Low Quality Standards Research Articles

Special issue on health economics and policy: Guest editors' introduction.

Special issue on health economics and policy: Guest editors' introduction.

The life-saving effect of hospital proximity.

We provide a new assessment of the effect of hospital proximity in an emergency situation-road-traffic accidents-exploiting the exogenous variation in the proximity to cities that are legally allowed to have a hospital on the basis of their population size. Our instrumental variable results show that a one-standard-deviation increase in the distance to the nearest hospital (5 km) raises the fatality rate by 13.84% at the sample average. This figure is equal to 0.92 additional deaths per 100 accidents. We show that both ordinary least squares and difference-in-differences estimates, common approaches in the literature, provide a downward-biased measure of the true effect of hospital proximity because they do not fully solve spatial sorting problems. Proximity is more important when the level of road safety is low, when emergency services are less responsive, and when the nearest hospital has relatively low quality standards.

Percepciones de la gestión del turismo en dos reservas de biosfera ecuatorianas: Galápagos y Sumaco

The tourism is considered as one of the key strategies to promote environmental conservation and socio-economic development oflocal communities in protected areas. UNESCO biosphere reserves are protected areas of extraordinary natural and cultural value, conceived as places for reconciliation between conservation and development. The primary objective of this research was to evaluate the key elements of the current management of tourism and its contribution to biodiversity conservation and development in two Ecuadorian biosphere reserves: Galapagos Islands and Sumaco (Amazon Basin). Moreover, the sustainability of tourism was evaluated. Data collection for the case studies was performed by the combination of quantitative and qualitative methods. Surveys were applied to residents in both reserves in order to find out about their socio-demographic characteristics, their main economic activities for supporting themselves and their attitude towards tourism, their level of knowledge about biosphere reserves, and their perception about advantages or disadvantages of living in a biosphere reserve. For qualitative analysis, in-depth semi-structured interviews with the main stakeholders in both biosphere reserves were applied. Experts in the management of protected areas, as well as representatives of different sectors directly and indirectly associated with tourism were interviewed. Although tourism is a concept that could be developed in accordance with the environment in these natural areas, in the case of Galapagos it is one of the main threats for the conservation of biodiversity in the archipelago due to the increasing number of tourists, among others. In contrast, in Sumaco tourism could be an important sustainable alternative to mining and oil extraction, which are the current threats to the conservation of the area.There are serious problems in both reserves, mainly linked to the contamination of water resources. Such pollution imposes risks to the health to both, residents and tourists. The invasion of exotic species in Galapagos is one of the most serious threats to the conservation, while deforestation in combination with illegal logging and mining activities is the greatest danger in Sumaco.Migration processes undoubtedly shape the attitudes and values of the current population in both reserves. In Galapagos most residents are immigrants, whereas in Sumaco a significant portion is Kichwa people who belong to the area's native population. In general, the inhabitants in both areas have not yet developed a true environmental awareness. Their awareness is based on usage, in the sense of “use it today and do not worry about it tomorrow”.In both reserves, tourist services offered by local communities have low quality standards and are targeted on a market segment consisting of tourists with a low budget. Thus, the community revenues obtained from tourism are generally only a small percentage of the total tourism market. This situation is much more noticeable in Galapagos where large companies that operate luxury cruises and hotels gain most of their revenues from tourism. Many of them have their headquarters in the main cities of Ecuador and abroad, which means that they pay their taxes in those cities and not in the places where they operate. Inequality in the distribution of the economic benefits of tourism leads to a situation of frustration among the residents. Despite this situation, tourism is still a profitable business and residents try to make the most ofit, no matter the cost impacts. Temporary and illegal tourism activities is often the normal state of the things: unregistered houses that offer rooms for tourists, taxi drivers who offer tours without being in possession of permits, tourist boat owners, tour guides and even large tourist companies that operate without legal licenses. This situation leads to a decrease of the quality of services, an uncontrolled increase of business, a consequent dumping of prices and the overall decline of the destination.There are some serious limitations regarding the technical and logistical capacity of the institutions responsible for controlling and managing the tourist activity; they consist mainly in the lack of staff and funding. Galapagos, given its special status, has increased the number of funding managers and staff members for controlling and management, but in many cases, these people are not fully qualified for their positions. Sumaco has only few tourism experts who can help to develop the tourism. The coordination and planning among all stakeholders involved in tourism is still a work in progress to ensure proper management of the tourist destinations. In any case, local communities are developing important initiatives in both biosphere reserves. Adequate planning and coordination are mandatory to achieve sustainable tourism in Galapagos and Sumaco.

