[Show abstract][Hide abstract] ABSTRACT: The question of whether there is a connection between income and psychological well-being is a long-studied issue across the social, psychological, and behavioral sciences. Much research has found that richer people tend to be happier. However, relatively little attention has been paid to whether happier individuals perform better financially in the first place. This possibility of reverse causality is arguably understudied. Using data from a large US representative panel, we show that adolescents and young adults who report higher life satisfaction or positive affect grow up to earn significantly higher levels of income later in life. We focus on earnings approximately one decade after the person's well-being is measured; we exploit the availability of sibling clusters to introduce family fixed effects; we account for the human capacity to imagine later socioeconomic outcomes and to anticipate the resulting feelings in current well-being. The study's results are robust to the inclusion of controls such as education, intelligence quotient, physical health, height, self-esteem, and later happiness. We consider how psychological well-being may influence income. Sobel-Goodman mediation tests reveal direct and indirect effects that carry the influence from happiness to income. Significant mediating pathways include a higher probability of obtaining a college degree, getting hired and promoted, having higher degrees of optimism and extraversion, and less neuroticism.
Proceedings of the National Academy of Sciences 11/2012;
[Show abstract][Hide abstract] ABSTRACT: It is commonly recognized that the setting of health priorities requires value judgements and that these judgements are social. Justifying social value judgements is an important element in any public justification of how priorities are set. The purpose of this paper is to review a number of social values relating both to the process and content of priority-setting decisions.
A set of key process and content values basic to health priority setting is outlined, and normative analysis applied to those values to identify their key features, possible interpretations in different cultural and institutional contexts, and interactions with other values.
Process values are found to be closely linked, such that success in increasing, for example, transparency may depend on increasing participation or accountability, and "content" values are found often to be hidden in technical criteria. There is a complex interplay between value and technical components of priority setting, and between process and content values. Levels of economic development, culture and need will all play a part in determining how different systems balance the values in their decisions.
Technical analyses of health priority setting are commonplace, but approaching the issues from the perspective of social values is a more recent approach and one which this paper seeks to refine and develop.
Journal of Health Organisation and Management 06/2012; 26(3):293-316.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this paper is to provide an overview of health priority setting structures in Germany. It reflects on how and which social values may influence decision making, and in particular investigates the role of the Institute for Quality and Efficiency in Health Care (IQWiG) in integrating evidence-based decision making into the German system.
The paper applies Clark and Weale's framework of analysis for Social Values and Health Priority Setting to the German context. Placing German health care decision making into Clark and Weale's framework allows for an analysis of the role and content of social values in different dimensions of decision making.
Germany has witnessed significant changes in its health care decision-making procedures in recent decades. The establishment of the Institute of Quality and Efficiency in Health Care (IQWiG) represents an effort to introduce health technology assessment (HTA) as a formal element of decision making in health care. In doing so, Germany has made unique methodological and structural choices that reflect the social values and institutional traditions that underpin its self-governing statutory health insurance (SHI) system. The empirical evidence suggests that the principle of solidarity is upheld as a core value in health priority setting in Germany.
The German case of health priority setting highlights some of the challenges involved when introducing centralised HTA structures to a self-governing SHI system. As such, this paper contributes to an understanding of the different forms that HTA can take, what social values they embody and how they can affect health priority setting in different ways.
Journal of Health Organisation and Management 06/2012; 26(3):374-83.
[Show abstract][Hide abstract] ABSTRACT: The Nuffield Council on Bioethics (NCOB) has published two reports (1999 and 2004) on the social and ethical issues involved in the use of genetically modified crops. This presentation summarises their core ethical arguments. Five sets of ethical concerns have been raised about GM crops: potential harm to human health; potential damage to the environment; negative impact on traditional farming practice; excessive corporate dominance; and the 'unnaturalness' of the technology. The NCOB examined these claims in the light of the principle of general human welfare, the maintenance of human rights and the principle of justice. It concluded in relation to the issue of 'unnaturalness' that GM modification did not differ to such an extent from conventional breeding that it is in itself morally objectionable. In making an assessment of possible costs, benefits and risks, it was necessary to proceed on a case-by-case basis. However, the potential to bring about significant benefits in developing countries (improved nutrition, enhanced pest resistance, increased yields and new products) meant that there was an ethical obligation to explore these potential benefits responsibly, to contribute to the reduction of poverty, and improve food security and profitable agriculture in developing countries. NCOB held that these conclusions were consistent with any practical precautionary approach. In particular, in applying a precautionary approach the risks associated with the status quo need to be considered, as well as any risks inherent in the technology. These ethical requirements have implications for the governance of the technology, in particular mechanisms for enabling small-scale farmers to express their preferences for traits selected by plant breeders and mechanisms for the diffusion of risk-based evaluations.
[Show abstract][Hide abstract] ABSTRACT: This article examines the impact of Britain's Freedom of Information (FOI) Act 2000 on British central government. The article identifies six objectives for FOI in the United Kingdom and then examines to what extent FOI has met them, briefly comparing the United Kingdom with similar legislation in Ireland, New Zealand, Australia, and Canada. It concludes that FOI has achieved the core objectives of increasing transparency and accountability, though the latter only in particular circumstances, but not the four secondary objectives: improved decision-making by government, improved public understanding, increased participation, and trust in government. This is not because the Act has “failed” but because the objectives were overly ambitious and FOI is shaped by the political environment in which it is placed.
