Delivery and funding are provincial matters in Canada

The following article is one of a series that deal with the provision of health care services around the world. Other countries in the series include Germany, Italy, Japan, Mexico, the Netherlands, and the United States. Countries scheduled for coverage in the series include Austria, France, Singapore, Spain, and the United Kingdom. The countries are described using a grid of characteristics so that comparisons may be made more easily. All of the analyses, along with further comparative data, will be gathered into a freestanding book to be published later in the year. Dr. Mendoza serves as editor for the project.     

Mexican system a mix of public and private providers

The following article is one of a series that deal with the provision of health care services around the world. Other countries in the series include Canada, Germany, Italy, Japan, the Netherlands, and the United States. Countries scheduled for coverage in the series include Austria, France, Singapore, Spain, and the United Kingdom. The countries are described using a grid of characteristics so that comparisons may be made more easily. All of the analyses, along with further comparative data, will be gathered into a freestanding book to be published later in the year. Dr. Mendoza serves as the editor for the project.     

A Tiered Approach for Risk‐Benefit Assessment of Foods

Risk‐benefit analyses are introduced as a new paradigm for old problems. However, in many cases it is not always necessary to perform a full comprehensive and expensive quantitative risk‐benefit assessment to solve the problem, nor is it always possible, given the lack of required date. The choice to continue from a more qualitative to a full quantitative risk‐benefit assessment can be made using a tiered approach. In this article, this tiered approach for risk‐benefit assessment will be addressed using a decision tree. The tiered approach described uses the same four steps as the risk assessment paradigm: hazard and benefit identification, hazard and benefit characterization, exposure assessment, and risk‐benefit characterization, albeit in a different order. For the purpose of this approach, the exposure assessment has been moved upward and the dose‐response modeling (part of hazard and benefit characterization) is moved to a later stage. The decision tree includes several stop moments, depending on the situation where the gathered information is sufficient to answer the initial risk‐benefit question. The approach has been tested for two food ingredients. The decision tree presented in this article is useful to assist on a case‐by‐case basis a risk‐benefit assessor and policymaker in making informed choices when to stop or continue with a risk‐benefit assessment.     

Decision Making for Animal Health and Welfare: Integrating Risk‐Benefit Analysis with Prospect Theory

This study integrated risk‐benefit analysis with prospect theory with the overall objective of identifying the type of management behavior represented by farmers’ choices of mastitis control options (MCOs). Two exploratory factor analyses, based on 163 and 175 Swedish farmers, respectively, highlighted attitudes to MCOs related to: (1) grouping cows and applying milking order to prevent spread of existing infection and (2) working in a precautionary way to prevent mastitis occurring. This was interpreted as being based on (1) reactive management behavior on detection of udder‐health problems in individual cows and (2) proactive management behavior to prevent mastitis developing. Farmers’ assessments of these MCOs were found to be based on asymmetrical evaluations of risks and benefits, suggesting that farmers’ management behavior depends on their individual reference point. In particular, attitudes to MCOs related to grouping cows and applying milking order to prevent the spread of mastitis once infected cows were detected were stronger in the risk domain than in the benefit domain, in accordance with loss aversion. In contrast, attitudes to MCOs related to working in a precautionary way to prevent cows from becoming infected in the first place were stronger in the benefit domain than in the risk domain, in accordance with reverse loss aversion. These findings are of practical importance for farmers and agribusiness and in public health protection work to reduce the current extensive use of antibiotics in dairy herds.     

MEASURING LABOR MARKET FRICTIONS: A CROSS‐COUNTRY COMPARISON

In this paper we define and estimate measures of labor market frictions using data on job durations. We compare different estimation methods and different types of data. We propose and apply an unconditional inference method that can be applied to aggregate duration data. It does not require wage data, it is invariant to the way in which wages are determined, and it allows workers to care about other job characteristics. The empirical analysis focuses on France, but we perform separate analyses for the United States of America, the United Kingdom, Germany, and the Netherlands. We quantify the monopsony power due to search frictions and we examine the policy effects of the minimum wage, unemployment benefits, and search frictions. (JEL: J63, J64)     

Using Probabilistic Terrorism Risk Modeling for Regulatory Benefit-Cost Analysis: Application to the Western Hemisphere Travel Initiative in the Land Environment

