This article focuses on the marketisation of education in Singapore since the mid-1980s. It descr... more This article focuses on the marketisation of education in Singapore since the mid-1980s. It describes and analyses two major manifestations of this phenomenon: the encouragement of greater school autonomy and the fostering of competition among schools. The article argues that the Singapore case does not involve a free market, but rather a regulated market. The promotion of such a quasi-market threatens to exacerbate not only the disparities between schools in terms of educational outcomes but also social inequalities. At the same time, it is not entirely clear whether the desired policy goals will be successfully attained. The discussion adds to the existing literature on the marketisation of education and its accompanying policy implications.
Abstract. We have developed learning environments that use learning by teaching with metacognitiv... more Abstract. We have developed learning environments that use learning by teaching with metacognitive support to help middle school students learn about complex science topics. We study the role of metacognitive feedback in learning by teaching environments by examining student behaviors and performance across a primary task and a transfer task, noting how the behavior patterns for the high and low performers change as they progress from the primary to the transfer task. In this paper, we examine the apparent behavior ...
To develop methods for investigating adherence to glaucoma medications by using a modified claims... more To develop methods for investigating adherence to glaucoma medications by using a modified claims data-based measure of adherence, validation by chart review, and patient and physician interviews. Data from administrative claims of 13,956 subjects receiving an initial glaucoma medication, and data from overlapping samples of 300 patients' charts, 300 interviews of patients, and 103 interviews of physicians were analyzed and compared. The mean medication possession ratio (MPR) was 0.64 (median 0.57) for the 13,956 subjects. Although 59% potentially had an ocular hypotensive agent at 12 months, only 10% had such medication available continuously. Chart review revealed that 31% of subjects "new to therapy" in claims data had actually been previously treated; and that 90% of the 17% who had medication added to initial monotherapy were misclassified by claims-based algorithms as medication switches or no change. Twenty percent of surveyed patients received samples on a regular basis and had lower MPR than those who did not (P < 0.05). Large pharmacy databases offer insight into medication usage but are vulnerable to errors from sampling (since patients who receive samples will be considered to have poor adherence), misidentification of newly treated patients, and misclassification of added versus switched medications. That a large proportion of patients stop and restart medications makes MPR a robust measure of adherence over time that reflects the resumption of medication after a gap in adherence. The data confirm that adherence to treatment with glaucoma medications is poor, similar to adherence in patients with other chronic diseases.
Uninterrupted use of ocular hypotensive medication by glaucoma patients is important to prevent v... more Uninterrupted use of ocular hypotensive medication by glaucoma patients is important to prevent vision loss, but medication persistence is poor. Efficacy and tolerability influence physicians' decisions and patient persistence, and differences between medications may impact persistence. To examine differences in physician's decisions to continue, switch, or discontinue therapy across three prostaglandin analogs (PGAs) latanoprost, bimatoprost, and travoprost using claims data supplemented by evaluation of physicians' charted therapeutic decisions. A year of pharmacy claims data for 6271 patients with a first (index) fill between 5/1/2001 and 11/30/2004 for PGA monotherapy were classified as 'persistent', 'switched', 'restarted', or 'discontinued' with initial PGA use. An analysis of index therapy continuation during the first 2 years reflected chart reviews for 223 patients with PGA monotherapy as the index prescription. Ten percent of patients had uninterrupted use of the initial PGA alone or in combination for a year. More than half (56%) stopped and then restarted, 16% switched, and 19% discontinued the initial PGA. Patients using latanoprost were more likely to be persistent (11%) compared to bimatoprost (9%) or travoprost (5%; p < 0.0001 overall comparison). Overall, 68% of patients on latanoprost persisted or restarted after a gap compared to 61% for bimatoprost and 58% for travoprost (p < 0.0001). Patient charts demonstrated a parallel pattern in physicians' decisions to continue latanoprost (56%), bimatoprost (45%), and travoprost (40%). Study limitations included the inability to establish causal links between variables, to account for sample use, or to document reasons for patient-driven changes in therapy. The study should be replicated in a more recent database including a larger population. Uninterrupted use of ocular hypotensive therapy for a full year is relatively rare. Differences in physicians' decisions to continue, switch, or discontinue PGAs were observed in claims data, and parallel trends were observed in patient medical records.
This chapter focuses on decentralization initiatives that have taken place in the Singapore educa... more This chapter focuses on decentralization initiatives that have taken place in the Singapore education system over the past two decades. These include the encouragement of greater school autonomy through the independent schools scheme, the autonomous schools scheme, and school clusters. Another initiative has been the promotion of aggressive inter-school competition through the annual publication of school ranking league tables and the institution of school quality awards. This sort of competition is supposed to promote diversity and choice and to improve overall educational standards. The chapter begins by discussing the goals of the various initiatives and proceeds to analyze their impact.
