Health Insurance Eligibility, Utilization of Medical care, and Child Health

The poor health status of children in the U.S. relative to other industrialized nations has motivated recent efforts to extend insurance coverage to underprivileged children. There is little past evidence that extending eligibility for public insurance to previously ineligible groups will increase health status or even utilization of medical resources. Using data from the Current Population Survey, the National Health Interview Survey, and state-level data on child mortality, we examine the utilization and health effects of eligibility for public insurance. Our models are identified by the recent expansions of the Medicaid program to low income children. We find that these expansions roughly doubled the fraction of children eligible for Medicaid between 1984 and 1992; by 1992, almost 1/3 of all children were eligible. But takeup of these expansions was much less than full even among otherwise uninsured children. Despite this takeup problem, we find that eligibility for Medicaid significantly increased the utilization of medical care along a number of dimensions. Medicaid eligibility was associated with large increases in care delivered in physician's offices, although there was some increase in care in hospital settings as well. While there was no effect of eligibility on parentally-assessed subjective health measures, we do find notable reductions in child mortality. Finally, we find that rising Medicaid eligibility is associated with reductions in racial disparities in the number of visits and in child disparities in the site at which care is delivered.

INSTITUTIONAL EFFECTS OF COMPARATIVE GOVERNMENT REGULATION FOR THE PROTECTION AND PRIVACY OF HEALTH DATA IN THE CLOUD

This research is a comparative study of the institutional effects of regulatory and compliance issues surrounding cloud computing in healthcare. Our focus is on health care organizations and the IT industry, and how these two important stakeholders interpret and apply the privacy and security rules from the U.S. and EU. As an institutional environment, healthcare is experiencing coercive, normative and mimetic isomorphic pressures on macro, meso and micro levels. International governments are seeking ways to build capacity in the cloud computing market, yet they are faced with difficult issues in relation to privacy and security of personal data. Our findings suggest that regulatory and compliance is being developed ‘in response to’ rather than ‘in anticipation of’ technical change. Normative pressures to encourage healthcare organizations to develop effective data protection and privacy policies to comply with new regulatory change are further complicated in an environment where cloud data may be transferred across different legal and regulatory jurisdictions. Our findings show that healthcare organizations and cloud providers need to work more closely together as business associates. However, translating HIPAA and EU rules and regulations into practice is thwarted by a lack of legal and regulatory knowledge, particularly in the smaller organizations

A CROSS-COUNTRY STUDY OF CLOUD COMPUTING POLICY AND REGULATION IN HEALTHCARE

International health IT policy currently supports the move towards cloud computing. Governments, industry leaders and advocacy groups are keen to build confidence among health professionals to adopt cloud-based solutions in healthcare. However, the potential benefits from cloud computing need to be evaluated against the risks. This research is a comparative study on U.S and EU health professionals´ views on the potential benefits and risks from cloud computing. The results from surveying healthcare organizations in the U.S and five EU countries (France, Germany, the Netherlands, Sweden and the UK) identify differences across countries in health IT policy, incentives for adoption, privacy and security, and trust in third party suppliers. Our findings show that privacy and security are important issus for healthcare organizations, yet differences exist between the U.S and across EU Member States in how these concepts are viewed. U.S laws and EU Directives on data protection are more advanced than other international regulatory systems. Our study provides insights on cross-jurisdictional approaches to personal data and privacy, regulations and rules on health data export, how countries interpret and implement different data protection regulations and rules, and the practical implementation of regulatory rules using a comparative research method. \

Unpacking the Societal and Institutional Risks of Crypto Assets: The Policy-Innovation Nexus

The Crypto Winter of 2022 exposed multi-dimensional risks in the crypto ecosystem which extend beyond technical imperatives to include societal and institutional factors. A domino effect saw several major crypto firms losing large amounts of investor cash or becoming bankrupt. This practitioner focused study adopts a grounded methodology to gather empirical data from regulators, crypto firms, and investors on developing a policy framework for crypto assets. The case study context is the US regulatory environment. Findings show regulatory agencies face ideological, operational, and technical obstacles, as they engage in debates about the efficacy of competing regulatory scenarios. The paper presents two major tensions which require the attention of policy makers and legislators to mitigate future societal and institutional risks from crypto assets

TECHNOLOGY LEAPFROGGING IN EUROPEAN HEALTH SYSTEMS: POLICY IMPLICATIONS FOR THE DIGITAL DIVIDE

The 27 Member States of the European Union are highly differentiated by population size, health expenditure, technology access and use, economic profile and demographics. This study builds on earlier digital-divide studies using a ICT and digital health taxonomy that positions countries as frontrunners (quartile 1), followers (quartile 2), leapfroggers (quartile 3), and laggards (quartile 4). The concept of technology leapfrogging is used to analyse the digital divide in Europe’s health systems. Results from multivariate statistical analysis show evidence of technology leapfrogging in some EU countries. However, digital health policy implications show a one-size-fits-all approach to digital health is unlikely to produce optimal outcomes. Rather, EU policy-makers will need to develop nuanced digital health policies which go beyond measuring technical imperatives

