Essays on Formal and Informal Long-Term Health Insurance Markets

This dissertation consists of two essays examining formal and informal long term health insurance markets. The first essay analyzes heterogeneity of Long-Term Care Insurance policyholders in their lapse decision, and how their ex-ante and ex-post subjective beliefs about the probability of needing Long-Term Care affect their lapse decisions. In this essay, I develop a model of lapse decision in a two-period insurance framework with a Bayesian learning process and implement several empirical specifications of the model using longitudinal data from the Health and Retirement Study. The results show that policyholders\u27 ex- ante point predictions of their probabilities and their uncertainties about them have a persistent but declining impact on lapse decisions. Those who believe that their risk is higher are indeed more likely to remain insured. However, as their uncertainties surrounding their ex-ante point predictions increase, their chances of lapsing increase regardless of their initial perception biases. These results are heterogeneous across cohorts and policyholders and, in particular, show that those in the older group near the average age of Nursing Home entry have a precise prediction of their risk levels compared to the younger cohort. Policy simulations show that a more informed initial purchase decision reduces the chance of lapsing down the road. The second essay examines the extent to which informal risk sharing arrangement provides insurance against health shocks. I develop a comprehensive model of informal risk sharing contract with two-sided limited commitment which extends the standard model to a regime with the following features. Information regarding the nature of realized health shocks is imperfect and individuals\u27 health capital stock serves as a storage technology and is a factor of production. The theoretical results show that, in such a regime, Pareto optimal allocations are history dependent even if participation constraints do not bind. I perform numerical analysis to show that risk sharing against health shock is less likely to be sustainable among non-altruistic individuals with different levels of biological survival rates and health capital productivity. The results also show that optimal allocations vary depending on the set of information available to individuals. Using panel data of households from villages in rural Ethiopia, I test the main predictions of the theoretical model. While there is negative history dependence in transfers among non-altruistic partners, history dependence is positive when risk sharing is along bloodline and kinship. However, neither short-term nor long-term health shocks are insured through informal risk sharing arrangements among non-altruistic individuals

Potential of Water Hyacinth (Eichhornia crassipes (Mart.) Solms) for the Removal of Chromium from Tannery Effluent in Constructed Pond System

The objective of the present study was to evaluate the potential use of water hyacinth for the removal of chromium (Cr) from tannery wastewater. This experiment was performed using healthy, young and acclimatized water hyacinth collected from unpolluted Awash River. Cr concentrations of 3, 5, 7, 10 and 20 mg/L were added to five different polyethylene tanks, containing 40 litre tap water cultured with Hoagland’s solution. A sixth tank containing Cr-free water was used as a control group. Six plants of equal wet mass (each 12.5 ± 2 g), shoot length (11 ± 2 cm) and root length (6 ± 2 cm) were transferred into each tank and allowed to grow in a greenhouse for 42 days. From each tank plants were harvested randomly every week. Bioaccumulation factor, translocation factor, shoot and root length; wet biomass and dry weight of the shoot and root were measured, and relative growth rate, tolerance index of the root and tolerance index of wet mass were analyzed. The maximum accumulation of 2.52 X 103 µg/g of water hyacinth was achieved in the plants exposed to 20 mg/L Cr solution. The root part of the plant accumulated 2.42 to 3.82 times higher than the shoot part. An overall Cr removal efficiency of up to 91% was achieved in this study, but the efficiency decreased as the concentration of Cr in water increased. The growth of the plant was inhibited at high concentration due to Cr toxicity. Therefore, the application of water hyacinth for Cr removal will be sustainable, if the concentration of Cr in wastewater does not exceed about 10 mg/L. The relative growth rate (RGR) of the plant decreased with increasing Cr concentration and the growth was inhibited above 15.3 mg/L Cr in water. Based on the above data, it could be concluded that water hyacinth can potentially be used for the removal of Cr from tannery effluents which is a major environmental problem in Ethiopia. However, further investigation is needed to ascertain the optimum conditions for maximum removal

