Essays in Health Economics and Public Finance

This dissertation focuses on topics in health economics and public finance. I deal with questions that have importance for health policy, and that are simultaneously of general economic interest; in particular, I consider the efficiency impact of privatization, the effects of competition in health care markets, and the effects of incomplete contracting and imperfect competition on rates of pass-through to consumers and governments. In Chapter One, I examine the extent to which contracting out by governments yields efficiency improvements, by looking to Medicaid contracting in New York State. To identify the efficiency impact of private, relative to public Medicaid, I exploit involuntary switching between the two; primarily, I leverage age-based rules forcing individuals to switch from private to public Medicaid at 65. I also leverage unique administrative data, which longitudinally tracks individual utilization across the public and private Medicaid settings. I find evidence that private Medicaid yields efficiency improvements, but find no evidence that these improvements are passed on to either governments or patients. Instead, I find that pass-through is substantially limited by incomplete contracting, with plans shifting costs to medical services that remain under government provision. In Chapter Two, I examine the effects of cost-sharing among a previously understudied population-those dually enrolled in Medicaid and Medicare. I leverage an exogenous court ruling that resulted in loss of Medicaid coverage in Tennessee, among 25,000 individuals who had previously been dually-enrolled. This disenrollment resulted in an increase in average cost-sharing rates, from around 0% to around 20%. I find that this cost-sharing increase resulted in a utilization reduction of about 30%, implying an arc-elasticity in spending of about -.2. In Chapter Three, with Mark Duggan and Amanda Starc, we examine how contracts are affected by their generosity, by looking to the Medicare Advantage program. In doing so, we exploit a substantial policy-induced increase in MA reimbursement in metropolitan areas with a population of 250,000 or more relative to MSAs below this threshold. Our findings also reveal that about one-eighth of the additional reimbursement is passed through to consumers in the form of better coverage

