Improving the contributions of technology assessment to the health care system of the U.S.A.

Summary Based on 14 case studies of highly effective therapies and the reasons they succeeded less frequently than they could, we propose a variety of steps to improve the health care system of the U.S.A. Whatever proposal emerges from current national debates until innovations are shown to be safe and effective, they should not be supported; when slightly better technologies are much more expensive than other good ones we need to consider appropriate choices carefully; simplified billing and bookkeping would reduce our costs; when a technology is rapidly introduced cautionnary measures may be needed; tracking immunization and repairing their omissions requires a new system; educational programs such as seen effective in hypertension should be applied in other areas such as vaccination; in organ transplantation the nation should consider “presumed consent”; our payment system sometimes creates perverse incentives and therefore needs review; and the preferences of the public in allocation of health resources need to be discovered once the public is informed about the issues. Research supported by Andrew W. Mellon Foundation.     

Government Risk Management Priorities: A Comparison of the Preferences of Asian Indian Americans and Other Americans

A survey was conducted of approximately 200 Asian Indian Americans and 200 other residents of New Jersey in order to understand the risk management priorities that they want government to have. We found that Asian Indian Americans, especially younger women, focused on personal/family risks, such as alcohol and drug abuse, sexual abuse, and domestic violence. The New Jersey comparison group, in contrast, placed war/terrorism and loss of health care services and insurance at the top of their priorities for government. These results suggest stressful acculturation-related issues within the Asian Indian community. Both populations want more risk management from government than they believe government is currently providing. Respondents who wanted more from government tended to dread the risk, be fearful of the consequences, trust government, and have a feeling of personal efficacy. Within the Asian Indian American sample, wide variations were observed by language spoken at home and religious affiliation. Notably, Muslims and Hindi language speakers tended not to trust government and hence wanted less government involvement. This study supports our call for studies of recent migrant populations and Johnson's for testing ethnic identity and acculturation as factors in risk judgments.     

Subjective probabilities and utility with event-dependent preferences

This article generalizes Savage's theory to include event-dependent preferences. The state space is partitioned into finitely many events. The induced preferences over consequences are assumed independent of the underlying states within, but not across, these events. This results in an additively separable representation of preferences over acts. The dependence of the preference relation over consequences on the events is represented by event-dependent mappings of the set of consequences onto itself. Given these mappings, the preferences on acts are represented by the expectation of event-dependent utilities on the consequences with respect to unique subjective probabilities on the states.Helpful discussions with David Schmeidler are gratefully acknowledged.     

Uncertain Numbers and Uncertainty in the Selection of Input Distributions—Consequences for a Probabilistic Risk Assessment of Contaminated Land

Risks from exposure to contaminated land are often assessed with the aid of mathematical models. The current probabilistic approach is a considerable improvement on previous deterministic risk assessment practices, in that it attempts to characterize uncertainty and variability. However, some inputs continue to be assigned as precise numbers, while others are characterized as precise probability distributions. Such precision is hard to justify, and we show in this article how rounding errors and distribution assumptions can affect an exposure assessment. The outcome of traditional deterministic point estimates and Monte Carlo simulations were compared to probability bounds analyses. Assigning all scalars as imprecise numbers (intervals prescribed by significant digits) added uncertainty to the deterministic point estimate of about one order of magnitude. Similarly, representing probability distributions as probability boxes added several orders of magnitude to the uncertainty of the probabilistic estimate. This indicates that the size of the uncertainty in such assessments is actually much greater than currently reported. The article suggests that full disclosure of the uncertainty may facilitate decision making in opening up a negotiation window. In the risk analysis process, it is also an ethical obligation to clarify the boundary between the scientific and social domains.     

冲突视角下运输订单商业竞争战略研究

运用图模型理论研究冲突视角下中欧班列运营过程中运输订单商业竞争战略,构建“渝新欧”班列运营商、“苏满欧”班列运营商和昆山IT企业之间的商业竞争冲突模型。利用TOPSIS法评估班列的运输效率,确定决策者偏好,通过计算均衡解获得符合各决策者利益的理性对策。借助灵敏度分析研究决策者偏好改变对模型冲突结果的影响。研究表明:在竞争中,运输效率较低的一方可以通过降低价格弥补自身劣势而获得订单;运输效率较高的一方只有通过降价才能获得订单。该研究为班列运营商提供利益冲突中的商业竞争战略,能为顾客企业选择高效合理的运输线路提供有效的战略决策,同时亦能为宏观调控者规范市场、提高市场运输效率提供有效的政策启示。     

Continuously Representable Paretian Quasi-Orders

Two forms of continuity are defined for Pareto representations of preferences. They are designated “continuity” and “coordinate continuity.” Characterizations are given of those Pareto representable preferences that are continuously representable and, in dimension two, of those that are coordinate-continuously representable.     

Ratio-Scale Measurement with Intransitivity or Incompleteness: The Homogeneous Case

In the homogeneous case of one-dimensional objects, we show that any relation that is positive and homothetic can be represented by a ratio-scale and a unique and constant biasing factor. This factor may favor or disfavor the preference for an object over another. In the first case, preferences are complete but not transitive and an object may be preferred even when its value is lower. In the second case, preferences are asymmetric and transitive but not negatively transitive and it may not be sufficient for an object to have a greater value to be preferred. In this manner, the biasing factor reflects the extent to which preferences may depart from a maximization process.     

German fathers and their preferences for shorter working hours for family reasons

This study is among the first to analyze fathers’ preference for shorter working hours specifying that the preference is related to the wish to spend more time with the family. Assuming that preferences are context-dependent, this article explores the relevance of the family and workplace context for preference formation. We develop need-based and capability-based arguments to contrast the job demands–resources approach and the capabilities approach in work–family research. Using a sample of 632 fathers from the German LEEP-B3 data with a representative linked employer–employee design for large work organizations we conclude that fathers’ preferences for shorter working hours are indeed context-dependent and that there is more evidence for need-based arguments than opportunity based arguments. Our results indicate that fathers with young children and fathers with high work demands are more likely to desire shorter working hours, whereas a reduction in working hours appears to be unnecessary for fathers who can satisfactorily reconcile work and family life through support from their supervisors. In contrast to capability-based arguments the perception of a highly demanding work culture was not found to decrease but increase the likelihood to desire to work shorter hours.     

Disagreement over the immigration of low-income earners in a welfare state

This paper studies natives’ economically motivated preferences over different levels of immigration of low-income earners. Immigration affects natives through both intra- and intergenerational redistribution programmes and in the labour market. Our analysis suggests, in a welfare state that looks after the poor and the aged, economic motivation does not necessarily lead a native to have an extreme opinion on the preferable level of immigration, although it causes disagreement among natives. We find, regardless of parameter values, high-income earners prefer at least as much immigration as low-income earners who, in turn, prefer at least as much immigration as pensioners. The median voter is then likely to be a low-income native.