In Malawi the future of a child in terms of academic achievement is known before a child completes a higher secondary education. This is determined by the type of secondary school a child has been selected to. The secondary schools in Malawi are classified into three types namely the grant aided, secondary schools, the district conventional secondary schools and the community day secondary schools. When a pupil has been selected to a grant aided secondary school the general public expectation is that such a student would achieve a high academic standard, similarly when a pupil has been selected to the community day secondary school the public expectation is that such a pupil would not achieve a high academic standard. On the other hand those who are selected to attend the district conventional secondary schools will have an academic achievement which is between the other two types of secondary schools. This research was carried out to find out the impact of the ADMISSIONS POLICY OF STUDENTS INTO MALAWI SECONDARY SCHOOLS by examining the factors which contribute to disparities in academic achievements from the three types of secondary schools. The study was carried out in Dowa District in the Central Region of Malawi. Specifically it was conducted in the Central East Education Division which is comprised of five education districts namely: Dowa, Ntchisi, Nkhotakota, Salima and Kasungu. The research was conducted using a number of methods namely: survey questionnaires, convenient sampling, interviews and snowballing. Through the research it was established that the grant aided secondary schools offer excellence of education where many students excel in academics and is seconded by the district conventional secondary schools, while the community day secondary schools offer poor education which attributes to poor academic achievement. The research has explained what has been responsible for the differences in academic achievement. / Public Administration & Management / MPA

Purpose: The purpose of this study was to determine the influence of out-of-pocket prescription and healthcare costs on adherence to guideline recommended statins, angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARB), and beta-blockers (BB) used for secondary prevention of coronary heart disease and the associations of adherence with cardiovascular mortality in community-dwelling Medicare beneficiaries ≥ 65 years. Methods: Data from the 2004, 2005, and 2006 Medicare Current Beneficiary Survey (MCBS) was utilized to conduct a retrospective, cross-sectional (i.e., multiple cohort) study. Dependent variables of interest included adherence to statins, ACE/ARBs or BBs, and all-cause mortality, with out-of-pocket (OOP) costs, and adherence to these medications the primary independent variables of interest in these models. Adherence was analyzed as a binary variable with ≥ 80 percent annual adherence the threshold utilized in primary analyses. Total OOP prescription costs for all medications and total OOP healthcare costs borne by the beneficiary were reported. Complex survey design-specified logistic regression with sampling weights was the main statistical analysis used. Sensitivity analyses on adherence thresholds and subgroups were additionally conducted. Results: A significant positive relationship between total OOP prescription costs and statin adherence was identified across observation years in the primary models. Similar relationships were noted for ACE/ARBs and BB in 2004, and ACE/ARBs in 2005. No significant association between adherence and total OOP healthcare costs was indicated in the primary models. Mortality could not be used as a clinical outcome of interest due to limitations with the data. Thus, acute coronary syndrome (ACS) events were used as the clinical outcome. At the ≥ 80 percent threshold, no significant reductions in ACS events were reported. However, various sensitivity analyses did suggest significant reductions in ACS events with ACE/ARBs. Additionally, significantly higher risk of ACS was noted when BB adherence thresholds were reduced to ≥ 60 percent. Conclusions: OOP prescription costs are a significant factor influencing adherence to these medications used for secondary prevention of CAD/MI in Medicare beneficiaries. Continuing to monitor how these costs impact adherence and ultimately outcomes will be critical, particularly given policy changes such as Medicare Part-D.

In this thesis we consider some network design games that arise from common network design problems. A network design game involves multiple players who control nodes in a network, each of which has a personal interest in seeing their nodes connected in some manner. To this end, the players will submit bids to a mechanism whose task will be to select which of the players to connect, how to connect their nodes, and how much to charge each player for the connection. We rely on many fundamental results from mechanism design (from [8], [9] & [5]) in this thesis and focus our efforts on designing and analyzing cost-sharing methods. That is, for a given set of players and their connection requirements, our algorithms compute a solution that satisfies all the players’ requirements and calculates ’fair’ prices to charge each of them for the connection. Our cost-sharing methods use a primal-dual framework developed by Agrawal, Klein and Ravi in [1] and generalized by Goemans &Williamson in [3]. We modify the algorithms by using the concept of death-time introduced by K¨onemann, Leonardi & Sch¨afer in [6]. Our main result is a 2-budget balanced and cross-monotonic cost sharing method for the downwards monotone set cover game, which arises naturally from any downwards monotone 0, 1-function. We have also designed a 2-budget balanced and cross-monotonic cost sharing method for two versions of the edge cover game arising from the edge cover problem. These games are special cases of the downwards monotone set cover game. By a result by Immorlica, Mahdian & Mirrokni in [4] our result is best possible for the edge cover game. We also designed a cross-monotonic cost sharing method for a network design game we call the Even Parity Connection game arising from the T-Join problem that generalizes proper cut requirement functions. We can show our algorithm returns cost shares that recover at least half the cost of the solution. We conjecture that our cost sharing method for the even parity connection game is competitive and thus 2-budget balance.

