Effect of workforce diversity on the cost-effectiveness of milk production systems participating in the "full bucket" program / Efeito do tipo de mão de obra na rentabilidade de sistemas de produção de leite participantes do programa "balde cheio"

This study aimed to analyze the effect of each workforce type on the cost-effectiveness of 20 dairy farms participating in the "Full Bucket" program, from January to December 2011, in the State of Rio de Janeiro. A stepwise multiple linear regression was used to identify the production cost components that most affected net margin, profitability, and cost-effectiveness. Workforce type influenced both profitability and cost-effectiveness, as well as total production cost. Economic analysis showed that farms with a hired workforce had the lowest total unit costs and a positive result. This way, the activity is able to produce in the long term and farmers are capitalizing. The farms that adopted mixed and family workforce had a positive net margin and a negative result, obtaining conditions to produce in the medium term. The highest representativeness on the items of effective operating cost in the family workforce stratum, in a descending order, were food, miscellaneous expenses, and energy. The most representative items in the mixed and hired workforce strata were food, workforce, and miscellaneous expenses.(AU)

Objetivou-se analisar o efeito do tipo de mão de obra na rentabilidade de 20 propriedades participantes do programa "Balde Cheio", entre janeiro a dezembro de 2011, no estado do RJ. O modelo utilizado foi o de regressão linear múltipla com o método stepwise, visando identificar os componentes do custo de produção que mais influenciaram na margem líquida, lucratividade e rentabilidade. O tipo de mão de obra influenciou a lucratividade e rentabilidade, e também o custo total de produção. Na análise econômica, as propriedades com mão de obra contratada tiveram os menores custos totais unitários e resultado positivo. Desta forma, a atividade tem condições de produzir no longo prazo e os produtores estão se capitalizando. Os estratos que adotaram mão de obra mista e familiar apresentaram margem líquida positiva e resultado negativo, obtendo condições de produzir no médio prazo. As maiores representatividades sobre os itens do custo operacional efetivo no estrato da mão de obra familiar, em ordem decrescente, foram a alimentação, despesas diversas e energia. Os itens mais representativos, nos estratos da mão de obra mista e contratada, foram alimentação, mão de obra e despesas diversas.(AU)

Effect of workforce diversity on the cost-effectiveness of milk production systems participating in the "full bucket" program / Efeito do tipo de mão de obra na rentabilidade de sistemas de produção de leite participantes do programa "balde cheio"

This study aimed to analyze the effect of each workforce type on the cost-effectiveness of 20 dairy farms participating in the "Full Bucket" program, from January to December 2011, in the State of Rio de Janeiro. A stepwise multiple linear regression was used to identify the production cost components that most affected net margin, profitability, and cost-effectiveness. Workforce type influenced both profitability and cost-effectiveness, as well as total production cost. Economic analysis showed that farms with a hired workforce had the lowest total unit costs and a positive result. This way, the activity is able to produce in the long term and farmers are capitalizing. The farms that adopted mixed and family workforce had a positive net margin and a negative result, obtaining conditions to produce in the medium term. The highest representativeness on the items of effective operating cost in the family workforce stratum, in a descending order, were food, miscellaneous expenses, and energy. The most representative items in the mixed and hired workforce strata were food, workforce, and miscellaneous expenses.

Objetivou-se analisar o efeito do tipo de mão de obra na rentabilidade de 20 propriedades participantes do programa "Balde Cheio", entre janeiro a dezembro de 2011, no estado do RJ. O modelo utilizado foi o de regressão linear múltipla com o método stepwise, visando identificar os componentes do custo de produção que mais influenciaram na margem líquida, lucratividade e rentabilidade. O tipo de mão de obra influenciou a lucratividade e rentabilidade, e também o custo total de produção. Na análise econômica, as propriedades com mão de obra contratada tiveram os menores custos totais unitários e resultado positivo. Desta forma, a atividade tem condições de produzir no longo prazo e os produtores estão se capitalizando. Os estratos que adotaram mão de obra mista e familiar apresentaram margem líquida positiva e resultado negativo, obtendo condições de produzir no médio prazo. As maiores representatividades sobre os itens do custo operacional efetivo no estrato da mão de obra familiar, em ordem decrescente, foram a alimentação, despesas diversas e energia. Os itens mais representativos, nos estratos da mão de obra mista e contratada, foram alimentação, mão de obra e despesas diversas.

The consequences of hospital autonomization in Colombia: a transaction cost economics analysis.

