104 results for Howell, Bronwyn, Scholarly text

  • Lessons From NZ For England's Proposed NHS Foundation Trust and Vice-Versa

    Howell, Bronwyn (2004)

    Scholarly text
    Victoria University of Wellington

    Bronwyn Howell presented Lessons from NZ for England's Proposed NHS Foundation Trust and Vice-Versa at the New Zealand Health Economics Meeting in November 2004.

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  • Restructuring Primary Heath Care Markets in NZ: Efficiency and Equity Implications of Provider-Insurers

    Howell, Bronwyn (2005)

    Scholarly text
    Victoria University of Wellington

    Bronwyn Howell presented Restructuring Primary Heath Care Markets in NZ: Efficiency and Equity Implications of Provider-Insurers at the Australian Conference of Health Economists conference held in Auckland in September 2005.

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  • Submission: Telecommunications Amendment Bill

    Howell, Bronwyn (2006)

    Scholarly text
    Victoria University of Wellington

    Bronwyn Howell presented Submission: Telecommunications Amendment Bill to the Finance and Expenditure Select Committee in September.

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  • Paying for the Doctors Strike and the Waiting List Cull at the GP's Surgery

    Howell, Bronwyn (2006)

    Scholarly text
    Victoria University of Wellington

    Bronwyn Howell presented Paying for the Doctors Strike and the Waiting List Cull at the GP's Surgery at LEANZ in August 2006.

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  • Injecting Change into Primary Health Care: The NZ Experience Part 1 Patient Subsidies from: Co-payments to Insurance Premiums

    Howell, Bronwyn (2005)

    Scholarly text
    Victoria University of Wellington

    Bronwyn Howell presented Injecting Change into Primary Health Care: The NZ Experience Part 1 Patient Subsidies from: Co-payments to Insurance Premiums in an ISCR two part Primary Health Care seminars: Patient Subsidies: from Co-Payments to Insurance Premiums and Competting for Governance in July 2005.

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  • Broadband Penetration: Does it Matter and does it require Local Loop Unbundling?

    Howell, Bronwyn (2006)

    Scholarly text
    Victoria University of Wellington

    Recent weeks have seen considerable controversy regarding the government's decision to unbundle the local loop. First Bronwyn Howell's select committee submission criticised the robustness of the analysis underpinning the unbundling decision suggesting that the case for both greater broadband participation and unbundling in New Zealand remained to be made.

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  • An Institutional Economics Analysis of Regulatory Institutions in the Telecommunications Sector

    Howell, Bronwyn (2006)

    Scholarly text
    Victoria University of Wellington

    This paper takes as a starting point for developing deeper understandings the assumption that both regulatory bodies and the sectors in which they operate are institutions. The body of literature about the operation of institutions provides a means of understanding the actors arrangements rules and culture values and norms that shape the ICTS sector. With this understanding it is then possible to analyse using the same frameworks how these same forces act upon and shape the regulatory institutions and ultimately how the regulatory institutions themselves contribute to shaping the wider ICTS sector in which they operate. The order of the paper is as follows: Section 1 describes the institutional economics conceptualisation of institutions and a specific model of interactions in complex institutional systems proposed by Koppenjan and Groeneweld (2005). Section two then applies this model to explore structures entities and interactions within the ICTS sector generally and those interactions specifically associated with the evolution and functioning of regulatory institutions. Finally section three takes the sector-specific application of the model from section two and applies it in the specific circumstances of the ICTS sector and regulatory change in the European Union in order to draw insights that may contribute to explaining why the attempts to build a common telecommunications market in the European Union have failed to deliver the desired outcomes despite substantial alterations to the regulatory institutions designed to bring them about.

