Willingness to Pay for Drug Rehabilitation: Implications for Cost Recovery

Objectives: This study estimates the value that clients place on drug rehabilitation services at the time of intake and how this value varies with the probability of success and availability of social services. Methods: We interviewed 241 heroin users who had been referred to, but had not yet entered, methadone maintenance treatment in Baltimore, Maryland. We asked each subject to state a preference among three hypothetical treatment programs that varied across 3 domains: weekly fee paid by the client out of pocket ($5 to$100), presence/absence of case management, and time spent heroin-free (3 to 24 months). Each subject was asked to complete 18 orthogonal comparisons. Subsequently each subject was asked if they likely would enroll in their preferred choice among the set of three. We computed the expected willingness to pay (WTP) as the probability of enrollment times the fee considered in each choice considered from a multivariate logistic model that controlled for product attributes. We also estimated the price elasticity of demand. Results: We found that 21% of clients preferred programs that were logically dominated by other options. The median expected fee subjects were willing to pay for a program that offered 3 months of heroin-free time was $7.30 per week, rising to$17.11 per week for programs that offered 24 months of heroin-free time. The availability of case management increased median WTP by $5.64 per week. The fee was the most important predictor of the self-reported probability of enrollment with a price elasticity of -0.39 (SE 0.042). Conclusions: Clients' median willingness to pay for drug rehabilitation fell short of the average program costs of$82 per week, which reinforces the need for continued subsidization as drug treatment has high positive externalities. Clients will pay more for higher rates of treatment success and for the presence of case management.

Writing the criminalized body: the body in the construction of female subjectivity in English women's writing c.1540-1640

This thesis argues that the criminalized body is the basis for the construction of criminalized subjectivity in English texts, c.1540-1640, focusing particularly on four women writers and their writings: Anne Askew, Elizabeth Tudor, Lady Elizabeth Cary, and Lady Mary Wroth. In doing so, this thesis engages in two areas of early modem English studies that have not yet received critical attention: the historically specific understanding of criminalized, rather than criminal, bodies and subjectivities, as well as the engagement with women writers and their writings from the perspective of crime. Accordingly, Part One identifies how the criminalized body was understood, its relationship to criminalized SUbjectivity, and the existence of a culture of criminalization in the period. Since early modern crimes were viewed as sinful, unnatural and illegal acts, the criminalized body was seen to break divine, natural and human laws, as well as being physically deformed; either because it was imagined to be so or because it was visibly deformed in some manner. This had several important consequences. Criminalized bodies were identifiable in society, resulting in a social process of criminalization that preceded, and did not necessarily involve, members of the judiciary and judicial processes. Also, criminalized bodies could be, and frequently were, located in a wide variety of contexts outside the judicial sphere, such as the political, theological, social, and literary. Together, these consequences evidence the currency of a culture of criminalization in early modern England. Most importantly, the identification of the body as the primary indicator of criminality reveals that it was the basis for the construction of criminalized subjectivity. This model of physicality and its consequent relationship to subjectivity dictates the employment of an alternative theoretical approach to those currently used by scholars of the period. Accordingly, I have identified Toril Moi's recent revisionist exposition of Simone De Beauvoir's theoretical formulations in The Second Sex as the most constructive way to think about these early modern criminalized bodies and subjectivities. Moi's re-interpretation of De Beauvoir's distinctions between the body as, and the body in, a situation offers a powerful tool for projects concerned with the historically specific body, as well as for those concerned with providing a non-reductive, non-essentialist account of embodied subjectivity. In the light of this, Part Two focuses on various constructions of female subjectivity in the context of criminalization in works by four early modem English women writers. The first two case studies examine two women who were judicially criminalized, confined, and subjected to judicial interrogation: Anne Askew and Elizabeth Tudor. I attend to the centrality of their bodies to constructions of their subjectivities and the strategies both women employ to de-criminalize themselves in their writings. Alternatively, the second two case studies examine two women who were not judicially criminalized: Lady Elizabeth Cary and Lady Mary Wroth, but whose works reveal an interest in criminalized female subjectivity. I examine Cary and Wroth's explorations of how women can be criminalized in various social contexts, as well as the centrality of the body to their constructions of fictional criminalized female subjectivity. subjectivity