Topology Optimization of Beam Structures with Various End andLoading Conditions

Topology optimization deals with optimum material (mass) distribution within a design domain to find optimal lay-out of a structure subjected to certain boundary and loading conditions. Topology optimization can be used to address conflicting requirements, such as light weight and high-strength/stiffness design. In this paper, a simulation program to analyze topology optimization of beam structures with seven different end conditions and three types of loads (single point load, two point loads and uniformly distributed load) is developed using MATLAB code adapted from Sigmund’s 99 line topology optimization code. Furthermore, the program has been enhanced with a graphical user interface for ease of use. Using the developed system, it is possible to analyze the effect of different parameters

Retrospective review of antiretroviral therapy program data in accredited private hospitals in Addis Ababa City Administration, Ethiopia

Background: Ethiopia is committed to improving access to human immunodeficiency virus (HIV) care and antiretroviral therapy (ART) service. In May 2005, some private hospitals in Addis Ababa City Administration received accreditation to provide ART services to eligible patients.Objective: To examine and describe the achievements of the ART Program in accredited private hospitals.Methods: Descriptive retrospective analyses of reported ART Program Data from accredited private hospitals, between May 2005 and 31st December 2009. The aggregate data was obtained from Addis Ababa Regional Health Bureau and consisted of information about patients enrolled for care, those who started ART, and those presently are on ART.Results: During the study period, 10,849 patients were enrolled for care, 9,442 who had just started ART and 5,608 already on it across the study private facilities. In general close to 75% of the total patients enrolled for  care at five facilities. Although the majority (87%) had started treatment in the past, only 59.4% were currently on treatment. Overall, the program retained 66.4% of the patients (n=6,270) and attrition was 32% (n=3,021).Conclusions: Differences in patient enrollment for care, ART initiation and retention were observed across facilities. A significant number of patients discontinued treatment and their outcome status was unclear. A better monitoring and reporting of ART Program Data will improve program quality. An effective strategy is needed to enhance patient retention and tracing in the accredited private hospitals in Addis Ababa City Administration. [Ethiop J Health Dev. 2011;25(2):110-115

Cardiosphere-derived cells demonstrate metabolic flexibility that Is influenced by adhesion status

Adult stem cells demonstrate metabolic flexibility that is regulated by cell adhesion status. The authors demonstrate that adherent cells primarily utilize glycolysis, whereas suspended cells rely on oxidative phosphorylation for their ATP needs. Akt phosphorylation transduces adhesion-mediated regulation of energy metabolism, by regulating translocation of glucose transporters (GLUT1) to the cell membrane and thus, cellular glucose uptake and glycolysis. Cell dissociation, a pre-requisite for cell transplantation, leads to energetic stress, which is mediated by Akt dephosphorylation, downregulation of glucose uptake, and glycolysis. They designed hydrogels that promote rapid cell adhesion of encapsulated cells, Akt phosphorylation, restore glycolysis, and cellular ATP levels

Prejudice and misconceptions about tuberculosis and HIV in rural and urban communities in Ethiopia: a challenge for the TB/HIV control program

<p>Abstract</p> <p>Background</p> <p>In Ethiopia, where HIV and tuberculosis (TB) are very common, little is known about the prejudice and misconceptions of rural communities towards People living with HIV/AIDS (PLHA) and TB.</p> <p>Methods</p> <p>We conducted a cross sectional study in Gilgel Gibe Field Research area (GGFRA) in southwest Ethiopia to assess the prejudice and misconceptions of rural and urban communities towards PLHA and TB. The study population consisted of 862 randomly selected adults in GGFRA. Data were collected by trained personnel using a pretested structured questionnaire. To triangulate the findings, 8 focus group discussions among women and men were done.</p> <p>Results</p> <p>Of the 862 selected study participants, 750(87%) accepted to be interviewed. The mean age of the respondents was 31.2 (SD ± 11.0). Of the total interviewed individuals, 58% of them were females. More than half of the respondents did not know the possibility of transmission of HIV from a mother to a child or by breast feeding. For fear of contagion of HIV, most people do not want to eat, drink, and share utensils or clothes with a person living with HIV/AIDS. A higher proportion of females [OR = 1.5, (95% CI: 1.0, 2.2)], non-literate individuals [OR = 2.3, (95%CI: 1.4, 3.6)], rural residents [OR = 3.8, (95%CI: 2.2, 6.6)], and individuals who had poor knowledge of HIV/AIDS [OR = 2.8, (95%CI: 1.8, 2.2)] were more likely to have high prejudice towards PLHA than respectively males, literates, urban residents and individuals with good knowledge. Exposure to cold air was implicated as a major cause of TB. Literates had a much better knowledge about the cause and methods of transmission and prevention of TB than non-literates. More than half of the individuals (56%) had high prejudice towards a patient with TB. A larger proportion of females [OR = 1.3, (95% CI: 1.0, 1.9)] and non-literate individuals [OR = 1.4, (95% CI: 1.1, 2.0)] had high prejudice towards patients with TB than males and literate individuals.</p> <p>Conclusion</p> <p>TB/HIV control programs in collaboration with other partners should invest more in social mobilization and education of the communities to rectify the widespread prejudice and misconceptions.</p

