Kavita Patel, Elizabeth Cliff, and Mark Fendrick in Health Affairs: “In Capitol Hill, there’s a growing chorus of support from both sides of the aisle to move the focus of health care payment incentives from volume to value. Earlier this month, legislators introduced proposals that would have fixed the sustainable growth rate in Medicare, as well as made other changes, including allowing for clinical nuance in Medicare benefit designs. The Centers for Medicare and Medicaid Services, too, is embracing this trend, recently asking for partners in a demonstration project to used value-based arrangements in benefit design. These efforts of policymakers and agencies to innovate Medicare’s benefit design are crucial both for the health of seniors and to ensure value in the Medicare program.
The concept of clinical nuance, implemented using value-based insurance design (V-BID), is a key innovation already widely implemented in the private and public payers. It recognizes two important facts about the provision of medical care: 1) medical services differ in the amount of health produced, and 2) the clinical benefit derived from a medical service depends on who is using it, who is delivering the service, and where it is being delivered.
Today’s Medicare beneficiaries face little clinical nuance in their benefit structure. Medicare largely uses a “one-size-fits-all” structure that does not recognize that some treatments, drugs or tests are more important to health than others. Not only does it create inefficiencies in the health system, it can actually harm the health of beneficiaries.
Some discussion of economics explains why. The concept of moral hazard, which posits that individuals over-consume when they are not on the hook for the cost of their behavior, is well established in health care. It is used to explain why those who are insured use more care than they might need to remain optimally healthy. But, that’s only half the story. There are lots of beneficial medications or services that we wish people would use—and for some treatment adherence is low. So what gives?
Recently, three economists — Katherine Baicker, Sendhil Mullainathan and Joshua Schwartzstein — coined the term “behavioral hazard.” They use it to refer to suboptimal choices that people make based on their own behavioral biases. For example, a diabetic patient might feel fine and choose to forgo regular eye exams, only to have their disease progress. Here, higher levels of cost sharing worsen the problem. A beneficiary who faces both financial and behavioral obstacles to treatment adherence is less likely to behave in a way that ensures optimal health.
That brings us back to the concept of clinical nuance. Clinically nuanced insurance designs recognize both moral and behavioral hazard, and seek to shape incentives to minimize their impact. When patients’ incentives are aligned with evidence-based medicine, it improves outcomes, helps patients and, in some clinical situations, lowers costs.”
How Cities Can Be Designed to Help—or Hinder—Sharing
Jay Walljasper in Yes!: Centuries before someone first uttered the words “sharing economy,” the steady rise of cities embodied both the principles and promise of that phrase. The reason more than half the people on earth now live in urban areas is the advantages that come from sharing resources, infrastructure, and lives with other people. Essential commons belonging to all of us, ranging from transportation systems to public health safeguards to plentiful social connections, are easier to create and maintain in a populated area.
Think about typical urban dwellers. They are more likely to reside in an apartment building, shared household, or compact living unit (saving on heating, utilities, original construction costs, and other expenses), walk or take transit (saving the environment as well as money), know a wide range of people (expanding their circle of friends and colleagues), and encounter new experiences (increasing their knowledge and skills).
Access to these opportunities for sharing offers economic, social, environmental, and educational rewards. But living in a populated area does not automatically mean more sharing. Indeed, the classic suburban lifestyle—a big, single-family house and a big yard isolated from everything else and reachable only by automobile—makes sharing extremely difficult….
“The suburbs were designed as a landscape to maximize consumption,” Fisher explains. “It worked against sharing of any kind. People had all this stuff in their houses and garages, which was going unused most of the time.”
Autos replaced streetcars. Kids rode school buses instead of walking to school.
Everyone bought their own lawn mower, shovels, tools, sports equipment, and grills.
Even the proverbial cup of sugar borrowed from a neighbor disappeared in favor of the 10-pound bag bought at the supermarket.
As our spending grew, our need for social connections shrank. “Mass consumption was good for the economy, but bad for our well-being,” Fisher notes. He now sees changes ahead for our communities as the economy evolves.
“The new economy is all about innovation, which depends on maximizing interaction, not consumption.”
This means redesigning our communities to bring people together by giving everyone more opportunities to “walk, live close together, and share.”
This shift can already be seen in farmers markets, co-working spaces, tool libraries, bike sharing systems, co-ops, credit unions, public spaces, and other sharing projects everywhere.
“Creative people in cities around the world are rising up…” declares Neal Gorenflo, co-founder of Shareable magazine. “We are not protesting, and we are not asking for permission, and we are not waiting—we are building a people-powered economy right under everyone’s noses.”
