Precautionary credit lines: A means to contain contagion in financial markets?

The liberalization of capital accounts and the integration of financial markets in recent years have helped to spur growth in many emerging markets and have allowed global investors to diversify risks internationally. Furthermore, increased capita! mobility has helped to tame governments in their fiscal and monetary policies. Nevertheless, the Asian currency and financial crisis and its aftermath have revealed structural problems on the national as well as on the international level and have imposed significant costs on emerging markets as well as on the world economy. • Triggered by these developments, a broad international consensus has emerged to support reforms to strengthen the international financial system. The aim of these reforms will be to create an international financial system that captures the benefits of open and integrated financial markets, and at the same time minimizes the risk of financial crises to emerge and spread to other countries. While the former refers to the need for greater transparency, accountability and prudential regulation, the latter is concerned with the improvement of existing and the creation of new mechanisms for the prevention and resolution of financial crises. International institutions such as the IMF can contribute to the stability of the international financial system. A prominent proposal initially raised by the Clinton administration in fall 1998 designs the creation of a new crisis facility of the IMF to prevent contagion in financial markets. On its recent meeting of April 23, the IMF's Executive Board agreed to provide Contingent Credit Lines for its member countries. The goal of such a facility is to provide preventive credit lines to countries whose economies are fundamentally sound, but which are threatened by financial market contagion and which may lose access to capital markets. In the absence of contagion, these countries should therefore be able to rely on a sustained flow of capital from abroad. The new facility gives rise to a number of questions. First, the distinction between countries in need of ex ante policy adjustments and countries that follow sound economic policies, i.e., the eligibility for the new facility, must be resolved in advance. Second, projections about the likely financial requirements of such a facility and the consequences for the Fund's liquidity position are needed. Another issue relates to the question whether and how private and bilateral creditors should be involved in this new facility. Finally, there is a need for clear guidelines about the terms and conditions that would apply to this new facility. However, as shown in the paper, it will prove difficult to fulfill these criteria and to avoid additional problems related to a precautionary credit line. Based on this skeptical judgment, the paper explores a number of alternative means to foster the stability of the international financial system through a better involvement of private sector creditors. This could be achieved through the introduction of option-type mechanisms that would allow debtors to trigger liquidity support in the case of a crisis. A more radical approach would involve limits to creditors in cases when they would like to reduce their short-term exposure. Another avenue would comprise a reorganization of private claims, either by modifying bond contracts or by adapting bankruptcy procedures. The main task for policy makers, however, remains to increase transparency and improve supervision in financial markets and to pursue sound economic policies

The labor market performance of first-generation immigrants: Evidence for Switzerland

This paper is concerned with the study of the labor market performance of immigrants. The unemployment rate is used as an indicator and natives as the reference group for the analysis. The analysis proceeds in two steps. In a first step, probit regressions on the unemployment probabilities are estimated for the pooled crosssection of 1991 and 1995, taking into account nationality- and gender-specific differences. In a second step, and based on the finding that unemployment rates usually differ significantly across sectors, the asymmetry in the sectoral distribution of immigrants with respect to natives is assessed. The empirical results indicate that Swiss and males exhibit significantly lower unemployment probabilities than immigrants and females. Furthermore, immigrants from Non-European countries have not only a higher unemployment probability than natives, but also the largest asymmetry in the employment structure

Endowment or Discrimination? An Analysis of Immigrant-Native Earnings Differentials in Switzerland

Recent studies have shown that there are significant earnings differentials between immigrants and natives in Switzerland. The goal of this paper is to determine whether these differences can be attributed to diverging socio-economic endowments or to discrimination. We use the well-known econometric technique, developed by Oaxaca (1973) and Blinder (1973), to determine the extent of discrimination. As data on earnings are available only for employed, we adopt a two-stage Heckman procedure to correct for sample-selection bias. Our analysis is based on data from the 1995 wave of the Swiss Labor Force Survey (SLFS). The decomposition of the earnings differential reveals that the discrimination effect plays a more important role in the explanation of the earnings differential than the endowment effect

Empirical Findings on the Swiss Migration Experience

Switzerland has experienced a substantial influx of immigrants over the last 50 years after World War II, which has led Switzerland to have among the highest share of foreigners in population among all OECD countries. This paper analyses the migration experience of Switzerland. The analysis centres around two main issues: the economic effects of migration and the labour market performance of immigrants. Two main results emerge from our study. First, as a result of the shortcomings of the Swiss migration policy, immigrants tend to have a negative impact on the Swiss economy. Second, the analysis of the labour market performance shows that there are substantial discrepancies in the performance between immigrants from different countries of origin. Immigrants from Northern European countries largely outperform immigrants from Southern European and Non-European countries. On the basis of the empirical analysis, this study finally outlines some reform options for the Swiss migration policy

Domestic and Foreign Banks in Germany: Do They Differ?

