Rent Extraction through Alternative Forms of Competition in the Provision of Paternalistic Goods

We compare the properties in terms of rent extraction of spatial competition and monopoly franchises using Dutch first price auctions, two of the most widely used tools to regulate public service provision. In a framework where the regulator can imperfectly observe costs, but the latter are not necessarily private information to each competitor, spatial competition is more effective in extracting rent if providers are very different in their productivity and if they can observe the costs of their competitors. When they are quite similar and have limited information on the competitors' characteristics, the use of a monopoly franchise through an auction mechanism should be preferred. In the latter environment, a multiple object auction allows more rent to be extracted from the provider

Il confronto della tutela della persona disabile e a mobilità ridotta nel trasporto aereo, marittimo e terrestre

COMPARISON OF THE PROTECTION PROVIDED FOR THE DISABLED AND PERSONS WITH REDUCED MOBILITY IN AIR, MARITIME AND LAND TRANSPORT The research on real means of protection for the disabled in order to guarantee their right to mobility and access to means of transport has received growing attention of the international and national regulations in the last 20 years. The measures that have derived, both in the EU legal system and in the national legislation, aim at guaranteeing not only to the disabled but also to the "persons with reduced mobility" (p.r.m.) a full exercise of their right to mobility and free movement on conditions comparable to those granted to the other users. The object of the present dissertation is, therefore, the comparison of the different sector-specific regulations that regulate the transport of all the persons that can be counted within the vast "p.r.m." category. Upon careful evaluation of the points of contact as well as of the ongoing differences among the applicable regulations, we shall try to identify proposals, modifications and solutions (also of a practical nature) that are appropriate, at least, to foster (if not to attain yet) the level of uniformity desired by the EU institutions with the aim of achieving greater protection for the p.r.m

Enhancing allocentric spatial recall in pre-schoolers through navigational training programme

Unlike for other abilities, children do not receive systematic spatial orientation training at school, even though navigational training during adulthood improves spatial skills. We investigated whether navigational training programme (NTP) improved spatial orientation skills in pre-schoolers. We administered 12-week NTP to seventeen 4- to 5-year-old children (training group, TG). The TG children and 17 age-matched children (control group, CG) who underwent standard didactics were tested twice before (T0) and after (T1) the NTP using tasks that tap into landmark, route and survey representations. We determined that the TG participants significantly improved their performances in the most demanding navigational task, which is the task that taps into survey representation. This improvement was significantly higher than that observed in the CG, suggesting that NTP fostered the acquisition of survey representation. Such representation is typically achieved by age seven. This finding suggests that NTP improves performance on higher-level navigational tasks in pre-schooler

A Performance Management System in Healthcare for All Seasons?

Health systems face challenges which are inherent to care demand and supply evolution (i.e., demographic change, new technologies) or are the results of unexpected occurrence originating outside the health system, such as economic shocks or epidemic outbreaks. Both challenges often require a paradigm shift in governance and organization, financing and resource allocation, accountability frameworks, as well as public health system responses. Based on key reviews and seminal papers of performance management, public health, sustainability and resilience, the article presents three emerging challenges for performance management systems in healthcare: i) the inclusion of the population approach; ii) the measurement and consideration of the multi-facets concepts of value; iii) the importance of resilience and sustainability. Performance management systems need to evolve to cope with this changing scenario. The article sheds light on uncovered areas by performance management, and it proposes a research agenda for scholars of both performance management and health service research

Bilateral total extraperitoneal inguinal hernia repair (TEP) has outcomes similar to those for unilateral TEP: population-based analysis of prospective data of 6,505 patients

Background: Whether bilateral total extraperitoneal (TEP) inguinal hernia repair is associated with worse outcomes than unilateral TEP continues to be a matter of debate. This study aimed to compare different outcomes of large cohorts of patients undergoing bilateral versus unilateral TEP. Methods: Based on prospective data of the Swiss Association of Laparoscopic and Thoracoscopic Surgery (SALTS), all patients undergoing elective unilateral or bilateral TEP from 1995 to 2006 were included in the study. The outcomes compared included conversion rates; intraoperative, surgical, and general postoperative complications; duration of operation; and length of hospital stay (LOS). Unadjusted and risk-adjusted multivariable analyses were performed. Results: Data for 6,505 patients undergoing unilateral (n=3,457) and bilateral (n=3,048) TEP were prospectively collected. The average age and the American Society of Anesthesiologists (ASA) score were similar in the two groups. The patients undergoing bilateral TEP repair had a slightly increased rate of intraoperative complications (bilateral, 3.1% vs. unilateral, 1.9%) and surgical postoperative complications (bilateral, 3.2% vs. unilateral, 2.3%). The operation time was longer for bilateral TEP repair (86 vs. 67min). No significant differences in postoperative LOS, general postoperative complications, or conversion rates were found. Conclusions: This is the first population-based analysis in the literature to compare different outcomes in a prospective cohort of more than 6,500 patients undergoing bilateral versus unilateral TEP. Although the rates for intraoperative and surgical postoperative complications were slightly higher for the patients undergoing bilateral TEP repair, the absolute differences were small and of minor clinical relevance. Bilateral TEP repair is associated with a minimal increase in operating time and similar LOS, general postoperative complications, and conversion rates. Therefore, for patients with bilateral inguinal hernia, a simultaneous endoscopic approach represents an excellent therapeutic optio

Changing relative and absolute socioeconomic health inequalities in Ontario, Canada:A population-based cohort study of adult premature mortality, 1992 to 2017

BackgroundThis study aimed to characterize trends in absolute and relative socioeconomic inequalities in adult premature mortality between 1992 and 2017, in the context of declining population-wide mortality rates. We conducted a population-based cohort study of all adult premature deaths in Ontario, Canada using provincial vital statistics data linked to census-based, area-level deprivation indices for socioeconomic status.MethodsThe cohort included all individuals eligible for Ontario's single-payer health insurance system at any time between January 1, 1992 and December 31, 2017 with a recorded Ontario place of residence and valid socioeconomic status information (N = 820,370). Deaths between ages 18 and 74 were used to calculate adult premature mortality rates per 1000, stratified by provincial quintile of material deprivation. Relative inequalities were measured using Relative Index of Inequality (RII) measures. Absolute inequalities were estimated using Slope Index of Inequality (SII) measures. All outcome measures were calculated as sex-specific, annual measures for each year from 1992 to 2017.ResultsPremature mortality rates declined in all socioeconomic groups between 1992 and 2017. Relative inequalities in premature mortality increased over the same period. Absolute inequalities were mostly stable between 1992 and 2007, but increased dramatically between 2008 and 2017, with larger increases to absolute inequalities seen in females than in males.ConclusionsAs in other developed countries, long-term downward trends in all-cause premature mortality in Ontario, Canada have shifted to a plateau pattern in recent years, especially in lower- socioeconomic status subpopulations. Determinants of this may differ by setting. Regular monitoring of mortality by socioeconomic status is the only way that this phenomenon can be detected sensitively and early, for public health attention and possible corrective action