Excited by this emerging grassroots movement, Shareable recently launched the Sharing Cities Network to be an independent resource “for sharing innovators to discover together how to create as many sharing cities around the world as fast as possible.”
The aim is to help empower and connect local initiatives around the world through online forums, peer learning, and other ways to boost collaboration, share best practices, and catalyze new projects.”
Visualizing Health IT: A holistic overview
Andy Oram in O’Reilly Data: “There is no dearth of health reformers offering their visions for patient engagement, information exchange, better public health, and disruptive change to health industries. But they often accept too freely the promise of technology, without grasping how difficult the technical implementations of their reforms would be. Furthermore, no document I have found pulls together the various trends in technology and explores their interrelationships.
I have tried to fill this gap with a recently released report: The Information Technology Fix for Health: Barriers and Pathways to the Use of Information Technology for Better Health Care. This posting describes some of the issues it covers.
Take a basic example: fitness devices. Lots of health reformers would love to see these pulled into treatment plans to help people overcome hypertension and other serious conditions. It’s hard to understand the factors that make doctors reluctant to do so–blind conservatism is not the problem, but actual technical factors. To become part of treatment plans, the accuracy of devices would have to be validated, they would need to produce data in formats and units that are universally recognized, and electronic records would have to be undergo major upgrades to store and process the data.
Another example is patient engagement, which doctors and hospitals are furiously pursuing. Not only are patients becoming choosier and rating their institutions publicly in Yelp-like fashion, but the clinicians have come to realize that engaged patients are more likely to participate in developing effective treatment plans, not to mention following through on them.
Engaging patients to improve their own outcomes directly affects the institutions’ bottom lines as insurers and the government move from paying for each procedure to pay-per-value (a fixed sum for handling a group of patients that share a health condition). But what data do we need to make pay-per-value fair and accurate? How do we get that data from one place to another, and–much more difficult–out of one ungainly proprietary format and possibly into others? The answer emerging among activists to these questions is: leave the data under the control of the patients, and let them share it as they find appropriate.
Collaboration may be touted even more than patient engagement as the way to better health. And who wouldn’t want his cardiologist to be consulting with his oncologist, nutritionist, and physical therapist? It doesn’t happen as much as it should, and while picking up the phone may be critical sometimes to making the right decisions, electronic media can also be of crucial value. Once again, we have to overcome technical barriers.
The The Information Technology Fix for Health report divides these issues into four umbrella categories:
- Devices, sensors, and patient monitoring
- Using data: records, public data sets, and research
- Coordinated care: teams and telehealth
- Patient empowerment
Underlying all these as a kind of vast subterranean network of interconnected roots are electronic health records (EHRs). These must function well in order for devices to send output to the interested observers, researchers to collect data, and teams to coordinate care. The article delves into the messy and often ugly area of formats and information exchange, along with issues of privacy. I extol once again the virtue of patient control over records and suggest how we could overcome all barriers to make that happen.”
“Government Entrepreneur” is Not an Oxymoron
Mitchell Weiss in Harvard Business Review Blog: “Entrepreneurship almost always involves pushing against the status quo to capture opportunities and create value. So it shouldn’t be surprising when a new business model, such as ridesharing, disrupts existing systems and causes friction between entrepreneurs and local government officials, right?
But imagine if the road that led to the Seattle City Council ridesharing hearings this month — with rulings that sharply curtail UberX, Lyft, and Sidecar’s operations there — had been a vastly different one. Imagine that public leaders had conceived and built a platform to provide this new, shared model of transit. Or at the very least, that instead of having a revolution of the current transit regime done to Seattle public leaders, it was done with them. Amidst the acrimony, it seems hard to imagine that public leaders could envision and operate such a platform, or that private innovators could work with them more collaboratively on it — but it’s not impossible. What would it take? Answer: more public entrepreneurs.
The idea of ”public entrepreneurship” may sound to you like it belongs on a list of oxymorons right alongside “government intelligence.” But it doesn’t. Public entrepreneurs around the world are improving our lives, inventing entirely new ways to serve the public. They are using sensors to detect potholes; word pedometers to help students learn; harnessing behavioral economics to encourage organ donation; crowdsourcing patent review; and transforming Medellin, Colombia with cable cars. They are coding in civic hackathons and competing in the Bloomberg challenge. They are partnering with an Office of New Urban Mechanics in Boston or in Philadelphia, co-developing products in San Francisco’s Entrepreneurship-in-Residence program, or deploying some of the more than $430 million invested into civic-tech in the last two years.
