Budgetary Perspective Research Articles

What is in a page charge?

The purpose of this note is to bring to your attention a trend that has emerged. The gap between authors/institutions that promise to honor the page charge and the subset that actually ends up honoring them is on the rise. While the page charge, as mentioned earlier, is not mandatory, from the budgetary perspective, it is imperative that your response accurately reflects your intentions. We would like to remind the authors and their sponsoring institutions that the page charge is a legitimate research investment and hence needs to be part of any R&D proposal. It is in this spirit that we appeal to you to honor all page charges and keep this in mind the next time you respond to a page charge query. If there is anything that we can do to help in this process, please let us know. As always, we appreciate your feedback.

Cutting-edge Discussions of Management, Policy, and Program Issues in Emergency Care

Cutting-edge Discussions of Management, Policy, and Program Issues in Emergency Care

Financing social and cohesion policy in an enlarged EU: plus ça change, plus c'est la même chose?

The development of the Open Method of Coordination, agreement on the Lisbon Agenda and EU enlargement offered the prospect of a new and substantial EU social policy agenda. This article considers EU social and cohesion policies in the context of the recent negotiation of the EU budget for 2007—13. We find the Commission's wish to redistribute EU spending in favour of these policy areas and new member states was thwarted by key political features of EU budget making: CAP spending levels which are downwardly sticky; institutional arrangements which provide for budget making as, at best, a zero-sum game; and the preferences of contributor member states in the EU-15 to contain overall spending while preserving their net budget positions. Questions are thus raised as to the ability of the EU to make any progress, from a budgetary perspective, on the social and cohesion policy agenda in an enlarged EU.

Labor Policies to Raise Employment

Using panel data for 15 industrial countries, active labor market policies (ALMPs) are shown to have a positive effect on employment rates, after controlling for institutional variables and country-specific effects. Among such policies, direct subsidies for job creation were the most effective. This paper shows that ALMPs raise employment by improving labor market functioning: higher expenditure on ALMPs is associated with lower wages for given levels of the unemployment rate. Whether ALMPs are cost-effective from a budgetary perspective remain to be determined, but they are certainly not substitutes for comprehensive institutional reforms. In particular, if higher expenditures on ALMPs are financed through increased labor income taxation, it could have deleterious effects on labor utilization.

What is in a page charge?

The purpose of this note is to bring to your attention a trend that has emerged. The gap between authors/institutions that promise to honor the page charge and the subset that actually ends up honoring them is on the rise. While the page charge, as mentioned earlier, is not mandatory, from the budgetary perspective, it is imperative that your response accurately reflects your intentions. We would like to remind the authors and their sponsoring institutions that the page charge is a legitimate research investment and hence needs to be part of any R&D proposal. It is in this spirit that we appeal to you to honor all page charges and keep this in mind the next time you respond to a page charge query. If there is anything that we can do to help in this process, please let us know. As always, we appreciate your feedback.

What is in a page charge?

The purpose of this note is to bring to your attention a trend that has emerged. The gap between authors/institutions that promise to honor the page charge and the subset that actually ends up honoring them is on the rise. While the page charge, as mentioned earlier, is not mandatory, from the budgetary perspective, it is imperative that your response accurately reflects your intentions. We would like to remind the authors and their sponsoring institutions that the page charge is a legitimate research investment and hence needs to be part of any R&D proposal. It is in this spirit that we appeal to you to honor all page charges, and keep this in mind the next time you respond to a page-charge query. If there is anything that we can do to help in this process, please let us know. As always, we appreciate your feedback.

An economic analysis of the EHAS telemedicine system in Alto Amazonas

Telemedicine systems providing voice communication and email by radio were installed at seven health centres (HCs) and 32 health posts (HPs) in the Alto Amazonas province of Peru during 2001. A cost analysis was performed to estimate the net effect on direct resource consumption from the perspective of society. Prior to the availability of the EHAS telemedicine system, there was a mean of 11.1 urgent patient referrals per year from the HPs and 14.0 referrals per year from the HCs. After the implementation of telemedicine, patient referrals fell to 2.5 per year from the HPs (P = 0.03) and to 8.4 per year from the HCs (P = 0.17). The net economic effect of the telemedicine programme over a four-year period was clearly positive, amounting to annual net savings of US$320,126 (using a 5% discounting rate). A one-way sensitivity analysis using a range of values for the discounting rate, and the number of urgent referrals, confirms that the programme was efficient (i.e. it made net financial savings) in all cases. From the restricted budgetary perspective of the health network, the results also demonstrate that the additional operational costs (telephone and maintenance) introduced by the telemedicine system were lower than the direct cost-savings produced for the health-care network.

