Chia-Ching Chen

Barriers to health care among the elderly in Japan.

Japan is undergoing a set of health care reforms aimed at cutting rising health care costs and increasing the efficiency of health care delivery. This empirical study used a large-scale community survey on 15,302 elderly people 65 years and older (56.0% women) conducted in seven municipalities in 2006, to reveal clear-cut evidence of barriers to necessary care. The reasons for not getting health care is attributed to health care cost for the elderly with lower income, while higher income counterparts reported being busy or having a condition not serious enough to seek care.

Too Smart to Be Selfish? Measures of Cognitive Ability, Social Preferences, and Consistency

Although there is an increasing interest in examining the relationship between cognitive ability and economic behavior, less is known about the relationship between cognitive ability and social preferences. We investigate the relationship between consequential measures of cognitive ability and measures of social preferences. We have data on a series of small-stakes dictator-type decisions, known as Social Value Orientation (SVO), in addition to choices in a larger-stakes dictator game. We also have access to the grade point averages (GPA) and SAT (formerly referred to as the Scholastic Aptitude Test) outcomes of our subjects. We find that subjects who perform better on the Math portion of the SAT are more generous in both the dictator game and the SVO measure. By contrast we find that subjects with a higher GPA are more selfish in the dictator game and more generous according to the SVO. We also find some evidence that the subjects with higher GPA and higher SAT outcomes offer more consistent responses. Our results involving GPA and social preferences complement previous work which employ measures of cognitive ability which are sensitive to the intrinsic motivation of the subject. Our results involving SAT scores are without precedent in the literature and suggest that measures of cognitive ability, which are less sensitive to the intrinsic motivation of the subject, are positively related to generosity.

Improving the Replication Success of Evidence-Based Interventions: Why a Preimplementation Phase Matters

PURPOSE Careful scrutiny of the literature reveals that the preimplementation phase is often overlooked by researchers interested in understanding the portability of evidence-based interventions to other settings. In this paper we document the importance of preimplementation and the planning year in enabling adopters to identify and resolve potential implementation barriers. METHODS Rogers diffusion of innovation theory and tenets of technology transfer models are the heuristic frameworks used to guide the analysis of the preimplementation phase of an abstinence replication study. RESULTS The planning year allowed for the securing and consolidation of stakeholder support; preparing the organization for implementation; redressing issues with the intervention packet; responding to the cultural norms of the adopting community; fine tuning the training approach and addressing emergent challenges. CONCLUSIONS Preimplementation provides adopters with opportunities to test the intervention before full implementation; and to identify and address potential threats to successful adoption.

Access Disparity and Health Inequality of the Elderly: Unmet Needs and Delayed Healthcare

The purpose of this study is to investigate healthcare access disparity that will cause delayed and unmet healthcare needs for the elderly, and to examine health inequality and healthcare cost burden for the elderly. To produce clear policy applications, this study adapts a modified PRECEDE-PROCEED model for framing theoretical and experimental approaches. Data were collected from a large collection of the Community Tracking Study Household Survey 2003–2004 of the USA. Reliability and construct validity are examined for internal consistency and estimation of disparity and inequality are analyzed by using probit/ols regressions. The results show that predisposing factors (e.g., attitude, beliefs, and perception by socio-demographic differences) are negatively associated with delayed healthcare. A 10% increase in enabling factors (e.g., availability of health insurance coverage, and usual sources of healthcare providers) are significantly associated with a 1% increase in healthcare financing factors. In addition, information through a socio-economic network and support system has a 5% impact on an access disparity. Income, health status, and health inequality are exogenously determined. Designing and implementing easy healthcare accessibility (healthcare system) and healthcare financing methods, and developing a socio-economic support network (including public health information) are essential in reducing delayed healthcare and health inequality.

Non-Communicable Diseases in Developing Countries: Causes and HealthPolicy/Program Assessments

Objectives: This study focuses on non-communicable diseases (NCDs) and evaluates the effectiveness and efficiency of government public health policies on cardiovascular diseases and diabetes deaths per 100,000 population with age-standardized estimate of adults aged 25 and above of 30 South Asian and 46 African countries. Findings suggest that government policy implementation with focus on the reduction of deaths from NCDs is more efficient than general public health policy. Methods: The study employed theoretically well founded PRECEDE-PROCEED model to assess effectiveness of public health programs. Three causal factors of NCDs and three policy issues constituted the core of this model. The causal factors included: body mass index (BMI) 30 & over; systolic blood pressure; and total cholesterol. The policy issues included: health-related economics; health-related infrastructure; enabling, reinforcing and predisposing factors. Multiple regressions with robust method were used to assess effectiveness and concentration index for efficiency. The data for this study was taken from World Heath Statistics: 2008-2010. Results: One percentage increase in BMI 30&more raises 3.829 deaths from NCDs per 100,000 populations by country and the increase in NCDs depend on the size of population. One dollar per capita per year increase in government healthcare expenditures reduces NCDs by about 791 persons per 100,000 per year. An increase of 10% in government healthcare expenditures leads to 0.54% reduction in deaths from NCDs. The cost of this reduction in deaths from NCDs is

