Informal risk-sharing between smallholders may be threatened by formal insurance: Lessons from a stylized agent-based model.
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ABSTRACT:
SUBMITTER: Will M
PROVIDER: S-EPMC7978336 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundIt is unclear how formal long-term care (LTC) availability affects formal /informal caregiving patterns and caregiver health. We tested the impact of reduced formal LTC availability on formal LTC service use, intensity of informal caregiving, and caregiver health.MethodsUsing a representative, repeated cross-sectional sample of Japanese caregivers providing care to co-resident family members from 2001 to 2016, we applied a difference-in-differences approach by observing caregivers before and after the major reform of the public Japanese LTC insurance (LTCI) in 2006. The reform reduced coverage benefits for non-institutionalized older persons with low care needs, but not for those with high care needs. We analyzed 12,764 caregivers aged ?30?years (mean age 64.3?±?11.8?years, 73.5% women) and measured indicators of formal LTC use, hours of informal caregiving, and caregiver self-reported health outcomes after propensity score matching to balance caregivers' background characteristics.ResultsWe found the 2006 LTCI reform relatively reduced the use of formal LTC services and relatively increased the percentage of experiencing long hours of informal caregiving (>?3?h per day) among the caregivers for seniors with low care needs compared to those for seniors with high care needs. The effects of the LTCI reform for the caregivers for seniors with low care needs were 2.2 percentage point higher on caregivers' experiencing poor self-rated health (95% confidence interval [CI]: 0.7-3.7; p?=?0.01), 2.7 percentage point higher on experiencing symptoms of a depressive state (95%CI: 0.5-4.8; p?=?0.03), and 4.7 percentage point higher on experiencing symptoms of musculoskeletal diseases (95%CI, 3.6-5.7; p?<?0.001), compared to those for seniors with high care needs.ConclusionsReduced formal care availability under the Japanese LTCI reform increased hours of informal caregiving corresponding to reduced use of formal LTC and deteriorated multiple dimensions of caregiver health. Our findings may highlight the importance of enhancing the availability of formal LTC services for caregiver health.
| S-EPMC7291452 | biostudies-literature
Project description:Crops are variously susceptible to biotic stresses-something expected to increase under climate change. In the case of staple crops, this potentially undermines household and national food security. We examine recent wheat rust epidemics and smallholders' coping mechanisms in Ethiopia as a case study. Wheat is a major food crop in Ethiopia widely grown by smallholders. In 2010/11 a yellow rust epidemic affected over one-third of the national wheat area. Two waves of nationally representative household level panel data collected for the preceding wheat season (2009/10) and three years after (2013/14) the occurrence of the epidemic allow us to analyze the different coping mechanisms farmers used in response. Apart from using fungicides as ex-post coping mechanism, increasing wheat area under yellow rust resistant varieties, increasing diversity of wheat varieties grown, or a combination of these strategies were the main ex-ante coping mechanisms farmers had taken in reducing the potential effects of rust re-occurrence. Large-scale dis-adoption of highly susceptible varieties and replacement with new, rust resistant varieties was observed subsequent to the 2010/11 epidemic. Multinomial logistic regression models were used to identify the key factors associated with smallholder ex-ante coping strategies. Household characteristics, level of specialization in wheat and access to improved wheat seed were the major factors that explained observed choices. There was 29-41% yield advantage in increasing wheat area to the new, resistant varieties even under normal seasons with minimum rust occurrence in the field. Continuous varietal development in responding to emerging new rust races and supporting the deployment of newly released resistant varieties could help smallholders in dealing with rust challenges and maintaining improved yields in the rust-prone environments of Ethiopia. Given the global importance of both wheat and yellow rust and climate change dynamics study findings have relevance to other regions.
| S-EPMC6668782 | biostudies-literature
Project description:OBJECTIVES: To test hypotheses concerning the relationship between formal and informal care and to estimate the impact of hours of formal care authorized for Medicaid Personal Care Services (PCS) on the utilization of informal care. DATA SOURCES/STUDY SETTING: Data included home care use and adult Medicaid beneficiary characteristics from assessments of PCS need in four Medicaid administrative areas in Texas. STUDY DESIGN: Cross-sectional design using ordinary least-squares (OLS) and instrumental variable (IV) methods. DATA COLLECTION/EXTRACTION METHODS: The study database consisted of assessment data on 471 adults receiving Medicaid PCS from 2004 to 2006. PRINCIPAL FINDINGS: Both OLS and IV estimates of the impact of formal care on informal care indicated no statistically significant relationship. The impact of formal care authorized on informal care utilization was less important than the influence of beneficiary need and caregiver availability. Living with a potential informal caregiver dramatically increased the hours of informal care utilized by Medicaid PCS beneficiaries. CONCLUSIONS: More formal home care hours were not associated with fewer informal home care hours. These results imply that policies that decrease the availability of formal home care for Medicaid PCS beneficiaries will not be offset by an increase in the provision of informal care and may result in unmet care needs.
