The Incidence of U.S. Climate Policy: Alternative Uses of Revenues from a Cap-and-Trade Auction

This paper evaluates the costs to households of a carbon dioxide (CO2) cap-and-trade program. We find important variation in the distribution of costs of the policy across 11 regions of the country and income deciles. The introduction of a price on CO2 is regressive, but this may be outweighed by the distribution value of CO2 emissions allowances. We evaluate five alternatives: three are progressive (expansion of the Earned Income Tax Credit and cap-and-dividend approaches), while the others are neutral (reduction in payroll tax) or amplify the regressivity (reduction in income tax). Regional differences are most substantial for low-income households.cap-and-trade, allocation, distributional effects, cost burden, equity

The Incidence of U.S. Climate Policy: Where You Stand Depends on Where You Sit

Federal policies aimed to slow global warming would impose potentially significant costs on households that vary depending on the policy approach that is used. This paper evaluates the effects of a carbon dioxide cap-and-trade program on households in each of 11 regions of the country and sorted into annual income deciles. We find tremendous variation in the incidence (the distribution of cost) of the policy. The most important feature that affects households is how the policy distributes the value created by placing a price on CO2 emissions. We evaluate 10 policy alternatives that yield results that range from moderately progressive (expansion of the Earned Income Tax Credit, investments in efficiency and capand- dividend) to severely regressive (reduce income taxes, free distribution to incumbent emitters and reduction of the payroll tax). To varying degrees the allocation of the value of emissions allowances amplifies or potentially resolves the tradeoff between equity and efficiency.cap-and-trade, allocation, distributional effects, cost burden, equity

Applying Bayes linear methods to support reliability procurement decisions

Bayesian methods are common in reliability and risk assessment, however, such methods often demand a large amount of specification and can be computationally intensive. Because of this, many practitioners are unable to take advantage of many of the benefits found in a Bayesian-based approach. The Bayes linear methodology is similar in spirit to a Bayesian approach but offers an alternative method of making inferences. Bayes linear methods are based on the use of expected values rather than probabilities, and updating is carried out by linear adjustment rather than by Bayes Theorem. The foundations of the method are very strong, based as they are in work of De Finetti and developed further by Goldstein. A Bayes linear model requires less specification than a corresponding probability model and for a given amount of model building effort, one can model a more complex situation quicker. The Bayes linear methodology has the potential to allow us to build ''broad-brush' models that enable us, for example, to explore different test setups or analysis methods and assess the benefits that they can give. The output a Bayes linear model is viewed as an approximation to 'traditional' probabilistic models. The methodology has been applied to support reliability decision making within a current United Kingdom Ministry of Defence (MOD) procurement project. The reliability decision maker had to assess different contractor bids and assess the reliability merit of each bid. Currently the MOD assess reliability programmes subjectively using expert knowledge - for a number of reasons, a quantitative method of assessment in some projects is desirable. The Bayes linear methodology was used to support the decision maker in quantifying his assessment of the reliability of each contractor's bid and determining the effectiveness of each contractor's reliability programme. From this, the decision maker was able to communicate to the project leader and contractors, why a specific contractor was chosen. The methodology has been used in other MOD projects and is considered by those within the MOD as a useful tool to support decision making. The paper will contain the following. The paper will introduce the Bayes linear methodology and briefly discuss some of the philosophical implications of adopting a Bayes linear methodology within the context of a reliability programme analysis. The paper will briefly introduce the reliability domain and the reasons why it is believed that the Bayes linear methodology can offer support to decision makers. An in-depth analysis of the problem will then be given documenting the steps taken in the project and how future decision makers can apply the methodology. A brief summary will then be given as to possible future work for those interested in the Bayes linear methodology

Achieving universal health coverage in small island states: could importing health services provide a solution?

BACKGROUND: Universal health coverage (UHC) is difficult to achieve in settings short of medicines, health workers and health facilities. These characteristics define the majority of the small island developing states (SIDS), where population size negates the benefits of economies of scale. One option to alleviate this constraint is to import health services, rather than focus on domestic production. This paper provides empirical analysis of the potential impact of this option. METHODS: Analysis was based on publicly accessible data for 14 SIDS, covering health-related travel and health indicators for the period 2003-2013, together with in-depth review of medical travel schemes for the two highest importing SIDS-the Maldives and Tuvalu. FINDINGS: Medical travel from SIDS is accelerating. The SIDS studied generally lacked health infrastructure and technologies, and the majority of them had lower than the recommended number of physicians in a country, which limits their capacity for achieving UHC. Tuvalu and the Maldives were the highest importers of healthcare and notably have public schemes that facilitate medical travel and help lower the out-of-pocket expenditure on medical travel. Although different in approach, design and performance, the medical travel schemes in Tuvalu and the Maldives are both examples of measures used to increase access to health services that cannot feasibly be provided in SIDS. INTERPRETATION: Our findings suggest that importing health services (through schemes to facilitate medical travel) is a potential mechanism to help achieve universal healthcare for SIDS but requires due diligence over cost, equity and quality control

The Trans-Pacific Partnership: Should We "Fear the Fear"? Comment on "The Trans-Pacific Partnership: Is It Everything We Feared for Health?"