Algorithms for purchasing AIDS vaccines

The authors delineate two different algorithms for the purchase of AIDS vaccines, to show how differences in policy objectives can greatly affect projections of the number of courses of vaccine that will be needed. They consider a hypothetical vaccine costing ten dollars to produce, and offering sixty percent, seventy five percent, and ninety percent reductions in the risk of HIV for ten years. For each of the world's ten major geographic divisions, they sue published estimates of the risk of AIDS, the value of medical costs averted, and the value of potential productivity losses. Under the"health sector"algorithm - in which purchases are made to minimize the impact of AIDS/HIV on government health spending - 766 million courses of vaccine would be purchased. Under the"societal"algorithm - in which purchases are made to minimize the impact of AIDS/HIV on health spending and GDP - more than 3.7 billion courses of vaccine would be purchased. Under an"equity"model - allocating vaccines to everyone in the world at high risk, as if they had the financial resources of Western Europeans - vaccine would be offered to 4.7 billion people. For a Western European man, reducing the risk of AIDS/HIV would be a $789 concern; in Africa,the comparable risk would be a$48,577 crisis. The authors conclude that financing AIDS vaccines solely on the fixed budget of a ministry of health, means large vulnerable populations wouldn't receive the vaccine. Allocating the vaccine based on society's ability to pay would still exclude many poor infants who would probably be immunized if they were born in more developed regions. Policymakers concerned about equity in health care must redouble efforts to making the financing of development, and distribution of AIDS vaccines, a global, not a regional concern.Disease Control&Prevention,Public Health Promotion,Health Monitoring&Evaluation,Early Child and Children's Health,HIV AIDS,HIV AIDS,Health Monitoring&Evaluation,Health Economics&Finance,Adolescent Health,Environmental Economics&Policies

Editorial: Enabling local health departments to save more lives: A public health perspective

No Abstrac

Paris is Always a Good Idea: Study into Paris’ Potenial to Regain a Place at the Top of the European Art Market

The objective of this thesis is to come to an informed conclusion, although inaccurate it may be, about Paris’ potential for growth, and for regaining its place at the top of the European art market given the current context. Through examination of its history, as well as of the current market through art fairs, auction houses and galleries as well as looking at the impact of Brexit and the French approach to culture, it aims to demonstrate the possibility that Paris can regain ground its lost over the years and recognition as the European capital of the art market

Cost-effectiveness of traffic enforcement: case study from Uganda

BACKGROUND: In October 2004, the Ugandan Police department deployed enhanced traffic safety patrols on the four major roads to the capital Kampala. OBJECTIVE: To assess the costs and potential effectiveness of increasing traffic enforcement in Uganda. METHODS: Record review and key informant interviews were conducted at 10 police stations along the highways that were patrolled. Monthly data on traffic citations and casualties were reviewed for January 2001 to December 2005; time series (ARIMA) regression was used to assess for a statistically significant change in traffic deaths. Costs were computed from the perspective of the police department in $US 2005. Cost offsets from savings to the health sector were not included. RESULTS: The annual cost of deploying the four squads of traffic patrols (20 officers, four vehicles, equipment, administration) is estimated at$72,000. Since deployment, the number of citations has increased substantially with a value of $327 311 annually. Monthly crash data pre- and post-intervention show a statistically significant 17$603 per death averted or $27 per life year saved discounted at 3$300 GDP per capita). CONCLUSION: The costs of traffic safety enforcement are low in comparison to the potential number of lives saved and revenue generated. Increasing enforcement of existing traffic safety norms can prove to be an extremely cost-effective public health intervention in low-income countries, even from a government perspective