59 research outputs found
Physicians' Multitasking and Incentives: Empirical Evidence from a Natural Experiment
We analyse how physicians respond to contractual changes and incentives within a multitasking environment. In 1999 the Quebec government (Canada) introduced an optional mixed compensation system, combining a fixed per diem with a discounted (relative to the traditional fee-for-service system) fee for services provided. We combine panel survey and administrative data on Quebec physicians to evaluate the impact of this change in incentives on their practice choices. We highlight the differentiated impact of incentives on various dimensions of physician behaviour by considering a wide range of labour supply variables: time spent on seeing patients, time devoted to teaching, administrative tasks or research, as well as the volume of clinical services and average time per clinical service. Our results show that, on average, the reform induced physicians who changed from FFS to MC to reduce their volume of (billable) services by 6.15% and to reduce their hours of work spent on seeing patients by 2.57%. Their average time spent per service increased by 3.58%, suggesting a potential quality-quantity substitution. Also the reform induced these physicians to increase their time spent on teaching and administrative duties (tasks not remunerated under the fee-for-service system) by 7.9%.Physician payment mechanisms, multitasking, mixed-payment systems, incentive contracts, labour supply, self-selection, panel estimation
Physicians' Multitasking and Incentives: Empirical Evidence from a Natural Experiment
We analyse how physicians respond to contractual changes and incentives within a multitasking environment. In 1999 the Quebec government (Canada) introduced an optional mixed compensation system, combining a xed per diem with a partial (relative to the traditional fee-for-service system) fee for services provided. We combine panel survey and administrative data on Quebec physicians to evaluate the impact of this change in incentives on their practice choices. We highlight the dierentiated impact of incentives on various dimensions of physician behaviour by considering a wide range of labour supply variables: time spent on seeing patients, time devoted to teaching, administrative tasks or research, as well as the volume of clinical services and average time per clinical service. Our results show that, on average, the reform induced physicians who changed from FFS to MC to reduce their volume of (billable) services by 6.15% and to reduce their hours of work spent on seeing patients by 2.57%. Their average time spent per service increased by 3.58%, suggesting a potential quality-quantity substitution. Also the reform induced these physicians to increase their time spent on teaching and administrative duties (tasks not remunerated under the fee-for-service system) by 7.9%.physician payment mechanisms; multitasking; mixed-payment systems; incentive contracts; labour supply; self-selection; panel estimation
Physiciansâ Multitasking and Incentives: Empirical Evidence from a Natural Experiment
We analyse how physicians respond to contractual changes and incentives within a multitasking environment. In 1999 the Quebec government (Canada) introduced an optional mixed compensation (MC) system, combining a fixed per diem with a partial (relative to the traditional fee-for-service system) fee for services provided. We combine panel survey and administrative data on Quebec physicians to evaluate the impact of this change in incentives on their practice choices. We highlight the differentiated impact of incentives on various dimensions of physician behaviour by considering a wide range of labour supply variables: time spent on seeing patients, time devoted to teaching, administrative tasks or research, as well as the volume of clinical services and average time per clinical service. Our results show that, on average, the reform induced physicians who changed from FFS to MC to reduce their volume of (billable) services by 6.15% and to reduce their hours of work spent on seeing patients by 2.57%. Their average