Healthcare Reforms in Bulgaria: Towards Diagnosis and Prescription

The paper studies the policy response to the market failures and challenges of healthcare in transition. Bulgaria chose a halfway shift from healthcare services provided entirely by the state to a system with private providers of outpatient services and public providers of inpatient services, both sectors financed mainly by state-run compulsory payroll insurance system. The paper shows the evolution of this reform path to low compliance by both customers (contributors) and service-providers (contractors with the National Health Insurance Fund), which leads to excessive regulations and control, and crowding out of the private sector. The outcome is a system that is increasingly driven by administrative controls at the expense of market incentives. Based on this analysis it identifies the relevant policy implications and opportunities for moving the stalled health reforms out of the institutional impasse.healthcare reform

Disease burden, cost modelling and the AIDS funding debate-towards clarity on whether the world is spending 'too much' on HIV/AIDS

With pressures from the recent financial crisis forcing donors to carefully review their spending priorities, some have claimed, firstly, that HIV/AIDS receives too much money relative to its disease burden and, secondly, that the future costs of treating those with the disease will become unmanageable. This paper seeks to clarify each of these two areas..

Payments pricing: who bears the cost? - a conference summary

As consumers and merchants increasingly adopt electronic payments, the pricing of these services has generated substantial scrutiny by public authorities around the world. To discuss these developments and related issues, the Federal Reserve Bank of Chicago hosted its ninth annual Payments Conference on May 14–15, 2009.Payment systems

Smart Pacing for Effective Online Ad Campaign Optimization

In targeted online advertising, advertisers look for maximizing campaign performance under delivery constraint within budget schedule. Most of the advertisers typically prefer to impose the delivery constraint to spend budget smoothly over the time in order to reach a wider range of audiences and have a sustainable impact. Since lots of impressions are traded through public auctions for online advertising today, the liquidity makes price elasticity and bid landscape between demand and supply change quite dynamically. Therefore, it is challenging to perform smooth pacing control and maximize campaign performance simultaneously. In this paper, we propose a smart pacing approach in which the delivery pace of each campaign is learned from both offline and online data to achieve smooth delivery and optimal performance goals. The implementation of the proposed approach in a real DSP system is also presented. Experimental evaluations on both real online ad campaigns and offline simulations show that our approach can effectively improve campaign performance and achieve delivery goals.Comment: KDD'15, August 10-13, 2015, Sydney, NSW, Australi

Financial Opening: Evidence and Policy Options

This paper evaluates the empirical evidence of increasing the chances of financial crises induced by opening up developing countries to short-term capital inflows, and appraises the various proposals made for mitigating the severity of financial crises. We point out that there is solid evidence that financial opening increases the chance of financial crises. There is more tenuous evidence that financial opening contributes positively to long-run growth. Hence, there may be a complex trade off between the adverse intermediate run and the beneficial long run effects of financial opening. The literature is abounded with proposals aimed at improving this intertemporal trade-off, reducing the costs of financial crises. A version of the Lucas critic may limit the welfare gain of these proposals. Hence, a better understanding of the structural characteristics leading to exposure and crises is the key for designing a successful restructuring of the global capital market. Some of the reforms may fall short of success due to coordination failure: they may be effective only if they were adopted comprehensively by all the relevant financial centers. Finally, some of the proposals may be too optimistic, ignoring the time inconsistency and political economy considerations, as well as presuming the ability to verify unambiguously the quality of adjustment.

Local Public Sector Performance: Are Wisconsin City and Village Taxes Too High?

This applied research project examines questions concerning the economic efficiency of municipal government spending and taxation levels in Wisconsin. Using economic notions of local government effectiveness and efficiency, a theoretical and empirical model is presented and estimated using data from Wisconsin cities and villages. Theory suggests that expenditure and taxation levels are capitalized into local property values. In short, public goods and services and corresponding taxes are viewed as a normal good in an economic sense: more is better, too much is bad. From a property valuation perceptive, higher levels of public goods and services should increase property values. But, overprovision of the public good places downward pressure on property values. This inverted-U relationship is easily estimated from an empirical perspective. Two separate tests are estimated. The first examines capitalization rates of service provision (i.e., expenditures) into property values. The second complementary test examines capitalization rates of taxation levels (i.e., municipal taxes) into property values. Results for Wisconsin cities and villages suggest that service and taxation levels are positively related to property values suggesting that neither services or local taxation is not systematically too high. In other words, based on rigorous economic theory, spending and taxing in Wisconsin's cities and villages are not too high and may indeed be too low. It is important to note that this applied research study focuses on city and village taxation and spending, attention is not paid to public schools, counties, towns or other special districts that have taxing authority.

