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Article

Incentives and Performance of Healthcare Professionals  

Martin Chalkley

Economists have long regarded healthcare as a unique and challenging area of economic activity on account of the specialized knowledge of healthcare professionals (HCPs) and the relatively weak market mechanisms that operate. This places a consideration of how motivation and incentives might influence performance at the center of research. As in other domains economists have tended to focus on financial mechanisms and when considering HCPs have therefore examined how existing payment systems and potential alternatives might impact on behavior. There has long been a concern that simple arrangements such as fee-for-service, capitation, and salary payments might induce poor performance, and that has led to extensive investigation, both theoretical and empirical, on the linkage between payment and performance. An extensive and rapidly expanded field in economics, contract theory and mechanism design, had been applied to study these issues. The theory has highlighted both the potential benefits and the risks of incentive schemes to deal with the information asymmetries that abound in healthcare. There has been some expansion of such schemes in practice but these are often limited in application and the evidence for their effectiveness is mixed. Understanding why there is this relatively large gap between concept and application gives a guide to where future research can most productively be focused.

Article

Corporate Governance in Business and Management  

Erik E. Lehmann

Corporate governance is a recent concept that encompasses the costs caused by managerial misbehavior. It is concerned with how organizations in general, and corporations in particular, produce value and how that value is distributed among the members of the corporation, its stakeholders. The interrelation of value production and value distribution links the ubiquitous technological aspect (the production of value) with the moral and ethical dimension (the distribution of value). Corporate governance is concerned with this link in general, but more specifically with the moral and ethical dimensions of distributing the generated value among the stakeholders. Value in firms is created by firm-specific investments, and the motivation and coordination of value-enhancing activities and investment is protected by the power concentrated at the pyramidal top of the organization. In modern companies, it is the CEO and the top management who decide how to create value and how to distribute it among the relevant stakeholders. Due to asymmetric information and the imperfect nature of markets and contracts, adverse selection and moral hazard problems occur, where delegated (selected) managers could act in their own interest at the costs of other relevant stakeholders. Corporate governance can be understood as a two-tailed concept. The first aspect is about identifying the (most) relevant stakeholder(s), separating theory and practice into two different and conflicting streams: the stakeholder value approach and the shareholder value approach. The second aspect of the concept is about providing and analyzing different mechanisms, reducing the costs induced by moral hazard and adverse selection effects, and balancing out the motivation and coordination problems of the relevant stakeholders. Corporate governance is an interdisciplinary concept encompassing academic fields such as finance, economics, accounting, law, taxation, and psychology, among others. As countries differ according to their institutions (i.e., legal and political systems, norms, and rules), firms differ according to their size, age, dominant shareholders, or industries. Thus, concepts in corporate governance differ along these dimensions as well. And while the underlying characteristics vary in time, continuously or as a result of an exogenous shock, concepts in corporate governance are dynamic and static, offering a challenging field of interest for academics, policymakers, and firm managers.

Article

The Presidency of the Council of the European Union  

Frank M. Häge

The Presidency plays a crucial role in the management and organization of the Council of the European Union’s work and the institution’s interactions with third parties. Formally, the Presidency just chairs the meetings of Council bodies; but over time, member states have endowed it with a range of procedural prerogatives to structure the Council’s agenda and broker agreements, which post holders can potentially use to advance their own private interests. The potential for abuse of these powers raises two related questions: first, why would member states grant these powers to the Presidency, and second, is the Presidency actually able to use these powers to advance its own priorities and policy preferences? In response to the first question, functionalist theories suggest that member states delegate powers to the Presidency to reduce transaction costs and solve collective action. According to Tallberg, member states grant the Presidency procedural prerogatives and provide it with administrative resources to ensure an efficient management of the Council’s agenda, avoid inadvertent negotiation failure or suboptimal negotiation outcomes, and provide adequate representation of the institution vis-à-vis external actors. Kleine’s theory suggests that the Presidency acts as an adjudicator of the legitimacy of demands for concessions by member states that find themselves in the minority but claim to experience strong domestic pressures for non-compliance. By making impartial and thus credible recommendations about whether the formal voting rule or consensus decision-making should apply in these situations, the Presidency contributes to the long-term sustainability of international cooperation. The two explanatory accounts disagree about whether the growing role of the Presidency reflects an incremental accumulation of powers over time in response to new tasks or just an extension of already existing powers into new areas. Historical research on the development of Presidency powers could shed more light on this topic. Responses to the second question about the actual influence of the Presidency can be distinguished according to whether they relate to the Presidency’s scheduling power or to its proposal-making power. Control over the schedule and agenda of meetings, as well as the time devoted to different issues during a meeting, allows the Presidency to affect the relative allocation of attention to different policies. Allowing the Presidency to structure the agenda according to its own priorities comes with tangible collective benefits while resulting in little redistributive costs for other member states. In contrast, the Presidency’s exercise of proposal-making power, through its first-mover advantage, control over the negotiation text, and its privilege to call a vote or declare consensus, leads to biased negotiation outcomes with little or no benefits for member states but direct and tangible redistributive consequences. Thus, the Presidency’s prerogatives are largely based on informal norms and behavioral practices, which can always be superseded by recourse to formal rules. However, member states have little incentive to do so when the Presidency exercises its scheduling power but ample incentive if it exercises its proposal-making power. Existing empirical research provides clear evidence that the Presidency can exercise both scheduling power and proposal-making power at least to some extent and under certain conditions. Interesting questions for future research relate to the overall size and prevalence of the effects of the Presidency’s powers, the mechanisms through which these effects are generated, as well as the conditions that explain their variation over time, across policy areas, and across member state characteristics.

Article

American Prosecutors as Principals and Agents  

Brett Curry and Banks Miller

The pervasiveness of their influence arguably makes prosecutors the most consequential actors in the American criminal justice system. Armed with discretion over which cases to pursue, what charges to file, and which issue areas to prioritize, prosecutors play a decisive role in determining what progresses from investigation to the courtroom. It is their charge to do justice in each case, but that obligation hardly forecloses the influence of politics on their decisions. Despite their centrality, however, prosecutors and their behavior have failed to garner even a fraction of the attention that scholars have directed toward law enforcement, correctional systems, or judges. The discretion of American prosecutors is theoretically immense; there are few formal constraints upon it. If a federal or state prosecutor declines to pursue a case that has been referred to him or her, that declination decision is essentially immune from judicial review. But these formalisms come with more practical limitations. At the federal level, United States Attorneys are appointed by the president and, therefore, are expected to carry out an administration’s general policy priorities. In the states, most district attorneys answer to the electorate, which imposes its own constraints on a prosecutor’s freedom of action. Chief prosecutors—state and federal—are simultaneously principals to their subordinates and agents of the people or the president. If those considerations were not enough, American prosecutors must be mindful of still other factors. How might their actions today impact their future career paths? What influence might legislative changes, public opinion, or judicial rulings have on how they operate? Scholarship on prosecutors has addressed some of these questions, but we still lack a good understanding of all the ways in which politics infects prosecutorial decision-making. As “progressive prosecutors”—many who are former public defenders—continue to win office, new questions will arise about how far prosecutors can push reform of the criminal justice system. A major looming question is how voters conditioned to law-and-order rhetoric will evaluate the new prosecutors. Some preliminary work shows that non-White prosecutors tend to reduce rates of incarceration, while Republican-affiliated prosecutors increase them.