Thesis (Ph. D.)--University of Texas at Austin, 2006. / Vita. Includes bibliographical references.

The purpose of this thesis is to empirically investigate the factors which drive the demand for and supply of mortgage finance in the United Kingdom. In particular, borrowers of long term mortgage funds are especially susceptible to the effects of inflation in `tilting' the stream of real repayments towards the initial years of the loan. As such, under certain circumstances inflation can be an important cause of mortgage default and thus plays a crucial role in the determination of mortgage demand. The mechanism through which mortgage default leads to households being possessed by their creditors is examined empirically. The results suggest that the ability to withdraw equity from the property either by remortgaging or `trading down' is important for borrowers who face financial difficulties. In addition, a relaxation of the non-interest terms of the mortgage contract is shown to lead to a rise in mortgage default, although this does not appear to have dampened the willingness of either mortgage borrowers or lenders to transact at high loan to value ratios. Understanding the underlying forces which cause repayment problems gives an important insight into the specification of both the mortgage demand and supply functions. In formulating such models, it is imperative that the dramatic structural changes in the market for mortgage finance are accounted for. This is particularly true for the supply side, and a formal theoretical model of building society interest rate setting is derived in which societies choose the degree to which they are either `member-' or `profit-oriented'. Interestingly, the model suggests that up to a point a building society may not alter either its mortgage or savings rate if its `preference for mutuality' were to change. Finally, reduced form cointegrating relationships for the quantity of mortgages traded, the mortgage interest rate and the loan to value ratio are estimated. The results are used to evaluate the extent of mortgage rationing during the 1970s; this research reaffirms the findings of other papers and anecdotal evidence to suggest that disequilibrium quantity rationing was substantial prior to 1980. In fact, a regime shift in the early 1980s is confirmed by the change in the way mortgage lenders have used combinations of the mortgage rate and the loan to value ratio to restrict lending.

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.

Distributive justice in the health sector in the context of the rationalization of health care This paper should briefly introduce the major principle of health service in the Czech Republic but also practised in most developed countries. Distributive justice is a system of accumulating and redistributing wealth in order to seek balance in society. In health sector it is most commonly associated with rationing i.e. distribution of limited and costly medical sources among those who are in need of medical care in a justifiable way. Not to be mistaken distributive justice with social justice even though there is a fine line between the two. The thesis is divided into fifteen chapters each describing certain aspect of distributive justice in the health sector or a related issue. Opening chapters are dedicated to theoretical, historical and philosophical overview; following part contains single elements of distributive justice both in general and in context of health care. Issues of medical standards and regulatory charges are discussed in subsequent chapters with regard to recent case law of the Constitutional court. In conclusion the problem of distributive justice in health care can be approached from two different points - communitarian and liberal. These issues are also political, philosophical and...

O racionamento de energia elétrica não foi a primeira crise no setor elétrico, sendo que ocorreram anteriormente outras crises no Brasil e em outros países. A causa do déficit, que gerou o racionamento, foi que o crescimento do parque gerador brasileiro não acompanhou o crescimento do consumo da forma adequada. O racionamento produziu impacto no consumo de energia elétrica de forma singular, provocando redução no consumo brasileiro em torno de 24 %, influenciando até onde não houve racionamento e mantendo efeitos no consumo mesmo após o seu término. Foram calculadas as conseqüências do racionamento no consumo de energia elétrica por região, por setor, na demanda e em casos específicos. Os métodos de cálculos foram empregados considerando o crescimento no consumo em 2001, no período pré-crise de energia levando em consideração a sazonalidade dos períodos. As influências do racionamento não ficaram restritas ao consumo de energia elétrica, tendo efeitos no setor elétrico, na indústria, no comércio, na economia, na política nacional e na vida das pessoas em geral. / The electric power rationing was not the first crisis in the electric section, and they happened other crises previously in Brazil and in other countries. The cause of the deficit that generated the rationing, was the growth of the generator Brazilian park didn't accompany the growth of the consumption in the appropriate way. The rationing impactou in the energy consumption electric in a singular way, provoking reduction in the Brazilian consumption around 24%, influencing up to where there was not rationing and maintaining effects in the same consumption after his end. The consequences of the rationing were calculated in the electric energy consumption by area, for section, in the demand and in specific cases. The methods of calculations were employees considering the growth in the consumption in 2001, in the period pré-crisis of energy taking into account the seasonal variation of the periods. The influences of the rationing were not restricted to the electric energy consumption, tends effects in the electric section, in the it elaborates, in the trade, in the economy, in the national politics and in the life of the people in general.