Always Articulating: Theorizing on Mobile and Wireless Technologies

Through this article we theorize on the nature and effects of articulation work relative to the take-up and use of information and communications technologies (ICT). Articulation work is “work that enables other work”: that which links people, processes, and technologies within organizations. Articulation work in organizations is both common and too often invisible from a managerial or budgetary perspective. Drawing on data from a study of the introduction and implementation of mobile computing technologies into criminal justice organizations, we highlight two findings: (1) There exist ongoing but unmet articulation needs present in any organization or work system. (2) Articulation is cumulative. We find, that as work becomes more complex (such as adding new work tasks and using new technologies), there is more articulation needed. These findings raise issues with assessing the costs of articulation on individuals, and making arrangements to accommodate explicit and implicit articulation in organizational work, particularly around the take-up and ongoing use of ICT-based systems.

Academic response to the European Commission’s Questionnaire on the patent system in Europe: An economic approach

This paper presents an economic opinion on the questionnaire on the European patent system that was recently issued by the European Commission. We argue that the debate on patent reform in Europe needs to be more focused on its economic purpose, namely the promotion of innovation. As a first step we unfold sub-issues and trade-offs underlying the general and consensual goal which “promoting innovation” is. We contrast the protection and diffusion functions of the patent system, both of which must be taken into account in order to create an original European patent regime geared towards innovation. We also emphasize the possibility for the European patent system to answer more specific needs, such as those of small and medium enterprises or those of industries with highly cumulative innovations. We discuss as the second step the capacity of the European patent system to achieve these policy goals through various levers. We especially argue that patent fees or translation requirements should be viewed as policy instruments rather than as in a purely budgetary perspective. We moreover consider the positive or negative consequences one can expect from the coexistence of different patent systems in Europe.

Public Investment in Transportation Infrastructure and Economic Performance in Portugal

In this paper, we use a VAR approach to investigate the effects of public investment in transportation infrastructures on private investment, employment, and output in Portugal. Estimation results suggest that public investment crowds in private investment and employment, and has a strong positive effect on output. We estimate that one euro in public investment increases output in the long-term by 9.5 euros, which corresponds to a rate of return of 15.9%. These figures imply that there are strong long-term budgetary benefits from public investment in the form of increased future tax revenues. A closer look at the effects of different types of public investment uncovers the same general patterns. These results are very important from a public policy perspective. They suggest that the strategy followed by the Portuguese authorities of investing in public infrastructures is justified, both from a long-term development perspective and a long-term public budgetary perspective.

What is in a page charge?

The purpose of this note is to bring to your attention a trend that has emerged. The gap between authors/institutions that promise to honor the page charge and the subset that actually ends up honoring them is on the rise. While the page charge, as mentioned earlier, is not mandatory, from the budgetary perspective, it is imperative that your response accurately reflects your intentions. We would like to remind the authors and their sponsoring institutions that the page charge is a legitimate research investment and hence needs to be part of any R&D proposal. It is in this spirit that we appeal to you to honor all page charges and keep this in mind the next time you respond to a page charge query. If there is anything that we can do to help in this process, please let us know. As always, we appreciate your feedback.

What is in a page charge?

The purpose of this note is to bring to your attention a trend that has emerged. The gap between authors/institutions that promise to honor the page charge and the subset that actually ends up honoring them is on the rise. While the page charge, as mentioned earlier, is not mandatory, from the budgetary perspective, it is imperative that your response accurately reflects your intentions. We would like to remind the authors and their sponsoring institutions that the page charge is a legitimate research investment and hence needs to be part of any R&D proposal. It is in this spirit that we appeal to you to honor all page charges and keep this in mind the next time you respond to a page charge query. If there is anything that we can do to help in this process, please let us know. As always, we appreciate your feedback.

A cost-benefit analysis of typhoid fever immunization programmes in an Indian urban slum community.

Many economic analyses of immunization programmes focus on the benefits in terms of public-sector cost savings, but do not incorporate estimates of the private cost savings that individuals receive from vaccination. This paper considers the implications of Bahl et al.'s cost-of-illness estimates for typhoid immunization policy by examining how community-level incidence estimates and information on distribution of costs of illness among patients and the public-health sector can be used in the economic analysis of vaccination-programme options. The findings illustrate why typhoid vaccination programmes may often appear to be unattractive to public-health officials who adopt a public budgetary perspective. Under many plausible sets of assumptions, public-sector expenditure on typhoid vaccination does not yield comparable public-sector cost savings. If public-health officials adopt a societal perspective on the economic benefits of vaccination, there are many situations in which different vaccination programmes will make economic sense. The findings show that this is especially true when public decision-makers recognize that (a) the incidence of typhoid fever is underestimated by blood culture-positive cases and (b) avoided costs of illness represent a significant underestimate of the actual economic benefits to individuals of vaccination.

Do Active Labor Market Policies Increase Employment?

Using panel data for 15 industrial countries, active labor market policies (ALMPs) are shown to have raised employment rates in the business sector in the 1990s, after controlling for many institutions, country-specific effects, and economic variables. Among such policies, direct subsidies to job creation were the most effective. ALMPs also affected employment rates by reducing real wages below levels allowed by technological growth, changes in the unemployment rate, and institutional and other economic factors. However, part of this wage moderation may be linked to a composition effect because policies were targeted to low-paid individuals. Whether ALMPs are cost-effective from a budgetary perspective remains to be determined, but they are certainly not substitutes for comprehensive institutional reforms.

