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Given an increasingly complex web of financial pressures on providers, studies have examined how hospitals’ overall financial health affects different aspects of hospital operations. In our study, we develop an empirical proxy for the concept of soft budget constraint (SBC, Kornai, Kyklos 39:3–30, 1986) as an alternative financialmeasure of a hospital’s overall financial health and offer an initial estimate of the effect of SBCs on hospital access and quality. An organization has a SBC if it can expect to be bailed out rather than shut down. Our conceptual model predicts that hospitals facing softer budget constraints will be associated with less aggressive cost control, and their quality may be better or worse, depending on the scope for damage to quality from noncontractible aspects of cost control. We find that hospitals with softer budget constraints are less likely to shut down safety net services. In addition, hospitals with softer budget constraints appear to have better mortality outcomes for elderly heart attack patients.

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International Journal of Healthcare Finance and Economics
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Karen Eggleston
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Using data from 276 general acute hospitals in the Pearl River Delta region of Guangdong Province from 2002 and 2004, we construct a preliminary metric of budget constraint softness. We find that, controlling for hospital size, ownership, and other factors, a Chinese hospital’s probability of receiving government financial support is inversely associated with the hospital’s previous net revenue, an association consistent with soft budget constraints.

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International Journal of Healthcare Finance and Economics
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Karen Eggleston
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A variety of recent theoretical and empirical advances have renewed interest in monopsonistic models of the labor market. However, there is little direct empirical support for these models, even in labor markets that are textbook examples of monopsony. We use an exogenous change in wages at Veterans Affairs hospitals as a natural experiment to investigate the extent of monopsony in the nurse labor market. In contrast to much of the prior literature, we estimate that labor supply to individual hospitals is quite inelastic, with short-run elasticity around 0.1. We also find that non-VA hospitals responded to the VA wage change by changing their own wages.

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Journal of Labor Economics
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On December 1, 2009 the Treaty of Lisbon entered into force, bringing to an end eight years of discussions on treaty reforms in the European Union (EU). It included many of the institutional reforms that were originally part of the proposed EU Constitution, voted down by voters in France and the Netherlands in 2005. The Treaty of Lisbon could potentially be one of the most important EU treaties, depending on whether, for example, the newly created permanent European Council Presidency will manage to assert its authority and whether the Parliament will succeed at imposing its interpretation of the treaties. The objectives of this seminar are twofold. First, it will present an overview of the most important political and institutional reforms of the Treaty of Lisbon, and discuss its implications. Second, it will focus on EU trade policy and study how the Treaty of Lisbon will affect it. Trade policy is a good policy area to analyze, because it is one of the areas in which the EU’s powers are most extensive, and because the Parliament acquired new powers in this area, as it did in many other policy domains. Procedurally trade policy differs significantly from other EU policies: the Commission negotiates trade agreements based on mandates it receives from the Council. Agreements need final approval from the Council and, since December, the Parliament. The seminar will present a political-economic analysis of EU trade policy, analyze the role of the mandate, and study the implications of the increased role of the Parliament.  

Christophe Crombez is a specialist of European Union (EU) politics and business-government relations in Europe. His research focuses on EU institutions, the institutions' impact on EU policies under alternative procedural arrangements, EU institutional reform, lobbying in the EU, and electoral laws and their consequences for voter representation, party politics and government formation.

Crombez has been at the Forum on Contemporary Europe (FCE) at the Freeman Spogli Institute for International Studies at Stanford University as a visiting professor since 1999. At FCE he organizes seminars and other events on European Union politics and economics and European political systems. Crombez is also visiting professor at Stanford's Graduate School of Business, where he teaches a course on Politics and Business in Europe. He also teaches in the International Relations Program.

Furthermore, Crombez is professor of political economy and strategy at the University of Leuven in Belgium. He has been teaching in Leuven's business and economics department since 1994. His teaching responsibilities include political business strategy and applied game theory.

Christophe Crombez obtained a B.A. (Licentiaat) in Applied Economics from the University of Leuven in 1989, and a Ph.D. in Business, Political Economics, from Stanford University in 1994.

