Rationing Antiretroviral Therapy for HIV/AIDS in Africa: Efficiency, Equity, and Reality

Background: Rationing of access to antiretroviral therapy already exists in sub-Saharan Africa and will intensify as national treatment programs develop. The number of people who are medically eligible for therapy will far exceed the human, infrastructural, and financial resources available, making rationing of public treatment services inevitable. Methods: We identified 15 criteria by which antiretroviral therapy could be rationed in African countries and analyzed the resulting rationing systems across 5 domains: clinical effectiveness, implementation feasibility, cost, economic efficiency, and social equity. Findings: Rationing can be explicit or implicit. Access to treatment can be explicitly targeted to priority subpopulations such as mothers of newborns, skilled workers, students, or poor people. Explicit conditions can also be set that cause differential access, such as residence in a designated geographic area, co-payment, access to testing, or a demonstrated commitment to adhere to therapy. Implicit rationing on the basis of first-come, first-served or queuing will arise when no explicit system is enforced; implicit systems almost always allow a high degree of queue-jumping by the elite. There is a direct tradeoff between economic efficiency and social equity. Interpretation: Rationing is inevitable in most countries for some period of time. Without deliberate social policy decisions, implicit rationing systems that are neither efficient nor equitable will prevail. Governments that make deliberate choices, and then explain and defend those choices to their constituencies, are more likely to achieve a socially desirable outcome from the large investments now being made than are those that allow queuing and queue-jumping to dominate

Marginalizing Risk

A major focus of finance is reducing risk on investments, a goal commonly achieved by dispersing the risk among numerous investors. Sometimes, however, risk dispersion can cause investors to underestimate and under-protect against risk. Risk can even be so widely dispersed that rational investors individually lack the incentive to monitor it. This Article examines the market failures resulting from risk dispersion and analyzes when government regulation may be necessary or appropriate to limit these market failures. The Article also examines how such regulation should be designed,including the extent to which it should limit risk dispersion in the first instance

Setting Standards for Fair Information Practice in the U.S. Private Sector

The confluence of plans for an Information Superhighway, actual industry self-regulatory practices, and international pressure dictate renewed consideration of standard setting for fair information practices in the U.S. private sector. The legal rules, industry norms, and business practices that regulate the treatment of personal information in the United States are organized in a wide and dispersed manner. This Article analyzes how these standards are established in the U.S. private sector. Part I argues that the U.S. standards derive from the influence of American political philosophy on legal rule making and a preference for dispersed sources of information standards. Part II examines the aggregation of legal rules, industry norms, and business practice from these various decentralized sources. Part III ties the deficiencies back to the underlying U.S. philosophy and argues that the adherence to targeted standards has frustrated the very purposes of the narrow, ad hoc regulatory approach to setting private sector standards. Part IV addresses the irony that European pressure should force the United States to revisit the setting of standards for the private sector

The dilemmas of risk-sensitive development on a small volcanic island

In the Small Islands Developing State (SIDS) of St Vincent and the Grenadines in the Caribbean, the most destructive disasters in terms of human casualties have been the multiple eruptions of La Soufrière volcano situated in the north of St Vincent. Despite this major threat, people continue to live close to the volcano and national development plans do not include risk reduction measures for volcanic hazards. This paper examines the development options in volcanic SIDS and presents a number of conundrums for disaster risk management on the island of St Vincent. Improvements in monitoring of volcanic hazards and ongoing programmes to enhance communications systems and encourage community preparedness planning have increased awareness of the risks associated with volcanic hazards, yet this has not translated into more risk-informed development planning decisions. The current physical development plan in fact promotes investment in infrastructure in settlements located within the zone designated very high-hazard. However, this is not an anomaly or an irrational decision: severe space constraints in SIDS, as well as other historical social and economic factors, limit growth and options for low-risk development. Greater attention needs to be placed on developing measures to reduce risk, particularly from low-intensity hazards like ash, limiting where possible exposure to volcanic hazards and building the resilience of communities living in high-risk areas. This requires planning for both short- and longer-term impacts from renewed activity. Volcanic SIDS face multiple hazards because of their geography and topography, so development plans should identify these interconnected risks and options for their reduction, alongside measures aimed at improving personal preparedness plans so communities can learn to live with risk

