Beliefs about informal payments in Albania

Informal payments for health care are a growing concern in Albania and other transitional economy countries. Recent international studies have shown that informal payments can have negative effects on health care access, equity and health status by causing people to forgo or delay seeking care, or sell assets to pay for care. Many countries are putting in place reforms meant to reduce informal payments. In order to be successful, such policies need to consider people's attitudes and beliefs about the practice. This study collected data from 222 citizens in Albania regarding intentions, past behaviours, attitudes and beliefs about informal payments. Comparing people who intend to make informal payments with people who do not intend to make payments, the study found differences in attitudes as well as beliefs about the consequences of making informal payments, in perceptions about what others think and in control beliefs, but no difference in moral beliefs or demographic characteristics. People who intend to make informal payments the next time they seek care are more likely to believe they will get faster and better quality care than non-intenders, but also think they must pay to receive any care at all. People who do not intend to make informal payments are more likely to report that they have connections with medical personnel, which may be substituting for informal payments. The study has implications for educational campaigns accompanying policy reforms. Campaigns which focus on anti-corruption messages are unlikely to be effective, as moral beliefs do not appear to influence intention.     

Cost efficiency,factor interchange,and technical progress in US specialized hospital pharmacies

Specialized hospitals perform unique, technologically more complex, and relatively expensive medical procedures. Growing use of high-cost biotechnology drugs and increased clinical pharmacy tasks at these facilities have increased costs. This paper used a unique data set supplied by Eli Lilly, and a dual translog cost system to model the costs of specialized hospital pharmacy production. Results show that the potential substitution of pharmacy technicians for registered pharmacists and the decomposed technical change savings effects of expensive factors of production offer the greatest opportunities for containing costs. Slight diseconomies of scale were also observed. © 1998 John Wiley & Sons, Ltd.     

What role for state health care in Asian transition economies?

The main findings of a study of the impact of changes to communism on health care in Asian transition economies are summarized. © 1997 John Wiley & Sons, Ltd.     

浙江省公立医院规模经济实证分析

目的分析浙江省公立医院的规模经济情况。方眭选取浙江省125所二级乙等以上公立医院为样本,运用道格拉斯生产函数,分别以医院服务量和医院业务收入作为因变量建立两种生产模型,分析2004-2006年样本医院投入与不同产出变量的关系。结果2004-2006年,样本医院的服务量与业务收入两大产出均处于规模经济阶段。产出增长率高于投入增长率;三级医院的服务量、业务收入、总资产和职工总数均明显高于二级医院（P=0．000）。结论规模经济是当前医院不断扩张的根本动因。为防止医院过度扩张所导致的医疗服务供给问题,医院应理性控制其规模的发展。     

医院规模的理论分析

应用交易费用、规模经济和范围经济理论,对医院横向和纵向边界的选择做初步探讨。指出,横向和纵向边界是医院规模的丽种经济学属性,规模边界的选择与医院自身生产能力和所在医疗市场有关,规模不是静态的,而是逐步优化的动态过程。     

Multilead quantitative electroencephalogram profile and cognitive evoked potentials (P300) in healthy subjects after a single dose of olanzapine

RATIONALE: Olanzapine is an atypical antipsychotic drug with a more favourable safety profile than typical antipsychotics with a hitherto unknown topographic quantitative electroencephalogram (QEEG) profile. OBJECTIVES: We investigated electrical brain activity (QEEG and cognitive event related potentials, ERPs) in healthy subjects who received olanzapine. METHODS: Vigilance-controlled, 19-channel EEG and ERP in an auditory odd-ball paradigm were recorded before and 3 h, 6 h and 9 h after administration of either a single dose of placebo or olanzapine (2.5 mg and 5 mg) in ten healthy subjects. QEEG was analysed by spectral analysis and evaluated in nine frequency bands. For the P300 component in the odd-ball ERP, the amplitude and latency was analysed. Statistical effects were tested using a repeated-measurement analysis of variance. RESULTS: For the interaction between time and treatment, significant effects were observed for theta, alpha-2, beta-2 and beta-4 frequency bands. The amplitude of the activity in the theta band increased most significantly 6 h after the 5-mg administration of olanzapine. A pronounced decrease of the alpha-2 activity especially 9 h after 5 mg olanzapine administration could be observed. In most beta frequency bands, and most significantly in the beta-4 band, a dose-dependent decrease of the activity beginning 6 h after drug administration was demonstrated. Topographic effects could be observed for the beta-2 band (occipital decrease) and a tendency for the alpha-2 band (frontal increase and occipital decrease), both indicating a frontal shift of brain electrical activity. There were no significant changes in P300 amplitude or latency after drug administration. Conclusion: QEEG alterations after olanzapine administration were similar to EEG effects gained by other atypical antipsychotic drugs, such as clozapine. The increase of theta activity is comparable to the frequency distribution observed for thymoleptics or antipsychotics for which treatment-emergent somnolence is commonly observed, whereas the decrease of beta activity observed after olanzapine administration is not characteristic for these drugs. There were no clear signs for an increased cerebral excitability after a single-dose administration of 2.5 mg and 5 mg olanzapine in healthy controls.     