O racionamento de energia elétrica não foi a primeira crise no setor elétrico, sendo que ocorreram anteriormente outras crises no Brasil e em outros países. A causa do déficit, que gerou o racionamento, foi que o crescimento do parque gerador brasileiro não acompanhou o crescimento do consumo da forma adequada. O racionamento produziu impacto no consumo de energia elétrica de forma singular, provocando redução no consumo brasileiro em torno de 24 %, influenciando até onde não houve racionamento e mantendo efeitos no consumo mesmo após o seu término. Foram calculadas as conseqüências do racionamento no consumo de energia elétrica por região, por setor, na demanda e em casos específicos. Os métodos de cálculos foram empregados considerando o crescimento no consumo em 2001, no período pré-crise de energia levando em consideração a sazonalidade dos períodos. As influências do racionamento não ficaram restritas ao consumo de energia elétrica, tendo efeitos no setor elétrico, na indústria, no comércio, na economia, na política nacional e na vida das pessoas em geral. / The electric power rationing was not the first crisis in the electric section, and they happened other crises previously in Brazil and in other countries. The cause of the deficit that generated the rationing, was the growth of the generator Brazilian park didn't accompany the growth of the consumption in the appropriate way. The rationing impactou in the energy consumption electric in a singular way, provoking reduction in the Brazilian consumption around 24%, influencing up to where there was not rationing and maintaining effects in the same consumption after his end. The consequences of the rationing were calculated in the electric energy consumption by area, for section, in the demand and in specific cases. The methods of calculations were employees considering the growth in the consumption in 2001, in the period pré-crisis of energy taking into account the seasonal variation of the periods. The influences of the rationing were not restricted to the electric energy consumption, tends effects in the electric section, in the it elaborates, in the trade, in the economy, in the national politics and in the life of the people in general.

In the first part of the thesis I focus on credit markets in developing countries, and describe the competitive interaction between Microfinance Institutions (MFIs). Microfinance has recently attracted a lot of attention from investors, politicians, scholars and, most of all, people working on development. As a results, a huge number of MFIs are being created all over the world so that, as of today, practitioners reckon that about 100 millions of customers are being served. Remarkably, about 67% of them are women. The reason of this extraordinary effort is that Microfinance is considered the most promising development tool currently available. This belief is based on two important features of Microfinance: (i) It promises to be financially viable (and in some cases even profitable) since poor people have proven to be reliable clients. As a result, Microfinance is potentially a zero-cost development tool. (ii) It hinges on the entrepreneurial abilities of the poor. It is designed to help the poor to help themselves, in their own home countries, by allowing them to use their skills, ideas and potentials. This should progressively make developing countries independent of rich ones' help. The growth of Microfinance has been so fast that many issues and related research questions are still not answered. In my thesis I try to address one of them, that I believe particularly important: the increase of competition between MFIs. As economic theory predicts, competition can have dramatic consequences in terms of borrower welfare, profitability of the institutions and, therefore, on the attractiveness of the business for potential investors, donors and entrants. I use the tools of industrial organization and contract theory to understand these effects, measure them, and give some interesting policy advice. In the first paper, I analyze the effects of entry of a new MFI in a previously monopolistic microcredit market. In order to catch the salient features of financial markets in developing countries, I use a model of asymmetric information and assume that institutions can offer only one type of contract. I consider different behavioral assumptions for the MFIs and study their influence on equilibrium predictions. The model allows showing that competition can lead to equilibria in which MFIs differentiate their contracts in order to screen borrowers. This process can, unfortunately, make the poor borrowers worse off. Interestingly, the screening process we describe creates a previously unexplored source of credit rationing. I also prove that the presence in the market of an altruistic MFI, reduces rationing and, via this channel, affects positively the competitor's profit. In the second paper, I study the effects of competition in those markets in which, due to the absence of credit bureaus, small entrepreneurs can simultaneously borrow from more than one institution. As in the first paper, I analyze an oligopolistic microcredit market characterized by asymmetric information and institutions that can offer only one type of contract. The main contribution is to show that appropriate contract design can eliminate the ex-ante incentives for multiple borrowing. Moreover, when the market is still largely unserved and particularly risky, a screening strategy leading to con- tract differentiation and credit rationing is unambiguously the most effective to avoid multiple borrowing. The result of this paper can also be read as important robustness checks of the findings of my first paper. In the last part of the thesis, I depart from the analysis of developing countries to consider, more generally, the corporate governance of financial infrastructures. The efficient functioning of financial markets relies more and more on the presence of infrastructures providing services like clearing, settlement, messaging and many others. The last years have been characterized by interesting dynamics in the ownership regime of these service providers. Both mutualizations and de-mutualizations took place, together with entry and exit of different players. Starting from this observation, in the last paper (with Joachim Keller), we analyze the effects of competitive interaction between differently owned financial providers. We mainly focus on the incentives to invest in safety enhancing measures and we describe the different equilibrium market configurations. We use a model in which agents need an input service for the financial market they operate in. They can decide whether to provide it them selves by forming a Cooperative or outsource it from a Third Party Provider. We prove that the co-existence of differently governed infrastructures leads to a significant reduction in the investment in safety. In most cases, monopolistic provision is preferable to competition. Moreover, the decision rule used within the Cooperative plays a central role in determining the optimal market configuration. All in all, throughout my thesis, I use the tools of industrial organization and contract theory to model the competitive interaction of the different actors operating in financial markets. Understanding the dynamics typical of developing countries can help in gaining a deeper comprehension of the markets in richer countries, and vice-versa. I am convinced that analyzing the differences and the similarities of financial markets in different regions of the world can be of great importance for economic theorists, in that it provides a counterfactual for the assumptions and the results on which our predictions and policy advices are based.