time spent per service increased by 3.81%, suggesting a potential quality-quantity substitution. Also the reform induced these physicians to increase their time spent on teaching and administrative duties (tasks not remunerated under the fee-for-service system) by 7.9%. En 1999, le ministĂšre de la SantĂ© et des Services Sociaux du QuĂ©bec introduisait un mode de rĂ©munĂ©ration mixte optionnel pour rĂ©munĂ©rer lâactivitĂ© hospitaliĂšre des mĂ©decins spĂ©cialistes. Ce mode combine une rĂ©munĂ©ration forfaitaire pour chaque jour de travail (per diem ou demi per diem) et une rĂ©munĂ©ration partielle Ă lâacte sâexprimant en un pourcentage du tarif habituellement applicable pour un service donnĂ©. Cette Ă©tude jumelle en panel des donnĂ©es de sondage du CollĂšge des MĂ©decins du QuĂ©bec et des donnĂ©es administratives de la RĂ©gie de lâassurance maladie du QuĂ©bec pour Ă©valuer lâimpact de ce mode de rĂ©munĂ©ration sur les choix de pratique des spĂ©cialistes. Nous mettons lâaccent sur lâeffet de la rĂ©munĂ©ration mixte sur plusieurs dimensions du comportement professionnel du mĂ©decin : heures consacrĂ©es aux patients, heures consacrĂ©es Ă lâenseignement, aux activitĂ©s mĂ©dicales administratives et Ă la recherche, volume de services mĂ©dicaux et temps moyen par service mĂ©dical. Nos rĂ©sultats montrent que lâintroduction de la rĂ©munĂ©ration mixte a incitĂ© les mĂ©decins qui sont passĂ©s de la rĂ©munĂ©ration Ă lâacte Ă la rĂ©munĂ©ration mixte Ă rĂ©duire leur nombre de services mĂ©dicaux (facturables) de 6,15 % et Ă rĂ©duire leurs heures de travail consacrĂ©es aux patients de 2,57 %. En revanche, le temps moyen par service mĂ©dical sâest accru de 3,81 %, ce qui peut suggĂ©rer une substitution entre la quantitĂ© et la qualitĂ© des services. La rĂ©forme a aussi incitĂ© ces mĂ©decins Ă accroĂźtre le temps consacrĂ© Ă lâenseignement et aux activitĂ©s mĂ©dicales administratives (activitĂ©s non rĂ©munĂ©rĂ©es par la rĂ©munĂ©ration Ă lâacte) de 7,9 %. En outre, le temps consacrĂ© par ces mĂ©decins Ă la recherche (activitĂ© non rĂ©munĂ©rĂ©e par lâun ou lâautre des modes de rĂ©munĂ©ration) a diminuĂ© de 14,7 %. Enfin, le revenu des mĂ©decins qui sont passĂ©s Ă la rĂ©munĂ©ration mixte sâest accru de 8,05 %, indiquant quâil Ă©tait financiĂšrement rentable pour ceux-ci de choisir ce mode de rĂ©munĂ©ration.physician payment mechanisms, multitasking, mixed-payment systems, incentive contracts, labour supply, self-selection, panel estimation., mĂ©canismes de rĂ©munĂ©ration des mĂ©decins, fonctionnement multitĂąche, rĂ©munĂ©ration mixte, contrats incitatifs, offre de travail, auto-sĂ©lection, estimation en panel
Pourquoi vient-on voir lâEverest ? ReprĂ©sentations collectives et pratiques touristiques dans la rĂ©gion du Khumbu
Beyond a simple fascination with the height of the summit itself, this article aims to explore the various sources of motivation that lead tens of thousands of visitors to come to the Everest (Khumbu) region of Nepal every year. Drawing on an analysis of collective representations by tourists, this article will show that the Khumbu region combines various principles of heterotopias (Foucault, 1967). This region, long unexplored and closed to outsiders, and its landscapes infused with religiosity, attracts tourists because it is still largely seen as a genuine lost paradise. These elements are conducive to the processes of physical and mental renewal, in addition to social distinction which allows trekkers âin a more or less conscious, temporary, or performance-based mannerâ to push themselves to their limits. The popularity and increasing openness of the Everest region and its inhabitants to globalisation, which could theoretically call into question the meaning and very principles of this heterotopia, do not seem to affect the experience of trekkers, despite the fact that their practices are based on a complete break with the places and time frames of their everyday life
The Sherpa community in the âYak Donaldâsâ era : Locational struggles for access to resources in Mount Everest touristic region (Nepal)
