weblinks-3-10-2012

The current clinical trial process in the United States is on shaky ground. In this era of personalized medicine, as diseases are increasingly defined by specific genetic and biologic markers and treatments are tailored accordingly, patient populations for new therapies grow smaller and smaller. Coupled with skyrocketing costs and expanding regulatory requirements, the completion of trials that are essential in bringing new and effective therapies to patients is no easy task.
On March 3 in the New England Journal of Medicine, a group of researchers from around the world propose a new model to revitalize the research engine in this country -- collaborative clinical trials. They believe collaborative trials -- in which different companies team up and share the costs to test new therapies or devices -- will ensure safe and effective treatments become available more quickly and at a lower cost than they do today.
步入"集体临床试验"时代---http://www.sciencedaily.com/releases/2011/03/110302171307.htm

Pharmacies sell your prescription records to data mining companies, who aggregate the information and sell it to drug companies for billions of dollars per year.  Drug companies use it to sell drugs.  Lots of drugs. Vermont physicians were appalled, and the state passed a law in 2007 extending privacy protections to prescription records that identified the physician.
佛蒙特州数据挖掘案 (Sorrell v. IMS Health)--http://feedproxy.google.com/~r/TheIncidentalEconomist/~3/HXhGtCvXEPM/

两个歧视

歧视---这里要谈两个截然不同的歧视问题：一是歧视的理论；二是价格歧视。

 

一、歧视的理论

歧视可分为品味歧视(或叫偏好歧视、歧视偏好都行taste discrimination)和统计歧视(statistical discrimination)。

品味歧视的研究方法将歧视当作一种偏好加以处理；1957年Becker就在他的论文中提出来，在1971年出版< The Economics of Discrimination>一书，他指出当一个人为了维持歧视的偏好时，将会导致可供交易的对象范围受到限缩，因此他会付出一定程度的代价。这歧视的品味或偏好不限于雇主对劳动者的选择，也适用于劳动者选择是否就业及何种职业上。在劳动市场上雇主拒绝雇用边际产值大于边际成本的劳动者，称为雇主歧视，雇主将为其非理性的选择负担额外的成本。雇用成本将由w，升高为w(1+d)，其中w代表净工资率，d表歧视系数。相对的，劳动者在劳动边际机会成本小于边际报酬之下仍拒绝进入劳动市场，其中必有非理性之因素。例如，为料理家务而退出劳动市场的妇女（蓝科正 1996）。

统计性歧视则基于交易成本的理论说明歧视的成因(Statistical Discrimination is an economic theory of racial or gender inequality based on stereotypes. According to this theory, inequality may exist and persist between demographic groups even when economic agents (consumers, workers, employers, etc...) are rational and non prejudiced. This type of preferential treatment is labeled "statistical" because stereotypes may be based on the discriminated group's average behavior. The theory is based on lack of information. Another way statistical discrimination might be applied is due to differing amount of knowledge about different groups.)。由Phelps在1972年提出（主要论文还有Arrow 1973），他认为歧视是信息不充分下的一种有效率措施。当雇主在录用员工之前，无法知道个别应征者的将来工作表现会如何，因此他对于应征者的工作品质处于一种信息不足的状态。虽然雇主为了确定应征者的工作品质可以一一进行调查与研究，但这么做可能导致成本过高而不可行。因此会雇主会以其对团体差异的认知与固有印象（stereotype）来做雇用决策。根据预期确认程序（expectancy confirmation sequence）的观点，则不难发现看似有效率的雇用程序，即使只是雇主的自证式预言。根据这观点，雇主期盼妇女会有某些特定行为（例如较细心适合文书工作、离职率较高等），因此指派例行性工作或提供不定的工作环境；反过来妇女也以相同的预期回应，更加深对固有印象的定位。再者，人们会倾向保留既有的固有印象而忽视其他相异的信息。因此在考虑雇用与否时，雇主极可能忽略与两性特征预期不符的信息，进而产生统计歧视（林钦明 1995）。即统计性歧视是将一个群体的典型特征看作该群体中每一个个体所具有的特征，并利用这个群体的典型特征作为雇佣标准而产生的歧视。

总之，歧视的出现并非全然来自于不理性的偏好，当人在信息不充分的情形下无法了解交易对象的属性时，统计性歧视便成为一种有效率的选择方法。（例如：目前在就业市场上，不论是公私部门，往往以学历作为工作资格的限制，或作为决定薪资高低的标准。这种就业市场上的"文凭主义(英文叫sheepskin effect羊皮效应)"作法也是统计性歧视的一种型态。）学历只能表示一个人通过学校方面的考试，但是并不能充分代表一个人的工作能力，这种措施之所以不被认为违法，主要原因应是在于学历与工作绩效之间具有某种程度的统计关联性，因此以学历筛选员工是一种有效率的措施。

