Health Programme Evaluation by Propensity Score Matching: Accounting for Treatment Intensity and Health Externalities with an Application to Brazil

Most of the literature on health programme evaluation has estimated average programme impacts relying on either: (i) data on the presence or absence of an intervention in a particular locality, or (ii) data on individual participation in the health programme. By estimating an average health impact which is independent of the programmes population coverage, the empirical approaches of these studies overlook the important fact that public health interventions create externalities whose magnitude depends crucially on the number of covered individuals in a locality. The lain contributions of this paper are to suggest and apply an empirical approach for the impact evaluation of public health interventions which also takes into account treatment externalities, when non-experimental, routine data are available and under the assumption of average treatment effects by a propensity score matching-difference-in-differences estimator adapted to the case of multiple treatments, jointly evaluating the impact of different programme coverage levels. The methods are used to conduct an impact evaluation of the Family Health Programme (Programa Saude da Familia PSF), the broadest health programme ever launched in Brazil, on adult and child health. --health programme evaluation,multiple treatments,propensity score matching,Brazil

Europe and Central Asia's great post-communist social health insurance experiment : impacts on health sector and labor market outcomes

The post-communist transition to social health insurance in many of the Central and Eastern European and Central Asian countries provides a unique opportunity to try to answer some of the unresolved issues in the debate over the relative merits of social health insurance and tax-financed health systems. This paper employs a regression-based generalization of the difference-in-differences method and instrumental variables on panel data from 28 countries for the period 1990-2004. The authors find that, controlling for any concurrent provider payment reforms, adoption of social health insurance increased national health spending and hospital activity rates, but did not lead to better health outcomes. The authors also find that adoption of social health insurance reduced employment in the economy as a whole and increased unemployment, although it did not apparently increase the size of the informal economy.Health Monitoring&Evaluation,Health Systems Development&Reform,Population Policies,Health Economics&Finance,Disease Control&Prevention

System-wide impacts of hospital payment reforms : evidence from central and eastern Europe and central Asia

Although there is broad agreement that the way that health care providers are paid affects their performance, the empirical literature on the impacts of provider payment reforms is surprisingly thin. During the 1990s and early 2000s, many European and Central Asian countries shifted from paying hospitals through historical budgets to fee-for-service or patient-based-payment methods (mostly variants of diagnosis-related groups). Using panel data on 28 countries over the period 1990-2004, the authors of this study exploit the phased shift from historical budgets to explore aggregate impacts on hospital throughput, national health spending, and mortality from causes amenable to medical care. They use a regression version of difference-in-differences and two variants that relax the difference-in-differences parallel trends assumption. The results show that fee-for-service and patient-based-payment methods both increased national health spending, including private (out-of-pocket) spending. However, they had different effects on inpatient admissions (fee-for-service increased them; patient-based-payment had no effect), and average length of stay (fee-for-service had no effect; patient-based-payment reduced it). Of the two methods, only patient-based-payment appears to have had any beneficial effect on"amenable mortality,"but there were significant impacts for only a couple of causes of death, and not in all model specifications.Health Monitoring&Evaluation,Health Systems Development&Reform,Health Economics&Finance,Health Law,Population Policies

Second harmonic generation from metallic arrays of rectangular holes

The generation process of second harmonic (SH) radiation from holes periodically arranged on a metal surface is investigated. Three main modulating factors affecting the optical response are identified: the near-field distribution at the wavelength of the fundamental harmonic, how SH light couples to the diffraction orders of the lattice, and its propagation properties inside the holes. It is shown that light generated at the second harmonic can excite electromagnetic modes otherwise inaccessible in the linear regime under normal incidence illumination. It is demonstrated that the emission of SH radiation is only allowed along off-normal paths precisely due to that symmetry. Two different regimes are studied in the context of extraordinary optical transmission, where enhanced linear transmission either occurs through localized electromagnetic modes or is aided by surface plasmon polaritons (SPPs). While localized resonances in metallic hole arrays have been previously investigated, the role played by SPPs in SH generation has not been addressed so far. In general, good agreement is found between our calculations (based on the finite difference time domain method) and the experimental results on localized resonances, even though no free fitting parameters were used in describing the materials. It is found that SH emission is strongly modulated by enhanced fields at the fundamental wavelength (either localized or surface plasmon modes) on the glass metal interface. This is so in the transmission side but also in reflection, where emission can only be explained by an efficient tunneling of SH photons through the holes from the output to the input side. Finally, the existence of a dark SPP at the fundamental field is identified through a noninvasive method for the first time, by analyzing the efficiency and far-field pattern distribution in transmission at the second harmonic.Comment: This paper was published in JOSA B and is made available as an electronic reprint with the permission of OSA. The paper can be found at the following URL on the OSA website: http://www.opticsinfobase.org/josab/abstract.cfm?URI=josab-32-1-15. Systematic or multiple reproduction or distribution to multiple locations via electronic or other means is prohibited and is subject to penalties under la

