经济学最新文献

Background: Given the significant impact of the COVID-19 pandemic, it is imperative to examine the economic response policies implemented by governments. This study aims to review evidence from the Middle East and North Africa (MENA) region, including Iran, on COVID-19 economic response policies designed to protect households, vulnerable groups, and businesses.

Methods: Utilizing Arksey and O'Malley's scoping review methodology, electronic search engines and databases were systematically searched to identify published studies within the timeframe of December 31, 2019, to 2022. Additionally, a gray literature search for relevant policy documents and reports was conducted. The following six-step approach was employed: (1) defining the review questions, (2) identifying relevant studies through database searches, (3) screening studies for inclusion, (4) extracting and charting data, (5) analyzing and presenting results, and (6) providing guidance and suggestions. Narrative synthesis was utilized for data analysis.

Results: After a rigorous screening process, 53 studies were selected from a pool of 3392 search results. The findings are categorized into three primary groups: Households, vulnerable groups, and economic businesses. The majority of MENA countries implemented economic and social measures to support these groups, including stimulus packages, tax deferrals and exemptions, wage subsidies, and debt obligation deferments. The size of stimulus packages in MENA countries varied significantly, ranging from 0 to 14% of real Gross Domestic Product (GDP). The average stimulus package size in MENA countries was 3.67%, notably lower than the global average of 11%. Among the 64 selected countries, the average government support as a share of GDP was 6.3%, with Ecuador at the lowest (0.05%) and Germany at the highest (23%). In Iran, government financial support contributed approximately 7% to the Gross National Product.

Conclusion: MENA countries, including Iran, implemented diverse economic strategies and policies in response to the critical circumstances of the COVID-19 pandemic, tailored to their specific conditions. Assessing the effectiveness of these policies and the extent of the pandemic's long-term economic, health, and lifestyle impacts requires a more extended timeframe.

With the rising spread of Assisted Reproductive Technology (ART), it becomes imperative to understand the determinants of resource utilization in ART versus spontaneous pregnancies to enhance policies directed to pregnancy care. The focus of our study is to examine the costs associated with ART from the perspective of the Italian NHS and to investigate in depth the contributing social and clinical factors.Using the healthcare informative system of Lombardy, a Region of Northern Italy, we gathered individual-level information for a cohort of women who experienced either spontaneous pregnancies or pregnancies following ART from 2007 until 2020. The information covered multiple healthcare services, and we used a propensity score matching technique to match couples of ART/No ART women based on a comprehensive set of confounders. We then applied statistical tests and regression models to identify the impact of ART on the reported cost differences.Our cohort was composed of 44652 women and results revealed significantly higher costs for ART pregnancies, especially in terms of hospital admissions (additional 1611€, 95% CI 1558-1666) and drug prescriptions (additional 216 €, CI 95% 204-228) occurring before delivery. In-depth analysis showed for ART pregnancies, i) a higher likelihood of incurring expenses related to complications and ii) higher costs associated with two established clinical practices that lack scientific evidence supporting their efficacy.Our study sheds light on the complex interplay of clinical and social factors influencing the ART burden, emphasizing the importance of tailored support and evidence-based practices in optimizing outcomes and resource allocation.

Background: The literature on care coordination refers to high service costs, low quality, and consumer dissatisfaction, as the consequences of institutional fragmentation and uncoordinated care.

Objectives: In this work we are concerned with the role financial incentives (reimbursement schemes) might play in promoting coordinated care when providers are organized sequentially along a care pathway and the clients (patients) are transferred from one caregiver to another.

Methods: We apply a game-theoretic framework to analyze the situation where three providers provide services to a patient group and there are interdependencies between the providers in terms of cost-externalities and altruistic patient preferences.

Results: For activity-based contracts, the incentives for cost containment are efficient (internal efficiency), while the incentives for quality provision are inefficient due to preference misalignments and poor coordination that derive from funding costs, imperfect altruism, the presence of externalities and strategic behavior. The optimal cost-based contracts are mixed contracts that vary across providers according to their position in the production chain, and they consist of the following three elements; (i) fixed budgets, (ii) payments contingent upon the treatment costs of production chain followers (integrated penalties), and (iii) payments contingent upon the providers' own treatment costs (positive or negative cost-sharing). For these contracts, the providers are typically internally inefficient, while the inefficiencies associated with preference misalignments and poor coordination are solved.

Conclusions: Our production chain perspective, when compared to single-provider approaches, enhances the appeal of cost-based contracts relative to pure prospective contracts.

China's primary healthcare (PHC) system, together with rural healthcare services, remains the Achilles' heel in the national healthcare system. Healthcare workers, specifically village doctors, are an integral part of the healthcare system. Using the two-stage data envelopment analysis (DEA) and Tobit regression analysis, this study aims to investigate the efficiency of healthcare expenditures on medical resources and services in China, as well as determine how different types of healthcare work influence efficiency. Compared with other types of healthcare workers, village doctors exerted a prominent impact on provincial and rural efficiency at all stages and played a key role in augmenting the efficiency of healthcare expenditures on health outcomes. Besides, township health centers (THCs) and village clinics (VCs) faced administrative overstaffing, mainly involving pharmacists, other nonmedical technologists, and health administrators, which adversely affected the efficiency of healthcare expenditures. This study suggests that the higher the proportion of these non-village doctor positions (e.g., pharmacists, health administrators, and nonmedical technologists) in THCs and VCs, the lower the efficiency of China's PHC system. Overall, the priority should be enhancing the training and remuneration of village doctors and other healthcare workers in rural areas to further enhance their performance and increase the overall efficiency of China's healthcare system.