Quality Choice Research Articles

The Social Determinants of Choice Quality: Evidence from Health Insurance in the Netherlands

Market provision of impure public goods such as insurance retirement savings and education is common and growing as policy makers seek to offer more choice and gain efficiencies. This approach induces an important trade-off between improved surplus from matching individuals to products and misallocation due to well documented choice errors in these markets. We study this trade-off in the health insurance market in the Netherlands, with a specific focus on misallocation and inequality. We characterize choice quality as a function of predicted health risk and leverage rich administrative data to study how it depends on individual human capital, socioeconomic status and social and information networks. We find that choice quality is low on average, with many people foregoing options that deliver substantive value. We also find a strong choice quality gradient with respect to key socioeconomic variables. Individuals with higher education levels and more analytic degrees or professions make markedly better decisions. Social influence on choices further increases inequality in decision making. Using panel variation in exposure to peers we find strong within firm, location and family impacts on choice quality. Finally, we use our estimates to model the consumer surplus effects of different counterfactual scenarios. While smart default policies could improve welfare substantially, including the choice of a high-deductible option delivers little welfare gain, especially for low-income individuals who make lower quality choices and are in worse health. Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.

Transporte inter-hospitalar do doente crítico: representação social dos enfermeiros

Enquadramento: a necessidade de cuidados diferenciados e realização de exames complementares de diagnóstico obriga a que se proceda ao transporte inter-hospitalar do doente em estado crítico. Objetivo: explorar a representação social dos enfermeiros experienciam sobre o transporte inter-hospitalar do doente crítico. Metodologia: estudo qualitativo, do tipo exploratório com uma amostra constituída por 110 enfermeiros. Recolha de dados com recuso a questionário online e análise de dados com a ferramenta IRAMUTEQ. Resultados: através da análise de similitude verificou-se que a medicação é o núcleo central da interpretação das vivências dos enfermeiros no transporte inter-hospitalar do doente crítico, ramificando-se em quatro: material, paragem cardiorrespiratória, monitorização e estabilidade. Conclusão: o transporte do doente crítico é suscetível de despoletar diversas vivências, por exigir do enfermeiro, no exercício da responsabilidade profissional, elevados níveis de conhecimento e confiança, promotores das escolhas mais adequadas à qualidade e eficiência dos cuidados prestados.

Product Market Competition’s Effect on Earnings Management When Audit Quality Is Endogenous: Theory and Evidence

Abstract A long standing question is whether product market competition disciplines a firm’s incentive to engage in earnings management. This paper argues that this question cannot be investigated adequately without accounting for the quality of firms’ auditors, because auditors affect the probability of discovering earnings management. Since firms choose their auditor, a non-compliant firm can alter its own probability of being detected. Consequently, a firm’s decision to manage earnings is a function of its auditor’s quality, which is itself endogenously chosen by the firm. To study this issue we develop a game-theoretic model that captures the potential inter-relationship between industry competition, the firms’ choice of audit quality, and compliance with accounting regulations (or the degree of earnings manipulation). We show that the link between financial compliance and product market competition is affected by the endogenously chosen audit quality. We estimate this model’s structural parameters and find that greater competition reduces both compliance and the demand for high quality audits.

Service Quality and Consumer Choice of Their Preferred Telecommunications Service Provider in Ghana

This study examines the effect of service quality on customer choice. Specifically, it investigated the relationship between service quality dimensions and customer choice, examining the effect of service quality dimensions on customer choice and the service quality dimension most preferred by customers. The quantitative research approach was used with a sample of 250 respondents using purposive and convenient sampling technique. Questionnaires were used to collect the data and analyzed using SPSS version 21. With regards to the correlation variables, it showed a strong positive relationship between service quality dimensions and customer choice of a mobile network service provider and the regression variables showed a significant effect between service quality and customer choice indicating that service quality is very important and influence customers’ choice in choosing a mobile network service provider. It was recommended that Mobile network service providers should continue to improve on the service quality dimensions (empathy, responsiveness, reliability assurance, and tangibility). Since customers look out for these dimensions when choosing a mobile network service provider.