In this thesis we consider some network design games that arise from common network design problems. A network design game involves multiple players who control nodes in a network, each of which has a personal interest in seeing their nodes connected in some manner. To this end, the players will submit bids to a mechanism whose task will be to select which of the players to connect, how to connect their nodes, and how much to charge each player for the connection. We rely on many fundamental results from mechanism design (from [8], [9] & [5]) in this thesis and focus our efforts on designing and analyzing cost-sharing methods. That is, for a given set of players and their connection requirements, our algorithms compute a solution that satisfies all the players’ requirements and calculates ’fair’ prices to charge each of them for the connection. Our cost-sharing methods use a primal-dual framework developed by Agrawal, Klein and Ravi in [1] and generalized by Goemans &Williamson in [3]. We modify the algorithms by using the concept of death-time introduced by K¨onemann, Leonardi & Sch¨afer in [6]. Our main result is a 2-budget balanced and cross-monotonic cost sharing method for the downwards monotone set cover game, which arises naturally from any downwards monotone 0, 1-function. We have also designed a 2-budget balanced and cross-monotonic cost sharing method for two versions of the edge cover game arising from the edge cover problem. These games are special cases of the downwards monotone set cover game. By a result by Immorlica, Mahdian & Mirrokni in [4] our result is best possible for the edge cover game. We also designed a cross-monotonic cost sharing method for a network design game we call the Even Parity Connection game arising from the T-Join problem that generalizes proper cut requirement functions. We can show our algorithm returns cost shares that recover at least half the cost of the solution. We conjecture that our cost sharing method for the even parity connection game is competitive and thus 2-budget balance.

In Malawi the future of a child in terms of academic achievement is known before a child completes a higher secondary education. This is determined by the type of secondary school a child has been selected to. The secondary schools in Malawi are classified into three types namely the grant aided, secondary schools, the district conventional secondary schools and the community day secondary schools. When a pupil has been selected to a grant aided secondary school the general public expectation is that such a student would achieve a high academic standard, similarly when a pupil has been selected to the community day secondary school the public expectation is that such a pupil would not achieve a high academic standard. On the other hand those who are selected to attend the district conventional secondary schools will have an academic achievement which is between the other two types of secondary schools. This research was carried out to find out the impact of the ADMISSIONS POLICY OF STUDENTS INTO MALAWI SECONDARY SCHOOLS by examining the factors which contribute to disparities in academic achievements from the three types of secondary schools. The study was carried out in Dowa District in the Central Region of Malawi. Specifically it was conducted in the Central East Education Division which is comprised of five education districts namely: Dowa, Ntchisi, Nkhotakota, Salima and Kasungu. The research was conducted using a number of methods namely: survey questionnaires, convenient sampling, interviews and snowballing. Through the research it was established that the grant aided secondary schools offer excellence of education where many students excel in academics and is seconded by the district conventional secondary schools, while the community day secondary schools offer poor education which attributes to poor academic achievement. The research has explained what has been responsible for the differences in academic achievement. / Public Administration and Management / MPA

