published_or_final_version / Public Administration / Master / Master of Public Administration

This thesis presents two applications of the incompleteness and one application of the imperfection of the market economy. The first application, Chapter 2, studies the decision making problem of an individual seeking to accumulate an optimal amount of human capital realizing that the wage income derived from the accumulated human capital is subject to incompletely insured uncertainty. In other words, the financial market that insures against wage income risk is not fully functional. We find that the individual's inability to diversify wage income risk tends to increase the need to accumulate more human capital in order to elevate wage path and compensate for the burden of its associated risk. This is particularly true when (i) the wage income risk is positively correlated with the rate-of-return risk in the financial market, resulting in an even greater risk burden to the individual, and (ii) the individual is more risk averse. There are two possibilities that no human capital is needed. The first possibility occurs when it is optimal to work as an unskilled worker because both the burden from wage income risk and the rate of return from education are low. The second possibility is the case where the risk burden is so high that the optimal time spent in school to acquire sufficient human capital to cover the risk is so long that the discounted rate of return from education is negative. In this case, the best strategy is to invest in financial assets alone and forfeit the opportunity to earn wage income - either as an educated or as an unskilled worker - to avoid its associated risk. Chapter 3 applies equilibrium unemployment theory with a frictional labor market to study the impact of immigration on the local labor market. Markets are imperfect in the sense that job matching takes time and recruitment is costly. We find that labor market outcomes of both the natives and existing immigrants depend crucially on how the economic surplus from successful matching is divided between the firms and the workers or, in other words, on the bargaining power of the workers. An arrival of immigrants with low bargaining power tends to benefit both the natives and the existing immigrants. A disparity between the two worker types in the matching efficiency also plays a major role. An inferior matching technology among the immigrants, interpreted here as reflecting their less established social network, lowers their wage rate and increases their unemployment rate. The natives are more likely to benefit from additional immigration than the existing immigrants and, when they do, the overall benefit can be decomposed into "job creation spillover" effect resulting from the immigrants' low bargaining power, and "job stealing" effect resulting from the immigrants' less efficient matching. The implications on the pattern of international migration flows are also discussed. In Chapter 4, a simple macroeconomic model is constructed and applied quantitatively to OECD countries, to analyze the effect of incomplete insurance on saving, growth and welfare in a closed economy. In this economy, precautionary saving motivated by uninsured idiosyncratic shocks raises growth rates but lowers risk-free returns. Welfare is measured by the sum of growth rates and risk-free rates of return, not growth rates alone. This welfare measure takes the negative impact of precautionary saving into consideration. Applied to the OECD data, three major results emerge: (i) the heterogeneous performance of growth and saving across the countries reflects different degrees of insurance incompleteness, (ii) since the externality of growth on productivity was very strong in the 1960's, the heavily constrained insurance market itself improves productivity by promoting growth, thereby enhancing welfare, (iii) while the externality of growth became weaker in the 1980's, the development of insurance markets lowered growth, but still contributed to a raise in welfare.

Economic data concerning the costs and benefits of Inuit subsistence in the Igloolik region of Nunavut were collected during the summer of 1992. The purpose of the research was to develop a method of valuation to showcase the high "profit", in economic terms, that harvested country food provides. / Wildlife harvesting in Inuit communities represents a traditional way of life which is threatened by the increasing expansion of wage employment, industrial development and the availability of store bought food. However, rather than having a marginalizing effect, these changes make subsistence hunting an essential economic activity. / This thesis develops a method to measure the harvest of country food through a dollar value standard thus quantifying the real economic benefits of Inuit subsistence. The value of harvested food can then be compared economically to store bought food. This comparison shows that subsistence hunting provides Inuit with a relatively inexpensive food source, equivalent to $6 million of income ``in kind'' per community in the Baffin Region. In this era of store bought food and wage employment, Inuit communities remain economically and socially integrated through subsistence hunting. Without harvesting, northern communities would be culturally and nutritionally poorer than at any time in the past.

