This paper is a presentation on recent trends and a survey of recent research on private security, and its relationship with policing in the United States. Recent research suggests a larger role for private security in crime deterrence efforts than was previously assumed. This research suggests that increases in some forms of private security generate reductions in some types of crime, and that private security can act as complements or substitutes for police in different environments. We also review the industry structures for private security and detectives, and do the same for public police and detectives. In addition, we examine how private security is regulated in the U.S. and the limitations of these regulations.

This chapter provides an overview of the contributions to this volume and draws suggestions for improving security and police performance with respect to their primary mission of deterring and responding to criminal events. In the context of recent increases in U.S. crime and public concern about police behavior, the role and responsibility of public and private police are important matters. Moreover, private security is becoming an important component of overall security, as police resources are stretched to fulfill a variety of obligations, some of which are not perfectly aligned with serious crime prevention. Throughout this chapter we explore the following options for security provision between public police and private security:

This chapter incorporates the major findings of the individual chapters to establish policy implications. There seems to be a general consensus for increasing competition in highway construction and management, leading to improved efficiency, reduced tolls, and greater introduction of technology. P3s were initiated in part because of inadequate government funding and have been reasonably successful. However, P3s seem to be an intermediate stage to more complete privatization of major highways. The reliance on the gasoline tax to fund roads and mass transit systems seem to be antiquated and could be inexpensively substituted with electronically monitored user fees.

This chapter describes, analyzes, and provides policy implications on Public Private Partnerships (P3s) in airports, taxicabs, buses, rail, and water ports. It provides the history of P3s, the advantages and disadvantages as reflected in the worldwide case studies analyzed. P3s combine efforts and risk sharing of public and private entities where each provides its comparative advantage. An advantage of P3 is reducing investments in “white elephants” requiring avoidance of availability payments. Currently, governments, mostly for historical reasons, provide services that could be privately provided where users fees are possible with low transaction costs attributed to recent technological innovations. Government could shift most transportation services from a monopolistic provider to a small number of experts that oversee the contracts of P3s in the public interest. Noteworthy, transportation services are interrelated. For example, P3s in rail would increase available resources, improve services to distant airports, thereby decrease current regional airport monopolies, and raise competition among them. Similarly, autonomous vehicles could reduce rail, bus, and taxicab monopolies, leading to greater competition among them and productivity gains.

There is strong evidence that the need for infrastructure investment will continue to grow in the future. However, there is also justifiable concern over the ability to obtain funds to support these investments. One option for obtaining these necessary funds is the use of public-private partnerships (P3s). This chapter summarizes a series of papers contained in the book entitled Public Private Partnerships in Transportation, Vol I: Airports, Water Ports, Rail, Buses, and Taxis which discuss the potential use of P3s to provide these needed funds.

Burglar alarms are the single most effective deterring and detecting measure for burglary. On net, alarms provide benefits to communities, but 94-99 percent of police responses to alarms are to false activations. Solving the false alarm problem could free up the resources equivalent to 35,000 U.S police officers. Response to false alarms is a private good while response to an actual crime is a public good. The paper analyzes a Public-Private-Partnership policy called Verified Response (VR) where the initial response is usually provided by private security under a competitive setting, and police respond only if a crime is verified. A case study of Salt Lake City, Utah is conducted using synthetic control methods to evaluate this program. The introduction of this policy is associated with an 87 percent annual reduction in police alarm response calls, a 26 percent reduction in burglaries, and faster response to all police calls. The paper relies on Public Choice theory to explain why this solution is not adopted in the majority of cities. (c) 2020 Elsevier Inc. All rights reserved.

This article examines the complexity of pharmaceutical pricing. Specifically, list prices are often considerably higher than net prices. PBMs have considerable market power to obtain substantial discounts (rebates) from pharmaceutical companies which encourages higher list prices. In general the generic market work well. At issue is how much of the discounts are passed on to other stakeholders. High prices during market exclusivity or patent protection encourages R&D. Pharmaceuticals spend a large percentage of revenues on R&D, earn large profits which are somewhat overstated and take substantial risk. Many firms never make a profit. Drugs provide great value and increase the quality of life of patients. Since subscribers often change insurance companies, insurers have a shorter time horizon than pharmaceutical firms, which could lead to coverage issues. Policies to mitigate high drug prices include changes to PBM rebate practices, stricter patent approvals and reduction of barriers for generics and biosimilars.

