Guaranteed renewability uniquely prevents adverse selection in individual health insurance

New models of multi-period insurance show that health insurance buyers can be protected against changes in premiums from health shocks associated with chronic conditions by the addition of “guaranteed renewability” provisions. These models assume that a buyer’s risk level in every time period is observed by all insurers. They also require a premium sequence that is “front-loaded,” which may be costly to buyers if capital markets are imperfect. We relax the common knowledge feature of the model by assuming that a person’s risk in any time period is known only by that individual and the current insurer. One might suspect that a premium sequence with higher later period premiums would be incentive compatible because low risks will have less desirable offerings from alternative insurers. However, we show that generally, only the original premium schedule is incentive compatible, and attempts to alter front-loading will not be an equilibrium.     

The Continuing Significance of Race: An Analysis Across Two Levels of Policing*

Objectives. Survey research has demonstrated that there is significant race variation in perceptions of the police, with black citizens holding lower levels of trust than do whites. Although these differences have been well documented, few studies have examined if and how these differences vary across police organizations. Using survey data from the North Carolina Highway Traffic Study, the objective of this research was to explore the influence of vicarious experience and perceptions of racial profiling in accounting for racial variation in trust across two levels of policing—highway patrol and city/local police. Methods. Ordinal logistic regression was utilized to assess both their independent and combined influences as the methodology. Results. The results suggest that across both police agencies, the race gap in trust is strongly associated with vicarious experience and perceptions of racial profiling. Conclusions. The results provide some support for examining perceptions of police across levels of policing as the results suggest that perceptions of one police organization are not necessarily generalizable across them all.     

The 'best interests of the child' thesis: some thoughts from Australia

In the 36 years since the 1973 publication of ' Beyond the Best Interests of the Child ' by Goldstein, Freud and Solnit, the phase 'the best interests of the child' has achieved biblical standing and is now embedded in childcare and protection legislation worldwide. It also resonates through clinical reports and other materials that form the basis for proceedings in Children's Courts and in Family Law Courts. Such is the power of the phrase that it is to be found in Article 18 of the Convention on the Rights of Children that was adopted by the United Nations in September 1989. In 1996, Goldstein, Solnit and Goldstein, with Freud, indicated a preference for the phrase 'least detrimental alternative' rather than 'the best interests of the child'. For this reason, and because the world in 2009 is a far different place from that which existed 36 years ago, we think it is time to re-examine this classic phrase both in terms of its underlying thesis and how it is used in present-day childcare and protection proceedings and practice.     

Managing conflict of interest in research: some suggestions for investigators

Conflict of interest situations threaten to compromise objectivity and tempt researchers to act wrongly. Allowing oneself to drift into such situations without appropriate preparation is negligence which is, itself, a sort of wrongdoing. Since conflict of interest is unlikely to be eliminated or tamed by the professional--and institutional--level safeguards currently under discussion, individual researchers must make their own preparations. We offer individuals ten strategies for managing their own conflicts of interest.     

Usual and Shortest Confidence Intervals on Odds Ratios from Logistic Regression

Based on the large-sample normal distribution of the sample log odds ratio and its asymptotic variance from maximum likelihood logistic regression, shortest 95% confidence intervals for the odds ratio are developed. Although the usual confidence interval on the odds ratio is unbiased, the shortest interval is not. That is, while covering the true odds ratio with the stated probability, the shortest interval covers some values below the true odds ratio with higher probability. The upper and lower limits of the shortest interval are shifted to the left of those of the usual interval, with greater shifts in the upper limits. With the log odds model γ + Xβ, in which X is binary, simulation studies showed that the approximate average percent difference in length is 7.4% for n (sample size) = 100, and 3.8% for n = 200. Precise estimates of the covering probabilities of the two types of intervals were obtained from simulation studies, and are compared graphically. For odds ratio estimates greater (less) than one, shortest intervals are more (less) likely to include one than are the usual intervals. The usual intervals are likelihood-based and the shortest intervals are not. The usual intervals have minimum expected length among the class of unbiased intervals. Shortest intervals do not provide important advantages over the usual intervals, which we recommend for practical use.     

Conservative confidence intervals for a single parameter

The method of constructing confidence intervals from hypothesis tests is studied in the case in which there is a single unknown parameter and is proved to provide confidence intervals with coverage probability that is at least the nominal level. The confidence intervals obtained by the method in several different contexts are seen to compare favorably with confidence intervals obtained by traditional methods. The traditional intervals are seen to have coverage probability less than the nominal level in several instances, This method can be applied to all confidence interval problems and reduces to the traditional method when an exact pivotal statistic is known.     

How the Reflection of Linear Correlation in Odds Ratios Depends on the Cut-Off Points

When an OR is calculated based on data measured on continuous scales, the magnitude of the OR is dependent on the cut-offs chosen for dichotomizing both dependent and independent variables even when the relationship is strictly linear. Cuts away from the median on either or both dependent and independent variables increase the expected OR. This increase is quite substantial when the cut-off is made at the extremes. Illustrations of the consequences of cut-off on OR for populations with varying values of linear correlation are provided in simulated and real data. Potential circumstances and motivations for such dichotomizations are discussed.     

A bayesian approach for testing periodicity of dichotomous observations

A Bayesian approach is utilized to test for periodicity in a dichotomous time series. Dichotomous data arise in a variety of circumstances when a variable takes on only two possible values. Conjugate and noninformative priors are considered as well as a hierarchical Bayes approach; the latter is considered the superior Bayes methodology. The situation of stochastic period lengths is also discussed. The generalization to the multinomial model is investigated to allow for the case that a variable takes on more than two possible values. In all cases decisions are made based on a Bayes factor. The proposed procedures are demonstrated on earthquake data in the central Virginia seismic zone     

Use of a single page elder abuse assessment and management tool: a practical clinician's approach to identifying elder mistreatment

Elder abuse is a growing, alarming public health issue. As health care professionals, our challenge is to balance our duty to protect the safety of the vulnerable elder with the elder's right to self-determination. Clinicians in busy practice settings across the continuum of care as well as community-based social workers, emergency medical system, police, and banking personnel are collaborative partners needing tools that focus on early recognition, assessment, intervention, and management of elder abuse. A simple one-page tool that provides principles of assessment and management, best practice guidelines and screening questions will hopefully serve to raise awareness of this important public health issue and maintain a high index of suspicion for elder abuse, neglect and financial exploitation.     

From the streets to assisted living: perceptions of a vulnerable population

The rapid growth of assisted-living facilities is paralleled by the necessity to understand the needs of the people living in them. A hallmark challenge for individuals who are poor and disabled, and often marginalized from mainstream society, is maintaining integrity and being a whole person, rather than a sum of broken parts. A key to maintaining this integrity is the ability to find stable housing and support systems. The inner-city assisted-living facility in this study is unique in that all of its residents are funded by Medicaid. The residents have complex needs related to histories of homelessness, mental illness, drug and/or alcohol addiction, and chronic illness. The purpose of this study was to explore the needs of this vulnerable population as they adapt to a new home and a new concept of assisted, yet independent, living. Structured interviews with key informants and oral survey questionnaires with residents provided quantitative and qualitative data about physical and mental health status, social support, perception of control, psychological wellbeing, and life satisfaction. This study provided valuable insights into the challenges inherent in providing a high quality of life in assisted living for a vulnerable population with diverse needs.