Health care provider choice in the case of patient-initiated contacts. An extended version of discrete choice of model demand

This paper analyzes the nature of health care provider choice inthe case of patient-initiated contacts, with special reference toa National Health Service setting, where monetary prices are zeroand general practitioners act as gatekeepers to publicly financedspecialized care. We focus our attention on the factors that mayexplain the continuously increasing use of hospital emergencyvisits as opposed to other provider alternatives. An extendedversion of a discrete choice model of demand for patient-initiatedcontacts is presented, allowing for individual and town residencesize differences in perceived quality (preferences) betweenalternative providers and including travel and waiting time asnon-monetary costs. Results of a nested multinomial logit model ofprovider choice are presented. Individual choice betweenalternatives considers, in a repeated nested structure, self-care,primary care, hospital and clinic emergency services. Welfareimplications and income effects are analyzed by computingcompensating variations, and by simulating the effects of userfees by levels of income. Results indicate that compensatingvariation per visit is higher than the direct marginal cost ofemergency visits, and consequently, emergency visits do not appearas an inefficient alternative even for non-urgent conditions.

Further evidence on the statistical properties of real GNP

The well-known lack of power of unit root tests has often been attributed to the shortlength of macroeconomic variables and also to DGP s that depart from the I(1)-I(0)alternatives. This paper shows that by using long spans of annual real GNP and GNPper capita (133 years) high power can be achieved, leading to the rejection of both theunit root and the trend-stationary hypothesis. This suggests that possibly neither modelprovides a good characterization of these data. Next, more flexible representations areconsidered, namely, processes containing structural breaks (SB) and fractional ordersof integration (FI). Economic justification for the presence of these features in GNP isprovided. It is shown that the latter models (FI and SB) are in general preferred to theARIMA (I(1) or I(0)) ones. As a novelty in this literature, new techniques are appliedto discriminate between FI and SB models. It turns out that the FI specification ispreferred, implying that GNP and GNP per capita are non-stationary, highly persistentbut mean-reverting series. Finally, it is shown that the results are robust when breaksin the deterministic component are allowed for in the FI model. Some macroeconomicimplications of these findings are also discussed.

Voting with preferences over margins of victory

This paper analyzes a two-alternative voting model with the distinctive feature that voters have preferences over margins of victory. We study voting contests with a finite as well as an infinite number of voters, and with and without mandatory voting. The main result of the paper is the existence and characterization of a unique equilibrium outcome in all those situations. At equilibrium, voters who prefer a larger support for one of the alternatives vote for such alternative.The model also provides a formal argument for the conditional sincerity voting condition in Alesina and Rosenthal (1995) and the benefit of voting function in Llavador (2006). Finally, we offer new insights on explaining why some citizens may vote strategically for an alternative different from the one declared as the most preferred.

A house price index defined in the potential outcomes framework

Current methods for constructing house price indices are based on comparisons of sale prices of residential properties sold two or more times and on regression of the sale prices on the attributes of the properties and of their locations. The two methods have well recognised deficiencies, selection bias and model assumptions, respectively. We introduce a new method based on propensity score matching. The average house prices for two periods are compared by selecting pairs of properties, one sold in each period, that are as similar on a set of available attributes (covariates) as is feasible to arrange. The uncertainty associated with such matching is addressed by multiple imputation, framing the problem as involving missing values. The method is applied to aregister of transactions ofresidential properties in New Zealand and compared with the established alternatives.

On the performance of small-area estimators: Fixed vs. random area parameters

Most methods for small-area estimation are based on composite estimators derived from design- or model-based methods. A composite estimator is a linear combination of a direct and an indirect estimator with weights that usually depend on unknown parameters which need to be estimated. Although model-based small-area estimators are usually based on random-effects models, the assumption of fixed effects is at face value more appropriate.Model-based estimators are justified by the assumption of random (interchangeable) area effects; in practice, however, areas are not interchangeable. In the present paper we empirically assess the quality of several small-area estimators in the setting in which the area effects are treated as fixed. We consider two settings: one that draws samples from a theoretical population, and another that draws samples from an empirical population of a labor force register maintained by the National Institute of Social Security (NISS) of Catalonia. We distinguish two types of composite estimators: a) those that use weights that involve area specific estimates of bias and variance; and, b) those that use weights that involve a common variance and a common squared bias estimate for all the areas. We assess their precision and discuss alternatives to optimizing composite estimation in applications.