There is, however, a big problem with public entrepreneurs: there just aren’t enough of them. Without more public entrepreneurship, it’s hard to imagine meeting our public challenges or making the most of private innovation. One might argue that bungled healthcare website roll-outs or internet spying are evidence of too much activity on the part of public leaders, but I would argue that what they really show is too little entrepreneurial skill and judgment.
The solution to creating more public entrepreneurs is straightforward: train them. But, by and large, we don’t. Consider Howard Stevenson’s definition of entrepreneurship: “the pursuit of opportunity without regard to resources currently controlled.” We could teach that approach to people heading towards the public sector. But now consider the following list of terms: “acknowledgement of multiple constituencies,” “risk reduction,” “formal planning,” “coordination,” “efficiency measures,” “clearly defined responsibility,” and “organizational culture.” It reads like a list of the kinds of concepts we would want a new public official to know; like it might be drawn from an interview evaluation form or graduate school syllabus. In fact, it’s from Stevenson’s list of pressures that pull managers away from entrepreneurship and towards administration. Of course, that’s not all bad. We must have more great public administrators. But with all our challenges and amidst all the dynamism, we are going to need more than analysts and strategists in the public sector, we need inventors and builders, too.
Public entrepreneurship is not simply innovation in the public sector (though it makes use of innovation), and it’s not just policy reform (though it can help drive reform). Public entrepreneurs build something from nothing with resources — be they financial capital or human talent or new rules — they didn’t command. In Boston, I worked with many amazing public managers and a handful of outstanding public entrepreneurs. Chris Osgood and Nigel Jacob brought the country’s first major-city mobile 311 app to life, and they are public entrepreneurs. They created Citizens Connect in 2009 by bringing together iPhones on loan together with a local coder and the most under-tapped resource in the public sector: the public. They transformed the way basic neighborhood issues are reported and responded to (20% of all constituent cases in Boston are reported over smartphones now), and their model is now accessible to 40 towns in Massachusetts and cities across the country. The Mayor’s team in Boston that started-up the One Fund in the days after the Marathon bombings were public entrepreneurs. We built the organization from PayPal and a Post Office Box, and it went on to channel $61 million from donors to victims and survivors in just 75 days. It still operates today….
It’s worth noting that public entrepreneurship, perhaps newly buzzworthy, is not actually new. Elinor Ostrom (44 years before her Nobel Prize) observed public entrepreneurs inventing new models in the 1960s. Back when Ronald Reagan was president, Peter Drucker wrote that it was entrepreneurship that would keep public service “flexible and self-renewing.” And almost two decades have passed since David Osborne and Ted Gaebler’s “Reinventing Government” (the then handbook for public officials) carried the promising subtitle: “How the Entrepreneurial Spirit is Transforming the Public Sector”. Public entrepreneurship, though not nearly as widespread as its private complement, or perhaps as fashionable as its “social” counterpart (focussed on non-profits and their ecosystem), has been around for a while and so have those who practiced it.
But still today, we mostly train future public leaders to be public administrators. We school them in performance management and leave them too inclined to run from risk instead of managing it. And we communicate often, explicitly or not, to private entrepreneurs that government officials are failures and dinosaurs. It’s easy to see how that road led to Seattle this month, but hard see how it empowers public officials to take on the enormous challenges that still lie ahead of us, or how it enables the public to help them.”
But imagine if the road that led to the Seattle City Council ridesharing hearings this month — with rulings that sharply curtail UberX, Lyft, and Sidecar’s operations there — had been a vastly different one. Imagine that public leaders had conceived and built a platform to provide this new, shared model of transit. Or at the very least, that instead of having a revolution of the current transit regime done to Seattle public leaders, it was done with them. Amidst the acrimony, it seems hard to imagine that public leaders could envision and operate such a platform, or that private innovators could work with them more collaboratively on it — but it’s not impossible. What would it take? Answer: more public entrepreneurs.
The idea of ”public entrepreneurship” may sound to you like it belongs on a list of oxymorons right alongside “government intelligence.” But it doesn’t. Public entrepreneurs around the world are improving our lives, inventing entirely new ways to serve the public. They are using sensors to detect potholes; word pedometers to help students learn; harnessing behavioral economics to encourage organ donation; crowdsourcing patent review; and transforming Medellin, Colombia with cable cars. They are coding in civic hackathons and competing in the Bloomberg challenge. They are partnering with an Office of New Urban Mechanics in Boston or in Philadelphia, co-developing products in San Francisco’s Entrepreneurship-in-Residence program, or deploying some of the more than $430 million invested into civic-tech in the last two years.
There is, however, a big problem with public entrepreneurs: there just aren’t enough of them. Without more public entrepreneurship, it’s hard to imagine meeting our public challenges or making the most of private innovation. One might argue that bungled healthcare website roll-outs or internet spying are evidence of too much activity on the part of public leaders, but I would argue that what they really show is too little entrepreneurial skill and judgment.
