La separació de funcions de compra i provisió pública : efectes del poder de mercat sobre l'eficiència dins el sistema sanitaria català

En la present tesi doctoral es contrasta la hipòtesi d’inducció a l’eficiència dels proveïdors sanitaris a través del poder de comprador. Per fer-ho s’analitza el cas de la concertació hospitalària a Catalunya. En primer lloc, s’ha construït un model principal-agent amb acció oculta que representa la compra de serveis per part de l’organisme públic competent a un proveïdor hospitalari. En segon lloc, a partir d’una mostra de 55 hospitals de la XHUP, s’ha construït un índex de mesura del poder de comprador relatiu del CatSalut sobre cadascun d’aquells proveïdors hospitalaris. Finalment, s’han obtingut els marcadors d’eficiència tècnica en la provisió de cada hospital emprant la tècnica Data Envelopment Analysis (DEA). D’altra banda, per tal de contrastar la hipòtesi s’ha emprat un model Tobit de regressió censurada. Els resultats de les estimacions aporten certa evidència en favor de l’existència d’un efecte d’inducció d’eficiència a través del poder de comprador.In this thesis we test the hypothesis of efficiency induction through buyer power. To do so, we analyse the case of public hospital contracting in Catalonia. First, we build a principal-agent model with hidden action, which describes the relationship between the public buyer and a hospital provider. Second, we build a measure of buyer power based upon a sample of 55 hospitals from the public network. This is an index that measures the relative buyer power exercised by the public buyer agency over each hospital. Finally, efficiency scores have been obtained using a Data Envelopment Analysis (DEA) approach. In order to test the hypothesis we use a Tobit regression model. Estimation results provide some evidence concerning a positive effect of buyer power on hospital provision efficiency

Evolución de la mortalidad por cáncer de mama y diseminación de la mamografía de cribado en Cataluña: un análisis por regiones sanitarias

Fundamento: El descenso de las tasas de mortalidad por cáncer de mama (CM) se ha atribuido a la implantación de programas de cribado y a avances terapéuticos. El objetivo de este trabajo es comparar la evolución de su mortalidad en las regiones sanitarias de Cataluña en el periodo 1993-2007. Paralelamente, se ha analizado la diseminación de la mamografía periódica en las regiones sanitarias. Métodos: Se analizaron los datos del registro de mortalidad y encuestas de salud. Se utilizaron regresiones de Poisson y «joinpoint» para comparar las tasas de mortalidad por CM y analizar su evolución temporal. Se utilizaron modelos de efectos mixtos para comparar el nivel y la evolución de la mortalidad por regiones. Resultados. La tasa de mortalidad por CM descendió un 3% anual en Cataluña. Entre 1993 y 2007, la tasa estandarizada varió de 34,8 a 23,3 por 100.000 mujeres. Barcelona ciutat presentó unas tasas de mortalidad más elevadas que las regiones Centre (ratio de tasas (RT)=0,87), Costa de Ponent (RT=0,89), Tarragona (RT=0,9) y Lleida (RT=0,915), pero estas diferencias tendieron a desaparecer. No se observaron cambios de tendencia en la evolución de la mortalidad de las regiones, excepto en la región Centre. Durante los años 1990 Barcelona ciutat presentó unos porcentajes de utilización de mamografía periódica del 36,1% de las mujeres de 40-74 años, en la encuesta de 1994, la región Centre (23,7%) y Costa de Ponent (25,2%). Conclusiones: La progresiva utilización de mamografía periódica y la disminución de la mortalidad por CM fueron similares en las regiones sanitarias de Cataluña.Background: The decrease of breast cancer (BC) mortality rates has been attributed to early detection programs and therapeutic advances. The objective is to compare BC mortality trend in health regions of Catalonia during the period 1993-2007. In parallel, dissemination of periodic mammography in the health regions has been analyzed. Methods: Mortality and health surveys data were used. Poisson and «joinpoint» regression analyses were used to compare regional BC mortality rates and quantify their temporal evolution. Mixed effects models were used to compare the rates and their evolution by region. Results: The BC mortality rate decreased 3% annually in Cataluña. Between 1993 and 2007, the standard mortality rate changed from 34.8 to 23.3 per 100,000 women. Barcelona ciutat showed higher mortality rates than the Centre (rate ratio (RR)=0.873), Costa de Ponent (RR=0.885), Tarragona (RR=0.9) and Lleida regions (RR=0.915), but these differences tend to disappear over time. There were no observed trend changes in the evolution of the regional mortality rates, except in the Centre region. The use of periodic mammography was similar across health regions. During the 90s, Barcelona ciutat had a 36.1% utilization of periodic mammography in women aged 40-74, in the 1994 survey, the Centre 23.7 and Costa de Ponent 25.2%. Conclusions: The progressive increase in the use of periodic mammography and the decrease of BC mortality were similar in the eight health regions of Catalonia

