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PubMed1979

Impasse at the crossroads: evolution or regulation.

Today, the free enterprise system of health care delivery is being challenged in the United States, where availability and consumption of health services and their cost are epochal. Review of the health care delivery systems of other nations reveals failure of the system when the national medical community has been divided, when government has monopolized the system, and when fee for service has been abandoned. Government intervention in American health care has been increasingly regulatory and promises to extend regulation in the immediate future. The American medical community can respond by unifying, by reducing its contribution to health care costs, and by changing physician behavior. Consumers have the responsibility to eliminate unnecessary utilization and to become more informed buyers of health care and insurance. The fiscal intermediary has the responsibility to provide tailored insurance options that are cost-effective. As informed and unified medical community can be a formidable force in shaping the future of health care in the United States.

Delivery of Health Care↗
PubMed2002

Food and drink packaging: who is complaining and who should be complaining.

This paper reports a questionnaire survey of shoppers at four supermarket stores in the UK. Regression analyses were used to determine factors in consumer complaints with the packaging of food and drink products. Neuroticism and treatment in hospital for an accident involving packaging in the last 3 years were significant associates. Analyses on who was most likely to suffer accidents or injuries while opening food and drink packaging indicated that handedness (that is, being left handed made accidents more likely) and scoring low on a measure of personal control during decision-making were significant associates. Analyses on who suffered the most serious accidents and injuries whilst opening food and drink packaging revealed that the decision-making style of social resistance (that is, the extent to which you resist asking for help from others) was related to susceptibility to the most severe accidents. These findings imply that individual factors (including both personal characteristics and personality traits) should be taken into account when considering the openability of packaging. The results of this study indicate that manufacturers should ensure that novel packaging closures have been tested on left handers in order to discover any unique difficulties for this sub-group, that packaging opening tools specifically for left-handed people should be made available and that manufacturers of packaging should always look at a 'worst case scenario' for their packaging closures as it is evident that some people will continue to struggle with difficult packaging until either they open it or they have injured themselves.

Accidents↗
PubMed1998

Human factors for pleasure in product use.

Traditionally, human factors have tended to concentrate on making products 'usable'--focusing on utilitarian, functional product benefits. This paper reports an interview-based study looking at the issue of 'pleasure' in product use. The study was a 'first pass' at addressing the hedonic and experiential benefits and penalties associated with product use, and at identifying the properties of a product that influence how pleasurable or displeasurable it is to use. Feelings associated with using pleasurable products included security, confidence, pride, excitement and satisfaction. Displeasurable products, meanwhile, were associated with feelings that included annoyance, anxiety, contempt and frustration. The properties of products that were salient in terms of influencing the level of pleasure/displeasure with a product included features, usability, aesthetics, performance and reliability. Responses to questions investigating behavioural correlates to pleasure in product use suggested that pleasurable products were used more regularly and that future purchase choices would be affected by the level of pleasure in product use. It is concluded that the issue of pleasure in product use involves more than usability alone. As the user's representative in the product creation process, the human factors specialist should consider many other factors in order to ensure that the user's experience of product use is maximised.

Consumer Behavior↗
PubMedDate not supplied

The return of the pharmaceutical industry to the market of contraception.

In the 1980s and 1990s, the litigious climate in the US had a catastrophic effect on sales of many major contraceptives. Although oral contraceptives escaped controversy, the intrauterine device (IUD) and Norplant(R) were two targets of damaging litigation. The IUD was withdrawn from the market in 1985. Since 1994 when the attacks began against Norplant, its US sales have dramatically declined, even though no fault has been found in the method or its development. In general, pharmaceutical companies were extremely hesitant to develop new contraceptives during this period. The bleak outlook, however, began to shift in the late 1990s, as fertility rates began to decrease worldwide and contraceptive users increased. By 2025, 2500 million women will comprise the customer base for contraception. Global pharmaceutical companies are now participating in expanding markets overseas and have launched and continue to develop a range of new long-term reversible, and highly effective, contraceptive products outside the traditional oral contraceptive field. Two new contraceptives on the way to the US market are: Mirena, a levonorgestrel-releasing intrauterine system manufactured by Schering-Leiras; and Implanon, a single implant system manufactured by Organon of the Netherlands. Other birth control methods soon to be launched include: emergency contraceptives, the contraceptive patch, monthly contraceptive injections, mifepristone for medical abortion, and modified oral contraceptives.