The solution to creating more public entrepreneurs is straightforward: train them. But, by and large, we don’t. Consider Howard Stevenson’s definition of entrepreneurship: “the pursuit of opportunity without regard to resources currently controlled.” We could teach that approach to people heading towards the public sector. But now consider the following list of terms: “acknowledgement of multiple constituencies,” “risk reduction,” “formal planning,” “coordination,” “efficiency measures,” “clearly defined responsibility,” and “organizational culture.” It reads like a list of the kinds of concepts we would want a new public official to know; like it might be drawn from an interview evaluation form or graduate school syllabus. In fact, it’s from Stevenson’s list of pressures that pull managers away from entrepreneurship and towards administration. Of course, that’s not all bad. We must have more great public administrators. But with all our challenges and amidst all the dynamism, we are going to need more than analysts and strategists in the public sector, we need inventors and builders, too.
Public entrepreneurship is not simply innovation in the public sector (though it makes use of innovation), and it’s not just policy reform (though it can help drive reform). Public entrepreneurs build something from nothing with resources — be they financial capital or human talent or new rules — they didn’t command. In Boston, I worked with many amazing public managers and a handful of outstanding public entrepreneurs. Chris Osgood and Nigel Jacob brought the country’s first major-city mobile 311 app to life, and they are public entrepreneurs. They created Citizens Connect in 2009 by bringing together iPhones on loan together with a local coder and the most under-tapped resource in the public sector: the public. They transformed the way basic neighborhood issues are reported and responded to (20% of all constituent cases in Boston are reported over smartphones now), and their model is now accessible to 40 towns in Massachusetts and cities across the country. The Mayor’s team in Boston that started-up the One Fund in the days after the Marathon bombings were public entrepreneurs. We built the organization from PayPal and a Post Office Box, and it went on to channel $61 million from donors to victims and survivors in just 75 days. It still operates today….
It’s worth noting that public entrepreneurship, perhaps newly buzzworthy, is not actually new. Elinor Ostrom (44 years before her Nobel Prize) observed public entrepreneurs inventing new models in the 1960s. Back when Ronald Reagan was president, Peter Drucker wrote that it was entrepreneurship that would keep public service “flexible and self-renewing.” And almost two decades have passed since David Osborne and Ted Gaebler’s “Reinventing Government” (the then handbook for public officials) carried the promising subtitle: “How the Entrepreneurial Spirit is Transforming the Public Sector”. Public entrepreneurship, though not nearly as widespread as its private complement, or perhaps as fashionable as its “social” counterpart (focussed on non-profits and their ecosystem), has been around for a while and so have those who practiced it.
But still today, we mostly train future public leaders to be public administrators. We school them in performance management and leave them too inclined to run from risk instead of managing it. And we communicate often, explicitly or not, to private entrepreneurs that government officials are failures and dinosaurs. It’s easy to see how that road led to Seattle this month, but hard see how it empowers public officials to take on the enormous challenges that still lie ahead of us, or how it enables the public to help them.”
The Potential of Crowdsourcing to Improve Patient-Centered Care
Michael Weiner in the Journal The Patient – Patient-Centered Outcomes Research: “Crowdsourcing (CS) is the outsourcing of a problem or task to a crowd. Although patient-centered care (PCC) may aim to be tailored to an individual’s needs, the uses of CS for generating ideas, identifying values, solving problems, facilitating research, and educating an audience represent powerful roles that can shape both allocation of shared resources and delivery of personalized care and treatment. CS can often be conducted quickly and at relatively low cost. Pitfalls include bias, risks of research ethics, inadequate quality of data, inadequate metrics, and observer-expectancy effect. Health professionals and consumers in the US should increase their attention to CS for the benefit of PCC. Patients’ participation in CS to shape health policy and decisions is one way to pursue PCC itself and may help to improve clinical outcomes through a better understanding of patients’ perspectives. CS should especially be used to traverse the quality-cost curve, or decrease costs while preserving or improving quality of care.”
The GovLab Index: Privacy and Security
Please find below the latest installment in The GovLab Index series, inspired by the Harper’s Index. “The GovLab Index: Privacy and Security” examines the attitudes and concerns of American citizens regarding online privacy. Previous installments include Designing for Behavior Change, The Networked Public, Measuring Impact with Evidence, Open Data, The Data Universe, Participation and Civic Engagement and Trust in Institutions.
