Retaining the visitor,enhancing the experience: identifying attributes of choice in repeat museum visitation

• How people make choices in relation to cultural and leisure consumption has been explored from the viewpoint of motivation, lifestyle segmentation, and lifecycle. Little is known about the specific characteristics associated with choices to visit, re‐visit, or not to visit a museum. Understanding characteristics of choice, developing incentives, bundled packages, and levels of pricing is an essential element in marketing strategies for museums operating in a competitive leisure marketplace. However, determining what really matters to cultural consumers is complex and methodologies to assist in unraveling such complexities are not easily identified. This study aimed to address ways in which people respond to specific incentives as influences in choosing museum visitation. The study was conducted in two major museums in Australia to determine how useful choice modeling is in identifying features that matter to cultural consumers. The results suggest that choice modeling has much to offer in relation to understanding the benefits people are seeking from a museum experience as well as offering strategic insight into potential collaborative ventures and re‐combinations of existing museum products and services.

Copyright © 2008 John Wiley & Sons, Ltd.     

Diffusion of an Accounting Innovation: Fixed Asset Accounting in the NHS in Wales

As part of ‘New Public Management’ in the UK, changes have been made to the accounting regime. These changes typically involve the adoption of private sector accounting and budgeting approaches using accruals accounting. The process by which new ideas are spread is known as diffusion; this paper deals with the aspect of diffusion relating to the imposition of a new idea, accruals accounting, and how it is absorbed by the organisation, in this case the NHS in Wales. In particular, the paper questions whether the lack of secondary diffusion is limiting the influence of the new accounting approach. To analyse the level of diffusion we have focused on one aspect, namely, information on capital assets. The paper uses a mixture of qualitative and quantitative research methods including in-depth interviews with senior managers at two NHS Trusts and a questionnaire survey with responses from senior finance staff in all NHS Trusts in Wales. We conclude that the diffusion of accruals accounting for fixed assets has been restricted to the primary level at the top layer of management and has not penetrated below that level. There is evidence of continuing managerial indifference to the accruals accounting consequences of owning fixed assets.     

Nursing home choice,family bargaining,and optimal policy in a Hotelling economy

We develop a model of family bargaining to study the impact of the distribution of bargaining power within the family on the choice of nursing homes by families, and on the locations and prices chosen by nursing homes in a Hotelling economy. In the baseline (static) model, where the dependent parent cares only about the location of the nursing home, the markup of nursing homes is increasing in the bargaining power of the dependent parent, and nursing homes are located at the extreme periphery. We compare the laissez‐faire with the social optimum (which involves more central locations of nursing homes), and examine its decentralization in first‐best and second‐best settings. We explore the robustness of our results to introducing a bequest motive in a dynamic overlapping generations model, which allows us to study the joint dynamics of wealth accumulation and nursing home prices. If the bequest motive is strong, the markup is decreasing in the bargaining power of the dependent. However, wealth accumulation, by reducing interest rates, raises markup rates and nursing homes prices.     

A review and validation of overall survival extrapolation in health technology assessments of cancer immunotherapy by the National Institute for Health and Care Excellence: how did the initial best estimate compare to trial data subsequently made available?

Background: Validation of overall survival (OS) extrapolations of immune-checkpoint inhibitors (ICIs) during the National Institute for Health and Care Excellence (NICE) Single Technology Assessment (STA) process is limited due to data still maturing at the time of submission. Inaccurate extrapolation may lead to inappropriate decision-making. The availability of more mature trial data facilitates a retrospective analysis of the plausibility and validity of initial extrapolations. This study compares these extrapolations to subsequently available longer-term data.

Methods: A systematic search of completed NICE appraisals of ICIs from March 2000 to December 2017 was performed. A targeted search was also undertaken to procure published OS data from the pivotal clinical trials for each identified STA made available post-submission to NICE. Initial Kaplan-Meier curves and associated extrapolations from NICE documentation were extracted to compare the accuracy of OS projections versus the most mature data.

Results: The review identified 11 STAs, of which 10 provided OS data upon submission to NICE. The extrapolations undertaken considered parametric or piecewise survival models. Additional data cut-offs provided a mean of 18 months of OS beyond the end of the original data. Initial extrapolations typically under-estimated OS from the most mature data cut-off by 0.4–2.7%, depending on the choice of assessment method and use of the manufacturer- or ERG-preferred extrapolation.

