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Team collaborations in which each member's output is critical to the overall success present organizations with difficult coordination problems. Despite the need for communication in such situations, team members often fail to share essential information. To examine why team communication and coordination fail, we develop a formal model with boundedly rational team members that links team size with the incentives to coordinate and the costs of communication. We show that even very small communication costs are enough to offset the expected individual benefit of sharing information with the team. Absent effective routines, the least efficient outcome is the most likely in the short and long run. Further, simulations lend support to a number of organizational routines and responses: mandating communication improves coordination and more so if the mandate recurs periodically. Increasing the incentives to coordinate is more important than subsidizing communication costs, which often adds little value unless the subsidies cover the costs completely. The results match a broad range of findings from the experimental and organizational literature, help to explain and provide a theoretical foundation for why team collaborations involving several organizational units often fail, and suggest new tests for promising communication routines.

This study examined a literacy program that targeted students most at risk of reading difficulties in kindergarten and first grade of 12 Swedish schools. The program used multi-sensory learning met...

What are the long-term effects of universal preschool programs on child outcomes? We review 26 studies using natural experiments to estimate the effects of universal preschool programs for children aged 0-6 years on child outcomes measured from third grade to adulthood. Studies comparing preschool with parental, family, or other informal modes of care show mixed effects on test scores, and on measures related to health, well-being, and behavior. However, all estimates for outcomes related to adequate primary and secondary school progression, years of schooling, highest degree completed, employment, and earnings indicate beneficial average effects of universal preschool programs. Three of the included studies calculate benefits-to-costs ratios and find ratios clearly above one. Universal preschool tends to be more beneficial for children with low socioeconomic status, and there are not consistently different effects for boys or girls. Only three studies compare two alternative types of universal preschool programs in terms of long-term outcomes.

Policies aiming to spur quality competition among health care providers are ubiquitous, but their impact on quality is ex ante ambiguous, and credible empirical evidence is lacking in many contexts. This study contributes to the sparse literature on competition and primary care quality by examining recent competition enhancing reforms in Sweden. The reforms aimed to stimulate patient choice and entry of private providers across the country but affected markets differently depending on the initial market structure. We exploit the heterogeneous impact of the reforms in a difference-in-differences strategy, contrasting more and less exposed markets over the period 2005-2013. Although the reforms led to substantially more entry of new providers in more exposed markets, the effects on primary care quality were modest: We find small improvements of patients' overall satisfaction with care, but no consistently significant effects on avoidable hospitalisation rates or satisfaction with access to care. We find no evidence of economically meaningful quality reductions on any outcome measure.