Globally
- Percentage of people who feel the Internet is eroding their personal privacy: 56%
- Internet users who feel comfortable sharing personal data with an app: 37%
- Number of users who consider it important to know when an app is gathering information about them: 70%
- How many people in the online world use privacy tools to disguise their identity or location: 28%, or 415 million people
- Country with the highest penetration of general anonymity tools among Internet users: Indonesia, where 42% of users surveyed use proxy servers
- Percentage of China’s online population that disguises their online location to bypass governmental filters: 34%
In the United States
Over the Years
- In 1996, percentage of the American public who were categorized as having “high privacy concerns”: 25%
- Those with “Medium privacy concerns”: 59%
- Those who were unconcerned with privacy: 16%
- In 1998, number of computer users concerned about threats to personal privacy: 87%
- In 2001, those who reported “medium to high” privacy concerns: 88%
- Individuals who are unconcerned about privacy: 18% in 1990, down to 10% in 2004
- How many online American adults are more concerned about their privacy in 2014 than they were a year ago, indicating rising privacy concerns: 64%
- Number of respondents in 2012 who believe they have control over their personal information: 35%, downward trend for 7 years
- How many respondents in 2012 continue to perceive privacy and the protection of their personal information as very important or important to the overall trust equation: 78%, upward trend for seven years
- How many consumers in 2013 trust that their bank is committed to ensuring the privacy of their personal information is protected: 35%, down from 48% in 2004
Privacy Concerns and Beliefs
- How many Internet users worry about their privacy online: 92%
- Those who report that their level of concern has increased from 2013 to 2014: 7 in 10
- How many are at least sometimes worried when shopping online: 93%, up from 89% in 2012
- Those who have some concerns when banking online: 90%, up from 86% in 2012
- Number of Internet users who are worried about the amount of personal information about them online: 50%, up from 33% in 2009
- Those who report that their photograph is available online: 66%
- Their birthdate: 50%
- Home address: 30%
- Cell number: 24%
- A video: 21%
- Political affiliation: 20%
- Those who report that their photograph is available online: 66%
- Consumers who are concerned about companies tracking their activities: 58%
- Those who are concerned about the government tracking their activities: 38%
- How many users surveyed felt that the National Security Association (NSA) overstepped its bounds in light of recent NSA revelations: 44%
- Respondents who are comfortable with advertisers using their web browsing history to tailor advertisements as long as it is not tied to any other personally identifiable information: 36%, up from 29% in 2012
- Percentage of voters who do not want political campaigns to tailor their advertisements based on their interests: 86%
- Percentage of respondents who do not want news tailored to their interests: 56%
- Percentage of users who are worried about their information will be stolen by hackers: 75%
- Those who are worried about companies tracking their browsing history for targeted advertising: 54%
- How many consumers say they do not trust businesses with their personal information online: 54%
- Top 3 most trusted companies for privacy identified by consumers from across 25 different industries in 2012: American Express, Hewlett Packard and Amazon
- Most trusted industries for privacy: Healthcare, Consumer Products and Banking
- Least trusted industries for privacy: Internet and Social Media, Non-Profits and Toys
- Respondents who admit to sharing their personal information with companies they did not trust in 2012 for reasons such as convenience when making a purchase: 63%
- Percentage of users who say they prefer free online services supported by targeted ads: 61%
- Those who prefer paid online services without targeted ads: 33%
- How many Internet users believe that it is not possible to be completely anonymous online: 59%
- Those who believe complete online anonymity is still possible: 37%
- Those who say people should have the ability to use the Internet anonymously: 59%
- Percentage of Internet users who believe that current laws are not good enough in protecting people’s privacy online: 68%
- Those who believe current laws provide reasonable protection: 24%
FULL LIST at http://thegovlab.org/the-govlab-index-privacy-and-trust/
Open Government: Building Trust and Civic Engagement
Gavin Newsom and Zachary Bookman in the Huffington Post: “Daily life has become inseparable from new technologies. Our phones and tablets let us shop from the couch, track how many miles we run, and keep in touch with friends across town and around the world – benefits barely possible a decade ago.
With respect to our communities, Uber and Lyft now shuttle us around town, reducing street traffic and parking problems. Adopt-a-Hydrant apps coordinate efforts to dig out hydrants after snowstorms, saving firefighters time when battling blazes. Change.org, helps millions petition for and effect social and political change.
Yet as a sector, government typically embraces technology well-behind the consumer curve. This leads to disheartening stories, like veterans waiting months or years for disability claims due to outdated technology or the troubled rollout of the Healthcare.gov website. This is changing.
Cities and states are now the driving force in a national movement to harness technology to share a wealth of government information and data. Many forward thinking local governments now provide effective tools to the public to make sense of all this data.