Opticourses: promoting healthier food purchases at no additional cost in low-income households

Abstract Introduction Healthy diets are generally more expensive than unhealthy diets, explaining why socially disadvantaged individuals perceive food prices as a barrier to improve their diets. It is thus crucial to develop strategies enabling the achievement of good nutritional quality with a low budget, taking into account actual beliefs and expectations of the target population. A co-construction approach is thus recommended, involving participants at each step of the intervention to maximize its impact. Methods The “Opticourses” program was launched in 2010 with a feasibility study, followed by an intervention research in 2012-2014, in order to develop and evaluate a prevention program aiming at improving the nutritional quality of food purchases at no additional cost in a socioeconomically disadvantaged population. In order to implement activities tailored to the target population, participants were involved in the development of the protocol and the tools of the intervention and evaluation processes. Results Opticourses’s workshops (8 to 12 participants) include different activities displayed in four 2h sessions around real food purchases of participants, and games and exchanges aimed at promoting food and food choices of good nutritional quality for their price. The intervention research showed improvements in food purchasing behaviors of Opticourses participants. A transferability phase was conducted in 2015-2017. Since 2017, Opticourses is spreading in several regions of France, through training of professionals, in particular the courses organized by the Health Education Regional Committee (CRES) in the South of France. Discussion Bringing an original, concrete, co-constructed and scientifically based response to an everyday life problem is the main strength of the program. One important risk of failure for such prevention program is the underestimation of the requirements of the intervention research, in terms of time and human and budgetary resources. Key messages From a research point of view, getting access to new food purchasing data will allow a continuous refinement and innovation in the improvement of the diet for people with budgetary constraints. By focusing on food purchasing, a familiar activity that most adults feel able to handle, the Opticourses program is engaging and pragmatic, in accordance with health promotion principles.

Explaining regional dynamics of marketing strategies: The experience of the Tuscan wine producers

Abstract In a traditional wine region such as Tuscany (Italy), the wine production is perceived by several industry players as weak and fragmented because it is mainly managed by small and medium-sized wineries that have limited market power compared to large companies and distributors. In this paper, we hypothesise that this problem was influenced - in a period of strong market growth - by producers' choices that underestimated the impact of several external forces (e.g. competition, changes in demand and regulation) and promoted strategies without considering their combination with key context-specific physical, structural and socio-cultural factors. The study investigates the origin of these marketing strategies confronted with the contested fragmentation, exploring both current and future trends of the wine market in Tuscany. The objective is to provide a better understanding on how the combinations between these factors and firm's activities define regional settings in which the different strategies are developed and how these settings can be used to promote more effective and calibrated strategies towards greater economic sustainability of the sector. The focus is to understand the nature and the dynamics of interlinkages between the adoption of quality-based differentiation strategies, the diversification of marketing channels, and their regional and local determinants. We adopt a mixed quantitative and qualitative research approach composed of an analytical framework, an econometric analysis, and interviews with wine producers. First, the method provides a conceptual framework to understand the interlinkages between producers' strategies and local and regional determinants. Then, the winery decision-making process is modelled through a two-by-two differentiation strategy model that represents the wineries' decision towards the adoption of PDO/PGI appellation or organic certification in relation with the choice of distribution channels. Through the reciprocal of the Herfindahl-Hirschman Index (HHI−1) - calculated on alternative marketing strategies – we verified the extent of diversification of sale channels under the different quality choices (i.e. PDO/PGI and organic or without them). Then, the determinants of the choice of distribution channels were quantified by applying a censored regression model and the results were elaborated and discussed in the light of 32 producers' interviews. The main trend highlights the fragmentation of wine production that has been determined by the differentiation model adopted by the regional producers. The results confirm a great divide in strategies between those producing quality wines and those who do not: on the one hand being mainly involved in PDO/PGI or organic certification positively affects the choice of multiple distribution channels; on the other hand, those who are not involved in quality labels have concentrated their production in a restricted number of marketing channels. The analysis shows that different producers' strategies have been influenced by the interaction between structural factors, farm characteristics and terroir in response to external changes. It also reveals a transformation process in progress that involves the concentration of the supply chain. Producers are promoting greater consolidation and reassembling of the production through new producer networks and associations that aim to reduce the fragmentation and related weakness with new common strategies.