统计性歧视的危害：统计性歧视能够强化人们的成见，并能减弱某一群体中成员提高技能和积累经验的激励，所以它会导致经济的无效率。（例如：传统上妇女被排除在工程师等数学能力要求较高的职业之外，结果妇女在报考学校核择业时容易倾向于人文社会科学，这个个结果反过来又会强化人们认为妇女对工程不感兴趣的成见。）统计性歧视不仅能将个人的群体特征类型化，而且还能减弱个人对教育和培训进行投资的激励，从而反过来又强化关于原有群体特征的成见。如果不利群体额总体统计性特征中，个体差异越大，那么利用群体特征来推断作为甄选标准的代价就越高。但是对于企业来说，这仍是不完全信息下的高效率的做法，与雇主利润最大化目标是一致的。但也有学者指出，随着相关人口群体内部的不可衡量的差别的越来越大，性别或其它区域群体信息被使用的可能性就会越来越小，统计性歧视也就会随之而逐步消失。

 

歧视理论的新发展是2004年那个苹果橘子经济学的Levitt uses contestant voting behavior on the US version of the television show Weakest Link to distinguish between taste-based and information-based theories of discrimination. Levitt found no discrimination against females or blacks, while finding taste-based discrimination against the old and information-based discrimination against Hispanics.

 

另有相关名词：Institutionalized discrimination

 

二、价格歧视(参加Samuelson的经济学可以)

价格歧视（price discrimination）实质上是一种价格差异，通常指商品或服务的提供者在向不同的接受者提供相同等级、相同质量的商品或服务时，在接受者之间实行不同的销售价格或收费标准。经营者没有正当理由，就同一种商品或者服务，对条件相同的若干买主实行不同的售价，则构成价格歧视行为。

价格歧视是一种重要的垄断定价行为，是垄断企业通过差别价格来获取超额利润的一种定价策略。它不仅有利于垄断企业获取更多垄断利润，而且使条件相同的若干买主处于不公平的地位，妨碍了它们之间的正当竞争，具有限制竞争的危害。因而，世界各国的反垄断法规基本上都对它做出限制。

 

价格歧视 - 存在条件　

1．厂商必须面对向下倾斜的需求曲线，即产品的需求与其价格成反比。　　

2．两个或两个以上的购买团体必须能在某一成本下区分开，该成本不超过区分他们所能带来的收入。即厂商能够以合理的成本进行市场细分。　　

3．必须阻止不同购买集团之间贱买贵卖的转卖行为。　　

4．不同的购买集团对产品的需求价格弹性必须不同，并且为厂商所知。即厂商了解购买集团对产品的不同的需求程度。

或两个条件：

First, the firm must be able to identify market segments by their price elasticity of demand.

Second, the firms must be able to enforce the scheme.

 

价格歧视--定价方式（即如何歧视）：一、直接差异定价，二、两部分定价，三、区域定价 ，四、产品线定价，五、产品集定价

 

价格歧视还可根据价格差别程度分为一级价格歧视，二级价格歧视，三级价格歧视：

①如果厂商对每一单位产品都按消费者所愿意支付的最高价格出售，这就是一级价格歧视;

②只要求对不同的消费数量段规定不同的价格，叫二级价格歧视;

③垄断厂商对同一种产品在不同的市场上收取不同的价格，叫三级价格歧视.

 

垄断与价格歧视的关系：一旦产品的卖方形成了垄断，就非常容易形成价格歧视。

 

价格歧视的例子非常多：

    * 4.1 Retail price discrimination

    * 4.2 Travel industry

    * 4.3 Coupons

    * 4.4 Premium pricing

    * 4.5 Segmentation by age group and student status

    * 4.6 Discounts for members of certain occupations

    * 4.7 Employee discounts

    * 4.8 Retail incentives

    * 4.9 Incentives for industrial buyers

    * 4.10 Gender-based examples

          o 4.10.1 "Ladies' night"

          o 4.10.2 Dry cleaning

          o 4.10.3 Haircutting

    * 4.11 Financial aid in education

    * 4.12 Haggling

    * 4.13 International price discrimination

    * 4.14 Academic pricing

    * 4.15 Dual pricing

    * 4.16 Wage discrimination

 

source：

-- Gary S. Becker (1957, 1971, 2nd ed.). The Economics of Discrimination. Chicago, University of Chicago Press.

--Arrow, K. J. (1973), "The Theory of Discrimination", in O. Ashenfelter and A. Rees (eds.), Discrimination in Labor Markets, Princeton, NJ: Princeton University Press.

--Phelps, Edmund S. (1972). "The Statistical Theory of Racism and Sexism". American Economic Review 62: 659–661.

--Levitt, Steven D. (2004). "Testing Theories Of Discrimination: Evidence From Weakest Link" (PDF). Journal of Law and Economics 47: 431. doi:10.1086/425591.

http://en.wikipedia.org/wiki/Statistical_discrimination_%28economics%29

http://en.wikipedia.org/wiki/Price_discrimination#Combination

http://zh.wikipedia.org/zh-cn/%E6%AD%A7%E8%A6%96

http://www.hudong.com/wiki/%E4%BB%B7%E6%A0%BC%E6%AD%A7%E8%A7%86

医疗VS预防--之一

A book published recently and entitled <Overdiagnosed: Making People Sick in the Pursuit of Health> by three reputable physicians (H. Gilbert Welch, Lisa M. Schwartz, and Steve Woloshin), argues forcefully that the nation is spending too much money on preventive care. This is doubtless regarded as heresy in some circles: the orthodox view is that prevention is the key to economizing on the expenses of health care: "an ounce of prevention is worth a pound of cure." The recent health care reform act seeks to promote preventive care.

