Les changements climatiques occupent une place centrale en gouvernance mondiale de l'environnement. Vu l'envergure des défis à résoudre, la plus récente Conférence des Parties (CdP) de la Convention-cadre des Nations Unies sur les changements climatiques (CCNUCC), la CdP-27, faisait face à de grandes attentes. Ce court article offre un bilan critique de la CdP-27. L'article présente une synthèse des résultats de cette CdP en étudiant quatre volets principaux, soit l'atténuation des émissions de gaz à effet de serre (GES), l'augmentation du financement climatique, l'adaptation aux changements climatiques et les pertes et préjudices. Il dresse ainsi un portait des résultats de la CdP-27 au regard des attentes qui avaient été établies au préalable par les parties prenantes. L'article se conclut par une analyse prospective des principaux enjeux à suivre d'ici la CdP-28 et au-delà. Il permet ainsi de faire le point sur les plus récents développements, d’éclairer les avancées à venir et de contribuer aux discussions sur la gouvernance mondiale du climat.

The South American Funds National Exchequer was established in 1818 to contribute to the consolidation of the public debt of Buenos Aires. It was the first financial innovation since the revolutionary outbreak in Buenos Aires, and its failure allowed the authorities to understand the limits of the fiscal and financial commitment they proposed by means of that institution. Its suppression, in 1821, offered an antecedent to develop a deep reform of the financial institutional matrix of Buenos Aires, based on the Public Credit office, the Amortization Exchequer and the Bank of Buenos Aires. The South American Funds National Exchequer was, thus, the first movement in the negotiation on the terms of the financial commitment assumed by the nascent State. This paper analyzes the 973 accounting entries of the institution, providing an interpretation of that failure and its importance for the course of public finances in Buenos Aires.

At present, pay for prescription models are insufficient at containing costs and improving access to medicines. Subscription financing through tenders, licensing fees and unrestricted or fixed volumes can benefit stakeholders across the supply chain. Pharmaceutical manufacturers can reduce the need for marketing expenses and gain certainty in revenue. This will decrease costs, improve predictability in budget expenditure for payers and remove price as a barrier of access from patients. Inherently, low- and middle-income countries lack the purchasing power to leverage price discounts through typical price arrangements. These markets can realise substantial savings for branded and generic medicines through subscription financing. Procuring of on-patent and off-patent drugs requires separate analysis for competition effects, the length of contract and encouraging innovation in the medicine pipeline. Prices of competitive on-patent medicines and orphan drugs can be reduced through increased competition and volume. Furthermore, pooling expertise and resources through joint procurement has the potential for greater savings. Incentivising research and development within the pharmaceutical industry is essential for sustaining a competitive market, preventing monopolies and improving access to expensive treatments. However, technical capacity, forecasting demand and the quality of generic medicines present limitations which necessitate government support and international partnerships. Ultimately, improving access requires progressive financing mechanisms with patients and cost containment in mind.

We consider the optimal financing (capital injections) and dividend payment problem for a Brownian motion model in the case of restricted dividend rates. The company has no obligation to inject capitals and therefore, the bankruptcy risk is present. Capital injections, if any, will incur both fixed and proportional transaction costs and dividend payments incur proportional transaction costs. The aim is to find the optimal strategy to maximize the expected present value of dividend payments minus the total cost of capital injections up to the time of bankruptcy. The problem is formulated as a mixed impulse-regular control problem. We address the problem via studying three cases of two auxiliary functions. We derive important analytical properties of the auxiliary functions and use them to study the value function and then identify the optimal control strategy. We show that the optimal dividend control is of threshold type and the optimal financing strategy prescribes to either never inject capitals or inject capitals only when the surplus reaches 0 with a fixed lump sum amount.

