Publication Type: Abstract
Abstract: We consider the estimation of drug cost within economic evaluations of pharmaceuticals, and argue that estimates based on U.S. pricing data frequently overstate the true cost of the medicines, both to healthcare organizations and to society. We show how this overestimation can lead to biased results. To demonstrate why pricing data may overstate the true acquisition cost to organizations, we provide an overview of the purchasing process for U.S. hospitals and managed care organizations. We then consider evaluations done from a societal perspective and present two arguments for why both prices and organizational acquisition costs overstate the marginal cost of a medicine to society. For both perspectives, we provide guidance for developing more accurate cost estimates. Our central points are: (1) in cases where the perspective of the analysis is more narrow than that of society, analysts should use an estimate of drug cost that reflects, as closely as possible, the actual acquisition cost to the payer; and (2) when the analysis is done from the perspective of society, the drug cost estimate should not be based on price or acquisition cost, but instead, be based on the marginal societal cost of producing and distributing the drug. We conclude that investigators should be cautious when claiming the adoption of a societal perspective, and we call for discussion about the perspective that should be taken and cost estimates used when conducting evaluations related to the new Medicare drug benefit.

Publication Type: Conference Paper/Unpublished Manuscript
Review Method: Peer Reviewed
Abstract: The aid effectiveness trend has dominated the literature on international aid policy recently. General ideas of alignment and harmonization suggest a model of cooperative and coordinated donor efforts. This model developed as a reaction to previous competitive models of development aid. Interestingly, another more monopolistic model has been proposed recently to reduce participation in sectors and countries to fewer or even a single donor, thereby increasing aid effectiveness through transaction cost reduction. Central to these models is the concept of transaction costs, but this is problematic because it is unclear whether aid effectiveness refers to program effectiveness or cost effectiveness. Add to this a vague use of transaction costs to describe processes such as negotiation alongside a lack of quantification and we have a poor understanding and use of a central concept in the drive to achieve a major objective in the donor assistance. Utilizing donor documents, research and secondary sources, this paper will detail the conceptual and theoretical problems regarding the reduction of transaction costs to achieve greater aid effectiveness. This paper finds that overall, utilizing poorly defined transaction costs concepts based on market imperfections does not serve the purpose of transaction cost analysis to compare overall organizational institutions and production chains.

Publication Type: Conference Paper/Unpublished Manuscript
Review Method: Peer Reviewed
Abstract: While communities across the country are establishing programs to divert individuals with mental illness and co-occurring substance use disorders from jails and prisons, the evidence base for establishing the cost savings of these programs has not kept pace with their growth. This paper will describe the results of the Mental Health Jail Diversion Cost Simulation Study in Austin, Texas, which analyzed the cost effectiveness of three different jail diversion models.

Publication Type: Proceeding
Abstract: In April 2005, tens of thousands of anti-Japanese protesters took to the streets of China’s largest cities, condemning Japan’s textbook revisions, its U.N. Security Council bid, and its claim to resources in the waters between China and Japan. The anti-Japanese protests demonstrated the capacity for mass collective action among China’s urban elite and potentially laid the groundwork for future challenges to the government itself. Given the risk to regime stability that these demonstrations posed, why did China’s authoritarian leaders permit the anti-Japanese protests to go on for weeks before reining them in? The 2005 Chinese protests are just one illustration of a larger puzzle: when will authoritarian leaders allow and even encourage anti-foreign protests, and when will they seek to prevent or crack down upon anti-foreign demonstrations? In this paper, which presents the preliminary results of my dissertation fieldwork, I suggest that the government’s decision to allow anti-foreign protests in April 2005 was a strategic choice--to use the specter of domestic instability and the escalating costs of domestic repression to gain leverage over Japan on the UN Security Council negotiations. Contrary to the standard literature on audience costs, I suggest that authoritarian governments can indeed generate credible signals vis-à-vis the decision to allow nationalistic protests.

Publication Type: Proceeding