Au-delĂ des reprĂ©sentations et des pratiques des alpinistes et trekkeurs, toujours plus nombreux, les conditions du dĂ©veloppement et de la pĂ©rennisation du systĂšme touristique associĂ©es Ă la rĂ©gion nĂ©palaise de lâEverest â le Khumbu â semblent de plus en plus reposer sur la valorisation de ressources comme lâeau, lâĂ©lectricitĂ© et lâemplacement foncier. Source de revenus considĂ©rables pour les populations locales, et plus particuliĂšrement pour les hĂ©bergeurs touristiques, lâaccĂšs Ă ces diffĂ©rentes ressources ne va pourtant pas de soi. Tous les acteurs nâoccupent pas les mĂȘmes positions, ni ne possĂšdent les mĂȘmes moyens pour les valoriser. Cet accĂšs aux ressources, et par extension Ă de nouvelles positions socio-spatiales, donne lieu Ă de multiples stratĂ©gies fondĂ©es sur les capitaux, compĂ©tences et intĂ©rĂȘts de chacun. Dans cette petite rĂ©gion, nĂ©anmoins hautement symbolique, ces stratĂ©gies dâaccĂšs aboutissent Ă une lutte des places entre dâune part les membres de la communautĂ© sherpa â qui revendiquent une position dâinsiders mais se dĂ©ploient Ă lâextĂ©rieur du Khumbu par des modes dâhabiter trĂšs polytopiques â, et dâautre part, de nouvelles populations originaires des basses vallĂ©es, en position dâoutsiders, qui cherchent Ă sây implanter. Dans le contexte dâun espace de plus en plus ouvert sur le monde, en pleine recomposition sociodĂ©mographique et culturelle, ce quâincarne le « Yak Donaldâs » â lâun des nombreux nouveaux pubs implantĂ©s dans la rĂ©gion â, se pose ainsi la question du partage et de la gouvernance des ressources et des revenus de ce haut-lieu du tourisme. Loin dâĂȘtre passifs, mais plutĂŽt Ă lâorigine de ces nouvelles dynamiques, cette thĂšse montre comment les manipulateurs de symboles sherpas contrĂŽlent encore largement le territoire et lâĂ©conomie du tourisme.Beyond the representations and practices of mountaineers and trekkers, conditions for the development and functioning of the touristic system linked to the Nepalese Mount Everest area (the Khumbu region) seem to be increasingly based upon resources such as water, electricity and property. With the rise of tourism, these various resources are source of considerable incomes for local populations, especially for lodge owners. However, sharing these resources is not simple. First, the different actors do not occupy the same positions in relation to them. Second, they donât have the same capacities (i.e., capital and skills) to exploit them. Eventually, they do not have the same interests depending on their social status, so their cooperation is not always guaranteed. In this small but highly symbolic region, local access to resources leads to âlocational strugglesâ (Lussault, 2009). This struggle opposes members of the Sherpa community - who claim to be deeply rooted inhabitants, but whose ways of life are very polytopic â and on the other hand, new populations from the lower valleys, who seek to establish themselves within the Khumbu region. In the context of intense interrelations with the rest of the world, as well as wide socio-demographic and cultural changes, which is embodied in one of the many new pubs established in the region; the "Yak Donald's", this questions the good resources governance of this tourist hub. Far from being passive, but rather very proactive, this thesis shows how the Sherpas still control the territory and its touristic economy
The Sherpa community in the âYak Donaldâsâ era : Locational struggles for access to resources in Mount Everest touristic region (Nepal)
Au-delĂ des reprĂ©sentations et des pratiques des alpinistes et trekkeurs, toujours plus nombreux, les conditions du dĂ©veloppement et de la pĂ©rennisation du systĂšme touristique associĂ©es Ă la rĂ©gion nĂ©palaise de lâEverest â le Khumbu â semblent de plus en plus reposer sur la valorisation de ressources comme lâeau, lâĂ©lectricitĂ© et lâemplacement foncier. Source de revenus considĂ©rables pour les populations locales, et plus particuliĂšrement pour les hĂ©bergeurs touristiques, lâaccĂšs Ă ces diffĂ©rentes ressources ne va pourtant pas de soi. Tous les acteurs nâoccupent pas les mĂȘmes positions, ni ne possĂšdent les mĂȘmes moyens pour les valoriser. Cet accĂšs aux ressources, et par extension