Conclusion: Long-term extrapolation of OS is required for NICE STAs based on initial immature OS data. The results of this study demonstrate that the initial OS extrapolations employed by manufacturers and ERGs generally predicted OS reasonably well when compared to more mature data (when available), although on average they appeared to underestimate OS. This review and validation shows that, while the choice of OS extrapolation is uncertain, the methods adopted are generally aligned with later-published follow-up data and appear appropriate for informing HTA decisions.     

Exploring the effectiveness of cigarette warning labels: findings from the United States and United Kingdom arms of the International Tobacco Control (ITC) Four Country Survey

• This paper explores the effectiveness of cigarette warning labels across two countries, one (the UK) with new and stricter legislation where text based labels have been made more prominent and one (the USA) with less stringent regulation, where labels are less visible. Using longitudinal data from the two countries, the research seeks to investigate the impact of the different types of warning labels on the information processing by consumers. This paper assesses the effectiveness of warning labels in terms of: consumer attention, elaboration, contemplation on quitting and behavioural compliance. This study provides a comprehensive examination of these key factors in a fixed causal sequence. Structural equation modelling was used to test this model based on longitudinal panel survey data from the International Tobacco Control (ITC) Four Country Survey. Analysis of a sample of 901 US smokers and 1459 UK smokers yielded results in full support of all hypothesised relationships in the model proposed for both countries. Findings suggest that the new European Union policy of more prominent warning labels has a direct effect on influencing behavioural compliance by smokers.

Copyright © 2007 John Wiley & Sons, Ltd.     

The demand for organic foods in the South of Italy: A discrete choice model

This paper analyses organic food consumer’s demand that can help advising on implementing organic food policies at European level or, for a particular European country. In particular, it investigates the main factors explaining organic food demand in the South of Italy. Following the Lancaster consumer’s demand theory we assume that consumer’s utility depends on product characteristics instead of the product itself. Thus, consumers will choose the product (organic versus conventional) that possesses the combination of attributes that maximises its utility. Consumer’s choice for organic foods is analysed within the random utility discrete choice model and a bivariate probit model has been specified. The data were collected through a questionnaire conducted in the Italian region of Campania (Naples) in 2003. Findings indicate that economic factors are still factors limiting the growth of organic demand in Europe. Moreover, the consumers’ perceived benefits of organic food (environmental and health) are factors promoting organic food demand. In addition, greater information on organic food products is crucial to expand its demand in the South of Italy because this information will increase the consumer’s organic knowledge. Then, higher organic knowledge will increase the probability to buy organic foods and, to a larger extent, the level of consumption among existing consumers.     

Does nutrition information on food products lead to healthier food choices?

This paper examines the link between nutrition label use and consumers’ healthier food choices. Label use is considered for the two main types of labels currently found on food products; nutrition facts panels and nutrition/health claims. This link is tested using a three-equation multivariate probit model. Data were obtained from an ad hoc survey conducted in two medium-sized Spanish cities. The results indicate that the use of nutrition information by consumers, whether this involves the fact panel or the claim labels, does influence consumer choice of healthier food products to the same extent, although different types of consumers use the various types of labels considered.     

"Quicker and sicker" under Medicare's prospective payment system for hospitals: new evidence on an old issue from a national longitudinal survey

Medicare's prospective payment system for hospitals (PPS), introduced in the USA in 1983, replaced cost reimbursement with a system of fixed rates which created incentives for hospitals to control costs. Previous studies found that elderly patients were discharged from hospital "quicker and sicker" under PPS and concluded that families were coping at home. We analyse a national longitudinal survey, the first National Health and Nutrition Examination Survey and its Epidemiologic Followup Study, which includes data on more outcomes over a longer period than earlier studies. We find that the rate of admission to nursing homes from the community in the first weeks after a hospital discharge more than tripled under PPS, suggesting that families were not always able to cope. As another response to sicker patients, discharges directly to nursing homes from hospitals, which jumped initially under PPS, may have risen further when payment rates were tightened in the early 1990s. Hospital readmissions fell after the first few years. Our findings are strengthened by the fact that we control for patients' health using health information collected independently of hospital admission.