Mõõtemääramatuse hindamine Eesti massi riigietaloni laboratooriumis

Väitekirja elektrooniline versioon ei sisalda publikatsioone.Riigi mõõteinfrastruktuuri tase ja sujuv toimimine on riigi konkurentsivõime, teaduslik-tehnoloogilise suutlikkuse ja elukeskkonna turvalisuse väga oluline element. Alates 2001.a on Eestis Metroloogia keskasutuses Metrosert sisse seatud massi, pikkuse, temperatuuri ja elektriliste suuruste riigietalonid rahvusvahelisel sekundaartasemel. Reeglina kehastab mõõteetalon riigi tipptaset vastavas teaduslik-tehnilises valdkonnas, kuid selle võimalusi saab täielikult ära kasutada vaid siis, kui on kindlustatud etaloni ja nende abil osutatud mõõtetenuste mõõtemääramatuse usaldusväärne hindamine ja rahvusvaheline ekvivalentsus. Etalonide tase ja rahvusvaheline ekvivalentsus ilmneb rahvusvahelise koostöös, eelkõige hea kooskõla kaudu võrdlusmõõtmistel, kusjuures võtmeks tulemuste kooskõla hindamisel on mõõtemäätamatus. Eesti massi riigietaloni laboratoorium realiseerib ja esitab massiskaala piirkonnas 1 mg kuni 50 kg, on võimeline kalibreerima rahvusvahelise klassifikatsiooni järgi kõige täpsemate OIML E1 klassi vihtide massi ja leppelist massi. Võimalik on määrata vihtide magnetiliste omaduste vastavust täpsusklassi nõuetele ja piirkonnas 1 g kuni 2 kg kalibreerida vihtide tihedust. Laboratooriumi käsutuses on kolm automaatset massikomparaatorit, rohkem kui sada vihti ja mitmeid abimõõtevahendeid. Laboratoorium asub konditsioneeritud filtreeritud õhuga mõõteruumis, milles kontrollitakse õhu temperatuuri ja suhtelist niiskust. Mõõtmised põhinevad neljale kogu mõõtepiirkonna ulatuses hoolikalt kontrollitud mõõtemudelile. Mõõtemääramatuse hindamist hõlbustab kõigile olulistele mõõtevahenditele viieteist aasta jooksul kogunenud ulatuslik kalibreerimisajalugu. Lisaks on läbi viidud mitu spetsiaalset uurimust, mis lubavad hinnata mõõtemääramatust paremini kui rutiintöös saadavad üsna napid andmed. Mõõtemääramatuse hindamise aluseks massi riigietaloni laboratooriumis on rahvusvaheline juhend GUM. Üldiselt vastavad selle alusel saadud määramatuse hinnangud enamiku rakenduste nõuetele, kuid praktikas esineb olukordi, mille korral GUM ei anna optimaalset lahendust. Üheks keerulisemaks küsimuseks on mõõteseeria keskmise alusel määratud mõõtetulemuse määramatuse hindamine, kui seeria tulemused omavahel korreleeruvad. Teiseks mitte vähem keeruliseks probleemiks komparaatori tulemuste hindamisel on süstemaatiliste efektide kindlakstegemine ja elimineerimine või siis vähemalt nende panuse arvessevõtmine mõõtemääramatuses. Mõlemad probleemid võivad tähelepanuta jätmisel viia mõõtemääramatuse ekslikule hindamisele. Antud uurimistöös väljatöötatud meetodid võimaldavad mõlemat ohtu vähendada ja neid saab rakendada ka teistes mõõtevaldkondades. Massi riigietaloni laboratooriumi mõõtetulemuste ja määramatuse hinnangute usaldusväärsust kinnitab hea kooskõla, mida on näidatud arvukatel rahvusvahelistel võrdlustel.A high-level well-working national measurement infrastructure is essential for competitiveness of country, for the advancement of science and technology, and for quality of life. Since 2001 in Estonia at the Central Office of Metrology, Metrosert, the national standards for mass, length, temperature and electric quantities are established at the internationally secondary level. National measurement standard usually represents the top level competence of the country in respective scientific-technical field. However, in order to use its capabilities effectively confidence in the measurement uncertainty and international equivalence of offered services is needed. Technical level and international equivalence of the standard are validated by international experts on the basis of inter-comparisons and peer evaluations, whereby measurement uncertainty is a key element for meaningful determination of the degree of equivalence between the standards and measurement results. Estonian standard laboratory for mass (NSLM) is realizing and representing the mass scale from l mg to 50 kg, being able to calibrate the mass and conventional mass value of the weights with the highest OIML E1 accuracy class. NSLM can test the conformity of magnetic properties of the weights to the requirements of the respective accuracy class. NSLM can calibrate the density of the weights in the range from 1 g to 2 kg. Mass laboratory is equipped with three automatic mass comparators, with more than 100 weights, and with many auxiliary instruments; laboratory is accommodated in air-conditioned measurement rooms with temperature and humidity control, and with filtered air. At the NSLM preferably four measurement models are used; these models are carefully validated for the whole relevant measurement range. For evaluation of the uncertainty in measurement for major part of instruments extensive calibration histories are available. Additionally, some special studies are conducted, in order to get better data base for uncertainty estimation as provided by routine measurements. Uncertainty of the weights representing the mass scale at the NSLM is estimated following the GUM standard procedures. In general, uncertainty evaluated according to GUM performs satisfactorily for majority of applications. Nevertheless, there are some situations in practice allowing improvement if sufficient measurement information is available. Not easy to handle is the effect of nonzero serial correlation. Another similarly complicated problem is revealing possible systematic effects in comparator readings in order to eliminate them or at least to take them into account in measurement result and uncertainty estimate. If not treated the uncertainty may be substantially underestimated. Methods proposed in this study will at least partly solve both problems and reduce risk of underestimation, and they are applicable in many other measurement fields. The agreement between the inter-comparison results presented by the NSLM and comparison reference values demonstrated to date shows that measurement methods, calibration procedures and respective uncertainty estimates developed and tested at the NSLM can reliably be applied in practice