Ă de nouvelles positions socio-spatiales, donne lieu Ă de multiples stratĂ©gies fondĂ©es sur les capitaux, compĂ©tences et intĂ©rĂȘts de chacun. Dans cette petite rĂ©gion, nĂ©anmoins hautement symbolique, ces stratĂ©gies dâaccĂšs aboutissent Ă une lutte des places entre dâune part les membres de la communautĂ© sherpa â qui revendiquent une position dâinsiders mais se dĂ©ploient Ă lâextĂ©rieur du Khumbu par des modes dâhabiter trĂšs polytopiques â, et dâautre part, de nouvelles populations originaires des basses vallĂ©es, en position dâoutsiders, qui cherchent Ă sây implanter. Dans le contexte dâun espace de plus en plus ouvert sur le monde, en pleine recomposition sociodĂ©mographique et culturelle, ce quâincarne le « Yak Donaldâs » â lâun des nombreux nouveaux pubs implantĂ©s dans la rĂ©gion â, se pose ainsi la question du partage et de la gouvernance des ressources et des revenus de ce haut-lieu du tourisme. Loin dâĂȘtre passifs, mais plutĂŽt Ă lâorigine de ces nouvelles dynamiques, cette thĂšse montre comment les manipulateurs de symboles sherpas contrĂŽlent encore largement le territoire et lâĂ©conomie du tourisme.Beyond the representations and practices of mountaineers and trekkers, conditions for the development and functioning of the touristic system linked to the Nepalese Mount Everest area (the Khumbu region) seem to be increasingly based upon resources such as water, electricity and property. With the rise of tourism, these various resources are source of considerable incomes for local populations, especially for lodge owners. However, sharing these resources is not simple. First, the different actors do not occupy the same positions in relation to them. Second, they donât have the same capacities (i.e., capital and skills) to exploit them. Eventually, they do not have the same interests depending on their social status, so their cooperation is not always guaranteed. In this small but highly symbolic region, local access to resources leads to âlocational strugglesâ (Lussault, 2009). This struggle opposes members of the Sherpa community - who claim to be deeply rooted inhabitants, but whose ways of life are very polytopic â and on the other hand, new populations from the lower valleys, who seek to establish themselves within the Khumbu region. In the context of intense interrelations with the rest of the world, as well as wide socio-demographic and cultural changes, which is embodied in one of the many new pubs established in the region; the "Yak Donald's", this questions the good resources governance of this tourist hub. Far from being passive, but rather very proactive, this thesis shows how the Sherpas still control the territory and its touristic economy
The Sherpa community in the âYak Donaldâsâ era : Locational struggles for access to resources in Mount Everest touristic region (Nepal)
Au-delĂ des reprĂ©sentations et des pratiques des alpinistes et trekkeurs, toujours plus nombreux, les conditions du dĂ©veloppement et de la pĂ©rennisation du systĂšme touristique associĂ©es Ă la rĂ©gion nĂ©palaise de lâEverest â le Khumbu â semblent de plus en plus reposer sur la valorisation de ressources comme lâeau, lâĂ©lectricitĂ© et lâemplacement foncier. Source de revenus considĂ©rables pour les populations locales, et plus particuliĂšrement pour les hĂ©bergeurs touristiques, lâaccĂšs Ă ces diffĂ©rentes ressources ne va pourtant pas de soi. Tous les acteurs nâoccupent pas les mĂȘmes positions, ni ne possĂšdent les mĂȘmes moyens pour les valoriser. Cet accĂšs aux ressources, et par extension Ă de nouvelles positions socio-spatiales, donne lieu Ă de multiples stratĂ©gies fondĂ©es sur les capitaux, compĂ©tences et intĂ©rĂȘts de chacun. Dans cette petite rĂ©gion, nĂ©anmoins hautement symbolique, ces stratĂ©gies dâaccĂšs aboutissent Ă une lutte des places entre dâune part les membres de la communautĂ© sherpa â qui revendiquent une position dâinsiders mais se dĂ©ploient Ă lâextĂ©rieur du Khumbu par des modes dâhabiter trĂšs polytopiques â, et dâautre part, de nouvelles populations originaires des basses vallĂ©es, en position dâoutsiders, qui cherchent Ă sây implanter. Dans le contexte dâun espace