Moral Hazard, Adverse Selection and Health Expenditures: A Semiparametric Analysis

Theoretical models predict asymmetric information in health insurance markets may generate inefficient outcomes due to adverse selection and moral hazard. However, previous empirical research has found it difficult to disentangle adverse selection from moral hazard in health care. We empirically study this question by using data from the Health and Retirement Study to estimate a structural model of the demand for health insurance and medical care. Using a two-step semi-parametric estimation strategy we find significant evidence of moral hazard, but not of adverse selection.

Time Preference, Time Discounting, and Smoking Decisions

This study examines the relationship between time discounting, other sources of time preference, and intertemporal choices about smoking. Using a survey fielded for our analysis, we elicit rates of time discount from choices in financial and health domains. We also examine the relationship between other determinants of time preference and smoking status. We find very high rates of time discount in the financial realm for a horizon of one year, irrespective of smoking status. In the health domain, the implied rates of time discount decline with the length of the time delay (hyperbolic discounting) and the sign of the payoff (the "sign effect"). We use a series of questions about the willingness to undergo a colonoscopy to elicit short- and long-run rates of discount in a quasi-hyperbolic discounting framework, finding no evidence that short-run and long-run rates of discount differ by smoking status. Using more general measures of time preference, i.e., impulsivity and length of financial planning horizon, smokers are more impatient. However, neither of these measures is significantly correlated with the measures of time discounting. Our results indicate that subjective rates of time discount revealed through committed choice scenarios are not related to differences in smoking behavior. Rather, a combination of more general measures of time preference and self-control, i.e., impulsivity and financial planning, are more closely related to the smoking decision.

Short Run Needs and Long Term Goals: A Dynamic Model of Thirst Management

Beverage consumption occurs many times a day in response to a variety of needs that change throughout the day. In making their choices, consumers self-regulate their consumption by managing short run needs (e.g., hydration and mood pickup) with long-term goals (e.g., health). Using unique intra-day beverage consumption, activity and psychological needs data, we develop and estimate a model of high frequency consumption choices that accounts for both intra-day changes in short run needs and individual level unobserved heterogeneity in the degree of self-regulation. A novel feature of the model is that it allows for dynamics of consumption and stockpiling at the level of product attributes. The model is used to evaluate introduction of new products in the beverage category and gain insight into the linkage between self-regulation and excess consumption. Broadly, the modeling framework of balancing short run needs with long-term goals has wide ranging applications in choices where long term effects are gradual (e.g., nutrition, exercise, smoking and preventive health care)

HIV-associated lymphoma—advances in clinical management

The association between human immunodeficiency virus (HIV) and lymphoma was observed early in the HIV epidemic in the 1980s. Lymphoma incidence remains significantly higher than in the general population. Previously people living with HIV (PLWH) had advanced immune suppression, organ dysfunction and consequently poor performance status (PS). The advent of combination antiretroviral therapy (ART) has led to improved immune reconstitution and significantly enhanced the outlook of PLWH, influenced the incidence of lymphoma subtypes and improved tolerability of treatment. However lymphoma still remains the most common cause of cancer related death. We describe the multidisciplinary management of HIV-associated lymphomas and outline recent advances. Challenges include the advanced stage at presentation, propensity for extranodal sites including the central nervous system (CNS), potential drug interactions and increased incidence of opportunistic infections (OIs). Overall management now focusses less on HIV-related factors and more on lymphoma characteristics, with favourable outcomes. Representation in lymphoma clinical trials however is lacking, as a positive serostatus is an exclusion criterion for the majority. Data is scant for the rarer subtypes. A number of small phase I/II trials have successfully recruited patients living with HIV. Immunotherapy trial and safety data will be essential in understanding toxicity and efficacy of this promising targeted treatment. We welcome the recent more permissive inclusion criteria for clinical trials and support the expansion of understudied targeted therapies particularly for rarer subtypes. Broadening access will provide better equity for those living with HIV

Testing the Mechanisms of Structural Models: The Case of the Mickey Mantle Effect

The article assesses the ability of structural econometric models to reasonably predict economic behavior. A lack of consideration of inherent variables in most structural models is found. There is no current means of recording how parental wealth transfers to children affect the child's college attendance choices, although it is recognized as an obvious factor. Research into free health insurance has found it does not lead to riskier behavior by consumers, contrary to the traditional moral hazard model. Health insurance is examined for what the authors call "the Mickey Mantle effect." Mantle died prematurely due to alcohol abuse, and once observed he'd have taken better care of himself had he known he'd live as long as he did. That comments represents how thee subjective thoughts of consumers affect economic models. An analysis of data on medical patients' life expectancy finds a strong correlation between shorter expectations and smoking, while results linking heavy drinking and high body mass index were mixed

Clinical Pharmacy Clerkship in Pakistan: A leap from paper to practice

This is the first article of its type to describe the advances taking place in clinical pharmacy education in Pakistan. The Pharmacy Council of Pakistan has developed a five-year Pharm.D program to replace the four-year B.Pharm degree. Completing clinical pharmacy clerkships is a prerequisite for receiving the Pharm.D degree. To meet this requirement, Ziauddin College of Pharmacy has developed a specialized clerkship program for its 4th and 5th year students. The College is fortunate to be linked with well developed tertiary care hospitals at three prime locations in the in the metropolitan city of Karachi, which provides opportunity for the students to gain exposure to real life situations and work with patients. The article presents an account of the efforts taken for development of the clinical pharmacy clerkship program, the problems encountered during its development, and the main outcomes of a clerkship program.   Type: Not

Analysis of Moving Object Imaging from Compressively Sensed SAR Data in the Presence of Dictionary Mismatch

We present compressed sensing (CS) synthetic aperture radar (SAR) moving target imaging in the presence of dictionary mismatch. Unlike existing work on CS SAR moving target imaging, we analyze the sensitivity of the imaging process to the mismatch and present an iterative scheme to cope with dictionary mismatch. We analyze and investigate the effects of mismatch in range and azimuth positions, as well as range velocity. The analysis reveals that the reconstruction error increases with the mismatch and range velocity mismatch is the major cause of error. Instead of using traditional Laplacian prior (LP), we use Gaussian-Bernoulli prior (GBP) for CS SAR imaging mismatch. The results show that the performance of GBP is much better than LP. We also provide the Cramer-Rao Bounds (CRB) that demonstrate theoretically the lowering of mean square error between actual and reconstructed result by using the GBP. We show that a combination of an upsampled dictionary and the GBP for reconstruction can deal with position mismatch effectively. We further present an iterative scheme to deal with the range velocity mismatch. Numerical and simulation examples demonstrate the accuracy of the analysis as well as the effectiveness of the proposed upsampling and iterative scheme

SAR imaging of moving targets by subaperture based low-rank and sparse decomposition

We propose a subaperture based method for synthetic aperture radar (SAR) imaging of moving targets. It exploits low-rank and sparse decomposition for extraction of moving targets from the complex SAR scene. First SAR raw data are divided into subapertures in the azimuth direction. Subsequently, low-rank and sparse decomposition is applied using the multiple subapertures data to accomplish the separation of moving targets from the stationary SAR background. A full resolution moving target image is reconstructed by combining the spectral information of the sparse subaperture images. Such an image has a high signal to clutter ratio and is well suited for motion estimation and focusing algorithms. This proposed framework extends the applicability of sparsity-driven moving target focusing methods to very low signal to clutter ratio environments. We demonstrate the performance of our approach through experiments with synthetic and real SAR data