Submitted in fulfilment of the academic requirements for the Degree of Magister Technologiae: Civil Engineering, Department of Civil Engineering and Surveying, Faculty of Engineering and the Built Environment, Durban University of Technology, 2009. / Infrastructure project costs are being scrutinised more closely and with greater skill and accuracy as projects have become larger, more complex and more expensive, and clients have become more exacting in their requirements. These and other factors compel engineers to design with greater care and in more detail. However, public planners spend very little time generating alternative project options, often presenting decision-makers with only a few poorly differentiated alternatives borrowed ad hoc from other projects. Even more disturbing is that they often devote the greatest amount of decision making resources to the development of a single decision rather than a variety of options. A systematic and iterative analysis of the cost consequences of different design solutions is commonly suggested for infrastructure projects, but rarely happens. There is a growing need to integrate design and costs. This study concentrates on the issue of cost optimisation of infrastructure projects (particularly at the design stage of the project) and applies construction economics, cost planning, cost optimisation and value engineering techniques to the design of such projects. The methodology proposed in this study for the optimisation of cost and design planning is the Infrastructure Cost Planning Model. This model divides the planning of a project into four stages and utilises twelve Cost Report Forms across these stages. The Cost Report Forms define in a comprehensive, precise and verifiable manner the essential characteristics of a deliverable component. They are used to measure, quantify, verify and audit the different design options. By means of the Cost Report Forms, the Infrastructure Cost Planning Model enables the client to select a combination of alternatives and evaluate a number of possible design options – with their cost implications – at each stage of the design process. This i promotes transparency and accountability, and enables consultants and clients to have greater control over the planning process and overall costs. Two case studies on infrastructure related projects were conducted and confirm that the Infrastructure Cost Planning Model can reduce costs. This study demonstrates that it is possible to overcome the problem of over expenditure by introducing cost effective design decisions prior to the infrastructure design approval process. The Infrastructure Cost Planning Model can improve infrastructure standards and procure design in a cost effective, equitable, competitive and transparent manner. This study contributes to the underdeveloped area of cost planning and forecasting of infrastructure projects. The findings are relevant to the South African government's infrastructure service delivery programme and the general issue of affordable infrastructure services.

Within the fields of network operation and performance measurement, it is a common requirement that the technologies involved must provide the basis for an effective, reliable, measurable and controllable service. In order to comply with the service performance criteria, the constrains often lead to very complex techniques and methodologies for the simulation, control, test, and measurement processes. This thesis addresses some of the factors that contribute to the overall spectrum of statistical performance measurements in telecommunication services. Specifically, it is concerned with the development of three low complexity and effective techniques for real-time traffic generation, control and measurement. These techniques have proved to be accurate and near optimum. In the three cases the work starts with a literature survey of known methodologies, and later new techniques are proposed and investigated by simulating the processes involved. The work is based on the use of high-speed Asynchronous Transfer Mode (ATM) networks. The problem of developing a fast traffic generation technique for the simulation of Variable Bit Rate traffic sources is considered in the first part of this thesis. For this purpose, statistical measures are obtained from the analysis of different traffic profiles or from the literature. With the aid of these measures, a model for the fast generation of Variable Bit Rate traffic at different time resolutions is developed. The simulated traffic is then analysed in order to obtain the equivalent set of statistical measures and these are compared against those observed in real traffic traces. The subject of traffic control comprises a very wide area in communication networks. It refers to the generalised classification of actions such as Connection Admission and Flow Control, Traffic Policing and Shaping. In the second part of this thesis, a method to modify the instantaneous traffic profile of a variable rate source is developed. It is particularly useful for services which have a hard bound on the cell loss probability, but a soft bound on the admissible delay, matching the characteristics of some of the services provided by ATM networks. Finally, this thesis is also concerned with a particular aspect of the operation and management of high speed networks, or OAM functions plane, namely with the monitoring of network resources. A monitoring technique based on numerical approximation and statistical sampling methods is developed and later used to characterise a particular traffic stream, or a particular connection, within a high speed network. The resulting algorithms are simple and computationally inexpensive, but effective and accurate at the same time, and are suitable for real-time processing.