The German banking market is notorious for its low degree of market penetration by foreign financial institutions, suggesting that markets serviced by domestic and foreign banks are segmented. This paper employs a number of tests to determine whether activities of domestic and foreign banks are related. Using data for the years 1986-1999, we fail to find evidence for similarities in the activities of domestic and foreign banks. This holds across the two types of domestic banks (large and savings banks) and across four different activities (loans and deposits of banks and non-banks) considered

Endogenous Constitutions: Politics and Politicians Matter, Economic Outcomes Don’t

We study changes in the form of government as an example of endogenously determined constitutions. For a sample of 202 countries over the period 1950-2006, we find that most changes are relatively small and roughly equally likely to be either in the direction of more parliamentarian or more presidential systems. Based on a fixed effects ordered logit panel data model estimated over the period 1951-2000 for 146 countries, we find that such changes in the constitution can be explained by characteristics of the political system, internal and external political conflicts, and political leaders, whereas economic and socio-demographic variables do not matter

Mapping Constitutionally Safeguarded Judicial Independence — A Global Survey

De jure judicial independence (JI) is the single most important predictor of de facto JI. In this paper, we describe under what conditions countries are likely to include JI in their constitutions. We describe and analyze both their original choice in this regard as well as change over time using a newly constructed dataset comprised of 100 countries and covering the years between 1950 and 2005. Three results stand out. First, legal origins do have an impact on the likelihood of explicitly anchoring JI in the constitution: countries belonging to the common law tradition are less likely to implement JI in their constitutions (and those with a socialist tradition are more likely to do so). Correspondingly, former British colonies are less likely to address JI explicitly as are states in the Caribbean. Second, religion has a significant impact on whether JI is included in the constitution: societies experiencing a high level of religious fractionalization are not only less likely to anchor JI in their constitutions, but are also less likely to change their constitutions in that direction later on. Finally, Muslim countries are more likely to include mention of JI, whereas Protestant countries are less likely to do so. Third, the distribution of resources within societies has important and largely unexpected effects: a higher percentage of family farms, a wider distribution of education, and a higher percentage of urban dwellers are all connected with a lower likelihood of JI being mentioned in the constitution

Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial

People with dementia are susceptible to adverse drug reactions (ADRs). However, they are not always closely monitored for potential problems relating to their medicines: structured nurse-led ADR Profiles have the potential to address this care gap. We aimed to assess the number and nature of clinical problems identified and addressed and changes in prescribing following introduction of nurse-led medicines' monitoring.Pragmatic cohort stepped-wedge cluster Randomised Controlled Trial (RCT) of structured nurse-led medicines' monitoring versus usual care.Five UK private sector care homes.41 service users, taking at least one antipsychotic, antidepressant or anti-epileptic medicine.Nurses completed the West Wales ADR (WWADR) Profile for Mental Health Medicines with each participant according to trial step.Problems addressed and changes in medicines prescribed.Information was collected from participants' notes before randomisation and after each of five monthly trial steps. The impact of the Profile on problems found, actions taken and reduction in mental health medicines was explored in multivariate analyses, accounting for data collection step and site.Five of 10 sites and 43 of 49 service users approached participated. Profile administration increased the number of problems addressed from a mean of 6.02 [SD 2.92] to 9.86 [4.48], effect size 3.84, 95% CI 2.57-4.11, P <0.001. For example, pain was more likely to be treated (adjusted Odds Ratio [aOR] 3.84, 1.78-8.30), and more patients attended dentists and opticians (aOR 52.76 [11.80-235.90] and 5.12 [1.45-18.03] respectively). Profile use was associated with reduction in mental health medicines (aOR 4.45, 1.15-17.22).The WWADR Profile for Mental Health Medicines can improve the quality and safety of care, and warrants further investigation as a strategy to mitigate the known adverse effects of prescribed medicines.ISRCTN 48133332

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707