Lottery Selection Research Articles

Heterogeneity within the Oregon Health Insurance Experiment: An application of causal forests.

Existing evidence regarding the effects of Medicaid expansion, largely focused on aggregate effects, suggests health insurance impacts some health, healthcare utilization, and financial hardship outcomes. In this study we apply causal forest and instrumental forest methods to data from the Oregon Health Insurance Experiment (OHIE), to explore heterogeneity in the uptake of health insurance, and in the effects of (a) lottery selection and (b) health insurance on a range of health-related outcomes. The findings of this study suggest that the impact of winning the lottery on the health insurance uptake varies among different subgroups based on age and race. In addition, the results generally coincide with findings in the literature regarding the overall effects: lottery selection (and insurance) reduces out-of-pocket spending, increases physician visits and drug prescriptions, with little (short-term) impact on the number of emergency department visits and hospital admissions. Despite this, we detect quite weak evidence of heterogeneity in the effects of the lottery and of health insurance across the outcomes considered.

Strategies for Combatting Health Disparities in Prioritization Schema for Medically-Necessary Time-Sensitive Orthopaedic Surgeries

Abstract: A decrease in non-emergent procedure volume was observed during the COVID-19 pandemic to conserve protective equipment, increase hospital capacity, and limit nosocomial infection. Decreasing COVID-19 infection rates, paired with increasing hospital financial pressure and concerns for patient welfare, have prompted the development of guidelines for re-introduction of medically-necessary time-sensitive (MeNTS) procedures. Such protocols have received criticism for potentially perpetuating inequities disfavoring vulnerable populations. Limited access to testing supplies and protective equipment, coupled with higher incidence of medical comorbidities attributable to social determinants of health, disadvantages vulnerable populations in seemingly objective prioritization schema. Here, we detail both an analysis of current guidelines as well as strategies aimed at mitigating these disparities (including prioritizing essential infrastructure workers, implementing questionnaires, improving scheduling communication, tracking patients via ZIP codes and insurance status, facilitating post-operative rehabilitation, acknowledging physician bias, and favoring lottery selection over first-come, first-served). These guidelines and strategies can apply to future pandemics and even routine prioritization schema.

Out of the Woodwork: Enrollment Spillovers in the Oregon Health Insurance Experiment.

We analyze the impact of expanded adult Medicaid eligibility on the enrollment of already-eligible children. We analyze the 2008 Oregon Medicaid lottery, in which some low-income uninsured adults were randomly selected to be allowed to apply for Medicaid. Children in these households were eligible for Medicaid irrespective of the lottery outcome. We estimate statistically significant but transitory impacts of adult lottery selection on child Medicaid enrollment: at three months after the lottery, for every 9 adults who enrolled in Medicaid due to winning the lottery, one additional child also enrolled. Our results shed light on the existence, magnitude, and nature of so-called "woodwork effects".

Are risk preferences consistent across elicitation procedures? A field experiment in Congo basin countries

We compare individual risk preferences elicited through a classic Ordered Lottery Selection (OLS) procedure with five gambles, and an extended procedure composed of nine gambles. The research question is about the consistency of the risk preferences across these two elicitation variants. We implemented a field experiment with 1002 rural households in the Congo Basin from December 2013 to July 2014. We show that 1/3 of the sample is extremely risk averse regardless of the procedure. We found inconsistencies in risk preferences elicited across procedures. Indeed, 45.71% are characterized by inconsistency of preferences, either weak (34.53%) or strong (11.18%); 42.81% of the sample exhibits consistent preferences and the remaining 11.48% of the sample - initially risk neutral in the classic procedure - is classified as risk loving in the extended procedure. Undereducation can be seen as the main driver of the strong inconsistency since the incremental change brought about by the attainment of secondary school on the likelihood to remain consistent is ten times greater than the other considered drivers.

Can Structural Changes Fix the Supreme Court?

Proposals for structural changes to the US Supreme Court have attracted attention in recent years amid a perceived “legitimacy crisis” afflicting the institution. This article first assesses whether the court is in fact facing a legitimacy crisis and then considers whether prominent reform proposals are likely to address the institutional weaknesses that reformers aim to resolve. The article concludes that key trends purportedly contributing to the crisis at the court are more ambiguous in their empirical foundations and normative implications than reformers often suggest. It also argues that prominent reform proposals—including term limits, age limits, lottery selection of justices, and explicit partisan balance requirements for court membership—are unlikely to resolve the institutional flaws that proponents perceive. It ends by suggesting a more modest (though novel) reform, which would allocate two lifetime appointments per presidential term and allow the size of the court to fluctuate within bounds.

