Carol Mansfield

Compensating for Public Harms: Why Public Goods Are Preferred to Money

This paper provides evidence that public goods represent a more acceptable response to public harms than monetary compensation. We demonstrate a preference for public goods over monetary compensation, in part because receipt of public goods may limit the sense of guilt or bribery from accepting compensation for the injury. More surprising, this preference for public goods over money in the presence of a harm remains in a free-market choice where guilt is not an issue. It appears that public goods psychologically mitigate or balance public harms in a way that makes them more valuable in the presence of public harms. (JEL Q2)

The Efficiency of Political Mechanisms for Siting Nuisance Facilities: Are Opponents More Likely to Participate than Supporters?

Public opposition often hinders the siting of nuisance and noxious facilities. However, there is often support for the siting plan within the community, especially when the facility will bring economic development or a compensation package funded by the company siting the facility. Why have opponents of these facilities been so effective compared to supporters? This article presents evidence that opponents of siting proposals are much more likely to vote or engage in other collective action, while supporters are more likely to remain passive and not take action to advance their position. The results suggest that political mechanisms for determining host communities for facilities such as town meetings or referenda may not accurately represent the preferences of the community and that opportunities for siting may be missed.

Preferences for public lands management under competing uses: the case of Yellowstone National Park.

We examine snowmobile use conflict in Yellowstone National Park to assess the effect of different winter management policies on heterogeneous visitors’ welfare. Using a stated preference choice experiment we quantify welfare changes for snowmobile riders and non-riders under different snowmobile restrictions. A key determinant of welfare change is visitors’ willingness to trade-off reduced snowmobile access for improved ambient conditions in the park. Our findings support the notion that welfare losses to snowmobile riders could be offset by welfare gains to non-riders, but net benefits will depend on the number of riders and non-riders and the specifics of the policy. (JEL Q26, Q51)

Community-Based Care Coordination Practical Applications for Childhood Asthma

Care coordination programs have been used to address chronic illnesses, including childhood asthma, but primarily via practice-based models. An alternative approach employs community-based care coordinators who bridge gaps between families, health care providers, and support services. Merck Childhood Asthma Network, Inc. (MCAN) sites developed community-based care coordination approaches for childhood asthma. Using a community-based care coordination logic model, programs at each site are described along with program operational statistics. Four sites used three to four community health workers (CHWs) to provide care coordination, whereas one site used five school-based asthma nurses. This school-based site had the highest caseload (82.5 per year), but program duration was 3 months with 4 calls or visits. Other sites averaged fewer cases (35 to 61 per CHW per year), but families received more (7 to 17) calls or visits over a year. Retention was 43% to 93% at 6 months and 24% to 75% at 12 months. Pre–post cross-site data document changes in asthma management behaviors and outcomes. After program participation, 93% to 100% of caregivers had confidence in controlling their child’s asthma, 85% to 92% had taken steps to reduce triggers, 69% to 100% had obtained an asthma action plan, and 46% to 100% of those with moderate to severe asthma reported appropriate use of controller medication. Emergency department visits for asthma decreased by 36% to 63%, and asthma-related hospitalizations declined by 26% to 78%. More than three fourths had fewer school absences. In conclusion, MCAN community-based care coordination programs improved management behaviors and decreased morbidity across all sites.

Stated Preference for Cancer Screening: A Systematic Review of the Literature, 1990–2013

Introduction Stated-preference methods provide a systematic approach to quantitatively assess the relative preferences for features of cancer screening tests. We reviewed stated-preference studies for breast, cervical, and colorectal cancer screening to identify the types of attributes included, the use of questions to assess uptake, and whether gaps exist in these areas. The goal of our review is to inform research on the design and promotion of public health programs to increase cancer screening. Methods Using the PubMed and EconLit databases, we identified studies published in English from January 1990 through July 2013 that measured preferences for breast, cervical, and colorectal cancer screening test attributes using conjoint analysis or a discrete-choice experiment. We extracted data on study characteristics and results. We categorized studies by whether attributes evaluated included screening test, health care delivery characteristics, or both. Results Twenty-two studies met the search criteria. Colorectal cancer was the most commonly studied cancer of the 3. Fifteen studies examined only screening test attributes (efficacy, process, test characteristics, and cost). Two studies included only health care delivery attributes (information provided, staff characteristics, waiting time, and distance to facility). Five studies examined both screening test and health care delivery attributes. Overall, cancer screening test attributes had a significant effect on a patient’s selection of a cancer screening test, and health care delivery attributes had mixed effects on choice. Conclusion A growing number of studies examine preferences for cancer screening tests. These studies consistently find that screening test attributes, such as efficacy, process, and cost, are significant determinants of choice. Fewer studies have examined the effect of health care delivery attributes on choice, and the results from these studies are mixed. There is a need for additional studies on the barriers to cancer screening uptake, including health care delivery attributes, and the effect of education materials on preferences.

Outcomes From a Cross-Site Evaluation of a Comprehensive Pediatric Asthma Initiative Incorporating Translation of Evidence-Based Interventions

This article reports on an evaluation of the Merck Childhood Asthma Network, Inc. (MCAN) initiative using pooled cross-site data on patient-reported outcomes pre- and postintervention to quantify the changes experienced by children in five program sites supported by the network. The results show a consistent pattern of improvement across all measured outcomes, including symptoms, hospital and emergency department use, school absences, and caregiver confidence. Children who started with uncontrolled asthma experienced larger improvements than children with controlled asthma at baseline. However, even considering the significant gains made by children with uncontrolled asthma at baseline, after 12 months, most of the outcomes for these children were significantly worse than the 12-month outcomes for children with controlled asthma at baseline. The evaluation of the MCAN initiative offers a model that can be used in cases where resources must be balanced between evaluation and delivering services to children. The design process and results from the common survey instrument provide information for future initiatives seeking to translate evidence-based interventions in a community-based setting.