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  • Competition, Regulation and Broadband Diffusion: the Case of New Zealand

    Howell, Bronwyn (2006)

    Scholarly text
    Victoria University of Wellington

    AbstractNew Zealand offers a through-provoking case study of the effects of different competition and regulatory policies on broadband diffusion rates. Despite having one of the highest rates of Internet connection and usage in the OECD widely available broadband infrastructure and low prices broadband uptake per capita languishes in the bottom third of the OECD. Whilst low uptake has typically been attributed to competition and regulatory factors associated with New Zealand's 'light-handed' regulatory regime this chapter proposes that the most likely reason is a combination of legacy demand-side regulations in particular the tariff options for voice telephony and limited value being derived by residential consumers from the small range of applications currently necessitating broadband connections. The New Zealand case illustrates the effect that legacy regulations can have on the diffusion of new technologies and indicates a need for more research on the effect of telecommunications industry regulations on demand-side uptake factors.

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  • Political Policies and Regulatory Processes: The Path to Local Loop Unbundling in NZ

    Howell, Bronwyn (2006)

    Scholarly text
    Victoria University of Wellington

    This presentation compares the issues of process and substance that formed the basis of each of the 2003 Telecommunications Commissioner's review of Local Loop Unbundling and the 2006 'Stocktake Report' of the industry overseen by the Ministry of Economic Development

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  • Unveiling 'Invisible Hands': Two-Sided Platforms in Health Care Markets

    Howell, Bronwyn (2006)

    Scholarly text
    Victoria University of Wellington

    A popularly-held tenet in health economics is that as a consequence of the presence of insurance subsidies for treatment costs health care markets differ so significantly from hypothetical 'perfect competition' that competition and antitrust laws possibly should not be enforced in health care markets or enforced differently in health care than in other markets. Drawing upon the principles of markets with two-sided platforms which are similarly characterised by approaches to competition where welfare is maximised when prices differ from marginal cost this paper develops an alternative taxonomy for thinking about institutional design and the application of competition principles in health care markets. The taxonomy separates out the aspects of health care markets that address the nonmarketability of the risk associated with an individual's uncertainty about demand for health care - the insurance 'platform' - from other information asymmetries attending the delivery of care. Comparison of the resulting taxonomy with the markets for other goods funded predominantly by insurance benefits (e.g. panelbeaters repairing crash-damaged vehicles) leads to the conclusion that it is predominantly the presence of insurance premium subsidies that leads to specific challenges in the design and operation of socially-optimal health care markets. The taxonomy places 'two-sided' insurance platforms at the core of health care markets. The ensuing implication is that contractual and institutional design in the sector should reflect this defining characteristic. Whilst the nature of competition in health care provision markets still matters it ensues from and is secondary to the nature of insurance market design. Deviations from the standard principles of competition in 'two-sided' insurance markets must therefore be analysed separately from competition in markets for health care service provision. Furthermore these principles can be utilised independent of the ownership form of either the insurers or the care providers and therefore provide guidance for both policy-makers designing health care markets and regulators monitoring and enforcing sector performance.

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  • Restructuring Primary Health Care Markets in New Zealand: Financial Risk, Competition, Innovation and Governance Implications

    Howell, Bronwyn (2005)

    Scholarly text
    Victoria University of Wellington

    New Zealand's primary health care sector has undergone fundamental changes under the Primary Health Care Strategy announced in 2001 and implemented from 2002. The strategy replaces historic fee-for-service general practitioner subsidies with population-based capitation subsidies and restructures the key contracting relationships within the sector. Primary Health Organisations take on the responsibilities for contracting with services providers to deliver services and for contracting with District Health Boards in order to secure funding and ascertain service type and quality requirements for the services delivered to patients. This paper uses the framework of economic contracts to analyse the effects of the changes brought about by the changes to primary health care arrangements in New Zealand. The paper finds that the change in arrangements is likely to lead to higher costs of financial risk and reduction in the level of competition between providers of health care services. When combined with the governance arrangements specified in the strategy these effects are likely to result in reductions in efficiency in the primary health care sector relative to the arrangements prevailing prior to the change and are unlikely to lead to the levels of innovation in service delivery anticipated by the strategy. These findings draw into question the extent of value for money that will be delivered from the substantial increases in government funding applied to the new strategy.

