Rationing of lifesaving resources in pandemics is likely to be an increasingly relevant issue. While the broad legal and ethical implications of pandemic preparedness have been explored at length, little attention has been paid to the legal issues associated with rationing. This thesis seeks to analyze the potential for administrative and private law challenges to governments’ rationing of vaccines, ventilators and antivirals. The wide variety of statutory authorities, and their associated conditions and discretionary limitations, that governments may rely on for mandating rationing protocols, makes them susceptible to administrative law challenges on the grounds of errors of jurisdiction. An analysis of the tort liability of governments, hospitals and physicians suggests that negligence suits will likely not be successful due to a lack of proximity required for a private law duty of care, the policy-making immunity of governments and a contextual standard of care.

Objective: To identify principles and rules used by stakeholders in making limit-setting decisions for publicly funded dental care. Methods: A purposive sample, including administrators, academics, funders, clinicians and community representatives was surveyed using a 28-item questionnaire, in the first round of a proposed three-round modified Delphi study. Using open and closed-ended questions participants made and explained decisions on prioritizing populations and services. Open-ended text was analyzed with a thematic qualitative approach using open and axial coding. Results: Consensus emerged on two rationing principles; achieving equity and providing essential care. Rules for eligibility were defined as the inability to pay and/or assume full personal responsibility for securing dental care. Inclusion/exclusion of treatment categories rested on relieving pain/infection, preventing disease and maintaining/restoring function. Conclusions: Stakeholders presented principles and rules that suggest extending the distribution of publicly funded dental care to include, at a minimum, essential services for those unable to afford care.

In Ontario, access to publicly funded home care services is managed by Community Care Access Centres (CCACs). CCAC case managers are responsible for assessing all potential clients and prioritizing the allocation of services. The objectives of this thesis were to: 1) describe the types of decisions made by CCAC organizations and by individual case managers concerning the allocation of nursing, personal support and homemaking services to long-term adult clients with no mental health issues; and 2) to describe and assess the factors and values that influence these decisions. We conducted two case studies in which qualitative data were collected through 39 semi-structured interviews and a review of relevant documents from an urban and a rural area CCAC. A modified thematic analysis was used to identify themes related to the types of priority setting decisions and the associated factors and values. An internet-based survey was then designed based on these results and answered by 177 case managers from 8 of the 14 CCACs. The survey contained discrete choice experiments to examine the relative importance of client attributes and values to prioritization choices related to personal support and homemaking services, as well as questions that examined case managers’ attitudes towards priority setting. We found that both the rural and the urban CCACs utilized similar forms of priority setting and that case managers made the majority of these decisions during their daily interactions with clients. Numerous client, CCAC, and external factors related to the values of safety, independence and client-focused care were considered by case managers during needs assessment and service plan development. The relative importance of the selected client attributes in defining need for personal support and homemaking services was tested and found to be significantly affected by the location of the case manager (rural or urban area), years of experience in home care, and recent experience providing informal care. Case managers allocated services in the spirit of equal service for equal need and in consideration of operational efficiency. We also identified a number of case manager-related, client-related and external factors that interfered with the achievement of horizontal equity.

Objective: To identify principles and rules used by stakeholders in making limit-setting decisions for publicly funded dental care. Methods: A purposive sample, including administrators, academics, funders, clinicians and community representatives was surveyed using a 28-item questionnaire, in the first round of a proposed three-round modified Delphi study. Using open and closed-ended questions participants made and explained decisions on prioritizing populations and services. Open-ended text was analyzed with a thematic qualitative approach using open and axial coding. Results: Consensus emerged on two rationing principles; achieving equity and providing essential care. Rules for eligibility were defined as the inability to pay and/or assume full personal responsibility for securing dental care. Inclusion/exclusion of treatment categories rested on relieving pain/infection, preventing disease and maintaining/restoring function. Conclusions: Stakeholders presented principles and rules that suggest extending the distribution of publicly funded dental care to include, at a minimum, essential services for those unable to afford care.

