To Reform Medicare, Reform Incentives and Organization

Alain C. Enthoven's paper, To Reform Medicare, Reform Incentives And Organization, explains how the principles of cost-responsible consumer choice among competing health-insurance plans, sometimes called "managed competition," can both improve quality and reduce cost in the federal government's Medicare program

Health Care in California and National Health Reform

CED believes that the U.S. employer-based health insurance system is failing -- and the recently enacted health reform, the Patient Protection and Affordable Care Act (PPACA), will not reverse that dynamic. Fewer American workers have insurance now than did ten years ago; and fewer American firms are offering health insurance now than did then. Many people do without care because they are not covered, or fear -- with justification -- that one illness or the loss of a job will cost them their coverage. The competitiveness of American firms is threatened by the cost of health insurance. Public budgets at every level of government are eroded by the costs of health care, including costs that previously were paid by employers. Although the new law will create pathways to private coverage for some people who are not insured by their employers, and many others will be made eligible for Medicaid, the clear intent is to maintain employer coverage for as many as possible -- and there is precious little in the law to improve this core structure of the U.S. healthcare system. We have proposed a fundamental restructuring of the health-care system to address this crisis. With the nation having focused on this issue, we have worked to learn what the health-care system of California can teach us about national reform, and how national reform might affect California

Unpacking opportunity recognition for sustainable entrepreneurship

Sustainable entrepreneurs can find solutions to the largest challenges that humanity faces by starting a new company. However, to be able to do that, they first need to recognize a business opportunity. Therefore, I analyse the following question: where, how, and why do entrepreneurs recognize business opportunities for a sustainable business? To recognize a business opportunity is crucial for entrepreneurs, because without a business opportunity, there is no entrepreneurship. Opportunity recognition is essentially a match of (1) resources that the entrepreneur has access to, and (2) a need, interest or want in the market. The entrepreneur combines these into an idea and a plan for a new venture. Sustainable entrepreneurs need to first recognize a sustainability problem and find a market solution to this problem, before they can recognize a sustainable opportunity. My research shows that: (1) sustainable entrepreneurs recognize opportunities at places in the Netherlands where there already is a concentration of entrepreneurs in the same sector, (2) identity, values and problem recognition conjointly explain why entrepreneurs recognize sustainable opportunities, (3) entrepreneurs recognize sustainable opportunities through identity processes and the translation of complex into specific problems, and (4) they create opportunities by fostering a sustainable consumer culture in market niches. These findings help to unpack the concept of sustainable opportunity recognition. The findings can also aid (aspiring) entrepreneurs to recognize new sustainable opportunities, help teachers to learn students to recognize new opportunities and to help policy makers to stimulate sustainable entrepreneurship based on regional characteristics

Regulatory and Nonregulatory Strategies for Controlling Health Care Costs

To date, three generic types of policy responses to the problem of rising health expenditures have been proposed. One is to increase greatly the share of medical costs that is paid by the patient so that consumers will have much more incentive to economize on medical services. A second is to leave intact the incentives for increasing expenditures in the fee-for-service, cost reimbursement, third-party intermediary system, but to impose economic and technical regulation on providers in an attempt to prevent the incentives from producing their natural effect. The third is to restructure the delivery and payments system in a manner that alters the basic financial incentives facing providers so that they find it in their interest to provide good quality but cost-effective care. The main thesis of this paper is that spending on health services cannot be effectively controlled in the present political context without the use of a policy of the third type