This is the Open Government movement.
For too long, government information has been locked away in agencies, departments, and archaic IT systems. Senior administrators often have to request the data they need to do their jobs from system operators. Elected officials, in turn, often have to request data from these administrators. The public remains in the dark, and when data is released, it appears in the form of inaccessible or incomprehensible facts and figures.
Governments keep massive volumes of data, from 500 page budget documents to population statistics to neighborhood crime rates. Although raw data is a necessary component of Open Government, for it to empower citizens and officials the data must be transformed into meaningful and actionable insights. Governments must both publish information in “machine readable” format and give people the tools to understand and act on it.
New platforms can transform data from legacy systems into meaningful visualizations. Instant, web-based access to this information not only saves time and money, but also helps government make faster and better decisions. This allows them to serve their communities and builds trust with citizens.
Leading governments like Palo Alto have begun employing technology to leverage these benefits. Even the City of Bell, California, which made headlines in 2010 when senior administrators siphoned millions of dollars from the general fund, is now leveraging cloud technology to turn a new page in its history. The city has presented its financial information in an easily accessible, interactive platform at Bell.OpenGov.com. Citizens and officials alike can see vivid, user generated charts and graphs that show where money goes, what services are offered to residents, and how much those services cost.
In 2009, San Francisco became an early adopter of the open data movement when an executive order made open and machine-readable the default for our consolidated government. That simple order spurred an entirely new industry and the City of San Francisco has been adopting apps like the San Francisco Heat Vulnerability Index and Neighborhood Score ever since. The former identifies areas vulnerable to heat waves with the hope of better preparedness, while the latter provides an overall health and sustainability score, block-by-block for every neighborhood in the city. These new apps use local, state, federal, and private data sets to allow residents to see how their neighborhoods rank.
The California State Lands Commission, responsible for the stewardship of the state’s lands, waterways, and natural resources, is getting in on the Open Government movement too. The Commission now publishes five years of expense and revenue data at CAStateLands.opengov.com (which just launched today!). California residents can now see how the state generates nearly half a billion dollars in revenue from oil and gas contracts, mineral royalties, and leasing programs. The State can now communicate how it manages those resources, so that citizens understand how their government works for them.
The Open Government movement provides a framework for improved public administration and a path for more trust and engagement. Governments have been challenged to do better, and now they can.”
Randomized control trials (RCTs): interesting, but a marginal tool for governments
ODI Researcher Philipp Krause at BeyondBudgets: “Randomized control trials (RCTs) have had a great decade. The stunning line-up of speakers who celebrated J-PAL’s tenth anniversary in Boston last December gives some indication of just how great. They are the shiny new tool of development policy, and a lot of them are pretty cool. Browsing through J-PAL’s library of projects, it’s easy to see how so many of them end up in top-notch academic journals.
So far, so good. But the ambition of RCTs is not just to provide a gold-standard measurement of impact. They aim to actually have an impact on the real world themselves. The scenario goes something like this: researchers investigate the effect of an intervention and use the findings to either get out of that mess quickly (if the intervention doesn’t work) or scale it up quickly (if it does). In the pursuit of this impact-seeker’s Nirvana, it’s easy to conflate a couple of things, notably that an RCT is not the only way to evaluate impact; and evaluating impact is not the only way to use evidence for policy. Unfortunately, it is now surprisingly common to hear RCTs conflated with evidence-use, and evidence-use equated with the key ingredient for better public services in developing countries. The reality of evidence use is different.
Today’s rich countries didn’t get rich by using evidence systematically. This is a point that we recently discussed at a big World Bank – ODI conference on the (coincidental?) tenth anniversary of the WDR 2004. Lant Pritchett made it best when describing Randomistas as engaging in faith-based activity: nobody could accuse the likes of Germany, Switzerland, Sweden or the US of achieving human development by systematically scaling up what works.
What these countries do have in spades is people noisily demanding stuff, and governments giving it to them. In fact, some of the greatest innovations in providing health, unemployment benefits and pensions to poor people (and taking them to scale) happened because citizens seemed to want them, and giving them stuff seemed like a good way to shut them up. Ask Otto Bismarck. It’s not too much of a stretch to call this the history of public spending in a nutshell….
The bottom line is governments s that care about impact have plenty of cheaper, timelier and more appropriate tools and options available to them than RCTs. That doesn’t mean RCTs shouldn’t be done, of course. And the evaluation of aid is a different matter altogether, where donors are free to be as inefficient about evidence-basing as they wish without burdening poor countries.
