A broad utilitarian theory of value and moral value

Never before has the American business community been challenged to justify and support its ethical standards as today. Hearings before government agencies, attacks by public interest groups, and emphasis on consumer interests have raised serious questions concerning the moral code of industry, the social responsibility of the business community, and what lies ahead for the business firm as it behaved in the past. Somehow much of the public believes that corporate responsibility has been compromised, and that regard for profits has become a way of life that overlooks humane and societal considerations. Management must recognize that it is invested with a definite ethical and moral, as well as legal, responsibility to demonstrate the highest traits of business leadership in its stewardship role. Anything short of such a standard may be catastrophic for the future of the American enterprise system.     

Policy Discrimination with and without Interpersonal Comparisons of Utility

Can the Pareto criterion guide policymakers who do not know the true model of the economy? If policymakers specify ex ante preferences for agents, then Pareto improvements from a distorted status quo are usually possible, and with more commodities than states, one can implement almost every Pareto optimum. Unlike the standard second welfare theorem, planners cannot dictate allocations: agents must trade. Unfortunately ex ante preferences impose interpersonal comparisons. If policymakers merely aim to maximize some social welfare function then optimal policies form an open set; hence small changes in the environment do not necessitate any policy response. Planners with symmetric information about agents can sometimes intervene without making interpersonal comparisons.     

Happiness Research: State and Prospects

This paper intends to provide an evaluation of where the economic research on happiness stands and in which interesting directions it might develop. First, the current state of the research on happiness in economics is briefly discussed. We emphasize the potential of happiness research in testing competing theories of individual behavior. Second, the crucial issue of causality is taken up illustrating it for a particular case, namely whether marriage makes people happy or whether happy people get married. Third, happiness research is taken up as a new approach to measuring utility in the context of cost-benefit analysis.     

亚洲健康相关生命质量工具概况及其发展建议

目的:介绍健康相关生命质量(HR-QOL)的概念,并对在亚洲国家应用HR-QOL工具提供帮助和建议。方法:在回顾国内外相关文献的基础上,总结亚洲国家可获得的HR-QOL测量量表,并举例说明HR-QOL在亚洲应用过程中存在的问题。结果与结论:HR-QOL工具在亚洲国家的应用绝大部分属于翻译和修改现存的工具,翻译的质量、版权等问题影响着翻译后的量表效度,另外量表管理模式以及亚洲各国的文化特点等都影响着HR-QOL工具在亚洲国家的发展。     

基于顾客忠诚理论的团购营销策略研究

随着电子商务的快速发展,团购营销策略是基于顾客的忠诚而成功的。根据顾客忠诚理论,构建团购营销策略下顾客忠诚度影响因素模型。利用实证研究对团购营销策略下消费者忠诚度进行评估,结果显示:影响团购顾客忠诚的关键因素,包括服务人员的服务质量、企业形象和网站响应性等。     

基于生命周期的高技术企业风险防范研究

高技术企业与传统企业相比较,生命周期特征更为明显.企业所处的生命周期阶段不同,所面临的问题与风险也不相同,研究高技术企业不同阶段风险的特征及防范对策,具有十分重要的现实意义.     

健康教育对血液透析患者生存质量的影响

目的探讨健康教育对血液透析患者生存质量的影响。方法抽取本中心新加入规律血液透析患者共52例,随机分成两组,观察组和对照组各26例。对照组进行常规护理;观察组在对照组基础上实施健康教育护理干预,随访观察12个月后,对比两组患者的营养状况、心理情绪、社会角色、运动等生活质量相关指标的变化。结果观察组接受系统的健康教育后营养状况、心理健康、社会角色等各项相关生存质量有明显改善,差异均有统计学意义（均P〈0.05）。结论全面系统的健康教育,可明显提高规律血液透析患者的生存质量。     

Pain,health related quality of life and healthcare resource utilization in Spain

Objectives:

The aim of this paper is to consider the relationship between the experience of pain, health related quality of life (HRQoL) and healthcare resource utilization in Spain.