Digital Transformation in Europe: An Analysis of the Digital Divide in e-Commerce and e-Government

The study analyzes the digital divide across 29 European countries using data from Eurostat in the context of EU policy to promote digital transformation in e-commerce and e-government. Using multivariate statistical methods, findings show continuing digital performance asymmetries with countries clustered into three groupings: leaders, followers, and laggards. As access to information and communications technology increases among Europe’s citizens, the drive towards digital transformation will only be achieved by increasing patterns of use through the development of fit-for-purpose digital platforms, websites, and applications

The Stellar Population of h and chi Persei: Cluster Properties, Membership, and the Intrinsic Colors and Temperatures of Stars

(Abridged) From photometric observations of $\sim$ 47,000 stars and spectroscopy of $\sim$ 11,000 stars, we describe the first extensive study of the stellar population of the famous Double Cluster, h and $\chi$ Persei, down to subsolar masses. Both clusters have E(B-V) $\sim$ 0.52--0.55 and dM = 11.8--11.85; the halo population, while more poorly constrained, likely has identical properties. As determined from the main sequence turnoff, the luminosity of M supergiants, and pre-main sequence isochrones, ages for h Persei, $\chi$ Persei and the halo population all converge on $\approx$ 14 Myr. From these data, we establish the first spectroscopic and photometric membership lists of cluster stars down to early/mid M dwarfs. At minimum, there are $\sim$ 5,000 members within 10' of the cluster centers, while the entire h and $\chi$ Persei region has at least $\sim$ 13,000 and as many as 20,000 members. The Double Cluster contains $\approx$ 8,400 M$_{\odot}$ of stars within 10' of the cluster centers. We estimate a total mass of at least 20,000 M$_{\odot}$. We conclude our study by outlining outstanding questions regarding the properties of h and $\chi$ Persei. From comparing recent work, we compile a list of intrinsic colors and derive a new effective temperature scale for O--M dwarfs, giants, and supergiants.Comment: 88 pages, many figures, Accepted for publication in The Astrophysical Journal Supplements. Contact lead author for version with high-resolution figure

Gene fragmentation in bacterial draft genomes: extent, consequences and mitigation

<p/> <p>Background</p> <p>Ongoing technological advances in genome sequencing are allowing bacterial genomes to be sequenced at ever-lower cost. However, nearly all of these new techniques concomitantly decrease genome quality, primarily due to the inability of their relatively short read lengths to bridge certain genomic regions, e.g., those containing repeats. Fragmentation of predicted open reading frames (ORFs) is one possible consequence of this decreased quality. In this study we quantify ORF fragmentation in draft microbial genomes and its effect on annotation efficacy, and we propose a solution to ameliorate this problem.</p> <p>Results</p> <p>A survey of draft-quality genomes in GenBank revealed that fragmented ORFs comprised > 80% of the predicted ORFs in some genomes, and that increased fragmentation correlated with decreased genome assembly quality. In a more thorough analysis of 25 <it>Streptomyces </it>genomes, fragmentation was especially enriched in some protein classes with repeating, multi-modular structures such as polyketide synthases, non-ribosomal peptide synthetases and serine/threonine kinases. Overall, increased genome fragmentation correlated with increased false-negative Pfam and COG annotation rates and increased false-positive KEGG annotation rates. The false-positive KEGG annotation rate could be ameliorated by linking fragmented ORFs using their orthologs in related genomes. Whereas this strategy successfully linked up to 46% of the total ORF fragments in some genomes, its sensitivity appeared to depend heavily on the depth of sampling of a particular taxon's variable genome.</p> <p>Conclusions</p> <p>Draft microbial genomes contain many ORF fragments. Where these correspond to the same gene they have particular potential to confound comparative gene content analyses. Given our findings, and the rapid increase in the number of microbial draft quality genomes, we suggest that accounting for gene fragmentation and its associated biases is important when designing comparative genomic projects.</p

Catching the Banksters: The Use of Big Data Analytics in Billion Dollar Regulatory Investigations

Following the financial crisis, emboldened regulators have increased the magnitude of fines levied for financial malfeasance. The automation of the data discovery process underpins the rise in internal investigations, which financial organizations are obliged to conduct on the behest of regulators, keen to reduce information asymmetries and bolster transparency. Yet little research exists into the technologies which underpin post-crisis regulatory agendas. Our study focuses on big data technologies (eDiscovery tools) which facilitate investigations, where rare yet serious breaches have occurred. We focus on the micro/data level (volume, veracity, variety and velocity) to understand how these tools are influencing regulatory outcomes. The findings illustrate the need for financial organizations to adopt robust information governance policies to ease future investigatory efforts. We identify various practices which may help compliance managers better respond to regulatory investigations faster and more easily to ease the burden of post-crisis regulation