Unpackaging demand for water service quality: evidence from conjoint surveys in Sri Lanka

In the early 2000s, the Government of Sri Lanka considered engaging private sector operators to manage water and sewerage services in two separate service areas: one in the town of Negombo (north of Colombo), and one stretching along the coastal strip (south from Colombo) from the towns of Kalutara to Galle. Since then, the government has abandoned the idea of setting up a public-private partnership in these two areas. This paper is part of a series of investigations to determine how these pilot private sector transactions (forming part of the overall water sector reform strategy) could be designed in such a manner that they would benefit the poor. The authors describe the results of a conjoint survey evaluating the factors that drive customer demand for alternative water supply and sanitation services in Sri Lanka. They show how conjoint surveys can be used to unpackage household demand for attributes of urban services and improve the design of infrastructure policies. They present conjoint surveys as a tool for field experiments and a source of valuable empirical data. In the study of three coastal towns in southwestern Sri Lanka the conjoint survey allows the authors to compare household preferences for four water supply attributes-price, quantity, safety, and reliability. They examine subpopulations of different income levels to determine if demand is heterogeneous. The case study suggests that households care about service quality (not just price). In general, the authors find that households have diverse preferences in terms of quantity, safety, and service options, but not with regard to hours of supply. In particular, they find that the poor have lower ability to trade off income for services, a finding that has significant equity implications in terms of allocating scarce public services and achieving universal water access.

Cross-Site Evaluation of a Comprehensive Pediatric Asthma Project The Merck Childhood Asthma Network, Inc. (MCAN)

The Merck Childhood Asthma Network, Inc. (MCAN) initiative selected five sites that had high asthma burden and established asthma programs but were ready for greater program integration across schools, health care systems, and communities. MCAN supported a community-based approach that was tailored to the needs of each program site. As a result, each site was unique in its combination of interventions, but all sites served common goals of integration of care, incorporation of evidence-based programs, and improvement in knowledge, self-management, health, and quality of life. This case study of the MCAN cross-site evaluation discusses the challenges associated with evaluating interventions involving multiple stakeholders that have been adjusted to fit the unique needs of specific communities. The evaluation triangulates data from site-specific monitoring and evaluation data; site documents, site visits, and cross-site meetings; qualitative assessments of families, organizational partners, and other stakeholders; and quantitative data from a common instrument on health indicators before and after the intervention. The evaluation employs the RE-AIM framework—reach, effectiveness, adoption, implementation, and maintenance—to assess the barriers and facilitators of translation from theory into practice. Our experience suggests trade-offs between rigor of evaluation and burden of assessment that have applicability for other community-based translational efforts.

Translating Evidence-Based Interventions Into Practice: The Design and Development of the Merck Childhood Asthma Network, Inc. (MCAN)

Pediatric asthma is a multifactorial disease, requiring complex, interrelated interventions addressing children, families, schools, and communities. The Merck Childhood Asthma Network, Inc. (MCAN) is a nonprofit organization that provides support to translate evidence-based interventions from research to practice. MCAN developed the rationale and vision for the program through a phased approach, including an extensive literature review, stakeholder engagement, and evaluation of funding gaps. The analysis pointed to the need to identify pediatric asthma interventions implemented in urban U.S. settings that have demonstrated efficacy and materials for replication and to translate the interventions into wider practice. In addition to this overall MCAN objective, specific goals included service and system integration through linkages among health care providers, schools, community-based organizations, patients, parents, and other caregivers. MCAN selected sites based on demonstrated ability to implement effective interventions and to address multiple contexts of pediatric asthma prevention and management. Selected MCAN program sites were mature institutions or organizations with significant infrastructure, existing funding, and the ability to provide services without requiring a lengthy planning period. Program sites were located in communities with high asthma morbidity and intended to integrate new elements into existing programs to create comprehensive care approaches.

Survey-Design and Analytical Strategies for Better Healthcare Stated-Choice Studies

Stated-choice (SC) surveys, such as conjoint analysis, present some interesting problems for researchers that are not addressed in the traditional survey-development literature. While the constraints imposed by preference theory, the experimental design of the choice sets, and the statistical methods used to analyze choice data all pose challenges for researchers new to SC methods, they also direct such researchers towards techniques that are not possible with more traditional survey methods. In this article, we focus on issues of preference heterogeneity (variation in preferences across subjects by observable and non-observable co-variates) and attribute dominance to illustrate the synergistic roles that survey-design and analytical strategies play in SC research. In this article, we show how advanced analytical techniques are likely to be more important than survey design solutions when addressing preference heterogeneity. Good practice supports the use of mixed-logit and similar modeling approaches to mitigate the problem of unobserved preference or variance heterogeneity. However, if the sample size is not large enough or the survey instrument does not contain questions about important subject characteristics, then the source of heterogeneity cannot be identified and the problems caused by heterogeneity will be magnified.In contrast, minimizing attribute dominance and testing for attribute dominance relies on careful survey design, rather than more complex analysis. In general, survey design needs careful attention from researchers. No amount of complex analysis can compensate for a poor survey design that can generate only flawed SC data.