The experience of high frequency gambling behaviour of older adult females in the United Kingdom: an interpretative phenomenological analysis

The prevalence of older adult female gambling participation and gambling disorder is increasing in the UK, and there is a paucity of published research available to understand possible risk factors for frequent gambling in this demographic. The aim of the current study was to identify and explore motivations and patterns of gambling behaviour in high frequency older adult female gamblers in the UK, from the perspective of individual and in the context of their experience of aging. Ten UK older adult female high frequency gamblers were recruited via stratified purposive sampling, with a mean age of 70.4 years. Data was collected via semi-structured interviews, and was analysed using Interpretative Phenomenological Analysis. Three core themes representative of the experience of this phenomenon emerged from the transcripts including: Filling Voids, Emotional Escape and Overspending. The present study has provided a contextualised understanding of motivating factors and several age-related vulnerabilities which may account for high gambling frequency in this population

Managing pharmaceutical regulation in Germany: Overview and economic assessment

Rising costs in pharmaceutical expenditure have become a major concern for policy makers in Germany over the last years. Therefore the pharmaceutical market in Germany has been increasingly targeted by different kinds of regulations, focussing both on the supply and the demand side, using price, volume and spending controls. Specific regulations include price reductions, reference pricing, pharmacy rebate for sickness funds, increasing co-payments, an aut-idem substitution, parallel imports, negative list, guidelines, and finally spending caps for pharmaceutical expenditure per physicians association. Although it is difficult to attribute certain effects to single measures, some measures like reference pricing and physician spending caps are more effective and long-lasting than others. Although highly disputed among physicians, the spending caps applied between 1993 and 2001 have limited pharmaceutical expenditure for an entire decade. However, while some measures do effectively control expenditures, their effect on allocative efficiency may be negative. -- Steigende Ausgaben für Arzneimittel stellen zunehmend ein Problem für Entscheidungsträger in Politik und Selbstverwaltung dar. Daher war der Arzneimittelmarkt in den letzten Jahren Ziel verschiedener Regulierungsformen, die sowohl auf der Angebotsseite als auch auf der Nachfrageseite ansetzen und sowohl Instrumente zur Preis, Mengen als auch Ausgabenregulierung nutzen. Sie umfassen dabei insbesondere Preisrabatte, Festbeträge, Zuzahlungen, Aut-idem substitution, Parallelimporte, Negativlisten, Leitlinien and Arzneimittelbudgets. Obwohl es schwierig ist, bestimmte Wirkungen monokausal auf einzelne Maßnahmen zu zurückzuführen, kann festgestellt werden, dass Arzneimittelbudgets und Festpreise nachhaltiger und effektiver als andere Regulierungsformen sind. Obwohl Arzneimittelbudgets bei niedergelassenen Ärzten sehr umstritten sind, waren sie hauptverantwortlich für die Begrenzung der Arzneimittelausgaben zwischen 1993 und 2001. Daneben existieren einige Regulierungsformen die zwar die Arzneimittel-ausgaben wirksam senken, deren allokative Effizienz jedoch insgesamt eher negativ ist.

Are treatment guides and rational drug use policies adequately exploited in combating respiratory system diseases?

SummaryThe aim of the present study was to increase awareness regarding the rational use of medicines. The data were obtained via the Material Resources Management System Module of the Ministry of Health. For the appropriateness of treatments, the Global Initiative for Asthma, the Global Initiative for Chronic Obstructive Lung Disease, and the guidelines for the rational use of medicines were used. We also investigated whether any de-escalation method or physical exercise was performed. Statistical analyses were performed using descriptive statistics to determine the mean, standard deviation, and frequency. The results showed that healthcare providers ignored potential drug reactions or adverse interactions, and reflecting the lack of adherence to the current treatment guides, 35.8% irrational use of medicines was recorded. Thus, de-escalation methods should be used to decrease costs or narrow the antibiotic spectrum, antibiotic selection should consider the resistance patterns, culturing methods should be analyzed, and monotherapy should be preferred over combination treatments