Consumer Behavior↗
PubMed2002

The effect on social welfare of a switch of second-generation antihistamines from prescription to over-the-counter status: a microeconomic analysis.

BACKGROUND: The US Food and Drug Administration (FDA) recently held a meeting to determine whether the status of second-generation antihistamines (SGAs) should be switched from prescription (Rx) to over-the-counter (OTC) status. OBJECTIVE: This article provides a conceptual microeconomic framework for addressing issues regarding the impact of such a switch on social welfare. METHODS: A review of the economic literature on Rx-to-OTC switches was conducted. Relevant articles published in English between 1990 and 2001 were identified through searches of ABI Info, EconLit, PsychInfo, MEDLINE, CANCERLIT, AIDSLINE, and HealthStar, as well as a general Internet search for statements in the press or on the FDA Web site. The search terms used were Rx, prescription, OTC, over-the-counter, second-generation antihistamines, nonsedating antihistamines, first-generation antihistamines, and sedating antihistamines. Microeconomic models focusing on consumer surplus were employed to determine the potential price response and social-welfare implications of a switch of SGAs to OTC status. RESULTS: Unlike the agents involved in previous Rx-to-OTC switches, SGAs are still under patent protection. Economic theory suggests that a firm that is protected by a patent will price aggressively. The market for OTC SGAs is likely to be more elastic due to a lack of insurance coverage for OTC products; hence, drug manufacturers would be likely to charge a lower price if SGAs were sold OTC. However, a lower price does not necessarily guarantee an improvement in social welfare; the net impact is determined by whether the increase in consumer surplus outweighs the deadweight loss (losses of consumer and producer surplus not transferred to other parties). Additionally, the assumption of a price reduction would be called into question if there were inequalities in marginal costs between the Rx and OTC markets. In this situation, the postswitch price might increase or not be reduced significantly. CONCLUSIONS: It is uncertain whether granting OTC status to SGAs would be cost saving to society, particularly as these drugs are patent protected. The social-welfare implications of such a switch would depend heavily on pricing strategies and consumer behavior. Further analyses are needed to determine how both factors influence social welfare; only then can the costs and benefits of a switch be understood completely.

Drug Industry↗
PubMed2000

A note on eliciting distributive preferences for health.

While in theory the strength of preferences for equity in health can be expressed in an 'inequality aversion parameter', in practice, analysts would have to obtain them from people's choices. We are faced with a number of methodological problems when turning to this type of empirical research. This note investigates which types of preference could explain the choices people make when responding to equity-efficiency questions of this kind. Respondents may be heavily influenced by concerns that are not related to their equity preferences, something which may lead them to choose distributions that are not consistent with models on the equity-efficiency trade-off. Specifically, a threshold effect is identified, which could explain why some people would rather prefer to concentrate than to diffuse health gains. The second aim of this note is to offer some lessons from a survey which was designed for eliciting people's distributive preferences for health gains.

Choice Behavior↗
PubMed2002

The impact of health plan report cards on managed care enrollment.

How does the release of health plan performance ratings influence employee health plan choice? A natural experiment at General Motors (GM) Corporation provides valuable evidence on this question. During the 1997 open enrollment period, GM disseminated a health plan report card for the first time. By comparing 1996 and 1997 enrollment patterns, our analysis estimates the impact of the report card information while accounting for fixed, unobserved plan traits. Results indicate that employees are less likely to enroll in plans requiring relatively high out-of-pocket contributions. Results with respect to report card ratings suggest that individuals avoid health plans with many below average ratings.

Benchmarking↗
PubMed2002

Switching costs, price sensitivity and health plan choice.

We investigate the extent to which sensitivity to health plan premiums differs across individuals according to characteristics related to the cost of switching plans. Our results indicate substantial variation in price sensitivity related to expected health care costs: younger, healthier employees are between two and four times more sensitive to price than employees who are older and who have been recently hospitalized or diagnosed with cancer. We also find evidence of status quo bias: estimated premium elasticities are significantly higher for new hires than for incumbent employees. Simulations combining our results with actuarial data illustrate the cost implications of risk-related differences in price elasticity.

Adult↗
PubMed2003

The integration of claims to health-care: a programming approach.