[Show abstract][Hide abstract] ABSTRACT: This article sets out to counteract HM Evans's "fair's fair argument" in support of abolishing veto to research participation. Evans's argument attempts to assimilate ordinary clinical practice to clinical research. I shall refer to this attempt as "assimilation claim". I shall attempt to show that this assimilation, as it is carried out in Evans's argument, is misleading and, ultimately, logically undermines the conclusion. I shall then proceed to show that when the fair's fair argument is proposed independently of the assimilation claim, Evans's conclusion is not unavoidable and possible alternatives are equally open within the terms of the argument itself.
[Show abstract][Hide abstract] ABSTRACT: Adult education has long been the Cinderella of the education system. This is not helped by the fact that there is currently an impasse between employers, government and individuals over who should finance such training. So what, if anything, can philosophers do to help resolve the normative question of who ought to pay, setting aside for the moment the practical question of how this might be put into effect? An important strand of contemporary egalitarian philosophy argues that equality of opportunity for education should be implemented in such a way that children with the same level of talent and the same willingness to make an effort have the same opportunity to attain skills and qualifications such that they are each able (at the onset of adult life) to compete effectively with others for advantageous positions and rewards in society. But what about children or teenagers who drop out of education or make such little effort that they achieve wholly inadequate exam results? Should they be offered second and third chances for free education as adults funded by the state? A case is made for lifelong as opposed to one-off equality of opportunity for education on a number of grounds, including efficiency, utility, the value of choice, the social bases of self-respect and responsibility-catering prioritarianism. This last view supports lifelong access to education (for reasons of priority) but with the additional (responsibility-catering) stipulation that adults should contribute at least some of the costs themselves in so far as they are accountable for not making enough effort the first time around.
Journal of Philosophy of Education 04/2006; 40(1):63 - 84.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to investigate whether adjusting for clinical case mix and social class explains more of the variation in home visits between general practices than adjusting for age and sex alone.
The setting was 60 general practices in England and Wales taking part in the 1 year Fourth National Morbidity Survey. The participants comprised 349 505 patients who were registered with one of the participating general practices for at least 180 days, and who had at least one consultation during the period. The outcome measure is whether or not a patient received a home visit in that year. A clinical case mix category (morbidity class) based on 1 year's diagnostic information was assigned to each patient using the Johns Hopkins Adjusted Clinical Groups (ACG) Case Mix System. The social class measure was derived from occupation and employment status and is similar to that of the 1991 UK census. Variations in home visits between practices were examined using multilevel logistic regression models. The variability between practices before and after adjusting for clinical case mix and social class was estimated using the intracluster correlation coefficient (ICC).
The overall percentage of patients receiving a home visit over the 1 year study period was 17%, and this varied from 7 to 31% across the 60 practices. The percentage of the total variation in home visits attributable to differences between practices was 2.5% [95% confidence interval (CI) 1.4-3.2%] after adjusting for age and sex. This reduced to 1.6% (95% CI 1.1-2.4%) after taking into account morbidity class. The results were similar when social class was included instead of morbidity class. Morbidity and social class together reduced variation in home visits between practices to 1.5% (95% CI 1.1-2.2%).
Age, sex, social class and clinical case mix are strong determinants of home visits in the UK. Adjusting for morbidity and social class results in a small improvement in explaining the variability in home visits between practices compared with adjusting for age and sex alone. There is far more variation between patients within practices; however, it is not straightforward to examine the factors influencing this variation. In addition to morbidity and social class, there could also be other unmeasured factors such as varying patient demand for home visits, disability or differences in GP home visiting practice style that could influence the large within-practice variability observed in this study.
[Show abstract][Hide abstract] ABSTRACT: The article by Feachem et al, published in the BMJ in 2002, claimed to show that, compared with the United Kingdom (UK) National Health Service (NHS), the Kaiser Permanente healthcare system in the United States (US) has similar healthcare costs per capita, and performance that is considerably better in certain respects.
To assess the accuracy of Feachem et al's comparison and conclusions.
Detailed re-examination of the data and methods used and consideration of the 82 letters responding to the article.
Analyses revealed four main areas in which Feachem et al's methodology was flawed. Firstly, the populations of patients served by Kaiser Permanente and by the NHS are fundamentally different. Kaiser's patients are mainly employed, significantly younger, and significantly less socially deprived and so are healthier. Feachem et al fail to adjust adequately for these factors. Secondly, Feachem et al have wrongly inflated NHS costs by omitting substantial user charges payable by Kaiser members for care, excluding the costs of marketing and administration, and deducting the surplus from Kaiser's costs while underestimating the capital charge element of the NHS budget and other costs. They also used two methods of converting currency, the currency rate and a health purchasing power parity conversion. This is double counting. Feachem et al reported that NHS costs were 10% less per head than Kaiser. Correcting for the double currency conversion gives the NHS a 40% cost advantage such that per capita costs are 1161 dollars and 1951 dollars for the NHS and Kaiser, respectively. Thirdly, Feachem et al use non-standardised data for NHS bed days from the Organisation for Economic Cooperation and Development, rather than official Department of Health bed availability and activity statistics for England. Leaving aside the non-comparability of the population and lack of standardisation of the data, the result is to inflate NHS acute bed use and underestimate the efficiency of performance by at least 10%. Similar criticisms apply to their selective use of performance measures. Finally, Feachem et al claim that Kaiser is a more integrated system than the NHS. The NHS provides health care to around 60 million people free at the point of delivery, long-term and psychiatric care, and continuing care after 100 days whereas Kaiser provides care to 6 million people, mainly employed and privately insured. Important functions, such as health protection, education and training of healthcare professionals, and research and development are not included or properly costed in Feachem et al's integrated model.
We have re-examined the statements made by Feachem et al and show that the claims are unsupported by the evidence. The NHS is not similar to Kaiser in coverage, costs or performance.
British Journal of General Practice 07/2004; 54(503):415-21; discussion 422.
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