Incentivizing professionals and patients: a consideration in the context of the United Kingdom and the United States

We are at the beginning of an era in which the pressure to secure the biggest possible "bang" for the health care "buck" is perhaps higher than it ever has been, on both sides of the Atlantic, and within the health policy discourse, incentives, for both professionals and patients, are occupying an increasingly prominent position. In this article, we consider issues related to motivating the professional and the patient to perform targeted actions, drawing on some of the evidence that has thus far been reported on experiences in the United Kingdom and the United States, and we present an admittedly somewhat speculative taxonomy of hypothesized effectiveness for some of the different methods by which each of these two broad types of incentives can be offered. We go on to summarize some of the problems of, and objections to, the use of incentives in health and health care, such as those relating to motivational crowding and gaming, but we conclude by positing that, following appropriate consideration, caution, and methodological and empirical investigation, health-related incentives, at least in some contexts, may contribute positively to the social good.     

Developmental validation of reduced-size STR Miniplex primer sets

This paper describes a developmental validation study of three Miniplex sets covering 12 of the 13 CODIS loci. As these new sets will be used for the analysis of degraded and low level DNA, the validation studies were performed using 100-125 pg of DNA, the lowest input level at which peak balance, peak intensity, and allele consistency were stable. To demonstrate the applicability of the Miniplex sets to forensic casework, these validation studies were completed in accordance with the Scientific Working Group on DNA Analysis Methods (SWGDAM). A range of tests were performed including studies of concordance with standard multiplex kits, sensitivity and reproducibility, and PCR amplification conditions. Additionally, studies of mixtures, nonhuman and environmentally degraded DNA, and simulated forensic samples were performed. Our results demonstrate that Miniplex STR amplification procedures are a robust and sensitive tool for the analysis of degraded DNA.     

Are Green Vehicles Worth the Extra Cost? The Case of Diesel‐Electric Hybrid Technology for Urban Delivery Vehicles

A central question for environmental policy is whether the long‐term benefits of energy‐saving technologies are sufficient to justify their short‐term costs, and if so, whether financial incentives are needed to stimulate adoption. The fiscal effects of incentivizing new technologies, and the revenue effects of using the technology, are also policy relevant, given current fiscal constraints. This study evaluates the economic and fiscal effects of promoting diesel‐electric hybrid technology in urban delivery vehicles, an application supported by U.S. policymakers. An economic model is used to simulate the conditional probability density functions of the net present values (NPVs) of diesel electric hybrids annually from 2012 to 2030. The NPV time paths, which reflect fuel price, environmental, and technology trends, show the expected dates that hybrids become economically viable, and allow an evaluation of the net benefits of hybrid technology as an investment over the entire simulation horizon. The NPV distributions are computed for five stakeholder classes, including transportation firms, parties benefiting from reduced externality damages, state and local governments, and the larger society. The analysis shows that hybrid technology investment does not appear to be justified from a societal perspective at a 7 percent discount rate, but the probability for positive net returns increases substantially at a 3 percent rate.     

Child abduction murder: the impact of forensic evidence on solvability

This study examined 733 child abduction murders (CAMs) occurring from 1968 to 2002 to explore the influence of forensic evidence on case solvability in CAM investigations. It was hypothesized that the presence of forensic evidence connecting the offender to the crime would enhance case solvability in murder investigations of abducted children. This study examined the impact of CAM of different types of forensic evidence and the impact of the summed total of forensic evidence items on case solvability by controlling for victim age, victim race, victim gender, and victim-offender relationship. Time and distance theoretical predictors were also included. Binomial logistic regression models were used to determine whether forensic evidence was a critical solvability factor in murder investigations of abducted children. This research indicated that, while forensic evidence increased case solvability, the impact of forensic evidence on solvability was not as important as other solvability factors examined.     

