The emergence of the new economy, and its challenge to financial intermediation and banking: A survey

Technological progress and knowledge-based innovations have more important role in economic growth and development than ever. This conjecture is often called the new economy, referring to economic growth that is strongly associated to the development of information and communication technology. In order to understand this ongoing process it is important to separate short and long term as well as micro- and macroeconomic aspects of the new economy. Financial intermediation and banking are under constant structural change due to new technologies and deregulation. Despite that, the basic functions of banks do not change. However, in the changing environment banks have to manage the potential threat of disintermediation, i.e., structural change from indirect to direct finance. As an example of the new challenges, banks are forced to create an online strategy in order to survive the everincreasing global competition.Uusi talous viittaa informaatio- ja kommunikaatioteknologian kehitykseen vahvasti liittyvään taloudellisen kasvuun. Teknologisella kehityksellä ja inhimilliseen pääomaan perustuvilla innovaatioilla on tärkeämpi merkitys taloudellisessa kasvussa ja kehityksessä kuin koskaan aiemmin. Meneillään olevan kehityksen ymmärtämiseksi on tärkeää tehdä ero talouden lyhyen ja pitkän tähtäyksen, kuten myös mikro- ja makrotaloudellisten tekijöiden välillä. Uuden teknologian ja sääntelyn purkamisen myötä rahoituksenvälitys ja pankkitoiminta ovat jatkuvassa rakennemuutoksessa. Siitä huolimatta pankkien perustehtävät eivät muutu. Muuttuvassa ympäristössä pankkien pitää kuitenkin ottaa huomioon toimialaliukumien yleistyminen ja siirtyminen epäsuorasta suoraan rahoitukseen. Yksi esimerkki uusista haasteista on se, että pankit ovat pakotettuja luomaan omat strategiansa suhteessa verkkopankkitoimintaan selviytyäkseen yhä kiristyvästä maailmanlaajuisesta kilpailusta

The Effects of Type 1 Diabetes and its Long-Term Complications on Physical and Mental Health Status

Objective: To analyse how type 1 diabetes mellitus (DM) and the symptoms of its chronic long-term complications correlate with health status domains in the adult population in Finland. Methods: A representative sample of patients with type 1 DM was selected randomly from the Finnish drug reimbursement registry. Participants reported symptoms, diagnoses and treatments indicating the presence and time of appearance of long-term complications, and completed the RAND 36 questionnaire. A principal component analysis was performed to compress the eight RAND 36 dimensions into composite domains of health status. The results were validated with split-sample analysis. Regression analyses were used to estimate the effects of age, sex, symptoms of long-term complications and comorbidities on the component T-scores. Results: Of the 752 (70.8%) responders, 592 fulfilled the criteria of type 1 DM. Of these, 82.6% fully completed the RAND 36 questionnaire. Principal component analysis of our data supports the theory of the 2-factor model of health, as physical and mental health domains were reflected unambiguously by different RAND 36 dimensions. The regression results show that the symptoms of long-term complications correlate more strongly with the physical than the mental domain of health status. Conclusion: Type 1 DM, and especially the symptoms of its long-term complications, correlate mainly with the physical domain of health, although the mental domain is also affected. The prevalence of long-term complications with type 1 DM is sufficiently high within the Finnish population to substantially influence the health status of people with type 1 DM.Quality-of-life, Type-1-diabetes-mellitus

Type 2 diabetes and treatment intensification in primary care in Finland

AimTo identify how the electronic health record (EHR) systems and national registers can be used for research purposes. We focused on how the primary care physicians adhere to clinical guidelines.MethodsStudy population included incident type 2 diabetes patients from four selected regions. Data were collected in two phases. At the first phase study cohort was identified using the prescription registers of the Social Insurance Institution (SII) and EHR systems used within the study regions. At second phase, data were collected from SII's registers, local EHR systems, the hospital discharge and the primary care registers of National Institute for Health and Welfare.ResultsMetformin was the most common choice as first drug. Among all study patients, 8375 (76.0%) started metformin monotherapy or combinations. The treatment was intensified at variable levels of HbA1c depending on the area. DPP4-inhibitors were by far the most common agent for treatment intensification. Sulphonylureas were used less often than basal insulin as the second-line agent. The use of DPP4-inhibitors increased between years 2009-2010, when first DPP4-inhibitor received reimbursement and this class became dominant drug for treatment intensification increasingly thereafter.ConclusionsThe EHR systems and national registers can be used for research purposes in Finland. The realization of diabetes treatment national guidelines are followed in primary care to a large extent. However, the subsequent intensification of therapy was delayed and occurred at elevated Hba1c levels.Peer reviewe

A Simulation Model for Estimating Direct Costs of Type 1 Diabetes Prevention

Background: The ongoing Type 1 Diabetes Prediction and Prevention Project in Finland (DIPP) is based on screening of genetic type 1 diabetes mellitus susceptibility, subsequent autoantibody follow-up and experimental preventive treatment with nasal insulin. Objective: To analyse direct costs of type 1 diabetes prevention therapy with nasal insulin as it is now being studied in the DIPP project, and as it might be used as a part of routine healthcare in Finland. Data and methods: For the purposes of cost analysis, two different diabetes prevention models were constructed. The research-oriented model followed accurately the DIPP protocol and the practice-oriented model was based on the estimates of a panel of experts on how the prevention would be conducted as a part of the routine healthcare in Finland. To take into account the uncertainty and variability attached to the use of resources, a Monte Carlo simulation model was utilised. The costs of the two models comprising 500 iterations each were simulated using the Monte Carlo model. Study perspective: This study was performed from the healthcare provider's viewpoint. Results: The total direct costs per person of the research-oriented model were 2102 and 1676 euros (EUR) in the first and second year and those of the practice-oriented model EUR827 and EUR675, respectively (EUR1 _ $US1.1; 2002 values). Subsequently, the costs rose only as a result of the increased use of insulin as the children grew older. After the 15th year, when the age structure of the population in the study had stabilised, the annual direct costs per person were EUR1798 (research-oriented model) and EUR797 (practice-oriented model). Conclusions: The costs of prevention with nasal insulin are low when compared with estimates of the annual healthcare costs of type 1 diabetes. This study suggests, with some critical assumptions (in particular, that nasal insulin is effective in the prevention of type I diabetes), that a 2 to 3-year delay in the disease onset may make prevention according to the practice-oriented model cost saving.Antihyperglycaemics, Cost analysis, Insulin, Pharmacoeconomics, Type 1 diabetes mellitus