Methods:

The analysis contrasts the contribution of pain severity and frequency of pain reported against respondents reporting no pain in the previous month. Data are from the 2010 National Health and Wellness Survey (NHWS) for Spain. Single equation generalized linear regression models are used to evaluate the association of pain with the physical and mental component scores of the SF-12 questionnaire as well as health utilities generated from the SF-6D. In addition, the role of pain is assessed in its association with self-reported healthcare provider visits, emergency room visits and hospitalizations in the previous 6 months.

Results:

The results indicate that the experience of pain, notably severe and frequent pain, is substantial and is significantly associated with the SF-12 physical component scores, health utilities and all aspects of healthcare resource utilization, which far outweighs the role of demographic and socioeconomic variables, health risk factors (in particular body mass index) and the presence of comorbidities. In the case of severe daily pain, the marginal contribution of the SF-12 physical component score is a deficit of ?17.86 compared to those reporting no pain (population average score 46.49), while persons who are morbidly obese report a deficit of only ?6.63 compared to those who are normal weight. The corresponding association with health utilities is equally dramatic with a severe daily pain deficit of ?0.186 compared to those reporting no pain (average population utility 0.71). The impact of pain on healthcare resource utilization is marked. Severe daily pain increases traditional provider visits by 208.8%, emergency room visits by 373.0% and hospitalizations by 348.5%.

Limitations:

As an internet-based survey there is the possibility of bias towards those with internet access, although telephone sampling is used to supplement responses. Respondents are asked to describe their experience of pain; there is no independent check on the accuracy of responses. Finally, while certain acute pain categories are omitted, the study focuses on pain in the last month and not on pain chronicity.

Conclusions:

The societal burden of severe and frequent pain in Spain is substantial. Although not reported on before, at a national level, the deficit impact of the experience of pain far outweighs the contribution of more traditional explanations of HRQoL deficits as well as being the primary factor associated with increased provider visits, emergency room visits and hospitalizations.     

Effects of patient-reported non-severe hypoglycemia on healthcare resource use,work-time loss,and wellbeing in insulin-treated patients with diabetes in seven European countries

Abstract

Purpose:

Hypoglycemia is a frequent side effect induced by insulin treatment of type 1 (T1DM) and type 2 diabetes (T2DM). Limited data exist on the associated healthcare resource use and patient impact of hypoglycemia, particularly at a country-specific level. This study investigated the effects of self-reported non-severe hypoglycemic events (NSHE) on use of healthcare resources and patient wellbeing.

Methods:

Patients with T1DM or insulin-treated T2DM diabetes from seven European countries were invited to complete four weekly questionnaires. Data were collected on patient demographics, NSHE occurrence in the last 7 days, hypoglycemia-related resource use, and patient impact. NSHE were defined as events with hypoglycemia symptoms, with or without blood glucose measurement, or low blood glucose measurement without symptoms, which the patient could manage without third-party assistance.

Results:

Three thousand, nine hundred and fifty-nine respondents completed at least one wave of the survey, with 57% completing all four questionnaires; 3827 respondents were used for data analyses. Overall, 2.3% and 8.9% of NSHE in patients with T1DM and T2DM, respectively, resulted in healthcare professional contact. Across countries, there was a mean increase in blood glucose test use of 3.0 tests in the week following a NSHE. Among respondents who were employed (48%), loss of work-time after the last hypoglycemic event was reported for 9.7% of NSHE. Overall, 10.2% (daytime) and 8.0% (nocturnal) NSHE led to work-time loss, with a mean loss of 84.3 (daytime) and 169.6 (nocturnal) minutes among patients reporting work-time loss. Additionally, patients reported feeling tired, irritable, and having negative feelings following hypoglycemia.

Limitations:

Direct comparisons between studies must be interpreted with caution because of different definitions of hypoglycemia severity, duration of the studies, and methods of data collection.

Conclusions:

NSHE were associated with use of extra healthcare resources and work-time loss in all countries studied, suggesting that NSHE have considerable impact on patients/society.     