 

Audio Synopsis:

Professor Crombez first highlights key characteristics of the EU treaty system: each iteration of the treaty increases European integration; the growth of majority voting promotes smoother decision making; and every new treaty requires compromise between member states, and between political factions within the EU. Crombez then outlines changes in the Lisbon Treaty, including new policy areas for cooperation such as climate change, space policy, sports, judicial and police cooperation, and homeland security. The treaty establishes the European External Action Service, a kind of European diplomatic corps. Majority voting has been implemented in 68 new policy areas, including transport policy, immigration policy, and social security for migrant workers. The treaty grants significant new power to Parliament in multiple policy areas, and creates a permanent EU presidency. Progress has not been smooth, however: the Lisbon Treaty was voted down by Ireland in 2008 (before later being ratified), and much progress on actual policy is slowed by the reluctance of member state representatives to vote against the views of their constituents. Areas for optimism, Crombez explains, include two clauses that enable progress without a change to the treaty:

1.     Passerelle Clause: 8 articles outlining new policy areas previously requiring unanimous decisions which can now be decided through majority voting, except on defense-related issues.

2.     Flexibility Clause: decisions can now be made on issues where the EU lacks explicit authority if those issues promote the goals of the treaty. Unanimity is required, but not a formal change of the treaty.

Professor Crombez then turns his focus to trade policy under the Lisbon Treaty. An important change is that Parliament now has the option of codecision, in addition to the existing procedure of consultation (where the Council approves the Commission's proposal by unanimous decision). Codecision, in contrast, allows for qualified majority voting - leading the Commission to propose policies it may not think are ideal but which will more likely pass. In this way, Crombez feels codecision has made EU trade policy resemble US trade policy, wherein the executive branch may desire more liberal policies than what the legislature will accept. Crombez predicts this system may "lower the bar" and lead to more protectionist trade policies.

Encina Ground Floor Conference Room

Encina Hall
Stanford University
Stanford, CA 94305

(650) 723-0249 (650) 723-0089
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Senior Research Scholar at The Europe Center
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Christophe Crombez is a political economist who specializes in European Union (EU) politics and business-government relations in Europe. His research focuses on EU institutions and their impact on policies, EU institutional reform, lobbying, party politics, and parliamentary government.

Crombez is Senior Research Scholar at The Europe Center at the Freeman Spogli Institute for International Studies at Stanford University (since 1999). He teaches Introduction to European Studies and The Future of the EU in Stanford’s International Relations Program, and is responsible for the Minor in European Studies and the Undergraduate Internship Program in Europe.

Furthermore, Crombez is Professor of Political Economy at the Faculty of Economics and Business at KU Leuven in Belgium (since 1994). His teaching responsibilities in Leuven include Political Business Strategy and Applied Game Theory. He is Vice-Chair for Research at the Department for Managerial Economics, Strategy and Innovation.

Crombez has also held visiting positions at the following universities and research institutes: the Istituto Italiano di Scienze Umane, in Florence, Italy, in Spring 2008; the Department of Political Science at the University of Florence, Italy, in Spring 2004; the Department of Political Science at the University of Michigan, in Winter 2003; the Kellogg Graduate School of Management at Northwestern University, Illinois, in Spring 1998; the Department of Political Science at the University of Illinois at Urbana-Champaign in Summer 1998; the European University Institute in Florence, Italy, in Spring 1997; the University of Antwerp, Belgium, in Spring 1996; and Leti University in St. Petersburg, Russia, in Fall 1995.

Crombez obtained a B.A. in Applied Economics, Finance, from KU Leuven in 1989, and a Ph.D. in Business, Political Economics, from Stanford University in 1994.

Christophe Crombez Speaker
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Why do Western democracies respond militarily to complex humanitarian emergencies when and as they do?  Why do they send peacekeepers or combat forces to some conflicts and not others?  When they do so, how do they choose the political goals, military strategies, and military resources that they contribute to these operations?  I will explain what I mean by the term ‘complex humanitarian emergency,' and lay out the humanitarian implications of different kinds of military responses.  To illustrate, I will provide a few examples of complex emergencies and Western responses to them.  I will also offer some ideas about the factors that influence these policy decisions, and demonstrate their importance with a few comparative examples of Australian responses to complex humanitarian emergencies in its region.

