Resumo Diferentes formulações têm dado destaque à Atenção Primária à Saúde como porta de entrada preferencial do sistema de saúde, base das redes de atenção e função de coordenação do cuidado. A ...regulação assistencial (ou do acesso), por sua vez, vem sendo considerada, no Brasil, uma estratégia e tecnologia central de gestão das redes. Este artigo objetivou caracterizar a interface entre atenção primária e regulação assistencial nas formulações e diretrizes nacionais sobre regulação assistencial do SUS, considerando o período de 2002 a 2017. Adotou-se a metodologia da análise documental, utilizando fontes de domínio público, notadamente portarias e manuais técnicos do Ministério da Saúde, organizando os conteúdos extraídos nas dimensões “conceitos de regulação”, “organização e gestão da regulação” e “estratégias e ferramentas de regulação”, dentro das quais se buscou caracterizar o lugar da atenção primária. Observou-se maior destaque para a interface entre regulação assistencial ambulatorial e atenção primária a partir de 2011 com a noção de microrregulação, de modo mais marcante nos documentos e iniciativas relacionados à gestão da atenção primária do que nos específicos da regulação, enfocando a elaboração de dispositivos de regulação a partir da atenção primária, destacando-se o Telessaúde.
Abstract Different formulations have emphasized Primary Health Care as the preferred gateway to the health system, the basis of care networks and the care coordination function. Access regulation, in turn, has been considered, in Brazil, as a strategy and central technology for network management. This article aimed to characterize how primary care is placed in the national formulations and guidelines on health care regulation of the SUS from 2002 to 2017. The methodology was the documentary analysis, using public domain sources, notably ordinances and technical manuals of the Ministry of Health, organizing the extracted contents in the dimensions “concepts of regulation”, “organization and management of regulation” and “strategies and tools of regulation”, which sought to characterize the place of primary care. Greater emphasis was given to the interface between health care regulation and primary care from 2011, more prominently in the documents and initiatives related to primary care management than in the specifics of regulation, focusing on the ambulatory dimension of access regulation and in the elaboration of regulation devices based on primary care, highlighting Telehealth.
The gradual liberalisation of the EU railway market, which began in the early 2000s, has entered its final phase with the formal opening of national markets for commercial passenger transport. ...However, the level of competition established in some countries is still not sufficient to increase passenger welfare. Based on the previous experience, this phenomenon stems from high barriers to entry for new operators, such as high sunk costs, relatively high infrastructure train access charges (TAC) for commercial passenger traffic, and competition between asymmetric participants, where the incumbent still dominates the market. One of the solutions to improve the conditions for entry is asymmetric market regulation, used in the telecommunications sector. The asymmetric access regulation is based on lower TAC for entrants than for incumbent for a limited period, which is part of the ladder of investment (LOI) approach. In principle, the current EU regulatory framework requires equal and non-discriminatory TAC for all railway operators which provide similar services in a similar market segment with similar infrastructure quality. Any deviation from this principle must be justified. In practice, infrastructure managers (IM) often charge much higher TAC than the marginal cost of using the infrastructure for long-distance passenger traffic because that market can absorb this higher cost. This does not leave much possibility for entry or survival of potential entrants in the passenger market segment. Therefore, this paper will present a duopoly competition model between asymmetric on-track competitors within the commercial passenger transport market segment. We will explain the pros and cons of the introduction of asymmetric access regulation as an essential package of market entry strategy to establish sustainable competition for commercial passenger railway transport services.
•The Low Emission Zone can reduce pollutant emissions within the regulated area.•A spillover effect might occur outside the Low Emission Zone.•The Low Emission Zone can contribute to promote ...sustainable travel habits.•Awareness of the benefits of the Low Emission Zone can increase modal shifts.•Behavioral changes after Low Emission Zone enforcement affect environmental impacts.
Exposure of the population living in urban areas to an increasing level of air pollution has led local authorities to implement vehicle access restrictions to limit the circulation of pollutant vehicles and foster sustainable travel habits. With these aims, Low Emission Zones (LEZs) have been introduced in several European cities. Many previous works have evaluated the impacts of such regulation; however, they adopted pre-defined assumptions about new travels to access the regulated area and neglected potential behavioral changes induced by the measure. The aim of this paper is to quantify the effects of a LEZ on vehicle pollutant emissions, considering potential short-term variations of travel habits after its introduction (i.e., vehicle replacement, modal shift and destination change), and the associated uncertainty. The study area was the Municipality of Padova (Italy), where a LEZ is likely to be enforced. A holistic evaluation framework was applied combining a behavioral model and a traffic simulation model, calibrated using responses from a mobility survey administered to local stakeholders and traffic counts. The results highlighted the measure could contribute to induce fleet renewal and modal shift toward sustainable transportation means, that could be furtherly fostered by increasing the awareness of the benefits of the LEZ. Furthermore, the outcomes confirmed that the intervention could significantly reduce vehicle pollutant emissions within the area. Nevertheless, a spillover effect could occur outside the LEZ, due to the long detours that travelers deciding to avoid entering the zone have to perform.
