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Ms. Li Lin and Mr. Mico Mrkaic
Healthcare in the United States is the most expensive in the world, with real per capita spending growth averaging 4 percent since 1980. This paper examines the role of market power of U.S. healthcare providers and pharmaceutical companies. It finds that markups (the ability to charge prices above marginal costs) for publicly listed firms in the U.S. healthcare sector have almost doubled since the early 1980s and that they explain up to a quarter of average annual real per capita healthcare spending growth. The paper also finds evidence that the Affordable Care Act and Medicaid expansion were successful in raising coverage and expanding care, but may have had the undesirable side-effect of leading to labor cost increases: Hourly wages for healthcare practitioners are estimated to have increased by 2 to 3 percent more in Medicaid expansion states over a five-year period, which could be an indication that the supply of medical services is relatively inelastic, even over a long time horizon, to the boost to demand created by the Medicaid expansion. These findings suggest that promoting more competition in healthcare markets and reducing barriers to entry can help contain healthcare costs.
International Monetary Fund. European Dept.
This 2020 Article IV Consultation with Italy reflects discussions with the Italian authorities in January 2020 and is based on the information available as of January 28, 2020. It focuses on Italy’s medium-term challenges and policy priorities and was prepared prior to the outbreak of COVID-19 in Italy. It, therefore, does not cover the outbreak or the related policy response, which has since become the overarching near-term priority. The outbreak has greatly amplified uncertainty and downside risks around the outlook. Staff is closely monitoring this health crisis and will continue to work on assessing its impact and the related policy response in Italy and globally. The overarching challenges are to raise growth and enhance resilience. The IMF staff projects growth in Italy to be the lowest in the European Union over the next five years. High public debt remains a key source of vulnerability. Substantial progress has been made in strengthening bank balance sheets, but important weaknesses remain. In order to durably raise growth and reduce vulnerabilities, Italy needs faster potential growth and medium-term fiscal consolidation.
International Monetary Fund. European Dept.
This Selected Issues paper explores the links between wage policies, non-wage cost developments, and competitiveness. A series of program-era policies helped to partially reverse this trend, including labor market policies that cushioned the effect of the crisis on employment and brought unit labor costs broadly in line with trading partners. However, the resulting more competitive wage structure only partly translated into price adjustments due to product market rigidities (with firms retaining some profit margin) and rising non-wage cost factors (e.g., taxes and financing costs). This incomplete internal devaluation and subsequent low productivity gains reinforce the view that Greece has further to go to address its external imbalances. However, labor policy reversals following program exit in August 2018 threaten this objective. The paper shows that Greece must preserve its labor cost competitiveness while increasing efforts to facilitate price adjustment in product markets and reduce non-wage costs.
International Monetary Fund. European Dept.

Abstract

Economic activity in Europe has slowed on the back of weakness in trade and manufacturing. For most of the region, the slowdown remains externally driven. However, some signs of softer domestic demand have started to appear, especially in investment. Services and domestic consumption have been buoyant so far, but their resilience is tightly linked to labor market conditions, which, despite some easing, remain robust. Expansionary fiscal policy in many countries, and looser financial conditions, have also supported domestic demand. On balance, Europe’ s growth is projected to decline. A modest recovery is forecast for 2020 as global trade is expected to pick up and some economies recover from past stresses. This projection, broadly unchanged from the April 2019 World Economic Outlook, masks significant differences between advanced and emerging Europe. Growth in advanced Europe has been revised down, while growth in emerging Europe has been revised up. Amid high uncertainty, risks remain to the downside, with a no-deal Brexit the key risk in the near term. An intensification of trade tensions and related uncertainty could also dampen investment. More broadly, the weakness in trade and manufacturing could spread to other sectors—notably services—faster and to a greater extent than currently envisaged. Other risks stem from abrupt declines in risk appetite, financial vulnerabilities, the re-emergence of deflationary pressures in advanced economies, and geopolitics.

Rahul Anand and Purva Khera
This paper investigates the implications of lowering formal regulations in labor and product markets on informality and macroeconomic outcomes in India. We estimate a DSGE model with an informal sector, and rigidities in the formal labor and product markets. Along with increasing GDP and employment, deregulation also leads to lower informality and greater product market competition. Slow reallocation of resources between the formal and informal sectors leads to some adverse impacts in the short run that can be minimized by implementing a combined package of reforms. These impacts are shown to be greater in an economy with a larger informal sector.
Oya Celasun, Gabriel Di Bella, Tim Mahedy, and Mr. Chris Papageorgiou
The notable rebound of U.S. manufacturing activity following the Great Recession has raised the question of whether the sector might be experiencing a renaissance. Using panel regressions, we find that a depreciating real exchange rate, an increasing spread in natural gas prices between the United States and other G-7 countries, and in particular decreasing unit labor costs have had a positive impact on U.S. manufacturing production. While we find it unlikely for manufacturing to become a main engine of growth in the United States, we find that U.S. manufacturing exports could provide nonnegligible growth opportunities going forward.
International Monetary Fund. European Dept.
Denmark’s public expenditure as a share of GDP is the highest in the OECD. The main difference between Denmark and the median OECD country is the larger amount of social protection expenditure. The public health expenditure of Denmark is the second highest in the OECD. Following years of strong public capital accumulation in facilities as well as in training, education, and research, Denmark’s expenditure on public investment is now low. The composition of Denmark’s expenditures is broadly in line with the high expenditure countries.
International Monetary Fund. European Dept.
Mounting funding pressures has tipped Portugal into an acute economic crisis in 2011. The roots of the crisis could be traced to Portugal’s failure to adapt to the rigors of monetary union. With economic institutions, policies, and incentives ill-adapted to the opportunities, Portugal’s external stability risks also rose gradually. However, the current account has improved substantially with financial imbalances being corrected across private and public sectors. Fiscal adjustment also made substantial progress, while structural reforms have been progressing.
International Monetary Fund. European Dept.
The 2012 Article IV Consultation with France discusses the financial and economic conditions of the country. Although France weathered the 2008 financial and subsequent euro area crises relatively well compared with other advanced countries, its recovery has been sluggish. France has become a less open economy and reported a steady loss of export market share relative to its European peers. The current challenge for France is to pursue fiscal policy consolidation that balances cyclical considerations with the need to preserve market confidence in French policies and in the euro area crisis resolution strategy.