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The changing hospital landscape: An exploration of international experiences

August 20, 2014 Comments off

The changing hospital landscape: An exploration of international experiences
Source: RAND Corporation

The nature of hospital activity is changing in many countries, with some experiencing a broad trend towards the creation of hospitals groups or chains and multi-hospital networks. This report seeks to contribute to the understanding of experiences in other countries about the extent to which different hospital ‘models’ may provide lessons for hospital provision in England by means of a review of four countries: France, Germany, Ireland and the United States, with England included for comparison. We find that here has been a trend towards privatisation and the formation of hospital groups in France, Germany and the United States although it is important to understand the underlying market structure in these countries explaining the drivers for hospital consolidation. Thus, and in contrast to the NHS, in France, Germany and the United States, private hospitals contribute to the delivery of publicly funded healthcare services. There is limited evidence suggesting that different forms of hospital cooperation, such as hospital groups, networks or systems, may have different impacts on hospital performance. Available evidence suggests that hospital consolidation may lead to quality improvements as increased size allows for more costly investments and the spreading of investment risk. There is also evidence that a higher volume of certain services such as surgical procedures is associated with better quality of care. However, the association between size and efficiency is not clear-cut and there is a need to balance ‘quality risk’ associated with low volumes and ‘access risk’ associated with the closure of services at the local level.

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Global Pensions Asset Study – 2014

February 27, 2014 Comments off

Global Pensions Asset Study – 2014
Source: Towers Watson

This is a study of the 13 largest pension markets in the world and accounts for more than 85% of global pension assets. The countries included are Australia, Canada, Brazil, France, Germany, Hong Kong, Ireland, Japan, Netherlands, South Africa, Switzerland, the UK and the US. The study also analyses seven countries in greater depth by excluding the six smallest markets (Brazil, France, Germany, Ireland, Hong Kong and South Africa).

The analysis includes:

  • Asset size, including growth statistics, comparison of asset size with GDP and liabilities
  • Asset allocation
  • Defined benefit and defined contribution share of pension assets
  • Public and private sector share of pension assets.

OECD Review of Fisheries: Country Statistics 2013

January 13, 2014 Comments off

OECD Review of Fisheries: Country Statistics 2013
Source: Organisation for Economic Co-operation and Development

Fisheries (capture fisheries and aquaculture) supply the world each year with millions of tonnes of fish (including, notably, fish, molluscs and crustaceans). Fisheries as well as ancillary activities also provide livelihoods and income. The fishery sector contributes to development and growth in many countries, playing an important role for food security, poverty reduction, employment and trade.

This publication contains statistics on fisheries from 2005 to 2012. Data provided concern fishing fleet capacity, employment in fisheries, fish landings, aquaculture production, recreational fisheries, government financial transfers, and imports and exports of fish.

OECD countries covered

Australia, Belgium, Canada, Chile, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Japan, Korea, Luxembourg, Mexico, Netherlands, New Zealand, Norway, Poland, Portugal, Slovak Republic, Spain, Sweden, Switzerland, Turkey, United Kingdom, United States

Non-member economies covered

Argentina, Chinese Taipei, Thailand

CRS — Sovereign Debt in Advanced Economies: Overview and Issues for Congress

November 4, 2013 Comments off

Sovereign Debt in Advanced Economies: Overview and Issues for Congress (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

Sovereign debt, also called public debt or government debt, refers to debt incurred by governments. Since the global financial crisis of 2008-2009, public debt in advanced economies has increased substantially. A number of factors related to the financial crisis have fueled the increase, including fiscal stimulus packages, the nationalization of private-sector debt, and lower tax revenue. Even if economic growth reverses some of these trends, such as by boosting tax receipts and reducing spending on government programs, aging populations in advanced economies are expected to strain government debt levels in coming years.

High levels of debt in advanced economies arose as an issue for concern for some analysts following the global financial crisis, after decades of attention on debt levels in developing and emerging markets. Four Eurozone countries, Greece, Ireland, Portugal, and Cyprus, have turned to the International Monetary Fund (IMF) and other European governments for financial assistance. Some analysts and policymakers are also concerned about are also concerned about debt levels in other advanced economies.

To date, many advanced-economy governments have embarked on fiscal austerity programs (such as cutting spending and/or increasing taxes) to address historically high levels of debt. This policy response has been criticized by some economists as possibly undermining a weak recovery from the global financial crisis. Others argue that the austerity plans do not go far enough, and that more reforms are necessary to bring debt levels down, especially considering the aging populations in many countries.

New Study: U.S. Ranks Last Among High-Income Nations on Preventable Deaths, Lagging Behind as Others Improve More Rapidly

September 28, 2011 Comments off

New Study: U.S. Ranks Last Among High-Income Nations on Preventable Deaths, Lagging Behind as Others Improve More Rapidly
Source: Commonwealth Fund (Health Policy)

The United States placed last among 16 high-income, industrialized nations when it comes to deaths that could potentially have been prevented by timely access to effective health care, according to a Commonwealth Fund–supported study that appeared online in the journal Health Policy this week and will be available in print on October 25th as part of the November issue. According to the study, other nations lowered their preventable death rates an average of 31 percent between 1997–98 and 2006–07, while the U.S. rate declined by only 20 percent, from 120 to 96 per 100,000. At the end of the decade, the preventable mortality rate in the U.S. was almost twice that in France, which had the lowest rate—55 per 100,000.