This article presents a framework for using probabilistic terrorism risk modeling in regulatory analysis. We demonstrate the framework with an example application involving a regulation under consideration, the Western Hemisphere Travel Initiative for the Land Environment, (WHTI‐L). First, we estimate annualized loss from terrorist attacks with the Risk Management Solutions (RMS) Probabilistic Terrorism Model. We then estimate the critical risk reduction, which is the risk‐reducing effectiveness of WHTI‐L needed for its benefit, in terms of reduced terrorism loss in the United States, to exceed its cost. Our analysis indicates that the critical risk reduction depends strongly not only on uncertainties in the terrorism risk level, but also on uncertainty in the cost of regulation and how casualties are monetized. For a terrorism risk level based on the RMS standard risk estimate, the baseline regulatory cost estimate for WHTI‐L, and a range of casualty cost estimates based on the willingness‐to‐pay approach, our estimate for the expected annualized loss from terrorism ranges from $2.7 billion to $5.2 billion. For this range in annualized loss, the critical risk reduction for WHTI‐L ranges from 7% to 13%. Basing results on a lower risk level that results in halving the annualized terrorism loss would double the critical risk reduction (14–26%), and basing the results on a higher risk level that results in a doubling of the annualized terrorism loss would cut the critical risk reduction in half (3.5–6.6%). Ideally, decisions about terrorism security regulations and policies would be informed by true benefit‐cost analyses in which the estimated benefits are compared to costs. Such analyses for terrorism security efforts face substantial impediments stemming from the great uncertainty in the terrorist threat and the very low recurrence interval for large attacks. Several approaches can be used to estimate how a terrorism security program or regulation reduces the distribution of risks it is intended to manage. But, continued research to develop additional tools and data is necessary to support application of these approaches. These include refinement of models and simulations, engagement of subject matter experts, implementation of program evaluation, and estimating the costs of casualties from terrorism events.     

More Than Fear Induction: Toward an Understanding of People's Motivation to Be Well‐Prepared for Emergencies in Flood‐Prone Areas

This article examines the extent and manner to which evaluations of flood‐related precautions are affected by an individual's motivation and perception of context. It argues that the relationship between risk perception and flood risk preparedness can be fruitfully specified in terms of vulnerability and efficacy if these concepts are put into the perspective of prevention‐focused motivation. This relationship was empirically examined in a risk communication experiment in a delta area of the Netherlands (n = 1,887). Prevention‐focused motivation was induced by contextualized risk information. The results showed that prevention‐focused individuals were more sensitive to the relevance of potential precautions for satisfying their needs in the context they found themselves in. The needs included, but were not limited to, fear reduction. Due to the heterogeneity of the residents, the evaluations reflected individual differences in the intensity and the selectivity of precautionary processes. Four types of persons could be distinguished according to their evaluation of precautionary measures: a high‐scoring minority, two more selective types, and a low‐scoring minority. For policymakers and risk communicators it is vital to consider the nature of prevention motivation and the context in which it is likely to be high.     

A Probabilistic Model for the Failure Frequency of Underground Gas Pipelines

A model is constructed for the failure frequency of underground pipelines per kilometer year, as a function of pipe and environmental characteristics. The parameters in the model were quantified, with uncertainty, using historical data and structured expert judgment. Fifteen experts from institutes in The Netherlands, the United Kingdom, Italy, France, Germany, Belgium, Denmark, and Canada participated in the study.     

Communicating Earthquake Preparedness: The Influence of Induced Mood,Perceived Risk,and Gain or Loss Frames on Homeowners’ Attitudes Toward General Precautionary Measures for Earthquakes

