Choice of contracts in the British National Health Service: An empirical study

Following major reforms of the British National Health Service (NHS) in 1990, the roles of purchasing and providing health services were separated, with the relationship between purchasers and providers governed by contracts. Using a mixed multinomial logit analysis, we show how this policy shift led to a selection of contracts that is consistent with the predictions of a simple model, based on contract theory, in which the characteristics of the health services being purchased and of the contracting parties influence the choice of contract form. The paper thus provides evidence in support of the practical relevance of theory in understanding health care market reform. © 2008 Elsevier B.V. All rights reserved.

Preferences for a third-trimester ultrasound scan in a low-risk obstetric population: a discrete choice experiment

Objective: Establish maternal preferences for a third-trimester ultrasound scan in a healthy, low-risk pregnant population.

Design: Cross-sectional study incorporating a discrete choice experiment.

Setting: A large, urban maternity hospital in Northern Ireland.

Participants: One hundred and forty-six women in their second trimester of pregnancy.

Methods: A discrete choice experiment was designed to elicit preferences for four attributes of a third-trimester ultrasound scan: health-care professional conducting the scan, detection rate for abnormal foetal growth, provision of non-medical information, cost. Additional data collected included age, marital status, socio-economic status, obstetric history, pregnancy-specific stress levels, perceived health and whether pregnancy was planned. Analysis was undertaken using a mixed logit model with interaction effects.

Main outcome measures: Women's preferences for, and trade-offs between, the attributes of a hypothetical scan and indirect willingness-to-pay estimates.

Results: Women had significant positive preference for higher rate of detection, lower cost and provision of non-medical information, with no significant value placed on scan operator. Interaction effects revealed subgroups that valued the scan most: women experiencing their first pregnancy, women reporting higher levels of stress, an adverse obstetric history and older women.

Conclusions: Women were able to trade on aspects of care and place relative importance on clinical, non-clinical outcomes and processes of service delivery, thus highlighting the potential of using health utilities in the development of services from a clinical, economic and social perspective. Specifically, maternal preferences exhibited provide valuable information for designing a randomized trial of effectiveness and insight for clinical and policy decision makers to inform woman-centred care.

Sparkling wine choice from supermarket shelves: the impact of certification of origin and production practices

We report the results of a study based on revealed and stated preference data on choice of Prosecco wines in retail stores close to the origin of production in Northern Italy. Emphasis is placed on ability to reconcile the utility structure of stated preference data with that underlying revealed preference data. We extend the analysis to cover nonattendance of key attributes, such as price and certification of origin, while controlling for the large range of brand effects.

Food miles or carbon emissions? Exploring labeling preference for food transport footprint with a stated choice study

The ecological footprint of food transport can be communicated using carbon dioxide emissions (CO2 label) or by providing information about both the length of time and the mileage travelled (food miles label). We use stated choice data to estimate conventional unobserved taste heterogeneity models and extend them to a specification that also addresses attribute nonattendance. The implied posterior distributions of the marginal willingness to pay values are compared graphically and are used in validation regressions. We find strong bimodality of taste distribution as the emerging feature, with different groups of subjects having low and high valuations for these labels. The best fitting model shows that CO2 and food miles valuations are much correlated. CO2 valuations can be high even for those respondents expressing low valuations for food miles. However, the reverse is not true. Taken together, the results suggest that consumers tend to value the CO2 label at least as much and sometimes more than the food miles label.

Consensus in organizations:Hunting for the social choice conundrum in APA elections

According to the axiomatic literature on consensus methods, the best collective choice by one method of preference aggregation can easily be the worst by another. Are award committees, electorates, managers, online retailers, and web-based recommender systems stuck with an impossibility of rational preference aggregation? We investigate this social choice conundrum for seven social choice methods: Condorcet, Borda, Plurality, Antiplurality, the Single Transferable Vote, Coombs, and Plurality Runoff. We rely on Monte Carlo simulations for theoretical results and on twelve ballot datasets from American Psychological Association (APA) presidential elections for empirical results. Each of these elections provides partial rankings of five candidates from about 13,000 to about 20,000 voters. APA preferences are neither domain-restricted nor generated by an Impartial Culture. We find virtually no trace of a Condorcet paradox. In direct contrast with the classical social choice conundrum, competing consensus methods agree remarkably well, especially on the overall best and worst options. The agreement is also robust under perturbations of the preference prole via resampling, even in relatively small pseudosamples. We also explore prescriptive implications of our findings.