Modeling changes in the tidal propagation and its implication for vessel navigation in Guadalquivir estuary ( Spain)

The Port of Seville is an inland harbour located in the Guadalquivir Estuary some 80 km from the river mouth and is the unique Spanish inland port. Vessel traffic in the estuary is a relevant economic activity and a suitable trade-off between vessel draught and safety to prevent ship aground is required and to optimize the port operability. The Guadalquivir is a mesotidal estuary with tidal range of 2-3 m, an important fraction of the minimum depth of the navigation waterway (presently 6.5m). Upstream navigation is favoured around high water as the tide progresses at 12 knots, which is comparable to the vessel speed, thus allowing greater vessel draughts. Oceanwards navigation of heavy vessels, on the contrary, is hampered by the tide because a low water is unavoidably met when heading downstream. A 3D, high resolution hydrodynamic model has been implemented in the whole estuary to study the tidal propagation. The model is forced by the oceanic tide at the mouth and freshwater discharges controlled by an upstream dam at the head. It has been satisfactorily validated and predicts tidal oscillations with high accuracy (less than 4 cm in amplitude and 20 min in phase everywhere in the estuary). Based on the model outputs of tidal heights and currents and using present-day estuary bathymetry, a MATLAB application has been developed for shipping planning (Vessel Traffic Decision Support System, VTDSS). The application allows the final users to test different traffic scheduling scenarios in order to assess the effects on navigational patterns and explore possible management and policy scenarios under sea level rise and changes in tidal propagation. A description of the model and an overview of the VTDSS are presented here; the effectiveness as a decision support tool is demonstrated via the simulated navigation time of several vessels.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech. Autoridad Portuaria de Sevill

Death by Market Power. Reform, Competition and Patient Outcomes in the National Health Service

The effect of competition on the quality of health care remains a contested issue. Most empirical estimates rely on inference from non experimental data. In contrast, this paper exploits a pro-competitive policy reform to provide estimates of the impact of competition on hospital outcomes. The English government introduced a policy in 2006 to promote competition between hospitals. Patients were given choice of location for hospital care and provided information on the quality and timeliness of care. Prices, previously negotiated between buyer and seller, were set centrally under a DRG type system. Using this policy to implement a difference-in-differences research design we estimate the impact of the introduction of competition on not only clinical outcomes but also productivity and expenditure. Our data set is large, containing information on approximately 68,000 discharges per year per hospital from 160 hospitals. We find that the effect of competition is to save lives without raising costs. Patients discharged from hospitals located in markets where competition was more feasible were less likely to die, had shorter length of stay and were treated at the same cost.competition, hospitals, quality

Enhancing organizational performance with social media use: the catalysing effect of corporate entrepreneurship

