Insurer-Provider Networks in the Medical Care Market

Managed care health insurers in the US restrict their enrollees' choice of hospitals to specific networks. This paper investigates the causes and welfare effects of the observed hospital networks. A simple profit maximization model explains roughly 63 per cent of the observed contracts between insurers and hospitals. I estimate a model that includes an additional effect: hospitals that do not need to contract with all insurance plans to secure demand (for example, providers that are capacity constrained under a limited or selective network) may demand high prices that not all insurers are willing to pay. Hospitals can merge to form "systems" which may also affect bargaining between hospitals and insurance plans. The analysis estimates the expected division of profits between insurance plans and different types of hospitals using data on insurers' choices of network. Hospitals in systems are found to capture markups of approximately 19 per cent of revenues, in contrast to non-system, non-capacity constrained providers, whose markups are assumed to be about zero. System members also impose high penalties on plans that exclude their partners. Providers that are expected to be capacity constrained capture markups of about 14 per cent of revenues. I show that these high markups imply an incentive for hospitals to under-invest in capacity despite a median benefit to consumers of over $330,000 per new bed per year.

The Welfare Effects of Restricted Hospital Choice in the US Medical Care Market

Managed care health insurers in the US restrict their enrollees' choice of hospitals to within specific networks. This paper considers the implications of these restrictions. A three-step econometric model is used to predict consumer preferences over health plans conditional on the hospitals they offer. The results indicate that consumers place a positive and significant weight on their expected utility from the hospital network when choosing plans. A welfare analysis, assuming fixed prices, implies that restricting consumers' choice of hospitals leads to a loss to society of approximately $1 billion per year across the 43 US markets considered. This figure may be outweighed by the price reductions generated by the restriction.

On the improvement of cosmological neutrino mass bounds

The most recent measurements of the temperature and low-multipole polarization anisotropies of the Cosmic Microwave Background (CMB) from the Planck satellite, when combined with galaxy clustering data from the Baryon Oscillation Spectroscopic Survey (BOSS) in the form of the full shape of the power spectrum, and with Baryon Acoustic Oscillation measurements, provide a $95\%$ confidence level (CL) upper bound on the sum of the three active neutrinos $\sum m _\nu< 0.183$ eV, among the tightest neutrino mass bounds in the literature, to date, when the same datasets are taken into account. This very same data combination is able to set, at $\sim70\%$ CL, an upper limit on $\sum m _\nu$ of $0.0968$ eV, a value that approximately corresponds to the minimal mass expected in the inverted neutrino mass hierarchy scenario. If high-multipole polarization data from Planck is also considered, the $95\%$ CL upper bound is tightened to $\sum m _\nu< 0.176$ eV. Further improvements are obtained by considering recent measurements of the Hubble parameter. These limits are obtained assuming a specific non-degenerate neutrino mass spectrum; they slightly worsen when considering other degenerate neutrino mass schemes. Current cosmological data, therefore, start to be mildly sensitive to the neutrino mass ordering. Low-redshift quantities, such as the Hubble constant or the reionization optical depth, play a very important role when setting the neutrino mass constraints. We also comment on the eventual shifts in the cosmological bounds on $\sum m_\nu$ when possible variations in the former two quantities are addressed.Comment: 9 pages, 3 figures, 2 table

Analyzing the Welfare Impacts of Full-line Forcing Contracts

Theoretical investigations have examined both anti-competitive and efficiency-inducing rationales for vertical bundling, making empirical evidence important to understanding its welfare implications. We use an extensive dataset on full-line forcing contracts between movie distributors and video retailers to empirically measure the impact of vertical bundling on welfare. We identify and measure three primary effects of fullline forcing contracts: market coverage, leverage, and efficiency. We find that bundling increases market coverage and efficiency, but has little impact on one distributor gaining leverage over another. As a result, we estimate that full-line forcing contracts increased consumer and producer surplus in this application.

The Use of Full-line Forcing Contracts in the Video Rental Industry

We provide an empirical study of bundling in a supply chain, referred to as fullline forcing. We use an extensive dataset on contracts between video retailers and movie distributors to analyze the choices made on both sides of the market: which distributors offer full-line forcing contracts, which retailers take them up, and whether their decisions are profitable. Most large distributors offer full-line forcing contracts in our data. Our simulations indicate that their choices of which contracts to offer are profit-maximizing. However, many retailers prefer to utilize linear pricing contracts even when our model indicates that this may not be profit-maximizing.

