Using contingent valuation to estimate willingness to pay for improved water source in rural Uganda

This research was conducted in August of 2011 in the villages of Kigisu and Rubona in rural Uganda while the author was serving as a community health volunteer with the U.S. Peace Corps. The study used the contingent valuation method (CVM) to estimate the populations’ willingness to pay (WTP) for the operation and maintenance of an improved water source. The survey was administered to 122 households out of 400 in the community, gathering demographic information, health and water behaviors, and using an iterative bidding process to estimate WTP. Households indicated a mean WTP of 286 Ugandan Shillings (UGX) per 20 liters for a public tap and 202 UGX per 20 liters from a private tap. The data were also analyzed using an ordered probit model. It was determined that the number of children in the home, and the distance from the existing source were the primary variables influencing households’ WTP.

Employment Situation of Parents of Long-Term Childhood Cancer Survivors.

BACKGROUND Taking care of children diagnosed with cancer affects parents' professional life. The impact in the long-term however, is not clear. We aimed to compare the employment situation of parents of long-term childhood cancer survivors with control parents of the general population, and to identify clinical and socio-demographic factors associated with parental employment. METHODS As part of the Swiss Childhood Cancer Survivor Study, we sent a questionnaire to parents of survivors aged 5-15 years, who survived ≥5 years after diagnosis. Information on control parents of the general population came from the Swiss Health Survey (restricted to men and women with ≥1 child aged 5-15 years). Employment was categorized as not employed, part-time, and full-time employed. We used generalized ordered logistic regression to determine associations with clinical and socio-demographic factors. Clinical data was available from the Swiss Childhood Cancer Registry. RESULTS We included 394 parent-couples of survivors and 3'341 control parents (1'731 mothers; 1'610 fathers). Mothers of survivors were more often not employed (29% versus 22%; ptrend = 0.007). However, no differences between mothers were found in multivariable analysis. Fathers of survivors were more often employed full-time (93% versus 87%; ptrend = 0.002), which remained significant in multivariable analysis. Among parents of survivors, mothers with tertiary education (OR = 2.40, CI:1.14-5.07) were more likely to be employed. Having a migration background (OR = 3.63, CI: 1.71-7.71) increased the likelihood of being full-time employed in mothers of survivors. Less likely to be employed were mothers of survivors diagnosed with lymphoma (OR = 0.31, CI:0.13-0.73) and >2 children (OR = 0.48, CI:0.30-0.75); and fathers of survivors who had had a relapse (OR = 0.13, CI:0.04-0.36). CONCLUSION Employment situation of parents of long-term survivors reflected the more traditional parenting roles. Specific support for parents with low education, additional children, and whose child had a more severe cancer disease could improve their long-term employment situation.

A model of factors determining levels of public support for health care policy in the United States

Public preferences for policy are formed in a little-understood process that is not adequately described by traditional economic theory of choice. In this paper I suggest that U.S. aggregate support for health reform can be modeled as tradeoffs among a small number of behavioral values and the stage of policy development. The theory underlying the model is based on Samuelson, et al.'s (1986) work and Wilke's (1991) elaboration of it as the Greed/Efficiency/Fairness (GEF) hypothesis of motivation in the management of resource dilemmas, and behavioral economics informed by Kahneman and Thaler's prospect theory. ^ The model developed in this paper employs ordered probit econometric techniques applied to data derived from U.S. polls taken from 1990 to mid-2003 that measured support for health reform proposals. Outcome data are four-tiered Likert counts; independent variables are dummies representing the presence or absence of operationalizations of each behavioral variable, along with an integer representing policy process stage. Marginal effects of each independent variable predict how support levels change on triggering that variable. Model estimation results indicate a vanishingly small likelihood that all coefficients are zero and all variables have signs expected from model theory. ^ Three hypotheses were tested: support will drain from health reform policy as it becomes increasingly well-articulated and approaches enactment; reforms appealing to fairness through universal health coverage will enjoy a higher degree of support than those targeted more narrowly; health reforms calling for government operation of the health finance system will achieve lower support than those that do not. Model results support the first and last hypotheses. Contrary to expectations, universal health care proposals did not provide incremental support beyond those targeted to “deserving” populations—children, elderly, working families. In addition, loss of autonomy (e.g. restrictions on choice of care giver) is found to be the “third rail” of health reform with significantly-reduced support. When applied to a hypothetical health reform in which an employer-mandated Medical Savings Account policy is the centerpiece, the model predicts support that may be insufficient to enactment. These results indicate that the method developed in the paper may prove valuable to health policy designers. ^