Social Media use has become pervasive and firms are increasingly relying on it, not only to relate to customers, but also to leverage internal processes like innovation. The strategic use of these tools can facilitate also the entrepreneurial orientation of the firm, as it provides useful knowledge which can make the firm more entrepreneurial, stimulating it to find new opportunities or innovative ideas where other companies do not recognize them. However, despite the relevance of the phenomenon in current hyper-competitive environments, empirical research on the topic remains scarce. To shed some light on the issue, the main purpose of the paper is to examine how Social Media use impacts the different dimensions of corporate entrepreneurship (new business venturing, innovativeness, proactiveness and self-renewal), enhancing also organizational performance. The study is intended to extend knowledge on this topic, by providing understanding of the path firms should take to benefit from Social Media use to become more entrepreneurial and achieve higher organizational performance, developing and nurturing competitive advantages. The paper analyses data obtained from a sample of 201 technological firms located in Spain. The methodology used is Structural equation modelling with LISREL analysis. Findings confirms how the use of Social Media tools positively impacted all the different dimensions of corporate entrepreneurship, translating also in enhanced performance. This paper contributes to the literature by empirically confirming in a structural model how Social Media use helps to create business value, by enhancing proactive behaviours, promoting strategic renewal inside the firm and increasing innovativeness and new business venturing and displaying the internal and sequential relationships among these dimensions.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tec

Desing and implementation of control hardware

The idea of adapting old mechatronic systems to new technologies leads to the creation of generic control hardware that upgrades them. With this in mind control hardware has been developed from the initial stages of design to the experimental tests. Altium software has been used to design the schematics and build the system conditioning circuit. To obtain experimental results some Simulink blocks diagrams have been implemented using Matlab. The hardware designed has been tested in two laboratory models. In addition, a study of the ESCs and the viability to use them as control systems for engines used in the automatic industry.Ingeniería Electrónica Industrial y Automátic

Evaluation to determine the transfer of sales and service center township Bello

Actualmente, la oficina de Bello- Antioquia ha incrementado en los últimos meses debido a que la afluencia de público que se dirige para hacer algún tipo de transacción, ya sea de caja o de servicio, por esta razón la cantidad de asesores capacitados no da abasto por la cantidad de solicitudes y requerimientos que se reciben a diario teniendo como consecuencia demora en los tiempos de atención y respuesta a estos requerimientos El crecimiento poblacional y la captación masiva de clientes ha incrementado el número de usuarios atendidos mensualmente por esta causa, hoy en día existen oficinas en las cuales el nivel de servicio es llevado a tope, por tal razón se realizan las ampliaciones o traslados con el fin de aumentar la capacidad de atención, incrementando el numero de asesores de servicio y cajeros mitigando los tiempos de atención, Es allí cuando se analiza el Nivel de Satisfacción al Usuario contando con que el tiempo mínimo de atención a un cliente en las oficinas debe ser inferior a 15 minutos desde el momento que toma del turno hasta la atención de la consulta que desea realizar. Para proyectar los crecimientos para el año 2016 se utiliza un modelo de tres niveles. El primero utiliza las proyecciones de cantidad de hogares en cada ciudad, realizadas por el Dane, para estimar el número de servicios activos por cada una de ellas, previamente se verifica la significativa correlación positiva que existe entre estas dos variables; el segundo nivel utiliza la estimación de servicios activos del paso anterior para pronosticar el tráfico en cada una de las oficinas. El tercer nivel del modelo utiliza la estimación de tráfico así como los tiempos promedio de atención, para calcular el número óptimo de asesores necesarios para atender todo el tráfico, manteniendo un nivel de servicio de 90%.ABSTRACT Currently, the office Bello Antioquia has increased in recent months due to the influx of people that goes for any type of transaction, whether cash or service, therefore the number of trained counselors can not cope by the number of requests and requirements are received daily having as delay times result in attention and response to these requirements Population growth and massive customer acquisition has increased the number of clients served monthly by this cause, today there are offices in which the level of service is taken to stop for that reason extensions or transfers are made in order to increase attention span, increasing the number of service advisors and ATMs mitigating service times, it's there when the level of satisfaction the user is analyzed having the minimum of attention to a client in the office should be less 15 minutes from the time it takes to shift the attention of the query you. To project growth for 2016 model uses three levels. The first uses the projected number of households in each city, conducted by the Dane, to estimate the number of active services for each previously significant positive correlation between these two variables is verified; the second level estimation uses the services active in the previous step to predict the traffic in each of the offices. The third level of the model used to estimate traffic and the average service time to calculate the optimal number of consultants needed to serve all traffic, while maintaining a level of service of 90%