Healthcare Price Transparency: Policy Approaches and Estimated Impacts on Spending

Healthcare price transparency discussions typically focus on increasing patients' access to information about their out-of-pocket costs, but that focus is too narrow and should include other audiences -- physicians, employers, health plans and policymakers -- each with distinct needs and uses for healthcare price information. Greater price transparency can reduce U.S. healthcare spending.For example, an estimated $100 billion could be saved over the next 10 years if three select interventions were undertaken. However, most of the projected savings come from making price information available to employers and physicians, according to an analysis by researchers at the former Center for Studying Health System Change (HSC). Based on the current availability and modest impact of plan-based transparency tools, requiring all private plans to provide personalized out-of-pocket price data to enrollees would reduce total health spending by an estimated$18 billion over the next decade. While $18 billion is a substantial dollar amount, it is less than a tenth of a percent of the$40 trillionin total projected health spending over the same period. In contrast, using state all-payer claims databases to gather and report hospital-specific prices might reduce spending by an estimated $61 billion over 10 years.The effects of price transparency depend critically on the intended audience, the decision-making context and how prices are presented. And the impact of price transparency can be greatly amplified if target audiences are able and motivated to act on the information. Simply providing prices is insufficient to control spending without other shifts in healthcare financing, including changes in benefit design to make patients more sensitive to price differences among providers and alternative treatments. Other reforms that can amplify the impact of price transparency include shifting from fee-for-service payments that reward providers for volume to payment methods that put providers at risk for spending for episodes of care or defined patient populations. While price transparency alone seems unlikely to transform the healthcare system, it can play a needed role in enabling effective reforms in value-based benefit design and provider payment

Measured unsteady transonic aerodynamic characteristics of an elastic supercritical wing with an oscillating control surface

Transonic steady and unsteady aerodynamic data were measured on a large elastic wing in the NASA Langley Transonic Dynamics Tunnel. The wing had a supercritical airfoil shape and a leading-edge sweepback of 28.8 deg. The wing was heavily instrumented to measure both static and dynamic pressures and deflections. A hydraulically driven outboard control surface was oscillated to generate unsteady airloads on the wing. Representative results from the wind tunnel tests are presented and discussed, and the unexpected occurrence of an unusual dynamic wing instability, which was sensitive to angle of attack, is reported

The JCMT Gould Belt Survey: the effect of molecular contamination in SCUBA-2 observations of Orion A

Thermal emission from cold dust grains in giant molecular clouds can be used to probe the physical properties, such as density, temperature and emissivity in star-forming regions. We present the SCUBA-2 shared-risk observations at 450 $\mu$m and 850 $\mu$m of the Orion A molecular cloud complex taken at the James Clerk Maxwell Telescope (JCMT). Previous studies showed that molecular emission lines can contribute significantly to the measured fluxes in those continuum bands. We use the HARP $^{12}$CO J=3-2 integrated intensity map for Orion A in order to evaluate the molecular line contamination and its effects on the SCUBA-2 maps. With the corrected fluxes, we have obtained a new spectral index $\alpha$ map for the thermal emission of dust in the well-known integral-shaped filament. Furthermore, we compare a sample of 33 sources, selected over the Orion A molecular cloud complex for their high $^{12}$CO J=3-2 line contamination, to 27 previously identified clumps in OMC-4. This allows us to quantify the effect of line contamination on the ratio of 850 $\mu$m to 450 $\mu$m flux densities and how it modifies the deduced spectral index of emissivity $\beta$ for the dust grains. We also show that at least one Spitzer-identified protostellar core in OMC-5 has a $^{12}$CO J=3-2 contamination level of 16 %. Furthermore, we find the strongest contamination level (44 %) towards a young star with disk near OMC-2. This work is part of the JCMT Gould Belt Legacy Survey.Comment: 13 pages, 6 figures, Accepted for publication in Monthly Notices of the Royal Astronomical Society (MNRAS

Breaking the Redshift Deadlock - I: Constraining the star formation history of galaxies with sub-millimetre photometric redshifts

Future extragalactic sub-millimetre and millimetre surveys have the potential to provide a sensitive census of the level of obscured star formation in galaxies at all redshifts. While in general there is good agreement between the source counts from existing SCUBA (850um) and MAMBO (1.25mm) surveys of different depths and areas, it remains difficult to determine the redshift distribution and bolometric luminosities of the sub-millimetre and millimetre galaxy population. This is principally due to the ambiguity in identifying an individual sub-millimetre source with its optical, IR or radio counterpart which, in turn, prevents a confident measurement of the spectroscopic redshift. Additionally, the lack of data measuring the rest-frame FIR spectral peak of the sub-millimetre galaxies gives rise to poor constraints on their rest-frame FIR luminosities and star formation rates. In this paper we describe Monte-Carlo simulations of ground-based, balloon-borne and satellite sub-millimetre surveys that demonstrate how the rest-frame FIR-sub-millimetre spectral energy distributions (250-850um) can be used to derive photometric redshifts with an r.m.s accuracy of +/- 0.4 over the range 0 < z < 6. This opportunity to break the redshift deadlock will provide an estimate of the global star formation history for luminous optically-obscured galaxies [L(FIR) > 3 x 10^12 Lsun] with an accuracy of 20 per cent.Comment: 14 pages, 22 figures, submitted to MNRAS, replaced with accepted versio

