Control Patterns in a Health Care Network

In this paper we present control patterns for the analysis and design of administrative control mechanisms in a network organization. A control pattern is a description of a generic and reusable control mechanism that solves a specific control problem, to be selected on the basis of the context. To represent the context and solution, we analyze a network organization as a set of actors who transfer objects of economic value. The usefulness and adequacy of the control patterns is demonstrated by a case study of the governance and control mechanisms of the Dutch public health insurance network for exceptional medical expenses (AWBZ)

The Global Spread of Stock Exchange, 1980-1998

Nations opened local stock exchanges at a rapid pace during the late 1980s and 1990s, creating a channel for investment capital from wealthy industrial nations to "emerging markets" as well as a mechanism for institutional change in local economies. This study examines the local and global processes by which exchanges spread, examining all nations "at risk" during the 1980s and 1990s. We find that local factors influencing the creation of stock exchanges included the size of the economy (overall and relative to population size); the legacy of colonialism; and a recent transition to multi-party democracy. Global factors associated with creating exchanges included levels of prior investment by multinationals; IMF "structural adjustment" aid; centrality in trade flows; and regional "contagion." In contrast to prior work in financial economics, we find no evidence for the influence of legal tradition, and contrary to the implications of dependency theory, we find no sign that foreign capital penetration affects the creation of exchanges. We also find no consistent evidence for the influence of stock exchanges on inequality or human development at the national level, above and beyond their effect on economic and population growth. The results indicate that globalization is usefully construed as a process analogous to institutional diffusion at the organization level.http://deepblue.lib.umich.edu/bitstream/2027.42/39725/3/wp341.pd

Institutional Technology and the Chains of Trust: Capital Markets and Privatization in Russia and the Czech Republic

The introduction of mass privatization policies in Russia and the Czech Republic depended on the creation of impersonal capital markets to finance the needs of privatized companies and to provide a secondary market for the trading of securities. Yet, mass privatization created the contradictory conditions of generating millions of poorly informed shareholders, with no efficient markets for the sale of the shares. The absence of financial markets created systematic pressures to move assets by illegal or non-transparent means to users who value them. Privatization created the incentives to destroy the financial markets critical to its success. A comparative case analysis of post-privatization market formation in both these countries demonstrates that the functional necessity for these markets does not engender their own creation. In the absence of institutional mechanisms of state regulation and trust, markets become arenas for political contests and economic manipulation. The irony of these policies is that a principal lesson has been that market reforms cannot create viable markets, only institutional formation can.http://deepblue.lib.umich.edu/bitstream/2027.42/39719/3/wp335.pd

The Global Spread of Stock Exchange, 1980-1998

Nations opened local stock exchanges at a rapid pace during the late 1980s and 1990s, creating a channel for investment capital from wealthy industrial nations to "emerging markets" as well as a mechanism for institutional change in local economies. This study examines the local and global processes by which exchanges spread, examining all nations "at risk" during the 1980s and 1990s. We find that local factors influencing the creation of stock exchanges included the size of the economy (overall and relative to population size); the legacy of colonialism; and a recent transition to multi-party democracy. Global factors associated with creating exchanges included levels of prior investment by multinationals; IMF "structural adjustment" aid; centrality in trade flows; and regional "contagion." In contrast to prior work in financial economics, we find no evidence for the influence of legal tradition, and contrary to the implications of dependency theory, we find no sign that foreign capital penetration affects the creation of exchanges. We also find no consistent evidence for the influence of stock exchanges on inequality or human development at the national level, above and beyond their effect on economic and population growth. The results indicate that globalization is usefully construed as a process analogous to institutional diffusion at the organization level.globalization, contagion, financial markets