| S-EPMC3401403 | biostudies-literature
Project description:The impact of formal care (co-paid by long term care (LTC) insurance) on informal care is critical to the improvement and promotion of public policy. We conducted an interview-based survey to examine how the use of formal care impacts the use of informal care in Shanghai, which was one of China's first long-term insurance pilots in 2016. In addition to total informal care time, the following four types of informal care were considered: (1) household activities of daily living (HDL) tasks, (2) activities of daily living (ADL) tasks, (3) instrumental activities of daily living (IADL) tasks, and (4) supervision tasks. Of the 407 families, an average of 12.36 h (SD = 6.70) of informal care was crowded out each week. Among them, ADL tasks, HDL tasks, and supervision tasks were reduced an average of 4.60 (SD = 3.59), 5.50 (SD = 3.38), and 2.10 h (SD = 3.06) per week, respectively. Each additional hour of formal care reduced 0.473 h of informal care. Care recipients' gender and health status were also determined to be associated with crowding out hours of informal care. These findings can be utilized as empirical evidence for decision-makers to consider the scope of funding for formal care, and this study provides comparable results to developing countries and regions.
| S-EPMC7216006 | biostudies-literature
Project description:BackgroundModels of health care coverage with varying degrees of patient cost-sharing have been shown to influence health care behaviors for chronic conditions including medication adherence. The effect of insurance cost-sharing subsidies on the probability of postoperative opioid refill, however, is unclear.MethodsThis retrospective cohort study examined 100% Medicare claims data among patients (N = 21,781) ages 65 and older undergoing orthopedic procedures in Michigan between January 2013 and September 2016. Patients were classified based on the presence of low-income subsidy and on prior opioid exposure using Medicare Part D prescription files of drug events. We investigated the association of these factors with the probability of both initial and second postoperative opioid fill within 90 days from the date of discharge.ResultsIn this cohort, 84.6% of patients filled an initial opioid prescription, and 66.4% refilled an opioid prescription. Patients with a full low-income subsidy had greater odds of refill within the postoperative 90 days compared with those patients without a low-income subsidy (odds ratio 1.38, 95% confidence interval 1.18-1.60). Among opioid naïve patients with a full low-income subsidy, the adjusted refill rate was 61.3% (95% confidence interval 58.0-64.7%) compared with 57.6% (95% confidence interval 51.4-63.7%) among those with partial low-income subsidy and 54.2% (95% confidence interval 52.8-55.6%) among patients without low-income subsidy.ConclusionAmong Medicare patients undergoing orthopedic procedures, a full medication subsidy is associated with an increased probability of opioid refill when compared with no subsidy. Going forward, it is critical to lessen financial barriers to ensure all patients have equitable access to postoperative analgesia, including both opioid and nonopioid analgesics by decreasing the patient burden of cost-sharing.
| S-EPMC8489972 | biostudies-literature
Project description:Increased integration and synergy between formal and informal learning environments is proposed to provide multiple benefits to science learners. In an effort to better bridge these two learning contexts, we developed an educational model that employs the charismatic nature of arachnids to engage the public of all ages in science learning; learning that aligns with the Next Generation Science Standards (NGSS Disciplinary Core Ideas associated with Biodiversity and Evolution). We created, implemented, and evaluated a family-focused, interactive science event-Eight-Legged Encounters (ELE)-which encompasses more than twenty modular activities. Volunteers facilitated participant involvement at each activity station and original artwork scattered throughout the event was intended to attract visitors. Initial ELE goals were to increase interest in arachnids and science more generally, among ELE participants. In this study, we tested the efficacy of ELE in terms of (i) activity-specific visitation rates and self-reported interest levels, (ii) the self-reported efficacy of our use of volunteers and original artwork on visitor engagement, and (iii) self-reported increases in interest in both spiders and science more generally. We collected survey data across five ELE events at four museum and zoo sites throughout the Midwest. We found that all activities were successful at attracting visitors and capturing their interest. Both volunteers and artwork were reported to be effective at engaging visitors, though likely in different ways. Additionally, most participants reported increased interest in learning about arachnids and science. In summary, ELE appears effective at engaging the public and piquing their interest. Future work is now required to assess learning outcomes directly, as well as the ability for participants to transfer knowledge gain across learning environments.
