Power of incentives with motivated agents in public organizations.

Public service motivation is often considered as an argument for low- powered incentive schemes in the public sector. In this paper, we characterize the optimal contract between a public regulator and an altruistic agent according to the degree of public service motivation, when the type of the public service consumer is privately observed. We show that the requested effort is non decreasing with and can be higher than the first best level. Moreover we show that the agent is put on a high powered contract when some customers are served but that this contract is associated with different types of consumers according to : In contrast, the agent is never put on a cost-plus contract. Finally, we show that the first best allocation can be achieved under budget balance for a degree of altruism higher than a threshold that we characterize.regulation; power of incentive schemes; altruism; public organization; countervailing incentives;

Risk sharing and moral hazard under prospective payment to hospitals : how to reimburse services for outlier patients

We analyze the regulation of a single health care provider (e.g. a hospital). According to several payment rules used in different countries, we consider a mixed linear payment in which the hospital is paid a fixed price per DRG (diagnosis related group) for most patients (inlier patients) and is reimbursed by a cost sharing payment for patients with exceptionally costly stays (outlier patients). Given this form of payment, we determine the optimal threshold above which to consider a patient as an outlier patient, as well as the optimal payment per DRG and the optimal cost sharing parameter. For the case where the regulator can use a two part tariff, we also determine the fixed charge the regulator has to impose in order to extract hospital rents. [Authors]]]> Financial Management, Hospital ; Diagnosis-Related Groups ; Risk Sharing, Financial eng oai:serval.unil.ch:BIB_397B1AA9E66E 2022-05-07T01:15:41Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_397B1AA9E66E Parachlamydia acanthamoebae enters and multiplies within pneumocytes and lung fibroblasts info:doi:10.1016/j.micinf.2005.12.011 info:eu-repo/semantics/altIdentifier/doi/10.1016/j.micinf.2005.12.011 info:eu-repo/semantics/altIdentifier/pmid/16697235 Casson, N. Medico, N. Bille, J. Greub, G. info:eu-repo/semantics/article article 2006-04 Microbes and Infection, vol. 8, no. 5, pp. 1294-300 info:eu-repo/semantics/altIdentifier/pissn/1286-4579 <![CDATA[Parachlamydia acanthamoebae is a Chlamydia-like organism that naturally infects free-living amoebae. P. acanthamoebae is a putative emerging agent of community-acquired and inhalation pneumonia that may enter and multiply within human macrophages. However, since Parachlamydia induces their apoptosis, macrophages may not represent a perennial niche for this obligate intracellular bacterium. Therefore, we investigated whether pneumocytes and lung fibroblasts are permissive to Parachlamydia infection and might act as a replicative niche. Entry of Parachlamydia into pneumocytes (A549) and lung fibroblasts (HEL) was confirmed by confocal and electron microscopy. In A549 cells, the mean number of Parachlamydia per cell increased 7-fold from day 0 to day 7, independently of the technique used to label the bacteria. The proportion of infected A549 cells also increased over time, whereas cell viability remained unaffected by Parachlamydia infection. The sustained (3 weeks) viability of Parachlamydia when incubated in the presence of A549 cells contrasted with that observed in the absence of cells. HEL cells were also permissive to Parachlamydia infection, as we observed a 3- to 4-fold increase in the mean number of bacteria per cell. In HEL cells, Parachlamydia retained some viability for 2 weeks. These findings demonstrate that Parachlamydia is able to enter and multiply within pneumocytes and fibroblasts. The viability of both cell types was not compromised after Parachlamydia infection. We therefore conclude that these cells may remain infected for a prolonged time and may represent an intrapulmonary niche for the strictly intracellular Parachlamydia. This indirectly supports the role of Parachlamydia as an agent of pneumonia