The Strength of Internet Ties

Presents findings from a survey that examines how Americans use the Internet and email to support and expand their social networks and access resources for assistance in making major life decisions

Models for schools of public health: A scoping review and synthesis of existing evidence

The final report on 'Models for schools of public health: A scoping review and synthesis of existing evidence' produced by Steven, Lombardo and Goodall and commissioned by Public Health Gateshead is now available. To date, existing evidence regarding models (organisational, structural, managerial, administrational) for Schools of Public Health (SsPH) has not been systematically collected or synthesised. This study aims to begin to fill that gap by using a combination of rapid review and scoping review techniques to retrieve and assess existing literature to identify potential and existing models, themes and issues and where possible highlight strengths and weaknesses

A Model of Total Factor Productivity Built on Hayek’s View of Knowledge: What Really Went Wrong with Socialist Planned Economies?

Because Hayek’s view goes beyond the Walrasian framework, his descriptive arguments on socialist planned economies are prone to be misunderstood. This paper clarifies Hayek’s arguments by using them as a basis to construct a model of total factor productivity. The model shows that productivity depends substantially on the intelligence of ordinary workers. The model indicates that the essential reason for the reduced productivity of a socialist economy is that, even though human beings are imperfect and do not know everything about the universe, they are able to utilize their intelligence to innovate. Decentralized market economies are far more productive than socialist economies because they intrinsically can fully utilize human beings’ intelligence, but socialist planned economies cannot, in large part because of the imagined perfect central planning bureau that does not exist.Hayek; Market economy; Socialist planned economy; Total factor productivity; Innovation; Experience curve effect; China

Corporate Governance and Firm Strategy in the Pharmaceutical Industry

Using the case of the pharmaceutical industry, this paper assesses how the leading German and UK firms are adapting to changes in their competitive environment, at both the national and international level. We attempt to link how firms create governance structures (management decision-making, the organisation of the R&D process, etc.), and the national system of innovation, impact the innovation strategies adopted in leading German and UK firms. Our results show that first, the firm competencies created in order to compete globally may still originate within national economies, in part because the generation of R&D remains relatively national. Second, towards the end of the 1970s, the scientific basis in the pharmaceutical industry began to change rapidly. The evidence presented shows that UK firms rapidly developed new competencies in biotechnology and other research areas in response to the structural changes. However, German firms tended, until very recently, to maintain and in some cases strengthen competencies in traditional research methods based on organic chemistry. ZUSAMMENFASSUNG - (Corporate Governance und Unternehmensstrategie in der pharmazeutischen Industrie) Am Beispiel der pharmazeutischen Industrie wird in diesem Beitrag aufgezeigt, wie führende deutsche und britische Firmen sich an Änderungen in ihrer Unternehmensumwelt anpassen, sowohl der nationalen wie auch der internationalen Umwelt. Es wird gezeigt, wie die Unternehmen Governance-Strukturen (Managemententscheidungen, die Organisation von FuE-Prozessen etc.) schaffen und wie nationale Innovationssysteme die Innovationsstrategien beeinflussen, die von führenden deutschen und britischen Firmen verfolgt werden. Erstens gelangt die Studie zu dem Ergebnis, daß die Kompetenz der Unternehmen so ausgerichtet wurde, daß sie für den globalen Wettbewerb fit sind, aber ihre Wurzeln dennoch innerhalb der nationalen Volkswirtschaften behalten, teilweise deshalb, weil FuE verhältnismäßig national fundiert ist. Zweitens begann zum Ende der siebziger Jahre eine dramatische Änderung in der wissenschaftlichen Basis der pharmazeutischen Industrie. Diese Evidenz zeigt, daß britische Firmen rasch neue Kompetenz in Biotechnologie und anderen Forschungsbereichen entwickelten, um auf die Änderungen zu reagieren. Deutsche Unternehmen tendierten jedoch noch bis vor kurzem dazu, ihre bisherige Kompetenz beizubehalten und in manchen Fällen in traditionellen Forschungsbereichen, basierend auf organischer Chemie, sogar zu verstärken.corporate governance; firm strategy; national systems of innovation; pharmaceuticals