Charlene Rohr

Do patients always prefer quicker treatment

The London Patient Choice Project (LPCP) was established to offer NHS patients more choice over where and when they receive treatment, and to reduce waiting times. The LPCP offered those patients waiting around 6 months for elective procedures a choice of treatment at an alternative NHS or private hospital, or treatment at an overseas hospital.The aim of this article is to investigate the following questions regarding patients’ response to choice: (a) What are the factors that patients consider when deciding whether to accept the alternatives they are offered? (b) What is the relative importance to patients of each factor when making their choices, i.e. what trade-offs are patients prepared to make between time waited and other factors? (c) Are there any systematic differences between subgroups of patients (in terms of their personal, health and sociodemographic characteristics) in their response to choice?Patients’ preferences were elicited using a discrete choice experiment. Patients eligible to participate in the LPCP were recruited prior to being offered their choice between hospitals and each presented with seven hypothetical choices via a self-completed questionnaire. Data were received from 2114 patients. Thirty percent of respondents consistently chose their ‘current’ over the ‘alternative’ hospital. All the attributes and levels examined in the experiment were found to exhibit a significant influence on patients’ likelihood of opting for an alternative provider, in the expected direction. Age, education and income had an important effect on the ‘uptake’ of choice. Our results suggest several important implications for policy. First, there may be equity concerns arising from some patient subgroups being more predisposed to accept choice. Second, although reduced waiting time is important to most patients, it is not all that matters. For example, the reputation of the proffered alternatives is of key importance, suggesting careful thought is required about what information on quality and reputation can/should be made available and how it should be made available to facilitate informed choice.

Modeling of Motorcycle Ownership and Commuter Usage: A UK Study:

This paper presents work, undertaken for the UK Department for Transport, to help determine how policy could affect motorcycle usage. There are two important choices that determine potential motorcycle use: the decision to own a motorcycle and, contingent on that, the decision to use a motorcycle for a particular trip. This research has addressed both of these, and this paper describes the development of models that represent these decision processes. The motorcycle ownership model predicts the number of motorcycles that a person owns and the engine sizes of these motorcycles, depending on the characteristics of the person and the average purchase cost. The structure of the ownership model is a disaggregate nested logit model, with structural parameters used to measure the sensitivity of the choice of engine size relative to motorcycle ownership. Existing travel surveys contained insufficient information with which to model the mode choice decisions of motorcycle owners. Therefore, new surveys that incorporated stated preference discrete choice experiments were designed. This also allowed the collection of data to examine how motorcycle usage may change as a result of policy and the impacts of other important influences, such as weather. The data were used to develop nested logit models of mode choice. These models also give some insight into how the ability to interlane filter influences mode choice. This is the first study from the United Kingdom that models both motorcycle ownership and mode choice. It provides useful insights for policy makers and illustrates the potential for the modeling of motorcycles within the same framework used other transport modes.

Youth exposure to alcohol advertising on television in the UK, the Netherlands and Germany

BACKGROUND Exposure of young people to alcohol advertising is a risk factor for underage drinking. This study assessed youth exposure to television alcohol advertising in the UK, the Netherlands and Germany, from December 2010 to May 2011. METHODS A negative binomial regression model predicted number of alcohol advertisements from the proportion of the television viewership in each age group. This allowed comparison of alcohol advertisement incidence for each youth age category relative to an adult reference category. RESULTS In the UK, those aged 10-15 years were significantly more exposed to alcohol advertisements per viewing hour than adults aged ≥ 25 years [incidence rate ratio (IRR) = 1.11; 95% confidence interval (95% CI): 1.06, 1.18; P < 0.01]; in the Netherlands, those aged 13-19 years were more exposed per viewing hour than adults aged ≥ 20 years (IRR = 1.29; 95% CI: 1.19, 1.39; P < 0.01). Conversely, in Germany, those aged 10-15 years were less exposed to alcohol advertisements than adults aged ≥ 25 years (IRR = 0.79; 95% CI: 0.73, 0.85; P < 0.01). In each country, young children (aged 4-9 years in the UK and Germany, 6-12 years in the Netherlands) were less exposed than adults. CONCLUSION Adolescents in the UK and the Netherlands, but not Germany, had higher exposure to television alcohol advertising relative to adults than would be expected from their television viewing. Further work across a wider range of countries is needed to understand the relationship between national policies and youth exposure to alcohol advertising on television.

