The New Politics of US Health Care Prices: Institutional Reconfiguration and the Emergence of All-Payer Claims Databases

Prices are a significant driver of health care cost in the United States. Existing research on the politics of health system reform has emphasized the limited nature of policy entrepreneurs’ efforts at solving the problem of rising prices through direct regulation at the state level. Yet this literature fails to account for how change agents in the states gradually reconfigured the politics of prices, forging new, transparency-based policy instruments called all-payer claims databases (APCDs), which are designed to empower consumers, purchasers, and states to make informed market and policy choices. Drawing on pragmatist institutional theory, this article shows how APCDs emerged as the dominant model for reforming health care prices. While APCD advocates faced significant institutional barriers to policy change, we show how they reconfigured existing ideas, tactical repertoires, and legal-technical infrastructures to develop a politically and technologically robust reform. Our analysis has important implications for theories of how change agents overcome structural barriers to health reform

Instrument constituencies and public policy-making: An introduction

For many years, policy-making has been envisioned as a process in which subsets of policy actors engage in specific types of interactions involved in the definition of policy problems, the articulation of solutions and their matching or enactment. This activity involves the definition of policy goals (both broad and specific), the creation or identification of the means and mechanisms that need to be implemented to realize these goals, and the set of bureaucratic, partisan, electoral and other political struggles involved in their acceptance and transformation into action. While past research on policy subsystems has often assumed or implied that these tasks could be undertaken by any actor, more recent research argues that distinct sets of actors are involved in these three tasks: epistemic communities that are engaged in discussions about policy dilemmas and problems; instrument constituencies that define and promote policy instruments and alternatives; and advocacy coalitions which compete to have their choice of policy alternative and problem frames adopted. Two of these three sets of actors are quite well known and, indeed, have their own literature about what it takes to be a member of an epistemic community or advocacy coalition, although interactions between the two are rarely discussed. The third subset, the instrument constituency, is much less known but has from the outset been considered in relation to these other policy actors. The articles in this special issue focus on better understanding the nature of actor interactions undertaken by instrument constituencies and how these relate to the other kinds of actors involved in policy-making

Scaling the laws of thermal imaging-based whale detection

Author Posting. © American Meteorological Society, 2020. This article is posted here by permission of American Meteorological Society for personal use, not for redistribution. The definitive version was published in Journal of the Atmospheric and Oceanic Technology 37(5), (2020): 807-824, doi:10.1175/JTECH-D-19-0054.1.Marine mammals are under growing pressure as anthropogenic use of the ocean increases. Ship strikes of large whales and loud underwater sound sources including air guns for marine geophysical prospecting and naval midfrequency sonar are criticized for their possible negative effects on marine mammals. Competent authorities regularly require the implementation of mitigation measures, including vessel speed reductions or shutdown of acoustic sources if marine mammals are sighted in sensitive areas or in predefined exclusion zones around a vessel. To ensure successful mitigation, reliable at-sea detection of animals is crucial. To date, ship-based marine mammal observers are the most commonly implemented detection method; however, thermal (IR) imaging–based automatic detection systems have been used in recent years. This study evaluates thermal imaging–based automatic whale detection technology for its use across different oceans. The performance of this technology is characterized with respect to environmental conditions, and an automatic detection algorithm for whale blows is presented. The technology can detect whales in polar, temperate, and subtropical ocean regimes over distances of up to several kilometers and outperforms marine mammal observers in the number of whales detected. These results show that thermal imaging technology can be used to assist in providing protection for marine mammals against ship strike and acoustic impact across the world’s oceans.This work was funded by the Office of Naval Research (ONR) under Award N000141310856, by the Environmental Studies Research Fund (ESRF; esrfunds.org) under Award 2014-03S and by the Alfred-Wegener-Institute Helmholtz Zentrum für Polar- und Meeresforschung. DPZ and OB declare competing financial interests: 1) Patent US8941728B2, DE102011114084B4: A method for automatic real-time marine mammal detection. The patent describes the ideas basic to the automatic whale detection software as used to acquire and process the data presented in this paper. 2) Licensing of the Tashtego automatic whale detection software to the manufacturer of IR sensor. The authors confirm that these competing financial interests did not alter their adherence good scientific practice. We thank P. Abgrall, J. Coffey, K. Keats, B. Mactavish, V. Moulton, and S. Penney-Belbin for data collection or IR image review. We thank S. Besaw, J. Christian, A. Coombs, P. Coombs, W. Costello, T. Elliott, E. Evans, I. Goudie, C. Jones, K. Knowles, R. Martin, A. Murphy, D. and J. Shepherd; and the staffs at the Irish Loop Express, the Myrick Wireless Interpretive Centre, the Mistaken Point Ecological Reserve, and the lighthouse keepers for logistical assistance at our remote field site. We thank D. Boutilier and B. McDonald (DFO) for assisting us in obtaining license to occupy permits for Cape Race. We thank D. Taylor (ESRF Research Manager) for his support

