Ranking and Prioritization of Emergency Departments Based on Multi-indicator Systems

In this work we discuss how Emergency Departments (EDs) can be ranked on the basis of multiple indicators. This problem is of absolute relevance due to the increasing importance of EDs in regional healthcare systems and it is also complex as the number of indicators that have been proposed in the literature to measure ED performance is very high. Current literature faces this problem using synthetic (or numerically aggregated) indicators of a set of performance measures but, although simple, this solution has a number of drawbacks that make this choice inefficient: a compensation effect among the indicators; a high degree of subjectivism in the indicators weighting; opacity in the decision making; all the EDs are considered to be comparable. Indeed, the situations in which EDs are comparable (i.e. when all the performance of one ED are not lower than the performance indicators of the other) are a minority and incomparability is by itself a source of information that should be used to identify situations for which different policy actions should be designed. In this work we propose to use non compensatory composite indicators and partial ordering theory to rank and compare EDs giving value to the reasons of such an incomparability. These methods are applied on a case study of 19 EDs in an administrative region in Italy.     

Measuring disparities in access to water based on the normative content of the human right

Measuring access to water in the Sustainable Development Goals era involves taking into account the human rights framework. Therefore, its content should be considered to conceptualize the level of service through adequate indicators and to follow-up inequities reduction at global, national and local level. This research develops and tests a methodology to measure intra-community disparities based on human right to water normative criteria through a stratified sampling, splitting households served by community based organizations and those self-provided. This approach implies considering much reduced populations, thus special care needs to be taken with sample sizes and uncertainty of estimators. The proposed methodology is practical to locate and accurately characterize minority sectors within rural communities and allows moving beyond central-tendency estimators. It implies higher costs for field data collection than traditional approaches, but this can be assumed given the relevance of the approach from a human rights perspective, which calls for adequate tools for equity-oriented policy making at local level. The research point out how results might be used to shape decision-making processes.     

The Unbalance Penalisation Method for Metrics of Social Progress

This study contributes to the debate on the development of aggregate metrics of societal progress. Summarising societal progress into a single number poses various methodological challenges, including the choice of indicators, normalisation, weighting and aggregation. This paper addresses the issue of aggregation in the case of metrics of well-being and uses as a case study the European Union regional Social Progress Index—EU-SPI—published by the European Commission. The index is an aggregate measure of 55 social and environmental indicators observed for all the European regions grouped into 12 components. In metrics of this type, while complete substitutability among components is rarely acceptable, controlling their level of substitutability is highly desirable. To this aim, we adopt a modified version of the unbalance penalisation approach originally proposed by Casadio Tarabusi and Guarini (Soc Indic Res 112:9–45, 2013). A penalisation is applied to the regions whose performance across the index components is unbalanced, that is when they perform well on some components but worse on others. The penalisation applied by this approach depends on two parameters that, in its original formulation, are generally arbitrarily chosen. We design a data-driven approach allowing for an informed choice of the penalisation parameters. The comparison between the EU-SPI original and penalised scores shows that the penalisation effect is particularly evident for regions with a strongly unbalanced profile across the components. The proposed method allows for adjusting the level of substitutability between components when constructing an aggregate metric, an important functionality especially when measuring societal progress for policy-making.

     

A Model and Indicator of Aggregate Need Satisfaction for Capped Objectives and Weighting Schemes for Situations of Scarcity