An empirical model to estimate the demand for primary care in urban settings

Objective. To measure the demand for primary care and its associated factors by building and estimating a demand model of primary care in urban settings.^ Data source. Secondary data from 2005 California Health Interview Survey (CHIS 2005), a population-based random-digit dial telephone survey, conducted by the UCLA Center for Health Policy Research in collaboration with the California Department of Health Services, and the Public Health Institute between July 2005 and April 2006.^ Study design. A literature review was done to specify the demand model by identifying relevant predictors and indicators. CHIS 2005 data was utilized for demand estimation.^ Analytical methods. The probit regression was used to estimate the use/non-use equation and the negative binomial regression was applied to the utilization equation with the non-negative integer dependent variable.^ Results. The model included two equations in which the use/non-use equation explained the probability of making a doctor visit in the past twelve months, and the utilization equation estimated the demand for primary conditional on at least one visit. Among independent variables, wage rate and income did not affect the primary care demand whereas age had a negative effect on demand. People with college and graduate educational level were associated with 1.03 (p < 0.05) and 1.58 (p < 0.01) more visits, respectively, compared to those with no formal education. Insurance was significantly and positively related to the demand for primary care (p < 0.01). Need for care variables exhibited positive effects on demand (p < 0.01). Existence of chronic disease was associated with 0.63 more visits, disability status was associated with 1.05 more visits, and people with poor health status had 4.24 more visits than those with excellent health status. ^ Conclusions. The average probability of visiting doctors in the past twelve months was 85% and the average number of visits was 3.45. The study emphasized the importance of need variables in explaining healthcare utilization, as well as the impact of insurance, employment and education on demand. The two-equation model of decision-making, and the probit and negative binomial regression methods, was a useful approach to demand estimation for primary care in urban settings.^

The prevalence of periodontal disease in Mexican American vs European American elderly in three distinct socio-economic communities in San Antonio, Texas

Purpose of the Study: This study evaluated the prevalence of periodontal disease between Mexican American elderly and European American elderly residing in three socio-economically distinct neighborhoods in San Antonio, Texas. ^ Study Group: Subjects for the original protocol were participants of the Oral Health: San Antonio Longitudinal Study of Aging (OH: SALSA), which began with National Institutes of Health (NIH) funding in 1993 (M.J. Saunders, PI). The cohort in the study was the individuals who had been enrolled in Phases I and III of the San Antonio Heart Study (SAHS). This SAHS/SALSA sample is a community-based probability sample of Mexican American and European American residents from three socio-economically distinct San Antonio neighborhoods: low-income barrio, middle-income transitional, and upper-income suburban. The OH: SALSA cohort was established between July 1993 and May 1998 by sampling two subsets of the San Antonio Heart Study (SAHS) cohort. These subsets included the San Antonio Longitudinal Study of Aging (SALSA) cohort, comprised of the oldest members of the SAHS (age 65+ yrs. old), and a younger set of controls (age 35-64 yrs. old) sampled from the remainder of the SAHS cohort. ^ Methods: The study used simple descriptive statistics to describe the sociodemographic characteristics and periodontal disease indicators of the OH: SALSA participants. Means and standard deviations were used to summarize continuous measures. Proportions were used to summarize categorical measures. Simple m x n chi square statistics was used to compare ethnic differences. A multivariable ordered logit regression was used to estimate the prevalence of periodontal disease and test ethnic group and neighborhood differences in the prevalence of periodontal disease. A multivariable model adjustment for socio-economic status (income and education), gender, and age (treated as confounders) was applied. ^ Summary: In the unadjusted and adjusted model, Mexican American elderly demonstrated the greatest prevalence for periodontitis, p < 0.05. Mexican American elderly in barrio neighborhoods demonstrated the greatest prevalence for severe periodontitis, with unadjusted prevalence rates of 31.7%, 22.3%, and 22.4% for Mexican American elderly barrio, transitional, and suburban neighborhoods, respectively. Also, Mexican American elderly had adjusted prevalence rates of 29.4%, 23.7%, and 20.4% for barrio, transitional, and suburban neighborhoods, respectively. ^ Conclusion: This study indicates that the prevalence of periodontal disease is an important oral health issue among the Mexican American elderly. The results suggest that the socioeconomic status of the residential neighborhood increased the risk for severe periodontal disease among the Mexican American elderly when compared to European American elderly. A viable approach to recognizing oral health disparities in our growing population of Mexican American elderly is imperative for the provision of special care programs that will help increase the quality of care in this minority population.^

