Measuring and decomposing inequity in self-reported morbidity and self-assessed health in Thailand

BACKGROUND In recent years, interest in the study of inequalities in health has not stopped at quantifying their magnitude; explaining the sources of inequalities has also become of great importance. This paper measures socioeconomic inequalities in self-reported morbidity and self-assessed health in Thailand, and the contributions of different population subgroups to those inequalities. METHODS The Health and Welfare Survey 2003 conducted by the Thai National Statistical Office with 37,202 adult respondents is used for the analysis. The health outcomes of interest derive from three self-reported morbidity and two self-assessed health questions. Socioeconomic status is measured by adult-equivalent monthly income per household member. The concentration index (CI) of ill health is used as a measure of socioeconomic health inequalities, and is subsequently decomposed into contributing factors. RESULTS The CIs reveal inequality gradients disadvantageous to the poor for both self-reported morbidity and self-assessed health in Thailand. The magnitudes of these inequalities were higher for the self-assessed health outcomes than for the self-reported morbidity outcomes. Age and sex played significant roles in accounting for the inequality in reported chronic illness (33.7 percent of the total inequality observed), hospital admission (27.8 percent), and self-assessed deterioration of health compared to a year ago (31.9 percent). The effect of being female and aged 60 years or older was by far the strongest demographic determinant of inequality across all five types of health outcome. Having a low socioeconomic status as measured by income quintile, education and work status were the main contributors disadvantaging the poor in self-rated health compared to a year ago (47.1 percent) and self-assessed health compared to peers (47.4 percent). Residence in the rural Northeast and rural North were the main regional contributors to inequality in self-reported recent and chronic illness, while residence in the rural Northeast was the major contributor to the tendency of the poor to report lower levels of self-assessed health compared to peers. CONCLUSION The findings confirm that substantial socioeconomic inequalities in health as measured by self-reported morbidity and self-assessed health exist in Thailand. Decomposition analysis shows that inequalities in health status are associated with particular demographic, socioeconomic and geographic population subgroups. Vulnerable subgroups which are prone to both ill health and relative poverty warrant targeted policy attention

Stochastic model of demand for medical care with endogenous labour supply and health insurance

The paper proposes a model of demand for medical care under uncertainty. Both health capital and wealth are modelled as Wiener processes. The model uses a continuous time stochastic optimisation technique to derive optimal solutions for consumption, leisure and medical care. Insurance against uncertain medical expenditure is then incorporated into the optimization problem under the assumption of constant relative risk aversion of the value function, and constant elasticity, relative risk aversion and relative prudence of the health investment function. The optimal solution is shown to depend on the curvature of the value function, the curvature of the health investment technology, and variances of the stochastic shocks. Dynamic simulations of the model are carried out

Health insurance and demand for medical care : theory and application to Australia

Private health insurance plays an important role in Australian health care finance, complementing the universal health insurance system, Medicare, established in 1984. The road to the current health insurance system was long and winding, filled with political passions and debates. This study covers the major historical steps leading to the introduction of Medicare, and analyses specific features of the Australian private health insurance sector. After the recent policy change, regulations of the private health insurance industry were somewhat eased, and a new range of benefits permitted to be provided. This thesis seeks to analyse the likely effects of the policies, and develops a theoretical model which adds to the existing literature on the demand for health. Studies of demand for medical care and health insurance constitute an important part of the health economics literature. Grossman’s theory of demand for health has become a major framework for the analysis. Generalisations of the Grossman model to incorporate uncertainty about health status and insurance against medical expenditure are major challenges for theoretical economists working in this area. This thesis proposes a new dynamic continuous time stochastic optimisation model of demand for medical care, in which uncertainty about health and wealth is modelled by correlated Wiener processes. Consumption and leisure decisions are included in the model. A health insurance contract with coinsurance rate is introduced in this model, and a two-stage procedure of choosing an optimal ex-ante coinsurance rate, and optimal ex-post amount of medical care, consumption and leisure is discussed. The theoretical model is then applied to the 1993-94 Household Expenditure Survey, Australia. Even though the full structure of the model cannot be tested on this dataset, some empirical evidence is found in support of the new theoretical model. A two-part bivariate probit model and quantile regression analysis allowed the estimation of the income elasticity of demand for medical care and health insurance, which was shown to vary with income. To study the quantitative effect of the recent policy change based on the new theoretical model, a finer level of data is needed