Background Low levels of numeracy and literacy skills are associated with a range of negative outcomes later in life, such as reduced earnings and health. Obtaining information about effective interventions for children with or at risk of academic difficulties is therefore important. Objectives The main objective was to assess the effectiveness of interventions targeting students with or at risk of academic difficulties in kindergarten to Grade 6. Search Methods We searched electronic databases from 1980 to July 2018. We searched multiple international electronic databases (in total 15), seven national repositories, and performed a search of the grey literature using governmental sites, academic clearinghouses and repositories for reports and working papers, and trial registries (10 sources). We hand searched recent volumes of six journals and contacted international experts. Lastly, we used included studies and 23 previously published reviews for citation tracking. Selection Criteria Studies had to meet the following criteria to be included: Population: The population eligible for the review included students attending regular schools in kindergarten to Grade 6, who were having academic difficulties, or were at risk of such difficulties. Intervention: We included interventions that sought to improve academic skills, were conducted in schools during the regular school year, and were targeted (selected or indicated). Comparison: Included studies used an intervention‐control group design or a comparison group design. We included randomised controlled trials (RCT); quasi‐randomised controlled trials (QRCT); and quasi‐experimental studies (QES). Outcomes: Included studies used standardised tests in reading or mathematics. Setting: Studies carried out in regular schools in an OECD country were included. Data Collection and Analysis Descriptive and numerical characteristics of included studies were coded by members of the review team. A review author independently checked coding. We used an extended version of the Cochrane Risk of Bias tool to assess risk of bias. We used random‐effects meta‐analysis and robust‐variance estimation procedures to synthesise effect sizes. We conducted separate meta‐analyses for tests performed within three months of the end of interventions (short‐term effects) and longer follow‐up periods. For short‐term effects, we performed subgroup and moderator analyses focused on instructional methods and content domains. We assessed sensitivity of the results to effect size measurement, outliers, clustered assignment of treatment, risk of bias, missing moderator information, control group progression, and publication bias. Results We found in total 24,414 potentially relevant records, screened 4247 of them in full text, and included 607 studies that met the inclusion criteria. We included 205 studies of a wide range of intervention types in at least one meta‐analysis (202 intervention‐control studies and 3 comparison designs). The reasons for excluding studies from the analysis were that they had too high risk of bias (257), compared two alternative interventions (104 studies), lacked necessary information (24 studies), or used overlapping samples (17 studies). The total number of student observations in the analysed studies was 226,745. There were 93% RCTs among the 327 interventions we included in the meta‐analysis of intervention‐control contrasts and 86% were from the United States. The target group consisted of, on average, 45% girls, 65% minority students, and 69% low‐income students. The mean Grade was 2.4. Most studies included in the meta‐analysis had a moderate to high risk of bias. The overall average effect sizes (ES) for short‐term and follow‐up outcomes were positive and statistically significant (ES = 0.30, 95% confidence interval [CI] = [0.25, 0.34] and ES = 0.27, 95% CI = [0.17, 0.36]), respectively). The effect sizes correspond to around one third to one half of the achievement gap between fourth Grade students with high and low socioeconomic status in the United States and to a 58% chance that a randomly selected score of an intervention group student is greater than the score of a randomly selected control group student. All measures indicated substantial heterogeneity across short‐term effect sizes. Follow‐up outcomes pertain almost exclusively to studies examining small‐group instruction by adults and effects on reading measures. The follow‐up effect sizes were considerably less heterogeneous than the short‐term effect sizes, although there was still statistically significant heterogeneity. Two instructional methods, peer‐assisted instruction and small‐group instruction by adults, had large and statistically significant average effect sizes that were robust across specifications in the subgroup analysis of short‐term effects (ES around 0.35–0.45). In meta‐regressions that adjusted for methods, content domains, and other study characteristics, they had significantly larger effect sizes than computer‐assisted instruction, coaching of personnel, incentives, and progress monitoring. Peer‐assisted instruction also had significantly larger effect sizes than medium‐group instruction. Besides peer‐assisted instruction and small‐group instruction, no other methods were consistently significant across the analyses that tried to isolate the association between a specific method and effect sizes. However, most analyses showed statistically significant heterogeneity also within categories of instructional methods. We found little evidence that effect sizes were larger in some content domains than others. Fractions had significantly higher associations with effect sizes than all other math domains, but there were only six studies of interventions targeting fractions. We found no evidence of adverse effects in the sense that no method or domain had robustly negative associations with effect sizes. The meta‐regressions revealed few other significant moderators. Interventions in higher Grades tend to have somewhat lower effect sizes, whereas there were no significant differences between QES and RCTs, general tests and tests of subdomains, and math tests and reading tests. Authors’ Conclusions Our results indicate that interventions targeting students with or at risk of academic difficulties from kindergarten to Grade 6 have on average positive and statistically significant short‐term and follow‐up effects on standardised tests in reading and mathematics. Peer‐assisted instruction and small‐group instruction are likely to be effective components of such interventions. We believe the relatively large effect sizes together with the substantial unexplained heterogeneity imply that schools can reduce the achievement gap between students with or at risk of academic difficulties and not‐at‐risk students by implementing targeted interventions, and that more research into the design of effective interventions is needed.

This is the protocol for a Campbell review. The objectives are as follows: To synthesize data from studies to assess the impact of adult/child ratio and group size in ECEC on measures of process characteristics of quality of care and on child outcome measures.

Antibiotic resistance is a major threat to public health worldwide. As the healthcare sector's use of antibiotics is an important contributor to the development of resistance, it is crucial that physicians only prescribe antibiotics when needed and that they choose narrow-spectrum antibiotics, which act on fewer bacteria types, when possible. Inappropriate use of antibiotics is nonetheless widespread, not least for respiratory tract infections (RTI), a common reason for antibiotics prescriptions. We examine if pay-for-performance (P4P) presents a way to influence primary care physicians' choice of antibiotics. During 2006-2013, 8 Swedish healthcare authorities adopted P4P to make physicians select narrow-spectrum antibiotics more often in the treatment of children with RTI. Exploiting register data on all purchases of RTI antibiotics in a difference-in-differences analysis, we find that P4P significantly increased the share of narrow-spectrum antibiotics. There are no signs that physicians gamed the system by issuing more prescriptions overall.

Socioeconomic status is a major predictor of educational achievement. This systematic review and meta-analysis seeks to identify effective academic interventions for elementary and middle school students with low socioeconomic status. Included studies have used a treatment-control group design, were performed in OECD and EU countries, and measured achievement by standardized tests in mathematics or reading. The analysis included 101 studies performed during 2000 to 2014, 76% of which were randomized controlled trials. The effect sizes (ES) of many interventions indicate that it is possible to substantially improve educational achievement for the target group. Intervention components such as tutoring (ES = 0.36), feedback and progress monitoring (ES = 0.32), and cooperative learning (ES = 0.22) have average ES that are educationally important, statistically significant, and robust. There is also substantial variation in effect sizes, within and between components, which cannot be fully explained by observable study characteristics.

