MEASURING THE BENEFITS FROM PUBLIC SERVICES: THE EFFECTS OF LOCAL GOVERNMENT SPENDING ON THE DISTRIBUTION OF INCOME IN NORWAY

The purpose of this paper is to provide an evaluation of how local public in-kind benefits affect the distribution of income in Norway. To this end, a method that accounts for differences between municipalities in capacity to produce the same standard of public services is used for assessing the value of sector-specific local public services in each municipality. Moreover, recipient frequencies in various demographic groups are used as basis for determining the allocation of the assessed value of services on citizens of the municipalities. The empirical results show that inequality in the (marginal) distribution of municipal in-kind benefits is rather high. The contribution of municipal in-kind benefits to inequality in the distribution of extended income (cash (after-tax) income plus municipal in-kind benefits) proves, however, to be approximately neutral.     

An estimation of the demand and supply for physician services using a panel data

Using the single-equation and simultaneous equations methods, demand and supply for physician services at medical practices are estimated with panel data, which is primarily based on American Medical Association divisional surveys. Fixed effects and no-effects models are employed for estimation of the parameters of the simultaneous equations and their elasticities. The results suggest that the demand is highly income inelastic. However, private insurance and Medicaid raise the rate of utilization. The adverse effect of uninsured is also evident, though it is not as high as private insurance. Evidence also supports the demand inducement hypothesis and points to the rising demand for health care as the U.S. population is aging. The supply function parameters generally demonstrate their expected pattern. It is notable that the malpractice liability premiums exhibit a negligible effect on the supply of office visits.     

More health care utilization with more insurance coverage? Evidence from a latent class model with German data

We analyse the impact of optional deductibles, private supplementary health insurance and income on the demand for health care utilization, measured as the number of physician visits with data from the German Socio-Economic Panel (SOEP). With a set of newly available variables for the years 2002, 2004 and 2006 that measure individual health more accurately and including risk-attitudes towards health we find that possible endogeneity of the insurance choice is not a problem. A latent class approach that takes into account the panel structure of the data reveals that especially individuals who have few doctor visits, the low users, respond strongest to insurance status and income. In this group we find that more insurance increases the demand for physician visits and there is a pro-rich inequity in health care utilization. No such effects are found for the high users.     

Energy demand in the transportation sector of Mexico

This paper report results of an analysis of the demand for energy in the Mexican transport sectors, focusing on the railroad, air transport and motor vehicle modes. The approach is an econometric one with emphasis placed on the structure for each mode. For two of the modes a two-stage approach is employed where in the first stage demands for services from the particular mode are modeled, and in the second stage demand is treated as a derived demand from these transport services. For the motor vehicle mode, gasoline demand is considered as the product of gasoline consumption per vehicle times the total number of vehicles, and then these components are related to economic and structural variables. Diesel demand of motor vehicles is modeled in a more reduced from approach. The principal finding is that changes in income play a more important role in affecting energy demand than do changes in energy prices, especially in the railroad and air transport sectors. For the gasoline and diesel fuel demand in the monitor vehicle sector, however, price is of substantial importance.     

THE RISE AND IMPACT OF NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS ON THEIR OWN AND CROSS-OCCUPATION INCOMES

There has been a dramatic increase in the authority granted to nurse practitioners (NP) and physician assistants (PA). This "expanded" authority has changed who can provide health-care services and has weakened the control physicians have traditionally held over the provision of medical services. These changes in regulation have varied by occupation, state, and year and provide variation that can be exploited to empirically measure the individual and collective impacts of changes in NP authority and PA authority on practitioner incomes. It is found that changes in NP and PA regulatory authority do impact the labor markets of all three practitioner categories. NPs having greater practice authority brings physician incomes down, has differential impacts on PA incomes, and improves their own earnings, other factors held constant. PAs having increased authority has a downward effect on NP earnings, a positive impact on physician income, and little impact on their own incomes. ( JEL I18, J18, J44, H75)     

THE EFFECTS OF ENDOGENOUS MARKET ENTRY OF PHYSICIAN‐OWNED HOSPITALS ON MEDICARE EXPENDITURES: AN INSTRUMENTAL VARIABLES APPROACH