Disclosure experience and associated factors among HIV positive men and women clinical service users in southwest Ethiopia

BACKGROUND: Disclosing HIV test results to one's sexual partner allows the partner to engage in preventive behaviors as well as the access of necessary support for coping with serostatus or illness. It may motivate partners to seek testing or change behavior, and ultimately decrease the transmission of HIV. The present study was undertaken to determine the rate, outcomes and factors associated with HIV positive status disclosure in Southwest Ethiopia among HIV positive service users. METHODS: A cross-sectional study was carried out from January 15, 2007 to March 15, 2007 in Jimma University Specialized Hospital. Data were collected using a pre-tested interviewer-administered structured questionnaire. RESULTS: A total of 705 people (353 women and 352 men), participated in the study of which 71.6% were taking ART. The vast majority (94.5%) disclosed their result to at least one person and 90.8% disclosed to their current main partner. However, 14.2% of disclosure was delayed and 20.6% did not know their partner's HIV status. Among those who did not disclose, 54% stated their reason as fear of negative reaction from their partner. Among those disclosures however, only 5% reported any negative reaction from the partner. Most (80.3%) reported that their partners reacted supportively to disclosure of HIV status. Disclosure of HIV results to a sexual partner was associated with knowing the partner's HIV status, advanced disease stage, low negative self-image, residing in the same house with partner, and discussion about HIV testing prior to seeking services. CONCLUSION: Although the majority of participants disclosed their test results, lack of disclosure by a minority resulted in a limited ability to engage in preventive behaviors and to access support. In addition, a considerable proportion of the participants did not know their partner's HIV status. Programmatic and counseling efforts should focus on mutual disclosure of HIV test results, by encouraging individuals to ask their partner's HIV status in addition to disclosing their own

Microbiome to Brain:Unravelling the Multidirectional Axes of Communication

The gut microbiome plays a crucial role in host physiology. Disruption of its community structure and function can have wide-ranging effects making it critical to understand exactly how the interactive dialogue between the host and its microbiota is regulated to maintain homeostasis. An array of multidirectional signalling molecules is clearly involved in the host-microbiome communication. This interactive signalling not only impacts the gastrointestinal tract, where the majority of microbiota resides, but also extends to affect other host systems including the brain and liver as well as the microbiome itself. Understanding the mechanistic principles of this inter-kingdom signalling is fundamental to unravelling how our supraorganism function to maintain wellbeing, subsequently opening up new avenues for microbiome manipulation to favour desirable mental health outcome

Transportation Algorithm for Optimizing Renewable Energy Resources Utilization at Rural Areas

his paper aims to address the issues related to renewable energy (RE) resources optimization at rural areas. A transportation algorithm is proposed in order to optimize the utilization of renewable energy and allocate various renewable energy resources to different demand stations. A rural area in Sarawak, Malaysia is selected as a pilot area for implementing the proposed method. The total annual energy demand for the pilot research area is 860,567.12 kWh, while the annual renewable energy potentially available is 879,419.48 kWh. The simulation results of this transportation model reflect that although there is a potential for solar and wind energy at the selected rural area, the model has selected hydropower and biomass as a more viable option. The results obtained from the proposed transportation model have been verified with the results of other RE studies. It is proven that the developed model could be used as a decision making tool to evaluate application of various alternative renewable energy resources and to determine the optimal location for development of these resources