Out of the Woodwork: Enrollment Spillovers in the Oregon Health Insurance Experiment

We analyze the impact of expanded adult Medicaid eligibility on the Medicaid enrollment of already-eligible children. To do so, we exploit the 2008 Oregon Medicaid lottery, in which some low-income uninsured adults were randomly selected for the chance to apply for Medicaid. Children in these households were eligible for Medicaid irrespective of whether the household won the lottery. We estimate statistically significant but transitory impacts of adult lottery selection on children’s Medicaid enrollment: for every 9 adults who enroll in Medicaid due to the lottery, one additional child also enrolls at the same time. Our results shed light on the existence, magnitude, and nature of so-called “woodwork effects.

The Effect of a Charter School in Peru (Fe Y AlegrÍA) on School Achievement:Exploiting a School Lottery Selection as a Natural Experiment

This study estimates the effect of one charter school (a public-private partnership) on mathematics and reading comprehension among second grade students in Peru between 2007 and 2012. The study uses an identification strategy to estimate the causal effect of a charter school. The strategy is based on a natural experiment of an admission lottery to determine which students would be accepted into second grade at the charter school. The results show that the charter school achieved substantial gains in the scores of the lottery winners that are equivalent to 0.4 standard deviations. We also find that this effect has increased over time.

Quantum-like model of subjective expected utility

We present a very general quantum-like model of lottery selection based on representation of beliefs of an agent by pure quantum states. Subjective probabilities are mathematically realized in the framework of quantum probability (QP). Utility functions are borrowed from the classical decision theory. But in the model they are represented not only by their values. Heuristically one can say that each value ui=u(xi) is surrounded by a cloud of information related to the event (A,xi). An agent processes this information by using the rules of quantum information and QP. This process is very complex; it combines counterfactual reasoning for comparison between preferences for different outcomes of lotteries which are in general complementary. These comparisons induce interference type effects (constructive or destructive). The decision process is mathematically represented by the comparison operator and the outcome of this process is determined by the sign of the value of corresponding quadratic form on the belief state. This operational process can be decomposed into a few subprocesses. Each of them can be formally treated as a comparison of subjective expected utilities and interference factors (the latter express, in particular, risks related to lottery selection). The main aim of this paper is to analyze the mathematical structure of these processes in the most general situation: representation of lotteries by noncommuting operators.

Relative Importance Assigned to Health Care Rationing Principles at the Bedside: Evidence From a Portuguese and Bulgarian Survey.

Activity was undertaken to develop a Prioritization Scoring Index for Portugal and Bulgaria that weights the importance given to ethical rationing principles that should guide decisions at the bedside. Data from two random samples of 355 Portuguese and 298 Bulgarian members of the public were collected from an online questionnaire. Questions asked about the level of importance given to specific issues related to patient's prioritization criteria. Responses were analyzed quantitatively with the SPSS. In the process of selecting the patient to treat, Portuguese and Bulgarian respondents seem unanimous in giving greater importance to (i) the treatment outcomes, (ii) the severity of illness, (iii) children, and (iv) patients' fragility. In general, Portuguese and Bulgarian respondents allocate more than 50% of the prioritization weight to equity considerations, approximately 35% to efficiency considerations, and 5% to lottery selection. Even so, Bulgarian respondents rate highly the equity and less the efficiency consideration than Portuguese respondents. Although the pursuit of efficiency seems to be valued by respondents, their major concern seems to be with the reduction of inequalities in health.

The Effect of Fe y Alegria on School Achievement: Exploiting a School Lottery Selection as a Natural Experiment

Fe y Alegria is an organization working in many developing countries as a public-private partnership. This study estimates the effect of one Fe y Alegria school in Peru on mathematics and reading comprehension among second grade primary pupils, between 2007 and 2012. The identification strategy is based on the fact that for this school Fe y Alegria conducted a lottery to determine which students would be accepted onto first grade. We could prepare our estimates only for one school where records for several years were available. The results show that this Fe y Alegria school generated substantial score gains for lottery winners, equivalent to 0.4 standard deviations. We also found that this effect has been increasing over time. In reading comprehension the effect was 0.17 s.d. in 2007 and 1.02 s.d. in 2012. In math, the effect was 0.29 s.d. in 2007 and 1.2 in 2012. These are promising results in a country where overall student achievement in standardized tests has been low, and where discussions on under what conditions may public partnerships result in better educational outcomes.