La provisión de servicios sanitarios en el ámbito público: una revisión crítica en torno al concepto de cuasimercado

This article is a review of the literature related to the concept of the quasi- market, also referred to as the internal market. This concept has provided a theoretical foundation for recent provision policies in universal health care systems. In particular, it provides a rationale to support the entry of private providers into the public health care network. A critical analysis of the literature demonstrates that the concept is confusing and is based on a series of a priori judgments concerning the neoclassical idea of perfect competition. Hence, the quasi-market definition does not offer an adequate starting point from which to analyze the policies that have been implemented in universal health care in recent years. Recognizing the limitations of the quasi- market concept allows certain analytical elements to be clarified and can guide future research in this areaEn este artículo se realiza una revisión de la literatura concerniente al conceptode cuasimercado, también llamado mercado interno. Este concepto ha servidode fundamento teórico de las políticas recientes de prestación de servicios sanitariosen los sistemas de atención universal, en particular dando cobertura a la entradade proveedores privados en la sanidad pública. A partir de un análisis crítico de esaliteratura, se pone de manifiesto que dicho concepto es confuso y está basado en unaserie de juicios a priori relativos a la idea neoclásica de competencia perfecta. Por ello,la definición de cuasimercado no constituye una base adecuada para el análisis delas prácticas que se han llevado a cabo en los últimos años en el ámbito de la sanidadpública universal. El reconocimiento de las limitaciones que entraña el concepto decuasimercado permite clarificar algunos elementos de análisis y puede guiar futuraslíneas de investigación en esta materia

L'anàlisi transaccional de l'empresa

El propósito de este artículo es definir la teoría de la firma que se desprende del análisis transaccional que efectúa la nueva economía institucional. En esta, la empresa deja de ser un capítulo de la teoría neoclásica de los mercados para pasar a ser definida como una estructura de contratos. De esta manera, con planteamientos críticos en el interior de la economía neoclásica, como los supuestos de racionalidad limitada, información imperfecta e incertidumbre, la teoría de los derechos de propiedad, la teoría de la agencia y la teoría de los costes de transacción han efectuado ajustes al modelo neoclásico de la empresa, con el objetivo de adaptarlo al modelo de empresa gerencial, donde el control efectivo ya no es ejercido por los titulares legales, sino por gerentes profesionales contratados.The present article aims to outline the theory of the firm that derives from a transactional analysis grounded in the New Institutional Economics. In this framework, the firm no longer constitutes a mere chapter of the neoclassical theory of market, but instead represents a well-defined structure of contracts. Critical approaches to Neoclassical Economics focusing on the problems of bounded rationality, imperfect information and uncertainty, such as the Theory of Property Rights, the Theory of Transaction Costs and Agency Theory, have amended the neoclassical model of the firm, seeking to adapt it to the managerial model in which actual control of the firm is not in the hands of legal owners but those of professional managers.Fil: Brunet Icart, Ignasi. Universitat Rovira i Virgili. Facultad de Ciencias Económicas y Empresariales; España.Fil: Baltar, Fabiola. Universidad Nacional de Mar del Plata. Facultad de Ciencias Económicas y Sociales; Argentina.Fil: Gregori Gomis, Aleix. Universitat Rovira i Virgili. Facultad de Ciencias Económicas y Empresariales; España

Dr. Strangelove or how I learnt to stop worrying and love microeconomics: film clips as a pedagogical tool in economic theory

Microeconomics is perceived by students as one of the toughest subjects they face at the undergraduate level in order to obtain an Economics or Business degree. This is due to a sometimes rather stringent mathematical content, which is essential to teach economic concepts keeping a proper rigorous approach. In this article we present an experience of using a film clip to support teaching in the microeconomics field. In this case, we chose a cut from Stanley Kubricks' film "Dr. Strangelove", which topic is closely related to game theory, an area of knowledge that lies at the core of any intermediate or advanced microeconomics course. The fragment was selected in order to get the maximum subject related content out of the film spending the minimum class time. Methods: The clip was played in front of too different undergraduate level groups, accounting for a total number of 65 students. Results were derived from behavioural observation in a guided debate on the clip's content and the marks obtained by students in a questionnaire that was administrated to them immediately after the film's view. Questions were aimed for the students to connect the content of the film with the concepts previously taught in class. Results: Students proved a higher degree of interest and attention than that shown in other class sessions of the course, both during the view and the following debate on the content. Additionally, questionnaire marks were on average higher than those obtained by students in other tests. On the whole, students proved a better comprehension of the economic concepts involved after the film's view, compared with that shown in previous sessions. Conclusions: Although film views are a rather innovative tool in the area of microeconomics, our experience shows that it can be a useful complement of usual lessons when teaching certain economic concepts that are explained to students on a mathematical basis. In this regard, the film clip used in this paper helped students to get a better understanding of those concepts and boosted their interest on the topic. We believe that the growing trend of media tools use at the undergraduate level must also be implemented gradually in the economic theory field