The impact of communication and cultural diversity in utilizing dental services among Saudi Arabian students in U.S.A.

Objectives: The purpose of this study is to understand the perceived effects of patient-dental staff communication and cultural diversity on the utilization of dental services in the U.S. by Saudi Arabian students who live in the U.S. and enrolled into the King Abdullah Scholarship program. Methods: The study design was an analytical cross-sectional study. Data for this study was obtained from the Saudi Dental Servicers Utilization Survey, a voluntary internet survey available online for one month through Facebook. Ordered logistic regression analyses and multinomial logistic regression analyses were used to measure the relationships between patient-dental staff communication and cultural diversity on the utilization of dental services. Results: Eight hundred and forty-seven responses were analyzed for this study. Overall, the majority of Saudi students reported having excellent communication experience with dental providers in the U.S. More than 58% of respondents reported at least one regular dental visit last year. Factors that influenced the use of regular dental care were: dentist's explanation of treatment plan, response of dental staff to patient's needs, respectful and polite dental staff, dental staff kindness, availability of up-to-date equipment, and overall communication with dentist. However, the utilization of emergency dental care was not associated with any measurement of patient-dental provider communication. Overall future utilization of dental care is associated with all aspects of patient-dental staff communication measured in this survey. Furthermore, more utilization of regular dental care was related to respondent's perception of the importance of trustworthiness dental staff and the importance of a dentist's reputation was only marginally associated. Respondent's perception of dentist's reputation was associated with more use of emergency dental services. Respondents are more likely to anticipate using dental care in the future if they perceived trustworthiness dental staff, and the dentist's reputation as influencing factors to their usage of dental services. Conclusions: Patient-dental staff communication was partially associated with utilization of regular dental care, not associated with utilization of emergency dental care, and broadly associated with anticipated future utilization of dental care. In addition, trustworthy dental staff, and a dentist's reputation were considered to be strong influencing factors towards utilization of dental services.^

Effect of insurance status on stage of breast cancer diagnosis

Objective: The purpose of this study is to compare the stages of breast cancer presented between the insured and uninsured patients diagnosed at The Rose, an active non-profit breast healthcare organization to determine if uninsured patients present with more advanced stage breast cancer as compared to their insured counterparts. ^ Study Design: Retrospective cross-sectional study. ^ Methods: The study included 1,265 patients who received breast healthcare services and were diagnosed with breast cancer at The Rose between FY 2007 and FY 2012. 738 of the patients in the study were presumably uninsured since their breast healthcare services were sponsored through various funding sources and they were navigated into treatment through The Rose patient navigation program. We compared breast cancer stages for women who had insurance with those who did not have insurance. The effects of age and race/ethnicity along with the insurance status on the stage of reast cancer diagnosis were also analyzed. We calculated the odds ratio using the contingency tables; and estimated odds ratios (ORs) and 95% confidence intervals (CIs) using ordinal logistic regression by applying multiple imputation method for missing tumor stage data. ^ Results: The ordered logistic regression analysis with ordered tumor stage as dependent variable and uninsured as independent variable gave us an odds ratio of 1.73 (OR=1.73; p-value<0.05; 95% CI: 1.36 - 2.12). ^ Conclusions: Insurance status is a strong predictor of stage of breast cancer diagnosed among women seen at The Rose. Uninsured women seen at The Rose are almost twice as likely to present at a advanced stage of breast cancer as opposed to their insured counterparts.^