Certifying the sustainability of biofuels: Promise and reality

While liquid biofuels play a prominent role in sustainable energy goals, the relationship between their ability to advance sustainability agendas and their governance has been poorly addressed. The recognition of a number of private sector initiated certification schemes as mechanisms to verify compliance with the requirements of the EU-Renewable Energy Directive has provided a strong stimulus for biofuels certification. The question asked in this article is: "To what extent does the application of these standards effectively contribute to the sustainable production of bioenergy?" The question is answered on the basis of a conceptual framework and literature review. Three elements of the effectiveness of market-based certification standards are reviewed: the substantive scope of emergent standards, the effectiveness of implementation, and levels and trends in market conversion. The proliferation of certificates for low quality standards, deficiencies in the certification process and low market conversion suggest that certification is an inadequate substitute for public regulation. For certification to hold any meaningful potential to strengthen sustainability governance in the biofuel sector, it must be embedded within a public governance system committed to redressing these deficiencies and structuring accountability not just towards global environmental values, but to local people and place.

¿Hacia una movilidad sustentable? Desafíos de las políticas de reordenamiento del transporte público en Latinoamérica. El caso de Lima

Durante las últimas dos décadas varias ciudades latinoamericanas han reorganizado sus servicios de transporte público, que presentaban bajos estándares de calidad, para establecer sistemas integrados de transporte con mayores niveles de planificación y regulación estatal. Ello ha coincidido con la creciente acogida del enfoque de movilidad sustentable, que busca superar las políticas urbanas centradas en el automóvil y fomentar formas de desplazamiento con una mayor sostenibilidad social y ambiental. Teniendo en cuenta el contexto descrito, el presente artículo analiza la experiencia de reordenamiento del transporte público en la ciudad de Lima. Asimismo, la contrasta con procesos precedentes de reordenamiento de la movilidad urbana en Curitiba, Santiago de Chile y Bogotá. Se concluye que el proceso de reordenamiento del transporte público de Lima, actualmente inconcluso, requiere una serie de ajustes en su diseño e implementación a fin de que el mismo propicie efectivamente el establecimiento de un modelo de movilidad sustentable en la capital peruana.

Network Trade and Development: What Do Patterns of Vertically Specialized Trade in ASEAN Tell Us About India’s Place in Asian Production Networks?

At a time when regional production networks have been resurgent, especially in Asia, why has India’s integration in regional markets not been deeper? Using highly disaggregated trade data and firm level field interviews, the paper found that despite low volumes, vertically specialized trade has been growing between India and ASEAN. Overall, we find that there is significant potential for deepening India’s engagement in ASEAN by expanding intermediates exports in the machinery sector, expanding into higher value specialty chemicals exports, unlocking the underexploited potential for growth in the electronics sector and moving up the value chain in the road vehicles and, telecommunications sectors where network exports are already important. Our field level interviews bear out these findings and show that besides the usual policy costs associated with supply side constraints in Indian manufacturing three factors hamper India’s deeper integration in Asian production networks: (i) low value addition in Indian manufacturing which translates into low-value component exports and a high degree of reliance on expensive imports creating a perverse effect on both learning and trade balance; (ii) a janus faced effect on technological change and productivity stemming from relatively low quality standards associated with cost-sensitive demand from domestic buyers and weak exports. This leads to technological stagnation on the one hand, and a growing capital intensity of routine operations on the other. (iii) and finally, despite the rise of export oriented industrial parks and SEZ’s there is a striking lack of an effective institutional eco-system of industrial advantage that agglomeration economies and colocation of interdependent, sectorally specialized firms can bring. Instead, sectoral fragmentation adds to manufacturing costs despite co-location. Although some firms have found innovative ways to cope, the coping costs are high.

The Life-Saving Effect of Hospital Proximity

We provide a new assessment of the effect of hospital proximity in an emergency situation exploiting the exogenous variation in the proximity to cities that are legally allowed to have a hospital based on their population size. Based on Italian municipal data, our instrumental variable results show that a one-standard-deviation increase in the distance to the nearest hospital (5 km) raises the fatality rate by 13.84% at the sample average. This figure is equal to 0.92 additional deaths per 100 accidents. We show that both OLS and DD estimates, generally used in the literature, provide a downward-biased measure of the true effect of hospital proximity because they do not fully solve spatial sorting problems. Proximity is more important when the level of road safety is low, when emergency services are less responsive, and when the nearest hospital has relatively low quality standards.