Doubly Enhanced Annuities (DEANs) and the Impact of Quality of Long-Term Care under a Multi-State Model of Activities of Daily Living (ADL)

The relatively small size of global voluntary immediate life annuity markets seemingly contradicts a well-known result that, under certain conditions, utility-maximizing retirees should annuitize all of their wealth upon retirement. This apparent contradiction contributes to what is called the “annuity puzzle.” The main explanations for the annuity puzzle include adverse selection, bequest motives, and retirees’ fear of health shocks that may require them to need long-term care. To explore a potential solution to this puzzle in the U.S. annuity market, we consider a cohort of retirees who are independent and identical except for a hidden immutable health parameter, , that identifies the retiree’s risk type. We assume that the “average” or “standard” retiree has θ = 1, with larger values of θ denoting less healthy individuals. Because private insurers fear that annuitants may live well beyond their life expectancy—that is, they fear adverse selection—voluntary immediate life annuities are generally priced in a manner that makes them attractive mainly to retirees who believe themselves to be healthier than average. These retirees, however, typically represent a small fraction of their cohort of retirees. To expand annuity markets, we are proposing a hybrid voluntary fixed immediate annuity product called a doubly enhanced annuity (DEAN), which we feel will be attractive to the larger retiree population; that is, retirees with . DEANs are medically underwritten to provide greater annual benefits to annuitants with shorter than average life expectancies, they provide long-term care benefits, and they satisfy a bequest motive through a death benefit. Our underlying model of retiree mortality and morbidity is based on a multi-state Markov process with states representing various levels of an insured retiree’s ability to perform activities of daily living (ADL). A major contribution of our research is to explicitly include in our multi-state Markov model a parameter, α, that reflects the level of quality of long-term care a retiree receives over her lifetime. Our main objectives are to develop a theoretical basis for pricing DEANs for the U.S. market, to determine a retiree’s expected discounted utility gained from these annuities, to determine the optimal choice of quality of care, and to explore some of the quality of life implications. A numerical example is provided.

Gene Expression Analysis in Bacteria by RT-qPCR.

Reverse-transcription quantitative real-time polymerase chain reaction (RT-qPCR) using fluorescent DNA-binding dyes is now a gold-standard methodology to study bacterial gene expression through relative quantitation of target mRNAs under specific experimental conditions, and recent developments in the technology allow for gene expression analysis in single cells. Nevertheless, several critical steps of the RT-qPCR protocol need to be carefully addressed in order to obtain reliable results, particularly regarding RNA sample quality and appropriate choice of reference genes. Besides, accurate reporting of study conditions is essential, as recommended by the MIQE guidelines. Herein, we provide a practical approach to quantitation of the transcript levels of bacterial genes using RT-qPCR, including a general protocol for obtaining good-quality bacterial RNA and a discussion on the selection and validation of candidate bacterial reference genes for data normalization.

Markets and welfare effects of food fraud

This study develops a theoretical framework of heterogeneous consumers and producers and imperfectly competitive food companies to analyse the system‐wide market and welfare effects of food fraud in the form of food adulteration and mislabelling. The results show that, while the price impacts of food fraud are product‐specific with the equilibrium prices of high‐quality and low‐quality products moving in different directions, the equilibrium quantities depend on the relative magnitude of the demand and supply effects of food fraud. Regarding the welfare effects of food fraud, they are shown to be highly asymmetric across different consumers and producers. In addition to enabling the disaggregation of the welfare effects of food fraud, the explicit consideration of agent heterogeneity, asymmetries in the probability of fraud detection and the endogeneity of the producer quality choices also enables the derivation of a key result of this study; contrary to what is traditionally believed, both low‐quality and high‐quality producers can have economic incentives to commit fraud. The group that is more likely to cheat is determined by the social attitudes towards fraudulent behaviour, the enforcement policy parameters and the relative magnitude of the demand and supply effects of food fraud. A comparison of the market effects of mislabelling and food adulteration reveals that, while the equilibrium quantity of the high‐quality product is higher in the presence of mislabelling, producers are more likely to mislabel than adulterate their products.

Prognostic and predictive markers for perineural and bone invasion of oral squamous cell carcinoma.