Reducing The Growth Of Medicare Spending: Geographic Versus Patient-Based Strategies

This paper explores the potential of two alternative approaches for reducing the rate of growth in Medicare spending. One strategy would focus on reducing the expenditures of high-spending individuals. Given that a large share of Medicare spending is consumed by relatively few beneficiaries, this approach targets the small group responsible for most of the spending. The other strategy would focus on reducing expenditures in high-spending regions. Because either approach would have to overcome major hurdles before lowering Medicare spending, the likely payoff from the alternative strategies is far from clear. Viewed from a budgetary perspective, concentration in Medicare spending suggests the importance of focusing on high-spending patients.

Do Active Labor Market Policies Increase Employment?

Using panel data for 15 industrial countries, active labor market policies (ALMPs) are shown to have raised employment rates in the business sector in the 1990s, after controlling for many institutions, country-specific effects, and economic variables. Among such policies, direct subsidies to job creation were the most effective. ALMPs also affected employment rates by reducing real wages below levels allowed by technological growth, changes in the unemployment rate, and institutional and other economic factors. However, part of this wage moderation may be linked to a composition effect because policies were targeted to low-paid individuals. Whether ALMPs are cost-effective from a budgetary perspective remains to be determined, but they are certainly not substitutes for comprehensive institutional reforms.

Do Active Labor Market Policies Increase Employment?

Using panel data for 15 industrial countries, active labor market policies (ALMPs) are shown to have raised employment rates in the business sector in the 1990s, after controlling for many institutions, country-specific effects, and economic variables. Among such policies, direct subsidies to job creation were the most effective. ALMPs also affected employment rates by reducing real wages below levels allowed by technological growth, changes in the unemployment rate, and institutional and other economic factors. However, part of this wage moderation may be linked to a composition effect because policies were targeted to low-paid individuals. Whether ALMPs are cost-effective from a budgetary perspective remains to be determined, but they are certainly not substitutes for comprehensive institutional reforms.

MM7 Issues in Developing Economic Models for Managed Care: The Case of Osteoporosis Prevention

Although efficacy and safety data remain the mainstay of formulary decisions, the need for economic evaluation of new pharmaceutical products has become increasingly important within the managed care environment. For many new products, insufficient information is generated from clinical trials to conduct a comprehensive economic evaluation. Therefore, economic modeling is often the only feasible option for delivering timely information to decision makers about a new product's value. Unfortunately, economic models presented to managed care plans often have limited usefulness because they lack relevance or applicability to the plan's members or the overall goals of the organization. Of considerable importance is whether the model takes a budgetary perspective, enabling the plan to evaluate the financial impact of the product's benefits and costs over the short term. Also important is the extent to which the model reflects the plan's population and the anticipated clinical benefits of the product in a “real-world” setting. This workshop will discuss issues related to developing an economic model for the prevention of osteoporosis that is targeted to the managed care audience. Topics will include: (1) clinical and economic consequences of osteoporosis that are relevant to managed care in the short term; (2) characteristics of osteoporosis prevention that present unique challenges to modeling; (3) issues in using surrogate measures (e.g., bone mineral density) in an osteoporosis model; and (4) the potential impact of compliance on the cost-effectiveness of preventive therapies for osteoporosis. The goal of this workshop is to heighten the participant's awareness of the pharmacoeconomic needs of managed care and to provide guidance on developing useful economic models for this audience.

Cost Benefit Analysis of Pharmaceutical Care in a Medicaid Population-From a Budgetary Perspective

The objective was to evaluate the economic impact of Medicaid pharmaceutical care services delivered to patients in four hospital-based primary care outpatient clinics in Baltimore, Maryland. Through cost benefit analysis, sensitivity analysis, and measurement of net present value of program benefits, the authors concluded that pharmaceutical care services demonstrated significant program benefits to the Medicaid population. The net present value of program benefits was $724,203.70 for 437 study patients, for average benefits of $1,657.20 per patient for 10 future years at a 4% discount rate. The study concluded that if this program were expanded to all Maryland Medicaid patients who are adults, non-institutionalized, and receiving drug therapy, the state could save as much as $22 million in the next fiscal year.

Financing mental health reform in kansas

This paper examines the impact of the Kansas Mental Health Reform Act of 1990 on the mental health care system, on the budget of the state, and on the budgets of the Community Mental Health Centers. Both the successes and the failures of Mental Health Reform suggest that coordination of institutional and financial arrangements are needed to improve the outcomes of care. From a budgetary perspective, Mental Health Reform demonstrates the central role of Medicare and Medicaid in financing services for vulnerable populations. The reform also demonstrates that shifting costs to Medicare and Medicaid is a component of prudent financial management by the states.