Objective – The study of the relation between treatment costs and disability of psychiatric patient groups. Design – Perspective assessment of costs and disability of 1371 adult psychiatric patients in charge at two Operative Psychiatric Units (OPU), followed during an average period of 9 months. Data are related to all OPU's psychiatric services, including ambulatory, full or half-residential and psychiatric departments of acute hospital services. Setting — OPUs of Magenta (MI) and Desio (MI). Methods – The disability level has been measured by Health of the Nation Outcome Scales (HoNOS) filled in at the inclusion of the patient in the study and every three—months on average thereafter. Besides other HoNOSs have been filled in both at admission and discharge from psychiatric departments of acute hospitals, Residential Centres of psychiatric Therapies and Rehabilitation and Guarded Communities. All patients have been grouped using the main psychiatric diagnosis (first digit ICD—10) and the maximum disability level shown in the whole period of the study. Direct costs of publicly financed psychiatric services have only been considered. Their attribution to each patient has been made applying standard costs or tariffs (diagnostic procedures) to the data perspectively collected by the regional Register and a purposely designed protocol. Results – Total cost of 1371 patients has been 9771.1 million lire with a cost per patient of 7127000 lire (sd 19499000) and a cost per «day in charge» of 27172 lire (sd 68358). The cost per day has been found unrelated with the length of observed time frame. At the inclusion the mean level of disability has been 4.26 points (sd 3.73) and 3.19 points (sd 3.26) at the end of the study. Its value, measured at maximum level shown by each problem in the whole period of study, has been 6.00 points (sd 4.64). Disability and treatment cost of each patient did result directly related (r = 0.626, p = 0.0001). All patients have been grouped in 12 classes with a significant (p = 0,0001) overall difference on both their disability level and treatment cost. Conclusion – All adult psychiatric patients could be grouped in disability related classes which sometimes have also a different treatment cost. A study on a greater number of patients is needed to confirm these results. It may also provide a more reliable basis for a new financing system of psychiatric services.

Until relatively recently life companies generally met their capital needs either from internal resources or by means of equity capital provided by shareholders. However, the financial pressures on life operations have led to more innovative alternatives being used. In response to these pressures different forms of capital support from reinsurers, banks or other group funds or companies have been developed. In April 1998 National Provident Institution (NPI) became the first life company to issue bonds to investors secured on the future profits expected to arise from part of its existing life business. This paper discusses: financing options available to life companies; the terms of NPI's securitisation; the relative merits of different financing and capital management alternatives; alternative forms of capital support; the implications for policyholders and their interests; and actuarial issues arising from the different forms of financing.

Aims – There is growing demand for economic analysis to support strategic decision-making for mental health but the availability of economic evidence, in particular on system performance remains limited. The Mental Health Economics European Network (MHEEN) was set up in 2002 with the broad objective of developing a base for mental health economics information and subsequent work in 17 countries. Methods – Data on financing, expenditure and costs, provision of services, workforce, employment and capacity for economic evaluation were collected through bespoke questionnaires developed iteratively by the Network. This was augmented by a literature review and analysis of international databases. Results – Findings on financing alone suggest that in many European countries mental health appears to be neglected while mechanisms for resource allocation are rarely linked to objective measure of population mental health needs. Numerous economic barriers and potential solutions were identified. Economic incentives may be one way of promoting change, although there is no one size fits all solution. Conclusions – There are significant benefits and synergies to be gained from the continuing development of networks such as MHEEN. In particular the analysis can be used to inform developments in Central and Eastern Europe. For instance there is much that can be learnt on both how the balance of care between institutional and non-institutional care has changed and on the role played by economic incentives in ensuring that resources were used to develop alternative community-based systems.

Declaration of Interest: none of the authors have received any financial support that presents a conflict of interest.

Although Canadian Medicare gives the population “reasonable” access” to all “medically necessary” physician and hospital services, long-term care is not formally subject to those conditions. In Ontario, long-term care involves a “patchwork quilt” of government, charitable, for-profit, and personally-provided services; an ongoing consultation has been under way in an attempt to rationalize service financing and provision. This paper reviews the series of policy proposals and the accompanying public consultation processes. It concludes that the emphasis on “community involvement” without a clear definition of “community” or the goals of participation has paradoxically increased the “scope of conflict,” increased frustration among stakeholders, and made policy action more difficult.