Routine smoking cessation intervention in health care systems.

Everyone agrees that insurance for long-term care is inadequate in the United States. Disagreement exists, however, on whether such insurance should be provided through the private or public sector. Private insurance generally uses the experience-rating principle that persons with higher risk of illness are charged higher premiums. For private insurance for long-term care, this principle creates a dilemma. Most policies will be purchased by the elderly; yet, because the elderly have a high risk of needing long-term care, only about 20% of them can afford the cost of premiums. A public-private partnership by which the government partially subsidizes private long-term-care insurance is unlikely to resolve this dilemma. Only a social insurance program for long-term care can provide universal, affordable, and equitable coverage.     

Reassessing insurers' access to genetic information: genetic privacy, ignorance, and injustice

Many countries have imposed strict regulations on the genetic information to which insurers have access. Commentators have warned against the emerging body of legislation for different reasons. This paper demonstrates that, when confronted with the argument that genetic information should be available to insurers for health insurance underwriting purposes, one should avoid appeals to rights of genetic privacy and genetic ignorance. The principle of equality of opportunity may nevertheless warrant restrictions. A choice-based account of this principle implies that it is unfair to hold people responsible for the consequences of the genetic lottery, since we have no choice in selecting our genotype or the expression of it. However appealing, this view does not take us all the way to an adequate justification of inaccessibility of genetic information. A contractarian account, suggesting that health is a condition of opportunity and that healthcare is an essential good, seems more promising. I conclude that if or when predictive medical tests (such as genetic tests) are developed with significant actuarial value, individuals have less reason to accept as fair institutions that limit access to healthcare on the grounds of risk status. Given the assumption that a division of risk pools in accordance with a rough estimate of people's level of (genetic) risk will occur, fairness and justice favour universal health insurance based on solidarity.     

Use of genetic data, employment and insurance: an international perspective

In this paper, I will say first of all a few words on what is novel in the potential exclusionary use of genetic information in the domains of work or insurance and to what extent legal protection specifically relating to genetic discrimination may be justified. Subsequently, I will briefly examine some of the proposed restrictions on the collection of genetic information for purposes of selection and the scope for international consensus on the issue; in doing so, I will deal separately with employment and private insurance. Finally, I will raise the question whether these issues require international handling and which international steps could be envisaged.     

Genetic information and insurance: some ethical issues.

Life is risky, and insurance provides one of the best developed ways of controlling risks. By pooling, and so transferring risks, those who turn out to suffer antecedently uncertain harms can be assured in advance that they will be helped if those harms arise; they can then plan their lives and activities with confidence that they are less at the mercy of ill fortune. Both publicly organized and commercial insurance can organize the pooling of risk in ways that are beneficial for all concerned. They provide standard ways of securing fundamental ethical values such as solidarity and mutuality. Although policy holders do not know or contract with one another, each benefits from the contribution of others to a shared scheme for pooling and so controlling risk. Although there is a limit to the degree to which commercially-based insurance, where premiums depend on risk level, can go beyond mutuality towards solidarity, in practice it too often achieves a measure of solidarity by taking a broad brush approach to pooling risk. However, the ordinary practices of insurance, and in particular of commercial insurance, also raise ethical questions. These may be put in simple terms by contrasting the way in which an insurance market discriminates between different people, on the basis of characteristics that (supposedly) determine their risk level, and our frequent abhorrence of discrimination, in particular on the basis on religious, racial and gender characteristics. Are the discriminations on which insurance practice relies upon as standard acceptable or not? The increasing availability of genetic information, which testing (of individuals) and screening (of populations) may provide, could lend urgency to these questions. Genetic information may provide a way of obtaining more accurate assessment of individual risks to health and life. This information could be used to discriminate more finely between the risk levels of different individuals, and then to alter the availability and the costs of health, life and unemployment insurance to them. Since all of these forms of insurance bear very directly on the way most people live, it will matter to them how (if at all) insurers take account of genetic information. Will use of this information improve or damage the capacity of insurance to provide confidence in the face of uncertain harms, and help if they happen? Will it discriminate in acceptable or in unacceptable ways? Will it support or damage the sorts of mutuality and solidarity various sorts of insurance schemes have successfully institutionalized?     