Manchester Motorway Box: Post-Survey Research of Induced Traffic Effects

In the 1990s, the usual assumption for an appraisal of road schemes in the UK was that total volumes of traffic were not affected by the capacity provided by the schemes. This assumption was questioned by the influential SACTRA committee in 1994, which also recommended that Before and After studies be undertaken to quantify the scale of traffic that would be “induced” by the provision of road capacity. An opportunity to investigate this issue arose with the completion of the M60 Manchester Motorway Box, one of the last major links in the UKs national road network, and a large program of Before and After data collection was undertaken. The paper describes the analysis that was made of the Before and After data, to which household interview records were added to form a large database linked to modeled level-of-service data and land-use data. This combined dataset has been used to estimate disaggregate models that represent frequency, mode, destination and time-of-day choice decisions within a hierarchical structure. Time-of-day choice has been represented by distinguishing four time periods that cover a day, and modeling the choice between those four time periods. The use of a hierarchical structure allows the scale of the different behavioral effects to be measured in a parametric form and also allows the construction of a detailed (market segmented) travel demand model. A further aim of the analysis was to distinguish the induced traffic effects from any other changes that may have occurred. Analysis of the level-of-service data showed that the conventional assignment procedures used were not able to reproduce the observed changes in journey times between the Before and After situations. Models including mode, destination and time-of-day choices were estimated separately, using observed journey times where available, for intercept surveys (correcting for the trip length bias in that data), for household interview data and then for combined data. The values of time and elasticities implied by the models were found to be reasonable. Application of the models took into account the relevant changes in the population in the period between the Before and After observations. The models indicated that the M60 Scheme is likely to have induced traffic at the level of a 15–17% increase across the most relevant screenline counts, of which the majority were due to destination switching and less to mode shift. Time-of-day effects were found to be negligible, although in the M60 situation, journey time changes across time periods were broadly similar.

Bus fare and journey time elasticities and diversion factors for all modes: A rapid evidence assessment

This study uses a rapid-evidence review process to identify evidence on bus fare and journey time elasticities and diversion factors for all modes (diversion factors quantify the impact of changes on one mode on the demand for other modes and for new trips). It uses a systematic search procedure to identify relevant academic and grey literature through structured database searches, as well as making enquiries to experts in the field to identify material, such as unpublished studies. The study focuses on material produced in or that is relevant to the UK. Little recent evidence on bus fare elasticities (in the UK) – and little evidence on bus journey time elasticities generally – was identified in the systematic search process. However, a substantial database of diversion-factor evidence was identified and collated. Recommendations are provided, based on analysis of the available evidence. In general, we find that the evidence on diversion factors is very diverse, covering a wide range of mainly metropolitan geographies, trip purposes, journey types and alternative transport options.

Travel in Britain in 2035: future scenarios and their implications for technology innovation

In this study, we developed future scenarios to examine the influence of technologies on travel and interviewed experts about the key policy implications. From these, we developed a strategic roadmap to inform future UK policies and investments.

Modeling Long-Distance Travel in Great Britain

Trips longer than 50 mi account for less than one-fortieth of all trips but nearly one-third of all distance traveled within Great Britain. Because of the small proportion of all travel that they form, long-distance trips may not be adequately represented in national databases and models. However, because they account for a substantial proportion of total distance traveled, particularly on motorways and rail, these trips are important for transport policy and have a substantial impact on congestion. Moreover, study of existing data indicates that travelers’ behavior in longdistance journeys differs substantially from that in routine journeys. Not only is the set of available modes different, but the profile of travelers is also substantially different, with income playing an important role in both travel frequency and mode choice. In addition, model responsiveness and values of time vary significantly with journey length. For these reasons, treatment of the specific properties of long-distance travel is essential for appraising the impact of transport policy aimed at this market, such as high-speed rail, highway construction and management policies, and policies directed toward domestic air travel. This paper describes the development of a model to address these policy issues. The specific aim of the modeling work is to provide empirical evidence on the relative importance of mode, destination, and frequency responses for long-distance travel models. The models that have been developed form the basis for a forecasting model that can be used for the appraisal of a wide range of transport policy aimed at long-distance journeys.

Measuring consumer preferences for postal services

This paper reports on the implementation of stated preference discrete choice experiments (SPDCEs) to measure business and residential consumers’ preferences for specific aspects of postal services in three European member states: Italy, Poland and Sweden.

Testing the Connection Between Social Spending and Better Health

T he United States spends much more on health care than other wealthy countries— but its people fare worse in many ways. Why the disconnect? New RAND research strengthens the link between social programs and better health. It also may give policymakers reason to rethink spending priorities.

Automobility in Brazil, Russia, India, and China: Quo Vadis?

This paper introduces an innovative methodology to answer the question, Toward which levels of automobility are the BRIC countries (Brazil, Russia, India, and China) headed? The authors applied this methodology as an aid to understanding why long-term saturation levels for car travel differed across the countries of the Organisation for Economic Co-operation and Development study and what this difference meant for the saturation levels that the BRIC countries might attain. This approach factored out development of the gross domestic product (GDP) to focus on the ways in which other factors influenced specific paths of automobility in individual countries. The focus was on this question: Why were the long-term automobility saturation levels so much higher for some countries than for others, even at similar levels of GDP? The methodology drew on quantitative analysis of historical developments in four industrialized countries (the United States, Australia, Germany, and Japan) that served as case studies representing prototypical paths of automobility with extremely different levels of per capita automobility, in combination with qualitative data derived from an expert-based approach. The qualitative approach was used to transfer historical experiences about the ways in which (a) automobility evolution was shaped in industrialized countries and (b) these experiences might affect the future of automobility in the BRIC countries. On the basis of this analysis, Brazil proved the most car-oriented country of the BRICs, with a potential long-term level of automobility between those of Germany and Australia. Russia was the second most car-oriented country, also with a likely long-term level of automobility above that of Germany. China and India, in contrast, were heading toward lower levels of automobility, below that of Germany but higher than that of Japan.