Oral squamous cell carcinoma (OSCC) is a growing problem worldwide. Several biological and molecular criteria have been established for making a prognosis of OSCC. One of the most important factors affecting the risk of tumor recurrence and overall prognosis is perineural invasion and bone invasion. Perineural invasion is defined as a tumor spreading and the ability of tumor cells to penetrate around or through the nerve tissue. Perineural invasion can cause the tumor to spread to distant areas from the primary tumor location. One possible explanation for this is the formation of microenvironment in the perineural space which may contain cellular factors that act on both nerve tissue and some types of tumor tissues. Bone invasion by OSCC has major implications for tumor staging, choice of treatment, outcome and quality of life. Oral SCCs invade the mandibular or maxillary bone through an erosive, infiltrative or mixed pattern that correlates with clinical behavior. Bone resorption by osteoclasts is an important step in the process of bone invasion by oral SCCs. Some cytokines (e.g. TNFα and PTHrP) lead to receptor activator of NF-κB ligand (RANKL) expression or osteoprotegerin (OPG) suppression in oral SCC cells and in cancer stromal cells to induce osteoclastogenesis. Oral SCCs provide a suitable microenvironment for osteoclastogenesis to regulate the balance of RANKL and OPG. A more molecular-based clinical staging and tailor-made therapy would benefit patients with bone invasion by OSCC.

Different from or similar to neighbors? An investigation of hotels' strategic distances

This paper examines how conformity and differentiation impacts hotel performance. It evaluates strategic outcomes of hotel entrepreneurs' choice of geographic location, capacity, and quality. Using instrumental variable (IV) estimation, we find that the distribution of similar competitors affects hotel performance and performance risk. Specifically, results show that choosing a similar capacity (conformity) to competitors may lead to higher and more stable performance. The results also reveal that locating geographically close to competitors or choosing a similar quality of product to competitors (both conformity strategies) can increase hotel performance but also increases performance risk. Additionally, when mixing conformity and differentiation strategies in terms of location, capacity, and quality selection, a higher dispersion of differentiation (i.e., highly differentiated in one product dimension while conforming to others in all remaining product dimensions) increases both performance and performance risk. Findings of this study can aid entrepreneurs in improving their strategic decisions and product positioning.

Understanding consumer’s motivations and behaviour in alternative food networks

PurposeThe purpose of this paper is to investigate the relationships in alternative food networks (AFNs) between the purchase of food, the motivations of consumers and their socio-demographic profiles.Design/methodology/approachThe study includes a total sample of 1,200 individual questionnaires, administered to the customers of 34 AFNs in different urban areas. The methodology employed is multilevel regression analysis, which is useful for dealing with data with a nested structure.FindingsThe results allowed us to depict some findings: the most important motivations in purchasing decisions are the perceived quality as well as comfort with the location of the markets, shopping experience, variety of offered products and delivery methods. Other interesting results relate to the presence of children in the families and the role of women in the choice of quality food.Practical implicationsThe observations could represent a basis for thinking about how to improve consumers’ behaviour and, at the same time, try to remove the obstacles to a greater recognition of the importance of AFNs by consumers.Originality/valueThe paper contributes to the debate on food policies. Indeed, the integration of the results into food policies could help to intercept the consumers’ trends and promote a transition of the food system towards a path of sustainability, in which the AFNs are the organisational expression of a change that concerns a wide geography and a large number of social and economic actors.

Environmental quality and monopoly pricing

This paper investigates various aspects of a monopolist's pricing and environmental quality choice, as two simultaneous decisions and with each as a separate decision, the other variable being exogenously fixed. Green quality is modeled as in Spence (1975), and the present analysis builds on his pioneering work. We contrast the private and the first-best socially optimal solutions. While the latter follows the intuitive property of assigning a higher price to higher quality, the former solution does so under a natural condition of log-supermodular demand. This condition is studied in some detail, and related to properties of an underlying utility function. We complete this characterization of optimal pricing by providing a counter-intuitive example where the two-dimensional interaction is such that the monopolist ends up charging a lower optimal price than the social planner, as well as producing a lower quality. Finally, we investigate respective sufficient conditions under which (i) the private and first-best solutions coincide, and (ii) either one is larger than the other.