Atypical antipsychotics (AAPs) (also known as second-generation antipsychotics) are the US Food and Drug Administration (FDA) approved medications for schizophrenia, bipolar I disorder, depression and autism. Compared to the typical antipsychotics, AAPs were marketed as reducing adverse side effects such as extrapyramidal symptoms. This resulted in extensive use of AAPs for not only the FDA approved indications but also other conditions that are not approved. However, several post-marketing clinical trials evaluated the use of AAPs and reported serious adverse side effects, including metabolic syndrome, cardiovascular events, or death. The extensive use of AAPs by pediatrics is an important policy problem that imposes serious concerns on public health and economy in the US. A large proportion of total pediatric AAP use is off-label in which the safety and effectiveness are not yet established. Moreover, among the off-label conditions for which AAPs were used, ADHD was the most common primary mental diagnosis. From public health perspective, the risk of type II diabetes in pediatric AAP users was estimated. A retrospective cohort study was conducted and a twice higher risk of developing type II diabetes was estimated for AAP users compared to non-users in pediatrics. From economic efficiency perspective, the cost-effectiveness of AAPs compared to other ADHD medications in pediatric ADHD patients was estimated. Among non-stimulant ADHD medication treatment strategies, AAPs resulted in the lower expected health outcome than other ADHD medications. Also, AAPs were not a favored choice with respect to cost-effectiveness. A comparative effectiveness study that compares resource utilization and costs between atypical antipsychotic (AAP) users and non-AAP users in ADHD revealed that AAP users were likely to visit a healthcare facility for outpatient and inpatient services more frequently than non-AAP users. Total health care costs were significantly higher for AAP users with additional costs of $1,393 (2012 dollars) during six months and $2,784 (2012 dollars) during a year after initiating the AAP treatment.

Introduction: Ensuring universal access to primary health care (PHC) is a key component of the Ethiopian nationalhealth policy. The policy also emphasises promoting and enhancing national self-reliance in health development bymobilizing and efficiently utilizing resources including community participation. To this end, the government introducedthe accelerated expansion of the PHC strategy through a comprehensive health extension programme (HEP). HEP is afamily and community-based health care delivery system institutionalised at health post level which combines carefullyselected high impact promotive, preventive and basic curative interventions. All HEP interventions are promotive and preventive except the malaria intervention which, in addition, incorporates a curative service. In the country, malaria is a leading disease. Unlike most Sub-Saharan African countries where P. falciparum accounts for almost all malaria infections, in Ethiopia both P. falciparum and P. vivax are co-dominant. Considering this peculiar epidemiological nature, the national guideline recommends alternative diagnosis and treatment strategies. Rationale: The lack of adequate resources and the efficiency with which available resources are being utilised are the main challenges in any health care setting. Therefore, if the HEP which consumes consideral amount of resource desires to reach its intended goal, monitoring and improving its efficiency is of great public heath importance. HEP has been successful in improving access to PHC including the malaria diagnosis and treatment service. Though this is a crucial measure, its quality ought to be considered. For the malaria curative service, studying the cost-effectiveness of the available strategy and patients’ adherence to the treatment regimen can be considered as proxy measures of quality for which local evidence is lacking. However, none of the existing studies in this field of research has addressed the Ethiopian malaria epidemiological context and its diagnosis and treatment guideline. In Tigray, for more than two decades, access to malaria early diagnosis and prompt treatment was facilitated by volunteer community healthworkers (CHWs). However, with the introduction of artemether-lumefantrine (AL) the service was compromised mainly for reasons of cost, safety and logistic. Therefore, it was important to explore the feasibility and the impact of community deployment of AL with rapid diagnostic tests (RDTs). The aim: to explore the overall performance of HEP and particularly the access to and quality of malaria early diagnosis and prompt treatment in the Tigray region of Ethiopia. Methods: Different study designs and populations were used for each of the four specific objectives. Data envelop analysis (DEA) was applied to assess the HEP efficiency. For this, register data for the output variables and primary data for the input and the environmental factors were collected. A health provider perspective cost-effectiveness analysis was used to determine which among the currently available diagnostic and treatment strategies is best for the country. Effectiveness data were generated from a stratified cross-sectional survey and secondary data were used to calculate the cost. For measuring adherence to the six-dose AL regimen, an assessment questionnaire and pill count was employed at patients´ home. To determine whether deploying AL with RDT at community level was feasible and effective, a number of designs were used: longitudinal follow-up, cross-sectional surveys, cost analysis, verbal autopsyquestionnaires and focal group discussions. Main findings: More than three-quarters of the health posts were found to be technically inefficient with an average score of 42%, which implies potentially they could improve their efficiency by 58%. Scale of operation was not a cause of inefficiency. None of the considered environmental factors was associated with efficiency. The Parascreen-based strategy (multispecies RDT-BS) was found to be the most cost-effective strategy, which allowed treating correctly an additional 65% of patients with less cost than the paracheck-BS. Presumptive-BS was highly dominated. Among P.falciparum positive patients to whom AL was prescribed, more than a quarter did not finish their treatment. The main reasons for interrupting the dose were ‘too many tablets’ and ‘felt better before finishing the dose’. The ownership of aradio, the belief that malaria cannot be treated traditionally and a delay of more than one day in seeking treatment after the onset of fever were significantly associated with being adherent. Deploying AL with RDT at community level was demonstrated to be effective and feasible. In the intervention district, almost 60% of suspected cases were managed by CHWs. Malaria transmission was lower at least threefold and malaria mortality risk by around 40% compared to the control district. The use of RDTs reduced cost and possibly the risk of drug resistance development. Conclusion: Though improving access to health care is important, it should be considered a means, not an end. Themore accessible a system is the more people could utilise it to improve their health. Thus, ensuring the access obtainedthrough HEP is maintained, its quality is improved and efficiently utilised to its optimal productivity level is a necessarytask. The DEA study revealed a high level of inefficiency where majority of the health posts needed improvement.This thesis also found parascreen-BS to be the most cost-effective strategy and that there is no epidemiological andeconomical contextual justification to keep both, the presumptive-BS and the RDT-BS specific only to P.falciparum.The high poor adherence levels raises great concern as it leads to recurrent malaria attacks of the patient, speed upthe development and spread of drug resistance strains and reduces the effect of the drug on the transmission. Therefore,providing effective drug alone is not sufficient; assessing and monitoring adherence to the treatment is by faressential. Deployment of AL with RDT through a community-based service has shown an enormous impact in termsof cost, transmission, morbidity and mortality. However, it is worth noting that this results came from an area wherea community-based service has been involved in the PHC system for more than three decades.

