La tesi si concentra su tre diverse problematiche largamente dibattute nell’Economia Sanitaria: la relazione tra obesità e conseguenze sul mercato del lavoro, azzardo morale causato dall’assicurazione sanitaria su comportamenti legati alla salute e la valutazione di un’iniziativa di assistenza per coinvolgere e mantenere in cura individui marginalizzati affetti da HIV.
Il primo capitolo, “Wages and Weight in Europe: Evidence using Quantile Regression Model”, studia l’aspetto economico del crescente tasso di obesità in Europa, esaminando la relazione tra obesità e salari utilizzando dati per nove Paesi ottenuti dall’European Community Household Panel (ECHP) nel periodo 1998-2001. L’apporto originale rispetto alla letteratura esistente consiste nell’approccio della Regressione Quantilica per caratterizzare l’impatto eterogeneo dell’obesità su diversi punti della distribuzione salariale. I nostri risultati mostrano che i) l’evidenza ottenuta dalle regressioni sulla media nascondono gran parte dell’eterogeneità poiché la relazione tra obesità e salari differisce tra Paesi e quantili salariali, e ii) aspetti culturali, ambientali o istituzionali non sono in grado di spiegare le differenze tra Paesi, lasciando spazio all’ipotesi di un puro effetto di discriminazione nei confronti degli obesi nel mercato del lavoro.
Il secondo capitolo, “Does Health Insurance make you fat?”, esamina se l’assicurazione sanitaria causa azzardo morale nei comportamenti associati al peso corporeo. Le spese per le cure sanitarie tra gli obesi, sono maggiori rispetto a quelle degli individui con peso corporeo regolare, e in assenza di premi assicurativi che tengono conto del rischio, gli individui sono protetti dai maggiori costi per le cure mediche associate all’obesità. Comunque, anche quando i premi dell’assicurazione sanitaria tengono conto del rischio, gli individui possono adottare scelte inefficienti rispetto ai comportamenti alimentari e all’attività fisica che portano all’obesità. In questo capitolo sviluppiamo un semplice modello teorico a due periodi in cui gli individui decidono quante risorse allocare per il consumo, risparmio e cure preventive per caratterizzare le esternalità dell’assicurazione sanitaria e mostriamo come l’effetto di azzardo morale può essere neutralizzato dall’avversione al rischio. Utilizziamo dati dal National Longitudinal Survey of Youth (NLSY) per il periodo 1989-2004 per stimare empiricamente il modello ed esaminare la relazione tra assicurazione sanitaria offerta dal datore di lavoro e peso corporeo, così come la relazione tra assicurazione sanitaria e attività fisica. Troviamo scarsa evidenza empirica per supportare l’esistenza di importanti esternalità in questo mercato, mettendo in discussione l’opportunità di un intervento governativo in risposta ai crescenti tassi di obesità.
Il terzo capitolo, “Does Retention in Care Increase Life Expectancy? Cost-Effectiveness Analysis of an Outreach Program”, è un’analisi costi benefici di strategie utilizzate per coinvolgere e mantenere in cura individui marginalizzati affetti da HIV negli Stati Uniti. L’Outreach Initiative (2004-2006), finanziata da Special Programs of National Significance (SPNS) è la principale fonte di dati per questa analisi. Abbiamo sviluppato un modello Markov per predirre le aspettative di vita dei partecipanti al programma basato su cambiamenti sul CD4 count, viral load, AIDS e aderenza a Highly Active Anti-Retroviral Therapy (HAART), avvenuti durante sei mesi di partecipazione al programma. Attraverso dati estrapolati dalla letteratura clinica, confrontiamo questo gruppo di intervento con un ipotetico gruppo di controllo e i nostri risultati mostrano come i partecipanti al programma hanno 1.415 anni di vita attesi in più rispetto ai non partecipanti, tenendo conto della qualità della vita. Incorporando i costi del programma nel modello, otteniamo che ciascun anno addizionale di vita costa 4,718perindividuo.Colmandoilvuotosullaricercanell’HIV/AIDSsuicostieglieffettidilungoperiododegliinterventidiassistenza,questorisultatosuggeriscecheilprogrammaeˋaltamenteconveniente,interminidicosti−benefici,secondoivaloridefinitidalWorldHealthOrganization(WHO)perl’analisicosti−benefici.Thethesisfocusesonthreedifferentissueslargelydebatedintheliteratureonhealtheconomics:therelationshipbetweenobesityandlabormarketoutcomes,themoralhazardonhealthrelatedbehaviourscausedbyhealthinsuranceandtheevaluationofanoutreachinitiativetoengageandretainunderservedindividualsaffectedbyHIVinprimarycare.Thefirstchapter,“WagesandWeightinEurope:EvidenceusingQuantileRegressionModel”studiestheeconomicsideoftheincreasingrateofobesitybyexaminingtherelationshipbetweenobesityandwagesusingdataforninecountriesfromtheEuropeanCommunityHouseholdPanel(ECHP)overtheperiod1998−2001.WeimproveupontheexistingliteraturebyadoptingaQuantileRegressionapproachtocharacterizetheheterogenousimpactofobesityatdifferentpointsofthewagedistribution.Ourresultsshowthati)theevidenceobtainedfrommeanregressionandpooledanalysishidesasignificantamountofheterogeneityastherelationshipbetweenobesityandwagesdiffersacrosscountriesandwagesquantilesandii)cultural,environmentalorinstitutionalsettingsdonotseemtobeabletoexplaindifferencesamongcountries,leavingroomforapurediscriminatoryeffecthypothesis.Thesecondchapter,“DoesHealthInsurancemakeyoufat?”,examineswhetherhealthinsurancecausesmoralhazardinhealthbehaviorsassociatedwithbodyweight.Healthcareexpendituresamongtheobesearehigherthanthoseofnormalweightindividuals,and,intheabsenceofrisk−ratedpremiums,individualswillbeshieldedfromtheincrementalmedicalcarecostsassociatedwithobesity.However,evenwhenhealthinsurancepremiumsareriskrated,individualsmaymakeinefficientdecisionswithrespecttoeatingandphysicalactivitythatleadtoobesity.Inthischapter,wedevelopasimpletwoperiodtheoreticalmodelofconsumption,savingandpreventiveefforttocharacterizethehealthinsuranceexternalitiesandshowhowthemoralhazardeffectcanbeneutralizedbyriskaversion.WeusedatafromtheNationalLongitudinalSurveyofYouth(NLSY)overtheperiod1989−2004toempiricallyestimatethemodelandexaminetherelationshipbetweenemployer−sponsoredhealthinsurancecoverageandbodyweightaswellastherelationshipbetweenhealthinsuranceandphysicalactivity.Wefindlittleevidencetosupporttheexistenceofimportantexternalitiesinthismarket,questioningthedesirabilityofgovernmentinterventionasaresponsetorisingratesofobesity.Thethirdchapter,“DoesRetentioninCareIncreaseLifeExpectancy?Cost−EffectivenessAnalysisofanOutreachProgram”,isacost−effectivenessanalysisofstrategiesusedtoengageandretainunderservedHIVpositiveindividualsinprimarycareintheUS.TheOutreachInitiative(2004−2006),fundedbytheSpecialProgramsofNationalSignificance(SPNS)servedastheprimarydatasourceforthisanalysis.WedevelopedaMarkovmodeltopredictthelifeexpectancyofprogramparticipantsbasedonchangesinCD4count,viralload,AIDSstatus,andHighlyActiveAnti−RetroviralTherapy(HAART)adherencethatoccurredduringsixmonthsofprogramparticipation.Throughdataextrapolatedfromclinicalliterature,wecomparethisinterventiongrouptoahypotheticalcontrolgroupandfoundthatprogramparticipantswerepredictedtolive1.415yearlongerthannon−participants,adjustingforqualityoflife.Byincorporatingprogramcostsintothemodel,withinthebase−casescenario,eachadditionallife−yeargainedcosts4,718 per person. Filling the void in HIV/AIDS research on costs and long term impacts of outreach interventions, this result suggests that the program is highly cost effective, according to the World Health Organization (WHO) thresholds for cost effectiveness analysis
This chapter investigates the causes and consequences of FLW, providing an extensive literature review that offers several insights into where FLW is produced and why. The chapter analyses micro-, meso and macro-level causes across the food supply chain. The impact of FLW is mainly analysed in terms of sustainability and food security. As for environmental consequences, it provides a thorough investigation of FLW’s impacts on greenhouse gas emissions, depletion of blue water and landfill disposal. Finally, the chapter provides an analysis of the complex interactions between FLW and food security, showing that positive outcomes following FLW reduction are not guaranteed
A geometric construction of one-factorisations of complete graphs Kq(q−1) is provided for the case when either q = 2d + 1 is a Fermat prime, or q = 9. This construction uses the affine group AGL(1, q), points and ovals in the Desarguesian plane PG(2, q2) to produce one-factorisations of the complete graph Kq(q−1)
This paper deals with the problem of determining whether a PD-set exists for a given linear code C and information set I. A computational approach is proposed and illustrated with two exceptional codes with auto-morphism groups isomorphic to the sporadic simple groups M12 and M22, respectively. In both cases, the existence of a PD–set is proven. In general, the algorithm works well whenever the code C has a very large automorphism group
This paper contributes to the literature on the determinants of rural livelihood diversification and its impact on household welfare in the short and medium term using data from a government-run social protection program in Zimbabwe. First, this study investigates whether cash transfers originally intended to ensure minimum food security in the poorest households can also induce the diversification of their livelihood strategies. Second, since diversification may lead to engagement in both low-return and high-return activities, this paper examines whether diversification resulting from the cash transfer increases household welfare. In the short run, the program causes only a small reduction in engagement in survival-led diversification; in the medium run, the program leads to a large shift from survival-led diversification and specialization in on-farm activities towards opportunity-led diversification. Further heterogeneity analysis shows that the program induces a medium-term change in livelihood strategies in both female- and male-headed households. In both time frames, opportunity-led diversification increases food and non-food consumption
The present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
The majority of papers reporting the results of experimental tests on individual behaviour concentrate on the average or aggregate behaviour of the subjects, even though different subjects may exhibit different kinds of behaviour. At the same time it is well-known that subjects are noisy in their responses, and thus may change their behaviour during an experiment. The question then arises as to whether this noise causes average behaviour to change during an experiment. We take the data from an experiment on behaviour under ambiguity, which try to identify which preference functional subjects are using, and analyse it in two halves. We find that, while some individual preferences seem to change from the first to the second half, on average, preferences are unchanged (though there is a reduction in the noise exhibited by subjects in the second half). This is a reassuring message for those who want to draw inferences from experiments
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