This study examines the effect of physician‐owned hospitals (POHs) on Medicare per enrollee expenditures at the metropolitan area (MSA) level nationwide, spanning the 8‐year time period from 1998 to 2005. The study uses fixed effects panel data estimation with instrumental variables to account for the bias introduced by endogenous POH market entry (i.e., POHs may be more likely to open in high‐growth/high‐demand markets with high levels of Medicare per enrollee expenditures). After controlling for other variables that are likely to affect expenditures (especially the age and sex distribution of the MSA), we find no association between POH presence and Medicare expenditures per enrollee at the MSA level. The results are robust to changes in model specification, estimation technique, and definition of geographic market. These findings suggest that the “demand inducement” aspects of physician ownership of acute care hospitals (if any) have no meaningful impact on market‐level Medicare expenditures per enrollee. Current policies based on an assumption that POHs are associated with significant increases in total expenditures may need to be reassessed. (JEL I11, L10, C33)     

中国居民消费需求不足原因研究——基于中国城乡分省数据

This paper uses Chinese urban and rural panel data for 30 provinces, autonomous regions and municipalities (except Tibet and Taiwan) on the consumption of Chinese urban and rural households in 1995–2005, by constructiong a random effect model, to analyze the impact of sources of household’s consumption demand on the Chinese economy. The quantitative analysis reveals that the per capita disposable income of households is highly relevant in explaining households’ per capita consumption expenditure, in these eleven years, and that China’s consumption function was fairly stable. On the basis of flow of funds accounts (barter transaction) data in 1992–2004, the paper further reveals that, since 1997–1998, China’s consumer demand remains in the doldrums because of the following distribution and redistribution process of the national income: The Government’s share of total income and disposable income is becoming ever larger, while the share of households is declining. Aside from the result that a rise in the burden of personal tuition has a negative impact on per capita consumption demand for urban households, we have not found that housing reform or medical expenses significantly reduce consumer demand in China. We believe that low household consumption demand is caused mainly by the income redistribution between households, government, and corporations rather than the inequality in income distribution across households.     

Income convergence clubs for Brazilian Municipalities: a non-parametric analysis

This article analyses the evolution of relative per capita income distribution of Brazilian municipalities over the period 1970–1996. Analyses are based on non-parametric methodologies and do not assume probability distributions or functional forms for the data. Two convergence tests have been carried out – a test for sigma convergence based on the bootstrap principle and a beta convergence test using smoothing splines for the growth regressions. The results obtained demonstrate the need to model the dynamics of income for Brazilian municipalities as a process of convergence clubs, using the methodology of transition matrices and stochastic kernels. The results show the formation of two convergence clubs, a low income club formed by the municipalities of the North and Northeast regions, and another high income club formed by the municipalities of the Center-West, Southeast and South regions. The formation of convergence clubs is confirmed by a bootstrap test for multimodality.     

经济增长中非经济性公共物品需求分析

利用2003—2010年我国29个省(自治区、直辖市)的面板数据,对教育支出、医疗卫生支出、科技支出、社会保障补助支出和环境保护支出五类非经济性公共物品支出需求函数进行了估计,实证检验了与公共支出需求相关的因素。结果显示:非经济性公共物品需求与人均收入、人口规模和城市化率正相关;在温饱问题解决后,随着居民收入的增加,即使居民的税收负担有所上升,居民对教育、医疗和科技的需求也会不断增加;失业率的上升会减少居民对教育、科技和医疗的需求,但会增加对社会保障的需求;环境保护关系到城市的可持续发展,产业结构调整可能有助于缓解环境保护支出与需求的矛盾。     

THE ASSOCIATION BETWEEN PHYSICIAN SUPPLY AND THE MIX OF GENERALIST AND SPECIALIST SERVICES USED

Variations in physician supply, and the impact on a patient's use of physicians, remains a concern. This article asks how the supply of physicians is associated with both the number of visits and the dollar value of services received from general practitioners and specialists. Ontario respondents in the Canadian Community Health Survey 2000/2001 are linked to their Ontario Health Insurance Program claims for 3 years (1999–2002). A geographic weighting method is employed to account for physician supply in surrounding jurisdictions. The results are consistent with the conclusion patients substitute one physician type for another when physician supply is constrained. (JEL I10, I12, C29, C39, C52)     

Income effects and physician labour supply: evidence from the threshold system in Ontario

Abstract. We examine a reform to the physician threshold system in Ontario that provides a unique opportunity to assess the effect of fee changes on physician behaviour, free from the biases that potentially affect simple time‐series or cross‐section inference. We find that: (1) the income effects of fee changes are small, but significant; (2) the income effect dominates the substitution effect only for a minority of services with relatively low prices and high volumes; and (3) the cross effects of fee changes tend to be significant only for services with relatively high prices and low volumes.     