Complementarity and the Measurement of Individual Risk Tradeoffs: Accounting for Quantity and Quality of Life Effects

This paper considers the factors responsible for differences with age in estimates of the wage compensation an individual requires to accept increased occupational fatality risk. We derive a relationship between the value of a statistical life (VSL) and the degree of complementarity between consumption and labor supplied when health status serves as a potential source of variation in this relationship. Our empirical analysis finds that variations in an individual’s health status or quality of life and anticipated longevity threats lead to significant differences in the estimated wage/risk tradeoffs. We describe how extensions to the specification of hedonic wage models, including measures for quality of life and anticipated longevity threats, help to explain the diversity in past studies examining how the estimated wage–risk tradeoff changes with age.      

Economic Valuation of Health for Environmental Policy: Comparing Alternative Approaches. Introduction and Overview

Protecting human health is a primary goal of environmental policy and economic evaluation of health can help policy-makers judge the relative worth of alternative actions. Economists use two distinct approaches in normatively evaluating health. Whereas environmental economists use benefit-cost analysis supported by monetary valuation in terms of willingness-to-pay, health economists evaluate interventions based on cost-effectiveness or cost-utility analysis (CEA), using quality-adjusted life-years (QALY) or similar indexes. This paper provides background on the controversy about the relative merits of these approaches and introduces the remaining papers in the special issue. These papers (with one exception) were presented at a conference sponsored by the Department of Economics at the University of Central Florida with support from the US Environmental Protection Agency. Although CEA might not lead to substantially different implications for environmental policy than benefit-cost analysis, and QALY may provide a benefit transfer tool to fill gaps in the morbidity valuation literature, the papers in this issue raise serious concerns about the suitability of QALY-based CEA for environmental regulatory analysis. QALY does not in general appropriately represent individual preferences for health and CEA is neither independent of income distribution nor adequate to assess efficiency.     

Formal institutions and subjective well-being: Revisiting the cross-country evidence

A long tradition in economics explores the association between the quality of formal institutions and economic performance. The literature on the relationship between such institutions and happiness is, however, rather limited, and inconclusive. In this paper, we revisit the findings from recent cross-country studies on the institution–happiness association. Our findings suggest that their conclusions are qualitatively rather insensitive to the specific measure of ‘happiness’ used, while the associations between formal institutions and subjective well-being differ among poor and rich countries. Separating different types of institutional quality, we find that in low-income countries the effects of economic–judicial institutions on happiness dominate those of political institutions, while analyses restricted to middle- and high-income countries show strong support for an additional beneficial effect of political institutions. Our results bear important implications that we discuss in the concluding section of the paper.     

Natural capital and quality of life: a model for evaluating the sustainability of alternative regional development paths

Natural capital contributes to the quality of life of a region in two complementary ways: first, by directly providing environmental services that cannot be imported, and second, by supplying the natural resources that, through a human controlled production process, become valuable to humans. The evolution of the combination of these two components of the quality of life determines the path of development a region takes. Environmental services also determine the ability of natural capital to regenerate itself. Ecosystems and other components of the regional natural capital produce environmental services that provide life-support functions necessary for natural capital reproduction. The destruction of this critical natural capital impairs the internal sources of improvement of the quality of life of a region, leading to a non-sustainable path of development. This article describes a model of the relationship between natural capital and quality of life that provides a stricter definition of sustainable development through explicit characterization and classification of natural capital according to its ability to produce life-supporting environmental services, by its substitutability, and by its possible reconstruction. Application of this model then shows that there are 51 possible regional development paths, only 32 of which are sustainable and only 14 of which are sustainable while also providing improvements in quality of life. Only six of these 14 sustainable development paths are attained with economic growth, however, while the other eight paths increase quality of life by increasing the production of environmental services. The model could help in the development of institutional interventions that would promote regional development paths that are sustainable.     

