Decentralizing the provision of health services : an incomplete contracts approach

The author studies the allocation-between a central government and a local authority--of responsibility for planning, financing, and operations for the delivery of health services, in the context of an incomplete contracts model. In this model, inputs are required of both the central government and local authorities but they are unable to write down, and commit to, a complete and binding contract describing the actions both should take. The model is meant to capture the tradeoff between central and local authority in decisions about both financing and the provision of services. Each party provides a specific input--for example, the central government establishes a drug procurement system while the local authority designs and implements an incentive scheme to get doctors to carry out their responsibilities appropriately. The responsibility for delivery of services is identified with the ownership of essential infrastructure, such as the clinic or hospital. The author finds that to maximize the joint surplus of the two public bodies: Ownership of the facility should be given to the party that most values the well-being of local residents. (This way, if ex post bargaining breaks down, each still enjoys some benefits from the other's actions.) Financing authority and responsibility for delivering services should be negatively correlated. Generally it is optimal to allocate tax authority to the party that values the residents'well-being less--in other words, separate spending responsibility (ownership) from financing authority. A heavier financing burden (access to a small and inefficient tax base) has the same incentive effect as asset ownership: It increases the return to effort. If transferring ownership of the physical asset is costly (because the party that builds the asset has an inherent advantage in operating it-that is, there is some human capital embodiment), it may be optimal for the party with the higher construction costs to have planning authority. Somewhat paradoxically, the greater the costs of transferring assets from one party to the other, the more likely that ownership of the facilities and their provision should be separated.International Terrorism&Counterterrorism,Decentralization,Environmental Economics&Policies,Economic Theory&Research,Labor Policies,Economic Theory&Research,National Governance,International Terrorism&Counterterrorism,Banks&Banking Reform,Environmental Economics&Policies

Public policy toward nongovernmental organizations in developing countries

The author presents two descriptive models of nongovernmental organizations and poses mormative questions about public polcy toward nongovernmental organizations (NGOs). In situations in which optimal government intervention in a distorted or inequitable economy employs an NGO-like body, he considers which kinds of NGO might be used. First, in many developing countries NGOs participate in the delivery of what are essentially private goods--inparticular, health care and education. In an economy without NGOs, there may be good redistributive and efficiency reasons for the government to provide these goods in kind. But if direct government provision of such services is ineffective or inefficient, when is contracting out to an NGO-like institution preferable to using a traditional for-profit firm? (Another way to frame this is to ask: What is the optimal taxation and regulation of private providers of publicly financed services?) NGOs also provide useful real and financial links with external donors. They are used to provide services the government favors and donors are willing to fund. In this model, the service provider is chosen to yield the best outcome for both government and donor. In this context, the author compares an international NGO and a grassroots organization. It may be more efficient to transfer donor funds through an international NGO than through a local NGO, but when donor-government cooperation fails, a project implemented by an international NGO is effectively killed. If a project implemented by a local organization can limp along, this otherwise less efficient organization might be preferred.Labor Policies,Poverty Monitoring&Analysis,Environmental Economics&Policies,Economic Theory&Research,Decentralization,Poverty Monitoring&Analysis,Economic Theory&Research,Environmental Economics&Policies,Health Economics&Finance,Education for the Knowledge Economy

Native advertising : attitudes, value and purchase intention

textNative-form advertising in the digital space can most easily be defined as promotional content constructed to mimic the form and structure of the website that it is embedded on. With the rise of user generated content and social media, digital native advertising is fast becoming a popular promotional tactic for brands looking to engage with an online audience. This study examines whether this form of advertising significantly impacts consumer attitudes towards the ad, value of the ad and purchase intention of the promoted product across three product categories. Although not significant, results suggest that native advertising positively impacts entertainment- and lifestyle-based products, while information-based service industries, including cyber security, saw a negative reaction from respondents. That said, product category did influence attitude toward the ad and ad value regardless of the ad type. Moreover, a strong positive correlation between product involvement and purchase intention was found, indicating the need to target specific audiences with online native advertising.Advertisin