Pressing Issues of Unlawful Application of Artificial Intelligence

The article discusses the problematic aspects of the implementation and application of artificial intelligence technology at the present stage of its development. The authors provide definitions of this technology, with its essential properties revealed based on their analysis. Criminological forecasting helps identify groups of crimes most likely to be committed through the use of artificial intelligence. The authors believe that at present there are not sufficient grounds for distancing ourselves from the issue of the subject of criminal liability in case of damage to public relations directly by the AI, but there are no circumstances due to which its resolution would not be delayed. The system of criminal law relations must be built based on scientifically developed provisions. The problems of criminal legal regulation, in terms of the impossibility of criminalizing and penalizing socially dangerous acts committed by artificial intelligence, are revealed. The legislator is asked to develop and adopt legal acts regulating the creation, operation, and use of artificial intelligence

Impact of horizontal resolution on global ocean–sea ice model simulations based on the experimental protocols of the Ocean Model Intercomparison Project phase 2 (OMIP-2)

This paper presents global comparisons of fundamental global climate variables from a suite of four pairs of matched low- and high-resolution ocean and sea ice simulations that are obtained following the OMIP-2 protocol (Griffies et al., 2016) and integrated for one cycle (1958–2018) of the JRA55-do atmospheric state and runoff dataset (Tsujino et al., 2018). Our goal is to assess the robustness of climate-relevant improvements in ocean simulations (mean and variability) associated with moving from coarse (∼ 1∘) to eddy-resolving (∼ 0.1∘) horizontal resolutions. The models are diverse in their numerics and parameterizations, but each low-resolution and high-resolution pair of models is matched so as to isolate, to the extent possible, the effects of horizontal resolution. A variety of observational datasets are used to assess the fidelity of simulated temperature and salinity, sea surface height, kinetic energy, heat and volume transports, and sea ice distribution. This paper provides a crucial benchmark for future studies comparing and improving different schemes in any of the models used in this study or similar ones. The biases in the low-resolution simulations are familiar, and their gross features – position, strength, and variability of western boundary currents, equatorial currents, and the Antarctic Circumpolar Current – are significantly improved in the high-resolution models. However, despite the fact that the high-resolution models “resolve” most of these features, the improvements in temperature and salinity are inconsistent among the different model families, and some regions show increased bias over their low-resolution counterparts. Greatly enhanced horizontal resolution does not deliver unambiguous bias improvement in all regions for all models

Impact of increased resolution on Arctic Ocean simulations in Ocean Model Intercomparison Project phase 2 (OMIP-2)

This study evaluates the impact of increasing resolution on Arctic Ocean simulations using five pairs of matched low- and high-resolution models within the OMIP-2 (Ocean Model Intercomparison Project phase 2) framework. The primary objective is to assess whether a higher resolution can mitigate typical biases in low-resolution models and improve the representation of key climate-relevant variables. We reveal that increasing the horizontal resolution contributes to a reduction in biases in mean temperature and salinity and improves the simulation of the Atlantic water layer and its decadal warming events. A higher resolution also leads to better agreement with observed surface mixed-layer depth, cold halocline base depth and Arctic gateway transports in the Fram and Davis straits. However, the simulation of the mean state and temporal changes in Arctic freshwater content does not show improvement with increased resolution. Not all models achieve improvements for all analyzed ocean variables when spatial resolution is increased so it is crucial to recognize that model numerics and parameterizations also play an important role in faithful simulations. Overall, a higher resolution shows promise in improving the simulation of key Arctic Ocean features and processes, but efforts in model development are required to achieve more accurate representations across all climate-relevant variables.</p

North Atlantic simulations in Coordinated Ocean-ice Reference Experiments phase II (CORE-II). Part I: Mean states

Simulation characteristics from eighteen global ocean–sea-ice coupled models are presented with a focus on the mean Atlantic meridional overturning circulation (AMOC) and other related fields in the North Atlantic. These experiments use inter-annually varying atmospheric forcing data sets for the 60-year period from 1948 to 2007 and are performed as contributions to the second phase of the Coordinated Ocean-ice Reference Experiments (CORE-II). The protocol for conducting such CORE-II experiments is summarized. Despite using the same atmospheric forcing, the solutions show significant differences. As most models also differ from available observations, biases in the Labrador Sea region in upper-ocean potential temperature and salinity distributions, mixed layer depths, and sea-ice cover are identified as contributors to differences in AMOC. These differences in the solutions do not suggest an obvious grouping of the models based on their ocean model lineage, their vertical coordinate representations, or surface salinity restoring strengths. Thus, the solution differences among the models are attributed primarily to use of different subgrid scale parameterizations and parameter choices as well as to differences in vertical and horizontal grid resolutions in the ocean models. Use of a wide variety of sea-ice models with diverse snow and sea-ice albedo treatments also contributes to these differences. Based on the diagnostics considered, the majority of the models appear suitable for use in studies involving the North Atlantic, but some models require dedicated development effort

