Personal attitudes in the assessment of the future of science and technology: A factor analysis approach

In 1996, the second German Delphi study (“Delphi '98”) was started. The Delphi '98 is a two-round Delphi expert survey being conducted by the Fraunhofer Institute for Systems and Innovation Research (ISI) on behalf of the German Federal Ministry of Education, Research, Science, and Technology (BMBF). The study was published in February 1998, and is now getting into its implementation phase. Its inherent focus is on the development of science and technology in 12 thematic fields in the next 30 years. To arrive at a better understanding of the influence of personal attitudes towards general developments in natural environment and society, the respondents were asked in the first round of the Delphi survey for their personal opinion towards several megatrends concerning the natural environment, economic, sociological, and political developments. Over 2,300 answers led to a very solid database, which gives insights into the general attitudes of the German R&D experts. On some topics, there is a high consensus, whereas in others, opposite opinions coexist. These results may serve as the database for a factor analysis leading to the identification of five different expert types. This paper examines the crucial question of whether different patterns in assessing the future development in science and technology by expert types can be observed. In general, it turned out that differences in personal attitudes towards megatrends do not influence the estimation of developments in science and technology. However, differences exist in specific topics and the distribution of the five experts types among the respondents differs significantly in the 12 fields.     

Eudaimonic well-being,inequality, and health: Recent findings and future directions

The theoretical and philosophical underpinnings of a eudaimonic model of well-being are examined, and its empirical translation into distinct dimensions of well-being is described. Empirical findings have documented aging declines in eudaimonic well-being, but there is considerable variability within age groups. Among older adults who remain purposefully engaged, health benefits (reduced morbidity, extended longevity) have been documented. Eudaimonic well-being also appears to offer a protective buffer against increased health risks among the educationally disadvantaged. Neural and genetic mechanisms that may underlie eudaimonic influences on health are briefly noted, and interventions designed to promote eudaimonic well-being are sketched. Needed future research directions include addressing problems of unjust societies wherein greed among privileged elites may be a force compromising the eudaimonic well-being of those less privileged. Alternatively, and more positive in focus, is the need to better understand the role of the arts, broadly defined, in promoting eudaimonic well-being across all segments of society.     

Relevance of barriers and facilitators in the use of health technology assessment in Colombia

Objectives: Several studies, mostly from developed countries, have identified barriers and facilitators with regard to the uptake of health technology assessment (HTA). This study elicited, using best-worst scaling (BWS), what HTA experts in Colombia consider to be the most important barriers and facilitators in the use of HTA, and makes a comparison to results from the Netherlands.

Methods: Two object case surveys (one for barriers, one for facilitators) were conducted among 18 experts (policymakers, health professionals, PhD students, senior HTA-researchers) from Colombia. Seven respondents were employees of the national HTA agency Instituto de Evaluación Tecnológica de Salud (IETS). In total, 22 barriers and 19 facilitators were included. In each choice task, participants were asked to choose the most and least important barrier/facilitator from a set of five. Hierarchical Bayes modeling was used to compute the mean relative importance scores (RIS) for each factor, and a subgroup analysis was conducted to assess differences between IETS and non-IETS respondents. The final ranking was further compared to the results from a similar study conducted in the Netherlands.

Results: The three most important barriers (RIS >6.00) were “Inadequate presentation format”, “Absence of policy networks”, and “Insufficient legal support”. The six most important facilitators (RIS >6.00) were “Appropriate timing”, “Clear presentation format”, “Improving longstanding relation”, “Appropriate incentives”, “Sufficient qualified human resources”, and “Availability to relevant HTA research”. The perceived relevance of the barriers and facilitators differed slightly between IETS and non-IETS employees, while the differences between the rankings in Colombia and the Netherlands were substantial.

Conclusion: The study suggests that barriers and facilitators related to technical aspects of processing HTA reports and to the contact and interaction between researchers and policymakers had the greatest importance in Colombia.     

Developments in discounting: With special reference to future health events

Research on time preferences and discounting has two main motivations: to inform decision making by providing a basis for the comparison of future costs and benefits; to explain the influence of the future on current behaviour. This paper introduces the wide range of discount functions which have been advocated in addition to the standard constant rate exponential model. The different approaches taken to estimating the parameters of the discount function are reviewed. The issues raised by discounting in the longer term are discussed. Particular attention is given to time preferences with respect to future health events which have for a number of reasons been a fruitful area for research on time preferences. Specifically the paper examines: the distinctive issues raised when discounting future health events; the methods which have been used to discount health events; the relationship between time preferences and health-affecting behaviour.     

Hard evidence and mechanism design

This paper addresses how hard evidence can be incorporated into mechanism-design analysis. Two classes of models are compared: (a) ones in which evidentiary decisions are accounted for explicitly, and (b) ones in which the players make abstract declarations of their types. Conditions are provided under which versions of these models are equivalent. The paper also addresses whether dynamic mechanisms are required for Nash implementation in settings with hard evidence. The paper shows that static mechanisms suffice in the setting of “evidentiary normality” and that, in a more general environment, one can restrict attention to a class of three-stage dynamic mechanisms.     

Patient care automation: the future is now. Part 5. The role of technology

A number of technical issues have been considered in this article; such issues need to be considered in a patient care systems procurement after the philosophic base of the system has been established.     

Hard Bargains and Lost Opportunities

A long tradition in economics assumes that any potential gains from trade will be exploited. This emphasis on efficiency clashes with the possibility that hard bargaining over the division of the surplus may cause some potential deals to be lost. We examine an Outside Option Game designed to study the tension between maximising the size of the surplus and bargaining over the division of this surplus among those who contributed to its creation. An experimental study confirms that subjects often fail to achieve efficient outcomes. A theoretical model accounts for this behaviour in terms of an equilibrium achieved in an imperfect world     

Patient selection in a mixed oligopoly market for health care: the role of the soft budget constraint

Competition in hospital care is often implemented through mixed markets where public and private hospitals compete for patients. The optimality of this market form has long been debated in the literature. In this paper, we investigate the role of soft budget constraint in affecting patient selection within a mixed market. Patient selection is the undesired effect of hospital competition when three conditions are met: asymmetry in hospitals’ objectives, presence of hospital’s private information and inability to enforce hard budget constraint. The paper shows that soft budget is a pre-condition for the existence of patient selection. Our paper adds an important dimension to the existing literature which considers asymmetry of information as the only cause for this market failure. The understanding of the mechanisms leading to patient selection makes it possible for the regulator to design measures to reduce such undesirable effect.     

Building a case for using technology: health literacy and patient education

The interplay of a mobile population can affect the quality of patient outcomes and the economics of health care delivery significantly. Helping patients with limited English proficiency understand the basics of self-care for optimal health will continue to be a challenge in the delivery of the highest quality nursing care. Becoming familiar with high-quality, peer-reviewed, and reliable health education materials and Web sites is the responsibility of every health care provider so that patients receive culturally and linguistically appropriate resources to support healthy lifestyles and choices.