Despite global efforts to reduce seismic risk, actual preparedness levels remain universally low. Although earthquake‐resistant building design is the most efficient way to decrease potential losses, its application is not a legal requirement across all earthquake‐prone countries and even if, often not strictly enforced. Risk communication encouraging homeowners to take precautionary measures is therefore an important means to enhance a country's earthquake resilience. Our study illustrates that specific interactions of mood, perceived risk, and frame type significantly affect homeowners’ attitudes toward general precautionary measures for earthquakes. The interdependencies of the variables mood, risk information, and frame type were tested in an experimental 2 × 2 × 2 design (N = 156). Only in combination and not on their own, these variables effectively influence attitudes toward general precautionary measures for earthquakes. The control variables gender, “trait anxiety” index, and alteration of perceived risk adjust the effect. Overall, the group with the strongest attitudes toward general precautionary actions for earthquakes are homeowners with induced negative mood who process high‐risk information and gain‐framed messages. However, the conditions comprising induced negative mood, low‐risk information and loss‐frame and induced positive mood, low‐risk information and gain‐framed messages both also significantly influence homeowners’ attitudes toward general precautionary measures for earthquakes. These results mostly confirm previous findings in the field of health communication. For practitioners, our study emphasizes that carefully compiled communication measures are a powerful means to encourage precautionary attitudes among homeowners, especially for those with an elevated perceived risk.     

AN INTERNATIONAL COMPARISON OF LIFETIME INEQUALITY: HOW CONTINENTAL EUROPE RESEMBLES NORTH AMERICA

We compare earnings inequality and mobility across the United States, Canada, France, Germany and the United Kingdom during the late 1990s. A flexible model of earnings dynamics that isolates positional mobility within a stable earnings distribution is estimated. Earnings trajectories are then simulated, and lifetime annuity value distributions are constructed. Earnings mobility and employment risk are found to be positively correlated with base‐year inequality. Taken together they produce more equalization in countries with high cross‐section inequality such that the countries in our sample have more similar lifetime inequality levels than cross‐section measures suggest.     

Reducing the Risk of Injury from Table Saw Use: The Potential Benefits and Costs of Automatic Protection

The use of table saws in the United States is associated with approximately 28,000 emergency department (ED) visits and 2,000 cases of finger amputation per year. This article provides a quantitative estimate of the economic benefits of automatic protection systems that could be designed into new table saw products. Benefits are defined as reduced health‐care costs, enhanced production at work, and diminished pain and suffering. The present value of the benefits of automatic protection over the life of the table saw are interpreted as the switch‐point cost value, the maximum investment in automatic protection that can be justified by benefit‐cost comparison. Using two alternative methods for monetizing pain and suffering, the study finds switch‐point cost values of $753 and $561 per saw. These point estimates are sensitive to the values of inputs, especially the average cost of injury. The various switch‐point cost values are substantially higher than rough estimates of the incremental cost of automatic protection systems. Uncertainties and future research needs are discussed.     

Catastrophe Risk Models for Evaluating Disaster Risk Reduction Investments in Developing Countries

Major natural disasters in recent years have had high human and economic costs, and triggered record high postdisaster relief from governments and international donors. Given the current economic situation worldwide, selecting the most effective disaster risk reduction (DRR) measures is critical. This is especially the case for low‐ and middle‐income countries, which have suffered disproportionally more economic and human losses from disasters. This article discusses a methodology that makes use of advanced probabilistic catastrophe models to estimate benefits of DRR measures. We apply such newly developed models to generate estimates for hurricane risk on residential structures on the island of St. Lucia, and earthquake risk on residential structures in Istanbul, Turkey, as two illustrative case studies. The costs and economic benefits for selected risk reduction measures are estimated taking account of hazard, exposure, and vulnerability. We conclude by emphasizing the advantages and challenges of catastrophe model‐based cost‐benefit analyses for DRR in developing countries.     

Cost‐Benefit Analysis for Optimization of Risk Protection Under Budget Constraints

Cost‐benefit analysis (CBA) is commonly applied as a tool for deciding on risk protection. With CBA, one can identify risk mitigation strategies that lead to an optimal tradeoff between the costs of the mitigation measures and the achieved risk reduction. In practical applications of CBA, the strategies are typically evaluated through efficiency indicators such as the benefit‐cost ratio (BCR) and the marginal cost (MC) criterion. In many of these applications, the BCR is not consistently defined, which, as we demonstrate in this article, can lead to the identification of suboptimal solutions. This is of particular relevance when the overall budget for risk reduction measures is limited and an optimal allocation of resources among different subsystems is necessary. We show that this problem can be formulated as a hierarchical decision problem, where the general rules and decisions on the available budget are made at a central level (e.g., central government agency, top management), whereas the decisions on the specific measures are made at the subsystem level (e.g., local communities, company division). It is shown that the MC criterion provides optimal solutions in such hierarchical optimization. Since most practical applications only include a discrete set of possible risk protection measures, the MC criterion is extended to this situation. The findings are illustrated through a hypothetical numerical example. This study was prepared as part of our work on the optimal management of natural hazard risks, but its conclusions also apply to other fields of risk management.     