Granting autonomy to public hospitals in developing countries has been common over recent decades, and implies a shift from hierarchical to contract-based relationships with health authorities. Theory on transactions costs in contractual relationships suggests they stem from relationship-specific investments and contract incompleteness. Transaction cost economics argues that the parties involved in exchanges seek to reduce transaction costs. The objective of this research was to analyse the relationships observed between purchasers and the 22 public hospitals of the city of Bogota, Colombia, in order to understand the role of relationship-specific investments and contract incompleteness as sources of transaction costs, through a largely qualitative study. We found that contract-based relationships showed relevant transaction costs associated mainly with contract incompleteness, not with relationship-specific investments. Regarding relationships between insurers and local hospitals for primary care services, compulsory contracting regulations locked-in the parties to the contracts. For high-complexity services (e.g. inpatient care), no restrictions applied and relationships suggested transaction-cost minimizing behaviour. Contract incompleteness was found to be a source of transaction costs on its own. We conclude that transaction costs seemed to play a key role in contract-based relationships, and contract incompleteness by itself appeared to be a source of transaction costs. The same findings are likely in other contexts because of difficulties in defining, observing and verifying the contracted products and the underlying information asymmetries. The role of compulsory contracting might be context-specific, although it is likely to emerge in other settings due to the safety-net role of public hospitals.

[Pay for performance in Colombian healthcare]. / Pago por desempeño en el sistema colombiano de salud.

OBJECTIVE: Describing the extent and forms of use of pay for performance (P4P) in Colombian healthcare. METHODS: This was a descriptive study based on interviews and surveys of health insurance agency managers in Bogotá, Colombia. The authors relied on transaction cost theory to interpret the results. RESULTS: P4P was found to be used by contribution scheme insurers in an outpatient setting, basically in promotion and prevention; P4P is not being used in a hospital setting. Subsidized scheme insurers do not use P4P. Similarly, P4P is not being used in the case of so called associated users. CONCLUSIONS: P4P use in Colombia is limited. Colombian practice only partially validates the transaction costs theory approach to governance model attributes, one of which is incentive intensity.

Effective subsidies in developing countries.

During the last decades, significant subsidies have been allocated to government-owned water and sewerage enterprises in developing countries. However, water and sewerage coverage is still far from desirable and the poor are particularly affected by the shortage of these services. The truth is that a considerable part of these subsidies have been used up to build huge infrastructure works that would make some construction firms happy, while often decreasing the service costs for the richer. The costs associated of delivering water and sanitation services to the poor are significantly higher, as they often live in slums or irregular urban developments without urban infrastructure. It is possible, and desirable, to improve government's effectiveness through the use of appropriate economic incentives. The Brazilian River Basin Pollution Abatement Program, based on the "output-based aid" concept, is a good example of how this can be achieved. The Program is a success story that shows that the quality of expenditures on sanitation can be considerably improved if governments of developing countries refrain from contracting sanitation infrastructure works and start paying for results, not for promises.

Physician reimbursement in Medicare risk contracting.

The Medicare population remains largely unmanaged despite its increasing cost burden. With a few notable exceptions, health maintenance organizations (HMOs) have historically avoided serving this expensive segment. In many cases, the inability to control costs results from failing to understand the importance of specialist reimbursement mechanisms. This article examines the importance of these mechanisms and describes how to successfully capitate specialty physicians in a Medicare risk program. The article also includes a case study on a successful capitation agreement between an HMO and a specialty group.

Selecting international markets: lessons from for-profit hospitals.

As growth potential in the U.S. market declines and regulatory constraints increase, providers of health-related services may look increasingly to international opportunities as a way to supplement the lost domestic market. In this article, critical factors bearing on the decision to compete in international markets are identified. Existing theories of multinational competition are expanded to provide a framework for analyzing international competition. Applied in the context of the proprietary hospital industry, the critical factors governing both the selection of foreign markets and mode of entry are proposed to be host country receptivity and market growth potential.

Improving the cost-effectiveness of AIDS health care in San Juan, Puerto Rico.

In an era of decreasing availability of funds and increasing demand, the AIDS epidemic threatens to overwhelm health-care services in some countries. We describe a comprehensive model for the treatment of AIDS in San Juan, Puerto Rico, and compare it with traditional hospital-based services. Given the existing allocation of funds, the comprehensive model emphasised prevention, education, surveillance, early detection, and outpatient care to reduce hospital care. In 1987, the last year of the traditional system, there were 95 admissions of AIDS patients to hospital, and in 1988, the first year of the comprehensive model, there were 100 admissions. The mean length of stay of AIDS inpatients was reduced from 22.3 days in 1987 to 11.3 days in 1988, a 46.8% reduction (p = 0.001). The annual mean (SE) cost of inpatient care per AIDS patient fell from $15,118 (1699) in 1987 to $3869 (659) in 1988. Savings were used to improve non-hospital services, including outreach, education, emergency and outpatient care, laboratory and epidemiological services, and research, and to introduce an employee incentive scheme. Management strategies that reduce the length of inpatient care and provide less costly treatment alternatives can improve AIDS health care in developing nations.