Cost variability, quality of care and hospitals' payment systems

In most European countries hospitals' payment is based on a prospective payment per DRG. This article highlights the potential drawbacks of such a payment system when the regulator (the National Health Insurance) can observe neither the quality enhancement nor the cost reduction efforts. In order to avoid hospitals' strategies such as patients' selection or quality reduction induced by the prospective payment, we show that mixed payment systems can solve the trade-off between different goals in a second best world. [Author]]]> eng oai:serval.unil.ch:BIB_8BE277EF6A16 2022-05-07T01:22:25Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_8BE277EF6A16 Specific Silencing of the REST Target Genes in Insulin-Secreting Cells Uncovers Their Participation in Beta Cell Survival. info:doi:10.1371/journal.pone.0045844 info:eu-repo/semantics/altIdentifier/doi/10.1371/journal.pone.0045844 info:eu-repo/semantics/altIdentifier/pmid/23029270 Martin, D. Allagnat, F. Gesina, E. Caille, D. Gjinovci, A. Waeber, G. Meda, P. Haefliger, J.A. info:eu-repo/semantics/article article 2012 Plos One, vol. 7, no. 9, pp. e45844 info:eu-repo/semantics/altIdentifier/eissn/1932-6203 urn:issn:1932-6203 <![CDATA[The absence of the transcriptional repressor RE-1 Silencing Transcription Factor (REST) in insulin-secreting beta cells is a major cue for the specific expression of a large number of genes. These REST target genes were largely ascribed to a function of neurotransmission in a neuronal context, whereas their role in pancreatic beta cells has been poorly explored. To identify their functional significance, we have generated transgenic mice expressing REST in beta cells (RIP-REST mice), and previously discovered that REST target genes are essential to insulin exocytosis. Herein we characterized a novel line of RIP-REST mice featuring diabetes. In diabetic RIP-REST mice, high levels of REST were associated with postnatal beta cell apoptosis, which resulted in gradual beta cell loss and sustained hyperglycemia in adults. Moreover, adenoviral REST transduction in INS-1E cells led to increased cell death under control conditions, and sensitized cells to death induced by cytokines. Screening for REST target genes identified several anti-apoptotic genes bearing the binding motif RE-1 that were downregulated upon REST expression in INS-1E cells, including Gjd2, Mapk8ip1, Irs2, Ptprn, and Cdk5r2. Decreased levels of Cdk5r2 in beta cells of RIP-REST mice further confirmed that it is controlled by REST, in vivo. Using siRNA-mediated knock-down in INS-1E cells, we showed that Cdk5r2 protects beta cells against cytokines and palmitate-induced apoptosis. Together, these data document that a set of REST target genes, including Cdk5r2, is important for beta cell survival

Risk sharing and moral hazard under prospective payment to hospitals: how to reimburse services for outlier patients

We analyze the regulation of a single health care provider (e.g. a hospital). According to several payment rules used in different countries, we consider a mixed linear payment in which the hospital is paid a fixed price per DRG (diagnosis related group) for most patients (inlier patients) and is reimbursed by a cost sharing payment for patients with exceptionally costly stays (outlier patients). Given this form of payment, we determine the optimal threshold above which to consider a patient as an outlier patient, as well as the optimal payment per DRG and the optimal cost sharing parameter. For the case where the regulator can use a two part tariff, we also determine the fixed charge the regulator has to impose in order to extract hospital rents.hospitals payment; cost; quality; incentives; DRG; risk sharing

Enchères anglaises inversées avec bonus de qualité dans les procédures d’E-procurement

Dans cet article, nous considérons la mise en œuvre du critère de l'offre économiquement la plus avantageuse dans des marchés publics passés par voie électronique. Pour cela, nous analysons la procédure usuelle de l'enchère anglaise inversée avec bonus de qualité en considérant que les coûts de production des offreurs sont croissants avec le niveau de qualité des produits et que la fonction d'utilité des acheteurs est concave en qualité. Nous montrons que cette procédure ne concrétise pas en général le mécanisme d'enchères optimal. Nous montrons ensuite qu'un plafonnement des prix dans l'enchère anglaise permet de restaurer l'optimalité de la procédure et de mettre en œuvre une discrimination analogue à la discrimination optimale dans le cas uniforme.Enchère, discrimination, achats publics, qualité

Transpressional tectonics and Carboniferous magmatism in the Limousin, Massif Central, France: Structural and ⁴⁰Ar/³⁹Ar investigations

New structural, microstructural, and 40Ar/39 Ar data from the NW Massif Central (France) provide additional constraints on the timing and tectonic setting of late Variscan granite magmatism. Previous studies had emphasized the role of late orogenic extension in the emplacement of granite plutons in the Limousin region. In contrast, the new data set is consistent with syntectonic emplacement of magma in a dextral simple shear active from 350 to 300 Ma in a transpressional regime. As an alternative hypothesis to late orogenic extension, we propose that magmas migrated into tensional bridges between active P shears associated with a lithospheric shear zone comparable to a pop-up structure. The Galician region, in the western end of the Ibero-Armorican tectonic arc, exhibits major left-lateral ductile shear zones which can be interpreted as conjugate structures to the Limousin and Armorican shear zones. Copyright 2007 by the American Geophysical Union