In “Variations in Amenable Mortality—Trends in 16 High Income Nations,” Ellen Nolte of RAND Europe and Martin McKee of the London School of Hygiene and Tropical Medicine analyzed deaths that occurred before age 75 from causes like treatable cancer, diabetes, childhood infections/respiratory diseases, and complications from surgeries. They found that an average 41 percent drop in death rates from ischemic heart disease was the primary driver of declining preventable deaths, and they estimate that if the U.S. could improve its preventable death rate to match that of the three best-performing countries—France, Australia, and Italy—84,000 fewer people would have died each year by the end of the period studied.

“This study points to substantial opportunity to prevent premature death in the United States. We spend far more than any of the comparison countries—up to twice as much—yet are improving less rapidly,” said Commonwealth Fund Senior Vice President Cathy Schoen. “The good news is we know lower death rates are achievable if we enhance access and ensure high-quality care regardless of where you live. Looking forward, reforms under the Affordable Care Act have the potential to reduce the number of preventable deaths in the U.S. We have the potential to join the leaders among high-income countries.”

+ Variations in Amenable Mortality—Trends in 16 High-Income Nations

Exporting Poor Health: The Irish in England

September 3, 2011 Comments off

Exporting Poor Health: The Irish in England
Source: RAND Corporation

The Irish-born population in England is in worse health than both the native population and the Irish population in Ireland, a reversal of the commonly observed healthy migrant effect. Recent birth-cohorts living in England and born in Ireland, however, are healthier than the English population. The substantial Irish health penalty arises principally for cohorts born between 1920 and 1960. This paper attempts to understand the processes that generated this migrant health pattern. The results suggest a strong role for early childhood conditions and economic selection in driving the dynamics of health differences between the Irish-born migrants and White English populations.

+ Full Paper (PDF)

CRS — Treasury Securities and the U.S. Sovereign Credit Default Swap Market

August 16, 2011 Comments off

Treasury Securities and the U.S. Sovereign Credit Default Swap Market (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

Paying the public debt is a central constitutional responsibility of Congress (Article I, Section 8). U.S. Treasury securities, which represent nearly all federal debt, have long been considered risk- free assets. The size of federal deficits and the projected imbalance between federal revenues and outlays, however, has raised concerns among some. Uncertainties surrounding the debt limit have raised issues related to a hypothetical federal default. Prices for Treasury securities suggest that financial markets consider a federal default unlikely, although credit rating agencies warned of possible downgrades, which could raise borrowing costs and negatively affect capital markets.

A typical credit default swap (CDS) contract specifies that a CDS holder, in exchange for an annual fee set by the market and paid quarterly, can trade an asset issued by a “reference entity” for its par value if a “credit event” occurs. Par, or face, value is the value of a bond at maturity. A corporation or a sovereign government could be a reference entity. A committee of the derivatives trade organization, the International Swaps and Derivatives Association (ISDA), determines if a credit event has occurred, according to their interpretation of applicable guidelines. In general, failure to make a timely payment usually constitutes a credit event.

The cost of buying CDS protection on federal debt for a one-year duration has roughly doubled since the start of 2011. U.S. CDS prices are currently about 54 basis points (one-hundredths of a percent)—slightly lower than for Germany—but much lower than the cost of CDS protection for Greece, Portugal, and Ireland. A CDS contract covering $1,000 of federal debt at a price of 54 basis points (bps) would require annual payment of $54.

Some financial market and federal budget analysts view price trends for CDSs for U.S. debt as an indicator of the market-perceived risks of a default by the federal government. Although CDS prices reflect market assessments of default probabilities, the market for U.S. CDSs is small and thinly traded, which may limit its reliability as a measure of the federal government’s fiscal condition. The notional value of U.S. CDSs is only about 0.5% of publicly held federal debt according to available data sources. In a small and thinly traded market, a few large trades could strongly affect prices.

CDSs may provide a more useful indicator of sovereign default risks for countries with more immediate fiscal challenges, such as Greece and Portugal, where sovereign default risks may be more salient due to higher levels of fiscal stress; or for larger European economies such as Italy and Spain, which have recently come under increased fiscal stress. A sovereign default occurs when a sovereign government is unable to meet its financial obligations. The fiscal situations of several European Union member states, including Greece, Portugal, and Ireland, have raised concerns of policymakers, financial institutions, and investors about wider economic, financial, and political consequences.

This report explains how the sovereign CDS market works and how such CDS price trends may illuminate fiscal stresses facing sovereign governments. Although CDS prices may be imperfect measures of the federal government’s fiscal condition, some investors may try to glean information from those price trends. CDS prices have been playing an important role in the European government debt markets and could potentially affect U.S debt markets in the future. European policymakers have debated certain restrictions on types of sovereign CDS trading, and such calls for reform may be of interest to U.S. lawmakers. This report will be updated as events warrant.

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