The effect of choice on motivation for young children on the autism spectrum during discrete trial teaching

Self-determination and decision-making are acknowledged internationally as key rights of persons with disabilities and should play an important role in the development of educational plans and procedures. Not only is the chance for individuals with developmental disabilities to select their own tasks, leisure activities or reinforcers a valuable way of enhancing rights-based education and personal dignity, but choice-making opportunities may also function as a useful clinical or educational tool if they actually improve the efficacy of programmes aimed at the acquisition of socially relevant behaviours and life skills or the reduction of challenging behaviours.

The study reported here assessed whether or not choice affected effectiveness of an educational procedure for three children on the autism spectrum. Following a preference assessment, a number of discrete teaching trials were conducted with each child and, contingent upon targeted responses, either the child or the therapist selected one of three preferred reinforcer items. Reinforcer choice did not affect intervention effectiveness for two of the children; however, performance and motivation improved for the third child. Results re-affirmed the importance of thorough preference assessments prior to intervention and showed that additional stimulus choice contingent on the target response may improve motivation and outcomes for some children.

Adolescents' views about a proposed rewards intervention to promote healthy food choice in secondary school canteens

Using rewards may be an effective method to positively influence adolescent eating behaviour, but evidence regarding this approach is limited. The aim of this study was to explore young adolescent views about a proposed reward intervention associated with food choice in school canteens. Focus groups were held in 10 schools located in lower socioeconomic areas within Northern Ireland and involved 90 pupils aged 11-12 years (54 girls, 36 boys). Our findings indicated a high degree of acceptability for a reward scheme but there was major diversity in the type of rewards valued by pupils, largely defined by geographical area and socio-cultural differences. Pupils from rural areas tended to emphasize group-based and longer-term rewards, whereas pupils from urban-city schools tended to suggest individualistic and immediate rewards. The major factors influencing food choice were food price, value for money, taste and visual appearance. Pupils felt that factors outside of their control, such as being assigned to the second lunch sitting placed considerable constraints on their food choice. This research not only indicated a high degree of acceptability for a rewards-based intervention but also highlighted a number of socio-cultural and environmental factors that should be considered by researchers when developing such an intervention.

A-level Mathematics Module Choice and Subsequent Performance in First Year of an Engineering Degree

The A-level Mathematics qualification is based on a compulsory set of pure maths modules and a selection of applied maths modules. The flexibility in choice of applied modules has led to concerns that many students would proceed to study engineering at university with little background in mechanics. A survey of aerospace and mechanical engineering students in our university revealed that a combination of mechanics and statistics (the basic module in both) was by far the most popular choice of optional modules in A-level Mathematics, meaning that only about one-quarter of the class had studied mechanics beyond the basic module within school mathematics. Investigation of student performance in two core, first-year engineering courses, which build on a mechanics foundation, indicated that any benefits for students who studied the extra mechanics at school were small. These results give concern about the depth of understanding in mechanics gained during A-level Mathematics.

Coexistence of GMOs in the EU – A Veritable Choice?

This chapter examines the issue of coexistence of genetically modified organisms (GMOs) alongside conventional and organic crops. The central focus is on whether there is a veritable opportunity for coexistence of all three types of crops, which allows for freedom of choice by both farmers and consumers. It commences by considering the nature of the general GM regime, the relationship between the frameworks for cultivation and the use and sale of GM food and feed, and the main elements of the cultivation regime. In light of this, the concept of coexistence is considered, with an evaluation of both the legal and practical elements. Although the general GM regime is controlled at an EU level, coexistence is apparently left to the Member States who may take appropriate coexistence measures. Nonetheless, the Commission has created Recommendations that are to guide the Member States in their choice of measures. To a great extent, what is considered ‘appropriate’ is to be determined by the economic impact upon the farmers and the relationship with the labelling thresholds. The chapter evaluates the future of coexistence, bearing in mind the continued use of the safeguard clauses, the declaration of ‘GM-free’ regions, the potential for national ‘opt-outs’ and the general practical challenges of maintaining coexistence including the ‘domino effect’. Overall, it is arguable that coexistence is a misnomer and that if the term’s meaning is strictly maintained then veritable coexistence that allows for freedom of choice by both farmers and consumers seems unattainable. Although not directly controlled by CAP, there are strong areas of overlap and they share a number of similar objectives; the chapter will conclude by considering whether the approaches in relation to CAP and the cultivation of GMOs are converging or diverging.