| S-EPMC5872292 | biostudies-literature
Project description:BackgroundSearching for web-based health-related information is frequently performed by the public and may affect public behavior regarding health decision-making. Particularly, it may result in anxiety, erroneous, and harmful self-diagnosis. Most searched health-related topics are cancer, cardiovascular diseases, and infectious diseases. A health-related web-based search may result in either formal or informal medical website, both of which may evoke feelings of fear and negativity.ObjectiveOur study aimed to assess whether there is a difference in fear and negativity levels between information appearing on formal and informal health-related websites.MethodsA web search was performed to retrieve the contents of websites containing symptoms of selected diseases, using selected common symptoms. Retrieved websites were classified into formal and informal websites. Fear and negativity of each content were evaluated using 3 transformer models. A fourth transformer model was fine-tuned using an existing emotion data set obtained from a web-based health community. For formal and informal websites, fear and negativity levels were aggregated. t tests were conducted to evaluate the differences in fear and negativity levels between formal and informal websites.ResultsIn this study, unique websites (N=1448) were collected, of which 534 were considered formal and 914 were considered informal. There were 1820 result pages from formal websites and 1494 result pages from informal websites. According to our findings, fear levels were statistically higher (t2753=3.331; P<.001) on formal websites (mean 0.388, SD 0.177) than on informal websites (mean 0.366, SD 0.168). The results also show that the level of negativity was statistically higher (t2753=2.726; P=.006) on formal websites (mean 0.657, SD 0.211) than on informal websites (mean 0.636, SD 0.201).ConclusionsPositive texts may increase the credibility of formal health websites and increase their usage by the general public and the public's compliance to the recommendations. Increasing the usage of natural language processing tools before publishing health-related information to achieve a more positive and less stressful text to be disseminated to the public is recommended.
| S-EPMC11344190 | biostudies-literature
Project description:This article examines the participation of Spanish older people in formal, non-formal and informal learning activities and presents a profile of participants in each kind of learning activity. We used data from a nationally representative sample of Spanish people between 60 and 75 years old (n = 4,703). The data were extracted from the 2007 Encuesta sobre la Participación de la Población Adulta en Actividades de Aprendizaje (EADA, Survey on Adult Population Involvement in Learning Activities). Overall, only 22.8 % of the sample participated in a learning activity. However, there was wide variation in the participation rates for the different types of activity. Informal activities were far more common than formal ones. Multivariate logistic regression indicated that education level and involvement in social and cultural activities were associated with likelihood of participating, regardless of the type of learning activity. When these variables were taken into account, age did not predict decreasing participation, at least in non-formal and informal activities. Implications for further research, future trends and policies to promote older adult education are discussed.
| S-EPMC5549119 | biostudies-other
Project description:Being able to replicate research results is the hallmark of science. Replication of research findings using computational models should, in principle, be possible. In this manuscript, we assess code sharing and model documentation practices of 7500 publications about individual-based and agent-based models. The code availability increased over the years, up to 18% in 2018. Model documentation does not include all the elements that could improve the transparency of the models, such as mathematical equations, flow charts, and pseudocode. We find that articles with equations and flow charts being cited more among other model papers, probably because the model documentation is more transparent. The practices of code sharing improve slowly over time, partly due to the emergence of more public repositories and archives, and code availability requirements by journals and sponsors. However, a significant change in norms and habits need to happen before computational modeling becomes a reproducible science.
| S-EPMC7493807 | biostudies-literature
Project description:Background :Entrustment of residents has been formalized in many competency-based graduate medical education programs, but its relationship with informal decisions to entrust residents with clinical tasks is unclear. In addition, the effects of formal entrustment on training practice are still unknown. Objective :Our objective was to learn from faculty members in training programs with extensive experience in formal entrustment how formal entrustment relates to informal entrustment decisions. Methods :A questionnaire was e-mailed to all Dutch obstetrics and gynecology program directors to gather information on how faculty entrusts residents with clinical independence. We also interviewed faculty members to explore the relationship between formal entrustment and informal entrustment. Interviews were analyzed with conventional content analysis. Results :Of 92 programs, 54 program directors completed the questionnaire (59% response rate). Results showed that formal entrustment was seen as valuable for generating formative feedback and giving insight into residents' progress in technical competencies. Interviewed faculty members (n = 12) used both formal and informal entrustment to determine the level of resident independence. Faculty reported they tended to favor informal entrustment because it can be reconsidered. In contrast, formal entrustment was reported to feel like a fixed state. Conclusions :In a graduate medical education program where formal entrustment has been used for more than a decade, faculty used a combination of formal and informal entrustment. Informal entrustment is key in deciding if a resident can work independently. Faculty members reported being unsure how to optimally use formal entrustment in practice next to their informal decisions.
| S-EPMC6194887 | biostudies-other