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There is a growing recognition that we cannot afford the provision of all new health care technologies, even those that are proven to be beneficial. This is increasingly true in the US, where health care spending is on an unsustainable upward trajectory. US health care spending is greatly in excess of that of other countries; however, with respect to key health metrics, the US health care system performs relatively poorly. Despite this, unlike many other developed countries economic evaluation, and more specifically cost effectiveness evidence, is used sparingly in the US health care system. Notably, the Centers for Medicare and Medicaid Services (CMS), administrators of the Medicare programme, state that cost-effectiveness evidence is not relevant to coverage decisions for medical technology and interventions evaluated as part of National Coverage Determinations (NCDs). The empirical aspect of this thesis evaluates the current use and potential value of using cost-effectiveness evidence in CMS NCDs. A database was built using data obtained from NCD decision memoranda, the medical literature, a Medicare claims database, and Medicare reimbursement information. The findings of the empirical work show that, CMS’s stated position notwithstanding, cost-effectiveness evidence has been cited or discussed in a number of coverage decisions, and there is a statistically significant difference between positive and non-coverage decisions with respect to cost effectiveness. When controlling for factors likely to have an effect on coverage decisions, the availability of cost-effectiveness evidence is a statistically significant predictor of coverage. In addition, the quality of the supporting clinical evidence, the availability of alternative interventions, and the recency of the decision are statistically significant variables. Further, when hypothetically reallocating resources in accordance with cost-effectiveness substantial gains in aggregate health are estimated. It is shown that using cost-effectiveness to guide resource allocation has an effect on resource allocation across patient populations and types of technology.

This study of local public sector efficiency, the first attempted in an Australian context using frontier measurement techniques, seeks to survey and estimate the level and determinants of productive, allocative, technical and scale efficiency in Australian local government. It finds that a major influence on efficiency in local government is the imposed contextual environment, that efficiency varies markedly across particular local governments, and that productive efficiency in the provision of local public services has improved during the recent program of microeconomic reform. The first theoretical section of the study examines the econometric and mathematical methods that have been employed in the recent history of efficiency measurement. Starting with an assessment of the significance of Farrell's (1957) pioneering work on the analysis of productive efficiency, it extends this approach to the orthodox analysis of deterministic frontiers, and discusses the ongoing analysis of stochastic frontiers. The theoretical section also examines the alternative mathematical programming approach to the analysis of productive efficiency, as well as examining some extensions to this approach. The section concludes with a discussion of various theoretical issues involved in selecting an appropriate analytical technique and interpreting the resultant findings. The second section of the study contains a comprehensive survey of empirical work on frontier efficiency measurement techniques. It examines various applications using microeconomic efficiency methods in the fields of financial services, healthcare, education, local public services, and other selected applications. Attention is paid to the preferred analytical techniques used in each field, especially those concerning input/output specification. The main finding of this section is that the nature of the sample itself often requires careful analysis, especially as institutional and environmental factors can exert a strong influence on efficiency measures. The third section of the study provides a brief overview of local government in Australia, with particular emphasis on internationally distinguishable characteristics. The function and financing of Australian local government is discussed, with special attention paid to the state of New South Wales. The institutional section also examines the progress of microeconomic reform in Australian local government, and discusses the extant approaches to comparative performance measurement and process benchmarking. The final section of the study is concerned with a contemporary empirical evaluation of local public sector efficiency in Australia. The analysis is not only the first undertaken in Australia using frontier measurement techniques, but this is also the only study to simultaneously evaluate efficiency in a number of different local government functions, across both jurisdictions and time. The results indicate that allocative inefficiency, rather than technical inefficiency, represents the main source of productive inefficiency in local government, and that technical inefficiency is largely the result of scale inefficiencies.