Location models in the public sector

The past four decades have witnessed an explosive growth in the field of networkbased facilitylocation modeling. This is not at all surprising since location policy is one of the mostprofitable areas of applied systems analysis in regional science and ample theoretical andapplied challenges are offered. Location-allocation models seek the location of facilitiesand/or services (e.g., schools, hospitals, and warehouses) so as to optimize one or severalobjectives generally related to the efficiency of the system or to the allocation of resources.This paper concerns the location of facilities or services in discrete space or networks, thatare related to the public sector, such as emergency services (ambulances, fire stations, andpolice units), school systems and postal facilities. The paper is structured as follows: first,we will focus on public facility location models that use some type of coverage criterion,with special emphasis in emergency services. The second section will examine models based onthe P-Median problem and some of the issues faced by planners when implementing thisformulation in real world locational decisions. Finally, the last section will examine newtrends in public sector facility location modeling.

Ambiguity in election games

We construct a model in which the ambiguity of candidates allows them toincrease the number of voters to whom they appeal when voters have intense preferences for one of the alternatives available. An ambiguous candidate may offer voters with different preferences the hope that their most preferred alternative will be implemented. We find conditions under which ambiguous strategies are chosen in equilibrium. These conditions include the case in which there is an outcome that is a majority winner against all other outcomes but is not the most preferred outcome for a majority of voters. It is shown that if the number of candidates or parties increases, ambiguity will not be possible in equilibrium, but a larger set of possible policies increases the chance that at least one candidate will choose to be ambiguous in equilibrium.

Small-area estimation with spatial similarity

A class of composite estimators of small area quantities that exploit spatial (distancerelated)similarity is derived. It is based on a distribution-free model for the areas, but theestimators are aimed to have optimal design-based properties. Composition is applied alsoto estimate some of the global parameters on which the small area estimators depend.It is shown that the commonly adopted assumption of random effects is not necessaryfor exploiting the similarity of the districts (borrowing strength across the districts). Themethods are applied in the estimation of the mean household sizes and the proportions ofsingle-member households in the counties (comarcas) of Catalonia. The simplest version ofthe estimators is more efficient than the established alternatives, even though the extentof spatial similarity is quite modest.

Revealed preference and indifferent selection

It is shown that preferences can be constructed from observed choice behavior in a way that is robust to indifferent selection (i.e., the agent is indifferent between two alternatives but, nevertheless, is only observed selecting one of them). More precisely, a suggestion by Savage (1954) to reveal indifferent selection by considering small monetary perturbations of alternatives is formalized and generalized to a purely topological framework: references over an arbitrary topological space can be uniquely derived from observed behavior under the assumptions that they are continuous and nonsatiated and that a strictly preferred alternative is always chosen, and indifferent selection is then characterized by discontinuity in choice behavior. Two particular cases are then analyzed: monotonic preferences over a partially ordered set, and preferences representable by a continuous pseudo-utility function.

On the justice of voting systems

What are the best voting systems in terms of utilitarianism? Or in terms of maximin, or maximax? We study these questions for the case of three alternatives and a class of structurally equivalent voting rules. We show that plurality, arguably the most widely used voting system, performs very poorly in terms of remarkable ideals of justice, such as utilitarianism or maximin, and yet is optimal in terms of maximax. Utilitarianism is bestapproached by a voting system converging to the Borda count, while the best way to achieve maximin is by means of a voting system converging to negative voting. We study the robustness of our results across different social cultures, measures of performance, and population sizes.