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  • Paying for the Hospital Waiting List Cull at the GP's Surgery: The Changing Locus of Financial Risk-Bearing in New Zealand's Primary Healthcare Sector

    Howell, Bronwyn (2006)

    Scholarly text
    Victoria University of Wellington

    In 2002 New Zealand's government-funded primary health care payments were changed from a fee-for-service basis to a capitation basis as part of a change towards a population-based managed care style of primary health care provision. However some specific differences characterise the New Zealand system. Government payments meet only a fraction of the costs of care and as no provisions have been made for alternative cost recovery all additional costs are paid only by individuals consuming primary care. The managed care entities have been established as nonprofit entities without risk reserves so pass on capitation payments to general practitioners who retain the right to charge patients for costs not covered by the capitation payments albeit subject to some weak forms of government oversight and potential regulation. Moreover government plans on increasing capitation payments progressively with commensurate requirements that patient payments be reduced for those patients receiving increased capitation funding. The New Zealand arrangements lead to some very unusual allocations of costs and financial risk relative to standard managed care models. Specifically all risk management responsibilities lie with a large number of very small providers leading to high costs in respect of statistical variation in the allocation of patient pools and demand for care amongst practitioners. As only practitioners can charge fees a disproportionate share of the costs of risk management are borne by ill individuals in proportion to each time they visit a general practitioner. The paper illustrates these 'perverse' effects using two recent demand shocks - a strike by hospital doctors and the culling and referral back to general practitioners of substantial numbers of patients on hospital waiting lists - showing how these exogenous factors will lead to price rises for all patients visiting general practitioners. The effects illustrated appear likely to be exacerbated by price regulation associated with the increasing number of individuals receiving government capitation payments. Relative to the previous system the capitated system is likely more costly and likely to lead to substantial changes in the structure and function of the New Zealand primary health care sector.

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  • The State of e-New Zealand: 2004

    Howell, Bronwyn; Mishra, Veena; Ryan, Lisa (2005)

    Scholarly text
    Victoria University of Wellington

    This State of E-New Zealand paper revisits the relative international measures of New Zealand's preparedness to utilise and capitalise upon the economic and social benefits promised by the use of technology. In the previous paper the authors concluded that New Zealand remained at the forefront of practically all electronic infrastructure indicators measured. Four years from the initial findings this paper concludes that New Zealand's relative ability to use its infrastructure to gain productive advantage is decreasing. Although it is well prepared in infrastructure New Zealand has slipped from its early leadership position relative to other countries in many as the information and communication technology market indicators as the New Zealand market approaches maturity and other countries catch up.

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  • Medical Misadventure and Accident Compensation in New Zealand: An Incentives-Based Analysis

    Howell, Bronwyn (2004)

    Scholarly text
    Victoria University of Wellington

    Under the provisions of New Zealand's no-fault government-indemnified accident compensation scheme (ACC) victims who are injured as a consequence of medical misadventure receive compensation for their injuries. In exchange for the certainty of compensation ACC legislation waives the right for victims to sue malfeasant practitioners for either compensation or exemplary damages in all but the most extreme cases of gross negligence or deliberate intention to cause harm. Whilst the scheme has been successful in ensuring that compensation has been awarded to many victims for whom the transaction costs of seeking redress via a tort-based system would have been prohibitive (Danzon 1990) it is less certain that the no-fault elements of the scheme provide sufficiently strong incentives to either medical practitioners their patients or third party administrative agents to take appropriate levels of care (Kessler 1999; Howell Kavanagh and Marriott 2002).Given that ACC imposes limitations upon the ability of tort- or contract-based instruments to provide incentives to those who have the power to change the outcomes for victims of medical misadventure greater reliance must be placed upon overt monitoring and enforcement by administrative agencies in order to for the system to deliver an efficient level of medical misadventure. However overt monitoring and enforcement systems are costly and are imperfect substitutes for some of the outcomes that may be achieved utilising the incentives in tort and contract instruments. Total reliance on overt administrative mechanisms leaves the system potentially exposed to risks of even higher levels of misadventure occurring especially if the administrative mechanisms are poorly resourced. Furthermore poor information flows within the system potentially conspire against both the detection and correction of negligent actions (Howell 2001; Prendergast 2001) and make the collection of information to design more effective systems problematic (Danzon 1990).This article discusses the role of incentives to reduce the occurrence of medical misadventure. It argues that appropriate incentives may induce the practice of appropriate levels of precaution by sharing the costs of insufficient levels of precaution between those with the power to exert clinical precaution (practitioners) and monitor and enforce its exertion (administrative agencies) and the victims who will otherwise bear the costs of inadequate levels of precaution being taken. The ability of each of tort-based and no-fault systems to achieve this level of care is discussed and then applied in the New Zealand ACC situation. Illustrations taken from recent medical misadventure cases in particular that of Dr Michael Bottrill in reading the cervical smears of women in the Gisborne region in the 1990s are used to analyse the incentives facing both medical practitioners and those charged with monitoring and enforcing the performance of both medical practitioners and the ACC system.