Medical Need,Equality, and Uncertainty

Many hold that distributing healthcare according to medical need is a requirement of equality. Most egalitarians believe, however, that people ought to be equal on the whole, by some overall measure of well‐being or life‐prospects; it would be a massive coincidence if distributing healthcare according to medical need turned out to be an effective way of promoting equality overall. I argue that distributing healthcare according to medical need is important for reducing individuals' uncertainty surrounding their future medical needs. In other words, distributing healthcare according to medical need is a natural feature of healthcare insurance; it is about indemnity, not equality.     

Poverty,insurance, and well-baby care among mainland Puerto Rican children

Using data from the Puerto Rican Maternal and Infant Health Study, we investigate the implications of family income and insurance status for well-baby care among mainland Puerto Ricans. Given the socioeconomic disadvantage of Puerto Ricans, it is critical to understand the extent to which low income and lack of health insurance create barriers to well-baby care and result in low utilization. The analysis shows that the income-to-needs ratio is related to barriers to well-baby care, and a key intervening factor is insurance status. The odds of reporting any barriers to care are lowest among those with both adequate income and private health insurance. Access to insurance is also vital in achieving adequate well-baby care. Uninsured children receive inadequate care more often than children with public or private insurance, especially when their income is also low. Children with public insurance are as likely as children with private insurance to receive an adequate number of well-baby visits, despite the fact that their mothers report more barriers to care.     

Managing uncertainty: information and insurance under the risk of starvation

In an uncertain world, animals face both unexpected opportunities and danger. Such outcomes can select for two potential strategies: collecting information to reduce uncertainty, or insuring against it. We investigate the relative value of information and insurance (energy reserves) under starvation risk by offering model foragers a choice between constant and varying food sources over finite foraging bouts. We show that sampling the variable option (choosing it when it is not expected to be good) should decline both with lower reserves and late in foraging bouts; in order to be able to reap the reduction in uncertainty associated with exploiting a variable resource effectively, foragers must be able to afford and compensate for an initial increase in the risk of an energetic shortfall associated with choosing the option when it is bad. Consequently, expected exploitation of the varying option increases as it becomes less variable, and when the overall risk of energetic shortfall is reduced. In addition, little activity on the variable alternative is expected until reserves are built up early in a foraging bout. This indicates that gathering information is a luxury while insurance is a necessity, at least when foraging on stochastic and variable food under the risk of starvation.     

Privatization and just healthcare

When advocates of insurance-privatization consider whether private insurance-dominated systems achieve justice at all, they tend to rely on an incomplete set of criteria for a just healthcare system. They also mistakenly assume that it is enough to show that justice is in principle achievable within a private insurance-dominated system. This essay offers a more complete set of criteria for a just healthcare system. It then argues that the motivational assumptions needed to make insurance-privatization at all plausible (on grounds of choice, efficiency, and quality of care) are inconsistent with the motivational assumptions needed to show that in practice a private insurance-dominated system will achieve justice. A private insurance-dominated system can be expected to satisfy the criteria for just healthcare only if (a) there is extensive and effective regulation to constrain the normal competitive behavior of private insurers or if (b) generous public funds are provided to fill the gaps in access left by the private insurance market. Yet the assumptions about the motivations and abilities of the public, regulators, and public officials needed to satisfy conditions (a) or (b) contradict the privatization advocate's explanations of how privatization will maximize efficiency, choice, and quality of care.     

