Unveiling vertical state downscaling: identity and/or the economy?

State rescaling may take a variety of shapes although scant research has been carried out into the mechanisms and economic incentives that underpin rescaling processes. Recent literature in economics, economic sociology and political economy has identified at least two broad rescaling mechanisms, namely the development of regional identity - operating at the cultural level and proxing preference heterogeneity-, and the heterogeneity in levels of economic development, which influence the extent of regional redistribution. This paper empirically examines the mechanisms of vertical state rescaling by drawing upon empirical evidence from Catalonia and the Basque Country, to explore the evolution of sub-state identity and the rise of inter-territorial fiscal grievances - weakening intraregional economic solidarity. Findings corroborate the idea that the combination of widening sub-national identity raises the costs of managing heterogeneous spatial identities and strengthens support for vertical state downscaling. Similarly, ending regional fiscal solidarity it is found to increase the average income of Catalonia by 37% and even 17% in the Basque Country. However, the effect of regional identity exceeds that of regional redistribution in explaining state rescaling support in the magnitude of one to seven. These findings speak to the debate on the formation of Europe, in that they reveal limits to regional redistribution and highlight the importance of a common spatial identity

A better understanding of the behavioural constraints that people face will help policy makers to more effectively target public policy interventions that aim to change their actions

Government interventions often have very different outcomes to those desired by policy makers. Joan Costa Font argues that the development of behavioural economics offers a means to more thoroughly examine the behavioural constraints faced by those who are targeted by specific policies. Behavioural economics is not only better equipped to account for failures but if applied to public policy, it could also give rise to more effective public sector intervention

The hedonic placebo effect of traditional medicines

To date, the scientific evidence on traditional medicines is scant and under-developed, yet, paradoxically individuals continue to use it and claim high satisfaction levels. What can explain this effect? Using self-collected data from Ghana we argue that variations in satisfaction across individuals can be attributed to the hedonic placebo effect gained from using traditional medicines, in which processes involved with its consumption are as important, if not more important, than measures of self-reported health outcome. Findings suggest that individuals’ health seeking behaviour should be evaluated using procedural, as well as outcome, utility

Does culture matter at all in explaining why people still use traditional medicines?

Why do individuals still use traditional medicines when modern treatments are available? Economic explanations for an individual’s use of traditional instead of modern medicines are scarce and often fail to consider explanations beyond the conventional. This paper puts forward an economic explanation for the use of traditional medicine. First, traditional medicines were the default form of health care available in pre-colonial times where industry influence was yet to develop. Hence, both those individuals who exhibit lower incomes and are left out of health insurance coverage are more likely to use traditional medicines. Second, cultural attitudes and ethnic group controls explain variation in utilisation, even among those who have health insurance. Results are suggestive of the validity of cultural interpretations

Medicines in parallel trade in the European Union: a gravity specification

While recent research has explored the phenomenon of drug parallel trade in regulated environments such as the European Union (EU), or the European Economic Area, little is known about the mechanisms that explain its origin or the role of the distribution chain in exporting and importing countries in determining its extent. By building on theoretical literature explaining the role of the distribution chain, this paper draws on an empirical specification of a gravity model to examine the determinants of inter-country flows of parallel-traded drugs. In this context, the paper deals with the effect of differences in the regulation of and competition in the distribution chain in the countries of origin and destination. The paper draws on proprietary data from the Intercontinental Medical Statistics database (for the Netherlands and other EU countries that export to the Netherlands) which identify the country of origin of parallel-imported medicines from 1997-2002 for a therapeutic group (statins) for which there is no generic competition. The study reveals that although parallel trade is a specific form of arbitrage, it is primarily a regulation-induced phenomenon. As a result, although the driving force for parallel trade is price differences across countries, the propagation mechanism lies in (a) the way drug prices are regulated across countries and (b) fragmentation and the underlying incentive structure in the wholesale distribution chain in countries where drug prices are regulated. The implications that flow from our study are that a more flexible and competitive and less fragmented (along national borders) distribution chain, particularly at wholesale level, might reduce the extent of and potential for parallel trade

Decomposing Cross-Country Gaps in Obesity and Overweight: Does the Social Environment Matter?