Evaluation of global ocean–sea-ice model simulations based on the experimental protocols of the Ocean Model Intercomparison Project phase 2 (OMIP-2)

We present a new framework for global ocean- sea-ice model simulations based on phase 2 of the Ocean Model Intercomparison Project (OMIP-2), making use of the surface dataset based on the Japanese 55-year atmospheric reanalysis for driving ocean-sea-ice models (JRA55-do).We motivate the use of OMIP-2 over the framework for the first phase of OMIP (OMIP-1), previously referred to as the Coordinated Ocean-ice Reference Experiments (COREs), via the evaluation of OMIP-1 and OMIP-2 simulations from 11 state-of-the-science global ocean-sea-ice models. In the present evaluation, multi-model ensemble means and spreads are calculated separately for the OMIP-1 and OMIP-2 simulations and overall performance is assessed considering metrics commonly used by ocean modelers. Both OMIP-1 and OMIP-2 multi-model ensemble ranges capture observations in more than 80% of the time and region for most metrics, with the multi-model ensemble spread greatly exceeding the difference between the means of the two datasets. Many features, including some climatologically relevant ocean circulation indices, are very similar between OMIP-1 and OMIP- 2 simulations, and yet we could also identify key qualitative improvements in transitioning from OMIP-1 to OMIP- 2. For example, the sea surface temperatures of the OMIP- 2 simulations reproduce the observed global warming during the 1980s and 1990s, as well as the warming slowdown in the 2000s and the more recent accelerated warming, which were absent in OMIP-1, noting that the last feature is part of the design of OMIP-2 because OMIP-1 forcing stopped in 2009. A negative bias in the sea-ice concentration in summer of both hemispheres in OMIP-1 is significantly reduced in OMIP-2. The overall reproducibility of both seasonal and interannual variations in sea surface temperature and sea surface height (dynamic sea level) is improved in OMIP-2. These improvements represent a new capability of the OMIP-2 framework for evaluating processlevel responses using simulation results. Regarding the sensitivity of individual models to the change in forcing, the models show well-ordered responses for the metrics that are directly forced, while they show less organized responses for those that require complex model adjustments. Many of the remaining common model biases may be attributed either to errors in representing important processes in ocean-sea-ice models, some of which are expected to be reduced by using finer horizontal and/or vertical resolutions, or to shared biases and limitations in the atmospheric forcing. In particular, further efforts are warranted to resolve remaining issues in OMIP-2 such as the warm bias in the upper layer, the mismatch between the observed and simulated variability of heat content and thermosteric sea level before 1990s, and the erroneous representation of deep and bottom water formations and circulations. We suggest that such problems can be resolved through collaboration between those developing models (including parameterizations) and forcing datasets. Overall, the present assessment justifies our recommendation that future model development and analysis studies use the OMIP-2 framework

Evaluation of global ocean–sea-ice model simulations based on the experimental protocols of the Ocean Model Intercomparison Project phase 2 (OMIP-2)