Supply-side risk adjustment and outlier payment policy

In most health care systems where a prospective payment system is implemented, an outlier payment is used to cover the hospitals' unusually high costs. When the hospital chooses its cost reduction effort before observing a patient's severity, we show that the best outlier payment is based on the realized cost when the hospital exerts the first best level of effort, for any level of severity. [Authors]]]> eng oai:serval.unil.ch:BIB_34BE96F8B7B9 2022-02-19T02:18:32Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_34BE96F8B7B9 Evaluation de la démarche "Quartiers durables by Sméo" sur la base de la perception des utilisateurs : rapport final Horber-Papazian, K. Jacot-Descombes, C. IDHEAP info:eu-repo/semantics/report techreport 2013-06 fre https://serval.unil.ch/resource/serval:BIB_34BE96F8B7B9.P001/REF.pdf http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_34BE96F8B7B94 info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_34BE96F8B7B94 info:eu-repo/semantics/submittedVersion info:eu-repo/semantics/openAccess Copying allowed only for non-profit organizations https://serval.unil.ch/disclaimer application/pdf oai:serval.unil.ch:BIB_34BF0625B509 2022-02-19T02:18:32Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_34BF0625B509 Combined deletion of cathepsin protease family members reveals compensatory mechanisms in cancer. info:doi:10.1101/gad.270439.115 info:eu-repo/semantics/altIdentifier/doi/10.1101/gad.270439.115 info:eu-repo/semantics/altIdentifier/pmid/26773004 Akkari, L. Gocheva, V. Quick, M.L. Kester, J.C. Spencer, A.K. Garfall, A.L. Bowman, R.L. Joyce, J.A. info:eu-repo/semantics/article article 2016 Genes and Development, vol. 30, no. 2, pp. 220-232 info:eu-repo/semantics/altIdentifier/eissn/1549-5477 urn:issn:0890-9369 <![CDATA[Proteases are important for regulating multiple tumorigenic processes, including angiogenesis, tumor growth, and invasion. Elevated protease expression is associated with poor patient prognosis across numerous tumor types. Several multigene protease families have been implicated in cancer, including cysteine cathepsins. However, whether individual family members have unique roles or are functionally redundant remains poorly understood. Here we demonstrate stage-dependent effects of simultaneously deleting cathepsin B (CtsB) and CtsS in a murine pancreatic neuroendocrine tumor model. Early in tumorigenesis, the double knockout results in an additive reduction in angiogenic switching, whereas at late stages, several tumorigenic phenotypes are unexpectedly restored to wild-type levels. We identified CtsZ, which is predominantly supplied by tumor-associated macrophages, as the compensatory protease that regulates the acquired tumor-promoting functions of lesions deficient in both CtsB and CtsS. Thus, deletion of multiple cathepsins can lead to stage-dependent, compensatory mechanisms in the tumor microenvironment, which has potential implications for the clinical consideration of selective versus pan-family cathepsin inhibitors in cancer

Marchés publics : règles rigides ou procédures flexibles ?

This paper studies the french public procurement mechanisms with respect to the public objectives : minimization of the procurement cost and maximization of the macroeconomic effects. The relations between the flexibility (rigidity) of the rules and the rigidity (flexibility) of the economy are analyzed. The opti- mality of the mechanisms are studied in the framework of auctions and incentive contracts theory.Cet article étudie les règles du Code des Marchés Publics en fonction des objectifs traditionnellement assignés aux commandes de l'Etat : gestion au moindre coût et impact macroéconomique. L'article montre que les règles rigides (adjudication, appel d'offres) sont associées aux situations de flexibilité de l'économie alors que les règles flexibles (négociation) concernent les économies rigides. Les propriétés des deux familles de procédures sont ensuite analysées dans le cadre de la théorie des enchères et des contrats optimaux.Mougeot Michel. Marchés publics : règles rigides ou procédures flexibles ?. In: Politiques et management public, vol. 4, n° 3, 1986. pp. 1-25