PubMed · 14906942
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1952. BUDGETS can be balanced.. https://pubmed.ncbi.nlm.nih.gov/14906942/
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Do Primary Care Physicians (PCPs) react strategically to financial incentives and if so how? To address this question, we follow a quasi-natural experiment in Quebec, using a panel system technique. In so doing, we both correct for underestimation biases in earlier time series findings and generate new results on the issue of complementarity/substitution between consultations with varying levels of technicality. Under both techniques, we show that PCPs are sensitive to the enforcement and subsequent temporary removals of expenditure caps and more generally, to changes in consultations' relative prices over time. These results support the existence of a discretionary power over the choice of consultation, PCPs increasing strategically the number of the more technical (and therefore more lucrative) consultations when pressed to defend their income. This finding for primary care parallels the now well-established DRG creep in hospitals. The panel system approach offers a better account of the complexity surrounding PCPs' decision-making process. In particular, it successfully addresses issues of physician heterogeneity, jointness between consultations and temporal breaks and generates robust estimates of PCPs volume and quality reactions to regulatory changes.
Economic theory asserts that to achieve maximum conservation benefits land acquisition needs to be cost effective. Yet the most common planning technique used by land conservation organizations is 'benefit-targeting' that focuses only on acquiring parcels with the highest benefits and ignores costs. Unlike most of the literature which focuses on covering problems, this research applies optimization techniques to achieve maximum aggregate conservation benefits for an ongoing land acquisition effort in the Catoctin Mountain Region in central Maryland. For this case study, optimization yields additional conservation benefits worth an estimated 3.1-3.9 million US dollars or achieves the same level of conservation benefits but at a cost savings ranging from 0.9 to 3.5 million US dollars, depending on the initial budget size. Finally, the highest efficiencies are achieved in low budget scenarios, like those most prevalent in conservation efforts.
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