A consideration of user financial incentives to address health inequalities

Health inequalities and user financial incentives to encourage health-related behavior change are two topical issues in the health policy discourse, and this article attempts to combine the two; namely, we try to address whether the latter can be used to reduce the former in the contexts of the United Kingdom and the United States. Payments for some aspects of medical adherence may offer a promising way to address, to some extent, inequalities in health and health care in both countries. However, payments for more sustained behavior change, such as that associated with smoking cessation and weight loss, have thus far shown little long-term effect, although more research that tests the effectiveness of different incentive mechanism designs, informed by the findings of behavioral economics, ought to be undertaken. Many practical, political, ethical, and ideological objections can be waged against user financial incentives in health, and this article reviews a number of them, but the justifiability of and limits to these incentives require more academic and public discourse so as to gain a better understanding of the circumstances in which they can legitimately be used.     

Inter-Agency Cooperation to Raise Awareness on Human Trafficking in Vietnam: Good Practices and Challenges

Awareness-raising tactics are arguably the first priority in the prevention strategies in Vietnam at present. Awareness-raising campaigns are implemented through two kinds of communication methods: community-based activities and mass media. Although anti-trafficking activities in Vietnam have achieved some successful results, recent evidence suggests that a lack of clear progress in the areas of trafficking awareness-raising still remains. The quality and extent of collaboration between authorised agencies are key factors in anti-trafficking activities, including raising awareness on human trafficking. However, to date, there has been no systematic research on inter-agency cooperation in awareness-raising activities in Vietnam. This paper first reviews the nature of human trafficking and legal framework on raising trafficking awareness in Vietnam. The paper then presents successes and challenges of current inter-agency collaborative activities undertaken to implement the awareness-raising strategies.     

A Retrospective Study of the Investigation of Homicidal Childhood Asphyxial Deaths

As one of the leading causes of traumatic deaths in newborns, infants, and young children, there is no anatomic or microscopic feature that is pathognomonic for asphyxial deaths. Instead, pathologists rely on investigation information, including confessions and/or witness statements, and potential evidence at the scene. Twenty cases of homicidal newborn, infant, and young children asphyxial deaths were reviewed, which included death and police investigation reports and autopsy reports, as well as histology slides of lung sections. This series of homicidal asphyxial deaths highlight that, in a vast majority of such cases, the final cause and manner of death rulings are dependent on confession by the perpetrator. Furthermore, this series highlights the possible role of histology to help forensic pathologists better certify asphyxial deaths. Finally, this series emphasizes important investigation points and considerations at autopsy during the investigation of asphyxial deaths in newborns, infants, and young children.     

Decomposing firm-level productivity growth and assessing its determinants: evidence from the Americas

This paper provides novel empirical evidence on productivity growth in the manufacturing sector in Chile, Colombia, Mexico and Peru. Relying on plant-level data, we first decompose productivity and productivity growth into plant-level growth and market allocation forces. While the average productivity of the survivors is higher than the overall contribution of reallocation forces, during recessions the inverse is true and reallocation gives a positive, albeit small, contribution to aggregate productivity growth. Next we analyze how policy measures can determine allocative efficiency levels and growth, and find important scope for action on education, financial regulation, and structural reforms.     

Advance directives in action in a regional palliative care service: "road testing" the provisions of the Medical Treatment Act 1988 (VIC)

In order to explore the usefulness and acceptability of the provisions of the Medical Treatment Act 1988 (Vic) for palliative care patients in a rural region in Victoria, Australia, between July and December 2004 patients were given information explaining the Act and the opportunity to discuss it with the research officer. Grounded theory methodology was used to evaluate client responses. Findings suggested that palliative care patients are willing to engage in advance care planning but they have to be well enough and need skilled, practical, face-to-face assistance to complete the required legal forms. Written materials alone are not adequate, but provide the opportunity for medical staff to have conversations about death and dying. Doctors and nurses should understand the provisions of the Act to assist patients and families. It is recommended that advance care planning, appropriate to the jurisdiction, be an integral part of the palliative care assessment process.