de plus en plus ouvert sur le monde, en pleine recomposition sociodĂ©mographique et culturelle, ce quâincarne le « Yak Donaldâs » â lâun des nombreux nouveaux pubs implantĂ©s dans la rĂ©gion â, se pose ainsi la question du partage et de la gouvernance des ressources et des revenus de ce haut-lieu du tourisme. Loin dâĂȘtre passifs, mais plutĂŽt Ă lâorigine de ces nouvelles dynamiques, cette thĂšse montre comment les manipulateurs de symboles sherpas contrĂŽlent encore largement le territoire et lâĂ©conomie du tourisme.Beyond the representations and practices of mountaineers and trekkers, conditions for the development and functioning of the touristic system linked to the Nepalese Mount Everest area (the Khumbu region) seem to be increasingly based upon resources such as water, electricity and property. With the rise of tourism, these various resources are source of considerable incomes for local populations, especially for lodge owners. However, sharing these resources is not simple. First, the different actors do not occupy the same positions in relation to them. Second, they donât have the same capacities (i.e., capital and skills) to exploit them. Eventually, they do not have the same interests depending on their social status, so their cooperation is not always guaranteed. In this small but highly symbolic region, local access to resources leads to âlocational strugglesâ (Lussault, 2009). This struggle opposes members of the Sherpa community - who claim to be deeply rooted inhabitants, but whose ways of life are very polytopic â and on the other hand, new populations from the lower valleys, who seek to establish themselves within the Khumbu region. In the context of intense interrelations with the rest of the world, as well as wide socio-demographic and cultural changes, which is embodied in one of the many new pubs established in the region; the "Yak Donald's", this questions the good resources governance of this tourist hub. Far from being passive, but rather very proactive, this thesis shows how the Sherpas still control the territory and its touristic economy
Why Do People Come to See Mount Everest? Collective Representations and Tourism Practices in the Khumbu Region
Beyond a simple fascination with the height of the summit itself, this article aims to explore the various sources of motivation that lead tens of thousands of visitors to come to the Everest (Khumbu) region of Nepal every year. Drawing on an analysis of collective representations by tourists, this article will show that the Khumbu region combines various principles of heterotopias (Foucault, 1967). This region, long unexplored and closed to outsiders, and its landscapes infused with religiosity, attracts tourists because it is still largely seen as a genuine lost paradise. These elements are conducive to the processes of physical and mental renewal, in addition to social distinction which allows trekkers âin a more or less conscious, temporary, or performance-based mannerâ to push themselves to their limits. The popularity and increasing openness of the Everest region and its inhabitants to globalisation, which could theoretically call into question the meaning and very principles of this heterotopia, do not seem to affect the experience of trekkers, despite the fact that their practices are based on a complete break with the places and time frames of their everyday life
Inventing the new Khumbu: the "Yak Donald's" and the Sherpa society
Vendue par les tour-opĂ©rateurs comme le « vĂ©ritable pays Sherpa » ou comme une « chaĂźne de montagnes mythiques, longtemps interdites aux Ă©trangers », la rĂ©gion nĂ©palaise de lâEverest (le Khumbu), fonde son attractivitĂ© touristique sur lâimage dâune sociĂ©tĂ© et dâun cadre naturel authentiques. Depuis vingt ans, le dĂ©veloppement du tourisme, de lâĂ©lectricitĂ© et des mobilitĂ©s participe nĂ©anmoins Ă la montĂ©e en gamme et Ă la diversification des structures dâaccueil touristiques. Dans certains villages, ce dĂ©veloppement donne naissance Ă de nouveaux lieux et Ă de nouvelles pratiques nimbĂ©s de rĂ©fĂ©rences plus ou moins facĂ©tieuses aux symboles de la culture locale et globale : apparition de « Comfort Inn », de « Yak Donaldâs » ou autre « Starbuck Coffee ». Loin de ne rĂ©pondre quâĂ la demande des touristes, cette communication souhaite montrer en quoi lâapparition de ces formes dâurbanitĂ©, produites et appropriĂ©es par une partie de la population locale, constituent des innovations sociales spĂ©cifiques et sâintĂšgrent dans des enjeux sociĂ©taux voire politiques plus vastes que leurs seules fins mercantiles.Pressions sur la ressource en eau et en sols dans l'Himalaya nĂ©palaisInnovation and Mountain Territorie