Nearly 80 years earlier, Henry Ford advised during the 1930 depression that: "A man who stops advertising to save money is like a man who stops a clock to save time". The purposes of this case study was to determine whether legal firms have taken cognisance of these wise words and have refrained from cutting back on expenses, and more particularly its promotional budget expenses during a down turning economy. It was discovered that, like nearly 80 years ago, costs today is still an important issue when considering and exploreing promotional opportunities. Small legal organisations have in general indicated that cost effectiveness is an important factor to take into consideration when deciding which type of promotion to explore. A further prerequisite was that the promotion should be target market orientated and effective. Interestingly enough, more than 60% of the sample organisations have failed to analyse their target market before commencing with any type of promotion. This immediately raised the question whether costs have not been wasted on wrong promotional efforts, rather than costs being an issue when considering promotion? It was concluded that small legal organisations have failed to properly analyse their target market and hence was unaware of their client?s needs. Various types of promotion were undertaken by the organisation, but in many instances were ineffective and costly. Should organisations have properly analysed their target markets they would have been in a better position to select an effective and less costly type of promotion. Limited recommendations were made in an attempt to assist small legal organisations to firstly analyse their target market which will result in more cost effective marketing and will enable them to address the needs of their target market directly. / Thesis (M.B.A.)--North-West University, Potchefstroom Campus, 2011.