The study analyzed the impact of the farm input subsidy programme (FISP) on the technical, allocative and economic efficiency and determining factors associated with these efficiencies of 12, 271 smallholder maize farmers from 2010 IHS3 dataset in Malawi. Descriptive statistics, stochastic frontier approach as and a Cobb-Douglas production function were applied. Yield responsiveness to production inputs was estimated by computing input elasticities. The findings indicate that technical efficiency of smallholder maize farmers ranged from 15.7 to 78.9 with a mean of 61.3 percent reflecting a substantial level of inefficiency. The allocative efficiency scores were between 23.5 and 86.2 with a mean of 66.9 percent reflecting a substantial level of allocative inefficiency. The economic efficiency scores were between 14.1 and 74.6 with amean of 59.2 percent reflecting a substantial economical inefficiency. An estimated return to scale was 0.87 indicating that during the period under review, smallholder maize farming decreased by about 13 percent. The results of second stage Tobit regression estimations indicates that the FISP programme improved the efficiencies of maize farmers in Malawi. In addition, t farmers’ age, farming experience, education years, having an income generating activity and receiving remittance were also identified as significant drivers of production capacity of smallholder farmers maize. However, farmers’ marital status, family size and distance to the market had a negative impact on smallholder farmers’ capacity in maize production. Smallholder farmers in Malawi were experiencing a decreased return to scale meaning that they were technical, allocative and economically inefficient in maize production. From the findings, among other issues to be considered for the improvement of technical, allocative and economic efficiencies of maize production among smallholders farmers, the government should support only energetic farmers, make farm inputs available and accessible to farmers, continued advocacy on v adoption of family planning to reduce population growth to carter for scarcity of resources, increase and enhance extension services to help in educating these smallholder farmers in handling new technologies associated with modern agriculture, encourage them to engage in IGAs to complement FISP in purchasing farm inputs, increased and extended cash transfer program to economically empower these smallholder farmers.

This dissertation is comprised of four chapters. Chapter 1 provides an introduction to economic growth and discusses the topics covered in each of the following chapters along with some main results therein. In Chapter 2, I develop a dynamic general equilibrium of innovation and imitation in which once a higher quality good is developed, there is an exogenously given rate at which the good is targeted for imitation. However, the innovator can undertake expenditure to protect the good from imitation and thereby lower the effective probability of imitation. It is shown that the total expenditure toward property right protection is inversely related to the cost of property right protection and the effectiveness of the property right system. Moreover, a subsidy that reduces the per unit cost of property right protection leads to an increase in the intensity of innovation. In the long run, the economy exhibits a constant steady state growth. I further show that an improvement in the efficiency of the property right system has an ambiguous effect on overall consumer welfare. Chapter 3 develops a two-good, closed economy model, that provides a possible explanation for the existence of misallocation of resources and examines the long-run consequences. In the model, inefficiencies arise as a result of lobbying by firms to establish or prevent barriers to the competitive allocation of factors of production (labor). First, I show that the extent of the inefficiency is determined by the relative lobbying power of the firms. The inefficiencies lead to a static welfare loss, which increase in the relative lobbying power of firms seeking to establish barriers. I further show that if the relative lobbying power of firms seeking the barriers is large, the economy will end up producing a ``wrong'' mix of goods in the long-run, relative to the perfectly competitive equilibrium. The resulting welfare loss depends on the elasticity of substitution between the two goods, and in the case when the two goods are poor substitutes, the total utility may go to zero in the long-run. In Chapter 4, I apply the model of lobbying developed in Chapter 3 to understand the link between misallocation of resources, international trade and economic growth. Misallocation leads to the possibility that the benchmark competitive free trade equilibrium is not achieved. This leads to a reduction in trade volume and consequently to welfare losses even for a country without domestic barriers. Further, domestic barriers cause a reduction in output growth in the short run. In the long run, however, there is a convergence to the competitive growth rates. / Ph. D.