The ViWaS Project: Future-proof Solutions for Wagonload Transport

Rail transports of single wagons or wagon groups are an indispensable part of the transport chain, such as for the forestry and the chemical industry. However, high production costs and low quality standards have led to a continuous decline in market shares in recent years. In order to counteract this tendency, ten European companies and research institutions, covering the areas of rail transport and logistics, have combined their forces in the scope of the research and development project ViWaS (Viable Wagonload Production Schemes). The goal: Innovative and simultaneously practical solutions for a sustainable wagonload transport. The applicability of these solutions and their effects have been proven with the aid of business cases in terms of field tests and pilot operations. The following main innovations have been achieved within the ViWaS project:(1)Improved “last-mile” operating concepts incorporating hybrid locomotives and bi-modal shunting engines (by Bentheimer Eisenbahn, Fret SNCF and SBB Cargo supported by HaCon and NEWOPERA): The new production method for last-mile delivery is based on the idea of separating train movements and sidings shunting processes by deploying bimodal road-rail tractors. Processes within the sidings have been simplified; as a result costs for equipment and staff could be reduced considerably. Hybrid locomotives are fundamental in securing a seamless access to regional distribution rail networks. Potential cost advantages have been identified comparing different traction combinations of real-life transport chains.(2)Modular wagon technologies for a flexible and efficient use of resources (by Wascosa and SBB Cargo): In detail, three components have been developed up to prototype status: Wascosa's Flex Freight Car is a light container wagon with an accessible floor and thereby applicable for various transport purposes. The Timber Cassette 2.0 is a new superstructure for log wood transport that features foldable stanchions and can be used in combination with a container wagon. In case the Timber Cassette is not loaded, it can be removed and stacked at the terminal or on a container wagon. Empty runs will be minimized generating efficiency improvements. Additionally, SBB Cargo has developed the so-called Container Loading Adapter, another add-on to a container wagon. It facilitates container loading and unloading in sidings. SBB Cargo will deploy this new component within the “Swiss Split” production system, combining intermodal with wagonload transport.(3)Smart wagon telematics allowing improved tracking at reduced costs (by Eureka): A separate abstract “Smart Telematics Enabling Efficient Rail Transport” (Contribution ID 875) has been submitted for TRA 2016).4.A new simulation tool for planning and optimizing single wagonload networks (by ETH Zürich): WagonSIM is an agent-based simulation tool for rail freight networks to facilitate the optimization of SWL production schemes. It is based on the OpenSource software MatSIM. The tool models the routing of freight wagons according to the routes within the real SWL network. Therefore, the modelling of two network levels is required, the production network and the physical infrastructure.The ViWaS project is co-financed by the European Commission in the scope of the Seventh Framework Programme.

Comparing the performance of the public social security and private health sub-system in Rosario (Argentina) / Comparacion del desempeño de la seguridad social pública y del sub-sistema de salud privado en Rosario (Argentina)

Introduction: Latin American health systems are generally described as comprising three health sub-systems that segregate the population in separate segments. The private sub-system (PrS) is usually described as serving the rich population with high quality standards; the public sub-system (PubS) as serving the poor population with low quality standards; and the social security (SS) falling some place in between. We argue that this is an oversimplified picture that persists because of the lack and fragmentation of data and the failure to recognize changes occurred in the private health market during the last decades. This work compares the performance of the PubS, SS and PrS health services in Rosario city. The findings are intended to contribute to the reflection and the current efforts to move forward to integrated and PHC-based health systems and to achieve universal health access and coverage in Latin America. Theory/Methods: This cross-sectional study compares the performance of the PubS, SS and PrS through a household survey to a representative sample of 822 inhabitants of Rosario Municipality, stratified by age with a confidence interval of 95% and 3.5% precision. The questionnaire included questions on population health status and insurance, demographic and socio-economic conditions, health services use and perception for core dimensions and sub-dimensions of PHC performance. The individuals were assigned to a health sub-system based on their affiliation of the self-reported usual provider to one of the health sub-systems. We did not consider health insurance as a stratified variable because of the high percentage of people with more than one type of insurance, as well as insured individuals that use public services. Sub-systems were compared to look for significant differences in PHC performance and in demographic socio-economic and health status) using Chi Square analysis for categorical variables and one-way ANOVA test for numerical variables. We use a categorical nonlinear

The Life Saving Effects of Hospital Proximity

We provide a new assessment of the effect of hospital proximity in an emergency situation exploiting the exogenous variation in the proximity to cities that are legally allowed to have a hospital based on their population size. Based on Italian municipal data, our instrumental variable results show that a one-standard deviation increase in the distance to the nearest hospital (5 km) raises the fatality rate by 13.84% at the sample average. This figure is equal to 0.92 additional deaths per 100 accidents. We show that both OLS and DD estimates, generally used in the literature, provide a downward-biased measure of the true effect of hospital proximity because they do not fully solve spatial sorting problems. Proximity is more important when the level of road safety is low, when emergency services are less responsive, and when the nearest hospital has relatively low quality standards.

