Background Physicians’ financial interests might conflict with the best service to patients. It is essential to gain a thorough understanding of the effect of remuneration systems on physician behaviour. Methods We conducted a controlled laboratory experiment using a within-subject design to investigate physician behaviour underpayment heterogeneity. Each physician provided medical care to patients whose treatments were paid for under fee-for-service (FFS) or capitation (CAP). Results We observed that physicians customized their care in response to the payment system. FFS patients received considerably more medical care than did CAP patients with the same illness and treatment preference. Physicians over-served FFS patients and under-served CAP patients. After a CAP payment reduction, we observed neither a quantity reduction under CAP nor a spillover in FFS patients’ treatment. Conclusions The results suggest that, in our experimental model, fee regulation can be used to some extent to control physician spending since we did not identify a behavioural response to the CAP payment cut. Physicians did not recoup lost income by altering treatment behaviour toward CAP and/or FFS patients. Experimental economics is an excellent tool for ensuring the welfare of all those involved in the health system. Further research should investigate payment incentives as a means of developing health care teams that are more efficient.

Background: The role of sociodemographic and economic characteristics in mental distress has been rarely investigated in Indonesia. Aims: To investigate the prevalence of common mental disorders (CMD) and identify any associations between mental distress and sociodemographic and economic characteristics among communities living in urban and rural (peri-urban) areas. Method: A community-based household survey was conducted in the province of Aceh, Indonesia, in 2018. The 20-item Self Reporting: Questionnaire (SRQ-20) screening tool was used to measure symptoms of CMD. Information on sociodemographic characteristics, family functioning, labour market outcomes and healthcare costs was collected. Multivariate regressions were conducted to analyse the relationships between the measures of mental distress and sociodemographic and economic characteristics. Results: We found that 14% of the respondents had CMD symptoms. SRQ-20 scores were higher for female, older and lower-educated individuals. CMD prevalence was higher among non-married participants and clustered within families. Participants with CMD perceive their families as performing significantly better in the dimensions of affective involvement and behaviour control compared with their counterparts. Their work was more often affected by negative feelings; they were also twice as likely to report a recent physical or mental health complaint and faced twice the treatment costs compared with their non-affected counterparts. Conclusions: The prevalence of mental disorders is especially high in disadvantaged population groups. Moreover, mental distress is associated with a lower perceived productivity and a higher physical health burden.

In corporate valuation, it is common to assume either passive or active debt management. However, it is questionable whether these pure financing policies reflect the real financing policies of firms with a sufficient degree of accuracy. This shortcoming has led to the development of mixed financing strategies as combinations of pure financing strategies. Whereas hybrid financing is directly linked to the two-phase model, it is unclear how to apply discontinuous financing in such a setting. In this study, according to the two versions of hybrid financing, we analyze the implementation of discontinuous financing in a two-phase model. Thereby, we present a simpler and more intuitive derivation of the valuation equation for discontinuous financing to increase its acceptance and its use for corporate valuation practice. Moreover, we compare the different mixed financing strategies with each other theoretically, and we conduct simulations to elucidate the impact on market values and the sensitivities of input parameters. The study concludes that the presented mixed financing strategies can help in the attempt to reflect the real financing behavior of firms more accurately and, therefore, constitute a valuable alternative to pure financing strategies for valuation.

Background The EU chemicals regulation “Registration, Evaluation, Authorisation and Restriction of Chemicals” (REACH) aims to reduce the usage of substances of very high concern (SVHCs) by firms. Therefore, a consumer right-to-know about SVHCs in articles is intended to create market-based incentives. However, awareness of the right-to-know among EU citizens is low. Moreover, the response window of 45 days afforded to suppliers impedes immediate, informed decisions by consumers. Consequently, despite being in effect for more than 10 years, only few consumer send requests. Civil society actors have developed smartphone applications reducing information search costs, allowing users to send right-to-know requests upon scanning an article’s barcode. Answers are stored in a database and made available to the public immediately. This paper assesses to which extent smartphone tools contribute to an increased use of the right-to-know by undertaking a case study of the application “ToxFox” by the German non-profit organisation Bund für Umwelt und Naturschutz Deutschland (BUND). Results An analysis of the data from the BUND database for the period 2016 to 2018 reveals that about 20 thousand users have sent almost 49 thousand requests. This has led to more than 9 thousand database entries, including 189 articles which contain SVHCs above the legal threshold. The data also indicate that receiving information on requested articles encourages further use of the application. Many suppliers accept the application and pro-actively provide information on articles without SVHCs above the threshold. However, most consumers use the application only for a short time, and suppliers are struggling to reply to right-to-know requests. Conclusion Evaluating the results, the study identifies options to enhance the application’s design in terms of user motivation and legal certainty, and to enhance the framework governing "barcode" assignments to articles with a view to better contributing to transparency. As for policy implications, a lack of consumer requests can in part be traced back to design flaws of the right-to-know and a lack of implementation and enforcement of REACH. In addition, suppliers have to increase their supply chain communication efforts to make sure they are in a position to properly answer consumer requests. We recommend several policy options addressing these and additional aspects, thus contributing to the legislative review of Art. 33 REACH.