Health insurance, neighborhood income, and emergency department usage by Utah children 1996–1998

BACKGROUND: It is estimated that approximately half of emergency department (ED) usage in the U.S. and other developed countries is for non-urgent conditions and that this usage is related to availability, social, and economic factors. We examined pediatric ED usage in a U.S. state with respect to income, health insurance status, types of medical conditions, and whether introduction of managed care affected utilization by Medicaid children. METHODS: Emergency department usage rates were calculated from 1996 through 1998 using Utah ED data for children with commercial health insurance, Medicaid, for uninsured children, and by income group estimating neighborhood household income from Zip code of residence. We analyzed usage following the July 1996 transition of Utah Medicaid to managed care. RESULTS: Children with Medicaid had approximately 50% greater ED utilization rates than children with commercial health insurance or uninsured children. The majority of usage for Medicaid and uninsured children was for non-traumatic conditions. Only 35% of total ED usage was for non-emergent or non-urgent conditions and this was related to both Medicaid and low household income. Children lacking health insurance were more likely to be discharged against medical advice (OR = 2.36, 95% C.I. 1.88–2.96). There was no reduction in Medicaid ED usage following the transition to managed care. CONCLUSION: Usage of ED services is related to both health insurance status and income. Children lacking health insurance and Medicaid children have excessive usage for conditions which could be treated in a primary care setting. That managed care does not reduce Medicaid ED usage is consistent with findings of other studies

The Cosmic Origins Spectrograph

The Cosmic Origins Spectrograph (COS) is a moderate-resolution spectrograph with unprecedented sensitivity that was installed into the Hubble Space Telescope (HST) in May 2009, during HST Servicing Mission 4 (STS-125). We present the design philosophy and summarize the key characteristics of the instrument that will be of interest to potential observers. For faint targets, with flux F(sub lambda) approximates 1.0 X 10(exp -14) ergs/s/cm2/Angstrom, COS can achieve comparable signal to noise (when compared to STIS echelle modes) in 1-2% of the observing time. This has led to a significant increase in the total data volume and data quality available to the community. For example, in the first 20 months of science operation (September 2009 - June 2011) the cumulative redshift pathlength of extragalactic sight lines sampled by COS is 9 times that sampled at moderate resolution in 19 previous years of Hubble observations. COS programs have observed 214 distinct lines of sight suitable for study of the intergalactic medium as of June 2011. COS has measured, for the first time with high reliability, broad Lya absorbers and Ne VIII in the intergalactic medium, and observed the HeII reionization epoch along multiple sightlines. COS has detected the first CO emission and absorption in the UV spectra of low-mass circumstellar disks at the epoch of giant planet formation, and detected multiple ionization states of metals in extra-solar planetary atmospheres. In the coming years, COS will continue its census of intergalactic gas, probe galactic and cosmic structure, and explore physics in our solar system and Galaxy

Mapping changing distributions of dominant species in oil-contaminated salt marshes of Louisiana using imaging spectroscopy

The April 2010 Deepwater Horizon (DWH) oil spill was the largest coastal spill in U.S. history. Monitoring subsequent change in marsh plant community distributions is critical to assess ecosystem impacts and to establish future coastal management priorities. Strategically deployed airborne imaging spectrometers, like the Airborne Visible/Infrared Imaging Spectrometer (AVIRIS), offer the spectral and spatial resolution needed to differentiate plant species. However, obtaining satisfactory and consistent classification accuracies over time is a major challenge, particularly in dynamic intertidal landscapes.Here, we develop and evaluate an image classification system for a time series of AVIRIS data for mapping dominant species in a heavily oiled salt marsh ecosystem. Using field-referenced image endmembers and canonical discriminant analysis (CDA), we classified 21 AVIRIS images acquired during the fall of 2010, 2011 and 2012. Classification results were evaluated using ground surveys that were conducted contemporaneously to AVIRIS collection dates. We analyzed changes in dominant species cover from 2010 to 2012 for oiled and non-oiled shorelines.CDA discriminated dominant species with a high level of accuracy (overall accuracy=82%, kappa=0.78) and consistency over three imaging dates (overall2010=82%, overall2011=82%, overall2012=88%). Marshes dominated by Spartina alterniflora were the most spatially abundant in shoreline zones (â¤28m from shore) for all three dates (2010=79%, 2011=61%, 2012=63%), followed by Juncus roemerianus (2010=11%, 2011=19%, 2012=17%) and Distichlis spicata (2010=4%, 2011=10%, 2012=7%).Marshes that were heavily contaminated with oil exhibited variable responses from 2010 to 2012. Marsh vegetation classes converted to a subtidal, open water class along oiled and non-oiled shorelines that were similarly situated in the landscape. However, marsh loss along oil-contaminated shorelines doubled that of non-oiled shorelines. Only S. alterniflora dominated marshes were extensively degraded, losing 15% (354,604m2) cover in oiled shoreline zones, suggesting that S. alterniflora marshes may be more vulnerable to shoreline erosion following hydrocarbon stress, due to their landscape position

