Rival markets like rideshare services, universities, and organ exchanges compete to attract participants, seeking to maximize their own utility at potential cost to overall social welfare. Similarly, individual participants in such multi-market systems also seek to maximize their individual utility. If entry is costly, they should strategically enter only a subset of the available markets. All of this decision making---markets competitively adapting their matching strategies and participants arriving, choosing which market(s) to enter, and departing from the system---occurs dynamically over time. This paper provides the first analysis of equilibrium behavior in dynamic competing matching market systems---first from the points of view of individual participants when market policies are fixed, and then from the points of view of markets when agents are stochastic. When compared to single markets running social-welfare-maximizing matching policies, losses in overall social welfare in competitive systems manifest due to both market fragmentation and the use of non-optimal matching policies. We quantify such losses and provide policy recommendations to help alleviate them in fielded systems.
Objective To determine whether increased cost sharing in health insurance plans induces higher levels of consumer sophistication in a non-elderly population.Study design This analysis is based on the collection of survey and demographic data collected from enrollees in the RAND health insurance experiment (HIE). During the RAND HIE, enrollees were randomly assigned to different levels of cost sharing (0, 25, 50 and 95%).Methods The study population compromises about 2000 people enrolled in the RAND HIE, between the years 1974 and 1982. Effects on health-care decision making were measured using the results of a standardized questionnaire, administered at the beginning and end of the experiment. Points of enquiry included whether or not enrollees' (i) recognized the need for second opinions (ii) questioned the effectiveness of certain therapies and (iii) researched the background/skill of their medical providers. Consumer sophistication was also measured for regular health-care consumers, as indicated by the presence of a chronic disease.Principal findings We found no statically significant changes (P < 0.05) in the health-care decision-making strategies between individuals randomized to high cost sharing plans and low cost sharing plans. Furthermore, we did not find a stronger effect for patients with a chronic disease.
ConclusionsThe evidence from the RAND HIE does not support the hypothesis that a higher level of cost sharing incentivizes the development of consumer sophistication. As a result, cost sharing alone will not promote individuals to become more selective in their health-care decision-making.
Community health worker (CHW) programs have become popular tools in reducing the burden of childhood illnesses. However, the efficacy of CHWs in facilitating behavior change, as a means of preventing waterborne diseases, remains unclear. Using a household survey (n = 225),in rural Tamil Nadu, South India, we assessed the effects of a CHW program on knowledge, attitudes and practices related to diarrheal illness through comparison with a control population that was not enrolled in the program. The CHW program in the experimental village entailed behavior change aimed at preventing diarrheal illness through home visits, community events and health education. Correlates of four key variables on knowledge of drinking water contamination and behavior change were examined by using logistic regression models. We found that while the program was effective in raising awareness of drinking water contamination, it did not significantly increase hygiene and water sanitation practices in the village community in comparison to the control population. Furthermore, villagers enrolled in the CHW program were unable to recognize the connections between contaminated drinking water and disease. The results of our survey indicated the CHW program did not significantly affect behavior in the experimental village. Possible shortcomings in the program are discussed.
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