La sociĂ©tĂ© sherpa Ă lâĂšre du « Yak Donaldâs » : lutte des places pour lâaccĂšs aux ressources dans la rĂ©gion touristique de lâEverest (NĂ©pal)
Beyond the representations and practices of mountaineers and trekkers, conditions for the development and functioning of the touristic system linked to the Nepalese Mount Everest area (the Khumbu region) seem to be increasingly based upon resources such as water, electricity and property. With the rise of tourism, these various resources are source of considerable incomes for local populations, especially for lodge owners. However, sharing these resources is not simple. First, the different actors do not occupy the same positions in relation to them. Second, they donât have the same capacities (i.e., capital and skills) to exploit them. Eventually, they do not have the same interests depending on their social status, so their cooperation is not always guaranteed. In this small but highly symbolic region, local access to resources leads to âlocational strugglesâ (Lussault, 2009). This struggle opposes members of the Sherpa community - who claim to be deeply rooted inhabitants, but whose ways of life are very polytopic â and on the other hand, new populations from the lower valleys, who seek to establish themselves within the Khumbu region. In the context of intense interrelations with the rest of the world, as well as wide socio-demographic and cultural changes, which is embodied in one of the many new pubs established in the region; the "Yak Donald's", this questions the good resources governance of this tourist hub. Far from being passive, but rather very proactive, this thesis shows how the Sherpas still control the territory and its touristic economy.Au-delĂ des reprĂ©sentations et des pratiques des alpinistes et trekkeurs, toujours plus nombreux, les conditions du dĂ©veloppement et de la pĂ©rennisation du systĂšme touristique associĂ©es Ă la rĂ©gion nĂ©palaise de lâEverest â le Khumbu â semblent de plus en plus reposer sur la valorisation de ressources comme lâeau, lâĂ©lectricitĂ© et lâemplacement foncier. Source de revenus considĂ©rables pour les populations locales, et plus particuliĂšrement pour les hĂ©bergeurs touristiques, lâaccĂšs Ă ces diffĂ©rentes ressources ne va pourtant pas de soi. Tous les acteurs nâoccupent pas les mĂȘmes positions, ni ne possĂšdent les mĂȘmes moyens pour les valoriser. Cet accĂšs aux ressources, et par extension Ă de nouvelles positions socio-spatiales, donne lieu Ă de multiples stratĂ©gies fondĂ©es sur les capitaux, compĂ©tences et intĂ©rĂȘts de chacun. Dans cette petite rĂ©gion, nĂ©anmoins hautement symbolique, ces stratĂ©gies dâaccĂšs aboutissent Ă une lutte des places entre dâune part les membres de la communautĂ© sherpa â qui revendiquent une position dâinsiders mais se dĂ©ploient Ă lâextĂ©rieur du Khumbu par des modes dâhabiter trĂšs polytopiques â, et dâautre part, de nouvelles populations originaires des basses vallĂ©es, en position dâoutsiders, qui cherchent Ă sây implanter. Dans le contexte dâun espace de plus en plus ouvert sur le monde, en pleine recomposition sociodĂ©mographique et culturelle, ce quâincarne le « Yak Donaldâs » â lâun des nombreux nouveaux pubs implantĂ©s dans la rĂ©gion â, se pose ainsi la question du partage et de la gouvernance des ressources et des revenus de ce haut-lieu du tourisme. Loin dâĂȘtre passifs, mais plutĂŽt Ă lâorigine de ces nouvelles dynamiques, cette thĂšse montre comment les manipulateurs de symboles sherpas contrĂŽlent encore largement le territoire et lâĂ©conomie du tourisme
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