Information quality choice and information disclosure in oligopoly

In this paper, we provide a framework to analyze the information disclosure and information quality choice in the oligopoly in which one firm has the opportunity to choose her information quality flexibly and then decide her information disclosure rule after she has observed her information.We find that in the Cournot (Bertrand)competition, when the goods are substitutes (complements) and the degree of substitution (complement) is small enough, the firm will choose the maximal information quality. However, if the degree of substitution (complement) is large enough, the information quality is some intermediate value. On the other hand, in the Cournot (Bertrand) competition, when the goods are complements (substitutes), the maximal information quality will be chosen. We also find that the Fully Revealing case in which the probability of information disclosure is one will occur in (i) the Cournot competition with sufficiently small degree of substitution; (ii) the Cournot competition when goods are complements; (iii) the Bertrand competition when goods are substitutes; (iv) the Bertrand competition with sufficiently small degree of complements. Moreover, we show that the No Revealing case in which the probability of information disclosure is zero will never show up.

Discovery of All Three Types in Cartilaginous Fishes Enables Phylogenetic Resolution of the Origins and Evolution of Interferons.

Interferons orchestrate host antiviral responses in jawed vertebrates. They are categorized into three classes; IFN1 and IFN3 are the primary antiviral cytokine lineages, while IFN2 responds to a broader variety of pathogens. The evolutionary relationships within and between these three classes have proven difficult to resolve. Here, we reassess interferon evolution, considering key phylogenetic pitfalls including taxon sampling, alignment quality, model adequacy, and outgroup choice. We reveal that cartilaginous fishes, and hence the jawed vertebrate ancestor, possess(ed) orthologs of all three interferon classes. We show that IFN3 groups sister to IFN1, resolve the origins of the human IFN3 lineages, and find that intronless IFN3s emerged at least three times. IFN2 genes are highly conserved, except for IFN-γ-rel, which we confirm resulted from a teleost-specific duplication. Our analyses show that IFN1 phylogeny is highly sensitive to phylogenetic error. By accounting for this, we describe a new backbone IFN1 phylogeny that implies several IFN1 genes existed in the jawed vertebrate ancestor. One of these is represented by the intronless IFN1s of tetrapods, including mammalian-like repertoires of reptile IFN1s and a subset of amphibian IFN1s, in addition to newly-identified intron-containing shark IFN1 genes. IFN-f, previously only found in teleosts, likely represents another ancestral jawed vertebrate IFN1 family member, suggesting the current classification of fish IFN1s into two groups based on the number of cysteines may need revision. The providence of the remaining fish IFN1s and the coelacanth IFN1s proved difficult to resolve, but they may also be ancestral jawed vertebrate IFN1 lineages. Finally, a large group of amphibian-specific IFN1s falls sister to all other IFN1s and was likely also present in the jawed vertebrate ancestor. Our results verify that intronless IFN1s have evolved multiple times in amphibians and indicate that no one-to-one orthology exists between mammal and reptile IFN1s. Our data also imply that diversification of the multiple IFN1s present in the jawed vertebrate ancestor has occurred through a rapid birth-death process, consistent with functional maintenance over a 450-million-year host-pathogen arms race. In summary, this study reveals a new model of interferon evolution important to our understanding of jawed vertebrate antiviral immunity.

The Interrelation between Audit Quality and Managerial Reporting Choices and Its Effects on Financial Reporting Quality

ABSTRACTTwo distinct lines of research have been dedicated to empirically testing how financial reporting quality (measured as the earnings response coefficient or ERC) is associated with management's choice of reporting bias and with audit quality. However, researchers have yet to consider how ERCs are affected by either the auditor's reaction to changes in the manager's reporting bias or the manager's reaction to changes in audit quality. Our study provides theoretical guidance on these interrelations and how changes in the manager's or the auditor's incentives affect both reporting bias and audit quality. Specifically, when the manager's cost (benefit) of reporting bias increases (decreases), we find that expected bias decreases, inducing the auditor to react by reducing audit quality. Because we also find that the association between expected audit quality and ERCs is always positive, changes in managerial incentives for biased reporting lead to a positive association between ERCs and expected reporting bias. When the cost of auditing decreases or the cost of auditor liability increases, we find that expected audit quality increases, inducing the manager to react by decreasing reporting bias. In this case, changes in the costs of audit quality lead to a negative association between ERCs and expected reporting bias. Finally, we demonstrate the impact of our theoretical findings by focusing on the empirical observations documented in the extant literature on managerial ownership and accounting expertise on the audit committee. In light of our framework, we provide new interpretations of these empirical observations and new predictions for future research.

