Suchergebnisse

The last two decades have witnessed a decrease in public health expenditure relative to total health spending. One may ask whether this decreasing role of Government expenditure in the financing of health care is due to mature options on the desired health care system or is more the result of Governments complying with more binding budget constraints. In this paper, we provide a first answer to this question, based on evidence for a set of OECD countries. The main point of the paper can be easily stated: the observed smaller role of public financing of health expenditures in total public expenditure is the result, to a significant extent, of exogenous political pressures for lower Government budget deficits. Given an overall budget ceiling, there is no evidence supporting a general time change in health spending priority in the budget bargaining process. However, we do find that Government budget constraints lead to lower priority of health care in the Government's budget allocation process. This conclusion seems to hold whether health public spending is determined by a bargaining process within the Government or by population needs. At least, the empirical evidence provided suggests that more research on the political process governing health care expenditures is desirable. ; N/A

Our concern is about a firm-specific industrial policy. When R&D subsidies or taxes are differentiated among firms, the question arises which firms in an industry should receive such support. We analyze a situation where firms differ in their R&D to in two distinct ways. They differ both in the costs of performing R&D activities and in the output obtained from such activities. The introduction of several domestic firms creates a corrective motive for government intervention with the firms' R&D activities in addition to Spencer and Brander's strategic motive. We find that the optimal firm-specific industrial policy. is affected differently by the two sources of firm heterogeneity. Another finding is that a change in a firm's R&D productivity has an ambiguous effect on the optimal policy towards the firm. ; N/A

Abstract
This paper examines the incentive to adopt a new technology resulting from common payment systems, namely mixed cost reimbursement and DRG reimbursement. Adoption is based on a cost–benefit criterion. We find that retrospective payment systems require a large enough patient benefit to yield adoption, while under DRG-linked payment, adoption may arise in the absence of patients benefits when the differential reimbursement for the old vs new technology is large enough. Also, mixed cost reimbursement leads to higher adoption under conditions on the differential reimbursement levels and patient benefits. In policy terms, mixed cost reimbursement system may be more effective than a DRG payment system to induce technology adoption. Our analysis also shows that current economic evaluation criteria for new technologies do not capture the different ways payment systems influence technology adoption. This gives a new dimension to the discussion of prospective vs retrospective payment systems of the last decades centered on the debate of quality vs cost containment.

We study how a third-party payer decides what providers to contract with. Two mechanisms are studied and their properties compared. A first mechanism consists of the so-called 'any willing provider' where the third-party payer announces a contract and every provider freely decides to sign it or not. The second mechanism is a bargaining procedure with the providers set up by the third-party payer. The main finding is that the decision of the third-party payer depends on the surplus to be shared. When it is relatively high (low) the third-party payer prefers the any willing provider system (negotiated solution). [Copyright 2008 Elsevier B.V.]

Altres ajuts: POCI/EGE/58934/2004 ; Altres ajuts: HP2003-0066 ; Ramsey pricing has been proposed in the pharmaceutical industry as a principle to price discriminate among markets while allowing to recover the (fixed) R&D cost. However, such analyses neglect the presence of insurance or the fund raising costs for most of drug reimbursement. By incorporating these new elements, we aim at providing some building blocks towards an economic theory incorporating Ramsey pricing and insurance coverage. We show how coinsurance affects the optimal prices to pay for the R&D investment. We also show that under certain conditions, there is no strategic incentive by governments to set coinsurance rates in order to shift the financial burden of R&D. This will have important implications to the application of Ramsey pricing principles to pharmaceutical products across countries.