An Evaluation of Healthcare Information on the Internet: The Case of Colorectal Cancer Prevention

12.15 per capita per year. Implementation of key activities related to NCDs management reduces deaths from NCDs by 0.073 persons per 100,000 populations. An increase of 10% in NCD management expenditures leads to a 0.21% reduction in deaths or a decrease of 8.921 million deaths from NCDs. It costs

Pharmaceutical Price Control Policy, Pharmaceutical Innovation, and Health Durability

25.72 per person per year. The estimated effect of cardiovascular diseases and diabetes management plan is 113.828 less NCD deaths per 100,000 populations than in countries without a plan to fight against NCDs. For efficiency, the concentration indices reveal that the NCDs management is more cost efficient than the government general healthcare expenditures. Conclusions: In general, government policies and programs are found effective against NCDs. However, policies and programs focused on the reduction of NCDs are more efficient than general public health initiatives. A wellconstructed tax system for financing policy/program to deal with NCDs and related deaths is required.

Evaluation of the Waste Tire Resources Recovery Program and Environmental Health Policy in Taiwan

Health information, provided through the Internet, has recently received attention from consumers and healthcare providers as an efficient method of motivating people to get screened for colorectal cancer (CRC). In this study, the primary purpose was to investigate the extent to which consumers were better educated about CRC screening information because of the information available on the Internet. Another purpose was to identify how better-informed consumers, with reliable and trustworthy health information, were enabled to make sound decisions regarding CRC screening. The data used in this study was taken from the 2003 Health Information National Trends Survey. People aged 55 and older were classified based on their compliance with recommended CRC screening. The study applied the PRECEDE-PROCEED model to evaluate the effects of health information taken from the Internet regarding CRC screening. The credibility and reliance of cancer related information on the Internet was significantly associated with patient compliance to be screened for CRC. Experience and knowledge of Internet use had a significant impact on the utilization of CRC screening. This analysis suggests that the design and publishing websites concerning CRC should emphasize credibility and reliance. Websites providing information about CRC must also contain the most current information so that people are able to make educated decisions about CRC screening.

Healthcare services accessibility of children in the USA

Background: The increase in R&D and upward trend of R&D/pharmaceutical sales has occurred despite government controlled pharmaceutical price reduction in Japan. This paper identifies the effect of the governments price control policy on pharmaceutical innovation and evaluates the influence of new chemical entities (NCE) on health durability. Method: The study employed pharmaceutical price, government approval, and new pricing adaptation policies to evaluate their influences on NCE. Quantitative and qualitative expressions of pharmaceutical innovation were analyzed to measure health durability. Results: The results show that the government pharmaceutical price and new pricing adaptation policies may have been effective in increasing NCE in the pharmaceutical industry. In addition, our findings show that the optimum R&D adjustment rate for NCE (32%) would cause a downward influence of 0.4494 billion yen of NCE in the long run, while a full adjustment (i.e. 100%) of R&D would bring an increase of 0.709 billion yen in the long run. Finally, the aggregate effects of NCE reduce illness-caused death. The six leading illnesses share a 65.95% decrease in death caused by illness of those aged 65 years or older. Conclusion: Pharmaceutical price control is not intended to hamper the pharmaceutical industry. It is a price reduction of the governments approved-list of pharmaceutical drugs under the national healthcare system geared toward controlling rapid and excessive growth of pharmaceutical expenditures.

Determinants of health insurance and hospitalization

This paper examines the effectiveness of Taiwanese environmental health policies, whose aim is to improve environmental quality by reducing tire waste via the Tire Resource Recovery Program. The results confirm that implemented environmental health policies improve the overall health of the population (i.e. a decrease in death caused by bronchitis and other respiratory diseases). Current policy expenditures are far below the optimal level, as it is estimated that a ten percent increase in the subsidy would decrease the number of deaths caused by bronchitis and other respiratory diseases by 0.58% per county/city per year on average.