Imperfect quality information in a quality-competitive hospital market

We examine the implications of policies to improve information about the qualities of profit seeking duopoly hospitals which face the same regulated price and compete on quality. We show that if the hospital costs of quality are similar then better information increases the quality of both hospitals. However if the costs are sufficiently different improved information will reduce the quality of both hospitals.Uncertain quality. Information. Competition. Hospitals.

The Effects of Budgets on Doctors Behaviour: Evidence from a Natural Experiment

In many health care systems primary care physicians act as ‘gatekeepers’ to secondary care. We investigates the impact of the UK fundholding scheme under which general practices could elect to hold a budget to meet the costs of elective surgery for their patients. We use a differences in differences methodology on a large four year panel of English general practices before and after the abolition of fundholding. Fundholding incentives reduced fundholder elective admission rates by 3.3% and accounted for 57% of the difference between fundholder and nonfundholder elective admissions, with 43% a selection effect due to unobservable differences in practice characteristics. Fundholding had no effect on emergency admissions.budgets, health care, fundholding, admission rates

The Effect of Budgets on Doctor Behaviour: Evidence From A Natural Experiment

In many health care systems primary care physicians act as 'gatekeepers' to secondary care. We investigates the impact of the UK fundholding scheme under which general practices could elect to hold a budget to meet the costs of elective surgery for their patients. We use a differences in differences methodology on a large four year panel of English general practices before and after the abolition of fundholding. Fundholding incentives reduced fundholder elective admission rates by 3.3% and accounted for 57% of the difference between fundholder and nonfundholder elective admissions, with 43% a selection effect due to unobservable differences in practice characteristics. Fundholding had no effect on emergency admissions.Budgets; Health care; Fundholding; Admission rates

The effects on waiting times of expanding provider choice:evidence from a policy experiment

Long waiting times for inpatient treatment in the UK National Health Service have long been a source of great popular and political concern, and therefore a target for policy initiatives. One such is the London Patient Choice Project, under which patients at risk of breaching inpatient waiting time targets were offered the choice of an alternative hospital with a guaranteed shorter wait. This paper uses a difference in difference econometric methodology to infer the impact of the choice project on ophthalmology waiting times. In line with our theoretical predictions, it finds that the project led to lower average waiting times in the London region and a convergence in waiting times amongst London hospitals.

Does Better Disease Management in Primary Care Reduce Hospital Costs?

We apply cross-sectional and panel data methods to a database of 5 million patients in 8,000 English general practices to examine whether better primary care management of 10 chronic diseases is associated with reduced hospital costs. We find that only primary care performance in stroke care is associated with lower hospital costs. Our results suggest that the 10% improvement in the general practice quality of stroke care between 2004/5 and 2007/8 reduced 2007/8 hospital expenditure by about £130 million in England. The cost savings are due mainly to reductions in emergency admissions and outpatient visits, rather than to lower costs for patients treated in hospital or to reductions in elective admissions.Quality; disease management; primary care; hospital costs; ambulatory care sensitive conditions; preventative care.

Waiting Times and Waiting Lists: A Model of the Market for Elective Surgery

We present a simple dynamic model of the demand and supply for elective surgery in the NHS and test it using a panel of quartely data for 123 English health authorities from the second quarter of 1987 to the first quarter of 1993. We find that supply is increasing in measures of the previous period's waiting time and that demand is decreasing in the previous period waiting time. The results imply that health care systems which are rationed by waiting do respond to indicators of waiting times and waiting lists. More generally, the paper adds to the small but consistent body of research which demonstrates that health care systems respond to the publication of high profile performance data.Waiting times; Rationing; Elective surgery.

Does better disease management in primary care reduce hospital costs? Evidence from English primary care

We apply cross-sectional and panel data methods to a database of 5 million patients in 8,000 English general practices to examine whether better primary care management of 10 chronic diseases is associated with reduced hospital costs. We find that only primary care performance in stroke care is associated with lower hospital costs. Our results suggest that the 10% improvement in the general practice quality of stroke care between 2004/5 and 2007/8 reduced 2007/8 hospital expenditure by about £130 million in England. The cost savings are due mainly to reductions in emergency admissions and outpatient visits, rather than to lower costs for patients treated in hospital or to reductions in elective admissions.Quality. Disease management. Primary care. Hospital costs. Ambulatory care sensitive conditions. Preventative care.

Parallelized and Vectorized Tracking Using Kalman Filters with CMS Detector Geometry and Events

The High-Luminosity Large Hadron Collider at CERN will be characterized by greater pileup of events and higher occupancy, making the track reconstruction even more computationally demanding. Existing algorithms at the LHC are based on Kalman filter techniques with proven excellent physics performance under a variety of conditions. Starting in 2014, we have been developing Kalman-filter-based methods for track finding and fitting adapted for many-core SIMD processors that are becoming dominant in high-performance systems. This paper summarizes the latest extensions to our software that allow it to run on the realistic CMS-2017 tracker geometry using CMSSW-generated events, including pileup. The reconstructed tracks can be validated against either the CMSSW simulation that generated the hits, or the CMSSW reconstruction of the tracks. In general, the code's computational performance has continued to improve while the above capabilities were being added. We demonstrate that the present Kalman filter implementation is able to reconstruct events with comparable physics performance to CMSSW, while providing generally better computational performance. Further plans for advancing the software are discussed

Evaluering av sammenheng mellom tiltak

While climate scientists have developed high resolution data sets on the distribution of climate risks, we still lack comparable data on the local distribution of public climate change opinions. This paper provides the first effort to estimate local climate and energy opinion variability outside the United States. Using a multi-level regression and post-stratification (MRP) approach, we estimate opinion in federal electoral districts and provinces. We demonstrate that a majority of the Canadian public consistently believes that climate change is happening. Belief in climate change's causes varies geographically, with more people attributing it to human activity in urban as opposed to rural areas. Most prominently, we find majority support for carbon cap and trade policy in every province and district. By contrast, support for carbon taxation is more heterogeneous. Compared to the distribution of US climate opinions, Canadians believe climate change is happening at higher levels. This new opinion data set will support climate policy analysis and climate policy decision making at national, provincial and local levels

Etiology of Persistent Tubo-Ovarian Abscess in Nairobi, Kenya

Objective To study the microbial etiology of tubo-ovarian abscess (TOA). Methods We recruited 11 women in Nairobi, Kenya who failed antibiotic therapy alone and required surgical drainage of a presumptive TOA. Pus from the nine abscesses and two pyosalpinges were collected and cultured for aerobic, facultative and anaerobic microorganisms. Results Eleven women suspected of having a TOA were hospitalized and treated for a median of 6 days (range 3–14 days) prior to surgical drainage of the abscess. Nine (82%) specimens were culture positive. Aerobes were present in all nine specimens. Seven of the nine positive cultures (78%) were polymicrobial and five of the polymicrobial cultures contained both anaerobes and aerobes. Anaerobic Gram-negative bacilli (Prevotella sp., Porphyromonas sp. and Bacteroides sp., Escherichia coli ) and Streptococcus sp. ( S. viridans and S. agalactiae) were the most common microorganisms isolated. Neisseria gonorrhoeae and Chlamydia trachomatis were not isolated by culture or detected by polymerase chain reaction. Conclusions In Kenya, persistent TOAs are associated with endogenous flora similar to that normally found in the gastrointestinal tract