Normative criteria for evaluations of economic and social outcomes are often formulated in terms of social welfare functions which are essentially and importantly non-satiable. However, there are good reasons to consider certain normative criteria and many policy objectives to be capped, i.e. bounded, and thus satiable provided sufficient resources are made available for their satisfaction. Inspired by the Foster–Greer–Thorbecke class of indicators, this paper uses an interdisciplinary approach to develop a model for assessing outcomes in terms of capped objectives based on an understanding of individual shortfalls from the objective, denoted needs. We present an indicator to measure need satisfaction in a population of individuals with heterogeneous needs and highlight an aggregation problem under scarcity. For such situations, we develop three ways in which the indicator can be weighted that reflect respectively concerns over the frequency, depth and severity of the need shortfalls and show that normative evaluations based on these weighting schemes can conflict, yielding mutually inconsistent outcome rankings. The indicator can be adapted to measure a wide variety of phenomena, e.g. health needs, education shortfalls, deprivation, etc., and it is suited for targeting exercises and other policy implementations. In particular, it allows for exogenous weighting schemes, i.e. weights that can incorporate non-shortfall characteristics relevant for the evaluation, e.g. age, gender, ethnicity, etc. The indicator thus enables new ways for researchers to promote and study satiable objectives in a wide variety of contexts relevant to economic and social policy, e.g. human development programs, poverty reduction, healthcare policies, etc.     

Building Universal Socio-cultural Indicators for Standardizing the Safeguarding of Citizens’ Rights in Smart Cities

This research explores the opportunity to use standards as recommender instruments for designing urban policy. Standards are soft regulatory mechanisms that can be used for monitoring and safeguarding. More precisely, we explore the potential use of social standards for centering the focus of the smart cities initiative back to the citizens, and establishing a citizen-centered approach. This is in contrast to the industrial drive and technological emphasis which currently dominates. Accordingly, we present a set of novel citizenship indicators which serve as the basis for the social standardization of smart cities, something which is not now taking place, in order to ensure and safeguard the basic social urban rights of citizens. The juridical basis and well-established points of reference for building indicators for citizens’ rights in the city are two International Charters. These are the European Charter for the Safeguarding of Human Rights in the City, and the Global Charter-Agenda for Human Rights in the City. In this paper, we start by comparing and analyzing the rights contained in each of the two Charters, and elaborating indicators for measuring the promotion and protection of these rights. The elaboration of indicators has been based on different criteria and under the common premise of universal existence of feeding data, which is the most recurrent problem when building indicators meant to be global. Next, at the request of the International Standards Organization (ISO), we select the most relevant socio-cultural indicators for the Global Charter Agenda, which will be introduced in the on-going revision of the smart cities and communities standard ISO 37120:2014 Sustainable development of communities—Indicators for city services and quality of life. This will make ISO 37120 a more beneficial social standard for monitoring and safeguarding citizens’ rights in the smart city.     

Tracking Poverty Reduction in Bhutan: Income Deprivation Alongside Deprivation in Other Sources of Happiness

This paper analyses poverty reduction in Bhutan between two points in time—2003 and 2007—from a multidimensional perspective. The measures estimated include consumption expenditure as well as other indicators which are directly (when possible) or indirectly associated to valuable functionings, namely, health, education, access to electricity, safe water, improved sanitation, enough room per person in dwelling, access to roads and land ownership. Interestingly, most of these indicators have been identified as sources of happiness in the 2007 Gross National Happiness Survey. Twelve different measures are estimated with a variety of values for the different parameters involved for robustness analysis. Also, estimates are bootstrapped creating 95 % confidence intervals. We find that over the study period there was an unambiguous reduction in multidimensional poverty regardless of the indicators’ weights, deprivation cutoffs and identification criterion of the poor. This reduction was mainly led by a reduction in the proportion of the poor which was accompanied by a reduction in the intensity of poverty among those who were less intensively poor, although not among those who were more intensively poor. Rather than accomplishing this poverty reduction by improving achievements in one or two indicators, there were significant reductions in several deprivations, especially in access to roads, electricity, water, sanitation, and education. We also find that when income alone is used to target the poor, inclusion errors are marginal but exclusion errors are sizeable. Despite Bhutan’s significant progress, challenges remain as poverty is still high in rural areas. A multidimensional measure in the lines proposed in this paper can prove useful for monitoring poverty reduction, prioritizing groups and evaluating upon investment.     