We present a new framework for global ocean–sea-ice model simulations based on phase 2 of the Ocean Model Intercomparison Project (OMIP-2), making use of the surface dataset based on the Japanese 55-year atmospheric reanalysis for driving ocean–sea-ice models (JRA55-do). We motivate the use of OMIP-2 over the framework for the first phase of OMIP (OMIP-1), previously referred to as the Coordinated Ocean–ice Reference Experiments (COREs), via the evaluation of OMIP-1 and OMIP-2 simulations from 11 state-of-the-science global ocean–sea-ice models. In the present evaluation, multi-model ensemble means and spreads are calculated separately for the OMIP-1 and OMIP-2 simulations and overall performance is assessed considering metrics commonly used by ocean modelers. Both OMIP-1 and OMIP-2 multi-model ensemble ranges capture observations in more than 80 % of the time and region for most metrics, with the multi-model ensemble spread greatly exceeding the difference between the means of the two datasets. Many features, including some climatologically relevant ocean circulation indices, are very similar between OMIP-1 and OMIP-2 simulations, and yet we could also identify key qualitative improvements in transitioning from OMIP-1 to OMIP-2. For example, the sea surface temperatures of the OMIP-2 simulations reproduce the observed global warming during the 1980s and 1990s, as well as the warming slowdown in the 2000s and the more recent accelerated warming, which were absent in OMIP-1, noting that the last feature is part of the design of OMIP-2 because OMIP-1 forcing stopped in 2009. A negative bias in the sea-ice concentration in summer of both hemispheres in OMIP-1 is significantly reduced in OMIP-2. The overall reproducibility of both seasonal and interannual variations in sea surface temperature and sea surface height (dynamic sea level) is improved in OMIP-2. These improvements represent a new capability of the OMIP-2 framework for evaluating process-level responses using simulation results. Regarding the sensitivity of individual models to the change in forcing, the models show well-ordered responses for the metrics that are directly forced, while they show less organized responses for those that require complex model adjustments. Many of the remaining common model biases may be attributed either to errors in representing important processes in ocean–sea-ice models, some of which are expected to be reduced by using finer horizontal and/or vertical resolutions, or to shared biases and limitations in the atmospheric forcing. In particular, further efforts are warranted to resolve remaining issues in OMIP-2 such as the warm bias in the upper layer, the mismatch between the observed and simulated variability of heat content and thermosteric sea level before 1990s, and the erroneous representation of deep and bottom water formations and circulations. We suggest that such problems can be resolved through collaboration between those developing models (including parameterizations) and forcing datasets. Overall, the present assessment justifies our recommendation that future model development and analysis studies use the OMIP-2 framework.This research has been supported by the Integrated Research Program for Advancing Climate Models (TOUGOU) of the Ministry of Education, Culture, Sports, Science and Technology (MEXT), Japan (grant nos. JPMXD0717935457 and JPMXD0717935561), the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) (grant no. 274762653), the Helmholtz Climate Initiative REKLIM (Regional Climate Change) and European Union's Horizon 2020 Research & Innovation program (grant nos. 727862 and 800154), the Research Council of Norway (EVA (grant no. 229771) and INES (grant no. 270061)), the US National Science Foundation (NSF) (grant no. 1852977), the National Natural Science Foundation of China (grant nos. 41931183 and 41976026), NOAA's Science Collaboration Program and administered by UCAR's Cooperative Programs for the Advancement of Earth System Science (CPAESS) (grant nos. NA16NWS4620043 and NA18NWS4620043B), and NOAA (grant no. NA18OAR4320123).Peer ReviewedPostprint (published version

Measuring and decomposing inequity in self-reported morbidity and self-assessed health in Thailand

<p>Abstract</p> <p>Background</p> <p>In recent years, interest in the study of inequalities in health has not stopped at quantifying their magnitude; explaining the sources of inequalities has also become of great importance. This paper measures socioeconomic inequalities in self-reported morbidity and self-assessed health in Thailand, and the contributions of different population subgroups to those inequalities.</p> <p>Methods</p> <p>The Health and Welfare Survey 2003 conducted by the Thai National Statistical Office with 37,202 adult respondents is used for the analysis. The health outcomes of interest derive from three self-reported morbidity and two self-assessed health questions. Socioeconomic status is measured by adult-equivalent monthly income per household member. The concentration index (CI) of ill health is used as a measure of socioeconomic health inequalities, and is subsequently decomposed into contributing factors.</p> <p>Results</p> <p>The CIs reveal inequality gradients disadvantageous to the poor for both self-reported morbidity and self-assessed health in Thailand. The magnitudes of these inequalities were higher for the self-assessed health outcomes than for the self-reported morbidity outcomes. Age and sex played significant roles in accounting for the inequality in reported chronic illness (33.7 percent of the total inequality observed), hospital admission (27.8 percent), and self-assessed deterioration of health compared to a year ago (31.9 percent). The effect of being female and aged 60 years or older was by far the strongest demographic determinant of inequality across all five types of health outcome. Having a low socioeconomic status as measured by income quintile, education and work status were the main contributors disadvantaging the poor in self-rated health compared to a year ago (47.1 percent) and self-assessed health compared to peers (47.4 percent). Residence in the rural Northeast and rural North were the main regional contributors to inequality in self-reported recent and chronic illness, while residence in the rural Northeast was the major contributor to the tendency of the poor to report lower levels of self-assessed health compared to peers.</p> <p>Conclusion</p> <p>The findings confirm that substantial socioeconomic inequalities in health as measured by self-reported morbidity and self-assessed health exist in Thailand. Decomposition analysis shows that inequalities in health status are associated with particular demographic, socioeconomic and geographic population subgroups. Vulnerable subgroups which are prone to both ill health and relative poverty warrant targeted policy attention.</p