Productive efficiency and regulatory reform: The case of vehicle inspection services.

Measuring productive efficiency provides information on the likely effects of regulatory reform. We present a Data Envelopment Analysis (DEA) of a sample of 38 vehicle inspection units under a concession regime, between the years 2000 and 2004. The differences in efficiency scores show the potential technical efficiency benefit of introducing some form of incentive regulation or of progressing towards liberalization. We also compute scale efficiency scores, showing that only units in territories with very low population density operate at a sub-optimal scale. Among those that operate at an optimal scale, there are significant differences in size; the largest ones operate in territories with the highest population density. This suggests that the introduction of new units in the most densely populated territories (a likely effect of some form of liberalization) would not be detrimental in terms of scale efficiency. We also find that inspection units belonging to a large, diversified firm show higher technical efficiency, reflecting economies of scale or scope at the firm level. Finally, we show that between 2002 and 2004, a period of high regulatory uncertainty in the sample’s region, technical change was almost zero. Regulatory reform should take due account of scale and diversification effects, while at the same time avoiding regulatory uncertainty.Productive Efficiency, Regulatory Reform, Vehicle Inspections.

Productive efficiency and regulatory reform : the case of vehicle inspection services

Measuring productive efficiency provides information on the likely effects of regulatory reform. We present a Data Envelopment Analysis (DEA) of a sample of 38 vehicle inspection units under a concession regime, between the years 2000 and 2004. The differences in efficiency scores show the potential technical efficiency benefit of introducing some form of incentive regulation or of progressing towards liberalization. We also compute scale efficiency scores, showing that only units in territories with very low population density operate at a sub-optimal scale. Among those that operate at an optimal scale, there are significant differences in size; the largest ones operate in territories with the highest population density. This suggests that the introduction of new units in the most densely populated territories (a likely effect of some form of liberalization) would not be detrimental in terms of scale efficiency. We also find that inspection units belonging to a large, diversified firm show higher technical efficiency, reflecting economies of scale or scope at the firm level. Finally, we show that between 2002 and 2004, a period of high regulatory uncertainty in the sample's region, technical change was almost zero. Regulatory reform should take due account of scale and diversification effects, while at the same time avoiding regulatory uncertainty

WHY FUZZY ANALYTIC HIERARCHY PROCESS APPROACH FOR TRANSPORT PROBLEMS?

The evaluation of transport projects has become increasingly complex. Different aspects have to be taken into account and the consequences of the problems are usually far reaching and the different policy alternatives are numerous and difficult to predict. Several pressure or action groups have also emerged causing an even more complex decision making process. The use of multi criteria analysis for the evaluation of transport projects has increased due to this increasing complexity of the problem situation. At the same time, the importance of stakeholders within this evaluation process should have been recognized. Researches on transport projects are generally carried out to provide information to policymakers that have to operate within restrictive parameters (political, economical, social, etc…). Researchers should therefore take greater account of the different priorities of stakeholders such as policymakers, private enterprises and households. These stakeholders should be incorporated explicitly in the evaluation process. The Analytic Hierarchy Process is one of the Fuzzy Multiple Criteria Decision Making methods. It can be applied in a very broad range of applications of decision problems. Logistics, urban planning, public politics, marketing, finance, education, economics are a part of this wide application area. In transport subjects it can be used for the evaluation of transport policy measures or decision making problems. Due to its wide range application area, it has been an exciting research subject for many different field researchers. The aim of this paper is to introduce AHP method and to offer how to benefit it for the preference of urban planners in transport problems. This paper is composed of two main parts. First part consists of the literature survey regarding with the AHP and its application areas. The advantage of methods had been mentioned. Second part focuses on a sample application of AHP technique. The study uses AHP technique to determine the selection criteria in the transhipment port selection decision-making process. Keywords: Analytic Hierarchy Process, Multi criteria analysis, Transshipment port selection.

Domestic violence in Australia: interim report

One in three Australian women have experienced physical violence since the age of 15 and almost one in five have experienced sexual violence.  A study of Victorian women demonstrated that domestic violence is the leading preventable contributor to death, disability and illness in women aged between 15 and 44, and is responsible for more of the disease burden than many well-known risk factors such as high blood pressure, smoking and obesity.  The emotional and personal costs of domestic violence in our community are enormous. Violence affects the victims themselves, children who are exposed6 to violence, extended families, friends, work colleagues and the broader community. The committee acknowledges these emotional and personal costs as well as the enormous economic cost of domestic violence. A study commissioned by the commonwealth government notes that the yearly cost of domestic violence in Australia in 2008-09 was $13.6 billion and the cost is increasing.   Senate Finance and Public Administration Committee Members Senator the Hon Kate Lundy (Chair) Senator Cory Bernardi (Deputy Chair) Senator John Faulkner (until 6 February 2015) Senator Claire Moore (from 12 February 2015) Senator Joseph Ludwig Senator Dean Smith Senator Janet Rice Substitute Member Senator Larissa Waters (replaced Senator Janet Rice) Participating Members Senator Claire Moore (until 12 February 2015) Senator Penny Wong Senator Nova Peris Secretariat: Ms Lyn Beverley (Secretary) Ms Ann Palmer (Principal Research Officer) Mr Nicholas Craft (Senior Research Officer) Ms Margaret Cahill (Research Officer) Ms Sarah Brasser (Administrative Officer