Andrea Everett is a 2009-2010 CISAC visiting scholar. A Ph.D candidate in international relations at the Department of Politics at Princeton University, she is also a 2004 CISAC Undergraduate Honors Program graduate.  After graduating from Stanford but before arriving at Princeton, Andrea spent a year studying transatlantic relations in Berlin, Germany on a Fulbright scholarship.

Andrea's research interests include international security and comparative democratic foreign policy. She is especially interested in the role of domestic political influences on democratic states' foreign policy decisions in the security arena. Her dissertation, "Responding to Catastrophe: Explaining Democratic Responsiveness to Complex Emergencies," seeks to explain why Western democracies respond to complex humanitarian emergencies abroad when and as they do. She focuses on understanding when and how these states decide to use military force in pursuit of positive humanitarian outcomes, and investigates the roles of public pressure, characteristics of complex emergencies, military capabilities, and national interests in these decisions.

Kenneth Schultz is an associate professor of political science at Stanford University and an affiliated faculty member at CISAC. His research examines how domestic political factors such as elections, party competition, and public opinion influence decisions to use force in international disputes and efforts to negotiate the end of international rivalries.

He is the author of Democracy and Coercive Diplomacy (Cambridge, 2001), as well as a number of articles in scholarly journals. He is the recipient of several awards, including the 2003 Karl Deutsch Award, given by the International Studies Association to a scholar under the age of 40 who is judged to have made the most significant contribution to the study of international relations and peace research. Schultz received his BA in Russian and Soviet studies from Harvard University and his PhD in political science from Stanford University.

Reuben W. Hills Conference Room

Andrea Everett CISAC Visiting Scholar Speaker
Kenneth A. Schultz Associate Professor of Political Science; CISAC Faculty Member Commentator
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Karen Eggleston
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In December 2009, the Asia Health Policy Program celebrates the first anniversary of the launch of the AHPP working paper series on health and demographic change in the Asia-Pacific. The series showcases research by AHPP’s own affiliated faculty, postdoctoral fellows, and visiting scholars, as well as selected works by other scholars from the region.

To date AHPP has released eleven research papers in the series, by authors from China, South Korea, Thailand, Taiwan, Pakistan, and the US, with more on the way from Japan and Vietnam. Topics range from “The Effect of Informal Caregiving on Labor Market Outcomes in South Korea” and “Comparing Public and Private Hospitals in China,” to “Pandemic Influenza and the Globalization of Public Health.”  The working papers are available at the Asia Health Policy website.

AHPP considers quality research papers from leading research universities and think tanks across the Asia-Pacific region for inclusion in the working paper series. If interested, please contact Karen Eggleston.

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Since the 1990's the US Department of Defense has been pioneering the development of more coherent approaches to improve the coordination of complex technologies, program, policies, and institutions.  Among the most significant and influential of these new approaches is Systems of Systems, which is an interdisciplinary field that focuses on organizing independent stand-alone components into more integrated solutions.

As one of the developers of this concept, Bill will draw on his expertise to review the history of this emerging field, summarize its major scientific and practical features, describe examples of its application in DoD and other arenas, and explore its relevance to a variety of technical and non-technical issues affecting security concerns.

 

Bill Reckmeyer is Professor of Leadership and Systems at San José State University, Faculty Chair of the International Study Program on Global Citizenship at the Salzburg Global Seminar, and a Visiting Professor at CISAC.  A systems scientist/cybernetician whose work emphasizes collaborative approaches to problematic organizational, national, and global issues, his research and consulting have focused on leading multi-year strategic planning efforts in diverse institutional settings and conducting senior-level policy studies on national strategy for the US Department of Defense.

During the 1990s Bill co-authored several studies on Revitalizing America for OSD's Office of Net Assessment, which originated the ideas for systems of systems approaches to address hyper-complex concerns whose resolution require the integration of independent complex systems.  From 2003-2006 he served as Chief Systems Scientist for the Systems of Systems Center of Excellence, which was established by Congress and funded by DoD to lead national efforts at developing more integrative solutions to interconnected challenges affecting defense acquisition and logistics, national security, homeland security, and international affairs.