This chapter provides an overview of the biosimilar market in the U.S. Biosimilars are defined as highly similar to the originator biologic. Biologics are some of the highest priced drugs that treat some of the most serious diseases. The R&D for biologics can be in the billions of dollars. Recently, patents on various biologics have expired, opening up the market to competition from biosimilars. An abbreviated pathway for biosimilars was created through the 2009 Biologic Price Competition and Innovation Act. Seven biosimilars have been approved with only 3 on the market. Exclusivity and patents and the various legal issues that biosimilars face are examined. We examine the potential gains from biosimilars and the future market structure of the biosimilar market. This analysis will help potential biosimilars producers take a holistic view towards the challenges and prepare for the upcoming competition in making biosimilars a reality.

This paper proposes a regional competitive governance and management of response and recovery from disasters. It presents problems experienced in major disasters, analyzes the failures, and suggests how a competitive system that relies on private and volunteer regional leaders, personnel, and capital can improve preparation, response and recovery efforts over the existing government system. A Public Choice approach is adopted to explain why government often fails, and how regional governance may be socially more efficient than the existing federal- state-local funded and managed disaster system. The paper suggests that the federal role might change from both funding and supplying aid in disasters to merely funding disaster recovery efforts. When a disaster occurs, available businesses and government resources in the region can be utilized under a competitive system. These resources could replace existing federal and state inventories and emergency personnel. An independent regionally controlled and managed council, which also develops its own financial resources, and local volunteer leaders are key for success. The paper suggests a new planning method that utilizes the statistical Factor Analysis methodology to derive an efficient organizational and functional model to confront disasters.

BACKGROUND:Accountable care organizations (ACOs) have been created to improve patient care, enhance population health, and reduce costs. Medicare in particular has focused on ACOs as a primary device to improve quality and reduce costs.OBJECTIVE:To examine whether the current Medicare ACOs are likely to be successful.DISCUSSION:Patients receiving care in ACOs have little incentive to use low-cost quality providers. Furthermore, the start-up costs of ACOs for providers are high, contributing to the minimal financial success of ACOs. We review issues such as reducing readmissions, palliative care, and the difficulty in coordinating care, which are major cost drivers. There are mixed incentives facing hospital-controlled ACOs, whereas physician-controlled ACOs could play hospitals against each other to obtain high quality and cost reductions. This discussion also considers whether the current structure of ACOs is likely to be successful.CONCLUSION:The question remains whether Medicare ACOs can achieve the Triple Aim of "improving the experience of care, improving the health of populations, and reducing per capita costs of health care." Care coordination in ACOs and information technology are proving more complicated and expensive to implement than anticipated. Even if ACOs can decrease healthcare costs and increase quality, it is unclear if the current incentives system can achieve these objectives. A better public policy may be to implement a system that encompasses the best practices of successful private integrated systems rather than promoting ACOs.

BACKGROUND:Counterfeit drugs comprise an increasing percentage of the US drug market and even a larger percentage in less developed countries. Counterfeit drugs involve both lifesaving and lifestyle drugs.OBJECTIVE:To review the health and economic consequences of counterfeit drugs on the US public and on the healthcare system as a whole.METHOD:This comprehensive review of the literature encompassed a search of MEDLINE/PubMed, Google Scholar, and ProQuest using the keywords "counterfeit drugs," "counterfeit medicines," "fake drugs," and "fake medicines." A search of the various FiercePharma daily newsletter series on the healthcare market was also conducted. In addition, the US Food and Drug Administration and the World Health Organization websites were reviewed for additional information.DISCUSSION:The issue of counterfeit drugs has been growing in importance in the United States, with the supply of these counterfeit drugs coming from all over the world. Innovation is important to economic growth and US competitiveness in the global marketplace, and intellectual property protections provide the ability for society to prosper from innovation. Especially important in terms of innovation in healthcare are the pharmaceutical and biopharmaceutical industries. In addition to taking income from consumers and drug companies, counterfeit drugs also pose health hazards to patients, including death. The case of bevacizumab (Avastin) is presented as one recent example. Internet pharmacies, which are often the source of counterfeit drugs, often falsely portray themselves as Canadian, to enhance their consumer acceptance. Adding to the problems are drug shortages, which facilitate access for counterfeits. A long and convoluted supply chain also facilitates counterfeits. In addition, the wholesale market involving numerous firms is a convenient target for counterfeit drugs. Trafficking in counterfeits can be extremely profitable; detection of counterfeits is difficult, and the penalties are modest.CONCLUSION:Counterfeit drugs pose a public health hazard, waste consumer income, and reduce the incentive to engage in research and development and innovation. Stronger state licensure supervision of drug suppliers would be helpful. Technological approaches, such as the Radio Frequency Identification devices, should also be considered. Finally, counterfeit drugs may raise concerns among consumers about safety and reduce patient medication adherence.

