Value Based Cost Sharing Meets the Theory of Moral Hazard: Medical Effectiveness in Insurance Benefits Design

The conventional theory of optimal coinsurance rates in health insurance in the presence of moral hazard indicates that, in situations of equal risk characteristics, coinsurance should vary if the price-responsiveness or price-elasticity of demand for different medical services varies, and should be larger for the more price responsive services. An alternative theory called "value-based cost sharing" indicates that coinsurance should be lower for services with higher (marginal) benefits relative to costs. This paper reconciles the two views. It shows that, if patient demands are based on correct information on benefits and costs, the conclusion of the conventional view is identical to the conclusion from the value-based approach. If patient demands differ from correct demands, it is shown that optimal coinsurance depends both on the extent and direction of information imperfection and on price-responsiveness or price elasticity. The paper also shows, as an alternative to adjusting coinsurance to deal with information imperfection, that providing better information which affects patient demands can be superior if uninformed patient demands exceed informed patient demands, but value based cost sharing can be superior to providing information (even if the cost of information is minimal) when patient demands fall short of informed demands. An extended numerical example illustrates these points.

Putting geography into phycology: recent advances

In the last decade, ecological and biogeographical studies (mainly terrestrial) have greatly benefited from recent developments in geographical techniques, and numerous test cases have been published. However, very few phycological studies emphasizing ecology and biogeography have incorporated these techniques, using traditional, nonspatially explicit descriptive and multivariate statistics instead. Here, we show a satellitebased seasonal mapping study of macroalgal communities in the Arabian Sea, and a global species’ distribution modelling effort of a cryptic green algal complex forming worldwide blooms on physically damaged coral reefs. We demonstrate how spatially explicit information contributes to more efficient work and new insights in marine ecology and biogeography, and comment on why previous studies did not include geographical techniques. Lastly, we briefly discuss future perspectives of spatially explicit phycological studies

Time and Life: Applications of Modern Chronobiology

Chronobiology is that branch of science which objectively quantifies and explores mechanisms of biological time structure. It is an integrating discipline that impacts on all forms of life. When physiological functions are plotted along a time scale, they appear as regularly repetitive wave forms with means, amplitudes, phasing and periods. In nature these rhythms are found to have many frequencies, from a fraction of a second (ultradian) to a year or more (infradian or circannual); and those with periods of about one day (circadian) have been explored extensively. Examples of several circadian rhythms are given for experimental animals and man. Evidence is presented to show that it is particularly important to consider biological rhythmicity when interpreting experimental results or attempting to extrapolate from one species to another. An organism is indeed a different biochemical and morphological entity at different times, and it may be expected to react differently to a stimulus at different circadian phases. By taking advantage of natural rhythms in the susceptability to drugs, it is possible to optimize chemotherapy and radiotherapy for cancer and other diseases

Conduction Channels of One-Atom Zinc Contacts

We have determined the transmission coefficients of atomic-sized Zn contacts using a new type of breakjunction which contains a whisker as a central bridge. We find that in the last conductance plateau the transport is unexpectedly dominated by a well-transmitting single conduction channel. We explain the experimental findings with the help of a tight-binding model which shows that in an one-atom Zn contact the current proceeds through the 4s and 4p orbitals of the central atom.Comment: revtex4, 5 pages, 5 figure

Use of Root Cause Analysis in Nursing Education: Best Practice from the Quality and Safety Officer

Teaching nursing students to be safe in practice is a key element to any nursing curriculum. This article will discuss the use of a Root Cause Analysis (RCO) framework with prelicensure nursing students, by the Quality and Safety Officer (QSO) in a School of Nursing and Health Professions, as a method to enhance transparency and improve patient safety. The aim is to provide a rationale for using this strategy, to identify the steps of a root cause analysis, to disclose barriers to its successful use, and to explore dissemination to the partnering healthcare environments

How to Enroll in Medicare Part D Prescription Drug Insurance After May 15, 2006

If you did not meet the May 15, 2006, deadline for open initial enrollment in Medicare Part D Prescription Drug Insurance, what can you do to get enrolled? This depends on your income, Medicare enrollment status, existing prescription drug coverage, and possible change of residence. Find the statement that best describes your situation to determine your options for enrollment in Medicare Part D

First measurements of the index of refraction of gases for lithium atomic waves

We report here the first measurements of the index of refraction of gases for lithium waves. Using an atom interferometer, we have measured the real and imaginary part of the index of refraction $n$ for argon, krypton and xenon, as a function of the gas density for several velocities of the lithium beam. The linear dependence of $(n-1)$ with the gas density is well verified. The total collision cross-section deduced from the imaginary part is in very good agreement with traditional measurements of this quantity. Finally, as predicted by theory, the real and imaginary parts of $(n-1)$ and their ratio $\rho$ exhibit glory oscillations

Experiences of aiding autobiographical memory Using the SenseCam

Human memory is a dynamic system that makes accessible certain memories of events based on a hierarchy of information, arguably driven by personal significance. Not all events are remembered, but those that are tend to be more psychologically relevant. In contrast, lifelogging is the process of automatically recording aspects of one's life in digital form without loss of information. In this article we share our experiences in designing computer-based solutions to assist people review their visual lifelogs and address this contrast. The technical basis for our work is automatically segmenting visual lifelogs into events, allowing event similarity and event importance to be computed, ideas that are motivated by cognitive science considerations of how human memory works and can be assisted. Our work has been based on visual lifelogs gathered by dozens of people, some of them with collections spanning multiple years. In this review article we summarize a series of studies that have led to the development of a browser that is based on human memory systems and discuss the inherent tension in storing large amounts of data but making the most relevant material the most accessible

Addressing Gaps in Quality and Safety Education during Pre-Licensure Clinical Rotations

United States national reports have called for improvement in healthcare professions education to better address patient care outcomes. In response, an initiative titled “Quality and Safety Education for Nurses (QSEN)” has been adopted by nursing programs across the nation, which describes the six main competencies to be included in nursing curricula. As early adopters of the QSEN competencies, the University of San Francisco nursing faculty promptly threaded the material throughout the 4-year Bachelor’s of Science in Nursing (BSN) curriculum. Confident that the topics were well covered in the classroom, we then sought to learn how often our students practiced these skills during their assigned clinical rotations. After completing an IRB-approved observational study of junior-level BSN students, we tallied the actual number of minutes spent in each competency area while assigned to the patient care unit. Using a time-on-task author developed QSEN-based tool, we found that our students spent little to no time engaged in quality improvement, evidence based practice, or informatics. This is a very important finding, as it indicates that our students may not be sufficiently developing these particular skills during assigned clinical hours. Weaving the six QSEN competencies throughout the curriculum is a good start, but as we saw in our observational study, all of the competencies are not equally demonstrated in the clinical setting. Continuing to provide QSEN enriched didactic courses, adding targeted simulation experiences, and nourishing academic/practice partnerships may help bridge the gaps