RLabonté et al entitle their paper in this issue of the International Journal of Health Policy and Management "The Trans-Pacific Partnership: Is It Everything We Feared for Health?" Tantalisingly, they do not directly answer the question they pose, and in this commentary, we suggest that it is the wrong question; we should not 'fear' the Trans-Pacific Partnership (TPP) at all, rather we should ask how we are to respond. The public health community is right to be concerned with the potential implications of trade and investment agreements (TIAs) for health, particularly with shifts from multilateral to regional/bilateral agreements including provisions with greater risk to public health. But it is critical to understand also the potential health benefits, and especially the mitigating policy and governance mechanisms to respond to adverse TIA implications. Given entrenched and divergent sectoral worldviews and perspectives between trade and health communities on these issues, achieving the requisite understanding will also likely require characterisation of these perspectives and identification of areas of common understanding and agreed solutions

Evaluation of public subsidy for medical travel: does it protect against household impoverishment?

BACKGROUND: In resource-constrained health systems medical travel is a common alternative to seeking unavailable health services. This paper was motivated by the need to understand better the impact of such travel on households and health systems. METHODS: We used primary data from 344 subsidized and 471 non-subsidized inbound medical travellers during June to December 2013 drawn from the North, Centre and South regions of the Maldives where three international airports are located. Using a researcher-administered questionnaire to acquire data, we calculated annual out-of-pocket (OOP) spending on health, food and non-food items among households where at least one member had travelled to another country for medical care within the last year and estimated the poverty head count using household income as a living standard measure. RESULTS: Most of the socio demographic indicators, and costs of treatment abroad among Maldivian medical travellers were similar across different household income levels with no statistical difference between subsidized and non-subsidized travellers (p value: 0.499). The government subsidy across income quintiles was also similar indicating that the Maldivian health financing structure supports equality rather than being equity-sensitive. There was no statistical difference in OOP expenditure on medical care abroad and annual OOP expenditure on healthcare was similar across income quintiles. Diseases of the circulatory system, eye and musculoskeletal system had the most impoverishing effect - diseases for which half of the patients, or less, did not receive the public subsidy. Annually, 6 and 14% of the medical travellers in the Maldives fell into poverty ($2 per day) before and after making OOP payments to health care. CONCLUSION: Evidence of a strong association between predominant public financing of medical travel and equality was found. With universal eligibility to the government subsidy for medical travel, utilization of treatment abroad, medical expenditures abroad and OOP expenditures on health among Maldivian medical travellers were similar between the poor and the rich. However, we conclude mixed evidence on the linkages between public financing of medical travel and impoverishment which needs to be further explored with comparison of impoverishment levels between households with and without medical travel

A Systems Thinking Approach to Inform Coherent Policy Action for NCD Prevention; Comment on “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention”

Lencucha and Thow tackle the enormous public health challenge of developing non-communicable disease (NCD) policy coherence within a world structured and ruled by neoliberalism. Their work compliments scholarship on other causal mechanisms, including the commercial determinants of health, that have contributed to creating the risk commodity environment and barriers to NCD prevention policy coherence. However, there remain significant gaps in the understanding of how these causal mechanisms interact within a whole system. As such, public health researchers’ suggestions for how to effectively prevent NCDs through addressing the risk commodity environment tend to remain fragmented, incomplete and piecemeal. We suggest this is, in part, because conventional policy analysis methods tend to be reductionist, considering causal mechanisms in relative isolation and conceptualizing them as linear chains of cause and effect. This commentary discusses how a systems thinking approach offers methods that could help with better understanding the risk commodity environment problem, identifying a more comprehensive set of effective solutions across sectors and its utility more broadly for gaining insight into how to ensure recommended solutions are translated into policy, including though transformation at the paradigmatic level

Advancing alcohol research in low-income and middle-income countries: a global alcohol environment framework.

Alcohol-related harm has gained increased attention in high-income countries (HICs) in recent years which, alongside government regulation, has effected a reduction in alcohol consumption. The alcohol industry has turned its attention to low-income and middle-income country (LMIC) markets as a new source of growth and profit, prompting increased consumption in LMICS. Alcohol use in LMICs is also increasing. There is a need to understand particularly in LMICs the impact of industry strategy in shaping local contexts of alcohol use. We draw on conceptualisations from food systems research, and research on the commercial determinants of health, to develop a new approach for framing alcohol research and discuss implications for alcohol research, particularly in LMICs, focusing on South Africa as an illustrative example. We propose a conceptualisation of the 'alcohol environment' as the system of alcohol provision, acquisition and consumption-including, critically, industry advertising and marketing-along with the political, economic and regulatory context of the alcohol industry that mediates people's alcohol drinking patterns and behaviours. While each country and region is different in terms of its context of alcohol use, we contrast several broadly distinct features of alcohol environments in LMICs and HICs. Improving understanding of the full spectrum of influences on drinking behaviour, particularly in LMICs, is vital to inform the design of interventions and policies to facilitate healthier environments and reduce the harms associated with alcohol consumption. Our framework for undertaking alcohol research may be used to structure mixed methods empirical research examining the role of the alcohol environment particularly in LMICs