Hotelling competition on quality in the health care market.

This paper aims to theoretically analyse recent health system reforms. Generally patients are free to choose, within the region they live in, the best provider among the private "accredited" and public ones. The criterion patients use to choose the provider which fits their expectations best is not, at least in a tax financed system, the price of the treatment since patients do not pay directly for the treatment they receive. Crucial in determining their choice is the quality level and the provider spatial location. In a normative perspective we want to analyse hospitals' Nash/Counot and Stackelberg equilibriums in a Hotelling spatial competition scenario. Because of asymmetric information, patients could be unable to observe the true quality provided. Thus the demand for health care services is assumed to depend on a perceived quality (different from true quality). New equilibrium outcomes are investigated when patient choice is affected by uncertainty.

It takes three to tango: Soft budget constraint and cream skimming in the hospital care market

Cream skimming is an illegal behaviour that consists in choosing to treat patients according to their ability to recover. It arises from the use of prospective payment schemes in an asymmetry of information framework. In this context in fact the provider can observe some relevant information (freely or at a cost) before making its effort which will then be used to its own advantage. The paper studies the scope for these types of behaviour in a mixed market for hospital care where the hospitals do not share the same objectives. We show that in this context cream skimming is made possible by the presence of two important elements: the public hospital prefers to treat high severity patients and the regulator is unable to enforce hard budget constraint rules. The paper adds an important dimension to the study of cream skimming as proposed by the traditional literature where asymmetry of information alone is considered the cause of this market failure. In our context, in fact, cream skimming arises mainly from a regulatory failure.

Social influence and neighbourhood effects in the health care market.

This work is intended to analyze the market for health care through a computational approach based on unsupervised neural networks. The paper provides a theoretical framework for a computational model that relies on Kohonen's self organizing maps (SOM), arranged into two layers: in the upper layer the competition dynamics of health care providers is modelled, whereas in the lower level patients behaviour is monitored. Interactions take place both vertically between the layers (in a bi-directional way), and horizontally, inside each level, exploiting neighbourhood features of SOM: signals move vertically from hospitals to patients and vice-versa, but they also spread out sideward, from patient to patient, and from hospital to hospital. The result is a new approach addressing the issue of hospital behaviour and demand mechanism modelling, which conjugates a robust theoretical implementation together with an instrument of deep graphical impact.self organizing maps; health market; adaptive behaviour; incomplete information; mixed market

Mean voting rule and strategical behavior: an experiment

This paper considers the problem of voting about the quantity of a public good. An experiment has been run in order to test the extent of the strategic bias that arises in the individual vote when the social choice rule is to select the mean of the quantities voted for; conflicting theoretical predictions are available in the literature on this purpose. The political implications of the mean rule and its e.ects upon e.ciency are also discussed. The role of voters' information is considered. A comparison is made with the working of the median rule.

Migrants and mafia as global public goods

Global public goods, differently from what it might be thought, are quite common in the real world. This work suggests that both the governments' struggle against Mafia and the prevention of immigration can be regarded as global public goods. We assume a federation of jurisdictions with two tiers of Government: the central and the local. Regional utility directly represents the preferences of citizens, since the local governments aim at individualistic utility maximization; central government uses the redistribution of resources among the members of the federation to maximize the social welfare which is given, as usual, by the sum of regional utilities. The Central Government aims at welfare maximization. To get its goal it has to find out the efficient way to fund and provide public goods taking into account not only their particular characteristics but also the fact that, in many circumstances, their production faces increasing cost, which may depend both on the quantity of good produced and on the type (high or low cost) of the producer (which, in this framework, coincides with the jurisdiction). Thus the first issue addressed by the paper concerns the choice between central and local provision. Furthermore, as far as the informational structure is concerned, the centre lacks information concerning the type of each region. Thus, the central government's key informational problem concerns the regional costs and quantities with regard both to the public and the private good. Indeed we assume that the centre can observe the expenditure levels but neither the costs nor the outputs associated with those expenditure levels.global public good, asymmetric information, adverse selection, redistribution, Mafia

Nash behaviour and public good

In this note we analyse the provision of a pure public good with non constant production cost in the context of a federation of jurisdictions with two tiers of Government: the central and the local. The central government aims at welfare maximization but this objective is constrained to the use of lump sum transfer. Local governments aim at their own utility maximization and they behave according to the Nash rule. The production cost for the public good is affected by the jurisdiction's type (high or low) and by the quantity of the good that is produced. It is shown that a social welfare improvement might take place, in some circumstances, even without any central government intervention. On the other hand a first best is unreachable under the hypothesis of Nash behaviour and lump sum transfer among jurisdictions.public good, Nash equilibrium, lump sum transfer

