Diffusion of Competing Innovations: The Effects of Network Structure on the Provision of Healthcare

Medical innovations, in the form of new medication or other clinical practices, evolve and spread through health care systems, impacting on the quality and standards of health care provision, which is demonstrably heterogeneous by geography. Our aim is to investigate the potential for the diffusion of innovation to influence health inequality and overall levels of recommended care. We extend existing diffusion of innovation models to produce agent-based simulations that mimic population-wide adoption of new practices by doctors within a network of influence. Using a computational model of network construction in lieu of empirical data about a network, we simulate the diffusion of competing innovations as they enter and proliferate through a state system comprising 24 geo-political regions, 216 facilities and over 77,000 individuals. Results show that stronger clustering within hospitals or geo-political regions is associated with slower adoption amongst smaller and rural facilities. Results of repeated simulation show how the nature of uptake and competition can contribute to low average levels of recommended care within a system that relies on diffusive adoption. We conclude that an increased disparity in adoption rates is associated with high levels of clustering in the network, and the social phenomena of competitive diffusion of innovation potentially contributes to low levels of recommended care.Innovation Diffusion, Scale-Free Networks, Health Policy, Agent-Based Modelling

Prices, Production and Inventories over the Automotive Model Year

This paper studies the within-model-year pricing and production of new automobiles. Using new monthly data on U.S. transaction prices, we document that for the typical new vehicle, prices fall over the model year at a 9.2 percent annual rate. Concurrently, both sales and inventories are hump shaped. To explain these time series, we formulate a market equilibrium model for new automobiles in which inventory and pricing decisions are made simultaneously. On the demand side, we use micro-level data to estimate time-varying aggregate demand curves for each vehicle. On the supply side, we solve a dynamic programming model of an automaker that, while able to produce only one vintage of a product at a time, may accumulate inventories and consequently sell multiple vintages of the same product simultaneously. The profit maximizing pricing and production strategies under a build-to-stock inventory policy imply declining prices and hump-shaped sales and inventories of the magnitudes observed in the data. Further, roughly half of the price decline is driven by inventory control considerations, as opposed to decreasing demand.

Plant trait effects on tidal wetland methane emission

High rates of carbon (C) sequestration exhibited by coastal wetlands is an important natural climate solution to global environmental change. At the same time, however, wetlands are the largest natural source of methane (CH4) to Earth’s atmosphere, a potent greenhouse gas that influences the global climate. Wetland CH4 emissions display high degrees of uncertainty in accounting for spatial and temporal variations in emissions due to the complex interactions between biotic and abiotic factors that influence methane production and transport, in addition to simultaneous influences from climate-driven effects on wetlands such as rapid sea level rise and increased atmospheric carbon dioxide concentration. Recent reports indicate that stratifying wetland CH4 emissions by dominant plant community reduces uncertainty, which is partially due to interspecific plant traits that both respond to global change factors and have direct and indirect influences on wetland methane production and emission. In this thesis, I compared CH4 flux rates between plant communities in a tidal brackish marsh that has undergone a drastic sea level rise-driven shift in plant community structure and I described CH4 flux patterns using biotic and abiotic factors known to influence CH4 production and emission. Contrary to previous reports from this system that higher elevation, Spartina patens-rich areas released more CH4 than other regions, low elevation plots composed of Schoenoplectus americanus released CH4 at the fastest rates in this study. I attributed this to the enlargement of the belowground carbon pool via Schoenoplectus radial oxygen loss (ROL) and subsequent stimulation of aerobic respiration. In addition, I provide evidence that the same mechanism of ROL-induced aerobic respiration led to greater CH4 emissions under elevated atmospheric carbon dioxide (eCO2) conditions. This work contributes to a growing body of literature that elucidates a mechanistic understanding of carbon cycling in tidal wetland ecosystems that will continue to change in plant species composition, trait adaptations, and location via upland transgression under a changing climate

Medical Care Expenditure Indexes: A Comparison of Indexes using MarketScan and Pharmetrics Data

In recent years, healthcare service utilization has undergone several shifts, having potentially important implications for the cost of medical care.

Utilising games to generate awareness regarding gender inequality in parliament

The paper highlights gender inequality within the context of the European parliament using a wicked problems approach. Gender parity in parliament engages with issues of ethics, human rights and democracy, such issues benefit from raising awareness and instigating discussion techniques. Our study proposes the application of games and the use of game mechanics, dynamics and rhetorics as a medium to initiate engagement and understanding towards gender parity in parliament. Specific focus is given to the justification of the game’s type, design and development as an appropriate tool for addressing gender inequality issues. This is presented through the empirical analysis of prototypes and engaging with current research (gamification, gameful design, procedural rhetoric). Utilising games as a medium to induce an emotional response within an artificial environment enables the user to engage with feelings of unfairness and frustration. We suggest an indirect method that enables a user-centered physical experience within an artificial environment to address the volatile issue of inequality, informed by multiple perspectives. Our aim is to develop a digital game that enables players to experience the unequal state of women’s representation in parliament today and that encourages collaboration to overcome inequality as a win condition

Findings from Health-e-App Public Access and Implications for ACA Implementation

California will implement the key enrollment expansions of the Patient Protection and Affordable Care Act (ACA) in January 2014, with preenrollment beginning in October 2013.The state will expand Medicaid, known as Medi-Cal in California, to include previously ineligible adults with incomes up to 138 percent of the federal poverty level. It will also launch a Health Insurance Marketplace, known as Covered California. Individuals, families,and small businesses can purchase insurance through Covered California, and those with low and moderate incomes may qualify for tax credits and cost-sharing subsidies. As many as 1.6 million Californians could gain health insurance coverage through the expansion of Medi-Cal. Approximately 2.6 million Californians are expected to qualify for credits or subsidies through Covered California, and another 2.7 million could enroll and benefit from guaranteed coverage.California is creating a new, statewide enrollment system to support this historic coverage expansion. The system, known as the California Healthcare Eligibility, Enrollment, and Retention System or CalHEERS, must accommodate consumer needs and preferences for ease, convenience, and assistance. The system must also enable the state to efficiently process an anticipated influx of applications and promptly notify consumers of their eligibility. Self-service online applications, required by the ACA, are one promising way to meet the dual goal of consumer friendliness and system efficiency. They could be an important source of applications for coverage.California has experience with self-service online enrollment, most notably through the statewide Health-e-App Public Access (HeA PA) system. HeA PA was introduced in December 2010 for Healthy Families, California's Children's Health Insurance Program (CHIP), and now is used for Medi-Cal for Families. Applicants can access HeA PA wherever and whenever they use the Internet. Available in English and Spanish, HeA PA automatically checks for errors and omissions and directs applicants only to questions that apply to them. The fully automated HeA PA eliminates most manual data entry and reduces the time that application processors spend pursuing complete or correct information from applicants.Mathematica Policy Research, Inc. has studied the first year of HeA PA implementation and presented findings in four research briefs. Although the circumstances surrounding the launch of HeA PA were quite different from the eligibility expansion, enrollment-system change, and mass outreach now under way in California, key findings from the HeA PA study have implications for ACA implementation in California and other states. HeA PA contributed to growth in program applications, was used and well received by a segment of Internet-connected applicants, and complemented the system of assisted-online applications that many applicants used. Each page of this final brief presents a key study finding and potential implications