Consumers of services that are financed by a third party, such as publicly financed health care or firm-sponsored health plans, are often allowed to freely choose provider. The rationale is that consumer choice may improve the matching of consumers and providers and spur quality competition. Such improvements are contingent on consumers having access to comparative information about providers and acting on this information when making their choice. However, in the presence of information frictions and switching costs, consumers may have limited ability to find suitable providers. We use two large-scale randomized field experiments in primary health care to examine if the choice of provider is affected when consumers receive comparative information by postal mail and small costs associated with switching are reduced. The first experiment targeted a subset of the general population in the Swedish region Skaane, and the second targeted new residents in the region, who should have less prior information and lower switching costs. In both cases, the propensity to switch provider increased significantly after the intervention. The effects were larger for new residents than for the general population, and were driven by individuals living reasonably close to alternative providers. (Less)

Background: The Scandinavian countries have a long history of implementing social interventions, but the interventions have not been examined using randomised controlled trials until relatively recently compared with countries like the United States and the United Kingdom. Purpose: The purpose of this paper is to examine the history of randomised controlled trials in Scandinavian compulsory schools (grades 0–10; pupil ages 6-15). Specifically, we investigate drivers and barriers for randomised controlled trials in educational research and the differences between the three Scandinavian countries Denmark, Norway, and Sweden.Methods: To locate relevant trials, we performed a systematic search of four bibliographic databases and a search for grey literature. Results were combined with trials located through direct contact with researchers and government officials. A trial was included if one or more interventions were randomly assigned to groups of students and carried out in a school setting with the primary aim of improving the academic performance of children aged 6-15 in grades 0–10 in Denmark, Norway, or Sweden. We included both conducted and ongoing trials. Publications that seemed relevant were screened based on full-text versions. Data extraction included information from the included studies on grade level, study period, sample size (N), project owner, funding source, and theme. In addition, we conducted two semi-structured interviews by phone or in person with central employees in funding agencies and ministries and 25 correspondences with researchers and policy makers.Findings and conclusion: RCTs in grades 0–10 were few in all of Scandinavia until about 2011, after which there was an increase in all three countries, although at different rates. The largest number of trials has been conducted in Denmark, and the increase is more marked in Denmark and Norway compared with Sweden. International trends towards more impact evaluations and results from international comparisons such as PISA have likely affected the development in all countries, but while many trials in Denmark and Norway are the result of policy initiatives, only one such example in Sweden was identified. We believe the lack of government initiatives to promote RCTs in Sweden is the most likely explanation for the differences across the Scandinavian countries. Funding and coordination from the government are often crucial for the implementation of RCTs and are likely more important in smaller countries such as the Scandinavian ones. Supporting institutions have now been established in all three countries, and we believe that the use of RCTs in Scandinavian educational research is likely to continue. Background: The Scandinavian countries have a long history of implementing social interventions, but the interventions have not been examined using randomised controlled trials until relatively recently compared with countries like the United States and the United Kingdom. Purpose: The purpose of this paper is to examine the history of randomised controlled trials in Scandinavian compulsory schools (grades 0–10; pupil ages 6-15). Specifically, we investigate drivers and barriers for randomised controlled trials in educational research and the differences between the three Scandinavian countries Denmark, Norway, and Sweden.Methods: To locate relevant trials, we performed a systematic search of four bibliographic databases and a search for grey literature. Results were combined with trials located through direct contact with researchers and government officials. A trial was included if one or more interventions were randomly assigned to groups of students and carried out in a school setting with the primary aim of improving the academic performance of children aged 6-15 in grades 0–10 in Denmark, Norway, or Sweden. We included both conducted and ongoing trials. Publications that seemed relevant were screened based on full-text versions. Data extraction included information from the included studies on grade level, study period, sample size (N), project owner, funding source, and theme. In addition, we conducted two semi-structured interviews by phone or in person with central employees in funding agencies and ministries and 25 correspondences with researchers and policy makers.Findings and conclusion: RCTs in grades 0–10 were few in all of Scandinavia until about 2011, after which there was an increase in all three countries, although at different rates. The largest number of trials has been conducted in Denmark, and the increase is more marked in Denmark and Norway compared with Sweden. International trends towards more impact evaluations and results from international comparisons such as PISA have likely affected the development in all countries, but while many trials in Denmark and Norway are the result of policy initiatives, only one such example in Sweden was identified. We believe the lack of government initiatives to promote RCTs in Sweden is the most likely explanation for the differences across the Scandinavian countries. Funding and coordination from the government are often crucial for the implementation of RCTs and are likely more important in smaller countries such as the Scandinavian ones. Supporting institutions have now been established in all three countries, and we believe that the use of RCTs in Scandinavian educational research is likely to continue.