Factores que influyen en la adopción de tecnologías de conservación de suelos en el secano interior de Chile Central

El desarrollo de sistemas agrícolas sustentables es un desafío en el contexto de políticas e incentivos tendientes a la conservación de los recursos naturales, especialmente en zonas de secano. El presente estudio examina variables demográficas y productivas que influyen en la adopción de tecnologías de conservación de suelos en 90 pequeños productores del secano interior de Chile Central, en las comunas de Pencahue y Curepto. Se utilizó un modelo de regresión Probit, el cual asocia la adopción de las tecnologías con las variables: edad del agricultor, tamaño familiar, superficie predial y forma de tenencia de la tierra; presencia de: plantaciones forestales, invernaderos, aboneras, animales mayores en el predio; experiencia en comercialización del productor y participación en actividades de capacitación. El modelo seleccionado tiene un alto poder de predicción, llegando a clasificar correctamente un 92,2% de las observaciones. Los resultados econométricos muestran que la participación en actividades de extensión, la superficie predial, la presencia de plantaciones forestales y el uso de aboneras, influyen de manera positiva y significativa sobre la adopción de tecnologías conservacionistas. Resulta relevante el impacto de la capacitación sobre la adopción de tecnologías de alto grado de inversión, así como la incorporación de prácticas de conservación de bajo nivel de inversión como las aboneras.

Images of Europeans: In-Group Trust and Support for European Integration. Jean Monnet/Robert Schuman Paper Series Vol. 14 No. 3, March 2014

Prior research on citizen support for European integration does not consider how individuals’ evaluations of European nationalities are associated with support. This paper fills this gap by developing a political cohesion model based on social identity theory. I claim that the probability of supporting integration increases with greater levels of trust in fellow Europeans, which assumes to reflect their positive images. Also, trust in eastern European Union nationalities has the highest impact on the probability for support, followed by trust in the southern nationalities, and then northern nationalities due to the eastern and southern nationalities relatively lower economic development. Controlling for various factors, the ordered logistic regression analysis of the European Election Study (2004) data support these claims.

Growth expectations of business owners:impact of human capital, firm characteristics and environmental transition

This paper presents an empirical study based on a survey of 399 owners of small and medium size companies in Lithuania. Applying bivariate and ordered probit estimators, we investigate why some business owners expect their firms to expand, while others do not. Our main findings provide evidence that SME owner's generic and specific human capital matter. Those with higher education and 'learning by doing' attributes, either through previous job experience or additional entrepreneurial experience, expect their businesses to expand. The expectations of growth are positively related to exporting and non-monotonically to enterprise size. In addition, we analyse the link between the perceptions of constraints to business activities and growth expectations and find that the factors, which are perceived as main business barriers, are not necessary those which are associated with reduced growth expectations. In particular, perceptions of both corruption and of inadequate tax systems seem to affect growth expectations the most.

Uncertainty and Fuzzy Sets: Classifying the Situation

The so called “Plural Uncertainty Model” is considered, in which statistical, maxmin, interval and Fuzzy model of uncertainty are embedded. For the last case external and internal contradictions of the theory are investigated and the modified definition of the Fuzzy Sets is proposed to overcome the troubles of the classical variant of Fuzzy Subsets by L. Zadeh. The general variants of logit- and probit- regression are the model of the modified Fuzzy Sets. It is possible to say about observations within the modification of the theory. The conception of the “situation” is proposed within modified Fuzzy Theory and the classifying problem is considered. The algorithm of the classification for the situation is proposed being the analogue of the statistical MLM(maximum likelihood method). The example related possible observing the distribution from the collection of distribution is considered.