The overarching aim of this dissertation is to use health services research methods to address three problems in behavioral health services. This dissertation seeks to address the knowledge gaps in behavioral health services through the generation of evidence intended to support evidence-based practices (EBP). Previous work has examined epidemiology of behavioral health disorders in the ED, but they have not attempted to examine disorders by the cause of injury. Chapter 2 examines the epidemiology of psychiatric disorders among adults who seek care in the emergency department (ED) by cause of injury. Data from a national hospital discharge survey was analyzed using logistic and multinomial regression. Estimates are given as average marginal effects (AME) to simplify the interpretation and application. Intentionally-caused injury and undetermined cause of injury are significantly associated with psychiatric disorders. Patients with undetermined cause of injury were more likely to be diagnosed with anxiety disorders, depressed mood, and psychoses relative to patients with unintentional injuries Since there are several treatment options for obsessive-compulsive disorder (OCD), including cognitive behavioral therapy (CBT), serotonin reuptake inhibitors (SRIs), and combinations of these, a comparison of treatment effects denominated in dollars is helpful when comparing risks and benefits. Chapter 3 builds on previous randomized control trials of treatments for OCD in children and adolescents by ranks the cost-benefits of first-line treatments. The analysis aggregates treatment effects from published trials in meta-analytic framework and a Monte Carlo simulation of 100,000 hypothetic children and adolescents to derive ranked cost-benefit. Treatments strategies starting with CBT, but not CBT and SRIs concurrently, were the most cost-beneficial. The relationship between cost-sharing and utilization of behavioral health services has been studied in the aggregate, but there has been little work examining the relationship by disorder and treatment modality. The aim of Chapter 4 is to examine the association between cost-sharing and utilization of psychotherapy and adherence to pharmacotherapy among insured adults with OCD. This chapter utilizes the Truven MarketScan Commercial Claims and Encounters dataset to perform zero-inflated negative binomial regression and logistic regression analyses. Increased cost-sharing was significantly, negatively associated with psychotherapy intensity and dose, but not associated with SRI adherence. This dissertation examined three different research questions to address gaps in the behavioral health services research. The findings of these chapters have implications for patients, clinicians, insurers, and policymakers. The results can be used to improve aspects of cost, quality, access, and efficiency of behavioral health services.

Submitted by Rodrigo Andrade (rodrigo.bomfim@fgvmail.br) on 2014-04-24T15:32:00Z No. of bitstreams: 1 diss_RodrigoAndrade.pdf: 591074 bytes, checksum: 533c9582d0fd79341698968896535e09 (MD5) / Approved for entry into archive by ÁUREA CORRÊA DA FONSECA CORRÊA DA FONSECA (aurea.fonseca@fgv.br) on 2014-04-30T19:55:08Z (GMT) No. of bitstreams: 1 diss_RodrigoAndrade.pdf: 591074 bytes, checksum: 533c9582d0fd79341698968896535e09 (MD5) / Approved for entry into archive by Marcia Bacha (marcia.bacha@fgv.br) on 2014-05-08T13:35:03Z (GMT) No. of bitstreams: 1 diss_RodrigoAndrade.pdf: 591074 bytes, checksum: 533c9582d0fd79341698968896535e09 (MD5) / Made available in DSpace on 2014-05-08T13:40:17Z (GMT). No. of bitstreams: 1 diss_RodrigoAndrade.pdf: 591074 bytes, checksum: 533c9582d0fd79341698968896535e09 (MD5) Previous issue date: 2014-03-17 / This paper studies cost-sharing rules under dynamic adverse selection. We present a typical principal-agent model with two periods, set up in Laffont and Tirole's (1986) canonical regulation environment. At first, when the contract is signed, the firm has prior uncertainty about its efficiency parameter. In the second period, the firm learns its efficiency and chooses the level of cost-reducing effort. The optimal mechanism sequentially screens the firm's types and achieves a higher level of welfare than its static counterpart. The contract is indirectly implemented by a sequence of transfers, consisting of a fixed advance payment based on the reported cost estimate, and an ex-post compensation linear in cost performance. / Este trabalho estuda regras de compartilhamento de custos sob seleção adversa dinâmica. Apresentamos um modelo típico de agente-principal com dois períodos, fundamentado no ambiente canônico de regulação de Laffont e Tirole (1986). De início, quando da assinatura do contrato, a firma possui incerteza prévia sobre seu parâmetro de eficiência. No segundo período, a firma aprende a sua eficiência e escolhe o nível de esforço para reduzir custos. O mecanismo ótimo efetua screening sequencial entre os tipos da firma e atinge um nível de bem-estar superior ao alcançado pelo mecanismo estático. O contrato é implementado indiretamente por uma sequência de transferências, que consiste em um pagamento fixo antecipado, baseado na estimativa de custos reportada pela firma, e uma compensação posterior linear no custo realizado.