Nearly 80 years earlier, Henry Ford advised during the 1930 depression that: "A man who stops advertising to save money is like a man who stops a clock to save time". The purposes of this case study was to determine whether legal firms have taken cognisance of these wise words and have refrained from cutting back on expenses, and more particularly its promotional budget expenses during a down turning economy. It was discovered that, like nearly 80 years ago, costs today is still an important issue when considering and exploreing promotional opportunities. Small legal organisations have in general indicated that cost effectiveness is an important factor to take into consideration when deciding which type of promotion to explore. A further prerequisite was that the promotion should be target market orientated and effective. Interestingly enough, more than 60% of the sample organisations have failed to analyse their target market before commencing with any type of promotion. This immediately raised the question whether costs have not been wasted on wrong promotional efforts, rather than costs being an issue when considering promotion? It was concluded that small legal organisations have failed to properly analyse their target market and hence was unaware of their client?s needs. Various types of promotion were undertaken by the organisation, but in many instances were ineffective and costly. Should organisations have properly analysed their target markets they would have been in a better position to select an effective and less costly type of promotion. Limited recommendations were made in an attempt to assist small legal organisations to firstly analyse their target market which will result in more cost effective marketing and will enable them to address the needs of their target market directly. / Thesis (M.B.A.)--North-West University, Potchefstroom Campus, 2011.

Darbo tikslas Įvertinti antro tipo cukrinio diabeto (2 tipo CD) chirurginio gydymo klinikinį ir ekonominį efektyvumą. Uždaviniai : 1. Ištirti visus pacientus operuotus dėl nutukimo ir 2 tipo CD LSMUL KK Chirurgijos klinikoje 2005-2010 metais. 2. Palyginti šių pacientų klinikinę būseną ir gyvenimo kokybę prieš ir praėjus daugiau kaip 1 metams po operacijos. 3. Palyginti 2 tipo CD gydymo išlaidas operuojant ir neoperuojant bei įvertinti skrandžio apylankos operacijos ekonominį efektyvumą. Tyrimo metodika Tyrimui atlikti buvo išduotas Kauno regioninio bioetikos komiteto leidimas Nr. BE-2-59. Atlikta pacientų, kuriems dėl nutukimo ir 2 tipo CD 2005-2010m. Kauno Klinikose buvo atlikta skrandžio apylankos operacija, duomenų retrospektyvinė analizė. Praėjus daugiau kaip 1 metams po operacijos detaliai ištirta pacientų klinikinė būsena. Gyvenimo kokybės ir operacinio gydymo naudingumo įvertinimui taikyti SF-36 klausimynas ir SF-6D konversijos modelis. Ekonominio naudingumo analizės modelis naudotas apskaičiuojant ir lyginant operacinio ir konservatyvaus 2 tipo CD tiesiogines gydymo išlaidas. Duomenys apdoroti ir analizuoti naudojant statistinį duomenų analizės paketą SPSS 15. Rezultatai 2005-2010 metais Kauno klinikų chirurginiame skyriuje dėl nutukimo ir 2 tipo CD operuoti 76 pacientai (52 moterys ir 24 vyrai). 67 pacientams buvo atlikta skrandžio apylankos operacija, 8 skrandžio apjuosimo reguliuojama juosta operacija ir 1 pacientui marginalinė skrandžio rezekcija (sleeve... [toliau žr. visą tekstą] / Aim To evaluate the clinical and cost-effectiveness of the laparoscopic Roux-en-Y gastric-bypass (LRYGB) in obese patients with type 2 diabetes. Tasks: 1. To investigate all the patients underwent the LRYGB on obesity and type 2 diabetes in LUHS Kaunas Hospital in 2005-2010. 2. To compare the clinical outcomes and quality of life (QoL) in operated patients before and 1 year or later after the surgery. 3. To evaluate the cost-effectiveness of LRYGB and to compare it with the conventional treatment cost. Methodology of the research The retrospective study of 51 patient underwent LRYGB on obesity and type 2 diabetes in LUHS Kaunas Hospital in 2005-2010. The clinical evaluation of operated patients 1 year or later after the laparoscopic gastric-bypass. SF-36 questionnaire and SF-6D conversion model were used to evaluate the QoL and health benefits after the surgery. To evaluate and to compare the surgical and conventional treatment costs in obese type 2 diabetes patients, the cost utility analysis model was used. Kaunas regional committee of bioethics approved the project (permission Nr BE-2-59). The data was processed and analysed using the package SPSS 15,0 of statistical data analysis. Results 76 patients (52 women and 24 men) were operated on obesity and type 2 diabetes in LUHS Kaunas Hospital in 2005-2010. 67 patients underwent LRYGB, in 8 patients the laparoscopic adjustable gastric banding and sleeve resection in 1 patient were performed. One year or later after the... [to full text]