Hirschmanian themes of social learning and change

Many development strategies assume (or desperately hope) that a country already has the capacity to plan and implement institutional reform or that such institutional reform can be pushed through with the external pressures of aid and conditionalities. In a decentralized reform strategy, developmental change is induced not by government fiat but by releasing and channeling local energies in smaller projects that will in due course spread through links, learning, imitation, and benchmarking. A"Christmas tree"of conditionalities hung on an adjustment loan is generally ineffective in getting a country to develop"ownership"of reform or in generating sustainable change. Development agencies need to work toward client governments genuine commitment to policy reform rather than believe that they can"buy"such commitment with aid money. But how does a country get from here to there? Here is where the Hirschmanian notion of unbalanced growth can be"rediscovered."A country that has already developed a"good policy environment"is like a country that can implement the"balanced growth plans"of the earlier debate. Such a country would be well on its way to development. When the central government lacks such a capability, the Hirschmanian approach is to look for"hidden rationalities"in small areas or on the periphery and then help the small beginnings to spread--using, where possible, the natural pressures of linkages. Rather than try to put all the pieces of a jigsaw puzzle together at once to make it look like the picture on the box, one starts in the small areas where the pieces are starting to fit together and builds outward, using the links between the pieces. the author shows several authors arriving at a similar strategy from different starting points. Similar ideas underlie the Japanese system of just-in-time production based on inventory, local problemsolving, benchmarking, and continuous improvement: Charles Lindblom's theory of incrementalism and muddling through; Donald Schon and Everett Rogers's treatment of decentralized social learning; and Charles Sabel's theory of learning by monitoring.Educational Sciences,ICT Policy and Strategies,Public Health Promotion,Enterprise Development&Reform,Health Monitoring&Evaluation,ICT Policy and Strategies,Health Monitoring&Evaluation,Educational Sciences,Economic Theory&Research,Environmental Economics&Policies

Institutional Technology and the Chains of Trust: Capital Markets and Privatization in Russia and the Czech Republic

The introduction of mass privatization policies in Russia and the Czech Republic depended on the creation of impersonal capital markets to finance the needs of privatized companies and to provide a secondary market for the trading of securities. Yet, mass privatization created the contradictory conditions of generating millions of poorly informed shareholders, with no efficient markets for the sale of the shares. The absence of financial markets created systematic pressures to move assets by illegal or non-transparent means to users who value them. Privatization created the incentives to destroy the financial markets critical to its success. A comparative case analysis of post-privatization market formation in both these countries demonstrates that the functional necessity for these markets does not engender their own creation. In the absence of institutional mechanisms of state regulation and trust, markets become arenas for political contests and economic manipulation. The irony of these policies is that a principal lesson has been that market reforms cannot create viable markets, only institutional formation can.

Health Care Costs and the Arc of Innovation

Health care costs continue their inexorable rise, threatening America’s long-term fiscal stability, competitiveness, and standard of living. Over the past half-century, efforts to rein in spending have uniformly failed. In this Article, we explain why, breaking with standard accounts of regulatory and market dysfunction. We point instead to the nexus of economics, mutual empathy, and social expectations that drives medical innovation and locks in low-value technologies. We show how law reflects and reinforces this nexus and how and why health-policy-makers avert their gaze. Next, we propose to circumvent these barriers instead of surmounting them. Rather than targeting today’s excessive spending, we seek to leverage available legal tools to bend the arc of innovation, away from marginally-beneficial technology and toward high-value advances. To this end, we set forth a novel, value-based approach to pricing and patent protection—one that departs sharply from current practice by rewarding innovators in proportion to the therapeutic benefits new tests and treatments yield. Using cancer therapy as an example, we explain how emerging information technology and large troves of electronic clinical data are opening the way to near-real-time assessment of efficacy. We then show how such assessment can power ongoing adjustment of pricing and patent terms. Finally, we offer a blueprint for how laws governing health care payment and intellectual property can be tailored to realize this value-focused vision. For the reasons we lay out, the transformation of incentives we urge will both slow clinical spending growth and greatly enhance the social value that this spending yields