What Drives Responses to Willingness-to-pay Questions? A Methodological Inquiry in the Context of Hypertension Self-management

Background: The use of economic evaluation to determine the cost-effectiveness of health interventions is recommended by decision-making bodies internationally. Understanding factors that explain variations in costs and benefits is important for policy makers. Objective: This work aimed to test a priori hypotheses defining the relationship between benefits of using self-management equipment (measured using the willingness-to-pay (WTP) approach) and a number of demographic and other patient factors. Methods: Data for this study were collected as part of the first major randomised controlled trial of self-monitoring combined with self-titration in hypertension (TASMINH2). A contingent valuation framework was used with patients asked to indicate how much they were willing to pay for equipment used for self-managing hypertension. Descriptive statistics, simple statistical tests of differences and multivariate regression were used to test six a priori hypotheses. Results: 393 hypertensive patients (204 in the intervention and 189 in the control) were willing to pay for self-management equipment and 85% of these (335) provided positive WTP values. Three hypotheses were accepted: higher WTP values were associated with being male, higher household incomes and satisfaction with the equipment. Prior experiences of using this equipment, age and changes in blood pressure were not significantly related to WTP. Conclusion: The majority of hypertensive patients who had taken part in a self-management study were prepared to purchase the self-monitoring equipment using their own funds, more so for men, those with higher incomes and those with greater satisfaction. Further research based on bigger and more diverse populations is recommended

Health Information Technology in the United States, 2008

Provides updated survey data on health information technology (HIT) and electronic health records adoption, with a focus on providers serving vulnerable populations. Examines assessments of HIT's effect on the cost and quality of care and emerging issues

Human Capital in the Knowledge Economy : A 3-Country Case Study in Healthcare

During the present knowledge economy there appear to be labor shortages at the same time and in the same regions in which there is an excess of labor supply. Such a pattern would run counter to previous major economic disruptions, as well as questioning traditional free market economic theory of supply and demand principles. Implications for policy where there are global labor shortages along with surplus labor availability in a market economy, are significant. It will likely indicate a drag on economic growth for business sectors, for regions and perhaps globally. It would indicate an accompanying growing disparity of income. Work is important, if not central to human well-being. Changes to economic thinking, and to economic growth pertaining to work and the labor force, would change the way we look at the world. Labor market change would be a warning that political and social response is needed to address the imbalance of supply and demand. A labor supply gap is researched in healthcare occupations for India, Poland, and the U.S for a global perspective and to suggest policy implications

Public Opinion on Automation and Globalization

Globalization and automation are transforming the international labor market. Although technological change has led to job polarization, rising income inequality, and labor displacement, many overwhelmingly blame globalization --- immigration, trade, and offshoring --- but not automation for economic dislocation. Why do some people point the finger at immigrants and workers abroad, but not robots? Which types of workers are more worried about automation, and why? A decade's worth of survey data show that people have largely positive attitudes toward technology despite its disruptions to the labor market. Most believe that technological innovations enhance our lives, make the world better off, and should continue to be prioritized. Using a nationally representative survey (chapter 2) and an online survey experiment (chapter 3) in the United States, I show that people tend to cope with employment threats from automation by displacing blame onto outgroups and demanding protectionist policies. Many believe in the fallacy that labor demand is fixed and workers compete in a zero-sum manner. With robots increasingly displacing labor, people want to stop outgroups --- immigrant and foreign workers --- from further dividing the pie. Hesitant to halt innovation, individuals opt to buffer the technological threat to domestic workers with substitute policies --- immigration and trade restrictions --- that they believe could improve national wages and employment prospects. As such, automation anxiety may have evoked individuals' protectionist instincts, intensified attempts to resist globalization, and contributed to the revival of radical politics. But not all workers are equally anxious about robots and machines. Chapter 4 leverages the household registration system in China to examine how institutions may lessen (or heighten) automation anxiety. This system creates a stratified labor market that discriminates between local and non-local workers. Drawing on data from semi-structured interviews, factory visits, and two original surveys conducted in coastal China, I find that local workers --- who are better protected by local labor regulations --- are more worried about technological displacement than non-local workers. The divergent legal-institutional environments faced by local and non-local workers influence their expectations and the availability of exit options comparable to their status quo. The undesirability of non-local workers' circumstances make their jobs less painful to lose and easier to substitute, leading to lower technological anxiety. The greater legal protection afforded to local workers makes them more expensive to hire, less competitive than non-local workers with the same skills, and more anxious about automation. These results suggest that opposition toward technology is more likely to originate from workers in relatively privileged positions (e.g. unions) with few exit options comparable to their status quo. Overall, this work contributes to the nascent but growing literature in political science on technological change, public opinion in international political economy, and labor politics.PHDPolitical ScienceUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/163171/1/nicolewu_1.pd