Does disaggregated electricity feedback reduce domestic electricity consumption? A systematic review of the literature

We examine 12 studies on the efficacy of disaggregated energy feedback. The average electricity reduction across these studies is 4.5%. However, 4.5% may be a positively-biased estimate of the savings achievable across the entire population because all 12 studies are likely to be prone to opt-in bias hence none test the effect of disaggregated feedback on the general population. Disaggregation may not be required to achieve these savings: Aggregate feedback alone drives 3% reductions; and the 4 studies which directly compared aggregate feedback against disaggregated feedback found that aggregate feedback is at least as effective as disaggregated feedback, possibly because web apps are viewed less often than in-home-displays (in the short-term, at least) and because some users do not trust fine-grained disaggregation (although this may be an issue with the specific user interface studied). Disaggregated electricity feedback may help a motivated sub-group of the population to save more energy but fine-grained disaggregation may not be necessary to achieve these energy savings. Disaggregation has many uses beyond those discussed in this paper but, on the specific question of promoting energy reduction in the general population, there is no robust evidence that current forms of disaggregated energy feedback are more effective than aggregate energy feedback. The effectiveness of disaggregated feedback may increase if the general population become more energy-conscious (e.g. if energy prices rise or concern about climate change deepens); or if users' trust in fine-grained disaggregation improves; or if innovative new approaches or alternative disaggregation strategies (e.g. disaggregating by behaviour rather than by appliance) out-perform existing feedback. We also discuss opportunities for new research into the effectiveness of disaggregated feedback.Comment: Accepted for oral presentation at the 3rd International NILM Workshop, Vancouver, 14-15 May 201

Metadata for Energy Disaggregation

Energy disaggregation is the process of estimating the energy consumed by individual electrical appliances given only a time series of the whole-home power demand. Energy disaggregation researchers require datasets of the power demand from individual appliances and the whole-home power demand. Multiple such datasets have been released over the last few years but provide metadata in a disparate array of formats including CSV files and plain-text README files. At best, the lack of a standard metadata schema makes it unnecessarily time-consuming to write software to process multiple datasets and, at worse, the lack of a standard means that crucial information is simply absent from some datasets. We propose a metadata schema for representing appliances, meters, buildings, datasets, prior knowledge about appliances and appliance models. The schema is relational and provides a simple but powerful inheritance mechanism.Comment: To appear in The 2nd IEEE International Workshop on Consumer Devices and Systems (CDS 2014) in V\"aster{\aa}s, Swede

Heckle and Chide: Results of a Randomized Road Safety Intervention in Kenya

In economies with weak enforcement of traffic regulations, drivers who adopt excessively risky behavior impose externalities on other vehicles, and on their own passengers. In light of the difficulties of correcting inter-vehicle externalities associated with weak third-party enforcement, this paper evaluates an intervention that aims instead to correct the intra-vehicle externality between a driver and his passengers, who face a collective action problem when deciding whether to exert social pressure on the driver if their safety is compromised. We report the results of a field experiment aimed at solving this collective action problem, which empowers passengers to take action. Evocative messages encouraging passengers to speak up were placed inside a random sample of over 1,000 long-distance Kenyan minibuses, or matatus, serving both as a focal point for, and to reduce the cost of, passenger action. Independent insurance claims data were collected for the treatment group and a control group before and after the intervention. Our results indicate that insurance claims fell by a half to two-thirds, from an annual rate of about 10 percent without the intervention, and that claims involving injury or death fell by at least 50 percent. Results of a driver survey eight months into the intervention suggest passenger heckling was a contributing factor to the improvement in safety.Kenya, traffic, driving regulations, matatus, safety