Evaluating the quality of life in Belgium

This paper deals with the evaluation of social welfare inequalities in order to establish a qualitative growth model for Flanders. As a base for the enquiry, quantitative, objective result indicators are chosen. The various quantified components are dealt with separately and different methods of aggregation are discussed. 32 indicators are selected on the basis of a specific definition of social welfare and taking account of the difficulties of collecting certain information. The indicators are aggregated in three different ways and in two stages: first per component for each region and secondly per region. The results show that major variations in the components are weakened by the aggregation and further that the different aggregation methods lead to only small differences. As a general conclusion one can speak of a regional homogeneity in Belgium.     

The Disadvantaged Among the Dutch: A Survey Approach to the Multidimensional Measurement of Social Exclusion

While combating social exclusion has been a key target of the European Union’s social policy in recent years, the concept remains contested and various ways of measuring its prevalence have been proposed. In the Netherlands a survey-based method has been in use since 2004, which refers to four theoretical elements of social exclusion: material deprivation, limited social participation, inadequate access to basic social rights and a lack of normative integration. In this article we propose an improved and more concise version of the instrument. Using focus groups and cognitive tests, the study first examined whether it adequately covers the different elements of social exclusion. Based on the results, the existing items were reformulated and supplemented. A revised questionnaire was then submitted to a new stratified sample of 650 respondents, randomly drawn from an online panel and a database of people without access to the Internet. The weighted outcomes may be regarded as representative for the entire adult Dutch population, although some caveats apply. Using nonlinear canonical correlation analysis, we identified a single underlying dimension in our new data set. This contains 15 items, with three to four indicators for each of the theoretical elements of social exclusion. According to our general index, just under 5 % of the Dutch population aged 18 years or older are faced with a serious degree of social exclusion. On the four subscales the figure ranges from 7 % (social rights) to 22 % (material deprivation).     

Being NEET in Europe Before and After the Economic Crisis: An Analysis of the Micro and Macro Determinants

The right to adequate minimum income protection is one of the key principles included in the European Pillar of Social Rights (EPSR). The EPSR takes a right-based and normative approach, aiming specifically at fulfilling people’s essential needs, not only by guaranteeing sufficiently high income levels, but also by promoting labour market inclusion and access to affordable goods and services of good quality. This paper takes the EPSR as a starting point to propose a needs-based indicator that assesses the adequacy of minimum income protection including these three dimensions in a comprehensive way. We argue that Reference Budgets (RBs), priced baskets of goods and services that represent an adequate living standard, are well-suited to construct such an indicator. To illustrate this empirically, we use RBs for adequate social participation in Belgium which have been constructed for the first time in 2008 and have been regularly updated since then. Through a combination of hypothetical household simulations of essential out-of-pocket costs and designated tax-benefits for families living on different minimum income schemes, we are able to assess the adequacy of minimum income protection for a range of household types over the period 2008–2017. The paper shows that, the proposed indicator is a useful policy tool for both ex-ante and ex-post evaluations of the adequacy of social policy measures in light of the social protection and inclusion rights included in the Pillar.

     

‘Valid’ empirical measurement of quality of life?

Results of empirical quality of life studies, undertaken hitherto, are subjectively influenced to a considerable extent by the researchers who try to measure the ‘quality of life’. In substantiation of this allegation it is shown on the basis of empirical data that the results are highly influenced, among others, (1) by the selection of indicators, (2) by the aggregation of indicators to one element, (3) by the weighting or non-weighting of the indicators, (4) by the indicator weigths given by different groups, (5) by employing different measurement techniques. Remarkable progress in empirical measurement could be made by the employment of objective indicators which are weighted by different groups (e.g., citizens, experts, decision makers, etc.). This approach can be called a ‘weighted objective indicator’ approach. In the second half of the article the proposal is made to measure infrastructure disparities both in physical and monetary terms. This permits a comprehensive assessment of the infrastructure's deficits and surplus on the level of indicators, subconcerns, and concerns.     