Cette thèse de doctorat a pour objet d’évaluer les effets potentiels d’une concurrence accrue sur le marché de la santé. Elle porte une attention particulière aux effets de la concurrence sur l’efficacité allocative du système de santé en termes de soins et de dépenses de santé. Dans leur ensemble, nos résultats suggèrent que les effets canoniques de la concurrence ne s’appliquent pas nécessairement au marché de la santé, et détaillent des circonstances dans lesquelles une hausse de la concurrence pourrait nuire au bien-être social. Cette thèse comporte une introduction et trois chapitres (articles académiques), chacun portant sur un aspect diffèrent de l’efficacité du système de santé. Le premier chapitre analyse l’impact de la concurrence sur les pratiques de soins hospitaliers et leur régulation par tarification prospective. Le second chapitre détaille les enjeux de régulation liés à la nature incomplète de l’information sur les patients au moment de choisir la procédure de soins à adopter, à commencer par la décision de mettre en œuvre des tests de diagnostic supplémentaires. Le dernier chapitre de cette thèse discute les conséquences possibles de l’asymétrie qui peut exister entre fournisseur de soins public et privé en termes d’obligation de couverture et pouvant être appliqué au marché de l’aide à domicile des personnes âgées. / The purpose of this thesis is to study the potential effects of an increased competition between health-care providers on the allocative efficiency of the health-care system. In a theoretical framework it discusses the effect of competitive pressure considering the decentralization of treatment decisions, diagnostic tests’ performance, and the organization of care coverage. It is composed of an introduction and three chapters (essays), each of them focusingon a different aspect of the health-care system efficiency. Our findings globally suggest that the canonical effect of competition does not necessarily applies to the health-care market,and detail circumstances in which competition could degrade social welfare. The first chapter analyses the impact of competition on hospitals’ treatment praxis and their regulation through fixed-repayments. The second chapter details the regulation issues related to the incomplete nature of the information on patients’ illness before the decision to perform diagnostic tests.The last chapter of this thesis discusses the possible outcomes of the asymmetry of obligation of services between public and private competitors in an application to the home-care market for the elderly.

This paper seeks to compare production costs of similar farms to determine competitiveness across countries. A data envelopment analysis (DEA) approach was used to calculate efficiency indices for farms producing corn, soybeans, wheat, both corn and soybeans, and both corn and wheat. Technical efficiency, allocative efficiency, and cost efficiency were compared for all farms. The data consisted of a five-year (2013-2017) panel of 24 corn-producing farms, 15 soybean-producing farms, 38 wheat-producing farms, 13 farms producing both corn and soybeans, and 17 farms producing both corn and wheat. The <i>agri benchmark</i> network at the Thünen Institute (TI) of Farm Economics manages the dataset that was used in this analysis. Outputs were measured using revenue. Input costs included direct costs, operating costs, and overhead costs.<br>

We investigate empirically the usefulness of price-cap and quality regulation in terms of allocative efficiency and welfare. An analytical framework allows us to determine sufficient conditions for an increase in welfare. We propose Malmquist productivity indices and their decomposition to check the conditions and to see whether it was a better-solved trade off between quality and costs that caused the welfare increase. The application of this method to a representative sample of Norwegian distribution system operators yields strong evidence for a positive effect of quality regulation on welfare. (author's abstract) / Series: Working Papers / Research Institute for Regulatory Economics

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Studies have found substantial differences in health-related behavior and health care usage between educational groups, which may explain part of the well-documented educational gradient in health. The allocative efficiency hypothesis offers a behavioral explanation for these reported differences. According to this theory, the educated possess more health knowledge and information, allowing them to make better health choices. We perform a mediation analysis to study this mechanism using original survey data from the Philippines, a lower-middle-income country. As an extension of previous empirical research, we construct a comprehensive index that captures different dimensions of health knowledge. Using generalized propensity scores, we find strong support for the allocative efficiency argument. Schooling is significantly associated with health knowledge levels, which explain up to 69% of the education effect on health lifestyle. This corresponds to twice the mediation strength of economic resources, suggesting an important role of this factor in explaining education effects on health decisions.