Current Developments in Social Care Services for Older Adults in the Czech Republic: Trends Towards Deinstitutionalization and Marketization

ABSTRACT

Deinstitutionalization and marketization of eldercare has been delayed by 20 years in the Czech Republic compared to Western Europe, and it takes place in a completely different context, characterized by the legacy of communism, a growing older population, and less generous public subsidies. This study is the first in the Czech Republic to examine how deinstitutionalization and marketization effect implementation of these principles on the availability and quality of eldercare services at regional and municipal levels. A mixed-method approach was used, combining several data sources (policy documents, administrative data, statistics, expert panel, and secondary use of qualitative data). The findings suggest that the support for and availability of home-based care has declined, despite the ever-increasing number of older adults and policy preference for deinstitutionalization. Furthermore, home-based services have failed to adjust to growing care needs of older adults (e.g., inflexible schedules, limited provision of time-demanding care, inadequate staff composition). This situation occasioned an unintended outcome: the emergence of nonregistered, semilegal, for-profit nursing homes offering low-quality care and poor working conditions, and subject to no quality control. The health and even lives of older adults are at risk if they choose such services. Research is needed to study older adult decision making and offer them tools to identify and avoid questionable services.     

Ellsberg paradox: Ambiguity and complexity aversions compared

We present a simple model where preferences with complexity aversion, rather than ambiguity aversion, resolve the Ellsberg paradox. We test our theory using laboratory experiments where subjects choose among lotteries that “range” from a simple risky lottery, through risky but more complex lotteries, to one similar to Ellsberg’s ambiguity urn. Our model ranks lotteries according to their complexity and makes different—at times contrasting—predictions than most models of ambiguity in response to manipulations of prizes. The results support that complexity aversion preferences play an important and separate role from beliefs with ambiguity aversion in explaining behavior under uncertainty.     

Games with a local permission structure: separation of authority and value generation

It is known that peer group games are a special class of games with a permission structure. However, peer group games are also a special class of (weighted) digraph games. To be specific, they are digraph games in which the digraph is the transitive closure of a rooted tree. In this paper we first argue that some known results on solutions for peer group games hold more general for digraph games. Second, we generalize both digraph games as well as games with a permission structure into a model called games with a local permission structure, where every player needs permission from its predecessors only to generate worth, but does not need its predecessors to give permission to its own successors. We introduce and axiomatize a Shapley value-type solution for these games, generalizing the conjunctive permission value for games with a permission structure and the $\beta $ -measure for weighted digraphs.     

A Note on the Compatibility of Bivariate Copulas

This article answers to a problem by Kolesárová, Mesiar, and Sempi about the class of all copulas that are compatible with two given bivariate copulas A and B. It is shown that, even if A and B are not completely dependent, the class of all copulas compatible with A and B may consist of a singleton.     

Estimation of the Intensity Parameter of the Germ‐Grain Quermass‐Interaction Model when the Number of Germs is not Observed

The Quermass‐interaction model allows to generalize the classical germ‐grain Boolean model in adding a morphological interaction between the grains. It enables to model random structures with specific morphologies, which are unlikely to be generated from a Boolean model. The Quermass‐interaction model depends in particular on an intensity parameter, which is impossible to estimate from classical likelihood or pseudo‐likelihood approaches because the number of points is not observable from a germ‐grain set. In this paper, we present a procedure based on the Takacs–Fiksel method, which is able to estimate all parameters of the Quermass‐interaction model, including the intensity. An intensive simulation study is conducted to assess the efficiency of the procedure and to provide practical recommendations. It also illustrates that the estimation of the intensity parameter is crucial in order to identify the model. The Quermass‐interaction model is finally fitted by our method to P. Diggle's heather data set.     

Independent Quadratic Forms in 3-Variance-Component Models

This article addresses derivation and existence of quadratic forms that were suggested by Burch (2007 Burch , B. D. ( 2007 ). Generalized confidence intervals for proportions of total variance in mixed linear models . J. Statist. Plann. Infer. 137 : 2394 – 2404 .[Crossref], [Web of Science ®] , [Google Scholar]) for procedures for inference on variance components in mixed linear models in combination with generalized fiducial inference. A relatively simple algorithm leading to the required quadratic forms in a general 3-variance-component model is stated and designs for two-way ANOVA models without interactions that permit Burch's procedure are characterized. This complements developments in the original article by Burch.     

Refusal to Answer Specific Questions in a Survey: A Case Study

It is well known that non ignorable item non response may occur when the cause of the non response is the value of the latent variable of interest. In these cases, a refusal by a respondent to answer specific questions in a survey should be treated sometimes as a non ignorable item non response. The Rasch-Rasch model (RRM) is a new two-dimensional item response theory model for addressing non ignorable non response. This article demonstrates the use of the RRM on data from an Italian survey focused on assessment of healthcare workers’ knowledge about sudden infant death syndrome (that is, a context in which non response is presumed to be more likely among individuals with a low level of competence). We compare the performance of the RRM with other models within the Rasch model family that assume the unidimensionality of the latent trait. We conclude that this assumption should be considered unreliable for the data at hand, whereas the RRM provides a better fit of the data.     

Divergence-based tests of homogeneity for spatial data

The problem of testing homogeneity in contingency tables when the data are spatially correlated is considered. We derive statistics defined as divergences between unrestricted and restricted estimated joint cell probabilities and we show that they are asymptotically distributed as linear combinations of chi-square random variables under the null hypothesis of homogeneity. Monte Carlo simulation experiments are carried out to investigate the behavior of the new divergence test statistics and to make comparisons with the statistics that do not take into account the spatial correlation. We show that some of the introduced divergence test statistics have a significantly better behavior than the classical chi-square test for the problem under consideration when we compare them on the basis of the simulated sizes and powers.