THE DEMAND FOR SCHOOL MEAL SERVICES BY SWISS HOUSEHOLDS*

In this paper we investigate the household demand for childcare during lunchtime at school using a stated preferences approach. Data are collected through phone‐structured interviews to 905 residents with children in the German‐speaking region of Switzerland during 2007. Poisson models with random and fixed effects are used to explore factors affecting the demand. Ordinal probit models are also considered as an alternative to count data models. The results show that price, household income, satisfaction with the current childcare service, family composition, and the area of residence significantly affect the number of weekly services demanded. We estimate that the willingness to pay for childcare during lunchtime is between 7.90 and 11.70 Swiss francs per day and does not depend on household income.     

Empirical determinants of physician incomes — Evidence from Canadian data

This paper makes use of the fact that the stock of medical manpower in Canada is institutionally and exogenously determined in order to develop a model predicting physician average net income. An econometric evaluation of this model on a sample involving Canada's ten provinces during 1968–1982 suggests that a one per cent increase in physician fees increases physician average net income by 0.70 per cent, and a one per cent increase in the physician to population ratio reduces average net income by 0.62 per cent. In both cases, the elasticities are less than unity because the supply function for an individual physician is backward bending — on average, a Canadian physician reduces his hours worked by an amount between 0.17 and 0.50 per cent (95 per cent confidence interval) if his real wage rate is increased by one per cent.     

Testing mean reversion in target-zone exchange rates

This study applies a multinomial logit model of human-capital migration to examine the factors influencing the movement of physicians within Canadian provinces between 1976 and 1992. The empirical investigation covers general practitioners and specialists (it excludes interns/residents) between seven regions (Atlantic Canada, Quebec, Ontario, Manitoba, Saskatchewan, Alberta and British Columbia). The results suggest that differences in real income have a positive and significant effect on a physician's decision to migrate form one province to another. Provinces with the highest after tax income, highest expenditure per physician, and highest fee-per-service rates have the highest net rate of in-migration. Income differences are however, not the only factor influencing a physician's choice to move. Working conditions within a province, which we proxy with the number of hospitals beds and health expenditures per capita, are also important factors. Likewise, the ratio of rural to urban population, distance between the major city in each province and provincial population all have a negative impact on a physician's migration choice. Finally, a dummy variable is used to allow for language differences between Quebec and the rest of the provinces and find that language differences have a significant and negative impact on a physician decision to migrate.     

The immiseration of the landlords: rent in a Kaldorian theory of income distribution

This paper incorporates rent within a Kaldorian model of distributionwhere income shares depend on aggregate investment and the propensitiesto save out of profits, rents and wages. The model is used tointerpret the significance of the secular decline in rents asa share of national income and to specify the circumstancesunder which both the capital/output ratio and the wage shareof national income may rise. The author pursues Keynes's suggestiveremarks about land's liquidity value and shows how an increasein the demand for land, by producers, consumers or wealthholdersreduces the rate of profit and therewith the inducement to invest.     

Demand for locally provided public services within the median voter's framework: the case of the Brazilian municipalities

In this paper we estimated the demand for local public spending for the Brazilian municipalities within a median voter's framework. The rationale for applying that framework came from the fact that in federal systems voters’ preferences are more likely to be reflected at the local level as the consumers of public services have a better knowledge of the benefits and costs of the local public expenditures. Results obtained are consistent with the theoretical background thus suggesting that this hypothesis might be useful to describe the demand for local public goods in Brazil. In particular, the use of quantile regression permitted us to investigate the impacts of the conditioning variables on local public expenses across different expenditures classes thus allowing for heterogeneity across municipalities. Our results also suggest that the impact of the city size on the quality of club goods shows crowding effects as γ is between zero and one. However, in the estimated models, marginal congestion slightly decreases with expenditure. This is a rather surprising result as one is tempted to conclude that the congestion effect should be higher on big cities. Yet, a more careful look shows the drawbacks of such an interpretation. The indivisibilities preclude the provision of certain services in small towns, concentrating their provision on larger cities. Hence, the higher expenditures of those big cities reflect not only a crowding cost but also the fact that these towns offer a wide range of services when compared to the small ones.     