Correlates of physician burnout across regions and specialties: a meta-analysis.

BackgroundHealth care organizations globally realize the need to address physician burnout due to its close linkages with quality of care, retention and migration. The many functions of health human resources include identifying and managing burnout risk factors for health professionals, while also promoting effective coping. Our study of physician burnout aims to show: (1) which correlates are most strongly associated with emotional exhaustion (EE) and depersonalization (DP), and (2) whether the associations vary across regions and specialties.MethodsMeta-analysis allowed us to examine a diverse range of correlates. Our search yielded 65 samples of physicians from various regions and specialties.ResultsEE was negatively associated with autonomy, positive work attitudes, and quality and safety culture. It was positively associated with workload, constraining organizational structure, incivility/conflicts/violence, low quality and safety standards, negative work attitudes, work-life conflict, and contributors to poor mental health. We found a similar but weaker pattern of associations for DP.Physicians in the Americas experienced lower EE levels than physicians in Europe when quality and safety culture and career development opportunities were both strong, and when they used problem-focused coping. The former experienced higher EE levels when work-life conflict was strong and they used ineffective coping. Physicians in Europe experienced lower EE levels than physicians in the Americas with positive work attitudes. We found a similar but weaker pattern of associations for DP.Outpatient specialties experienced higher EE levels than inpatient specialties when organization structures were constraining and contributors to poor mental health were present. The former experienced lower EE levels when autonomy was present. Inpatient specialties experienced lower EE levels than outpatient specialties with positive work attitudes. As above, we found a similar but weaker pattern of associations for DP.ConclusionsAlthough we could not infer causality, our findings suggest: (1) that EE represents the core burnout dimension; (2) that certain individual and organizational-level correlates are associated with reduced physician burnout; (3) the benefits of directing resources where they are most needed to physicians of different regions and specialties; and (4) a call for research to link physician burnout with performance.

No-Fault Peer Review Charges: The Price of Selectivity Need Not Be Access Denied or Delayed

Plans by universities and research funders to pay the costs of Open Access Publishing (Gold OA) are premature. Funds are short; 80% of journals (including virtually all the top journals) are still subscription-based, tying up the potential funds to pay for Gold OA; the asking price for Gold OA is still high; and there is concern that paying to publish may inflate acceptance rates and lower quality standards. What is needed now is for universities and funders to mandate OA self-archiving (of authors' final peer-reviewed drafts, immediately upon acceptance for publication) (Green OA). That will provide immediate OA; and if and when universal Green OA should go on to make subscriptions unsustainable (because users are satisfied with just the Green OA versions) that will in turn induce journals to cut costs (print edition, online edition, access-provision, archiving), downsize to just providing the service of peer review, and convert to the Gold OA cost-recovery model; meanwhile, the subscription cancellations will have released the funds to pay these residual service costs. The natural way to charge for the service of peer review then will be on a no-fault basis, with the author's institution or funder paying for each round of refereeing, regardless of outcome (acceptance, revision/re-refereeing, or rejection). This will minimize cost while protecting against inflated acceptance rates and decline in quality standards.

The selection principle and market failure in systems competition

If governments stepped in where markets failed, reintroducing markets through the backdoor of systems competition will again result in market failure. Three models are presented which illustrate this wisdom. The first is concerned with congestion-prone public goods and shows that fiscal competition may be ruinous for the governments. The second considers the insurance function of redistributive taxation and shows that systems competition may suffer from adverse selection. The third studies the role of quality regulation and shows that systems competition may be a competition of laxity resulting in inefficiently low quality standards.

Processed Biogas for Public Utility by Niersverband, F.R.G.

At the biggest sewage treatment plant of Niersverband methane gas is recovered from surplus digestion gas and injected into low pressure public utility pipeline in compliance with low calorific natural gas quality standards. The necessary surplus gas yield availability is evaluated. The variations of supply to utility and the probability of peak load capacity running time are displayed. Operation expenditures costs and economy are evaluated. Utilization of 1,6 Million m3/a processed biogas is expected.

GOING FOR A FEE — YOUR OWN BUILDERS

In 1978 the National Economic Development Office published a major survey on “Construction for industrial recovery”. The summary said: “Much of British industry is hampered by poor buildings which are unsuitable for modern production methods. Many factories are old. Yet others are built to low quality standards. Such unsuitable buildings hold down productivity and increase operating costs”.