Prior literature finds that firms incur a lower cost of debt capital when they voluntarily disclose information. However, the economic literature demonstrates that creditors' lending standards become more stringent (lax) when credit is rationed (abundant) suggesting that they value voluntary disclosure from borrowers differentially across credit market regimes. I draw upon the economic and finance literature on credit rationing to test whether the effects of voluntary disclosure on firms' cost of debt capital is greater during periods of credit rationing. I provide some evidence that confirms this prediction. Moreover, I provide some evidence that this relation is stronger for smaller firms than larger firms during periods of credit rationing suggesting that creditors value voluntary disclosure more from firms that have fewer resources to cover the increased agency cost of lending during periods of credit rationing.

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.

The New Zealand health system is two-tiered with elective treatments are performed by both publicly funded state hospitals and by private hospitals. Publicly funded operations are rationed using a prioritisation system which was introduced in 1998 to curtail expanding waiting lists for elective surgery. One of the aims of the new booking system was to generate national tools for prioritising patients in order to improve the equality of access to public elective surgery throughout New Zealand. However, priority scoring systems were not implemented in a consistent manner and access to elective surgery remains very unequal. Despite large media attention and a high public profile, waiting times have attracted little research in medical geography or within the wider social sciences community. The subject has been partly reserved for public health commentators within the medical field, who have found that variation in waiting times has much to do with the referral practices of physicians, the management of waiting lists by District Health Board (DHB) staff and the amount of private practice that occurs within each district. Most notably several studies have identified that in areas associated with high private admissions, patients tend to suffer higher waiting times for the same procedures in the public hospital system. This study examines the performance of the New Zealand Booking System (NZBS) during the years 2004 to 2007 to assess the equitable delivery of publicly funded elective surgery procedures. Waiting times (NBRS) and admissions (NMDS) datasets were sourced from the New Zealand Health and Information Service (NZHIS) of The Ministry of Health. Mean and Median waiting times were compared spatially between each of New Zealand’s 21 DHBs, compared with Australian waiting times and then broken down into five common medical specialties. Waiting times were then analysed by ethnicity, level of material deprivation and other individual factors using data from the 2006 New Zealand Census. Finally, rates of admissions were calculated for the public and private hospital sectors during the study period. These were used to correlate waiting times results with the amount of private practice in each DHB. ACC cases were extracted from the dataset to avoid bias in waiting times as much of this work is contracted out to the private sector and not subject to lengthy waiting times for treatment. A number of medical specialists and hospital administrators were interviewed to discuss results, explain prioritisation tools and management practices. Results showed large variations in the median waiting times of New Zealand DHBs. A north south gradient is observed in which southern DHBs suffer longer waits for care. Vastly better results were observed for Australian public hospitals than those seen in New Zealand. For waiting times as determined by individual factors, Maori and Pacific Island patients and those from lower socio-economic backgrounds suffered longer waiting times nationwide although, in certain DHBs inequalities for access to elective surgery were exacerbated. However, ethnic differences were more pronounced than socio-economic variations. Admissions results showed significant positive correlations between the amount of private practice and the waiting times experienced in each DHB which are supported by previous research. Feedback from interviews confirmed inconsistency in the use of scoring tools, manipulation occurring on behalf of the DHB management to achieve performance goals set by the Ministry of Health and provided some further explanation of the other quantitative results. Access to elective surgery is determined partly by location of residence, ethnicity, deprivation and where hospital resources are located but most importantly by the willingness to pay for treatment within the private hospital sector and the ability to manipulate the public prioritisation system.