Eesti ja vene naiste arvamused toiduriskidest

To find out the perception of food risks among women, media analysis and interviews with Estonian and Russian women were made. Media analysis overviewed the amount and approach of articles about food risks in Postimees (Estonian newspaper) and Molodjozh Estonii (Estonian Russian language newspaper) during one year (November 2005- November 2006). I also overviewed magazines for women (two Estonian and two Russian magazines that are published in Estonia). The interviews were made with five Estonian young women who have little children and five Russian young mothers. I supposed that young mothers are more sensitive in the perception of food risks. Food risks and their perception are dependent on people personal experiences, their cultural environment, governmental activities and restrictions and such issues like media. Media analysis has showed that during one year only few articles in different media channels have entirely reflected subjects about food risks. In Russian newspaper Molodjozh Estonii was published five times less information about food risks than in Estonian Postimees. All together in four magazines only nine articles were written about food risks. Four of them were published in Russian language magazine Lada. The analysis of the interviews shows that knowledge of food risks among young women who have little children is not very high. Though everyone stated that they are trying to eat healthy food, the perception of food risks is more superficial. The most important food risks that were named - overweight, allergy, skin problems. Allergy also tends to influence very strongly the choice of food in the shop. Few respondents have stated that either they or their children have allergy on some products. The fact is that everyone has stated that with their child’s birth and with pregnancy they have changed their usual diet to healthier one. Comparing to respondents’ parents some food habits occur also now in their own family, but some habits have been changed. That means that family does not have very strong influence on personal diet, though Russian interviewees think that firstly family influences the diet strategy of children. Estonian respondents think that the whole social environment influences child’s choices (advertisement, media, school, kindergarten). Though people and media are not paying enough attention to food risks and how they can influence on us, qualitative characteristics of Estonians’ health are quiet sad. None of the respondents found it significant the threats of cardiovascular disease. The last is the first reason of people’s death in Estonia. There were no essential differences between young Estonian and Russian women, which might be explained that Russian women have lived in Estonia for quiet long time and Estonian culture is sometimes closer to them than traditional Russian culture. But Russian and Estonian women said that they prefer cooking at home and love Russian cuisine. Estonia is a multi-cultural country and Russian cuisine example shows that some traditions are mixed here. Women think that magazines and newspapers are writing about diets and give receipts (food subjects in media). They get mostly information about diets in the internet and women’s magazines. They are looking for the concrete information if they know concretely what they need to find out. But also everyone thinks that it is much better to follow your intuition and feelings while choosing the diet.http://www.ester.ee/record=b3754398*es

Comparison of Above-Water Seabird and TriOS Radiometers along an Atlantic Meridional Transect

The Fiducial Reference Measurements for Satellite Ocean Color (FRM4SOC) project has carried out a range of activities to evaluate and improve the state-of-the-art in ocean color radiometry. This paper described the results from a ship-based intercomparison conducted on the Atlantic Meridional Transect 27 from 23rd September to 5th November 2017. Two different radiometric systems, TriOS-Radiation Measurement Sensor with Enhanced Spectral resolution (RAMSES) and Seabird-Hyperspectral Surface Acquisition System (HyperSAS), were compared and operated side-by-side over a wide range of Atlantic provinces and environmental conditions. Both systems were calibrated for traceability to SI (Système international) units at the same optical laboratory under uniform conditions before and after the field campaign. The in situ results and their accompanying uncertainties were evaluated using the same data handling protocols. The field data revealed variability in the responsivity between TRiOS and Seabird sensors, which is dependent on the ambient environmental and illumination conditions. The straylight effects for individual sensors were mostly within ±3%. A near infra-red (NIR) similarity correction changed the water-leaving reflectance (ρw) and water-leaving radiance (Lw) spectra significantly, bringing also a convergence in outliers. For improving the estimates of in situ uncertainty, it is recommended that additional characterization of radiometers and environmental ancillary measurements are undertaken. In general, the comparison of radiometric systems showed agreement within the evaluated uncertainty limits. Consistency of in situ results with the available Sentinel-3A Ocean and Land Color Instrument (OLCI) data in the range from (400…560) nm was also satisfactory (-8% < Mean Percentage Difference (MPD) < 15%) and showed good agreement in terms of the shape of the spectra and absolute values

