competitiveness of territories emerges as a central issue, in order to secure employment stability, benefits from external integration, continuing growth of local wellbeing and wealth. The arguments put forward by Paul Krugman, defining the concept of competitiveness wrong and misleading, cannot be accepted in a territorial 'regional and urban' context.
The provincial health insurance plans of Canada, still prized by a population that relies on universal coverage of hospital care and physicians' services, nevertheless suffered a dramatic loss of public confidence in the 1990s as a result of sharp cutbacks in the federal budget. These cutbacks have led to restricted access to specialists, longer waiting times for nonemergency surgery, and the closing or merger of many hospitals, resulting in a loss of beds. The reductions, a central feature of the federal government's successful effort in recent years to eliminate the large annual budget deficit, are now being partially reversed, but . . .
The U.S. health care system is in bad shape. Medical services are restricted or rationed, many patients receive poor care, and high rates of preventable medical error persist. There are wide and inexplicable differences in costs and quality among providers and across geographic areas. In well-functioning competitive markets--think computers, mobile communications, and banking--these outcomes would be inconceivable. In health care, these results are intolerable, with life and quality of life at stake. Competition in health care needs to change, say the authors. It currently operates at the wrong level. Payers, health plans, providers, physicians, and others in the system wrangle over the wrong things, in the wrong locations, and at the wrong times. System participants divide value instead of creating it. (And in some instances, they destroy it.) They shift costs onto one another, restrict access to care, stifle innovation, and hoard information--all without truly benefiting patients. This form of zero-sum competition must end, the authors argue, and must be replaced by competition at the level of preventing, diagnosing, and treating individual conditions and diseases. Among the authors' well-researched recommendations for reform: Standardized information about individual diseases and treatments should be collected and disseminated widely so patients can make informed choices about their care. Payers, providers, and health plans should establish transparent billing and pricing mechanisms to reduce cost shifting, confusion, pricing discrimination, and other inefficiencies in the system. And health care providers should be experts in certain conditions and treatments rather than try to be all things to all people. U.S. employers can also play a big role in reform by changing how they manage their health benefits.
American policymakers and health policy analysts have a love-hate relationship with job-based health insurance. The policy press routinely runs articles about the demise of the current system of voluntary employer-sponsored health insurance coverage. Conservatives argue that it ought to be replaced with individually-purchased insurance, such as tax-favored spending accounts (see Mark Pauly’s article this issue). Liberals assert that government insurance ought to supplant it.
Meanwhile, as the debate rages on about the future of employer coverage, states and the federal government pass legislation buttressing and building on the existing employment-based system. Most recently, California has passed an employer mandate requiring employers to cover their workers (and many other states have contemplated similar legislation) and Maine has adopted a universal coverage initiative that includes a voluntary small employer insurance program offered through a state agency (Dirigo Health Care).
General Motors president Rick Wagoner caused controversy when he blamed the US health-care system for his company's near-bankrupt status. But, as Paul Webster explains, health care and the US and Canadian automotive industry's economic decisions are increasingly interlinked.
The rising cost of health care has become a serious problem for employers who provide health insurance to their workers. In this second part of a two-part Health Policy Report, Blumenthal discusses an array of strategies that employers and health-insurance companies are adopting to reduce health care costs and improve the efficiency of the nation's health care system.
Large and mid-size employers are "between a rock and hard place" when it comes to health benefits: They are both unable to manage their health care costs effectively or simply get out of offering these benefits entirely. Although there is considerable diversity in how employers approach health care, several goals underlie most of their decisions. It is unlikely that the current round of employer-based health initiatives will succeed at managing rising costs. As a result, employers are likely to become more interested than at any time in the past decade in exiting their roles as providers of health benefits.
Since the early 1990s, the concept of regional competitiveness has become a hegemonic discourse within public policy circles in developed countries. However, it is a somewhat chaotic and ill-defined discourse based on a relatively narrow conception of how regions compete, prosper and grow. This paper seeks to problematise the discourse with reference to theory, and to explain how and why it has assumed such significance in policy circles. It is argued that the answer lies within the policy process and the imperative of legitimating certain courses of policy action. Copyright 2005, Oxford University Press.