Prior to joining Stanford Bill also held posts as a Visiting Professor or a Senior Fellow at Harvard, Southern California, Maryland, Stockholm, St. Gallen, Aveiro, and several other major universities in the United States and Europe.  He currently serves as Strategic Advisor to the California Levees Roundtable and as a Core Faculty member in the CA Agricultural Leadership Program.

A former President of the American Society for Cybernetics in 1983-1985, Bill was a Kellogg National Leadership Fellow in 1988-1992 and a Salzburg Global Fellow on five occasions from 1995-2004.  He earned his PhD in Russian Studies at American University in 1982 and completed several advanced leadership programs at Harvard University from 1990-1995.

Reuben W. Hills Conference Room

William Reckmeyer CISAC Visiting Professor Speaker
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In the four years since a State Council think tank, the Development Research Center, bluntly declared the failure of three decades of healthcare reform, China has placed a high political priority on designing, building and financing a modern, equitable health delivery system that serves every last one of its 1.3 billion people. As publisher of practice-building trade magazines for medical specialists in China and India, Jeffrey Parker has developed unique and valuable perspectives on what's wrong with China's healthcare system -- and how Indian practitioners are able to deliver results despite a per-capita GDP that is roughly half of China's. Through an unprecedented China-India training exchange, Mr. Parker has begun testing whether Indian models of self-financed grassroots medical startup practices can help doctors shake free of China’s Stalinist paralysis without having to wait for sweeping programmatic reforms that are always on the horizon, but seem never to come. What's more, would such grassroots empowerment models not create unprecedented opportunities for participation by international investors who up to now have been largely marginalized in China's healthcare development?

In this lunchtime colloquium, Mr. Parker reviews his experiences in China and India over the past six years and looks at several exciting recent developments in China. These include:

  • An ambitious rural reimbursement scheme that already has begun to complete a nationwide healthcare safety net. The program is creating a vast pool of funds to finance rural medical services, but how will Beijing populate the countryside with sustainable grassroots practices?
  • The first domestic healthcare IPO, by which Aier Ophthalmology raised some $50 million as one of 28 debut listings in the Shenzhen's new "ChiNext" Growth Enterprise Market. New wind in the sails of healthcare privatization?
  • Licensing reforms that have begun delinking doctors' certification from their "work unit" hospitals under trials in Beijing and Yunnan, removing a vexing obstacle to hands-on surgical training of young practitioners. Will the breaking of senior doctors' "skills monopoly" create opportunities for private-sector training programs that will shake up China's Soviet-style residency programs?

Jeffrey Parker has lived in Greater China since 1990, first as a journalist and since 2003 as a publisher. His transition from chronicler of China's historic rise to active proponent of its economic development gives him a unique perspective on the opportunities still opening up in China -- and the challenges facing anyone keen to participate. With a twin B.A. in Asian Studies and Geography from U.C. Santa Barbara and Masters training in Journalism from Columbia University, Parker trimmed his sails for a China career from an early age. After early editorial jobs in New York and Washington, D.C., he was dispatched to Beijing by United Press International as senior correspondent in 1990. During the next 10 years with UPI and then Reuters, he covered a wide range of political, economic and social stories from postings in Hong Kong, Taiwan and the Peoples Republic. In his final two years at Reuters, Parker got his first taste of media development, launching local-language multimedia news and video feeds in China, Japan, Korea, India and Southeast Asia. Since 2003, Parker has built up a family of world-class doctors' magazines serving more than 50,000 specialists in China and India from the Shanghai base of ILX Media Group, where he is editorial director, chief operating officer, a corporate director and investor. Among his objectives is to help foster a badly needed transformation of medical practice across China by inspiring grassroots doctors to deliver high-quality, cost-effective services in rural and less-developed communities left behind by government health care.

Daniel and Nancy Okimoto Conference Room

Jeffrey Parker Speaker ILX Media Group, Shanghai, PRC
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Martha Crenshaw, a senior fellow at FSI's Center for International Security and Cooperation, testified Thursday, November 19, before the House Subcommittee on Intelligence, Information Sharing and Terrorism Risk Assessment on the subject of "Reassessing the Evolving al-Qa'ida Threat to the Homeland." Crenshaw, who recently launched a three-year effort to build a global database of terrorist 'family trees,' was joined by three terrorism experts at the hearing in Washington, D.C.

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