Collaboration in teams in which each member's output is critical to the overall success present organizations with difficult coordination problems. We develop a model and run simulations to analyze how costly communication affects team coordination and output efficiency. We show that absent any organizational routines to structure team communication the least efficient outcome is the most frequent output. We then derive formal conditions and simulate efficiency gains for several communication routines that improve team coordination and efficiency. Our model and simulation results match a broad range of findings from the experimental and organizational literature, help explain and provide a theoretical foundation for why collaborations involving several organizational units often fail, and suggest new tests for promising communication routines.

Summary Antibiotic resistance is a major threat to public health worldwide. As the healthcare sector's use of antibiotics is an important contributor to the development of resistance, it is crucial that physicians only prescribe antibiotics when needed and that they choose narrow‐spectrum antibiotics, which act on fewer bacteria types, when possible. Inappropriate use of antibiotics is nonetheless widespread, not least for respiratory tract infections (RTI), a common reason for antibiotics prescriptions. We examine if pay‐for‐performance (P4P) presents a way to influence primary care physicians' choice of antibiotics. During 2006–2013, 8 Swedish healthcare authorities adopted P4P to make physicians select narrow‐spectrum antibiotics more often in the treatment of children with RTI. Exploiting register data on all purchases of RTI antibiotics in a difference‐in‐differences analysis, we find that P4P significantly increased the share of narrow‐spectrum antibiotics. There are no signs that physicians gamed the system by issuing more prescriptions overall.

How does costly communication affect organizational coordination? This paper develops a model of costly communication based on the weakest-link game and boundedly rational agents. Solving for the stochastically stable states, we find that communication increases the possibilities for efficient coordination compared to a setting where agents cannot communicate. But as agents face a trade-off between lowering the strategic uncertainty for the group and the costs of communication, the least efficient state is still the unique stochastically stable one for many parameter values. Simulations show that this is not just a long run phenomena, the stochastically stable state is the most frequent outcome also in the short run. Making communication mandatory induces efficient coordination, whereas letting a team leader handle communication increases efficiency when the leader expects others to follow and has enough credibility. The results are broadly consistent with recent experimental evidence of communication in weakest-link games.

Conflicts of interest within hierarchic government organizations regarding the importance of fiscal discipline create the need for institutions that curb the bargaining power of units in charge of implementing policy and align their incentives to the interests of the whole organization. We examine this general public sector problem by collecting unique data on budget institutions and conflicts of interest within the Swedish municipalities. Our estimations suggest that institutions pertaining to both the planning stage and the implementation stage of the budget process are important for fiscal performance. The fiscal surplus is higher in municipalities that have centralized their budget process to some degree, and where local committees are allowed to carry over surpluses or forced to carry over deficits between fiscal years. The associations however differ between municipalities with different degrees of conflicts of interests, calling for further research to understand the incentives given by the result carry-over rules. We further find that the fiscal surplus is higher in municipalities where local managers face a relatively high risk of dismissal as a consequence of budget deficits.

Whenever a central government faces a sub-unit in financial distress, the unpleasant question arises of whether to assist the unit or not. On the one hand, resisting to bail out the unit may lead to default or bankruptcy, which could be very costly both economically and politically. On the other hand, bailouts may increase problems of soft budget constraints: noting that the central government steps in in times of trouble, sub-units may come to expect that bailouts will be available when needed. Restricting attention to the relation between central and local governments, bailouts have been found to be followed by deteriorating fiscal discipline in case studies of several fiscally decentralized countries (e.g. Bordignon and Turati, 2009; Pettersson-Lidbom, 2010; Fink and Stratmann, 2011). Little is however known about whether such tendencies can be dampened if assistance is made conditional upon the local governments' own fiscal efforts. We examine a case in which the Swedish central government provided conditional grants to 36 financially troubled municipalities: to receive the grant, municipalities first had to cut costs and balance their budgets. There were also 23 municipalities that applied for the grant, but whose applications were rejected. We examine the program effect on fiscal discipline over the decade after the launch of the program. Two major identification problems are that the program effect may vary between municipalities, and that selection into the program was not random. We address these two problems by employing the synthetic control method, a case study method developed in Abadie and Gardeazabal (2003) and Abadie et al. (2010), and also combine this method with fixed effects estimations. Our results reveal substantial heterogeneity in the municipal responses to the program and also highlight the importance of the choice of comparison group. For the average effect on admitted municipalities, the main bulk of the evidence point to no increases in the level of per capita costs in the longer run. Fixed effects estimations show consistently better net revenues on average. Moreover, admitted municipalities do better on average than rejected municipalities, who arguably received a signal of hard budget constraints. We conclude that conditional bailouts need not erode fiscal discipline.