Conceptualizing sustainable development: An assessment methodology connecting values, knowledge, worldviews and scenarios

Sustainability science poses severe challenges to classical disciplinary science. To bring the perspectives of diverse disciplines together in a meaningful way, we describe a novel methodology for sustainability assessment of a particular social-ecological system, or country. Starting point is that a sustainability assessment should investigate the ability to continue and develop a desirable way of living vis-à-vis later generations and life elsewhere on the planet. Evidently, people hold different values and beliefs about the way societies sustain quality of life for their members. The first step, therefore, is to analyze people's value orientations and the way in which they interpret sustainability problems i.e. their beliefs. The next step is to translate the resulting worldviews into model-based narratives, i.e. scenarios. The qualitative and quantitative outcomes are then investigated in terms of associated risks and opportunities and robustness of policy options.The Netherlands Environmental Assessment Agency (PBL) has followed this methodology, using extensive surveys among the Dutch population. In its First Sustainability Outlook (2004), the resulting archetypical worldviews became the basis for four different scenarios for policy analysis, with emphases on the domains of transport, energy and food. The goal of the agency's Sustainability Outlooks is to show that choices are inevitable in policy making for sustainable development, to indicate which positive and negative impacts one can expect of these choices (trade-offs), and to identify options that may be robust under several worldviews. The conceptualization proposed here is both clear and applicable in practical sustainability assessments for policy making.     

Effects of a holiday trip on health and quality of life: evidence from a natural experiment in South Korea

We examine whether having a holiday trip affects an individual’s well-being, namely quality of life, health status, stress level and health behaviours. We use the two-stage estimation method to control for endogeneity of a travel experience, exploiting a natural experiment of distributing Travel Vouchers at random among qualified applicants in South Korea in 2012. We find that, for applicants whose decision to travel is influenced by receiving a voucher, a travel experience has no significant effects on the traveller’s well-being measured 3–12 months later. We also find that the OLS estimates overstate benefits of a travel.     

中西医结合治疗肺尘埃沉着病合并慢性阻塞性肺疾病患者的疗效

目的探讨噻托溴铵联合黄根片治疗肺尘埃沉着病合并慢性阻塞性肺疾病患者的临床疗效。方法选取2017年12月至2019年2月郴州市疾病预防控制中心收治的肺尘埃沉着病合并慢性阻塞性肺疾病患者157例为观察组,选取同期郴州市疾病预防控制中心收治的肺尘埃沉着病合并慢性阻塞性肺疾病患者143例为对照组。两组均予以吸氧、止咳祛痰平喘、肺灌洗、预防感染、康复训练等常规对症治疗。对照组患者吸入噻托溴铵粉雾剂,观察组在对照组基础上口服黄根片。比较治疗前后两组中医临床症状积分、肺功能、生命质量评分及血清白细胞介素(IL-1)、肿瘤坏死因子-α(TNF-α)水平。结果治疗前,两组中医临床症状积分、用力肺活量(FVC)、第一秒钟用力呼气容积(FEV1)、每分钟最大通气量(MVV)、生命质量评分及血清IL-1、TNF-α水平比较,差异无统计学意义(P>0.05);治疗后,两组FVC、FEV1及MVV高于治疗前(P<0.05),且观察组高于对照组(P<0.05);治疗后,两组各中医临床症状积分,症状、活动受限、疾病影响评分及生命质量总评分,血清IL-1、TNF-α水平低于治疗前(P<0.05),且观察组低于对照组(P<0.05)。结论噻托溴铵联合黄根片治疗肺尘埃沉着病合并慢性阻塞性肺疾病患者可改善其临床症状与肺功能,提高生命质量。     

