Technological adoption in health care

This paper addresses the impact of payment systems on the rate of technology adoption. We present a model where technological shift is driven by demand uncertainty, increased patients’ benefit, financial variables, and the reimbursement system to providers. Two payment systems are studied: cost reimbursement and (two variants of) DRG. According to the system considered, adoption occurs either when patients’ benefits are large enough or when the differential reimbursement across technologies offsets the cost of adoption. Cost reimbursement leads to higher adoption of the new technology if the rate of reimbursement is high relative to the margin of new vs. old technology reimbursement under DRG. Having larger patient benefits favors more adoption under the cost reimbursement payment system, provided that adoption occurs initially under both payment systems. JEL codes: I11, I12, Q33

Bargaining and idle public sector capacity in health care

A feature present in countries with a National Health Service is the co-existence of a public and a private sector. Often, the public payer contracts with private providers while holding idle capacity. This is often seen as inefficiency from the management of public facilities. We present here a different rationale for the existence of such idle capacity: the public sector may opt to have idle capacity as a way to gain bargaining power vis-à-vis the private provider, under the assumption of a more efficient private than the public sector.

Technological adoption in health care

This paper addresses the impact of payment systems on the rate of technology adoption. We present a model where technological shift is driven by demand uncertainty, increased patients' benefit, financial variables, and the reimbursement system to providers. Two payment systems are studied: cost reimbursement and (two variants of) DRG. According to the system considered, adoption occurs either when patients' benefits are large enough or when the differential reimbursement across technologies offsets the cost of adoption. Cost reimbursement leads to higher adoption of the new technology if the rate of reimbursement is high relative to the margin of new vs. old technology reimbursement under DRG. Having larger patient benefits favors more adoption under the cost reimbursement payment system, provided that adoption occurs initially under both payment systems.Health care, technology adoption, payment systems

Negotiation Advantages of Professional Associations in Health Care

In several instances, third-party payers negotiate prices of health care services with providers. We show that a third-party payer may prefer to deal with a professional association than with the sub-set constituted by the more efficient providers, and then apply the same price to all providers. The reason for it is the increase in the bargaining position of providers. The more efficient providers are also the ones with higher profits in the event of negotiation failure. This allows them to ext act a higher surplus from the third-party payer.Professional Associations, Health Care, Negotiation

Preventive health care and payment systems to providers

Prevention has been a main issue of recent policy orientations in health care. This renews the interest on how different organizational designs and the definition of payment schemes to providers may affect the incentives to provide preventive health care. We present, both the normative and the positive analyses of the change from independent providers to integrated services. We show the evaluation of that change to depend on the particular way payment to providers is done. We focus on the externality resulting from referral decisions from primary to acute care providers. This makes our analysis complementary to most works in the literature allowing to address in a more direct way the issue of preventive health care.Preventive health care, payment systems to providers

Chronic infection by Leishmania amazonensis mediated through MAPK ERK mechanisms

Leishmania amazonensis is an intracellular protozoan parasite responsible for chronic cutaneous leishmaniasis (CL). CL is a neglected tropical disease responsible for infecting millions of people worldwide. L. amazonensis promotes alteration of various signaling pathways that are essential for host cell survival. Specifically, through parasite-mediated phosphorylation of extracellular signal regulated kinase (ERK), L. amazonensis inhibits cell-mediated parasite killing and promotes its own survival by coopting multiple host cell functions. In this review we highlight Leishmania-host cell signaling alterations focusing on those specific to 1) motor proteins, 2) prevention of NADPH subunit phosphorylation impairing reactive oxygen species production (ROS), and 3) localized endosomal signaling to up-regulate ERK phosphorylation. This review will focus upon mechanisms and possible explanations as to how Leishmania spp. evades the various layers of defense employed by the host immune response by looking at scaffolding complexes, reactive oxygen species, and motor proteins

Incorporating the water footprint and virtual water into policy: reflections from the Mancha Occidental Region, Spain

Water resource management is often a controversial issue in semiarid regions. Most water resources experts admit that water conflicts are not caused by the physical water scarcity but they are mainly due to inadequate water management. The virtual water concept (the volume of water used in the production of a commodity, good or service) together with the water footprint (indicator of water consumption that looks at both direct and indirect water use of a consumer or producer), links a large range of sectors and issues, thus providing a potentially appropriate framework to support more optimal water management practices by informing production and trade decisions. This paper provides an analysis of these two concepts within the context of the Mancha Occidental region, Spain, exploring the hydrological and economic aspects of agricultural production. In doing so, this work not only distinguishes between green and blue water but also between surface and groundwater. We conclude by discussing the practical implications of the results, as well as their potential limitations from the policy standpoint

Thinking Adaptive: Towards a Behaviours Virtual

In this paper we name some of the advantages of virtual laboratories; and propose that a Behaviours Virtual Laboratory should be useful for both biologists and AI researchers, offering a new perspective for understanding adaptive behaviour. We present our development of a Behaviours Virtual Laboratory, which at this stage is focused in action selection, and show some experiments to illustrate the properties of our proposal, which can be accessed via Internet