Dynamic Enfranchisement

Why would a political elite voluntarily dilute its political power by extending the voting franchise? This paper develops a dynamic recursive framework for studying voter enfranchisement. We specify a class of dynamic games in which political rights evolve over time. Each period, private decisions of citizens co-mingle with government policies to act upon a state variable such as a capital stock, a public good, or the likelihood of an insurrection. Policies are determined by a pivotal decision maker in a potentially restricted franchise. The pivotal decision maker can also delegate decision authority to a new decision maker in the subsequent period. We describe conditions under which an equilibrium of this "dictator delegation game" corresponds to a majority vote decision by the enfranchised group to expand the set of citizens with voting rights. Under these conditions, each period's pivotal decision maker is a median voter who can designate authority to a new median of a larger voting franchise in the next period. We characterize the equilibria by their Euler equations. In certain games, the equilibria generate paths that display a gradual, sometimes uneven history of enfranchisement that is roughly consistent with observed patterns of extensions. Our main result shows that extensions of the franchise occur in a given period if and only if the private decisions of the citizenry have a net positive spillover to the dynamic payoff of the current median voter. The size of the extension depends on the size of the spillover. Since the class of games we study can accommodate a number of proposed explanations for franchise extension (e.g., the threat of insurrection, or ideological or class conflict within the elite, etc), the result suggests a common causal mechanism for these seemingly different explanations. We describe a number of parametric environments that correspond to the various explanations, and show how the mechanism works in eachDynamic games, voter enfranchisement, franchise extension, dictator delegation game

Dynamic Enfranchisement

Why would a political elite voluntarily dilute its political power by extending the voting franchise? This paper develops a dynamic recursive framework for studying voter enfranchisement. We specify a class of dynamic games in which political rights evolve over time. Each period, private decisions of citizens co-mingle with government policies to act upon a state variable such as a capital stock, a public good, or the likelihood of an insurrection. Policies are determined by a pivotal decision maker in a potentially restricted franchise. The pivotal decision maker can also delegate decision authority to a new decision maker in the subsequent period. We describe conditions under which an equilibrium of this "dictator delegation game" corresponds to a majority vote decision by the enfranchised group to expand the set of citizens with voting rights. Under these conditions, each period's pivotal decision maker is a median voter who can designate authority to a new median of a larger voting franchise in the next period. We characterize the equilibria by their Euler equations. In certain games, the equilibria generate paths that display a gradual, sometimes uneven history of enfranchisement that is roughly consistent with observed patterns of extensions. Our main result shows that extensions of the franchise occur in a given period \emph{if and only if} the private decisions of the citizenry have a net positive spillover to the dynamic payoff of the current median voter. The size of the extension depends on the size of the spillover. Since the class of games we study can accommodate a number of proposed explanations for franchise extension (e.g., the threat of insurrection, or ideological or class conflict within the elite, etc), the result suggests a common causal mechanism for these seemingly different explanations. We describe a number of parametric environments that correspond to the various explanations, and show how the mechanism works in each.Dynamic games, voter enfranchisement, franchise extension equilibria, dictator delegation game

Health investments and economic growth : macroeconomic evidence and microeconomic foundations

This paper reviews the correlations and potential links between health and economic growth and summarizes the evidence on the role of government in improving health status. At the macroeconomic level, the evidence of an impact of health on growth remains ambiguous due both to difficulties in measuring health, and to the methodological challenges of identifying causal links. The evidence on the micro linkages from health investments to productivity and income are robust. Progress in life expectancy over the past two centuries has been spectacular, fueled by: improved agriculture that has increased food quantity; knowledge of disease transmission, and effective public health interventions that have controlled communicable diseases such as malaria, yellow fever, and hookworm; and, most recently and importantly, investments in very young children that pay off in healthier and more productive adults. Whether public investments in medical care affect health hinges on the quality of health institutions. In much of the developing world, factors such as chronic absenteeism among public providers, poor budget execution, ineffective management, and virtually no accountability weaken public efforts. Institutional issues are central in efforts to enhance public health investments, which in turn have a direct impact on the population's welfare and, perhaps over the long term, improvements in national income.Health Monitoring&Evaluation,Health Systems Development&Reform,Population Policies,Health Economics&Finance,Disease Control&Prevention