Choice determinants of the mobility in the Dutch health insurance market

We estimate a Logit model for the choice determinants of the mobility in the Dutch market for health insurance in 2006. The results highlight that socio-economic, geographical, and health-related factors matter in the decision to switch health care insurer. Moreover, previous contact with the insurer and the former type of health policy are also of influence.

Human Health and the Environment: In Harmony or in Conflict?

Health policy frameworks usually construe environmental protection and human health as harmonious values. Policies that protect the environment, such as pollution control and pesticide regulation, also benefit human health. In recent years, however, it has become apparent that promoting human health sometimes undermines environmental protection. Some actions, policies, or technologies that reduce human morbidity, mortality, and disease can have detrimental effects on the environment. Since human health and environmental protection are sometimes at odds, political leaders, citizens, and government officials need a way to mediate and resolve conflicts between these values. Unfortunately, few approaches to applied bioethics have the conceptual tools to do accomplish this task. Theories of health care ethics have little to say about the environment, and theories of environmental ethics don’t say much about human health. In this essay, I defend an approach to ethical decision-making that gives policy-makers some tools for balancing promotion of human health and protection of the environment.

Redistributive effects in public health care financing

This article focuses on the redistributive effects of different measures to finance public health insurance. We analyse the implications of different financing options for public health insurance on the redistribution of income from good to bad health risks and from high-income to low-income individuals. The financing options considered are either income-related (namely income taxes, payroll taxes, and indirect taxes), health-related (co-insurance, deductibles, and no-claim), or neither (flat fee). We show that governments who treat access to health care as a basic right for everyone should consider redistributive effects when reforming health care financing.

Well-Being and Health

One way of evaluating health is in terms of its impact on well-being. It has been shown, however, that evaluating health this way runs into difficulties, since health and other aspects of well-being are not separable. At the same time, the practical implications of the inseparability problem remain unclear. This paper assesses these implications by considering the relations between theories, components, and indicators of well-being.

Methodological considerations in developing local-scale health impact assessments: balancing national, regional, and local data

National-scale health impact assessments (HIAs) have been conducted for many years and have become reasonably systematized. Recently, there has been growing interest in utilizing HIA methods at local scales, in the context of Environmental Public Health Tracking and in other settings. This paper investigates the data and analytical challenges to estimating the incidence of health effects associated with changes in air pollution concentrations at the local scale, focusing on ozone and fine particulate matter. Although it could be argued that the local-scale HIA is simply a more geographically discrete version of the national-scale assessment and, therefore, has similar challenges, in practice, many key inputs in national-scale assessments are assumed to be spatially uniform or vary only at coarse geographic resolution. For a national-scale assessment, this assumption may not contribute appreciable bias, but the bias could be significant for any individual location. Thus, local-scale assessments require more geographically resolved air quality data, concentration–response (C-R) functions, and baseline incidence rates than are often used. However, comprehensive local data may not be available, may be incomplete, or may be time-intensive and resource-intensive to develop, especially for C-R functions for which small-scale epidemiological studies will often be underpowered. Given this context, this paper considers how best to develop credible local-scale HIAs, identifying factors that contribute to variability across geographic areas, study designs, and time periods. This paper also describes which key sources of analytical uncertainty change as the scope shifts from the national to the local scale. These challenges notwithstanding, the paper concludes that a well-designed local-scale HIA, following key principles and recommendations, can be both informative and defensible.

Editorial

Ohne Zusammenfassung

---

Ungleichheit in der Mundgesundheit

Ohne Zusammenfassung

---

Editorial

Ohne Zusammenfassung

---

Pesticides and farmer health in Nicaragua: a willingness-to-pay approach to evaluation

A contingent valuation approach to assess the health effects of chemical pesticides among Nicaraguan vegetable farmers is presented. Farmers’ valuation of health is measured as their willingness to pay (WTP) for low-toxicity pesticides. Results show that farmers are willing to spend an additional amount of about 28% of current pesticide expenditure for avoiding health risks. The validity of results is established in scope tests and with a two-step regression model. WTP depends on farmers’ experience with poisoning, income variables, and current exposure to pesticides. The results can help in designing rural health policies and in the formulation of programmes aiming to reduce the negative effects of pesticides.

Editorial

Ohne Zusammenfassung

---

Why the econometrician is in good spirits: a workshop through the looking glass

Vita brevis, ars longa (or...life is too short for abstracts).

Total costs of injury from accidents in the home and during education, sports and leisure activities: estimates for Norway with assessment of uncertainty

Injury accidents occurring in the home, during educational, sports or leisure activities were estimated from samples of hospital data, combined with fatality data from vital statistics. Uncertainty of estimated figures was assessed in simulation-based analysis. Total economic costs to society from injuries and fatalities due to such accidents were estimated at approximately NOK 150 billion per year. The estimated costs reveal the scale of the public health problem and lead to arguments for the establishment of a proper injury register for the identification of preventive measures to reduce the costs to society.