Public opinion surveys as guides to public policy and spending

Public opinion surveys purport to express the public's opinion. The literature on survey techniques has, however, recognized various potential limitations to the validity of survey results. While improved survey methodology may reduce statistical bias and improve validity, it cannot avoid the implicit weighting of preferences. This normative aspect of surveying has often been unrecognized or disguised as a purely technical matter. Such things as sample selection, choice of survey instrument and the method of aggregating results will each contribute to a pattern of preference weights. Several common survey techniques are examined in this light. It is proposed that no single ‘correct’ method of preference aggragation exists. Increased public recognition of, and debate on this normative aspect of surveying is recommended.     

Using Ranked Weights and Acceptability Analysis to Construct Composite Indicators: A Case Study of Regional Sustainable Society Index

A variety of published composite indicators, i.e., Energy Trilemma Index and Sustainable Society Index, are commonly aggregated with equal weights. However, this plausible scheme is criticized as eclecticism and ignores the discriminating power of the different indicators. Differing from the traditional methods that assign weights to each indicator for the purpose of aggregation, this paper proposes a new mechanism to construct composite indicators using ranked weights and stochastic multicriteria acceptability analysis. More specifically, this study comprehensively consider all possible preferences among the indicators. Under each preference, we develop a sophisticated mathematical transformation to calculate the least and most favorable scores of each entity, which formulates the lower and upper bounds of the intervals. Then an interval decision matrix, alternatively described as a stochastic decision problem, is formulated to construct the composite indicators. Holistic acceptability indices are generated and regarded as a new composite indicator, which is capable of providing a comprehensive and robust composite indicator with more discriminating power. We apply the proposed method to modify the regional sustainable society index and present the obtained results and comparisons.     

Rank-Optimal Weighting or “How to be Best in the OECD Better Life Index?”

We present a method of rank-optimal weighting which can be used to explore the best possible position of a subject in a ranking based on a composite indicator by means of a mathematical optimization problem. As an example, we explore the dataset of the OECD Better Life Index and compute for each country a weight vector which brings it as far up in the ranking as possible with the greatest advance of the immediate rivals. The method is able to answer the question “What is the best possible rank a country can achieve with a given set of weighted indicators?” Typically, weights in composite indicators are justified normatively and not empirically. Our approach helps to give bounds on what is achievable by such normative judgments from a purely output-oriented and strongly competitive perspective. The method can serve as a basis for exact bounds in sensitivity analysis focused on ranking positions. In the OECD Better Life Index data we find that 19 out the 36 countries in the OECD Better Life Index 2014 can be brought to the top of the ranking by specific weights. We give a table of weights for each country which brings it to its highest possible position. Many countries achieve their best rank by focusing on their strong dimensions and setting the weights of many others to zero. Although setting dimensions to zero is possible in the OECD’s online tool, this contradicts the idea of better life being multidimensional in essence. We discuss modifications of the optimization problem which could take this into account, e.g. by allowing only a minimal weight of one. Methods to find rank-optimal weights can be useful for various multidimensional datasets like the ones used to rank universities or employers.     

The effect of normative pressures on fertility

Using longitudinal data from a sample of urban, white, married U.S. couples, this paper shows the effects of normative pressures from family and friends on whether or not the couple had a pregnancy within one year. A comparison of parity-specific and all-parity models indicates that more information and better predictions can be obtained from parity-specific models. Normative pressures predict pregnancy best at zero parity, with progressively attenuated predictions at higher parity. A comparison of models using husband and wife data together shows that two-sex models are better than models using either sex alone. In a variety of different models, normative pressures reported by husbands are better predictors of pregnancy than are normative pressures reported by wives. A comparison of models using aggregated measures of normative pressures with models identifying the separate individual sources of pressures indicates that each treatment provides different insights into the effects of normative pressures, but that predictive power is lost through aggregation.This study was supported by a grant from the Center for Population Research, NICHD (Grant No. N01-HD-42804). Boone Turchi and Karl Bauman were collaborators on the original study. The authors would like to thank Judy Kovenock for data analysis. Requests for reprints should be directed to J. Richard Udry, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27514.     