Fiducial Reference Measurements for Satellite Ocean Colour (FRM4SOC)

Earth observation data can help us understand and address some of the grand challenges and threats facing us today as a species and as a planet, for example climate change and its impacts and sustainable use of the Earth’s resources. However, in order to have confidence in earth observation data, measurements made at the surface of the Earth, with the intention of providing verification or validation of satellite-mounted sensor measurements, should be trustworthy and at least of the same high quality as those taken with the satellite sensors themselves. Metrology tells us that in order to be trustworthy, measurements should include an unbroken chain of SI-traceable calibrations and comparisons and full uncertainty budgets for each of the in situ sensors. Until now, this has not been the case for most satellite validation measurements. Therefore, within this context, the European Space Agency (ESA) funded a series of Fiducial Reference Measurements (FRM) projects targeting the validation of satellite data products of the atmosphere, land, and ocean, and setting the framework, standards, and protocols for future satellite validation efforts. The FRM4SOC project was structured to provide this support for evaluating and improving the state of the art in ocean colour radiometry (OCR) and satellite ocean colour validation through a series of comparisons under the auspices of the Committee on Earth Observation Satellites (CEOS). This followed the recommendations from the International Ocean Colour Coordinating Group’s white paper and supports the CEOS ocean colour virtual constellation. The main objective was to establish and maintain SI traceable ground-based FRM for satellite ocean colour and thus make a fundamental contribution to the European system for monitoring the Earth (Copernicus). This paper outlines the FRM4SOC project structure, objectives and methodology and highlights the main results and achievements of the project: (1) An international SI-traceable comparison of irradiance and radiance sources used for OCR calibration that set measurement, calibration and uncertainty estimation protocols and indicated good agreement between the participating calibration laboratories from around the world; (2) An international SI-traceable laboratory and outdoor comparison of radiometers used for satellite ocean colour validation that set OCR calibration and comparison protocols; (3) A major review and update to the protocols for taking irradiance and radiance field measurements for satellite ocean colour validation, with particular focus on aspects of data acquisition and processing that must be considered in the estimation of measurement uncertainty and guidelines for good practice; (4) A technical comparison of the main radiometers used globally for satellite ocean colour validation bringing radiometer manufacturers together around the same table for the first time to discuss instrument characterisation and its documentation, as needed for measurement uncertainty estimation; (5) Two major international side-by-side field intercomparisons of multiple ocean colour radiometers, one on the Atlantic Meridional Transect (AMT) oceanographic cruise, and the other on the Acqua Alta oceanographic tower in the Gulf of Venice; (6) Impact and promotion of FRM within the ocean colour community, including a scientific road map for the FRM-based future of satellite ocean colour validation and vicarious calibration (based on the findings of the FRM4SOC project, the consensus from two major international FRM4SOC workshops and previous literature, including the IOCCG white paper on in situ ocean colour radiometry)

A Review of Protocols for Fiducial Reference Measurements of Water-Leaving Radiance for Validation of Satellite Remote-Sensing Data over Water