Ecological hazard/risk assessment: lessons learned and new directions

A series of workshops held in the 1970s and 1980s, beginning at the University of Michigan Biological Station near Pellston, Michigan (and thus called the Pellston Series), focused on identifying the basic tenets of ecological hazard/risk assessment. The purpose of this discussion, produced roughly two decades after the first Pellston workshop, is to examine the impacts of this series on the development of the ecological hazard/risk assessment process, to explore some barriers hindering the development of this process, and suggest some new directions and challenges yet unaddressed by any of the workshop series. Probably the most important factor identified since the series of workshops began is persuasive circumstantial evidence that the learning process proceeds at different rates for individuals and institutions both in the government and private sectors, including academe. Evidence presently available suggests that individuals are frequently two or three decades ahead of institutions, and some individuals have already rejected paradigms generally accepted by the profession and are developing new ones. The major contribution of the workshops to the profession was connecting toxicity with environmental fate and transformation of chemicals and thus, bioavailability. Astonishingly, before the first Pellston workshop, this now-obvious connection did not play a dominant role in the peer-reviewed professional literature or in government documents, although the indefatigable investigator could find some minor indications that some professionals were aware of the importance of these relationships. Major suggestions for new directions and challenges focus on: (1) an emphasis on ecosystem health or condition rather than on mere absence of deleterious effects; (2) entering the information age requires that the type of information discussed here be integrated with and related to the broader array of other types of information used in making decisions at the societal or system level — failure to do so will mean that hazard/risk information will have little or no impact; (3) restoration ecology must emerge as a field of considerable importance because inevitably some estimates of hazard/risk will be inaccurate and damage will be done to ecosystems, which must then be repaired; (4) for all of this to function, environmental literacy must be markedly improved over its present level.     

Evidence-based underwriting in the molecular age: the politics of reinsurance companies towards the genetics issue

One of the most contentious topics in public policy debates on genetics has been the use of genetic information by private insurance companies. Confronted with legislation prohibiting the use of genetics in private insurance, the insurance industry has been prompted to deal proactively with the issue. One central feature of this change in tactics is the investment in “evidence-based underwriting”, currently promoted by transnational reinsurance companies. This strategy should contribute to de-politicizing the genetics issue in insurance. Drawing on fieldwork in reinsurance companies and in the broader field of insurance, this article analyzes how reinsurance companies deal with this strategy of evidence-based underwriting and whether it has delivered on its promises. Making use of the theoretical work of Barry and others on the politics of calculation in transnational technical zones, we show how the explicit goal of evidence-based underwriting by reinsurance companies helps to reveal uncertainty in life underwriting, which in turn stimulates new contestation and discussion over the issue of genetics and, more generally, the life underwriting process. In fact, it seems that the turn towards evidence-based underwriting standards has provoked new sources of politicization. While the intentions of evidence-based underwriting strategies are to de-politicize the genetics issue, the effects of this politics of calculation may appear to be political (again).     

Kin-selection,reciprocal altruism,and information sharing among Maine lobstermen

In this paper, the sharing of information about the location of lobsters among lobstermen in two Maine harbors is described. First, why the sharing of such information is likely to entail an economic loss for the transmitters is explained. Then, the extent to which the principles of kin-selection and reciprocal altruism can account for the sharing of information is determined. Many cases of information sharing in one of the harbors do not appear to be the type of kin-directed or reciprocal acts expected to be produced by kin-selection or reciprocal altruism as they are usually conceived. The behavior of these lobstermen may be the result of the advantages of maintaining a complex web of social relationships among them. Failure to appreciate the complexity of such relationships in some fishing communities is suggested to be a major shortcoming in the economic models previously used to explain information management among commercial fishermen. I conclude that a more complex model of reciprocal altruism is needed to account for the information sharing among this group of Maine lobstermen, and perhaps many other human social groups.     

Earthquake Insurance and Earthquake Risk Management

The Wenchuan earthquake is the largest devastating earthquake striking China since the 1976 Tangshan earthquake. In this catastrophe, loss payments were mainly from the government and public endowment. The insurance industry is expected to take more responsibility in the future, since earthquake insurance is one of the most effective and equitable instruments to disperse earthquake losses. In this article, earthquake risk management and the development of earthquake insurance in China are reviewed. Earthquake insurance is suggested as an instrument in earthquake risk management, where the premium rate of earthquake insurance is a key factor that needs to be determined reasonably. Seismic hazard is analyzed for the Wenchuan earthquake-stricken area, and is combined with primary loss estimation to construct the exceeding probability curve. Earthquake insurance premium rates are calculated for buildings in the area, including RC (Reinforced Concrete), frame, and brick, corresponding to two kinds of insurance deductible.     