Demand for education in China

Abstract

This paper offers an explanation of the quantitative changes in education spending by the framework of demand analysis, including the changes in the ratio of educational funding to GDP in the period 1991–2002. The income effect is estimated mainly by using cross-provincial data, while time series data are used to estimate the price effect. Changes in government and non-government spending through time can be satisfactorily explained by the income and price effects. Demand for education services in the three levels of primary school, secondary school and higher education, and aggregate demand for all education services are investigated. The relation between income inequality and inequality in education opportunities is briefly discussed. Ten important findings are stated.     

Domestic Violence Against Rural Women in Colombia: The Role of Labor Income

This paper analyzes the effect of women’s earnings on domestic violence in rural Colombia during the period 2009–2013. To this end, it builds an indicator of domestic violence against women at the municipal level, based on the number of visits of women who attended health facilities where a report on suspected domestic violence was issued by their physician, which overcomes the bias introduced by self-reporting victims. Results indicate that greater income generation by women in rural areas in most economic activities (coffee, fruits, commerce, and industry) decreases domestic violence, while in services, the opposite occurs. The latter could be the result of the mainly menial jobs women perform in this sector, which may be undervalued in their homes, thus making them more vulnerable. The study also finds that improvements in the municipality’s economic activity and access to education contribute to the reduction of domestic violence against women.     

Is the median voter decisive? Evidence from referenda voting patterns

This paper examines whether the voter with the median income is decisive in local spending decisions. Previous tests have relied on cross-sectional data while we make use of a pair of California referenda to estimate a first difference specification. The referenda proposed to lower the required vote share for passing local educational bonding initiatives from 67 to 50% and 67 to 55%, respectively. We find that voters rationally consider future public service decisions when deciding how to vote on voting rules. However, the empirical evidence strongly suggests that an income percentile below the median is decisive for majority voting rules, especially in communities that have a large share of high-income voters with attributes that suggest low demand for public services. Based on a model that explicitly recognizes that each community contains voters with both high and low demand for public school spending, we also find that an increase in the share of low demand voters is associated with a lower decisive voter income percentile for the high demand group. This two type model implies that our low demand types (individuals over age 45 with no children) have demands that are 45% lower than other voters. Collectively, these findings are consistent with high-income voters with weak preferences for public educational services voting with the poor against increases in public spending on education.     

Satisfaction with botulinum toxin treatment in post-stroke spasticity: results from two cross-sectional surveys (patients and physicians)

Objective:

To characterize patient and physician satisfaction with current standard-of-care botulinum toxin treatment regimens for symptom control in patients with post-stroke spasticity using structured interviews with patients and physicians.

Research design and methods:

Two cross-sectional surveys were conducted in Canada, France, Germany, and the US. The patient survey included patients with post-stroke spasticity who had undergone at least two botulinum toxin A injection cycles. Information on patients’ current and prior botulinum toxin treatment cycles and quality of life was collected. The physician survey included physicians treating post-stroke spasticity with botulinum toxins and collected information regarding physician satisfaction with botulinum toxin treatment for post-stroke spasticity.

Results:

Of 79 participating patients with post-stroke spasticity, 61 (77%) received treatment with onabotulinumtoxinA, 15 (19%) with abobotulinumtoxinA, and three (4%) with incobotulinumtoxinA. Overall, 40.5% of patients were very satisfied, 48.1% were somewhat satisfied, and 11.4% were not at all satisfied with botulinum toxin treatment. Patient satisfaction was lowest just before injection and highest at the time of peak effect. The mean injection interval was 13.7 (SD?=?3.5) weeks; however, 43.4% of patients expressed a preference for intervals of ≤10 weeks. Most of the 105 participating physicians’ were moderately (57.7%) or very (36.5%) satisfied with botulinum toxin treatment. However, physicians estimated that 16.2% of their patients with post-stroke spasticity could benefit from shorter injection intervals, and that 24.6% of patients could benefit from higher doses than those permitted by current country directives.

Study limitations:

Patients’ responses were based on subjective recollections and physicians’ responses were based on general impressions.

Conclusions:

These surveys indicate that patients’ and physicians’ satisfaction with botulinum toxin therapy for post-stroke spasticity is overall very good. However, patients’ satisfaction over the treatment cycle varied with onset, peak, and trough of treatment effects and patients and physicians expressed a need for treatment individualization.