The demand for security depends on several socioeconomic characteristics such as income, property, family size that may affect the demand for pure public security or private security. In the case of a homogeneous population, the identical demands lead to an equal use of the shared public good along with an equal sharing of payments. In a heterogeneous population with a rectangular distribution of demands, security will be composed of both the pure equally shared public security along with private security that is paid individually and purchased in different quantities as a supplement to the pure public security. This combination could be applied permanently in order to achieve a social welfare improvement in comparison to the solely public security provided for the heterogeneous population.

BACKGROUNDThe high cost of pharmaceuticals, especially biologics, has become an important issue in the battle to control healthcare costs. The Hatch-Waxman Act encourages generic competition but still provides incentives for pioneers to develop new drugs. The Biologics Price Competition and Innovation Act is intended to do the same for biologics and biosimilars.OBJECTIVETo examine information related to biosimilars to determine their potential impact on competition in the biologic market.METHODUsing information concerning the European Union (EU) and the pharmaceutical industry, this article reviews and analyzes the experience of biosimilars in the EU, as well as the obstacles and opportunities that biosimilars face in the United States. Much of the analysis is based on examining current trends in biologic drugs and the potential implications on the future of biosimilars.DISCUSSIONThis article reviews the mixed success of biosimilars in the EU and the implications for the United States. Because biologics are produced from living organisms, manufacturing issues are more important than in the chemical drug market. The barriers to biosimilar entry into the marketplace are much more difficult to overcome than challenges generic manufacturers typically face and are similar to obstacles specialty injectable producers encounter. The competitive responses by pioneers are also likely to be more important. The capital costs and risk issues with biosimilars make alliances and partnering arrangements very likely. Biosimilars often enter emerging markets, where the barriers to entry are easier to overcome. Nevertheless, the United States represents the greatest opportunity for biosimilar producers, in part because it is the largest biologics market and has high prices for biologics. As the United States enters the biosimilar market, the pharmaceutical industry is likely to grow at an accelerated pace. Automatic substitution is likely to be slow to develop, because of safety and quality concerns. The beneficial impact of biosimilars is likely to take a long time to be realized and to be fraught with more difficulties than was the case for small-molecule generics.CONCLUSIONVarious factors, such as safety, pricing, manufacturing, entry barriers, physician acceptance, and marketing, will make the biosimilar market develop different from the generic market. The high cost to enter the market and the size of the biologic drug market make entry attractive but risky.

This article discusses the changing landscape of US crime, and both describes and evaluates the growth of private security in total security provided. Since the mid-1970s violent and basic property crimes have constantly declined while the number of economic crimes like identity theft, counterfeit goods and cyber misdeeds increased substantially. Monopolistic police have not addressed the changing landscape of crime and continue to deliver their traditional services. As market forces have limited influence on government, private security that is highly competitive and client oriented has been quicker to adopt technology and management innovations and address the new types of crime. Private police are estimated to be three times larger than public law enforcement. The article concludes that the increased penetration of private security is socially beneficial by improving efficiency, delivering client-oriented services and forcing police to improve their performance.

Autonomy, innovation, and drug access may be at stake along with personalized medicine. Can all stakeholders be satisfied and should cost be a factor?

Policymakers often assume that there is considerable market power under duopoly and oligopoly. However, theoretical analysis is ambiguous about the nature of duopoly and empirical and experimental analysis reveal many examples of duopolistic markets that are highly competitive, while attempts to broaden those markets could lead to consumer harm. This paper reviews the theoretical and empirical evidence on duopolies and market power.