This paper introduces distributional regression also known as generalized additive models for location, scale and shape (GAMLSS) as a modeling framework for analyzing treatment effects beyond the mean. In contrast to mean regression models, GAMLSS relate each distributional parameter to covariates. Therefore, they can be used to model the treatment effect not only on the mean but on the whole conditional distribution. Since they encompass a wide range of different distributions, GAMLSS provide a flexible framework for modeling non-normal outcomes in which additionally nonlinear and spatial effects can easily be incorporated. We elaborate on the combination of GAMLSS with program evaluation methods including randomized controlled trials, panel data techniques, difference in differences, instrumental variables, and regression discontinuity design. We provide practical guidance on the usage of GAMLSS by reanalyzing data from the Mexican Progresa program. Contrary to expectations, no significant effects of a cash transfer on the conditional consumption inequality level between treatment and control group are found.

The effects of demographic change and the lack of acceptance represent some of the main problems for the public transport infrastructure in rural areas. As a consequence, the development of new transport service options becomes especially relevant for rural communities. The Max-Planck-Institute for Dynamics and Self-Organization developed a new form of Demand Responsive Transport the EcoBus to examine the viability of new DRT systems in rural Germany. Our work draws on customer satisfaction data during the trial runs of the EcoBus. Based on the survey data, this paper develops regression models to explain the determinants of DRT customer satisfaction. Our main findings include the importance of waiting times and the ease of entry for overall customer satisfaction. Nevertheless, we found no evidence that the presence of other guests in the vehicle had any negative impact on customer satisfaction. Findings of other works that women are significantly more likely to use DRT services could not be validated from our data.

Ratios of medians or other suitable quantiles of two distributions are widely used in medical research to compare treatment and control groups or in economics to compare various economic variables when repeated cross-sectional data are available. Inspired by the so-called growth incidence curves introduced in poverty research, we argue that the ratio of quantile functions is a more appropriate and informative tool to compare two distributions. We present an estimator for the ratio of quantile functions and develop corresponding simultaneous confidence bands, which allow to assess significance of certain features of the quantile functions ratio. Derived simultaneous confidence bands rely on the asymptotic distribution of the quantile functions ratio and do not require re-sampling techniques. The performance of the simultaneous confidence bands is demonstrated in simulations. Analysis of expenditure data from Uganda in years 1999, 2002 and 2005 illustrates the relevance of our approach.

Existing studies show how population growth and rising incomes will cause a massive increase in the future global demand for food. We add to the literature by estimating the potential effect of increases in human weight, caused by rising BMI and height, on future calorie requirements. Instead of using a market based approach, the estimations are solely based on human energy requirements for maintenance of weight. We develop four different scenarios to show the effect of increases in human height and BMI. In a world where the weight per age-sex group would stay stable, we project calorie requirements to increases by 61.05 percent between 2010 and 2100. Increases in BMI and height could add another 18.73 percentage points to this. This additional increase amounts to more than the combined calorie requirements of India and Nigeria in 2010. These increases would particularly affect Sub-Saharan African countries, which will already face massively rising calorie requirements due to the high population growth. The stark regional differences call for policies that increase food access in currently economically weak regions. Such policies should shift consumption away from energy dense foods that promote overweight and obesity, to avoid the direct burden associated with these conditions and reduce the increases in required calories. Supplying insufficient calories would not solve the problem but cause malnutrition in populations with weak access to food. As malnutrition is not reducing but promoting rises in BMI levels, this might even aggravate the situation

To investigate the factors contributing to pioglitazone-induced edema, we analyzed sodium excretion and several clinical parameters before and after administration of pioglitazone. We analyzed these parameters before and after 8 weeks of administration of pioglitazone to female subjects with type 2 diabetes. When we evaluated whether a significant correlation was found between salt excretion and blood pressure, six patients showed such correlation and 20 patients did not. After 8 weeks of pioglitazone administration, five patients had developed edema, and, surprisingly, such correlation was not found in all five subjects. Salt excretion after administration of pioglitazone was significantly lower in subjects who developed edema and those who showed the correlation, and the hematocrit was significantly lower after administration in the subjects who showed the correlation, but not in the edema group. Pioglitazone-induced edema would be caused not only by fluid retention, but also by other factors, such as vascular permeability.

OBJECTIVES: This study aims to determine the prevalence of and factors associated with underweight children under the age of 5 in Punjab, Pakistan. DESIGN: We analysed cross-sectional household-level subnationally representative Multiple Indicator Cluster Survey. SETTINGS: Punjab province, Pakistan. PARTICIPANTS: 24 042 children under 5 years of age. DATA ANALYSIS: Multilevel multivariate logistic regression analysis. RESULTS: Prevalence of moderately and severely underweight children was found to be (33.3% and 11.3%, respectively). Multivariate multilevel logistic regression results show that as the child grows older the likelihood of the child being underweight increases significantly (eg, children between 12 and 23 months are one and half times more likely to be underweight, whereas children between the ages of 36 and 47 months are two and a half times more likely to be underweight). Gender was found to be another significant factor contributing to underweight prevalence among children under the age of 5. The likelihood of a girl child being underweight is more than that of a boy child being underweight (OR 0.92, 95% CI 0.8 to 1.0). Similarly, a child whose birth order is three or more is two times more likely to be underweight (OR 1.96, 95% CI 1.5 to 2.5) relative to a child of a lower birth order. Moreover, diarrhoea also significantly increases the likelihood of the child being underweight (OR 1.31, 95% CI 1.1 to 1.5). Child size is another determinant for underweight prevalence among children under 5, for example, a child with a size smaller than average at the time of birth is 2.7 times more likely to be moderately underweight than a child with an average or larger than average size at the time of birth. CONCLUSION: Rigorous community-based interventions should be developed and executed throughout the province to improve this grave situation of underweight prevalence in Punjab. Mother's education should be uplifted by providing them formal education and providing awareness about the importance of proper nutrition for children.