The impact of interventions in the global land and agri‐food sectors on Nature’s Contributions to People and the UN Sustainable Development Goals

Interlocked challenges of climate change, biodiversity loss, and land degradation require transformative interventions in the land management and food production sectors to reduce carbon emissions, strengthen adaptive capacity, and increase food security. However, deciding which interventions to pursue and understanding their relative co‐benefits with and trade‐offs against different social and environmental goals have been difficult without comparisons across a range of possible actions. This study examined 40 different options, implemented through land management, value chains, or risk management, for their relative impacts across 18 Nature's Contributions to People (NCPs) and the 17 Sustainable Development Goals (SDGs). We find that a relatively small number of interventions show positive synergies with both SDGs and NCPs with no significant adverse trade‐offs; these include improved cropland management, improved grazing land management, improved livestock management, agroforestry, integrated water management, increased soil organic carbon content, reduced soil erosion, salinization, and compaction, fire management, reduced landslides and hazards, reduced pollution, reduced post‐harvest losses, improved energy use in food systems, and disaster risk management. Several interventions show potentially significant negative impacts on both SDGs and NCPs; these include bioenergy and bioenergy with carbon capture and storage, afforestation, and some risk sharing measures, like commercial crop insurance. Our results demonstrate that a better understanding of co‐benefits and trade‐offs of different policy approaches can help decision‐makers choose the more effective, or at the very minimum, more benign interventions for implementation.     

Hadza meat sharing

In most human foraging societies, the meat of large animals is widely shared. Many assume that people follow this practice because it helps to reduce the risk inherent in big game hunting. In principle, a hunter can offset the chance of many hungry days by exchanging some of the meat earned from a successful strike for shares in future kills made by other hunters. If hunting and its associated risks of failure have great antiquity, then meat sharing might have been the evolutionary foundation for many other distinctively human patterns of social exchange. Here we use previously unpublished data from the Tanzanian Hadza to test hypotheses drawn from a simple version of this argument. Results indicate that Hadza meat sharing does not fit the expectations of risk-reduction reciprocity. We comment on some variations of the “sharing as exchange” argument; then elaborate an alternative based partly on the observation that a successful hunter does not control the distribution of his kill. Instead of family provisioning, his goal may be to enhance his status as a desirable neighbor. If correct, this alternative argument has implications for the evolution of men's work.     

PRIVATIZATION AND JUST HEALTHCARE

When advocates of insurance-privatization consider whether private insurance-dominated systems achieve justice at all, they tend to rely on an incomplete set of criteria for a just healthcare system. They also mistakenly assume that it is enough to show that justice is in principle achievable within a private insurance-dominated system. This essay offers a more complete set of criteria for a just healthcare system. It then argues that the motivational assumptions needed to make insurance-privatization at all plausible (on grounds of choice, efficiency, and quality of care) are inconsistent with the motivational assumptions needed to show that in practice a private insurance-dominated system will achieve justice. A private insurance-dominated system can be expected to satisfy the criteria for just healthcare only if (a) there is extensive and effective regulation to constrain the normal competitive behavior of private insurers or if (b) generous public funds are provided to fill the gaps in access left by the private insurance market. Yet the assumptions about the motivations and abilities of the public, regulators, and public officials needed to satisfy conditions (a) or (b) contradict the privatization advocate's explanations of how privatization will maximize efficiency, choice, and quality of care     

Information sharing in a competitive supply chain with capacity constraint

This paper studies the incentives for vertical demand information sharing in a two-echelon supply chain formed by many downstream retailers and one upstream manufacturer with a limited production capacity. The retailers are engaged in a Cournot competition, and endowed with some private information about the demand. The total order of all the retailers may exceed the manufacturer’s capacity, and in that case, an allocation strategy is required. We show that a discriminated allocation strategy will encourage the retailers to share their demand information. We also find the condition under which full information sharing can be reached. Furthermore, we prove that when the manufacturer cannot satisfy the total order of all the retailers, social welfare and consumer surplus will be locked by the capacity.     