The Impact of Geographic Proximity on What to Buy,How to Buy,and Where to Buy: Evidence from High‐Tech Durable Goods Market*

Social contagion effects due to geographical proximity refer to the social effects wherein the behavior of an individual varies with the behavior of other individuals who are geographically close. Although the influence of such effects on consumer choices has been established in several contexts, much of the extant studies have focused on its effect on consumers’ decision of whether to buy a new product or adopt a new innovation. There has been no systematic examination of the influence of geographic proximity on other aspects of consumers’ product buying process such as what to buy (i.e., brand choice), how to buy (i.e., the channel), and where to buy (i.e., retailers). Such effects can matter significantly in high‐technology and durable goods markets and therefore, it is critical to understand the scope of these on consumers’ choice of retailers and channel as well. Drawing on literatures from word of mouth effects, ecommerce, and consumers’ perception of risk in their purchase process, we develop a set of hypotheses on the effect of geographic proximity on consumers’ choices of what to buy, how to buy, and where to buy. Leveraging a microlevel dataset of purchases of personal computers, we develop brand‐, retailer‐, and channel‐related measures of proximity effects at the individual consumer level and estimate a joint disaggregate model of the three choices that make up a product purchase process to test these hypotheses. Our results indicate a significant contagion effect on each of the three choices. Furthermore, we find evidence of a greater effect of geographic proximity on inexperienced consumers—those who are new to the product category. Our results thus help develop a holistic understanding of the influence of social contagion effects on consumers’ decision making.     

Part II: Quantitative Evaluation of Choices Used in Setting Noncancer Chronic Human Health Reference Values Across Organizations

Environmental and public health organizations, including the World Health Organization (WHO) and the U.S. Environmental Protection Agency (USEPA), develop human health reference values (HHRV) that set “safe” levels of exposure to noncarcinogens. Here, we systematically analyze chronic HHRVs from four organizations: USEPA, Health Canada, RIVM (the Netherlands), and the U.S. Agency for Toxic Substances and Disease Registry. This study is an extension of our earlier work and both closely examines the choices made in setting HHRVs and presents a quantitative method for identifying the primary factors influencing HHRV agreement or disagreement.⁽¹⁾ We evaluated 171 organizational comparisons, developing a quantitative method for identifying the factors to which HHRV agreement (that is, when both organizations considering the same data set the identical HHRV values) is most sensitive. To conduct this analysis, a Bayesian belief network was built using expert judgment, including the specific science policy choices analysis made in the context of setting an HHRV. Based on a sensitivity of findings analysis, HHRV agreement is most sensitive to the point of departure value, followed by the total uncertainty factor (UF), critical study, critical effect, animal model, and point of departure approach. This analysis also considered the specific impacts of individual UFs, with the database UF and the subchronic‐to‐chronic UF being identified as primary factors impacting the total UF differences observed across organizations. The sensitivity of findings analysis results were strengthened and confirmed by frequency analyses evaluating which choices most often disagreed when the HHRV and the total UF disagreed.     

Consumption of Bovine Spongiform Encephalopathy (BSE) Contaminated Beef and the Risk of Variant Creutzfeldt‐Jakob Disease

To date, the variant Creutzfeldt‐Jakob disease (vCJD) risk assessments that have been performed have primarily focused on predicting future vCJD cases in the United Kingdom, which underwent a bovine spongiform encephalopathy (BSE) epidemic between 1980 and 1996. Surveillance of potential BSE cases was also used to assess vCJD risk, especially in other BSE‐prevalent EU countries. However, little is known about the vCJD risk for uninfected individuals who accidentally consume BSE‐contaminated meat products in or imported from a country with prevalent BSE. In this article, taking into account the biological mechanism of abnormal prion PrP^res aggregation in the brain, the probability of exposure, and the expected amount of ingested infectivity, we establish a stochastic mean exponential growth model of lifetime exposure through dietary intake. Given the findings that BSE agents behave similarly in humans and macaques, we obtained parameter estimates from experimental macaque data. We then estimated the accumulation of abnormal prions to assess lifetime risk of developing clinical signs of vCJD. Based on the observed number of vCJD cases and the estimated number of exposed individuals during the BSE epidemic period from 1980 to 1996 in the United Kingdom, an exposure threshold hypothesis is proposed. Given the age‐specific risk of infection, the hypothesis explains the observations very well from an extreme‐value distribution fitting of the estimated BSE infectivity exposure. The current BSE statistics in the United Kingdom are provided as an example.     