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  • Telecommunications Usage in New Zealand: 1993-2003

    Howell, Bronwyn; Obren, Mark (2003)

    Scholarly text
    Victoria University of Wellington

    This report suggests that the telecommunications market in New Zealand is surprisingly mature. We infer that the potential for growth is limited. There has been negligible growth in any of the number of fixed lines either business or residential since 2000. The number of residential lines is growing only in proportion to the number of households indicating that household penetration is now saturated. Business line connections have been constant since approximately August 1999 although there is evidence of substitution away from Public Switched Telephone Network (PSTN) connections towards Independently Switched Digital Network (ISDN) connections in this market. ISDN is predominantly used for voice access by New Zealand businesses with less than 0.1% of connections being used for data communications in January 2002.While the number of mobile connections has been increasing the total volume of voice-based telephony traffic (local and long distance fixed line and mobile) has settled at a constant level. Diffusion of mobile telephony sits at approximately 75% of the population over 10 years of age and while still growing the rate of growth appears to be slowing implying that this technology is close to saturation as well. Average usage per mobile account is declining indicating that the connection growth that is being recorded is related to users with lower than average demand for the service.The data offer significant evidence of substitution between technologies (fixed line to mobile) for voice traffic. Thus the presumption that mobile and fixed line telephony are separate markets must be questioned. This is particularly evident in the residential market; as the evidence supporting substitution coincides with the introduction of prepay accounts which have been targeted at residential consumers.The only telephony volume to show significant growth is that of dial-up Internet traffic. However even this traffic is showing signs of slowing both on measures of volume per fixed line and volume per Internet Service Provider (ISP) account. Diffusion of this technology is also widespread with nearly 60% of households having connections. Thus this technology may also be approaching maturity in the New Zealand market as with mobile technology new connections represent users with lower than average demand. Whilst there is some evidence of substitution of dial-up Internet access technology with DSL in the business market in the residential market substitution still appears to be dominated by learning effects associated with the applications that consumers use and the individual valuation of time.

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  • Building Best Practices Broadband in New Zealand: Bringing Infrastructure Supply and Demand Together

    Howell, Bronwyn (2003)

    Scholarly text
    Victoria University of Wellington

    This paper adopts a productivity-based approach to assess the state of the New Zealand broadband market. This approach presumes that broadband penetration is a proxy for the ultimate objective of increased economic and social benefit which can be measured as increases in productivity. The state of the market is examined from the technology-agnostic perspective of competition for the provision of broadband services in terms of availability and price. This is then juxtaposed with a detailed analysis of New Zealand broadband purchase and utilization behaviors. Broadband purchase is seen in this analysis as merely another technology that may enable increased productivity from the use of information exchange over the Internet.

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  • The Rural-Urban "Digital Divide" in New Zealand Progress Since September 2000

    Howell, Bronwyn; Marriott, Lisa (2002)

    Scholarly text
    Victoria University of Wellington

    The purpose of our study is to provide some additional data to increase understanding of any potential New Zealand geographical differences in business use of the Internet. Consistent with the definition of electronic commerce used in both the MED/BRC and ISCR studies we define "business use of the internet" to be any business use to which the Internet is put thus including both transactions of information (email advertising web-based searches) and buying and selling (business to business and business to consumer) exchanges. To distinguish between the bases of urban and rural used in other studies we define "metropolitan" to be the four main cities in New Zealand: Auckland Wellington Christchurch and Dunedin. "Provincial" centres are defined to be the principal towns in each of the 14 districts defined in the Telecom Yellow Pages data excluding the "metropolitan" centres while "rural" is defined as the rural hinterland surrounding each provincial centre in each of the regions17. Where "urban" is used this encompasses both metropolitan and provincial centre classifications.