[cat] Una qüestió clau sobre la producció de salut relativament poc explorada es refereix a la influència dels factors socioeconòmics i mediambientals sobre el pes i l’obesitat. Aquesta problemàtica adquireix particular rellevància quan es comparen dos països Mediterranis com Itàlia i Espanya. És interessant adonar-se que l’obesitat a Espanya és 5 punts percentual més elevada al 2003 mentre que a l’any 1990 era aproximadament la mateixa en ambdós països. Aquesta article presenta una descomposició no lineal dels gaps o diferencials en taxes de sobrepès (índex de massa corporal – IMC- entre 25 i 29.9 9 kg/m2), obesitat classe 1 (IMC≥30 kg/m2) i classe 2 (IMC≥35 kg/m2) entre Espanya i Itàlia per gènere i grups d’edat. En explicar aquests gaps entre països aïllem les influències dels estils de vida, els efectes socioeconòmics i els mediambientals. Els nostres resultats indiquen que quan no es controla pels efectes mediambientals (efectes de grup o ‘peer effects’) els hàbits alimentaris i el nivell educatiu són els principals predictors del gaps totals entre països (36-52%), si bé aquests dos factors exerceixen un impacte diferenciat segons gènere i edat. Un tant paradoxalment, quan controlem pels efectes de grup aquests predictors perden la seva capacitat explicativa i els efectes de grup passen a explicar entre el 46-76% dels gaps en sobrepès i obesitat i mostren un patró creixent amb l’edat.[eng] A key question underpinning health production, and one that remains relatively unexplored, is the influence of socio-economic and environmental factors on weight gain and obesity. Such issues acquire particular relevance when data from two Mediterranean countries (Italy and Spain) are compared. Interestingly, the obesity rate was 5 percentage points higher in Spain in 2003 while in 1990 it had been roughly the same in the two countries. This paper reports a non-linear decomposition of gaps in overweight (body mass index – BMI - between 25 and 29.9 kg/m2), class 1 (BMI≥30 kg/m2) and class 2 obesity (BMI≥35 kg/m2) between Spain and Italy by both gender and age. We isolate the influence of lifestyles, socioeconomic and environmental effects in explaining cross-country gaps in the prevalence of obesity. Our findings suggest that when the social environment (peer effects) is not controlled for, eating habits and education are the main predictors of total cross-country gaps (36-52%), albeit that these two factors have a different impact depending on gender and age. Somewhat paradoxically, however, when we controlled for the social environment, these previous predictors lost their explanatory power and peer effects were found to explain between 46 and 76% of gaps and to exhibit an increasing age pattern

Does cost sharing really reduce inappropriate prescriptions?

This paper explores different empirical strategies to examine the effect of cost sharing for prescription drugs in some dimensions of medication-related quality, namely the probability of inappropriate prescription drug use among United States seniors. Using data from 1996 to 2005, we explore various specifications that correct for sample selection, endogeneity¸ and unobserved heterogeneity. We find a small, but measurable, negative price elasticity for inappropriate drug use with respect to self-reported average out-of-pocket costs for all drugs consumed. That is, user fees reduce the use of potentially inappropriate medications, however the elasticity of cost sharing is lower than that of drugs in general and the price elasticity is relatively close to zero, suggesting that any quality improvements from co-payments are small

Descentralización de los sistemas sanitarios europeos: ¿entre la innovación y la eficiencia?

La sanidad es una de las principales políticas públicas en el ámbito europeo cuya gestión se ha descentralizado a niveles subestatales. No obstante, dadas las complejidades de la financiación sanitaria, hay que resaltar las enormes limitaciones que acompañan a la investigación económica sobre los efectos de la descentralización sanitaria, en particular, sobre desequilibrios verticales y horizontales. El presente artículo intenta ofrecer una perspectiva e interpretación de la copiosa literatura en esta área. Los estudios sobre los que se basa el articulo apuntan a la existencia de un dividendo asociado a la descentralización sanitaria, y en especial mejoras en la innovación de programas específicos y, en menor medida, mejoras de equidad y eficiencia a largo plazo. No obstante, en la mayoría de los sistemas sanitarios descentralizados persisten problemas de diseño, especialmente algunos desequilibrios verticales que dan lugar a los llamados «déficit sanitarios», cuando las restricciones presupuestarias subcentrales son percibidas como débiles. Sensu contrario, la experiencia descentralizadora parece indicar un efecto reductor que disminuye los desequilibrios fiscales horizontales.Health care is one of the main public policy areas in which management has been decentralised at sub-state level in Europe. However, given the complexities of health care funding, economic research into the effects of such decentralisation, and particularly into vertical and horizontal imbalances, comes up against considerable limitations. This article seeks to offer an interpretation of the large body of literature on this area The studies reviewed show improvements in innovation in specific health care system programmes and improvements in equity and long-term inefficiency, albeit to a lesser extent. However most decentralised health-care systems continue to suffer from design problems, particularly vertical imbalances, which give rise to so-called «healthcare deficits», when sub-central budget constraints are perceived as weak. On the other hand, experiences of decentralisation seem to indicate that there is a reducing effect that decreases horizontal fiscal imbalances

Parallel trade in medicinal drugs is putting the welfare of EU patients at risk

The term ‘parallel trade’ refers to instances in which a product sold for a low price in one country is bought and transported to a second country in which the same product sells for a higher price, allowing for a profit to be made. Joan Costa-i-Font writes that the EU’s single market has helped facilitate this practice in Europe with respect to the trade in medicinal drugs. He notes that one of the potential dangers of parallel trade is that shortages of certain drugs could develop in countries where prices are low due to companies buying up products and exporting them to more expensive markets