But for governments the choice of how to go about using systematic evidence is theirs to make. And it’s a tough capability to pick up. Many governments choose not to do it, and there’s no evidence that they suffer for it. It would be wrong for donors to suggest to low-income countries that RCTs are in any way critical for their public service capability. Better call them what they are: interesting, but marginal.”
Index: Privacy and Security
The Living Library Index – inspired by the Harper’s Index – provides important statistics and highlights global trends in governance innovation. This installment focuses on privacy and security and was originally published in 2014.
Globally
- Percentage of people who feel the Internet is eroding their personal privacy: 56%
- Internet users who feel comfortable sharing personal data with an app: 37%
- Number of users who consider it important to know when an app is gathering information about them: 70%
- How many people in the online world use privacy tools to disguise their identity or location: 28%, or 415 million people
- Country with the highest penetration of general anonymity tools among Internet users: Indonesia, where 42% of users surveyed use proxy servers
- Percentage of China’s online population that disguises their online location to bypass governmental filters: 34%
In the United States
Over the Years
- In 1996, percentage of the American public who were categorized as having “high privacy concerns”: 25%
- Those with “Medium privacy concerns”: 59%
- Those who were unconcerned with privacy: 16%
- In 1998, number of computer users concerned about threats to personal privacy: 87%
- In 2001, those who reported “medium to high” privacy concerns: 88%
- Individuals who are unconcerned about privacy: 18% in 1990, down to 10% in 2004
- How many online American adults are more concerned about their privacy in 2014 than they were a year ago, indicating rising privacy concerns: 64%
- Number of respondents in 2012 who believe they have control over their personal information: 35%, downward trend for 7 years
- How many respondents in 2012 continue to perceive privacy and the protection of their personal information as very important or important to the overall trust equation: 78%, upward trend for seven years
- How many consumers in 2013 trust that their bank is committed to ensuring the privacy of their personal information is protected: 35%, down from 48% in 2004
Privacy Concerns and Beliefs
- How many Internet users worry about their privacy online: 92%
- Those who report that their level of concern has increased from 2013 to 2014: 7 in 10
- How many are at least sometimes worried when shopping online: 93%, up from 89% in 2012
- Those who have some concerns when banking online: 90%, up from 86% in 2012
- Number of Internet users who are worried about the amount of personal information about them online: 50%, up from 33% in 2009
- Those who report that their photograph is available online: 66%
- Their birthdate: 50%
- Home address: 30%
- Cell number: 24%
- A video: 21%
- Political affiliation: 20%
- Those who report that their photograph is available online: 66%
- Consumers who are concerned about companies tracking their activities: 58%
- Those who are concerned about the government tracking their activities: 38%
- How many users surveyed felt that the National Security Association (NSA) overstepped its bounds in light of recent NSA revelations: 44%
- Respondents who are comfortable with advertisers using their web browsing history to tailor advertisements as long as it is not tied to any other personally identifiable information: 36%, up from 29% in 2012
- Percentage of voters who do not want political campaigns to tailor their advertisements based on their interests: 86%
- Percentage of respondents who do not want news tailored to their interests: 56%
- Percentage of users who are worried about their information will be stolen by hackers: 75%
- Those who are worried about companies tracking their browsing history for targeted advertising: 54%
- How many consumers say they do not trust businesses with their personal information online: 54%
- Top 3 most trusted companies for privacy identified by consumers from across 25 different industries in 2012: American Express, Hewlett Packard and Amazon
- Most trusted industries for privacy: Healthcare, Consumer Products and Banking
- Least trusted industries for privacy: Internet and Social Media, Non-Profits and Toys
- Respondents who admit to sharing their personal information with companies they did not trust in 2012 for reasons such as convenience when making a purchase: 63%
- Percentage of users who say they prefer free online services supported by targeted ads: 61%
- Those who prefer paid online services without targeted ads: 33%
- How many Internet users believe that it is not possible to be completely anonymous online: 59%
- Those who believe complete online anonymity is still possible: 37%
- Those who say people should have the ability to use the Internet anonymously: 59%
- Percentage of Internet users who believe that current laws are not good enough in protecting people’s privacy online: 68%
- Those who believe current laws provide reasonable protection: 24%
Security Related Issues
- How many have had an email or social networking account compromised or taken over without permission: 21%
- Those who have been stalked or harassed online: 12%
- Those who think the federal government should do more to act against identity theft: 74%
- Consumers who agree that they will avoid doing business with companies who they do not believe protect their privacy online: 89%
- Among 65+ year old consumers: 96%
Privacy-Related Behavior
- How many mobile phone users have decided not to install an app after discovering the amount of information it collects: 54%
- Number of Internet users who have taken steps to remove or mask their digital footprint (including clearing cookies, encrypting emails, and using virtual networks to mask their IP addresses): 86%
- Those who have set their browser to disable cookies: 65%
- Number of users who have not allowed a service to remember their credit card information: 73%
- Those who have chosen to block an app from accessing their location information: 53%
- How many have signed up for a two-step sign-in process: 57%
- Percentage of Gen-X (33-48 year olds) and Millennials (18-32 year olds) who say they never change their passwords or only change them when forced to: 41%
- How many report using a unique password for each site and service: 4 in 10
- Those who use the same password everywhere: 7%
Sources
- “2012 Most Trusted Companies for Privacy,” Ponemon Institute, January 28, 2013.