Characterization of VRC01, a potent and broadly neutralizing anti-HIV mAb, produced in transiently and stably transformed tobacco

The proposed clinical trial in Africa of VRC01, a potent broadly neutralizing antibody (bNAb) capable of neutralizing 91% of known HIV-1 isolates, raises concerns about testing a treatment which will be too expensive to be accessible by the most important target population, the poor in under-developed regions such as sub-Saharan Africa. Here, we report the expression of VRC01 in plants as an economic alternative to conventional mammalian-cell-based production platforms. The heavy and light chain genes of VRC01 were cloned onto a single vector, pTRAk.2, which was transformed into Nicotiana benthamiana or Nicotiana tabacum using transient and stable expression production systems respectively. VRC01 has been successfully expressed transiently in plants with expression level of approximately 80 mg antibody/kg; stable transgenic lines expressing up to 100 mg antibody/kg were also obtained. Plant-produced VRC01 from both systems showed a largely homogeneous N-glycosylation profile with a single dominant glycoform. The binding kinetics to gp120 IIIB (approximately 1 nM), neutralization of HIV-1 BaL or a panel of 10 VRC01-sensitive HIV-1 Env pseudoviruses of VRC01 produced in transient and stable plants were also consistent with VRC01 from HEK cells

Reason and Reasoning : Truth, Truthfulness and Integrity

In the time of Descartes, philosophers on both sides of the English Channel inhabited the same universe of discourse, were concerned with the same range of questions and argued about them in mutually intelligible ways. Descarte's own central concern, of course, was questions ofcertainty, knowledge and truth; as Anthony Kenny has put it, "his whole philosophy can be described as "the search for truth"

Anomalies in the stress tensor of a chiral fermion in a gauge background

In this thesis we study the anomalies of a chiral fermion in a gauge background, using a different regularization from those already present in literature. The aim here is to study all the anomalies involving the stress tensor. The final motivation is to eventually focus on the trace anomaly, which has been of some interest recently. Thus, after a brief introduction to the issue of anomalies in QFT, we proceed by studying the symmetries of a massless left-handed Weyl fermion coupled to an abelian gauge background and to gravity as well (used as an external source for the stress tensor). The regularization of the corresponding QFT is then implemented through Pauli-Villars (PV) fields having a Dirac mass. Particular emphasis is put on the unusual mass term used at this stage, consisting of a customary Dirac mass multiplied by the vierbein determinant e raised to the generic power a. After devoting a chapter to the mathematical tool of the heat kernel, we restrict ourselves to flat space, present the regulators of the model, the "jacobians" associated to each of its symmetries, and all the useful heat kernel coefficients needed for the anomaly calculations. Finally, we evaluate all the anomalies of our model: the usual chiral anomaly and the anomalies in the stress tensor, namely the trace anomaly, the anomaly in the symmetry of the stress tensor (the local Lorentz anomaly), and the anomaly in the conservation of the stress tensor (the gravitational anomaly). The latter is the most demanding task, as it requires the use of particular heat kernel coefficients which have been rarely treated in literature. The calculation of all these anomalies is the leading task accomplished in this thesis. Of course, one does not expect all these anomalies to be genuine, as some are expected to be canceled by the variation of local counterterms, leaving at the end only the chiral and trace anomalies with their known expression. That this is the case is left for future research

Libertàdi scelta e contratti prospettici: l'asimmetria informativa nel mercato delle cure sanitarie ospedaliere.

The model studies the role of reputation in contracts between providers and purchasers of health care services. The economic literature has examined the case when the demand for health services depends on the quality offered, but because of information asymmetry, we assume that quality is not directly observable by patients. However, patients can obtain information (not perfect) about the provider, i.e. they can observe its reputation. In this paper we suppose that patient demand is influenced by the provider's reputation. The model shows that by a prospective payment contract the purchaser can overcome the quality / cost reducing effort trade off, but optimal levels for all the variables of interest are not achievable. Controlling the payment scheme (fixed price per patient treated) the purchaser can get a second best equilibrium outcome. If the main purchaser's concern is quality, he will obtain that result at the cost of a higher price than in the perfect information scenario. Information asymmetry brings an inefficient solution. Transversality conditions underline the equilibrium outcome when the demand mechanism by reputation is not used: the quality / cost trade off can not be avoided.