Are prescribing doctors sensitive to the price that their patients have to pay in the Spanish National Health System?

[EN] Background This study aims to design an empirical test on the sensitivity of the prescribing doctors to the price afforded for the patient, and to apply it to the population data of primary care dispensations for cardiovascular disease and mental illness in the Spanish National Health System (NHS). Implications for drug policies are discussed. Methods We used population data of 17 therapeutic groups of cardiovascular and mental illness drugs aggregated by health areas to obtain 1424 observations ((8 cardiovascular groups * 70 areas) + (9 psychotropics groups * 96 areas)). All drugs are free for pensioners. For non-pensioner patients 10 of the 17 therapeutic groups have a reduced copayment (RC) status of only 10% of the price with a ceiling of €2.64 per pack, while the remaining 7 groups have a full copayment (FC) rate of 40%. Differences in the average price among dispensations for pensioners and non-pensioners were modelled with multilevel regression models to test the following hypothesis: 1) in FC drugs there is a significant positive difference between the average prices of drugs prescribed to pensioners and non-pensioners; 2) in RC drugs there is no significant price differential between pensioner and non-pensioner patients; 3) the price differential of FC drugs prescribed to pensioners and non-pensioners is greater the higher the price of the drugs. Results The average monthly price of dispensations to pensioners and non-pensioners does not differ for RC drugs, but for FC drugs pensioners get more expensive dispensations than non-pensioners (estimated difference of €9.74 by DDD and month). There is a positive and significant effect of the drug price on the differential price between pensioners and non-pensioners. For FC drugs, each additional euro of the drug price increases the differential by nearly half a euro (0.492). We did not find any significant differences in the intensity of the price effect among FC therapeutic groups. Conclusions Doctors working in the Spanish NHS seem to be sensitive to the price that can be afforded by patients when they fill in prescriptions, although alternative hypothesis could also explain the results found.

Location-price competition with externality: an application to the Tenerife tram

[EN] This paper presents a location–price equilibrium problem on a tree. A sufficient condition for having a Nash equilibrium in a spatial competition model that incorporates price, transport, and externality costs is given. This condition implies both competitors are located at the same point, a vertex that is the unique median of the tree. However, this is not an equilibrium necessary condition. Some examples show that not all medians are equilibria. Finally, an application to the Tenerife tram is presented.

Ni una más. International cooperation against gender-based discrimination: the femicide case in Ciudad Juárez, Chihuahua, Mexico

The femicide in Ciudad Juárez is a story made of extreme violence against women for different reasons, by different actors, under different circumstances, and following different behavioural patterns. All within a gender discrimination frame based on the idea that women are inferior, interchangeable and disposable according to the patriarchal hierarchy still present in Mexico, but strongly reinforced by a sort of conspiracy of silence provoked either by the high impunity rate, the governmental incompetence to solve the crimes, or the general indifference of the population. It is the story of hundreds of kidnapped, raped, in many cases tortured, and murdered young women in the border between Mexico and the United States. The murders first came into light in 1993 and up to now young women continue to “disappear” without any hope of bringing the perpetrators to justice, stopping impunity, convicting the assassins, and bringing justice to the families of the deceased girls and women. The main questions about femicide in Ciudad Juárez seem to be: why were they brutally assassinated?, why most of the crimes have not been solved yet?, why and how is Ciudad Juárez different from other border cities with the same characteristics?, which powers are behind those crimes in a city that implies mainly women as its labor force, and which has the lowest unemployment rate in the whole country? But there are also many other questions dealing more with the context, the Juarences’ lifestyles, the eventual hidden powers behind the crimes, the possible murderers’ reasons, the response of the local civil society, or the international community actions to fight against femicide there, among many other things, that are still waiting for an answer and that this paper will ‘narrate’ in order to provide a holistic panorama for the readers. But above all there is the need to remember that every single woman or girl assassinated there had a name, an identity, a family, a story to be told time after time and as many times as necessary, in order to avoid accepting these crimes just as statistics, as cold numbers that might make us forget the human tragedy that has been flagellating the city since 1993. We must remember as well that their deaths express gender oppression, the inequality of the relations between what is male and what is female, a manifestation of domination, terror, social extermination, patriarchal hegemony, social class and impunity. The city is the perfect mirror where all the contradictions of globalization get reflected. It is there where all the globalization evils are present and survive by sucking their women’s blood. It is a city where some concepts such as gender, migration and power are closely related with a negative connotation.

Cut-first branch-and-price-second for the capacitated arc-routing problem

This paper presents the first full-fledged branch-and-price (bap) algorithm for the capacitated arc-routing problem (CARP). Prior exact solution techniques either rely on cutting planes or the transformation of the CARP into a node-routing problem. The drawbacks are either models with inherent symmetry, dense underlying networks, or a formulation where edge flows in a potential solution do not allow the reconstruction of unique CARP tours. The proposed algorithm circumvents all these drawbacks by taking the beneficial ingredients from existing CARP methods and combining them in a new way. The first step is the solution of the one-index formulation of the CARP in order to produce strong cuts and an excellent lower bound. It is known that this bound is typically stronger than relaxations of a pure set-partitioning CARP model.rnSuch a set-partitioning master program results from a Dantzig-Wolfe decomposition. In the second phase, the master program is initialized with the strong cuts, CARP tours are iteratively generated by a pricing procedure, and branching is required to produce integer solutions. This is a cut-first bap-second algorithm and its main function is, in fact, the splitting of edge flows into unique CARP tours.

Disclosure, discrimination and desire: experiences of Black and South Asian gay men in Britain

Using findings from a qualitative investigation based on in-depth email interviews with 47 Black and South Asian gay men in Britain, this paper explores the cross-cutting identities and discourses in relation to being both gay and from an ethnic minority background. Taking an intersectional approach, detailed accounts of identity negotiation, cultural pressures, experiences of discrimination and exclusion and the relationship between minority ethnic gay men and mainstream White gay culture are presented and explored. The major findings common to both groups were: cultural barriers limiting disclosure of sexuality to family and wider social networks; experiences of discrimination by White gay men that included exclusion as well as objectification; a lack of positive gay role models and imagery relating to men from minority ethnic backgrounds. Among South Asian gay men, a major theme was regret at being unable to fulfil family expectations regarding marriage and children, while among Black gay men, there was a strong belief that same-sex behaviour subverted cultural notions related to how masculinity is configured. The paper concludes by highlighting the importance of social location, particularly education and income, when examining the intersection of ethnicity and sexuality in future research.

In-the-canal versus behind-the-ear microphones improve spatial discrimination on the side of the head in bilateral cochlear implant users

To test whether in-the-canal (ITC) microphones have an impact on spatial discrimination and speech perception by taking advantage of auricular cues.