Exploring risk attitude by a comparative experimental approach and its implication to disaster insurance practice in China

This study employs the ordered lottery selection approach with field experiment to measure risk attitude of two distinct population groups in China – farmers in Wuhan and freelancers in media and advertising in Beijing. A comparative design was used to reveal the cross-population difference in risk attitude and its affecting factors. The results showed that both groups exhibited constant partial risk aversion and decreasing absolute risk aversion, while the farmers were more risk-averse than the freelancers. The farmer and freelancer respondents demonstrated very different sensitivity to the warming-up games types involving ‘gain-only’ or ‘gain-loss’ while extremely risk-averse respondents in the warming-up games possessed the consistent attitudinal behavior in the formal tests. The comparative experiment revealed that gender and income were two statistically significant factors affecting risk attitude and they appeared to be consistent across the two distinct groups. Surprisingly, respondents’ perceived frequency of risk occurrence was not correlated to their risk attitude. Moreover, the factors of leisure and investment behavior were significantly linked to the freelancers’ risk attitude but not the farmers’. The experiment also found a non-linear relationship between risk attitude and education, and receiving college education was found to be a critical switching point that was significantly linked to respondents’ risk choices. While further research is needed to better understand the governing mechanism in risk attitude, perception, and behavior, this paper tried to link the experimental results to the natural disaster insurance practice in China and discussed their implication to the policy design.

Choosing Between Lotteries: Remarkable Coordination Without Communication

The current research examines tacit coordination behavior in a lottery selection task. Two hundred participants in each of three experiments and 100 in a fourth choose to participate in one of two lotteries, where one lottery has a larger prize than the other. Independent of variations in the complexity of the mechanism of prize allocation, the prize amounts, and whether the lottery is the participant's first or second choice, we typically find that the percentage of participants who choose the high versus low-prize lotteries does not significantly differ from the equilibrium predictions. This coordination is achieved without communication or experience. We additionally find that participants with an analytical thinking style and a risk-averse tendency are more likely to choose the low-prize lottery over the high-prize lottery. This tendency seems to be stable across choices. The pattern of our results suggests that to achieve tacit coordination, having a subset of individuals who attend to the choices of others is sufficient.

How motivation affects academic performance: a structural equation modelling analysis

Few studies in medical education have studied effect of quality of motivation on performance. Self-Determination Theory based on quality of motivation differentiates between Autonomous Motivation (AM) that originates within an individual and Controlled Motivation (CM) that originates from external sources. To determine whether Relative Autonomous Motivation (RAM, a measure of the balance between AM and CM) affects academic performance through good study strategy and higher study effort and compare this model between subgroups: males and females; students selected via two different systems namely qualitative and weighted lottery selection. Data on motivation, study strategy and effort was collected from 383 medical students of VU University Medical Center Amsterdam and their academic performance results were obtained from the student administration. Structural Equation Modelling analysis technique was used to test a hypothesized model in which high RAM would positively affect Good Study Strategy (GSS) and study effort, which in turn would positively affect academic performance in the form of grade point averages. This model fit well with the data, Chi square = 1.095, df = 3, p = 0.778, RMSEA model fit = 0.000. This model also fitted well for all tested subgroups of students. Differences were found in the strength of relationships between the variables for the different subgroups as expected. In conclusion, RAM positively correlated with academic performance through deep strategy towards study and higher study effort. This model seems valid in medical education in subgroups such as males, females, students selected by qualitative and weighted lottery selection.

Celebrity Election versus Lottery Selection: A Reconsideration

In The Just State, Richard Dien Winfield has completed his exposition of the immanent logic of ethical life, the earlier parts of which are developed in his books The Just Economy, The Just Family, and Law in Civil Society. The purpose of his exposition is not to discuss isolated or miscellaneous topics pertaining to politics or ethics. Instead, his goal from the beginning has been to show objectively what justice looks like when it is fully embodied in a state's political and social institutions. The just state, as he presents it, is simply the largest possible political framework for maintaining equitable arrangements within a country's already established civil society, a framework that permits civil society to adjust to new contingencies as they arise, be they domestic or international. The purpose of the just state is to preserve, not to tamper with, the political and nonpolitical freedoms of its citizens. The essence of these freedoms is that they are all modes of self-determination, whereby what one does is freely determined by oneself and not by the arbitrary controlling authority of others. An individual whose life is determined by family, by tradition, or by commandment, is unfree. A state whose people are imposed on by a leadership class, or by any authority other than that of the people themselves, is likewise unfree. In order to establish freedom and justice, the citizens of a sovereign state must codetermine their own institutions. In accordance with this purpose, their institutions must be constructed in a particular way, which is the subject of The Just State.

The Magic of Tacit Coordination: Can Skill Break the Spell?