A reconsideration of economies of scale in the health care field.

The Health Care Financing Administration has demonstrated an interest in the economies of scale phenomenon as it might apply to reimbursement methodologies. This paper provides a critical evaluation of the economies of scale research methodology and a critical review of both the analytical (LRAC estimates) and the implied economies of scale (spreading fixed costs) literature. Given that estimates of Minimum Optimum Scale are based on individual coefficients generated by a regression model, this work illustrates the danger inherent in this approach and examines the volatility of the coefficient values and their dependence upon model specification. The ambiguity present in the literature addressing the LRAC estimates is thereby explained. An evaluation of the implied economies of scale literature reveals that average fixed costs decrease with increasing levels of output. This should not be a surprise to anyone. The notion of economies of scale is implied in this literature but never addressed. It is suggested in this work that the means to better standardize the output of the hospital industry, the sine qua non of economies of scale research, is now available in various methodologies of patient grouping.     

Classroom procedures for remediating behavior disorders

Numerous effective interventions for the control of behavior problems in the classroom have been developed. These have included relatively simple strategies such as providing contingent attention for appropriate behaviors and social reprimands or timeout for inappropriate behavior. Behavior control procedures have grown in sophistication to involve more complex systems such as token economies, skill straining strategies, peer interventions, and self-control procedures. Each technique has proved effective in improving classroom behavior, however, the combination of multiple techniques has had the most powerful effects on students. The ultimate goal of remediating complex behavior disorders such that appropriate behavior generalizes across new settings and events will require more comprehensive programs and continued analysis of new and promising practices.     

Concentrating Emergency Rooms: Penny‐Wise and Pound‐Foolish? An Empirical Research on Scale Economies and Chain Economies in Emergency Rooms in Dutch Hospitals

In this paper, we address the issue of whether it is economically advantageous to concentrate emergency rooms (ERs) in large hospitals. Besides identifying economies of scale of ERs, we also focus on chain economies. The latter term refers to the effects on a hospital's costs of ER patients who also need follow‐up inpatient or outpatient hospital care. We show that, for each service examined, product‐specific economies of scale prevail indicating that it would be beneficial for hospitals to increase ER services. However, this seems to be inconsistent with the overall diseconomies of scale for the hospital as a whole. This intuitively contradictory result is indicated as the economies of scale paradox. This scale paradox also explains why, in general, hospitals are too large. There are internal (departmental) pressures to expand certain services, such as ER, in order to benefit from the product‐specific economies of scale. However, the financial burden of this expansion is borne by the hospital as a whole. The policy implications of the results are that concentrating ERs seems to be advantageous from a product‐specific perspective, but is far less advantageous from the hospital perspective. © 2016 The Authors. Health Economics Published by John Wiley & Sons, Ltd.     

分次口服碘油后碘的排泄率和供碘有效期的实验研究

目的：探讨绒猴分７次口服２００ｍｇ碘油后碘的排泄率及供碘有效期。方法；以药代动力学的方法研究碘的排泄过程。结果：分次口服碘油碘的半衰期和有效期较１次性口服等剂量碘油的半衰期和有效期延长。低碘绒猴的半衰期和有效期较正常绒猴有轻度缩短。