MEASURING QUALITY OF LIFE: ECONOMIC,SOCIAL, AND SUBJECTIVE INDICATORS

Thinkers have discussed the “good life” and the desirable society for millennia. In the last decades, scientists offered several alternative approaches to defining and measuring quality of life: social indicators such as health and levels of crime, subjective well-being measures (assessing people's evaluative reactions to their lives and societies), and economic indices. These alternative indicators assess three philosophical approaches to well-being that are based, respectively, on normative ideals, subjective experiences, and the ability to select goods and services that one desires. The strengths and weaknesses of the various approaches are reviewed. It is argued that social indicators and subjective well-being measures are necessary to evaluate a society, and add substantially to the regnant economic indicators that are now favored by policy makers. Each approach to measuring the quality of life contains information that is not contained in the other measures.     

Health conditions in rural and urban areas of developing countries

The poor quality and meagre supply of data prohibit conclusions as to the relationship of health status to rural-urban residence in underdeveloped countries. Demographic indicators of health, specifically infant mortality and average life expectancy, do not seem to vary systematically according to rural-urban residence in the less developed countries ofAsia, Africa and Latin America. Further differences between rural and urban areas in availability of health services and facilities do not always conform with apparent differences between the areas in health status. However, nutritional standards, housing conditions, and sanitation, water supply and other pertinent environmental circumstances account to some extent for differences observed in health status between rural and urban inhabitants of these countries.     

Poverty and Old Age in Scandinavia: A Problem of Gendered Injustice? Evidence from the 2010 GERDA Survey in Finland and Sweden

Material deprivation is represented in different forms and manifestations. Two individuals with the same deprivation score (i.e. number of deprivations), for instance, are likely to be unable to afford or access entirely or partially different sets of goods and services, while one individual may fail to purchase clothes and consumer durables and another one may lack access to healthcare and be deprived of adequate housing. As such, the number of possible patterns or combinations of multiple deprivation become increasingly complex for a higher number of indicators. Given this difficulty, there is interest in poverty research in understanding multiple deprivation, as this analysis might lead to the identification of meaningful population sub-groups that could be the subjects of specific policies. This article applies a factor mixture model (FMM) to a real dataset and discusses its conceptual and empirical advantages and disadvantages with respect to other methods that have been used in poverty research. The exercise suggests that FMM is based on more sensible assumptions (i.e. deprivation covary within each class), provides valuable information with which to understand multiple deprivation and is useful to understand severity of deprivation and the additive properties of deprivation indicators.     

Dynamic Well-Being: Connecting Indicators of what People Anticipate with Indicators of what they Experience

There are many indicators of a person’s well-being that could be used for policy purposes. Few would argue that any single indicator of well-being is appropriate in all contexts and, increasingly, social scientists are attempting to integrate the various indicators. Further successful integration depends on understanding how the various indicators of well-being relate to one another in a dynamic way. This paper attempts to connect indicators of what people anticipate to indicators of what is actually experienced and, in so doing, inform the normative debate about the appropriateness of different indicators in policy contexts.     

An Introduction to ‘Benefit of the Doubt’ Composite Indicators

Despite their increasing use, composite indicators remain controversial. The undesirable dependence of countries’ rankings on the preliminary normalization stage, and the disagreement among experts/stakeholders on the specific weighting scheme used to aggregate sub-indicators, are often invoked to undermine the credibility of composite indicators. Data envelopment analysis may be instrumental in overcoming these limitations. One part of its appeal in the composite indicator context stems from its invariance to measurement units, which entails that a normalization stage can be skipped. Secondly, it fills the informational gap in the ‘right’ set of weights by generating flexible ‘benefit of the doubt’-weights for each evaluated country. The ease of interpretation is a third advantage of the specific model that is the main focus of this paper. In sum, the method may help to neutralize some recurring sources of criticism on composite indicators, allowing one to shift the focus to other, and perhaps more essential stages of their construction. An abridged version of this paper was presented at the Workshop on European Indicators and Scoreboards, organised by DG Education and the Joint Research Centre within the auspices of CRELL, in Brussels, October 24–25, 2005.