SANEPIC: A Map-Making Method for Timestream Data From Large Arrays

We describe a map-making method which we have developed for the Balloon-borne Large Aperture Submillimeter Telescope (BLAST) experiment, but which should have general application to data from other submillimeter arrays. Our method uses a Maximum Likelihood based approach, with several approximations, which allows images to be constructed using large amounts of data with fairly modest computer memory and processing requirements. This new approach, Signal And Noise Estimation Procedure Including Correlations (SANEPIC), builds upon several previous methods, but focuses specifically on the regime where there is a large number of detectors sampling the same map of the sky, and explicitly allowing for the the possibility of strong correlations between the detector timestreams. We provide real and simulated examples of how well this method performs compared with more simplistic map-makers based on filtering. We discuss two separate implementations of SANEPIC: a brute-force approach, in which the inverse pixel-pixel covariance matrix is computed; and an iterative approach, which is much more efficient for large maps. SANEPIC has been successfully used to produce maps using data from the 2005 BLAST flight.Comment: 27 Pages, 15 figures; Submitted to the Astrophysical Journal; related results available at http://blastexperiment.info/ [the BLAST Webpage

High Angular Resolution Observations of Four Candidate BLAST High-Mass Starless Cores

We discuss high-angular resolution observations of ammonia toward four candidate high-mass starless cores (HMSCs). The cores were identified by the Balloon-borne Large Aperture Submillimeter Telescope (BLAST) during its 2005 survey of the Vulpecula region where 60 compact sources were detected simultaneously at 250, 350, and 500 micron. Four of these cores, with no IRAS-PSC or MSX counterparts, were observed with the NRAO Very Large Array (VLA) in the NH3(1,1) and (2,2) spectral lines. Our observations indicate that the four cores are cold (Tk <~ 14K) and show a filamentary and/or clumpy structure. They also show a significant velocity substructure within ~1km/s. The four BLAST cores appear to be colder and more quiescent than other previously observed HMSC candidates, suggesting an earlier stage of evolution.Comment: Submitted to the Astrophysical Journal on January 22, 2010. Accepted for publication on April 15, 2010. The paper has 21 pages and 17 figures

Measuring star formation in high-z massive galaxies: A mid-infrared to submillimeter study of the GOODS NICMOS Survey sample

We present measurements of the mean mid-infrared-to-submillimeter flux densities of massive (M\ast \approx 2 \times 10^11 Msun) galaxies at redshifts 1.7 < z < 2.9, obtained by stacking positions of known objects taken from the GOODS NICMOS Survey (GNS) catalog on maps: at 24 {\mu}m (Spitzer/MIPS); 70, 100, and 160{\mu}m (Herschel/PACS); 250, 350, 500{\mu}m (BLAST); and 870{\mu}m (LABOCA). A modified blackbody spectrum fit to the stacked flux densities indicates a median [interquartile] star-formation rate of SFR = 63 [48, 81] Msun yr^-1 . We note that not properly accounting for correlations between bands when fitting stacked data can significantly bias the result. The galaxies are divided into two groups, disk-like and spheroid-like, according to their Sersic indices, n. We find evidence that most of the star formation is occurring in n \leq 2 (disk-like) galaxies, with median [interquartile] SFR = 122 [100,150] Msun yr^-1, while there are indications that the n > 2 (spheroid-like) population may be forming stars at a median [interquartile] SFR = 14 [9,20] Msun yr^-1, if at all. Finally, we show that star formation is a plausible mechanism for size evolution in this population as a whole, but find only marginal evidence that it is what drives the expansion of the spheroid-like galaxies.Comment: Accepted by MNRAS. 10 pages, 3 figures, 3 table

Analytical solution of a model for complex food webs

We investigate numerically and analytically a recently proposed model for food webs [Nature {\bf 404}, 180 (2000)] in the limit of large web sizes and sparse interaction matrices. We obtain analytical expressions for several quantities with ecological interest, in particular the probability distributions for the number of prey and the number of predators. We find that these distributions have fast-decaying exponential and Gaussian tails, respectively. We also find that our analytical expressions are robust to changes in the details of the model.Comment: 4 pages (RevTeX). Final versio