Fiscal equalisation in Australia: proposals for an efficiency-based system

We argue that Australian equalisation should be driven by efficiency concerns. To this end, we propose an efficiency-based equalisation model and argue that, if implemented, this model would yield welfare gains in all States, relative to the status quo. Our model is also shown to yield superior welfare outcomes to an equal per capita allocation model (as proposed by some researchers to replace the existing model). The conclusion notes that given the magnitude of the resources involved, and the on-going concerns over equalisation, efficiency and equity, there is a case for a comprehensive and impartial review of the Australian grant system, including the equalisation methodology

Predicting the Need for Ventilation in Term and Near-Term Neonates

To determine whether the need for respiratory support can be predicted by oxygen requirement within the first 72 h in term and near-term infants. Methods: To mimic the population of infants that would often be delivered outside a tertiary centre we studied a retrospective cohort of infants greater than or equal to 32 weeks requiring oxygen, divided into three groups: cot oxygen only, nasal continuous positive airway pressure (NCPAP) only, or intermittent positive pressure ventilation (IPPV). We recorded each infant's peak fraction of inspired oxygen (FiO2) - i.e. FiO 2 in the first 72 h in the cot oxygen only group or maximum FiO2 prior to commencing the highest level of respiratory support. The peak FiO2 was used as a diagnostic test to predict any respiratory support or IPPV-sensitivity and specificity were calculated and receiver operating characteristic (ROC) curves plotted (FiO2 0.21-1.00) to identify the best balance point for prediction. Results: The cohort included 592 infants: 516 cot oxygen only, 46 NCPAP only and 30 IPPV. The proportion ventilated increased with increasing peak FiO2 - above 0.45 the proportion of infants ventilated exceeded 50%. To predict any respiratory support, the cut-point balancing sensitivity and specificity was a FiO2 greater than or equal to 0.35-58/136 required respiratory support (sensitivity = 0.76, specificity = 0.85, positive predictive value (PPV) = 43%, negative predictive value (NPV) = 96%). To predict IPPV the cut-point was a FiO2 greater than or equal to 0.5-28/47 treated with IPPV (sensitivity = 0.93, specificity = 0.97, PPV = 60%, NPV = 100%). Conclusion: The need for respiratory support can be predicted by oxygen requirement within the first 72 h in term and near-term infants with reasonable sensitivity and excellent specificity

Assessing relative spending needs of devolved government: the case of healthcare spending in the UK

The system used to allocate resources to the UK's devolved territories, known as the Barnett formula, takes no account of the relative expenditure needs of the territories. In this paper we investigate the prospects of developing a needs based model for allocating healthcare resources to Scotland, Wales and Northern Ireland. We compare the method used by the National Health Service in England to allocate resources geographically within England with the method used by the NHS in Scotland to allocate resources to territorial Health Boards. By applying both approaches to the UK's devolved territories, we are able to examine similarities and differences in the two methods, and explore implications for an assessment of the relative healthcare expenditure need of each territory. The implications for the way in which revenue is distributed to Wales, Scotland and Northern Ireland are discussed

A note on political factors in federal fiscal arrangements in Australia

The Commonwealth Grants Commission represents a sophisticated institutional method of dealing with the problem of horizontal fiscal imbalances in Australia, which has managed to combine equity and efficiency considerations without untoward political bias. By contrast, the problem of vertical imbalance has been addressed by specific purpose payments, which are much more amenable to party political calculation, and can thus be employed to maximise electoral support. This note briefly reviews public finance and public choice models of intergovernmental grant determination and shows that a public choice perspective can shed at least some light on how party political factors may influence grants like specific purpose payments