This paper reviews the state of the art of protocols for measurement of water-leaving radiance in the context of fiducial reference measurements (FRM) of water reflectance for satellite validation. Measurement of water reflectance requires the measurement of water-leaving radiance and downwelling irradiance just above water. For the former there are four generic families of method, based on: (1) underwater radiometry at fixed depths; or (2) underwater radiometry with vertical profiling; or (3) above-water radiometry with skyglint correction; or (4) on-water radiometry with skylight blocked. Each method is described generically in the FRM context with reference to the measurement equation, documented implementations and the intra-method diversity of deployment platform and practice. Ideal measurement conditions are stated, practical recommendations are provided on best practice and guidelines for estimating the measurement uncertainty are provided for each protocol-related component of the measurement uncertainty budget. The state of the art for measurement of water-leaving radiance is summarized, future perspectives are outlined, and the question of which method is best adapted to various circumstances (water type, wavelength) is discussed. This review is based on practice and papers of the aquatic optics community for the validation of water reflectance estimated from satellite data but can be relevant also for other applications such as the development or validation of algorithms for remote-sensing estimation of water constituents including chlorophyll a concentration, inherent optical properties and related products

A review of protocols for fiducial reference measurements of water-leaving radiance for validation of satellite remote-sensing data over water

© 2019 by the authors. This paper reviews the state of the art of protocols for measurement of water-leaving radiance in the context of fiducial reference measurements (FRM) of water reflectance for satellite validation. Measurement of water reflectance requires the measurement of water-leaving radiance and downwelling irradiance just above water. For the former there are four generic families of method, based on: (1) underwater radiometry at fixed depths; or (2) underwater radiometry with vertical profiling; or (3) above-water radiometry with skyglint correction; or (4) on-water radiometry with skylight blocked. Each method is described generically in the FRM context with reference to the measurement equation, documented implementations and the intra-method diversity of deployment platform and practice. Ideal measurement conditions are stated, practical recommendations are provided on best practice and guidelines for estimating the measurement uncertainty are provided for each protocol-related component of the measurement uncertainty budget. The state of the art for measurement of water-leaving radiance is summarized, future perspectives are outlined, and the question of which method is best adapted to various circumstances (water type, wavelength) is discussed. This review is based on practice and papers of the aquatic optics community for the validation of water reflectance estimated from satellite data but can be relevant also for other applications such as the development or validation of algorithms for remote-sensing estimation of water constituents including chlorophyll a concentration, inherent optical properties and related products

A review of protocols for Fiducial Reference Measurements of downwelling irradiance for the validation of satellite remote sensing data over water

This paper reviews the state of the art of protocols for the measurement of downwelling irradiance in the context of Fiducial Reference Measurements (FRM) of water reflectance for satellite validation. The measurement of water reflectance requires the measurement of water-leaving radiance and downwelling irradiance just above water. For the latter, there are four generic families of method, using: (1) an above-water upward-pointing irradiance sensor; (2) an above-water downward-pointing radiance sensor and a reflective plaque; (3) a Sun-pointing radiance sensor (sunphotometer); or (4) an underwater upward-pointing irradiance sensor deployed at different depths. Each method-except for the fourth, which is considered obsolete for the measurement of above-water downwelling irradiance-is described generically in the FRM context with reference to the measurement equation, documented implementations, and the intra-method diversity of deployment platform and practice. Ideal measurement conditions are stated, practical recommendations are provided on best practice, and guidelines for estimating the measurement uncertainty are provided for each protocol-related component of the measurement uncertainty budget. The state of the art for the measurement of downwelling irradiance is summarized, future perspectives are outlined, and key debates such as the use of reflectance plaques with calibrated or uncalibrated radiometers are presented. This review is based on the practice and studies of the aquatic optics community and the validation of water reflectance, but is also relevant to land radiation monitoring and the validation of satellite-derived land surface reflectance