The current research examines the effect of feeling skillful on tacit coordination behavior in a lottery selection task. In two experiments participants were asked to choose between one of two lotteries, where one lottery had a larger prize than the other. We manipulated the relevance of skill and examined how one’s feelings of skillfulness affect coordination. In the first experiment we selected participants based on their high reported knowledge in soccer and in the second we induced them with a feeling of high skillfulness. We found that when outcomes rely on skill, skillful decision makers tend to choose the high prize lottery excessively, are more likely to ignore their expectations about others' choices, and fail to coordinate. However, when outcomes are randomly determined, decision makers' behavior is not predicted by their skillfulness assessment and is more in line with the equilibrium behavior. We discuss implications and directions for further research.

Critical Care Contingency Planning: Phased Responses and Triaging Framework

As most of our readers will be aware from previous publications and from the special articles contained in this edition, a lot of work has gone into highlighting the implications of an influenza pandemic for critical care services and trying to work out how to make the best use of the resources that may be available. The latest Department of Health Document ‘Pandemic influenza: surge capacity and prioritisation in health services – provisional UK guidance’ (available on the DH website) has made an encouraging start in providing official recognition of the problems likely to be encountered as a result of limited bed capacity, and also supports the concept that triaging decisions cannot be left to secondary care (and particularly critical care specialists) alone. Regrettably, however, even if its recommendations for patient selection are fully followed and the number of inappropriate referrals to critical care is reduced significantly, there is still a strong probability that during the peak of a pandemic the number of patients who are likely to benefit from critical care will still significantly exceed bed capacity – even if this is maximally expanded. In the original working of the Critical Care Contingency Planning Group a draft document on Phased Responses and Triaging was produced as a starter to addressing these difficulties. Further work on this was then put on-hold pending the production of official ethical guidance and other documentation to address these problems. However, now that these have been finalised and we still face potential dilemmas about how ICUs will be able to cope, feedback from critical care network discussions has persuaded us that it may be useful to circulate a revised version of this document, updated to include more recent recommendations, in the hope that this may be of help in assisting local planning. In particular, the document addresses two concepts that were initially felt to be inappropriate or unacceptable, but which now may be considered reasonable/realistic. These are the possibility of using some method of lottery selection if there are several appropriate referrals but insufficient bed numbers, and the fact that at some point there may be a requirement to accept temporary closure of intensive care to further referrals if no beds are available. It is hoped that consensus support for the principles of this document may help to produce reassurance for staff (with the support of local PCTs and Trust Management) that if potentially preventable deaths occur in such circumstances they will not be vulnerable to litigation or professional criticism when no other treatment options were available.

Use of a self-selected scheduling method in a large academic emergency medicine group

We describe a method for scheduling shifts in a large academic emergency medicine group. The method starts with a survey of the faculty to assign shift equivalent values to each of the 13 different shifts used during the week. A weekday day shift is assigned a value of 1.0, and the shifts range in value up to 2.1 units. Each faculty member is then assigned a shift allocation for the academic year equally divided among the various shift types. Faculty members can request reallocation of shift types on the basis of the individual shift equivalent values. Once the number of the different shifts are allocated as required by the schedule, a lottery is held whereby individual faculty members choose specific shifts in turn for the upcoming year. The lottery selection is done by the faculty members accessing a common server from their office computers during a specified period. The lottery process continues until all shifts are filled. The creation of shift equivalent values facilitates the initial allocation of shifts and subsequent trades between faculty members. [Ann Emerg Med. 2003;41:653-658.]

An integrated web computing application for tasks related to course selection and registration

We have developed an integrated Internet application system including an OODB, which provides instant lottery selection of applicants for courses with capacity limitations, and which allows students to create their own weekly timetables and at the same time to complete their course registration to be verified/analyzed and confirmed instantly, reducing the time needed for course registration-related work before the beginning of each semester from several days to less than one hour. Information on courses held at each time period and taught by each instructor as well as the syllabus of each course can be viewed using multiple hypertext links, and no keyboard operations are needed for these.

Observing Violations of Transitivity by Experimental Methods

The preference reversal phenomenon is usually interpreted as evidence of nontransitivity of preference, but has also been explained as the result of the difference between individuals' responses to choice and valuation problems; the devices used by experimenters to elicit valuations; and the random lottery selection incentive system. This paper reports an experiment designed so that none of these factors could generate systematic nontransitivities; yet systematic violations of transitivity were still found. The pattern of violation was analogous with that found in previous preference reversal experiments and is consistent with regret theory. Copyright 1991 by The Econometric Society.