Better Outcomes, Lower Costs: How Community-Based Funders Can Transform U.S. Health Care

Mark Kramer and Dr. Atul Gawande discuss the untapped potential for community-based funders to transform the cost and quality of health care in the United States. Individually, these funders have the opportunity to make a profound and lasting impact on the health of their communities; together, they have the opportunity to create a national movement to achieve better outcomes at lower cost

Can Improved Cooking Stoves Work? The Nepal Chulo Experience

What motivates rural households to switch from older cooking methods to newer, more improved, ones? Improved cooking stoves (ICS) technology has demonstrated capacity to reduce health hazards from smoke inhalation, especially for mothers and young children in poor rural households. Additional advantages such as fuel economy are also possible. However, policies encouraging rural households to switch have met with little success. Initially enthusiastic acceptance has seldom led to long-term adoption. Possibly, faulty policy implementation is to blame, but it is likely that policymakers have not come to terms with the fact that adopting the ICS requires changing generations-old behavior. This paper contributes in two ways, using a primary survey of rural households in Nepal. It first uses tests of independence to investigate sources of resistance to adopting the ICS by associating characteristics of the heads of households with their adoption decision. Association of self-reported health outcomes with adoption is also examined. Second, the paper sheds light on the role of economic benefits such as fuel economy, fuel costs, and government subsidy and their association with ICS adoption. Nepal is an appropriate setting for studying ICS adoption, for its plentiful wood supply has deemed the traditional stove or chulo the status quo cooking technology. Nepal’s government also has a history of experimenting with ICS adoption. Some lessons from the Nepal experience are useful for other countries as they seek to change the behavior of their rural households

Governance and Performance: Theory-Based Evidence from US Coast Guard Inspections

Given three stylized facts about the US Coast Guard (USCG), namely, soft penalties for safety violations, low incidence of penalties relative to the number of violations, and substantial resources devoted to inspections of vessels, this paper seeks (i) a theoretical lens to view USCG activities and (ii) an empirical assessment of whether those activities improve performance. Harrington’s (1988) model is motivated by these stylized facts about US regulation in general, and provides a solution via targeting of good and poor performers. The model generates hypotheses about optimal regulation in the context of pollution prevention activities of the USCG. An organization-level panel data set consisting of thousands of US flag tank barges is constructed to test those hypotheses. A count model that controls for vessel heterogeneity yields mixed evidence. If USCG inspections are considered exogenous variables (as the theory presumes), they appear to prevent pollution spills. But if inspections are endogenous and respond to previous spills then correcting for endogeneity reverses the earlier result. In addition, violations are found to be good predictors of pollution occurrences, suggesting that inspections are not as effective as they could be. Targeting as in Harrington’s model therefore appears to be incomplete, and the findings suggest that more complete targeting could increase performance. An interesting finding is that stronger penalties could increase performance.Harrington model; Inspections; Penalties; Oil Spills; USCG;

Can foreign lobbying enhance development ? The case of tourism in the Caribbean

There exist legal channels for informational lobbying of U.S. policymakers by foreign principals. Foreign governments and private sector principals frequently and intensively use this institutional channel to lobby on trade and tourism issues. The authors empirically study whether such lobbying effectively achieves its goal of trade promotion in the context of Caribbean tourism and it is the first paper to examine the potential for using foreign lobbying as a vehicle for development. They use panel data to explore and quantify the association between foreign lobbying by Caribbean principals and U.S. tourist arrivals to Caribbean destinations. A variety of sensitivity analyses support the finding of a strong association. The policy implications are obvious and potentially important for developing countries.Tourism and Ecotourism,Economic Theory&Research,Accommodation&Tourism Industry,Political Systems and Analysis,Politics and Government