Willingness to Pay for Health Insurance in the Informal Sector of Sierra Leone

Purpose: The objective of this project is to study the willingness to pay (WTP) for health insurance (HI) of individuals working in the informal sector in Sierra Leone, using a purposely-designed survey of a representative sample of this sector. Methods: We elicit the WTP using the Double-Bounded Dichotomous Choice with Follow Up method. We also examine the factors that are positively and negatively associated with the likelihood of the respondents to answer affirmatively to joining a HI scheme and to paying three different possible premiums, to join the HI scheme. We additionally analyze the individual and household characteristics associated with the maximum amount the household is willing to pay to join the HI scheme. Results: The results indicate that the average WTP for the HI is 20,237.16 SLL (3.6 USD) per adult but it ranges from about 14,000 SLL (2.5 USD) to about 35,000 SLL (6.2 USD) depending on region, occupation, household and respondent characteristics. The analysis of the maximum WTP indicates that living outside the Western region and working in farming instead of petty trade are associated with a decrease in the maximum premium respondents are WTP for the HI scheme. Instead, the maximum WTP is positively associated to being a driver or a biker; having secondary or tertiary education (as opposed to not having any); the number of pregnant women in the household; having a TV; and, having paid for the last medical requirement. Conclusions: In summary, the various analyses show that a premium for the HI package could be set at approximately 20,000 SLL (3.54 USD) but also that establishing a single premium for all individuals in the informal sector could be risky. The efficient functioning of a HI scheme relies on covering as much of the population as possible, in order to spread risks and make the scheme viable. The impact of the various population characteristics raises the issue of how to rate premiums. In other words, setting a premium that may be too high for a big proportion of the population could mean losing many potential enrollees and might have viability consequences for the operation of the scheme

Anorexia, Body Image and Peer Effects: Evidence from a Sample of European Women

Excessive preoccupation with self-image (or identity) is regarded as a factor contributing to the proliferation of food disorders, especially among young women. This paper models how self-image and peer effects influence health-related behaviours, specifically food disorders. We empirically test this claim using data from the European survey. Our findings suggest that the larger the peers‟ body-mass, the lower the likelihood of being anorexic. Self-image is correlated with body weight. We use several definitions of peers‟ body mass and we find that all are negatively associated with the likelihood of women being thin or extremely thin

Consequences of Biomarker Analysis on the Cost-Effectiveness of Cetuximab in Combination with FOLFIRI as a First-Line Treatment of Metastatic Colorectal Cancer: Personalised Medicine at Work

Background Therapies may be more efficacious when targeting a patient subpopulation with specific attributes, thereby enhancing the cost-effectiveness of treatment. In the CRYSTAL study, patients with metastatic colorectal cancer (mCRC) were treated with cetuximab plus FOLFIRI or FOLFIRI alone until disease progression, unacceptable toxic effects or withdrawal of consent. Objective To determine if stratified use of cetuximab based on genetic biomarker detection improves cost-effectiveness. Methods We used individual patient data from CRYSTAL to compare the cost-effectiveness, cost per life-year (LY) and cost per quality-adjusted LY (QALY) gained of cetuximab plus FOLFIRI versus FOLFIRI alone in three cohorts of patients with mCRC: all randomised patients (intent-to-treat; ITT), tumours with no detectable mutations in codons 12 and 13 of exon 2 of the KRAS protein (‘KRAS wt’) and no detectable mutations in exons 2, 3 and 4 of KRAS and exons 2, 3 and 4 of NRAS (‘RAS wt’). Survival analysis was conducted using RStudio, and a cost-utility model was modified to allow comparison of the three cohorts. Results The deterministic base-case ICER (cost per QALY gained) was £130,929 in the ITT, £72,053 in the KRAS wt and £44,185 in the RAS wt cohorts for cetuximab plus FOLFIRI compared with FOLFIRI alone. At a £50,000 willingness-to-pay threshold, cetuximab plus FOLFIRI has a 2.8, 20 and 63% probability of being cost-effective for the ITT, KRAS wt and RAS wt cohorts, respectively, versus FOLFIRI alone. Conclusion Screening for mutations in both KRAS and NRAS may provide the most cost-effective approach to patient selection

A Discrete Choice Experiment to Elicit the Willingness to Pay for Health Insurance by the Informal Sector Workers in Sierra Leone

The current health care financing system in Sierra Leone is unsustainable and poses challenges ranging from increased in out of pocket health care expenditure to accessibility problems, particularly in rural areas where living standards are low and health care facilities are scarce. This paper investigates whether privately financed health Insurance can improve the accessibility to formal health care in Sierra Leone and mitigate the effects of OOPs on poor households. To do so, we estimate the Willingness To Pay (WTP) for health insurance among informal sector workers in Sierra Leone using a Discrete Choice Experiment approach. Eight informal sector activities were selected namely – petty trading, subsistence farming, commercial bike riding, cattle rearing, fishing, tailoring, mining and quarrying. A random effect logit model is used to estimate households’ WTP for an improvement in coverage, choice of health care provider and a reduction in waiting time. Our study reveals that households were WTP more to have better attributes (better coverage, less waiting time) and to go to a faith - based provider. Our findings also suggest that location – rural versus urban – matters in determining the WTP since urban households were WTP more for health insurance than their rural counterparts, (SLL 54,348 or $7.34) and (SLL 37,250.5 or$5.03), respectively