INVESTIGATING POSSIBILITIES AND PROBABILITIES OF BIOMEDICAL INFORMATICS (BMI): BEYOND BIOLOGY AND INFORMATION

My work focuses on how medicalized minds and bodies are refashioned through the concepts and technologies of Biomedical Informatics (BMI). I attempt to make visible objects of informatics that mark the human as a digital machine operating among and within computerized agencies, artificial intelligence, and what has been termed Big Data correlation. Specifically, the anthropological puzzle that I investigate focuses on the BMI imagination and its implicit and implemented effects upon doctors as operators, patients as sites, and informaticians as technicians of “new” medicine in a world of expanding computerized data that shifts and refashions the human care encounter. I argue that the contemporary of BMI has a far wider organizing effect upon healthcare and medicalized bodies than previous aspirations based on computer technology as mere tools in medicine. Through a rapid development and deployment of intelligent databases and computerized networks, BMI is currently restructuring modes of clinical care. As a set of scientific practices, it is reconstituting earlier medical informatics of the 1970s, 1980’s, 1990’s and pushing these modes of care in different directions. Such restructurings come in contact with non-human operations of medico-scientific systems of knowledge and through programmable expressions that impinge upon doctors’ deliberations through everyday encounters with patients. I approach these puzzles and clinical experiences through the figure of an informatics body that frames emergent arrangements of computerized algorithms, organization, disease, genomics, and therapeutic order. As an informatics body, the human falls under questions embedded in this deeper convergence of medical digitalization. Complex computerizations and algorithmic forms that are designed to bring clinical improvement are giving rise to unanticipated effects that are refashioning the body of the patient and the mind of the physician in ways that have been under-examined. In futures of biomedicine that I investigate, an informatics-based medicine, the figure of the human in the continuum of care is constantly being reengineered and redeployed. Throughout my investigation I ask What acts, human and non-human, possess the possibility of therapeutic improvement and can bring other things to life that do not originate in current therapeutic order? I suggest that systems of machine agency that are targeting and monitoring for disease and health are reconstituting who and what has access to care, as well as access to decision agency among intelligent and computerized care data

Empirical Assessment of the Role of Technology-Related Factors and Organization-Related Factors in Electronic Medical Records Implementation Success

The objective of this research was to investigate if certain technology-related and organization-related factors that have most often been associated with successful IT/MIS implementations in other information technology and information science domains are also associated with successful Electronic Medical Records (EMR) implementations. This research uncovered a unique set of technology-related factors and organization-related factors associated with successful EMR implementations from the perspective of healthcare enablers and healthcare providers. Specific technology-related factors considered in this research were the innovativeness of EMR (measured with respect to the relative advantage, compatibility and complexity of EMR), privacy and security attributes of EMR, and usefulness of EMR. Specific organization-related factors considered were the readiness of the organization for change and the !eve! of product/process innovation in the organization where the EMR was implemented

Behaviours, motivations and values: Validity, reliability, and utility of novice motorcyclist' self-report in road safety research

The continuing use of self-report methods demands consideration of the validity, reliability, and utility of self-report in road safety research. This thesis assesses self-report issues with respect to four key constructs in motorcycle safety research—exposure, on-road behaviours, riding motivations, and perceived value in a sample of Australian novice motorcycle riders. In Study 1 a comprehensive set of statistical analyses was performed to test the validity and reliability of various self-report measures of riding exposure. In Study 2 and Study 3 previously untested psychometric properties of stability, content validity, and predictive validity of the Motorcycle Rider Behaviour Questionnaire and the Motorcycle Rider Motivation Questionnaire in terms of police-recorded offences and crashes as well as previously assessed factor structure, internal consistency, and predictive validity in terms of self-reported crashes were examined. In Study 4 I demonstrated the utility of a contingent valuation (CV) survey in measuring, understanding, and therefore addressing the perceived value of rider training amongst novice riders. The four studies highlight that the appropriateness of self-report depends on not only the nature of the phenomenon under study but the extent to which the factors that contribute to validity and reliability are accounted for in the design of self-report measures

Behaviours, motivations and values: Validity, reliability, and utility of novice motorcyclist' self-report in road safety research

The continuing use of self-report methods demands consideration of the validity, reliability, and utility of self-report in road safety research. This thesis assesses self-report issues with respect to four key constructs in motorcycle safety research—exposure, on-road behaviours, riding motivations, and perceived value in a sample of Australian novice motorcycle riders. In Study 1 a comprehensive set of statistical analyses was performed to test the validity and reliability of various self-report measures of riding exposure. In Study 2 and Study 3 previously untested psychometric properties of stability, content validity, and predictive validity of the Motorcycle Rider Behaviour Questionnaire and the Motorcycle Rider Motivation Questionnaire in terms of police-recorded offences and crashes as well as previously assessed factor structure, internal consistency, and predictive validity in terms of self-reported crashes were examined. In Study 4 I demonstrated the utility of a contingent valuation (CV) survey in measuring, understanding, and therefore addressing the perceived value of rider training amongst novice riders. The four studies highlight that the appropriateness of self-report depends on not only the nature of the phenomenon under study but the extent to which the factors that contribute to validity and reliability are accounted for in the design of self-report measures