Does a mandatory telemedicine call prior to visiting a physician reduce costs or simply attract good risks?

This paper aims to estimate empirically the efficiency of a Swiss telemedicine service introduced in 2003. We used claims' data gathered by a major Swiss health insurer, over a period of six years and involving 160 000 insured adults. In Switzerland, health insurance is mandatory, but everyone has the option of choosing between a managed care plan and a fee-for-service plan. The present paper focuses on a conventional fee-for-service plan including a mandatory access to a telemedicine service; the insured are obliged to phone this medical call centre prior to visiting a physician. This type of plan generates much lower average health expenditures than a conventional insurance plan. Reasons for this may include selection, incentive effects or simply efficiency. In our sample, about 90% of the difference in health expenditure can be explained by selection and incentive effects. The remaining 10% of savings due to the efficiency of the telemedicine service amount to about SFr 150 per year per insured, of which approx. 60% is saved by the insurer and 40% by the insured. While the plan is cost-effective, the big winners are the insured who not only save monetary and non-monetary costs, but also benefit from reduced premiums.health, insurance, selection, efficiency, telemedicine

Chromaticity in all-reflective telescopes for astrometry

Chromatic effects are usually associated with refractive optics, so reflective telescopes are assumed to be free from them. We show that all-reflective optics still bears significant levels of such perturbations, which is especially critical to modern micro-arcsecond astrometric experiments. We analyze the image formation and measurement process to derive a precise definition of the chromatic variation of the image position, and we evaluate the key aspects of optical design with respect to chromaticity. The fundamental requirement related to chromaticity is the symmetry of the optical design and of the wavefront errors. Finally, we address some optical engineering issues, such as manufacturing and alignment, providing recommendations to minimize the degradation that chromaticity introduces into astrometry.Comment: 10 pages, 8 figure

A Score Test for Individual Heteroscedasticity in a One-way Error Components Model

The purpose of this paper is to derive a Rao's efficient score statistic for testing for heteroscedasticity in an error components model with only individual effects. We assume that the individual effect exists and therefore do not test for it. In addition, we assume that the individual effects, and not the white noise term may be heteroscedastic. Finally, we assume that the error components are normally distributed. We first establish, under a specific set of assumptions, the asymptotic distribution of the Score under contiguous alternatives. We then derive the expression for the Score test statistic for individual heteroscedasticity. Finally, we discuss the asymptotic local power of this Score test statistic.panel data; error components model; score test; individual heteroscedasticity: contiguous alternatives; asymptotic local power

Separating selection and incentive effects in health insurance

This paper provides an analysis of the health insurance and health care consumption. A structural microeconomic model of joint demand for health insurance and health care is developed and estimated using full maximum likelihood method using Swiss insurance claims data for over 60 000 adult individuals. The estimation strategy relies on the institutional features of the Swiss system, in which each individual chooses among the same menu of contracts, ranked by the size of their deductible. The empirical analysis shows strong and robust evidence of selection effects. Nevertheless, once selection effects are controlled for, an important incentive effect ("ex-post moral hazard") remains. A decrease in the copayment rate from 100% to 10% increases the marginal demand for health care by about 90% and from 100% to 0% by about 150%. The correlation between insurance coverage and health care expenditures may be decomposed into the two effects: 75% may be attributed to selection, and 25 % to incentive effects.health insurance ; demand for health care ; moral hazard ; adverse selection ; full maximum likelihood estimation

About the beginnings of wireless

Many scientists and engineers contributed - more or less successfully - to the development of radio and wireless. This historical survey describes briefly the projects realized more than a century ago by some of them, at the early beginnings of wireless. It is hoped, in this manner, to draw attention to the unknown or forgotten researchers who built up the considerable body of knowledge that led to Marconi's remarkable achievement

Effect of dietary sunflower meal, fish meal, and vitamin E on turkeys uninfected and infected with stunting syndrome

Experiments were conducted to determine whether feeding diets of different ingredient composition to poults could reduce severity of experimentally-induced stunting syndrome (SS). One-day-old poults were dosed per os with either saline or an inoculum of a homogenate prepared using intestines from SS-infected poults. Diets containing 14% sunflower meal (SFM) or 10% fish meal (FM) and two dietary concentrations of vitamin E (VE), 12 IU VE/kg of diet (LE) and 800 IU VE/kg of diet (HE) were evaluated with uninfected (UI) and infected (I) poults in 21-day experiments, starting at 1 day of age. SS depressed (P \u3c.01) body weight (BW) from 5 to 21 days of age in all experiments, and impaired feed efficiency (FE) until 9 days of age, irrespective of treatments. Feeding either FM or SFM improved (P \u3c.05) BW up to 5 and 13 days of age, respectively, in both UI and I poults. Poults fed FM or SFM had better (P \u3c.01) FE from 1 to 5 and 9 to 13 days of age. HE increased (P \u3c.05) BW of poults from 9 to 21 days of age, however, HE did not improve FE at any age. SS increased (P \u3c.05) liver [alpha]-tocopherol concentration in the first experiment. In the second experiment, however, there was no effect of SS on liver [alpha]-tocopherol but plasma [alpha]-tocopherol concentration decreased (P \u3c.05). HE increased (P \u3c.01) the concentrations of [alpha]-tocopherol in liver and plasma at all ages. Similarly, HE increased the concentration of [alpha]-tocopherol in the very low density lipoprotein (VLDL) and low density lipoprotein (LDL) fractions from 5 days and that of the high density lipoprotein (HDL) from 9 days of age until 21 days. These effects were consistent, irrespective of type of inoculation or diet, in overcoming the usual early posthatching depletion suffered by the young poults when LE was fed

"TraVajo" : análisis de la vinculación entre políticas sociales y trabajo trans

Esta investigación, trata sobre la situación laboral del colectivo trans en San Juan en un marco de análisis crítico, biopolítico y descolonial. El contexto de análisis se desarrolla en marco de las políticas sociales de identidad de género generadas desde el 2012 con la Ley 26.743 (Ley de Identidad de Género). Con la intención de pensar al cuerpo y las corporalidades como vehículos u obstáculos para la vida digna de los seres. Entendiendo que la heteronormatividad, el capitalismo somete y mercantiliza los cuerpos, en función de segmentar y encorsetar a los cuerpos no privilegiados en trabajos especificos. La investigación es relevante en el actual debate en el seno mismo del feminismo latinoamericano entre trabajo sexual o abolicionismo. Es importante, analizar este proceso desde un pensamiento crítico, alejándose de los discursos homogéneos y binarios que se imponen. Es por ello que se propone un análisis cualitativo y cuantitativo sobre indicadores de trabajo, profundizando sobre las experiencias de este colectivo mediante entrevistas a sus protagonistas, procurando a la vez, un análisis de la conflictividad, las intersecciones y las condiciones laborales trans.Fil: Gardiol, Alejandra. Universidad Nacional de San Juan