Potential competition and quality disclosure

AbstractThis study presents a model of quality disclosure in which an incumbent, through its quality and disclosure choices, influences the potential that a new entrant enters the market. In this regard, we consider a sequential framework in which the incumbent chooses its quality and decides whether to disclose it to the market; subsequently, the entrant makes the same decisions, if it enters the market. We show that the potential competition can create strategic incentives for the incumbent to choose nondisclosure, because the availability of information about the incumbent's quality promotes entry by enhancing the entrant's expected profit from the market. In addition, an analysis of the effects of mandatory disclosure laws suggests that they can be effective in encouraging new market entrants and in improving the product quality of established firms.

Endoscope decontamination: making the guidance work in practice

Endoscope decontamination prevents cross-infection and misdiagnosis. Legislation and guidance exist to ensure this, and Joint Advisory Group (JAG) accreditation is dependent on correct adherence. Due to their cost and complex construction, endoscopes have to be decontaminated between patients. Manual cleaning is an integral part of the decontamination process and helps ensure prions, which can transmit Creutzfeldt-Jakob disease (CJD), are cleared. Guidelines and standards include Medicines and Healthcare products Regulatory Agency (MHRA) Top Ten Tips, British Society of Gastroenterology (BSG) guidance, Department of Health and Social Care (DHSC) advice and the health technical memorandum, MTH-01-06. Over recent years, guidance has been updated. Changes incorporate tracking and traceability, levels of essential practice and best practice requirements, time from bedside clean to endoscope washer disinfection processing and issues around CJD. Guidance includes following the manual decontamination process, use of endoscope washer disinfectors, choice of disinfectants, rinse-water quality, safety, endoscope storage, operational management, environmental design and training. By following the most up-to-date guidance and legislation, nurses can ensure the safety of both patients and staff.

Soil parameters, onion growth, physiology, biochemical and mineral nutrient composition in response to colored polythene film mulches

The present study evaluated the effect of different colored plastic mulching viz. olive polythene film (OPF), silver polythene film (SPF), white polythene film (WPF), black polythene film (BPF) and blue polythene film (BLPF) on soil properties, growth, physiology, biochemical and mineral nutrient composition in onion bulbs. Soil properties at 0–10 cm depth are variably affected by colored polythene film mulches. The highest values of soil moisture and pH were found when covered with a silver film, whereas black film provided the higher temperature among other types of film. The contents of nitrogen, phosphorus, potassium, and sulfur in the soils were slightly enhanced by mulching. Fresh biomass of shoot, bulb, and root was enhanced by silver colored mulching due to suitable moisture conditions, temperature and nutrients in the root zone. Plant height, number of leaves, bulb diameter and bulb length, were also remarkably increased after mulching where also the utmost values of dry biomass of shoot, bulb, and root were found. Under different colored polythene film mulches, a significant difference was found only for blue-yellow chromaticity (b*) while lightness (L*) and green-red chromaticity (a*) of onion skin did not affect significantly. With the mulching of olive colored polythene film, the skin of onion bulbs exhibited maximum b* values in compare to all mulches and control. Sugars, pyruvate and mineral nutrient concentration in onion bulbs also increased in all colored mulches whereas silver film provided the utmost value almost in all. Comparing all results, silver color polythene mulching is found to be the best choice for better onion growth, physiology, and quality.

Strategic product variety and quality choice

We examine the linkages between strategic product assortment, quality choice, and pricing by multi-product firms as well as the welfare effects from those linkages. The analysis shows that strategic effects can lead to relevant inefficiencies. Specifically, the analysis identifies effects which can induce insufficient or excessive product quality relative to the socially optimal level of quality.