How Solid Is the Dutch (and the British) National Risk Assessment? Overview and Decision‐Theoretic Evaluation

Internationally, national risk assessment (NRA) is rapidly gaining government sympathy as a science‐based approach toward prioritizing the management of national hazards and threats, with the Netherlands and the United Kingdom in leading positions since 2007. NRAs are proliferating in Europe; they are also conducted in Australia, Canada, New Zealand, and the United States, while regional RAs now exist for over 100 Dutch or British provinces or counties. Focused on the Dutch NRA (DNRA) and supported by specific examples, summaries and evaluations are given of its (1) scenario development, (2) impact assessment, (3) likelihood estimation, (4) risk diagram, and (5) capability analysis. Despite the DNRA's thorough elaboration, apparent weaknesses are lack of stakeholder involvement, possibility of false‐positive risk scenarios, rigid multicriteria impact evaluation, hybrid methods for likelihood estimation, half‐hearted use of a “probability × effect” definition of risk, forced comparison of divergent risk scenarios, and unclear decision rules for risk acceptance and safety enhancement. Such weaknesses are not unique for the DNRA. In line with a somewhat reserved encouragement by the OECD (Studies in Risk Management. Innovation in Country Risk Management. Paris: OECD, 2009), the scientific solidity of NRA results so far is questioned, and several improvements are suggested. One critical point is that expert‐driven NRAs may preempt political judgments and decisions by national security authorities. External review and validation of major NRA components is recommended for strengthening overall results as a reliable basis for national and/or regional safety policies. Meanwhile, a broader, more transactional concept of risk may lead to better national and regional risk assessments.     

Flood Risk Assessment in the Netherlands: A Case Study for Dike Ring South Holland

Large parts of the Netherlands are below sea level. Therefore, it is important to have insight into the possible consequences and risks of flooding. In this article, an analysis of the risks due to flooding of the dike ring area South Holland in the Netherlands is presented. For different flood scenarios the potential number of fatalities is estimated. Results indicate that a flood event in this area can expose large and densely populated areas and result in hundreds to thousands of fatalities. Evacuation of South Holland before a coastal flood will be difficult due to the large amount of time required for evacuation and the limited time available. By combination with available information regarding the probability of occurrence of different flood scenarios, the flood risks have been quantified. The probability of death for a person in South Holland due to flooding, the so‐called individual risk, is small. The probability of a flood disaster with many fatalities, the so‐called societal risk, is relatively large in comparison with the societal risks in other sectors in the Netherlands, such as the chemical sector and aviation. The societal risk of flooding appears to be unacceptable according to some of the existing risk limits that have been proposed in literature. These results indicate the necessity of a further societal discussion on the acceptable level of flood risk in the Netherlands and the need for additional risk reducing measures.     

Analyzing Precautionary Regulation: Do Precaution,Science, and Innovation Go Together?

In this article we argue that the precautionary principle, as applied to the regulation of science and technology, cannot be considered in any general manner inconsistent with the norms and methods of scientific knowledge generation and justification. Moreover, it does not necessarily curtail scientific‐technological innovation. Our argument flows from a differentiated view of what precaution in regulation means. We first characterize several of the most relevant interpretations given to the precautionary principle in academic debate and regulatory practice. We then use examples of actual precaution‐based regulation to show that, even though science can have varying functions in different circumstances and frames, all of those interpretations recur to scientific method and knowledge, and tend to imply innovation in methods, products, and processes. In fact, the interplay of regulation and innovation in precautionary policy, at least in the case of the interpretations of precaution that our analysis takes into account, could be understood as a way of reconciling the two fundamental science and technology policy functions of promotion and control.