Distributive justice and the Nash bargaining solution

Suppes-Sen dominance or SS-proofness (SSP) is a commonly accepted criterion of impartiality in distributive justice. Mariotti (Review of Economic Studies, 66, 733–741, 1999) characterized the Nash bargaining solution using Nash’s (Econometrica, 18, 155–162, 1950) scale invariance (SI) axiom and SSP. In this article, we introduce equity dominance (E-dominance). Using the intersection of SS-dominance and E-dominance requirements, we obtain a weaker version of SSP (WSSP). In addition, we consider α − SSP, where α measures the degree of minimum acceptable inequity aversion; α − SSP is weaker than weak Pareto optimality (WPO) when α = 1. We then show that it is still possible to characterize the Nash solution using WSSP and SI only or using α -SSP, SI, and individual rationality (IR) only for any a Î [0,1)[01). Using the union of SS-dominance and E-dominance requirements, we obtain a stronger version of SSP (SSSP). It turns out that there is no bargaining solution that satisfies SSSP and SI, but the Egalitarian solution turns out to be the unique solution satisfying SSSP.

Heterogeneity in service delivery and inequity in access are common characteristics of chronic heart failure management programs

Background: The prevalence of heart failure in Australia is similar to that of Europe. In Australia, chronic heart failure management programs (CHF-MPs) have become part of standard care for patients with Chronic Heart Failure (CHF). However, heterogeneity among programs is common which can result in variable patient outcomes.

Method: A national survey was undertaken of 59 post-discharge CHF-MPs identified from within the Australian health care system. Two had ceased operating and one centre declined to participate in the study. A 33-item investigator-developed questionnaire, examining the characteristics and interventions used within each CHF-MP, was sent to the remaining 56 CHF-MPs. A response rate of 100% was achieved.

Results: Our survey revealed a disproportional distribution of CHF-MPs across the Australian continent: the State of Victoria had 3.6 CHF-MPs/million population, New South Wales had 3.7 CHF-MPs/million population, Queensland had 1 program/million population, South Australia had 0.3 CHF-MPs/million population and Western Australia had 1 program/million population.Overall, 8000 postdischarge CHF pts (median: 126; IQR: 26-260) were managed via CHF-MPs. Approximately 40,000 CHF pts are discharged from metropolitan institutions nationally, this represents only 22% of the potential caseload for these cost-effective CHF-MPs. Only 8% of these programs were located within rural regions. The majority of CHF-MPs were located within an acute metropolitan hospital (52%) and 36% were community based (all associated with a hospital). Heterogeneity of CHF-MPs in applied models of care was evident with 75% of CHF-MPs offering CHF outpatient clinics and 77% conducting home visits. Of the programs offering home visits 78% were funded by regional government (p<0.048). There were no nurse-led CHF outpatient clinics. A hybrid approach to CHF-MPs was common with many CHF-MPs comprising an outpatient clinic, home visits and inpatient visits. Various medications were titrated by nurses in 43% of CHF-MPs. In the programs that allowed nurses to titrate medications 79% were located in an acute hospital (p<0.011).

Conclusion: Variability of service availability is of concern within the context of universal coverage. In addition, heterogeneity between programs and the diversity in models of care delivery highlights the inconsistency and questions the quality of health related outcomes. We are currently analysing health outcome data from the 1015 patients managed in these CHF-MPs to describe the relationship between quality of care and health outcomes.

Traffic fatalities: does income inequity create an externality?

Responsible for 20 million severe injuries and/or deaths annually, few epidemics receive less attention than traffic accidents. Going beyond confirming an inverted U-shaped relationship between mean income and fatalities, we show theoretically that income inequality can positively affect fatalities in two ways. Each operates through heterogeneity between road users, and while the direct effect can be expected to evaporate with rising income, the indirect effect may prove to be an externality in that the relationship remains regardless of the level of income. Our model is supported by evidence from 79 countries between 1970 and 2000.

Conditioned taste aversion reduces fox depredation on model eggs on beaches

Context:  Conditioned taste aversion (CTA) is induced by an association of a food item with a negative experience, such as illness, which causes animals to avoid subsequent consumption of that particular food item. Inducing CTA may help reduce depredation rates of threatened fauna where predator population control is undesirable, impractical or unsuccessful.

Aims:  We investigated whether CTA could be induced among foxes (Vulpes vulpes) to model eggs which mimicked those of the threatened hooded plover (Thinornis rubricollis).

Methods:   Model eggs treated with a potential CTA-inducing chemical (sodium carbonate) and control eggs free of the agent were exposed to fox depredation for 28 days to simulate a hooded plover incubation period. To investigate whether CTA would persist in wild foxes, we implemented a part-time agent treatment (an initial 14 day exposure period of model eggs with the CTA agent followed by a second 14 day period when model eggs were free of the agent).

Key results:  Similar intervals to the first depredation event were found for all model eggs regardless of treatment. After the first depredation event by foxes, the rate and likelihood of fox depredation was significantly lower in treated eggs than in control eggs. The likelihood or rate of depredation across the three treatments did not differ between the first and second periods.