This article focuses on the marketisation of education in Singapore since the mid-1980s. It descr... more This article focuses on the marketisation of education in Singapore since the mid-1980s. It describes and analyses two major manifestations of this phenomenon: the encouragement of greater school autonomy and the fostering of competition among schools. The article argues that the Singapore case does not involve a free market, but rather a regulated market. The promotion of such a quasi-market threatens to exacerbate not only the disparities between schools in terms of educational outcomes but also social inequalities. At the same time, it is not entirely clear whether the desired policy goals will be successfully attained. The discussion adds to the existing literature on the marketisation of education and its accompanying policy implications.
Abstract. We have developed learning environments that use learning by teaching with metacognitiv... more Abstract. We have developed learning environments that use learning by teaching with metacognitive support to help middle school students learn about complex science topics. We study the role of metacognitive feedback in learning by teaching environments by examining student behaviors and performance across a primary task and a transfer task, noting how the behavior patterns for the high and low performers change as they progress from the primary to the transfer task. In this paper, we examine the apparent behavior ...
To develop methods for investigating adherence to glaucoma medications by using a modified claims... more To develop methods for investigating adherence to glaucoma medications by using a modified claims data-based measure of adherence, validation by chart review, and patient and physician interviews. Data from administrative claims of 13,956 subjects receiving an initial glaucoma medication, and data from overlapping samples of 300 patients' charts, 300 interviews of patients, and 103 interviews of physicians were analyzed and compared. The mean medication possession ratio (MPR) was 0.64 (median 0.57) for the 13,956 subjects. Although 59% potentially had an ocular hypotensive agent at 12 months, only 10% had such medication available continuously. Chart review revealed that 31% of subjects "new to therapy" in claims data had actually been previously treated; and that 90% of the 17% who had medication added to initial monotherapy were misclassified by claims-based algorithms as medication switches or no change. Twenty percent of surveyed patients received samples on a regular basis and had lower MPR than those who did not (P < 0.05). Large pharmacy databases offer insight into medication usage but are vulnerable to errors from sampling (since patients who receive samples will be considered to have poor adherence), misidentification of newly treated patients, and misclassification of added versus switched medications. That a large proportion of patients stop and restart medications makes MPR a robust measure of adherence over time that reflects the resumption of medication after a gap in adherence. The data confirm that adherence to treatment with glaucoma medications is poor, similar to adherence in patients with other chronic diseases.
Uninterrupted use of ocular hypotensive medication by glaucoma patients is important to prevent v... more Uninterrupted use of ocular hypotensive medication by glaucoma patients is important to prevent vision loss, but medication persistence is poor. Efficacy and tolerability influence physicians' decisions and patient persistence, and differences between medications may impact persistence. To examine differences in physician's decisions to continue, switch, or discontinue therapy across three prostaglandin analogs (PGAs) latanoprost, bimatoprost, and travoprost using claims data supplemented by evaluation of physicians' charted therapeutic decisions. A year of pharmacy claims data for 6271 patients with a first (index) fill between 5/1/2001 and 11/30/2004 for PGA monotherapy were classified as 'persistent', 'switched', 'restarted', or 'discontinued' with initial PGA use. An analysis of index therapy continuation during the first 2 years reflected chart reviews for 223 patients with PGA monotherapy as the index prescription. Ten percent of patients had uninterrupted use of the initial PGA alone or in combination for a year. More than half (56%) stopped and then restarted, 16% switched, and 19% discontinued the initial PGA. Patients using latanoprost were more likely to be persistent (11%) compared to bimatoprost (9%) or travoprost (5%; p < 0.0001 overall comparison). Overall, 68% of patients on latanoprost persisted or restarted after a gap compared to 61% for bimatoprost and 58% for travoprost (p < 0.0001). Patient charts demonstrated a parallel pattern in physicians' decisions to continue latanoprost (56%), bimatoprost (45%), and travoprost (40%). Study limitations included the inability to establish causal links between variables, to account for sample use, or to document reasons for patient-driven changes in therapy. The study should be replicated in a more recent database including a larger population. Uninterrupted use of ocular hypotensive therapy for a full year is relatively rare. Differences in physicians' decisions to continue, switch, or discontinue PGAs were observed in claims data, and parallel trends were observed in patient medical records.
This chapter focuses on decentralization initiatives that have taken place in the Singapore educa... more This chapter focuses on decentralization initiatives that have taken place in the Singapore education system over the past two decades. These include the encouragement of greater school autonomy through the independent schools scheme, the autonomous schools scheme, and school clusters. Another initiative has been the promotion of aggressive inter-school competition through the annual publication of school ranking league tables and the institution of school quality awards. This sort of competition is supposed to promote diversity and choice and to improve overall educational standards. The chapter begins by discussing the goals of the various initiatives and proceeds to analyze their impact.
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