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Douven R.,CPB Netherlands Bureau for Economic Policy Analysis | Douven R.,Erasmus University Rotterdam | McGuire T.G.,Harvard University | McWilliams J.M.,Harvard University
Health Affairs | Year: 2015

One goal of the Medicare Shared Savings Program for accountable care organizations (ACOs) is to reduce Medicare spending for ACOs' patients relative to the organizations' spending history. However, we found that current rules for setting ACO spending targets (or benchmarks) diminish ACOs' incentives to generate savings and may even encourage higher instead of lower Medicare spending. Spending in the three years before ACOs enter or renew a contract is weighted unequally in the benchmark calculation, with a high weight of 0.6 given to the year just before a new contract starts. Thus, ACOs have incentives to increase spending in that year to inflate their benchmark for future years and thereby make it easier to obtain shared savings from Medicare in the new contract period. We suggest strategies to improve incentives for ACOs, including changes to the weights used to determine benchmarks and new payment models that base an ACO's spending target not only on its own past performance but also on the performance of other ACOs or Medicare providers. © 2015 Project HOPE.

Bollen J.,CPB Netherlands Bureau for Economic Policy Analysis | Hers S.,KYOS Energy Consulting | van der Zwaan B.,Energy Research Center of the Netherlands | van der Zwaan B.,Columbia University
Energy Policy | Year: 2010

This article presents an integrated assessment of climate change, air pollution, and energy security policy. Basis of our analysis is the MERGE model, designed to study the interaction between the global economy, energy use, and the impacts of climate change. For our purposes we expanded MERGE with expressions that quantify damages incurred to regional economies as a result of air pollution and lack of energy security. One of the main findings of our cost-benefit analysis is that energy security policy alone does not decrease the use of oil: global oil consumption is only delayed by several decades and oil reserves are still practically depleted before the end of the 21st century. If, on the other hand, energy security policy is integrated with optimal climate change and air pollution policy, the world's oil reserves will not be depleted, at least not before our modeling horizon well into the 22nd century: total cumulative demand for oil decreases by about 24%. More generally, we demonstrate that there are multiple other benefits of combining climate change, air pollution, and energy security policies and exploiting the possible synergies between them. These benefits can be large: for Europe the achievable CO2 emission abatement and oil consumption reduction levels are significantly deeper for integrated policy than when a strategy is adopted in which one of the three policies is omitted. Integrated optimal energy policy can reduce the number of premature deaths from air pollution by about 14,000 annually in Europe and over 3 million per year globally, by lowering the chronic exposure to ambient particulate matter. Only the optimal strategy combining the three types of energy policy can constrain the global average atmospheric temperature increase to a limit of 3°C with respect to the pre-industrial level. © 2010 Elsevier Ltd.

Brekelmans R.,University of Tilburg | Den Hertog D.,University of Tilburg | Roos K.,Technical University of Delft | Eijgenraam C.,CPB Netherlands Bureau for Economic Policy Analysis
Operations Research | Year: 2012

Dike height optimization is of major importance to the Netherlands because a large part of the country lies below sea level, and high water levels in rivers can cause floods. Recently impovements have been made on the cost-benefit model introduced by van Dantzig after the devastating flood in the Netherlands in 1953. We consider the extension of this model to nonhomogeneous dike rings, which may also be applicable to other deltas in the world. A nonhomogeneous dike ring consists of different segments with different characteristics with respect to flooding and investment costs. The individual segments can be heightened independently at different moments in time and by different amounts, making the problem considerably more complex than the homogeneous case. We show how the problem can be modeled as a mixed-integer nonlinear programming problem, and we present an iterative algorithm that can be used to solve the problem. Moreover, we consider a robust optimization approach to deal with uncertainty in the model parameters. The method has been implemented and integrated in software, which is used by the government to determine how the safety standards in the Dutch Water Act should be changed. © 2012 INFORMS.

Noailly J.,CPB Netherlands Bureau for Economic Policy Analysis | Batrakova S.,University College Dublin
Energy Policy | Year: 2010

In the Netherlands where the building sector accounts for 33% of carbon emissions, the government aims to halve the total energy use from buildings by 2030 compared to 1990 levels. To this end, the Dutch government has set specific goals in order to foster technological innovation related to energy efficiency in buildings. The objective of this paper is to explore the links between technological innovation and public policies in this sector over the last 30 years. The paper aims (1) to measure the evolution of innovations related to energy efficiency in buildings in the Netherlands using patent counts and (2) to provide a historical overview of the policy framework. Descriptive data on patenting activities show that the Netherlands have a clear comparative advantage in the field of energy-saving lighting technologies, mainly due to intensive patenting activities by Philips. High-efficiency boilers also represent a substantial share of Dutch innovation activities in this domain over the last decades. In many other fields (such as insulation, heat-pumps and cogeneration, solar boilers, etc.), however, Germany, Austria and Scandinavian countries rank much higher than the Netherlands. The descriptive analysis of Dutch energy policy shows an intensification of energy policy in the mid-1990s, followed by a slight decline after 2001. Overall, the simultaneous introduction of policy instruments makes it difficult to evaluate the effectiveness of policies. Also, the policy framework is characterized by the introduction of a large number of short-lived policy instruments and frequent policy changes. The lack of stability and continuity of energy policy may be damaging for innovation. © 2010 Elsevier Ltd.

Vermeulen W.,CPB Netherlands Bureau for Economic Policy Analysis | Vermeulen W.,University | Vermeulen W.,Spatial Economics Research Center | Rouwendal J.,VU University Amsterdam | Rouwendal J.,Tinbergen Institute
Journal of Regional Science | Year: 2014

Foregone benefits of the open space that is sacrificed through urban sprawl are hard to quantify. We obtain a simple benchmark measure by introducing a demand for trips beyond the urban boundary into the monocentric city model. The externality arises from the increase in travel costs that expansion of the city imposes on its prior inhabitants. An empirical application illustrates the moderate informational requirements. It indicates that open space externalities warrant rather mild restrictions on urban expansion. © 2013 Wiley Periodicals, Inc.

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