Washington: Round 1 - State-Level Field Network Study of the Implementation of the Affordable Care Act

This report is part of a series of 21 state and regional studies examining the rollout of the ACA. The national network -- with 36 states and 61 researchers -- is led by the Rockefeller Institute of Government, the public policy research arm of the State University of New York, the Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania.The state of Washington is expanding its Medicaid program and operating its own health insurance marketplace, as authorized by the Patient Protection and Affordable Care Act (ACA). The state legislature made the decision to run an insurance exchange in 2011, ahead of the June 2012 Supreme Court decision on the ACA's constitutionality, and well in advance of the 2012 presidential election. On July 1, 2013, Governor Jay Inslee signed the state's biennial budget, which authorized Medicaid expansion. Thus began the formal action signaling Washington State's intent to fully implement the ACA

The provision of informal care in terminal illness: An analysis of carers? needs using a discrete choice experiment

There is an increasing expectation that families will provide care at home for those with chronic, acute and terminal illness. There is a range of services available to support the home care of these patients. Carers of those in the terminal phase of illness face different demands and challenges than those caring for the chronically ill, disabled or aging; the patient?s health is deteriorating, often rapidly, and death is imminent. Yet the needs and requirements of this group of carers has been far less studied than those caring for people with chronic and continuing conditions. We argue that considering the reciprocal nature of relationships is important in understanding the provision of informal care. Carers? feelings for which tasks and responsibilities are most difficult are not the same as their preferences for additional support services. Carers preferences are influenced by their relationship with the patient. This study investigates carers? preferences for services to support their caregiving role. Carer preferences were investigated using a discrete choice experiment, in which 168 carers were asked first to choose between two packages of care and then between the chosen package and their current support. Data were analysed using mixed logit. The DCE results showed that the support most wanted was palliative care nursing, general nursing, and telephone advice available 24 hours. Carers providing high levels of care wanted respite care provided at home and help with the patient?s personal care. Where the care-giving need was relatively low, carers wanted help with household tasks, transport and a case co-ordinator. Overall, carers appeared to be satisfied with the support they received from palliative care services, but this varied with the personal circumstances of the carer. This study provides useful insights for those who plan and deliver palliative care in the community. It supports the view that effective support for carers must recognise the differing needs of individual carers. While our results do not provide any insight into how the pre-existing relationship between carer and recipient may affect preferences for care, it points to the need to explore further differences in preferences across respondents both in discrete choice work in general, and in designing services to support rather than replace informal carers.Informal care; carer's perspective; discrete choce experiment

Using qualitative methods to validate a stated preference survey for evaluating health services, CHERE Discussion Paper No 47

This study used a qualitative approach to assess parents? opinions of a self-completed stated preference discrete choice modelling (SPDCM) questionnaire for assessing the uptake of a new childhood vaccination against chickenpox. The aim was to assess the way parents understood and used the technical information provided, the factors they deemed important to decisions about childhood immunisation and the extent to which these were consistent with the models produced by analysis of the questionnaire data. Following completion of the SPDCM questionnaire, 34 respondents participated in a semi-structured interview by telephone. Interview transcripts were analysed using content analysis. Comparisons were then made with the SPDCM questionnaire results. The technical information used to describe the program attributes appeared to be used appropriately by respondents, although their explanations indicated that their understanding did not always come from the questionnaire information. Only one respondent appeared to misunderstand the stated preference task, and a small number thought that the complexity and length should be reduced. The group results for the questionnaire data were supported by the qualitative study, with the notable features of the model being reflected in the views commonly expressed about the immunisation decision. Generally, the study provides support for the potential usefulness of the SPDCM methodology for predicting the uptake of a new vaccination.Discrete choice modelling, questionnaires, methodology

Non-United States Firms\u27 Exchange Rate Exposure and the Pricing of Exchange Rate Risk in Foreign Stock Markets

This two part dissertation is an in depth study of the measurement of foreign currency economic exposure faced by foreign firms and whether or not this exposure is associated with significant risk premia within these firms\u27 national equity markets. Firms from four foreign countries; Germany, the United Kingdom, Japan and Canada are classified as purely domestic firms, exporters with low (20%-39%) percentages of foreign sales to total sales, exporters with high (over 40%) percentages of foreign sales to total sales, or multinational corporations. Essay I focuses on the economic exposure of these non-US firms. Foreign exchange rate volatility can impact a firm\u27s cash flows and discount rate. Economic exposure can therefore effect the firm\u27s long run profitability, consequentially producing changes in shareholder\u27s wealth. We find that while purely domestic and low exporting firms are not typically exposed to exchange rate changes, high exporting and multinational firms are. Although the level of this exposure varies across exchange rates, it is consistently positive. The percent foreign sales to total sales is a significant determinant of this exposure. We also find that country specific domestic market indexes explain more of the various sample variances than does a world market index. Essay II extends the Chen, Roll, and Ross (1986) multi-factor pricing model to the four national equity markets represented by the firms in Essay I. Multi-factor pricing tests are run on sub-samples designated by the primary trading activities previously describes, as well as on well diversified samples for each country. The results indicate that exchange rate change is not a diversifiable risk in the equity markets of Germany and Japan. We also find that the significant pricing of exchange rate risk is not consistently based upon underlying levels of economic exposure

Pulp-based computing: A framework for building computers out of paper

In this video, we describe a series of techniques for building sensors, actuators and circuit boards that behave, look, and feel like paper. By embedding electro-active inks, conductive threads and smart materials directly into paper during the papermaking process, we have developed seamless composites that are capable of supporting new and unexpected application domains in ubiquitous and pervasive computing at affordable costs