'Ready to complete the survey on Facebook': Web 2.0 as a research tool in business studies

Practical issues associated with sampling and data collection are of real concern to business researchers. Some important methodological issues are the willingness to participate of the individuals and the provision of accurate information. Therefore, the aim of this article is to present the results obtained from the combination of social networking sites (Facebook) with an online questionnaire to study transnational entrepreneurs in Spain. The article analyses the pattern of answer of 219 entrepreneurs surveyed, and a cluster analysis of respondents and types of question is developed. The conclusion is that new technologies can help researchers to tackle some of the limitations associated with the administration of surveys to business people (e.g. lack of motivation to answer, intermediate filters) and can improve the quality of the information collected (e.g. higher level of response to confidential questions). However, it is acknowledged that ethical and methodological considerations are of great importance in this kind of study.Fil: Gregori Gomis, Aleix. Universitat Rovira i Virgili. Facultad de Ciencias Económicas y Empresariales; España.Fil: Baltar, Fabiola. Universidad Nacional de Mar del Plata. Facultad de Ciencias Económicas y Sociales; Argentina

Necessity versus opportunity immigrant entrepreneurs: the case of argentineans in Spain

The aim of the paper is to discuss what kinds of firms are founded by the Argentinean entrepreneurs in Spain. The hypothesis is that, like other non community immigrants, there are Argentinean entrepreneurs who start up business motivated by necessity, but there are others who detect opportunities in the market. As there is not a registry of firms according to the nationality of the owner, we used virtual social networks (Facebook's groups) and traditional snowball sampling to contact potential Argentinean entrepreneurs. Finally, 214 entrepreneurs living in Spain were contacted. We made a conglomerate analysis using as criteria the previous labour experience, the sector of activity (knowledge-based or traditional ones) and the motivation to start up a business (opportunity or necessity). The results show that there is heterogeneity among Argentinean entrepreneurs We identified six groups: 1) entrepreneurs motivated by necessity; 2) intrapreneurs in Argentina that start up businesses in sectors that are not knowledge-based; 3) entrepreneurs in Argentina that start up businesses in not knowledge-based sectors; 4) inactive in Argentina that is potentially innovating; 5) intrapreneurs in Argentina that start up businesses in knowledge-based sectors and 6) entrepreneurs in Argentina, with previous business experience, that start up businesses in knowledge-based sectors. Except the first group, they are all "opportunity/driven entrepreneurs". Each group was correlated with the level of education, the performance of the firm and the willingness to return to Argentina. The relationship shows that groups with firms based on knowledge are positively correlated with education and business performance but negatively correlated with the probability to return to the homeland. These conclusions have several policy implications, providing policy makers with information about the different activities carried out by immigrants in order to implement policies for the non-EU ones that lead to a system that would value more this kind of immigrants in society

Evolución de la mortalidad por cáncer de mama y diseminación de la mamografía de cribado en Cataluña: un análisis por regiones sanitarias

Fundamento: El descenso de las tasas de mortalidad por cáncer de mama (CM) se ha atribuido a la implantación de programas de cribado y a avances terapéuticos. El objetivo de este trabajo es comparar la evolución de su mortalidad en las regiones sanitarias de Cataluña en el periodo 1993- 2007. Paralelamente, se ha analizado la diseminación de la mamografía periódica en las regiones sanitarias. Métodos: Se analizaron los datos del registro de mortalidad y encuestas de salud. Se utilizaron regresiones de Poisson y «joinpoint» para comparar las tasas de mortalidad por CM y analizar su evolución temporal. Se utilizaron modelos de efectos mixtos para comparar el nivel y la evolución de la mortalidad por regiones. Resultados. La tasa de mortalidad por CM descendió un 3% anual en Cataluña. Entre 1993 y 2007, la tasa estandarizada varió de 34,8 a 23,3 por 100.000 mujeres. Barcelona ciutat presentó unas tasas de mortalidad más elevadas que las regiones Centre (ratio de tasas (RT)=0,87), Costa de Ponent (RT=0,89), Tarragona (RT=0,9) y Lleida (RT=0,915), pero estas diferencias tendieron a desaparecer. No se observaron cambios de tendencia en la evolución de la mortalidad de las regiones, excepto en la región Centre. Durante los años 1990 Barcelona ciutat presentó unos porcentajes de utilización de mamografía periódica del 36,1% de las mujeres de 40-74 años, en la encuesta de 1994, la región Centre (23,7%) y Costa de Ponent (25,2%). Conclusiones: La progresiva utilización de mamografía periódica y la disminución de la mortalidad por CM fueron similares en las regiones sanitarias de Cataluña