An economic analysis of options for utilising additional land on a high rainfall Gippsland dairy farm

A range of options for utilising additional land on a dairy farm in the high rainfall area of Gippsland were analysed. The aim was to determine if additional land may assist the owners/operators in maintaining or increasing profit in the medium term (5-10 years). Historical trends have been towards fewer, larger, more intensive enterprises, and this project studies the value of additional land in continuing or altering this trend. A case study farm and spreadsheet modelling approach was used to examine these issues. Five different uses for additional land were identified by an expert steering committee, and were compared to the base farm system over a 10-year development period. The results suggest that expanding the milking area by purchasing additional land without a significant increase in herd size (2A) increased annual operating profit by approximately $70,000/year without increasing variability when compared to the base farm system. This was the only option examined to earn a high enough internal rate of return on additional capital investment to justify the investment without capital gains. Additional milking area with a substantial increase in stocking rate (2C) significantly reduced annual operating profit (by approximately$70,000/year) and notably increased the variability of these returns. The purchase of an outblock for conserved fodder production improved profitability, but would require some capital gains to be an attractive option on profit measures alone. The most appropriate changes to dairy farm businesses in response to changes in the operating environment will vary from farm to farm. The analysis indicated that simple following previous industry trends may not be appropriate on many farms. Optimising the amount of home grown feed and efficiently using purchased supplements are important, particularly if the milk produced is subject to the fluctuations of an export milk price.Farm Management,

New Insights into Stroke from Continuous Passively Collected Temperature and Sleep Data Using Wrist-Worn Wearables

Actigraphy may provide new insights into clinical outcomes and symptom management of patients through passive, continuous data collection. We used the GENEActiv smartwatch to passively collect actigraphy, wrist temperature, and ambient light data from 27 participants after stroke or probable brain transient ischemic attack (TIA) over 42 periods of device wear. We computed 323 features using established algorithms and proposed 25 novel features to characterize sleep and temperature. We investigated statistical associations between the extracted features and clinical outcomes evaluated using clinically validated questionnaires to gain insight into post-stroke recovery. We subsequently fitted logistic regression models to replicate clinical diagnosis (stroke or TIA) and disability due to stroke. The model generalization performance was assessed using a leave-one-subject-out cross validation method with the selected feature subsets, reporting the area under the curve (AUC). We found that several novel features were strongly correlated (|r|>0.3) with stroke symptoms and mental health measures. Using selected novel features, we obtained an AUC of 0.766 to estimate diagnosis and an AUC of 0.749 to estimate whether disability due to stroke was present. Collectively, these findings suggest that features extracted from the temperature smartwatch sensor may reveal additional clinically useful information over and above existing actigraphy-based features

Terapia cognitivo conductual grupal con niños y niñas a nivel primario que presentan el trastorno de comportamiento perturbador no especificado, entre 8 y 12 años, del Centro Educativo Nuevo Arraiján, Panamá Oeste

La investigación realizada consistió en un estudio con diseño cuasi experimental con un solo grupo con pre y post test aplicado a 8 niños de nivel primario que oscilan entre 8 a 12 años de edad, quienes presentan en el aula de clases trastornos de comportamiento perturbador no especificado y fueron referidos por los docentes de las asignaturas de español, inglés y educación física. Para ello, se aplican la Escala de Alteración del Comportamiento (ACE) y la Evaluación del Trastornos por Déficit Atencional (EDAH). Una vez seleccionada la población para la investigación, se organiza una reunión con los padres, con la finalidad de explicar el estudio y conocer la participación de ellos. Posteriormente, se aplica a la muestra seleccionada, un pre test para registrar las conductas perturbadoras por las cuales fueron referidos por los docentes. Después de haber realizado 10 sesiones de terapia cognitivo conductual grupal; estas son analizadas a través de la prueba no paramétrica de Wilcoxon basándose en un muestreo, es decir, se hace una exploración a la población seleccionada como muestra de la investigación con la finalidad de describir las conductas perturbadoras que presentan. El análisis de los resultados muestra que la intervención psicoterapéutica cognitivo conductual grupal en los niños con el trastorno de comportamiento perturbador no especificado fue eficaz

Food science and technology students self-evaluate soft and technical skills

Food Scientists and Technologists (FS&T) need diverse skills in the globalized food and drink sector: Food-specific or scientific / technical skills and generic or intuitive soft skills. This study determined how satisfied FS&T students were with overall improvement, and in key technical and soft skills, based on their university work; and if satisfaction was linked to geography, degree in progress, anticipated degree, anticipated work place or anticipated job responsibility. An on-line survey was completed by 267 students in over 20 countries using a 5-point Likert scale to evaluate satisfaction. Responses were analyzed by the Friedman or Kruskal Wallis tests for more than two groups, otherwise by the Wilcoxon Signed Rank or Mann-Whitney tests. There were no differences in Overall Satisfaction with technical and soft skills training. Among soft skills, training in Working with Others and Being Responsible were more often rated “Excellent” and students were more satisfied with their training than with Solving Problems, Communication and Positive Attitude. Students anticipating a job with high responsibility were more satisfied with overall soft skill training and with 3 of the 5 specific soft skills. Among technical skills, students were more satisfied with improvement in basic sciences (Microbiology, Chemistry, Processing, Safety), and those in Northern Europe were more satisfied with overall technical training. These data show variations in perception and/or efficacy of technical and soft skill training in Food Science programmes and underline the need for separate attention to the incorporation of soft skill training into the design of FS&T coursesinfo:eu-repo/semantics/publishedVersio