Assessing seismic safety from a justice standpoint

Disasters occur when a hazard interacts with an exposed and vulnerable society or community, whose capacities to cope with the hazardous event are exceeded. The fact that large, damaging earthquakes impact different segments of society disproportionately can be perceived as an injustice. Conceptualizing this problem within the domain of justice implies a recognition that its source is the result of an unequal social system formed by a long sequence of human decisions, and not by God’s or nature’s desires. The discussion of disaster justice is still nascent, with the term itself being coined only in 2010. However, disaster justice can be understood as a concern of how the crisis and systemic collapse caused by disasters bring issues of socioecological justice to the front. Disaster justice stems from, builds on, and refers to some of the concepts and claims of environmental and climate justice, but expands them to address the scale, scope, dynamics, and challenges that are particular to disaster contexts as opposed to normal times. This article presents the different frameworks of social justice in the context of environmental hazards (i.e., environmental, climate, and disaster justice) and opens the discussion about how justice claims can be incorporated into the discussion and practice of providing seismic safety and increasing disaster resilience

100 MHz Amplitude and Polarization Modulated Optical Source for Free-Space Quantum Key Distribution at 850 nm

We report on an integrated photonic transmitter of up to 100 MHz repetition rate, which emits pulses centered at 850 nm with arbitrary amplitude and polarization. The source is suitable for free space quantum key distribution applications. The whole transmitter, with the optical and electronic components integrated, has reduced size and power consumption. In addition, the optoelectronic components forming the transmitter can be space-qualified, making it suitable for satellite and future space missions.Comment: 6 figures, 2 table

Understanding earthquake resilience in Chile: The pros and cons of safe buildings

Chile is one of the most seismic yet also one of the most earthquake-resilient countries in the world. This article seeks to understand the process of resilience building in the country and its implications for urban contexts. For this purpose, semi-structured interviews are conducted to 16 Chilean experts from the fields of seismic engineering, urban planning, emergency management and disaster risk reduction (DRR), and representatives from different public and private stakeholders (e.g., academics, practitioners, public servants, local government authorities). Results show that the main approach that the Chilean state has used to provide seismic resilience has been purely rational, by means of safe and high-quality buildings. This has led to earthquake risk being essentially absent from the urban planning regulation. Although this approach has provided good overall results in time, over-reliance in seismic safety of buildings has contributed to a weak national DRR system which failed its most recent test after the 2010 earthquake and tsunami. The increasing complexity and concentration of people and assets in cities, together with the dynamism of knowledge about local seismicity are challenging this rational approach. Thus, a call for a more comprehensive approach for seismic resilience provision arises, which based on the successfully provided safe buildings could also tackle the social and political dimensions of earthquake risk in urban contexts

The temporal dynamics of resource use by frugivorous birds: a network approach

Ecological network patterns are influenced by diverse processes that operate at different temporal rates. Here we analyzed whether the coupled effect of local abundance variation, seasonally phenotypic plastic responses, and species evolutionary adaptations might act in concert to shape network patterns. We studied the temporal variation in three interaction properties of bird species (number of interactions per species, interaction strength, and interaction asymmetry) in a temporal sequence of 28 plant frugivore interaction networks spanning two years in a Mediterranean shrubland community. Three main hypotheses dealing with the temporal variation of network properties were tested, examining the effects of abundance, switching behavior between alternative food resources, and morphological traits in determining consumer interaction patterns. Our results demonstrate that temporal variation in consumer interaction patterns is explained by short-term variation in resource and bird abundances and seasonal dietary switches between alternative resources (fleshy fruits and insects). Moreover, differences in beak morphology are associated with differences in switching behavior between resources, suggesting an important role of foraging adaptations in determining network patterns. We argue that beak shape adaptations might determine generalist and specialist feeding behaviors and thus the positions of consumer species within the network. Finally, we provide a preliminary framework to interpret phylogenetic signal in plant animal networks. Indeed, we show that the strength of the phylogenetic signal in networks depends on the relative importance of abundance, behavioral, and morphological variables. We show that these variables strongly differ in their phylogenetic signal. Consequently, we suggest that moderate and significant phylogenetic effects should be commonly observed in networks of species interactions. Read More: http://www.esajournals.org/doi/abs/10.1890/07-1939.

UWB MST MEMS-based near-field imaging system

In this paper a new family of illuminators and MST measurement architectures is presented and the di erent aspects are studied.Peer ReviewedPostprint (author’s final draft