Thesis (Ph. D.)--Columbia University, 1945. / Vita. Includes bibliographical references (p. 253-271).

This collection of papers originates from my interest in the reform efforts in transitional economies. Each of the chapters is self-contained. Chapter one presents a brief literature survey of those schools of thought that have contributed to our knowledge about privatization. In chapter two, a public firm model and a private firm model are compared based on agency approach, assuming that the owner of a firm has cost information but also bears the cost of production. I find that the question which type of ownership, private or public, is superior does not have a clear cut answer. Private ownership may induce higher work effort but suffers from a discrepancy of private and social goals. While production distortion is less serious, an obvious disincentive to work exists in the public firm. Chapter three examines how privatization can be considered as a threat to stimulate a public firm manager's work incentive when his effort level cannot be observed by the government. I find that, in the case when commitment to privatize is impossible, the government will set a strictly positive wage rate and a strictly positive investment subsidy to signal the government's determination to implement the privatization policy. In chapter four, I examine the role that public investment plays in a financial market with a credit rationing problem. Two kinds of borrowers co-exist in the economy, namely the public and the private. Public borrowers enjoy a "first mover" advantage to borrow money from banks. In this situation, the credit rationing is found escalating. But since the success of a public project (owned by a public borrower) can exert positive externality on the productivity of private projects, the adverse effect induced by credit rationing can be alleviated. We show that if the quality of the public projects is good enough, the economic growth rate can be higher than the case without public projects in the economy. / Ph. D.

This dissertation looks at models in which agents make decisions under various economic frictions, and examines the role of their preferences. The first two chapters analytically characterize an infinite-horizon open economy under the friction of a stock collateral constraint, whereby borrowing is limited by the value of capital assets available. The model that is considered allows for general subjective discounting of households and fully variable productivity. The third chapter looks at a model of an ambiguity-averse benevolent mediator tasked with choosing a price contract at which a risk neutral buyer and seller transact an indivisible good under the friction of unquantifiable uncertainty of their reservation values. The first chapter establishes that it is possible for households to enjoy the allocation they would obtain absent a stock collateral constraint under a condition that relates to their patience; this condition requires a long-run depression when agents are impatient relative to the market, and allows for an economic expansion when agents are more patient relative to the market. When this condition is not met, households are tightly constrained at least once and experience debt deleveraging in all periods and deflation of asset prices in periods preceding the constrained period relative to their unconstrained allocation. Households also ration their consumption more when they expect to be more tightly constrained in the future. The second chapter is a sequel to the first chapter and shows that under constant output, agents who are impatient relative to the market can face two and three-period cycles in consumption, debt, and asset prices. Further, large initial debt can lead to multiple equilibria. The third chapter considers a mediator who plays a Stackelberg game against Nature to maximize the distributionally worst-case expected weighted Nash product subject to known mean and boundary constraints on buyer and seller reservation values. We study the role of bargaining power and show that relative to what the buyer and seller themselves would choose when equipped with the mediator's information, the mediator's price contract has a shallow dependency on bargaining power, which is only exacerbated by the possibility of dependent buyer and seller values. Comparative statics results are obtained.

This dissertation is a collection of essays on financial market development and economic growth. In contrast to existing literature, which considers credit for investment along, we investigate the relationship between credit market development and economic growth in the framework where both investment and consumption are financed via credit markets. The environment developed on this dissertation creates a role for each kind of credit to play. First, credit market conditions of entrepreneurs and consumers are related and depend on each other. Second, the interactions between consumers and entrepreneurs are of importance for economic growth. The models are empirically relevant, as they can explain why the effect of credit market development on economic growth appears to differ between high-income and middle- and low-income countries. / Ph. D.

Thesis (D.P.H.)--University of Michigan.

Thesis (D.P.H.)--University of Michigan.