Preventive care does reduce health costs in some cases, but not in all, and maybe not in most. The costs of prevention have to be weighed along with the benefits. And private and social costs have to be distinguished. Subsidy programs such as Medicare reduce the private costs of medical treatment to patients, but the social costs are not reduced; their incidence is merely shifted. Generally, preventive care has two phases: screening and treatment.

So not only is there compelling evidence of what Welch and his coauthors call overdiagnosis; there are good reasons to believe the evidence because the incentive structure for screening and preventive care makes overdiagnosis a theoretical prediction as well as an empirical reality.

source：http://www.becker-posner-blog.com/2011/02/the-overdiagnosis-problemposner.html

动物的生命也有价值

"Economic Value, the Value of Economists, and the Meaning of Life "
Don Coursey，芝大Harris学院教授

[Excerpt]:

In the study, I looked at every land animal on the official list of
endangered species. Then I took the total amount of spending by the
government on each species and divided it by the population of that
species. The result was a measure of value, not value defined by its
biological importance, but a measure of how much we as a nation are
willing to spend on each member of each endangered species.

My measure of value was based on analyzing a set of political and
bureaucratic outcomes.... had no morality attached to them.

To many, my conclusions about species value seem at odds with the
basic instinct that all life is worth saving. This is what makes
public policy involving economic valuation of life so difficult. It
also makes economists unpopular at cocktail parties. The fundamental
notions of budgets, opportunity costs, and trade-offs become
complicated when they are publicly applied to the value of life. The
challenge facing the economist in these settings is to find a way of
advancing economic reality through the cloud of emotional attachment
people hold toward life.

hat is a child worth? The question itself may be repugnant. Some may
say that the value of a child's life is infinite, that it is
hierarchically more important than other values, or that it is only
appropriate to use philosophical or ethical tools to describe a
child's value. But while we may all feel that the value of a child's
life is infinite, in most cases we do not act as if that is the case.

source：http://www.econlib.org/library/Columns/Courseyvalue.html#

Argu From HA -- 城乡卫生服务差距

北大公卫简伟研2010年12月在HA的"China's Rural-Urban Care Gap Shrank For Chronic Disease Patients, But Inequities Persist"引来一轮争议。
首先原文使用2003-08年的国家调查数据，分析城乡慢性病患者的卫生服务和保险。农村居民相比03年更易于开展住院治疗了，但是因为高copayment rate，他们放弃治疗的几率是城市居民的两倍。作者还提到服务差距缩小的最强证据是中部，西部和东部的证据比较mixed（有意思~~）

Wang Xin去信"Narrowing The Rural-Urban Care Gap In China"，认为2010年制定的新一轮五年计划中的要推广的社保卡将有效缩小城乡服务差距，作者认为这是发展中国家解决类似问题的好榜样，因为
People who are insured can use the social security card at any time and any place for services such as checking their personal social security record and being reimbursed for medical expenses. With this card, rural residents can go to any covered hospital in China for medical treatment and enjoy the same reimbursement as urban residents.

简回信"Chinese Rural-Urban Care Gap: The Authors Respond"，认为社保卡新系统主要是用来simplify medical services transactions and does not directly address the rural-urban care gap，因为
It is important to consider the role of socioeconomic development as well as the integration of the rural and urban health insurance systems. Unbalanced socioeconomic development has led to dramatic differences in local governments' financing capabilities. The funding pool for health insurance in rural China is at the county level, which makes service rebates outside residents' home counties administratively complicated.
而且
The approach to closing the rural-urban gap is likely to be multifaceted, requiring new financing and service-provision mechanisms and greater availability of services. No single policy is likely to constitute a magic bullet. Monitoring and evaluation will be key.

source：10.1377/hlthaff.2011.0203 Health Aff March 2011 vol. 30 no. 3 537
10.1377/hlthaff.2011.0208 Health Aff March 2011 vol. 30 no. 3 537
10.1377/hlthaff.2009.0989 Health Aff December 2010 vol. 29 no. 12 2189-2196

谁是US最快乐的人？

Gallup-Healthways Well-Being Index，他们的网站是www.well-beingindex.com

他们干的活是专门收集美国人（个体或群体）每天对幸福和快乐的心态意向，结果发现这些特征是最快乐的标志：male, Asian-American, a religious Jew, self-employed, living in Hawaii, married, has children, receiving a household income of at least $120,000。然后顺着这个profile去寻找这个理论上最快乐的人，结果居然被他们找到了，哈哈，你说奇迹不。就是下面的这位（羡慕啊~~）：

Courtesy of Alvin Wong The (theoretically) happiest person in America, Alvin Wong, with his wife, Trudy Schandler-Wong.