According to many, we live in an age in which convergence between formerly distinct national ‘models’ is taking place. Central
to this process is a learning dynamic in which best practices originating from within one model—Japan in the 1980s, United
States in the 1990s—are supposedly adopted by firms elsewhere. This paper addresses two key questions concerning this process.
First, what are the actual mechanisms or processes through which this learning-driven convergence might occur? Second, what
role do institutions play in shaping, influencing, or constraining firms' choice of practices and their ability to ‘learn’?
The paper examines eight specific channels of convergence representing a continuum of opportunities for learning-through-interacting.
It then assesses critically a range of competing arguments about the role of institutional influences at three different scales:
the region, the nation-state, and the firm. It concludes that while regional and firm-level arguments, on their own, do not
provide an adequate explanatory framework for understanding how firms' practices are determined, national level theory needs
to be made supple enough to accommodate a significant role for regional institutions and the agency of the firm.
While France has a universal public health insurance system, the coverage it provides is incomplete and the vast majority the French population has private complementary health insurance. Among OECD countries, the share of health care financed by private insurance is third highest behind the US and the Netherlands, two countries where private coverage is the primary source of payment for a large percentage of the population.
France’s high rate of private insurance coverage is partly explained by historical factors and partly by the preferential tax treatment of employer-sponsored coverage. Because of the high rate of employerprovision – roughly half of all contracts are obtained through the workplace – coverage tends to vary with activity and industry classification. Historically, coverage was also positively related with income. In 2000, the French government introduced a new program, the Couverture Maladie Universelle (CMU), which extended eligibility for publicly funded ...
Si la France a un système d'assurance maladie publique universel, la couverture qu'il propose n'est pas complète et la majorité de la population française a une assurance complémentaire privée. La France est le troisième pays de l'OCDE en ce qui concerne la part des dépenses de santé financée par l'assurance privée, après les Etats-Unis et les Pays-Bas, deux pays où l'assurance privée représente la seule source de couverture pour une grande partie de la population.
L'importance de l'assurance privée en France s'explique pour partie par des facteurs historiques mais aussi par le traitement fiscal préférentiel dont bénéficient les assurances de groupe. Etant donnée qu'environ la moitié des contrats sont obtenus par le biais de l'emploi, la couverture est très liée à la participation au marché du travail et au secteur d'activité. Historiquement, le taux couverture de la population augmentait avec le r
Обсуждается вопрос о поисках наилучшей модели рынка труда. Анализируется как на самом деле функционируют институты рынка труда, влияют ли эти институты (нормы и правила) на результаты труда; как соотносятся между собой различные, ныне существующие модели устройства рынка труда (для анализа предложено 11 характеристик, связанных с определенными институтами).
This paper analyses the development of the union avoidance industry in the United States during the past half-century. Focusing on one leading example from each group, it examines the activities of the four main actors that constitute that industry: consultants, law firms, industry psychologists and strike management firms. Although these firms have experienced a fall in business as unions have declined in strength and numbers - a development that the union avoidance industry has contributed to - they continue to play an important role in the US system of industrial relations. Over three-quarters of employers hire consultants when confronted by organizing campaigns, and large union avoidance firms are increasingly seeking export markets for their expertise. Copyright Blackwell Publishing Ltd/London School of Economics 2006.
Health Status, Health Care, and Inequality: Canada vs. the U.S. NBER Working Paper Series Working Paper 13429 Redefining competition in health care
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O'Neill, J. E. and D. M. O'Neill (2007). Health Status, Health Care, and Inequality: Canada vs. the U.S. NBER Working Paper Series Working Paper 13429. 29 rPorter, M. E. and E. O. Teisberg (2004). Redefining competition in health care. Harvard Business Review 82(6): 64-+
The Health Care Crisis and What to Do About It
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How Structural Costs Imposed on US Manufacturers Harm Workers and Threaten Competitiveness
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