果胶铋联合三联疗法对消化性溃疡患者血清炎症介质及生命质量的影响

目的探讨果胶铋联合三联疗法对消化性溃疡患者血清炎症介质及生命质量的影响。方法选取2019年8月至2020年2月于大石桥市第三人民医院治疗的90例消化性溃疡患者作为研究对象,按随机数字表法分为对照组与观察组,每组45例。对照组患者予以呋喃唑酮片+奥美拉唑肠溶胶囊+阿莫西林治疗,观察组患者在对照组治疗基础上采用胶体果胶铋胶囊治疗。比较两组患者治疗后幽门螺杆菌(Hp)根除率,以及治疗前后血清一氧化氮(NO)、一氧化氮合酶(NOS)、炎症介质、消化病生命质量指数(GLQI)评分。结果治疗后,观察组Hp根除率为97.78%,明显高于对照组的77.78%,差异有统计学意义(P<0.05)。治疗前,两组患者血清NO、NOS、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)水平及GLQI评分差异无统计学意义(P>0.05);治疗后,两组患者血清NO、NOS、IL-6、IL-8水平及GLQI评分较治疗前有所改善,且观察组明显优于对照组,差异有统计学意义(P<0.05)。结论果胶铋联合三联疗法可通过降低胃溃疡患者血清IL-6、IL-8水平,提高NO、NOS水平,发挥改善胃黏膜微循环、提高黏膜血容量、减轻炎症反应、抑制胃酸形成、保护胃黏膜、提高患者生命质量的作用。     

Development and Psychometric validation of the Diabetes Therapy-Related QOL (DTR-QOL) Questionnaire

Abstract

Objective:

We developed and evaluated the psychometric properties of the Diabetes Therapy-Related QOL (DTR-QOL) as a disease-specific, self-administered questionnaire to assess the influence of diabetes treatment on patient QOL, regardless of treatment method.

Methods:

This new questionnaire was developed and validated in a standardized manner: Item development, pilot-testing and psychometric validation. A survey was conducted using the provisional version of the questionnaire, and reliability and validity were evaluated with psychometric testing.

Results:

The provisional version of the questionnaire was generated with 29 items through literature review and pilot testing. For psychometric assessment, analyses were performed on the responses of 284 adult Japanese patients with diabetes. Factor analysis by the principal factor method with promax rotation revealed 4 factors; “burden on social activities and daily activities” (13 items), “anxiety and dissatisfaction with treatment” (8 items), “hypoglycemia” (4 items), and “satisfaction with treatment” (4 items). For reliability, the intraclass correlation was 0.92, and Cronbach’s alpha coefficient was 0.94, indicating adequate test-retest reliability and internal consistency. For known-group validity, there were significant differences in scores for following variables: age, diabetes type, HbA1c, treatment method, glycemic control, hypoglycemia, nocturnal hypoglycemia, concern about weight gain, health status (patient assessment), and degree of communication with physician.

Conclusions:

The DTR-QOL, with good reliability and validity, can assess the influence of diabetes treatment on patient QOL. The DTR-QOL can be used regardless of treatment method that patients receive, and this characteristic enables to detect a difference on patients QOL between treatment methods before and after a switch of treatment. Limitations of this study include representativeness of the patient sample. The relatively small number of patients with type 1 diabetes should be noted. Also, responsiveness of the DTR-QOL has not yet been examined.     

Hedonic adaptation and the role of decision and experience utility in public policy

Many economists are becoming supportive of ‘soft’ paternalistic interventions that help people to avoid common decision errors without curtailing individual autonomy. To identify when such interventions could be beneficial, and to assess their success, requires a welfare criterion. However, traditional preference or choice-based criteria cannot serve this function because they assume that whatever people choose makes them better off. An alternative criterion that bases welfare on happiness rather than choice avoids this problem but has several of its own drawbacks. Most notably, people often adapt to serious chronic health conditions, and exhibit high levels of happiness, even though both those with and those without the condition agree that it is much preferable to be healthy. After reviewing different lines of research that shed light on the pros and cons of these alternative welfare criteria, we argue that no simple criterion based on either concept can surmount these problems. Instead, evaluations of welfare will inevitably have to be informed by a combination of both approaches, patched together in a fashion that depends on the specific context.     

总量均衡区间与宏观调控应确立的若干新原则

现代市场经济条件下,供给方调整其生产规模所需的成本可称为调节成本。由于存在调节成本,传统分析中的“总量均衡中心点”两侧便分别存在着“低位临界点”与“高位临界点”,这两点界定了一个特殊的“总量均衡区间”。“总量均衡区间”的出现对宏观调控将产生诸多重要影响,使之面临一系列新问题、新挑战。为有效应对这种新情况,在宏观调控实践中有必要相应地确立“近似均衡原则”、“适度超前原则”、“临界点原则”、“供给方原则”。