Field Intercomparison of Radiometer Measurements for Ocean Colour Validation

A field intercomparison was conducted at the Acqua Alta Oceanographic Tower (AAOT) in the northern Adriatic Sea, from 9 to 19 July 2018 to assess differences in the accuracy of in- and above-water radiometer measurements used for the validation of ocean colour products. Ten measurement systems were compared. Prior to the intercomparison, the absolute radiometric calibration of all sensors was carried out using the same standards and methods at the same reference laboratory. Measurements were performed under clear sky conditions, relatively low sun zenith angles, moderately low sea state and on the same deployment platform and frame (except in-water systems). The weighted average of five above-water measurements was used as baseline reference for comparisons. For downwelling irradiance (), there was generally good agreement between sensors with differences of <6% for most of the sensors over the spectral range 400 nm–665 nm. One sensor exhibited a systematic bias, of up to 11%, due to poor cosine response. For sky radiance () the spectrally averaged difference between optical systems was <2.5% with a root mean square error (RMS) <0.01 mWm−2 nm−1 sr−1. For total above-water upwelling radiance (), the difference was <3.5% with an RMS <0.009 mWm−2 nm−1 sr−1. For remote-sensing reflectance (), the differences between above-water TriOS RAMSES were <3.5% and <2.5% at 443 and 560 nm, respectively, and were <7.5% for some systems at 665 nm. Seabird HyperSAS sensors were on average within 3.5% at 443 nm, 1% at 560 nm, and 3% at 665 nm. The differences between the weighted mean of the above-water and in-water systems was <15.8% across visible bands. A sensitivity analysis showed that accounted for the largest fraction of the variance in , which suggests that minimizing the errors arising from this measurement is the most important variable in reducing the inter-group differences in . The differences may also be due, in part, to using five of the above-water systems as a reference. To avoid this, in situ normalized water-leaving radiance () was therefore compared to AERONET-OC SeaPRiSM as an alternative reference measurement. For the TriOS-RAMSES and Seabird-Hyperspectral Surface Acquisition System (HyperSAS) sensors the differences were similar across the visible spectra with 4.7% and 4.9%, respectively. The difference between SeaPRiSM and two in-water systems at blue, green and red bands was 11.8%. This was partly due to temporal and spatial differences in sampling between the in-water and above-water systems and possibly due to uncertainties in instrument self-shading for one of the in-water measurements

Complete characterization of ocean color radiometers

Verifying and validating waterleaving radiance measurements from space for an accurate derivation of Ocean/Water Colour biogeophysical products is based on concurrent high-quality fiducial reference measurements (FRM) carried out on the ground or water body. The FRM principles established by the Committee on Earth Observation Satellites (CEOS) recommend that in situ Ocean Colour radiometers (OCR) have a documented history of SI traceable calibrations including uncertainty budgets. Furthermore, there can be significant differences between calibration and use of the instruments in the field due to differences in operating temperature, angular variation of the light field (especially for irradiance sensors), the intensity of the measured radiation, and spectral variation of the target, among others. Each of these factors may interact with individual properties of the instrument when deployed in the field, and estimation of such uncertainties requires instrument characterization in addition to the absolute radiometric calibration if expanded uncertainties within ±10% (k = 2) are the aim. The FRM4SOC Phase 2 project - funded by the European Commission in the frame of the Copernicus Programme and implemented by EUMETSAT - contributes to these efforts, aiming at developing an operational and sustained network of radiometric measurements of FRM quality. Within FRM4SOC-2, scientists from the Tartu Observatory (TO) of the University of Tartu performed an unprecedented batch of calibrations and characterizations on a set of 37 hyperspectral field radiometers representative of the most used OCR classes within the OC community. The calibrations and characterizations performed include the determination of radiometric responsivity, long-term stability, the accuracy of the spectral scale, non-linearity and accuracy of integration times, spectral stray light, angular response of irradiance sensors in air, dark signal, thermal sensitivity, polarization sensitivity, and signal-to-noise ratio of individual OCRs. Consistent correction of biases and extended uncertainty analysis procedures of in situ data obtained from different instruments and measurement models need to be clearly defined, which is the objective of this paper