- “Fortinet 2014 Privacy Survey Reveals Gen-X and Millennial Attitudes Surrounding Passwords, Personal Data, Email Snooping and Online Marketing Practices” Fortinet, Feb 24, 2014.
- “Global Privacy Survey 2013,” MEFMobile, 2013.
- “Internet Security Priorities,” Computer and Communications Industry Association, December 20, 2013.
- Kiss, Jemima. “Privacy Tools used by 28% of the online world, research finds,” The Guardian, 21 January 2014.
- Kumaraguru, Ponnurangam, and Lorrie Faith Cranor. “Privacy indexes: a survey of Westin’s studies.” Institute for Software Research International, Carnegie Mellon University, and Carnegie Mellon CyLab. December 2005.
- “Most Trusted Retail Banks for Privacy,” Ponemon Institute, October 10, 2013.
- “TRUSTe 2014 US Consumer Confidence Privacy Report,” TRUSTe, 2014.
- Rainie, Lee, Kiesler, Sara, Kang, Ruogu, and Madden, Mary. “Anonymity, Privacy, and Security Online,” PewResearch Internet Project, September 05, 2013.
- Smith, Aaron and Mary Madden. “Privacy and Data Management on Mobile Devices,” PewResearch Internet Project, September 5, 2012.
- Turow, Joseph, Carpini, Michael, Draper, Nora, and Rowan Howard-Williams. “Americans Roundly Reject Tailored Political Advertising,” Annenberg School for Communication, University of Pennsylvania.
Statistics and Open Data: Harvesting unused knowledge, empowering citizens and improving public services
House of Commons Public Administration Committee (Tenth Report):
“1. Open data is playing an increasingly important role in Government and society. It is data that is accessible to all, free of restrictions on use or redistribution and also digital and machine-readable so that it can be combined with other data, and thereby made more useful. This report looks at how the vast amounts of data generated by central and local Government can be used in open ways to improve accountability, make Government work better and strengthen the economy.
2. In this inquiry, we examined progress against a series of major government policy announcements on open data in recent years, and considered the prospects for further development. We heard of government open data initiatives going back some years, including the decision in 2009 to release some Ordnance Survey (OS) data as open data, and the Public Sector Mapping Agreement (PSMA) which makes OS data available for free to the public sector. The 2012 Open Data White Paper ‘Unleashing the Potential’ says that transparency through open data is “at the heart” of the Government’s agenda and that opening up would “foster innovation and reform public services”. In 2013 the report of the independently-chaired review by Stephan Shakespeare, Chief Executive of the market research and polling company YouGov, of the use, re-use, funding and regulation of Public Sector Information urged Government to move fast to make use of data. He criticised traditional public service attitudes to data before setting out his vision:
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- To paraphrase the great retailer Sir Terry Leahy, to run an enterprise without data is like driving by night with no headlights. And yet that is what Government often does. It has a strong institutional tendency to proceed by hunch, or prejudice, or by the easy option. So the new world of data is good for government, good for business, and above all good for citizens. Imagine if we could combine all the data we produce on education and health, tax and spending, work and productivity, and use that to enhance the myriad decisions which define our future; well, we can, right now. And Britain can be first to make it happen for real.
3. This was followed by publication in October 2013 of a National Action Plan which sets out the Government’s view of the economic potential of open data as well as its aspirations for greater transparency.
4. This inquiry is part of our wider programme of work on statistics and their use in Government. A full description of the studies is set out under the heading “Statistics” in the inquiries section of our website, which can be found at www.parliament.uk/pasc. For this inquiry we received 30 pieces of written evidence and took oral evidence from 12 witnesses. We are grateful to all those who have provided evidence and to our Specialist Adviser on statistics, Simon Briscoe, for his assistance with this inquiry.”
Table of Contents:
Summary
1 Introduction
2 Improving accountability through open data
3 Open Data and Economic Growth
4 Improving Government through open data
5 Moving faster to make a reality of open data
6 A strategic approach to open data?
Conclusion
Conclusions and recommendations