Disparate healthcare experiences continue to pose a challenge; vulnerable populations such as low-income and racial and ethnic minorities may not be able to afford or utilize care when needed or receive quality care. The sources of disparities are complex and multi-factorial, which include health care system-level factors such as insurance and health care workforce. It is relatively less known to what extent these contribute to disparities related to a patient’s overall health care experience across three important domains – affordability, utilization and satisfaction with care. This dissertation has three objectives. First, to assess how insurance benefit design affects health care utilization among poorest adults. Second, examine the role of insurance in addressing racial and ethnic disparities in access to preventive care. Finally, examine the role of health care providers in differences related to satisfaction with care among low-income patients. To answer questions posed in this dissertation, two different types of datasets are used: a unique hospital administrative data from a coverage program for low-income adults and 2008-2014 Medical Expenditure Panel Survey (MEPS). To examine the role of insurance and health care providers in disparities related to different outcomes of patient experience, several models are estimated; including mixed effects linear probability and negative binomial regressions, decomposition and multivariate linear probability models. Several efforts are being made to address inequalities through coverage expansions, removal of financial barriers for preventive services and incentivizing health care providers to improve patient satisfaction. The findings suggest that differences in utilization and satisfaction with care continue to persist among low-income and racial and ethnic minorities. However, policy levers and system-level reforms including value-based insurance designs that may curb healthcare costs without shifting the cost burden to poorer adults, continued reforms to expand coverage and improve access to a usual of care, and policy interventions that extend beyond improving workforce diversity and enhance provider skills to elicit patient communication preferences may foster positive patient experiences and ameliorate existing disparities. Improving patient experiences of care will thus require policy efforts with a comprehensive multi-level strategy that targets broad sectors – including payers, health care providers and society at large.

Excerpt: Contributors detail what it means to be an academic mother and to think about academic motherhood, while also exploring both the personal and specific institutional challenges academic women face, the multifaceted strategies different academic women are implementing to manage those challenges, and investigating different theoretical possibilities for how we think about academic motherhood.

Les quatre chapitres de cette thèse analysent la manière selon laquelle les différents aspects du droit de la faillite influencent les résultats économiques d’une procédure de faillite notamment le degré de recouvrement de la dette des créanciers. Le premier chapitre montre que les lois sur les faillites présentent des conditions différentes de vote de créanciers en fonction de leur origine légale telle que : l’origine anglaise, l’origine française, l’origine allemande et celle nordique. Le second chapitre soutient que l’utilisation nationale de la procédure de réorganisation est favorisée par des processus moins stricts d’acceptation. Le troisième chapitre montre que les systèmes Est-Européens de faillite offrent une protection plus forte des créances garanties que dans le cas de créances publiques. Une concentration plus élevée de la dette diminue les taux de recouvrement en cas de la procédure de liquidation. Les estimations confirment l'existence de deux effets d'interaction entre les classes de créanciers Est-Européens: l'effet d'entraînement et l'effet de rivalité. Le dernier chapitre propose un modèle théorique qui prédit que les débiteurs ont des fortes incitations à proposer aux créanciers de plans de réorganisation avec un partage sous-Optimal de coûts quelque soit l'orientation de l'environnement juridique de la faillite y compris une orientation pro-Créancier ou une orientation pro-Débiteur. / This thesis analyzes the influence of various aspects of bankruptcy law on the economic outcomes of bankruptcy proceedings, mainly the amounts of the debt recovered by claimants. First, we show that bankruptcy laws settle different voting conditions of creditors according to their legal origin, i.e. English origin, French origin, German origin, and Nordic origin. Second, the national use of reorganization procedures seems to be favoured by less strict approval processes. Third, we find that the Hungarian, the Polish, and the Romanian bankruptcy systems provide stronger protection of the private secured claims than the public ones. A higher concentration of the claims also decreases the total recovery rates produced by the liquidation procedure. Our estimations confirm the existence of two interaction effects between the claimants, i.e. the ripple effects and the rivalry effects. Fourth, we developed a theoretical model that predicts that debtors have strong incentives to submit reorganization plans with suboptimal cost sharing regardless of the orientation of the bankruptcy environment, i.e. creditor-Friendly or debtor-Friendly.