The size and distribution of donations: Effects of numbers of potential recipients

Whereas much literature exists on choice overload, little is known about effects of numbers of alternatives in donation decisions. How do these affect both the size and distribution of donations? We hypothesize that donations are affected by the reputation of recipients and increase with their number, albeit at a decreasing rate. Allocations to recipients reflect different concepts of fairness equity and equality. Both may be employed but, since they differ in cognitive and emotional costs, numbers of recipients are important. Using a cognitive (emotional) argument, distributions become more uniform (skewed) as numbers increase. In a survey, respondents indicated how they would donate lottery winnings of 50 Euros. Results indicated that more was donated to NGO s that respondents knew better. Second, total donations increased with the number of recipients albeit at a decreasing rate. Third, distributions of donations became more skewed as numbers increased. We comment on theoretical and practical implications.

A recoverable production planning model

Aware of the importance of developing new alternatives to improve the performance of the companies, our purpose in this paper is to develop a medium term production planning model that deals with the concepts of Partnership and Reverse Logistics. Our model takes advantage of the synergies of integration, developing a model for global production planning that generates the optimal production and purchasing schedule for all the companies integrating a logistic chain. In a second part of the paper we incorporate products returns to the first model proposed, and analyze the implications they have over this model. We use some examples with different configurations of supply chains varying the number of production plants, distribution centers and recovery plants. To solve the model we have combined optimization and simulation procedures.

La violència dels joves: una mirada des del medi obert

Tota anàlisi integral de la violència ha de començar per definir les diverses formes que aquesta adopta amb la finalitat de facilitar-ne el mesurament científic. Hi ha moltes maneres possibles de definir la violència. Tradicionalment, l’adolescència s’ha associat amb un moment de crisi, inestabilitat i immaduresa. L’adolescència comença amb una forma de violència produïda per la naturalesa, que són els canvis físics de la pubertat. Aquest és també un període de profunds canvis psicològics (pèrdues del món infantil, confirmació dels caràcters sexuals distintius del gènere). En definitiva, una etapa d’incertesa a l’espera d’arribar a una identitat on el jo fràgil i insegur tem quedar atrapat en la situació infantil i atribueix a l’entorn les seves dificultats per progressar. Ataca buscant uns límits externs que el continguin i li serveixin per regular-se i trobar-se. Altres vegades per por anticipada al fracàs busca com a identitat una posició on no hi ha exigències, ni perill de fracassar, perquè és la identitat del fracàs mateix (fracàs escolar, addiccions, marginalitat, violència). Així la conducta violenta és una defensa davant amenaces externes i internes a un jo fràgil en perill de ser diluït i aixafat en la seva identitat poc sòlida i definida. La sensació de no ser considerat com a subjecte pot ser objectiva o imaginària, present o ancorada en el passat (JEAMET 2003) però, en qualsevol cas, és una pressió real per l’individu que l’afecta notablement

La Gestió del risc d'inundació a la ciutat de Girona

En aquest article es presenten les diferents mesures que la societat gironina ha anat adoptant al llarg dels anys per fer front al risc d'avingudes, fent especial èmfasi, però, a les mes recents. Aquestes mesures d'adaptació poden classificar-se en dos grans grups, que no son ni moltmenys excloents: les mesures estructurals, integrades bàsicament per les obres hidràuliques, i les mesures no-estructurals, mes dirigides a l'àmbit del comportament individual i col·lectiu enfront el risc. Finalment es realitzarà una valoració de l'estat actual del sistema de defenses de la ciutat i es proposaran un seguit d'alternatives

La percepción del riesgo de inundación: experiencias de aprendizaje en la costa brava

Taking as an example three study cases in the Costa Brava area, this paper examines through surveys and interviews the perception of floods among residents living in hazardous areas. perception is then related to vulnerability, flood management, and citizens preferences regarding alternatives to curb flood losses in the future. The study concludes that flood awareness and the willingness to take actions regarding this hazard is clearly related to the degree of social involvement with the affairs of the local community