Conclusions: Our results suggest that during an exposure period of at least 28 days, CTA can be induced in wild foxes to eggs on beaches. Our results also suggest that 14 days may be insufficient time for wild foxes to develop a lasting CTA to familiar food items such as eggs.

Implications:  Treatment of eggs with a CTA-inducing chemical may present a viable alternative to traditional predator control techniques for hooded plovers, as well as other ground-nesting birds, provided that an extended exposure to the CTAinducing agent occurs.

Inequity in health: older rural driving and dementia

Introduction The number of drivers with dementia is expected to increase exponentially over the coming decades. Most individuals with moderate-to-severe dementia (table 1) are unfit to drive.1 Drivers with moderate-to-severe dementia have higher rates of MVCs than age-matched controls.2 Identifying and preventing these individuals from driving is crucial, particularly in urban areas. The density of cars and pedestrians, and the complexity of traffic typically place greater demands on drivers in urban areas, and, therefore, require greater reactivity and forward planning than in rural environments.3 ,4 The ability to drive is a critical means of maintaining one's social inclusion, and is commonly a practical necessity. Therefore, decisions about the entitlement to drive should not unfairly restrict mobility or unnecessarily compound the disadvantages experienced by older people with mild cognitive impairment and early dementia (table 1), particularly as diagnoses are now being made earlier.1 This paper describes the difficulties inherent in addressing the question of when and in what circumstances a diagnosis of dementia might render a person unfit to drive and focuses on those who live in rural areas. We examine the consequences of dementia diagnosis on driving, driver testing requirements and licensing procedures, and the impacts of driving cessation. We then discuss how living in rural areas may alter the level of risk of drivers with dementia and practical implications for licensing policies.

A historical review of the nurse practitioner role in Australia

Internationally, the nurse practitioner role has been shown to be cost-effective, safe, and instrumental in improving patient outcomes. The nurse practitioner role in Australia is in its infancy. Major stakeholders such as the nurses' boards and state departments of health throughout Australia were contacted to identify major policies and discussion papers. Database searches were conducted in CINAHL and EBSCOhost. Disparity between states exists in all facets of the nurse practitioner role, especially in definition of the role, scope of practice, educational qualifications, and specialized functions. Access to Medicare funding is unobtainable, resulting in inequity of access to health services for disadvantaged communities. The State Nurse Practitioner Taskforce Reports highlight the disparity between the role of nurse practitioner in each State of Australia and has led to fragmentation of the role at a national level. There is a need for consistency, which could be achieved if it were coordinated by a national nursing body with a voice in national health policy development and implementation

Heterogeneity of heart failure management programs in Australia

Background: Heart Failure Management Programs (HFMPs) have proven to be cost-effective in minimising recurrent hospitalisations, morbidity and mortality. However, variability between the programs exists which could translate into variable health outcomes.
Objective: To survey the characteristics of HFMPs throughout Australia and to identify potential heterogeneity in their organisation and structure.
Method: Thirty-nine post-discharge HFMPs were identified from a systematic search of the Australian health-care system in 2002. A comprehensive 19-item questionnaire specifically examining characteristics of HFMPs was sent to co-ordinators of identified programs in early 2003.
Results: All participants responded with six institutions (15%) indicating that their HFMP had ceased operations due to a lack of funding. The survey revealed an uneven distribution of the 33 active HFMPs operating throughout Australia. Overall, 4450 post-discharge HF patients (median: 74; IQR: 24–147) were managed via these programs, representing only 11% of the potential caseload for an Australia-wide network of HFMPs. Heterogeneity of these programs existed in respect to the model of care applied within the program (70% applied a home-based program and 18% a specialist HF clinic) and applied interventions (30% of programs had no discharge criteria and 45% of programs prevented nurses administering/titrating medications). Sustained funding was available to only 52% of the active HFMPs.
Conclusion: Inequity of access to HFMPs in Australia is evident in relation to locality and high service demand, further complicated by inadequate funding. Heterogeneity between these programs is substantial. The development of national benchmarks for evidence-based HFMPs is required to address program variability and funding issues to realise their potential to improve health outcomes.

Consumer complaint actions: a conceptual model based on complainants about advertising in Australia

This article presents a new conceptual model detailing consumer complaint responses relating to exposure to unacceptable advertising. The model is initiated by consumer perceptions of negative inequity which elicits one of three consumer complaint responses based on the identified triggers that may influence complaining propensity such as demographic, psychographic, cultural, situational and social factors. Complainant perception of the process encountered together with the overall outcome of their experience affect future complaint behaviour as shown by this evolving model as the end reaction flows on to form the consumer’s next response to a similar situation. The advertising industry in Australia is valued annually at over $8 billion and some advertisements have been identified as ‘unacceptable’ by elements in society. Industry and regulatory response to consumer complaints is thus an important area to address and there is no extant literature utilising such an holistic model.