Food SMEs’ innovation profile – the Hungarian case

The small and medium sized enterprises (SMEs) in the Hungarian agri-food sector play determining role. The innovation capacity (efforts, activities and results) however of the individual SMEs is very limited. Food production (including SMEs) has to fulfil food safety requirements in a rapidly increasing extent, which implies a continuous innovation and development process from all market players. In Hungary the agri-food sector had to face a suddenly increased competition especially after the EU enlargement. Based on survey data this paper examines the efforts, activities and results in knowledge acquisition, utilisation, coordination and transfer in the Central Hungarian food SMEs. We have found (using ordered logistic regression) that R&D expenditures, achieved innovations, export/import orientation as well as the networking activity of the SMEs play significant role in market development.

Innovation across the food chain – the Hungarian case

The small and medium sized enterprises (SMEs) in the Hungarian agri-food sector play determining role. The innovation capacity (efforts, activities and results) however of the individual SMEs is very limited. Food production (including SMEs) has to fulfil food safety requirements in a rapidly increasing extent, which implies a continuous innovation and development process from all market players. In Hungary the agri-food chain had to face a suddenly increased competition especially after the EU enlargement. Based on survey data this paper examines the efforts, activities and results in knowledge acquisition, utilisation, coordination and transfer in the Central Hungarian food SMEs. We have found (using ordered logistic regression) that R&D expenditures, achieved innovations, export/import orientation as well as the networking activity of the SMEs play significant role in market development.

Value creation and appropriation through the Hungarian SME’s food chain

Value creation is the result of the continuous innovation activity of the entrepreneur, which is carried out mainly in form of open innovation among the agri-food SMEs. However value creation is not the ultimate goal of the enterprises. They are more interested in increased appropriation of the created value. Although the value creation (innovation) is very well explored and cultivated area of research, there are some voids in the field of agriculture and food industry: the behavioural aspect of open innovation is very rare. The value capturing is even much less studied, therefor our research approach is largely explorative one. Data are drawn from a survey carried out in Hungary among the agri-food SMEs in 2014. We use Structural Equation Modelling as well as ordered probit and semi-non parametric ordered probit models for analysing the data. Our results show that there is positive relationship between the knowledge sharing with chain partners and the innovativeness. We could explore that size of the firm, absorptive capacity and openness to foreign trade ambiguously affects value capturing. However trust in chain partners, reciprocity in knowledge sharing with chain partners and willingness to cooperate with buyers positively influence the appropriation of the created value.

Essays on risk aversion, diversification and non -participation

My dissertation consists of three essays. The central theme of these essays is the psychological factors and biases that affect the portfolio allocation decision. The first essay entitled, “Are women more risk-averse than men?” examines the gender difference in risk aversion as revealed by actual investment choices. Using a sample that controls for biases in the level of education and finance knowledge, there is evidence that when individuals have the same level of education, irrespective of their knowledge of finance, women are no more risk-averse than their male counterparts. However, the gender-risk aversion relation is also a function of age, income, wealth, marital status, race/ethnicity and the number of children in the household. The second essay entitled, “Can diversification be learned ?” investigates if investors who have superior investment knowledge are more likely to actively seek diversification benefits and are less prone to allocation biases. Results of cross-sectional analyses suggest that knowledge of finance increases the likelihood that an investor will efficiently allocate his direct investments across the major asset classes; invest in foreign assets; and hold a diversified equity portfolio. However, there is no evidence that investors who are more financially sophisticated make superior allocation decisions in their retirement savings. The final essay entitled, “The demographics of non-participation ”, examines the factors that affect the decision not to hold stocks. The results of probit regression models indicate that when individuals are highly educated, the decision to not participate in the stock market is less related to demographic factors. In particular, when individuals have attained at least a college degree and have advanced knowledge of finance, they are significantly more likely to invest in equities either directly or indirectly through mutual funds or their retirement savings. There is also evidence that the decision not to hold stocks is motivated by short-term market expectations and the most recent investment experience. The findings of these essays should increase the body of research that seeks to reconcile what investors actually do (positive theory) with what traditional theories of finance predict that investors should do (normative theory).