THE DATA REDUCTION PIPELINE FOR THE APACHE POINT OBSERVATORY GALACTIC EVOLUTION EXPERIMENT

The Apache Point Observatory Galactic Evolution Experiment (APOGEE), part of the Sloan Digital Sky Survey III, explores the stellar populations of the Milky Way using the Sloan 2.5-m telescope linked to a high resolution (R ~ 22,500), near-infrared (1.51–1.70 µm) spectrograph with 300 optical fibers. For over 150,000 predominantly red giant branch stars that APOGEE targeted across the Galactic bulge, disks and halo, the collected high signal-to-noise ratio (>100 per half-resolution element) spectra provide accurate (~0.1 km s-1) RVs, stellar atmospheric parameters, and precise (lesssim0.1 dex) chemical abundances for about 15 chemical species. Here we describe the basic APOGEE data reduction software that reduces multiple 3D raw data cubes into calibrated, well-sampled, combined 1D spectra, as implemented for the SDSS-III/APOGEE data releases (DR10, DR11 and DR12). The processing of the near-IR spectral data of APOGEE presents some challenges for reduction, including automated sky subtraction and telluric correction over a 3°-diameter field and the combination of spectrally dithered spectra. We also discuss areas for future improvement

IARC Monographs: 40 Years of Evaluating Carcinogenic Hazards to Humans

Background: Recently, the International Agency for Research on Cancer (IARC) Programme for the Evaluation of Carcinogenic Risks to Humans has been criticized for several of its evaluations, and also for the approach used to perform these evaluations. Some critics have claimed that failures of IARC Working Groups to recognize study weaknesses and biases of Working Group members have led to inappropriate classification of a number of agents as carcinogenic to humans. Objectives: The authors of this Commentary are scientists from various disciplines relevant to the identification and hazard evaluation of human carcinogens. We examined criticisms of the IARC classification process to determine the validity of these concerns. Here, we present the results of that examination, review the history of IARC evaluations, and describe how the IARC evaluations are performed. Discussion: We concluded that these recent criticisms are unconvincing. The procedures employed by IARC to assemble Working Groups of scientists from the various disciplines and the techniques followed to review the literature and perform hazard assessment of various agents provide a balanced evaluation and an appropriate indication of the weight of the evidence. Some disagreement by individual scientists to some evaluations is not evidence of process failure. The review process has been modified over time and will undoubtedly be altered in the future to improve the process. Any process can in theory be improved, and we would support continued review and improvement of the IARC processes. This does not mean, however, that the current procedures are flawed. Conclusions: The IARC Monographs have made, and continue to make, major contributions to the scientific underpinning for societal actions to improve the public’s health

The Apache Point Observatory Galactic Evolution Experiment (APOGEE)

The Apache Point Observatory Galactic Evolution Experiment (APOGEE), one of the programs in the Sloan Digital Sky Survey III (SDSS-III), has now completed its systematic, homogeneous spectroscopic survey sampling all major populations of the Milky Way. After a three-year observing campaign on the Sloan 2.5 m Telescope, APOGEE has collected a half million high-resolution (R ~ 22,500), high signal-to-noise ratio (>100), infrared (1.51–1.70 μm) spectra for 146,000 stars, with time series information via repeat visits to most of these stars. This paper describes the motivations for the survey and its overall design—hardware, field placement, target selection, operations—and gives an overview of these aspects as well as the data reduction, analysis, and products. An index is also given to the complement of technical papers that describe various critical survey components in detail. Finally, we discuss the achieved survey performance and illustrate the variety of potential uses of the data products by way of a number of science demonstrations, which span from time series analysis of stellar spectral variations and radial velocity variations from stellar companions, to spatial maps of kinematics, metallicity, and abundance patterns across the Galaxy and as a function of age, to new views of the interstellar medium, the chemistry of star clusters, and the discovery of rare stellar species. As part of SDSS-III Data Release 12 and later releases, all of the APOGEE data products are publicly available