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Background: Stigma is a barrier to the uptake of buprenorphine to treat opioid use disorder. Harm reduction treatment models intend to minimize this stigma by organizing care around non-judgmental interactions with people who use drugs. There are few examples of implementing buprenorphine treatment using a harm reduction approach in a primary care setting in the USA. Methods: We conducted a qualitative study by interviewing leadership, staff, and external stakeholders at Respectful, Equitable Access to Compassionate Healthcare (REACH) Medical in Ithaca, NY. REACH is a freestanding medical practice that provides buprenorphine treatment for opioid use disorder since 2018. We conducted semi-structured interviews with 17 participants with the objective of describing REACH's model of care. We selected participants based on their position at REACH or in the community. Interviews were recorded, transcribed, and analyzed for themes using content analysis, guided by the CDC Evaluation Framework. Results: REACH provided buprenorphine, primary care, and mental health services in a low-threshold model. We identified three themes related to delivery of buprenorphine treatment. First, an organizational mission to provide equitable and low-stigma healthcare, which was a key to organizational identity. Second, a low-threshold buprenorphine treatment approach that was critical, but caused concern about over-prescribing and presented logistical challenges. Third, creation and retention of a harm reduction-oriented workforce by offering value-based work and by removing administrative barriers providers may face elsewhere to providing buprenorphine treatment. Conclusions: A harm reduction primary care model can help reduce stigma for people who use drugs and engage in buprenorphine treatment. Further research is needed to evaluate whether this model leads to improved patient outcomes, can overcome community stakeholder concerns, and is sustainable. [ABSTRACT FROM AUTHOR]

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We study the impact of the Fukushima disaster on environmental concerns, well-being, risk aversion, and political preferences in Germany, Switzerland, and the UK. In these countries, overall life satisfaction did not significantly decrease, but the disaster significantly increased environmental concerns among Germans. One underlying mechanism likely operated through the perceived risk of a similar meltdown of domestic reactors. After Fukushima, more Germans considered themselves as 'very risk averse.' However, drastic German policy action shut down the oldest reactors, implemented the phaseout of the remaining ones, and proclaimed the transition to renewables. This shift in energy policy contributed to the subsequent decrease in environmental concerns, particularly among women, Green party supporters, and people living in close distance to the oldest reactors. In Germany, political support for the Greens increased significantly, whereas in Switzerland and the UK, this increase was limited to people living close to reactors. [ABSTRACT FROM AUTHOR]

We present a new theory and quantitative evidence on the incidence of unigeniture. Existing theories hypothesize some sort of indivisibility or increasing returns to scale in wealth to overcome the testator's inclination toward equal sharing among heirs. Examining a micro-level data set of seventeenth-century English wills, we find that even after controlling for land and other presumed sources of increasing returns to scale and indivisibility, other variables such as financial wealth still correlate with the incidence of unigeniture. This leads us to propose a model where unigeniture is an efficient way to provide insurance against income shocks. An important implication of the theory is that observed unequal bequests are partially counteracted by ex post transfers. Therefore, inequality of bequests cannot be taken as evidence of inequality of consumption between heirs. [ABSTRACT FROM AUTHOR]

This study empirically evaluates the effectiveness of different health care cost containment measures. The measures investigated were introduced in Germany in 1997 to reduce moral hazard and public health expenditures in the market for rehabilitation care. Of the analyzed measures, doubling the daily copayments was clearly the most effective cost containment measure, resulting in a reduction in utilization of about $$20\,\%$$ . Indirect measures such as allowing employers to cut federally mandated sick pay or paid vacation during inpatient post-acute care stays did not significantly reduce utilization. There is evidence neither for adverse health effects nor for substitution effects in terms of more doctor visits. [ABSTRACT FROM AUTHOR]

Using representative microdata from the German Socio-Economic Panel Study (SOEP), we show that the welfare measure choice has a substantial impact on the degree of welfare-related health inequality. To assess the sensitivity of welfare-related health inequality measures, we combine a unique set of income and wealth measures with different subjective, cardinalized, and (quasi-)objective health measures. The influence of the welfare measure is more pronounced when using subjective health measures than when using (quasi-)objective health measures. [ABSTRACT FROM AUTHOR]

The positive association between moderate alcohol consumption and wages is well documented in the economic literature. Positive health effects as well as networking mechanisms serve as explanations for the “alcohol–income puzzle.” Using individual-based microdata from the SOEP for 2006, we confirm that this relationship exists for Germany as well. More importantly, we shed light on the alcohol–income puzzle by analyzing, for the first time, the association between beverage-specific drinking behavior and wages. In our analysis, we disentangle the general wage effect of drinking into diverse effects for different types of drinkers. Mincerian estimates reveal significant and positive relationships between wine drinkers and wages as well as between multiple beverage drinkers and wages. When splitting the sample into age groups, the “drinking gain” disappears for employees under the age of 35 and increases in size and significance for higher age groups. We also find a “beer gain” for the oldest age group and male residents of rural areas as well as a “cocktail gain” for residents of urban areas. Several explanations for our empirical results are discussed in view of the likelihood that the alcohol–income puzzle is a multicausal phenomenon. [ABSTRACT FROM AUTHOR]