Big and Beautiful: Attractiveness and Health Ratings of the Female Body by Male “Fat Admirers”

This study examined the body weight and waist-to-hip ratio (WHR) preferences of “fat admirers” (FAs), that is, individuals who are sexually attracted to heavier partners. Fifty-six heterosexual men involved in the FA community rated a series of line drawings that varied in three levels of body weight and six of WHR for physical attractiveness and health. The results showed significant main effects of body weight and WHR, as well as a significant body weight × WHR interaction for both health ratings. In general, there was a preference for heavyweight figures and high WHRs for ratings of attractiveness and normal-weight figures and mid-ranging WHRs for ratings of health. Limitations of the study and explanations for fat admiration are discussed.

Can Mediterranean diet really influence obesity? Evidence from propensity score matching

Worldwide obesity rates have stimulated interest in healthy dietary patterns. One well-known dietary pattern is the Mediterranean diet, which has been linked with several beneficial health effects. However, concerns have also been raised regarding the Mediterranean diet’s role in promoting weight gain. We explored the effect of the Mediterranean diet on body mass index using the propensity score matching approach. We found no statistically significant average treatment effect on the treated and therefore cannot confirm that a causal link exists between Mediterranean diet and body mass index.

Research on Transition to Adulthood: Building the Evidence Base to Inform Services and Supports for Youth and Young Adults with Serious Mental Health Disorders

Since the mid-1990s, research has established a clear picture of the poor real-life outcomes achieved by transition-age youth and young adults who have been diagnosed with a serious mental health disorder. The purpose of this article is to: (1) introduce the reader to the other eight articles in this special issue on Transition to Adulthood Research; (2) illustrate how each is contributing to the research base available to more fully understand these challenges as well as guide the creation of developmentally appropriate and effective services and supports for youth and young adults and their families; and (3) suggest future directions for continuing to advance this field of research and program implementation to improve outcomes though practice and policy improvements.

Do quality-adjusted life years take account of lost income? Evidence from an Australian survey

The procedures used in cost utility analysis for eliciting quality of life weights have generally omitted any instruction concerning the level of consumption in a health state, despite the fact that some health states preclude the possibility of normal employment. This introduces ambiguity into the interpretation of quality of life (QoL) scores, and project ranking is sensitive to the subsequent treatment of consumption in the analysis. This article reports the results of a study that questioned 131 respondents to a time trade-off (TTO) interview about their assumptions concerning consumption and the amount of thought given to consumption. Results indicate that, without prompting, most assumed unchanged consumption, implying little bias in existing studies.

Employment Training for At-risk Youth: A Program Evaluation Focusing on Changes in Psychological Well-being

The purpose of this study was to present and evaluate an employment training program specifically designed to help at-risk youth find work. Fifty-nine at-risk youth living in a small urban area participated in a 7-month program designed to help youth develop employment skills and improve their psychological well-being. Results of this pre- and post-test study showed significant improvement among participants on measures of psychological well-being by program’s end. These results are discussed in terms of the need for employment training programs to be more holistic by working with youth to improve their psychological health, and thus helping them to overcome a barrier to employment.

The principle of double effect as a guide for medical decision-making

Many medical interventions have both negative and positive effects. When health care professionals cannot achieve a particular desired good result without bringing about some bad effects also they often rely on double-effect reasoning to justify their decisions. The principle of double effect is therefore an important guide for ethical decision-making in medicine. At the same time, however, it is a very controversial tool for resolving complex ethical problems that has been criticized by many authors. For these reasons, I examine in this paper whether the principle of double effect can serve as a basis for ethical decisions in medicine. The conclusion reached in this article is that even though this principle has desirable effects on clinical conduct, it is only an unreliable guide and physicians and nurses cannot feel secure in continuing to use this principle for ethical guidance.

Quality choice in a health care market: a mixed duopoly approach

We investigate a health care market with uncertainty in a mixed duopoly, where a partially privatized public hospital competes against a private hospital in terms of quality choice. We use a simple Hotelling-type spatial competition model by incorporating mean–variance analysis and the framework of partial privatization. We show how the variance in the quality perceived by patients affects the true quality of medical care provided by hospitals. In addition, we show that a case exists in which the quality of the partially privatized hospital becomes higher than that of the private hospital when the patient’s preference for quality is relatively high.

Money,Case Complexity,and Wait Lists: Perspectives on Problems and Solutions at Children’s Mental Health Centers in Ontario

Senior managers of children’s mental health centers across Ontario, Canada were interviewed regarding the challenges and solutions of access and delivery of care. The central challenges—funding, case complexity, waitlists, staffing, and system integration—revealed a complex interplay between the policies and financing of children’s mental health services and the provision of clinical services at the agency level and within the community. The desire for integration and collaboration was countered by competition for funding and service demands. A need for policies that allow for local solutions while providing leadership for sustained improvements in the ease and timeliness of access to care and effective clinical services emerged.