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  • The State of e-New Zealand

    Evans, Lewis; de Boer, David Boles; Howell, Bronwyn (2000)

    Scholarly text
    Victoria University of Wellington

    Our study is based upon publicly available sources of information. Internationally published statistics have been used to supplement New Zealand data to assess New Zealand's relative position. While international studies have provided some basis for comparison the supplementary information sourced for this study has enabled a more complete picture of New Zealand to be painted. The infrastructures we examine to make our assessment of E-New Zealand are those of Internet penetration and uptake the electronic banking backbone of the payments system and the telecommunications environment. We then use this base to explore the extent to which this infrastructural base is utilised in electronic commerce applications. While we acknowledge that it is limited by the shortage of reliable and publicly available information this analysis enables us to postulate some explanations for apparent and observed behaviours which may have led others to conclude that despite the infrastructural advantage New Zealand's application uptake is not as advanced.

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  • The State of e-New Zealand 12 months on

    Howell, Bronwyn; Marriott, Lisa (2004)

    Scholarly text
    Victoria University of Wellington

    In The State of e-New Zealand: 12 Months On we revisit the measures of New Zealand's preparedness to utilise and capitalise upon the economic and social benefits promised by the uses of electronic infrastructures addressed in our November 2000 paper The State of e-New Zealand. We acknowledge the considerable difficulties in measuring and assessing the complete range ofbenefits arising from the use of these technologies given that the ultimate effects of their use are hard to separate out from other factors. Hence we once again test our hypothesis: that if New Zealand is performing at the international forefront of infrastructure indicators then there is every reason to believe that in the absence of any evidence to the contrary it is performing well also in those areas where no measurable or reliable indicators of performance are available. Once more we find support for our hypothesis. New Zealand remained at the forefront of practically all publicly-available electronic infrastructure indicators throughout 2000 and into 2001. In particular the comparative advantage identified over Australia in the 2000 report is largely maintained.

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  • Health Sector Failures in New Zealand: Act of God, Act of Man or Inadequacies in Control Design

    Howell, Bronwyn (2001)

    Scholarly text
    Victoria University of Wellington

    While the Cartwright Duffy and Cull inquiries investigated in some detail the health system processes that led to the specific instances of malpractice that prejudiced the health states of the main 'whistleblowers' a key element of these processes - the design incentives and monitoring of the contracts both explicit and implicit that make up these processes - has been consistently overlooked. New insights can be found in a systematic exploration of both the individual contracts and the nexus of contracts that makes up the publicly funded health system in New Zealand. This paper utilises the economic theory of contracts to examine the ways in which contracts between patients and their practitioners for the delivery of services and between the public and their political agents politicians and public servants and public servants and health practitioners for the funding of services interact. In particular the paper examines ways in which these contracts and the information asymmetries that are associated with them both facilitate and frustrate the flows of information required to monitor and enforce performance of the myriad of contracts involved. The paper also analyses the incentives associated with monitoring and enforcing contract performance in an environment where there may be considerable distancing of the incentives to monitor and enforce the contract from the information necessary to do so.Evidence from the Duffy Inquiry is used to show how failure to address the systemic interrelationships between contracts both implicit and explicit in the design of the New Zealand National Cervical Screening Programme (NCSP) resulted in the creation of obstacles that actively prevented the nexus of contracts from performing either efficiently or effectively in the interests of the patients concerned. Further this example illustrates that the use of a contracting model reliant upon practitioner and public servant monitoring and enforcement of service provision processes inside a public funding model reliant upon monitoring and enforcement of political process performance without due consideration given to the information necessary for adequate monitoring and enforcement led to a system where patients were left with few avenues via which to discipline their errant agents irrespective of whether it was the political agent or the medical agent who had erred. Thus the 'problem' is found to lie not in the corporate contracting model of the 1990s but within the inconsistent alignment of incentives monitoring and enforcement within the publicly-funded model.

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