Identifying and controlling for program-level differences in comparative cost analysis: lessons from the economic evaluation of the National Breast and Cervical Cancer Early Detection Program

Performing economic evaluations of established health care programs is essential to identify and control for underlying program-level variations and to make valid comparisons. At a time when the need for such evaluations is growing, health care professionals have limited information on the methodological challenges of performing these evaluations. In this study, we used the National Breast and Cervical Cancer Early Detection Program to illustrate these potential underlying variations. We performed site visits to four grantees and collected activity-based cost data from nine additional representative programs. We identified five specific types of cost factors that should be considered when evaluating and comparing health care programs: clinical services, service mix, in-kind contributions, indirect costs, and year-to-year expenditures of specific activities. A key lesson is that case studies and pilot testing should be performed before initiating cost analysis to identify underlying variation and to test appropriate methods to adequately control for these differences.     

Inference of Signs of Interaction Effects in Simultaneous Games With Incomplete Information

This paper studies the inference of interaction effects in discrete simultaneous games with incomplete information. We propose a test for the signs of state‐dependent interaction effects that does not require parametric specifications of players' payoffs, the distributions of their private signals, or the equilibrium selection mechanism. The test relies on the commonly invoked assumption that players' private signals are independent conditional on observed states. The procedure is valid in (but does not rely on) the presence of multiple equilibria in the data‐generating process (DGP). As a by‐product, we propose a formal test for multiple equilibria in the DGP. We also implement the test using data on radio programming of commercial breaks in the United States, and infer stations' incentives to synchronize their commercial breaks. Our results support the earlier finding by Sweeting (2009) that stations have stronger incentives to coordinate and air commercials at the same time during rush hours and in smaller markets.     

The best-laid schemes: An analysis of discrepancies between migration intentions and behavior

A longitudinal survey approach is used in a largely rural area in the Philippines to examine consistency between migration intentions and subsequent migration behavior. Inconsistencies in movement behavior, the timing of a move, and the destination are analyzed. Discrepancies between intentions and behavior are explained in terms of unanticipated constraints and facilitators as well as changes in the conditions that precipitated the migration intention in the first place. Intended international movers who did not actually move in a 2-1/2 year period were thwarted mainly by legal hurdles that could not be overcome. Intended internal migrants who did not actually move remained in their origin area primarily because of changes in job opportunities or family relationships. Methodological and theoretical implications of the findings are discussed.The best laid schemes o' Mice an' Men Gang aft agley, An' la'e us nought but grief an' pain, For promis'd joy! we must bear in mind the distinction between direct and facilitating factors involved in migration processes . migration analysis should consider some factors that facilitate or impede migration rather than determine migration directly (Goldscheider, 1971:38).This article was originally presented at the annual meetings of the Population Association of American in Minneapolis, Minnesota, May 2–5, 1984. The authors wish to thank Lynna Sycip for her assistance in the preparation of the tabulations for this article. In addition to the authors, the co-investigators for this project are James T. Fawcett, East-West Population Institute and Ricardo G. Abad, Institute of Philippine Culture, Ateneo de Manila University. Research for this article has been supported by NIH Grant No. R01-HD13115, the Population Center Foundation, Manila, Philippines, and the East-West Population Institute.     

Power in families,communication, and fertility decision-making

Decisions on family size and fertility regulation are made within the household, and yet little research has focused on the effects of power relationships within families on demographic decisions. To clarify the situation, the paper presents an original framework, linking bases of power between husbands and wives, resulting communication processes, and decision-making outcomes. The framework is applied to decision-making regarding contraceptive use or abortion, which can be a passive decision, a unilateral decision made openly or surreptitiously by one partner, or a joint decision between husband and wife, depending upon the particular power relationship pre-dominating in the family: coercive, reward, legitimate, referent, expert, or informational power. To illustrate the utility and viability of this framework, available data from fertility surveys and anthropological studies conducted in Latin America are reviewed and analyzed, as well as policy implications for the design of family planning delivery programs.The author wishes to thank Kurt W. Back, Mead T. Cain, Michele G. Shedlin, Joanne Spicehandler, and J. Mayone Stycos for their comments on an earlier version of this paper, and Luis de la Macorra for his permission to cite data collected by PROFAM-PIACT de México. Requests for reprints should be directed to Paula E. Hollerbach, The Population Council, Center for Policy Studies, One Dag Hammarskjold Plaza, New York, New York 10017.     

Facilitators and barriers to disclosing abuse among women with disabilities

An anonymous audio computer-assisted self-interview (A-CASI) designed to increase awareness of abuse was completed by 305 women with diverse disabilities. Data were also collected about lifetime and past year abuse; perpetrator risk characteristics; facilitators and barriers to disclosing abuse; abuse disclosure to a health provider, case manager, or police officer; and whether a health provider had ever discussed abuse or personal safety. A total of 276 (90%) women reported abuse, 208 (68%) reported abuse within the past year. Women who reported the most abuse experiences in the past year and the most dangerous perpetrators endorsed fewer facilitators and more barriers, but were also more likely to have ever disclosed abuse. Only 15% reported that a health provider had ever discussed abuse and personal safety.     

Afraid to care; unable to care: A critical ethnography within a long-term care home

This paper describes the findings of a critical ethnographic research study conducted in an urban long-term care home. While our intention was to learn more about the culture of care, specifically as it relates to mental health care provision, the participants in the study consistently spoke with us about (what we have labeled as) a culture of compliance. In a context where new long-term care legislation is being implemented along with new, standardized resident assessment instruments, gaining a deeper understanding of the (un)intended consequences of government's efforts to ensure a high quality of care is of paramount importance. This research demonstrates how policy-driven structural mechanisms can (re)produce conditions that result in frontline staff being afraid and unable to care, and thus contributes to a better understanding of the lived experience of frontline long-term care staff who find that their caregiving responsibilities are displaced by caregiving accountabilities.     

Integrated scheduling and inventory management of an oil products distribution system

The oil supply chain is facing new challenges due to emerging issues such as new alternative energy sources, oil sources scarcity, and price variability with high impact on demand and production and profit margins reduction. Additionally, the existence of large, complex and world wide spread businesses implies a complex system to be managed where distribution can be seen as one of the key areas that needs to be efficiently and effectively managed. Different types of distribution modes characterize the oil supply chain where the pipeline mode is one of the most complex to operate when having multiproduct characteristics. This paper addresses the planning of a generic oil derivatives transportation system characterized by a multiproduct pipeline that connects a single refinery to a storage tank farm. Two alternative mixed integer linear programming models (MILP) that aim to attain a set of planning objectives such as fulfilling costumers’ demands (which is mandatory) while minimizing the medium flow rate are developed. Additionally, final inventory levels are avoided to be excessively low. A real world scenario of a Portuguese company is used to validate and compare the two alternative MILP models developed in this paper.