The paper contributes to the use of social choice and welfare theory in health economics by developing and applying the integration of claims framework to health-care rationing. Related to Sen's critique of neo-classical welfare economics, the integration of claims framework recognises three primitive sources of claim: consequences, deontology and procedures. A taxonomy is presented with the aid of which it is shown that social welfare functions reflecting these claims individually or together, can be specified. Some of the resulting social choice rules can be regarded as generalisations of health-maximisation and all have normative justifications, though the justifications may not be universally acceptable. The paper shows how non-linear programming can be used to operationalise such choice rules and illustrates their differential impacts on the optimal provision of health-care. Following discussion of relations to the capabilities framework and the context in which rationing occurs, the paper concludes that the integration of claims provides a viable framework for modelling health-care rationing that is technically rigorous, general and tractable, as well as being consistent with relevant moral considerations and citizen preferences.

Attitude to Health↗
PubMed2002

Microbiological and organoleptic qualities of vacuum-packaged ground beef prepared from pasteurized manufacturing beef.

Manufacturing beef was pasteurized by immersion in water of 85 degrees C for 60 s, or was not pasteurized before being coarsely ground. The coarsely ground beef was vacuum-packaged and stored at 2 degrees C for up to 6 weeks. Before storage and at weekly intervals, three packs of pasteurized and three of unpasteurized beef were opened. The meat from each pack was finely ground and displayed in two overwrapped packs at 4 degrees C for 3 days after storage for up to 3 weeks, or for 2 days after longer storage times. Samples for microbiological analysis were obtained at the times of preparation of display packs and at the end of display. Displayed meat was assessed daily for colour, discolouration and retail acceptability, and for odour intensity and acceptability at the end of display. Before storage, the numbers of total aerobic bacteria, presumptive pseudomonads and presumptive Brochothrix thermosphacta recovered from pasteurized meat were >1 log unit less than the corresponding numbers recovered from unpasteurized meat, but the numbers of presumptive lactic acid bacteria and presumptive enterobacteria were <1 log unit less from pasteurized than from unpasteurized meat. After all periods of storage and display, the numbers of bacteria recovered from pasteurized and unpasteurized meat at each time were mostly similar. The colour of pasteurized meat was perceived as being paler than that of unpasteurized meat, but discolouration and retail acceptability of pasteurized and unpasteurized meat were perceived as similar at most times. The odours of displayed, pasteurized and unpasteurized meat were perceived to be similar at all times that odours were assessed. The findings indicate that pasteurizing of manufacturing beef to improve the microbiological safety of ground beef would not unacceptability degrade the appearance of the ground product, but that the storage life of ground beef would not be greatly extended by the treatment.

Animals↗
PubMed2004

State of the art and future prospects of the biological control of postharvest fruit diseases.

Synthetic fungicides are the primary means to control postharvest diseases of fruits. Biological control has emerged as one of the most promising alternatives to chemicals. During the last 20 years, several biological control agents have been widely investigated for use on different pathogens and fruit crops. Many biological control mechanisms have been suggested for use on fruit including antibiosis, parasitism, induced resistance in the host tissue and competition. With the aim of extending the use of the biofungicides, there have been many studies on the application of various combinations of control agents, and on the application integrated with chemical and physical means of protection. The formulation and application methods are key issues for the efficacy and successful outcome of the commercial product. Genetic engineering may provide a useful tool in the enhancement of the biological control efficacy. Since biofungicides are usually not as effective as pesticides, this approach should be viewed as an important component of an integrated disease management scheme given that a significant and permanent reduction of pesticide use is our goal.

Antibiosis↗
PubMed2003

A new look at neighborhoods near National Priorities List sites.

A geodemographic database can assess characteristics of communities by providing (1) annual demographic estimates for these small areas, and (2) statistically based models that integrated consumer behavior and lifestyle data. When applied to neighborhoods proximate to National Priorities List (NPL) sites, information from a geodemographic database can inform environmental health risk assessments and aid in targeting health education activities. This study utilized such a database with 1999 census block group population estimates and neighborhood descriptors in the USA. We examined patterns of neighborhood type based on NPL site classification by activity and waste type (e.g., manufacturing, mining). Overall, block groups described as "Military Quarters" are at highest risk of being located near an NPL site. Other, distinct, neighborhood differences are described.

Censuses↗