Social learning strategies and predation risk: minnows copy only when using private information would be costly

Animals can acquire information from the environment privately, by sampling it directly, or socially, through learning from others. Generally, private information is more accurate, but expensive to acquire, while social information is cheaper but less reliable. Accordingly, the 'costly information hypothesis' predicts that individuals will use private information when the costs associated with doing so are low, but that they should increasingly use social information as the costs of using private information rise. While consistent with considerable data, this theory has yet to be directly tested in a satisfactory manner. We tested this hypothesis by giving minnows (Phoxinus phoxinus) a choice between socially demonstrated and non-demonstrated prey patches under conditions of low, indirect and high simulated predation risk. Subjects had no experience (experiment 1) or prior private information that conflicted with the social information provided by the demonstrators (experiment 2). In both experiments, subjects spent more time in the demonstrated patch than in the non-demonstrated patch, and in experiment 1 made fewer switches between patches, when risk was high compared with when it was low. These findings are consistent with the predictions of the costly information hypothesis, and imply that minnows adopt a 'copy-when-asocial-learning-is-costly' learning strategy.     

ISBP: Understanding the Security Rule of Users' Information-Sharing Behaviors in Partnership

The rapid growth of social network data has given rise to high security awareness among users, especially when they exchange and share their personal information. However, because users have different feelings about sharing their information, they are often puzzled about who their partners for exchanging information can be and what information they can share. Is it possible to assist users in forming a partnership network in which they can exchange and share information with little worry? We propose a modified information sharing behavior prediction (ISBP) model that can help in understanding the underlying rules by which users share their information with partners in light of three common aspects: what types of items users are likely to share, what characteristics of users make them likely to share information, and what features of users’ sharing behavior are easy to predict. This model is applied with machine learning techniques in WEKA to predict users’ decisions pertaining to information sharing behavior and form them into trustable partnership networks by learning their features. In the experiment section, by using two real-life datasets consisting of citizens’ sharing behavior, we identify the effect of highly sensitive requests on sharing behavior adjacent to individual variables: the younger participants’ partners are more difficult to predict than those of the older participants, whereas the partners of people who are not computer majors are easier to predict than those of people who are computer majors. Based on these findings, we believe that it is necessary and feasible to offer users personalized suggestions on information sharing decisions, and this is pioneering work that could benefit college researchers focusing on user-centric strategies and website owners who want to collect more user information without raising their privacy awareness or losing their trustworthiness.     

Fatal collision? Are wireless headsets a risk in treating patients?

Wireless-enabled headsets that connect to the internet can provide remote transcribing of patient examination notes. Audio and video can be captured and transmitted by wireless signals sent from the computer screen in the frame of the glasses. But using wireless glass-type devices can expose the user to a specific absorption rates (SAR) of 1.11–1.46 W/kg of radiofrequency radiation. That RF intensity is as high as or higher than RF emissions of some cell phones. Prolonged use of cell phones used ipsilaterally at the head has been associated with statistically significant increased risk of glioma and acoustic neuroma. Using wireless glasses for extended periods to teach, to perform surgery, or conduct patient exams will expose the medical professional to similar RF exposures which may impair brain performance, cognition and judgment, concentration and attention and increase the risk for brain tumors. The quality of medical care may be compromised by extended use of wireless-embedded devices in health care settings. Both medical professionals and their patients should know the risks of such devices and have a choice about allowing their use during patient exams. Transmission of sensitive patient data over wireless networks may increase the risk of hacking and security breaches leading to losses of private patient medical and financial data that are strictly protected under HIPPA health information privacy laws.