Prioritization of patients' access to health care services

L'accès aux services de santé et les longs délais d'attente sont l’un des principaux problèmes dans la plupart des pays du monde, dont le Canada et les États-Unis. Les organismes de soins de santé ne peuvent pas augmenter leurs ressources limitées, ni traiter tous les patients simultanément. C'est pourquoi une attention particulière doit être portée à la priorisation d'accès des patients aux services, afin d’optimiser l’utilisation de ces ressources limitées et d’assurer la sécurité des patients. En fait, la priorisation des patients est une pratique essentielle, mais oubliée dans les systèmes de soins de santé à l'échelle internationale. Les principales problématiques que l’on retrouve dans la priorisation des patients sont: la prise en considération de plusieurs critères conflictuels, les données incomplètes et imprécises, les risques associés qui peuvent menacer la vie des patients durant leur mise sur les listes d'attente, les incertitudes présentes dans les décisions des cliniciens et patients, impliquant l'opinion des groupes de décideurs, et le comportement dynamique du système. La priorisation inappropriée des patients en attente de traitement a une incidence directe sur l’inefficacité des prestations de soins de santé, la qualité des soins, et surtout sur la sécurité des patients et leur satisfaction. Inspirés par ces faits, dans cette thèse, nous proposons de nouveaux cadres hybrides pour prioriser les patients en abordant un certain nombre de principales lacunes aux méthodes proposées et utilisées dans la littérature et dans la pratique. Plus précisément, nous considérons tout d'abord la prise de décision collective incluant les multiples critères de priorité, le degré d'importance de chacun de ces critères et de leurs interdépendances dans la procédure d'établissement des priorités pour la priorisation des patients. Puis, nous travaillons sur l'implication des risques associés et des incertitudes présentes dans la procédure de priorisation, dans le but d'améliorer la sécurité des patients. Enfin, nous présentons un cadre global en se concentrant sur tous les aspects mentionnés précédemment, ainsi que l'implication des patients dans la priorisation, et la considération des aspects dynamiques du système dans la priorisation. À travers l'application du cadre global proposé dans le service de chirurgie orthopédique à l'hôpital universitaire de Shohada, et dans un programme clinique de communication augmentative et alternative appelé PACEC à l'Institut de réadaptation en déficience physique de Québec (IRDPQ), nous montrons l'efficacité de nos approches en les comparant avec celles actuellement utilisées. Les résultats prouvent que ce cadre peut être adopté facilement et efficacement dans différents organismes de santé. Notamment, les cliniciens qui ont participé à l'étude ont conclu que le cadre produit une priorisation précise et fiable qui est plus efficace que la méthode de priorisation actuellement utilisée. En résumé, les résultats de cette thèse pourraient être bénéfiques pour les professionnels de la santé afin de les aider à: i) évaluer la priorité des patients plus facilement et précisément, ii) déterminer les politiques et les lignes directrices pour la priorisation et planification des patients, iii) gérer les listes d'attente plus adéquatement, vi) diminuer le temps nécessaire pour la priorisation des patients, v) accroître l'équité et la justice entre les patients, vi) diminuer les risques associés à l’attente sur les listes pour les patients, vii) envisager l'opinion de groupe de décideurs dans la procédure de priorisation pour éviter les biais possibles dans la prise de décision, viii) impliquer les patients et leurs familles dans la procédure de priorisation, ix) gérer les incertitudes présentes dans la procédure de prise de décision, et finalement x) améliorer la qualité des soins.Access to health care services and long waiting times are one of the main issues in most of the countries including Canada and the United States. Health care organizations cannot increase their limited resources nor treat all patients simultaneously. Then, patients’ access to these services should be prioritized in a way that best uses the scarce resources, and to ensure patients’ safety. In fact, patients’ prioritization is an essential but forgotten practice in health care systems internationally. Some challenging aspects in patients’ prioritization problem are: considering multiple conflicting criteria, incomplete and imprecise data, associated risks that threaten patients on waiting lists, uncertainties in clinicians’ decisions, involving a group of decision makers’ opinions, and health system’s dynamic behavior. Inappropriate prioritization of patients waiting for treatment, affects directly on inefficiencies in health care delivery, quality of care, and most importantly on patients’ safety and their satisfaction. Inspired by these facts, in this thesis, we propose novel hybrid frameworks to prioritize patients by addressing a number of main shortcomings of current prioritization methods in the literature and in practice. Specifically, we first consider group decision-making, multiple prioritization criteria, these criteria’s importance weights and their interdependencies in the patients’ prioritization procedure. Then, we work on involving associated risks that threaten patients on waiting lists and handling existing uncertainties in the prioritization procedure with the aim of improving patients’ safety. Finally, we introduce a comprehensive framework focusing on all previously mentioned aspects plus involving patients in the prioritization, and considering dynamic aspects of the system in the patients’ prioritization. Through the application of the proposed comprehensive framework in the orthopedic surgery ward at Shohada University Hospital, and in an augmentative and alternative communication (AAC) clinical program called PACEC at the Institute for Disability Rehabilitation in Physics of Québec (IRDPQ), we show the effectiveness of our approaches comparing the currently used ones. The implementation results prove that this framework could be adopted easily and effectively in different health care organizations. Notably, clinicians that participated in the study concluded that the framework produces a precise and reliable prioritization that is more effective than the currently in use prioritization methods. In brief, the results of this thesis could be beneficial for health care professionals to: i) evaluate patients’ priority more accurately and easily, ii) determine policies and guidelines for patients’ prioritization and scheduling, iii) manage waiting lists properly, vi) decrease the time required for patients’ prioritization, v) increase equity and justice among patients, vi) diminish risks that could threaten patients during waiting time, vii) consider all of the decision makers’ opinions in the prioritization procedure to prevent possible biases in the decision-making procedure, viii) involve patients and their families in the prioritization procedure, ix) handle available uncertainties in the decision-making procedure, and x) increase quality of care