The evolution of broadband penetration has shown substantial differences between OECD countries. This paper empirically investigates to what extent different forms of regulated competition explain ...these international differences. It distinguishes three modes of competition between broadband internet access providers that result from regulatory policies: (1) inter-platform competition; (2) facilities-based intra-platform competition; and (3) service-based intra-platform competition. In most countries these forms of competition co-exist although their intensity varies from country to country. Intra-platform competition may differ among countries depending on the degree of mandatory access obligations imposed by the regulator on the dominant network firm. Based on a sample of OECD countries, the analysis finds that inter-platform competition has been a main driver of broadband penetration. The two types of intra-platform competition have a considerably smaller effect on the broadband penetration. Linking these findings back to access regulation suggests that the “stepping stone” or “ladder of investment” theories might not provide the justification to impose extensive mandatory access obligations on DSL incumbents.
This paper investigates the market reaction to recent legislative and regulatory actions pertaining to corporate governance. The managerial power view of governance suggests that executive pay, the ...existing process of proxy access, and various governance provisions e.g., staggered boards and Chief Executive Officer (CEO)-chairman duality are associated with managerial rent extraction. This perspective predicts that broad government actions that reduce executive pay, increase proxy access, and ban such governance provisions are value-enhancing. In contrast, another view of governance suggests that observed governance choices are the result of value-maximizing contracts between shareholders and management. This perspective predicts that broad government actions that regulate such governance choices are value destroying. Consistent with the latter view, we find that the abnormal returns to recent events relating to corporate governance regulations are, on average, decreasing in CEO pay, decreasing in the number of large blockholders, decreasing in the ease by which small institutional investors can access the proxy process, and decreasing in the presence of a staggered board.
•We study coexistence of access regulations for legacy (copper) and fiber networks.•Theoretical model accounts for presence of alternative firms with legacy networks.•We test theoretical predictions ...using novel panel data from 27 EU member states.•Stricter access regulations decrease incumbent operators’ fiber investments.•In contrast, cable operators are not affected by access regulations.
In this paper, we study how the coexistence of access regulations for legacy (copper) and fiber networks shapes the incentives to invest in fiber-based network infrastructures. To this end, we first develop a theoretical model that extends the existing literature by, among other things, considering alternative firms with proprietary legacy network (e.g., cable operators) and the presence of asymmetric mandated access to networks. In the empirical part, we test the theoretical predictions using a novel panel data from 27 EU member states pertaining to the last decade. Our main finding is that, in line with the theoretical results, stricter access regulations (i.e., a decrease in access price to legacy network and the adoption of fiber regulation) decrease the incumbent operators’ fiber investments. On the other hand, cable operators are not affected by access regulation. Our paper thus provides policy insights for the on-going revision of the EU regulation framework for the electronic communications industry.
In recent years, and in line with EC plans, telecom operators have been facing the need to deploy high-speed, fiber-based infrastructure. What is the socio-economic impact of these new investments on ...growth and local development? What are their effects on the labor market outcomes, in terms of firm productivity and entrepreneurship? What is the role of regulation and competition in spurring the deployment and the adoption of ultra-fast broadband networks? In this survey, we review the existing literature on ultra-fast, fiber-based broadband network, devoting special attention to the results and to the methodology used in the most recent studies.
•The paper surveys existing literature on ultra-fast broadband.•It studies the socio-economic impact of these new investments on growth and local development.•It considers the effects on the labor market outcomes, in terms of firm productivity and entrepreneurship.•It studies the role of regulation and competition on ultra-fast broadband deployment and adoption.
Investment in broadband communications and its infrastructures (the so-called
Next Generation Networks) is receiving extraordinary attention from policy makers all over the world, due to the ...significant impact of high-speed Internet access on the whole economy and society. However, even before the recent financial crises, a dramatic downward trend in telecommunications investment has occurred, mainly due – at least according to incumbent operators – to excessively intrusive regulatory intervention. The typical conflict between regulation, competition and investment emerges. It is therefore important, for both future research and regulatory and practitioners’ references, to review the specialized but growing branch of the literature on this interesting and policy-relevant issue. The purpose of this paper is therefore to survey the relevant theoretical and empirical literature on the relationship between regulation, at both retail and wholesale level, and investment in telecoms infrastructures. The picture that emerges is not conclusive, and further research is still needed, both theoretically and empirically, to better understand the real impact of regulatory incentives on investments.
In September 2016, the European Commission (EC) published its proposal for a directive establishing the European Electronic Communications Code (EECC) – with one key aim being the provision of ...sufficient incentives for infrastructure investments into high-speed communication networks. Based on a detailed review of the theoretical and empirical literature of the most relevant regulatory measures – that is, co-investment models as well as different types of access regulation – we provide a critical appraisal of the respective provisions in the EECC. We find that, although the EECC can generally be seen as a step into the right direction, the expected effects on investment incentives as well as substantial implementation challenges in combination with a high degree of complexity of the envisaged measures contain substantial potential for improvement.
In the face of recent refugee migration, early integration of asylum seekers into the labor market has been proposed as an important mechanism for easing their economic and social lot in the short as ...well as in the long term. However, little is known about the policies that foster or hamper their participation in the labor market, in particular during the important initial period of their stay in the host country. In order to evaluate whether inclusive labor market policies increase the labor market participation of asylum seekers, we exploit the variation in asylum policies in Swiss cantons to which asylum seekers are as good as randomly allocated. During our study period from 2011 to 2014, the employment rate among asylum seekers varied between 0 and 30.2% across cantons. Our results indicate that labor market access regulations are responsible for a substantial proportion of these differences, in which an inclusive regime increases participation by 11 percentage points. The marginal effects are larger for asylum seekers who speak a language that is linguistically close to the one in their host canton.
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