INSURANCE‐INDUCED MORAL HAZARD: A DYNAMIC MODEL OF WITHIN‐YEAR MEDICAL CARE DECISION MAKING UNDER UNCERTAINTY

This study quantifies the moral hazard effect of health insurance on medical expenditure by estimating a dynamic model of within‐year medical care consumption that allows for insurance selection, endogenous health transitions, and individual uncertainty about medical care prices in an environment where insurance has nonlinear cost‐sharing features. The results suggest that moral hazard accounts for 53.1%, on average, of total annual medical expenditure when insured. This estimate is significantly different, and generally larger, than that produced by an alternative model that is representative of the annual medical care decision‐making models commonly found in the literature.     

Real Incentive Effects of Soft Information

Both soft, noncontractible, and hard, contractible, information are informative about managerial ability and future firm performance. If a manager's future compensation depends on expectations of ability or future performance, then the manager has implicit incentives to affect the information. We examine the real incentive effects of soft information in a dynamic agency with limited commitment. When long-term contracts are renegotiated, the rewards for future performance inherent in long-term contracts allow the principal partial control over the implicit incentives. This is because the soft information affects the basis for contract renegotiation. With short-term contracts, the principal has no control over the basis for contract negotiation, and thus long-term contracts generally dominate short-term contracts. With long-term contracts, the principal's control over implicit incentives is characterized in terms of effective contracting on an implicit aggregation of the soft information that arises from predicting (forming expectations of) future performance. We provide sufficient conditions for soft information to have no real incentive effects. In general, implicit incentives not controllable by the principal include fixed effects, such as career concerns driven by labor markets external to the agency. When controllable incentives span the fixed effects of career concerns, the latter have no real effects with regard to total managerial incentives—they would optimally be the same with or without career concerns. Our analysis suggests empirical tests for estimating career concerns that should explicitly incorporate noncontractible information.     

Working days in a London construction team in the eighteenth century: evidence from St Paul's Cathedral

This article provides new information and data on the work and pay of skilled and semi-skilled men on a large London construction project in the early 1700s. It offers firm-level evidence on the employment relation in the construction industry at the time and sheds some light on the number of days worked per year and per week, showing that employment was more irregular and seasonal than current estimates of income infer. The patterns are considered in the context of new debates about industriousness and economic growth.     

Tobacco retail licences and state formation in early modern England and Wales

This article addresses one under‐studied aspect of Charles I's finances during his Personal Rule: the licensing of tobacco retailers. While it was ultimately a failed project, the tobacco retail licence project was fiscally successful before the transformative events of the 1640s triggered its demise. The project enabled tobacco retail licensees to establish commercial outlets for the marketing of tobacco throughout England and Wales, and cooperation with pre‐existing officeholders contributed to the apprehension of unlicensed retailers. Ultimately, the geographic breadth of tobacco licences translated into much‐needed royal revenue which, when added to other projects and patents, contributed to the king's financial survival. The evidence presented here suggests that we may want to rethink some of our assumptions for how the process of state formation worked and that earlier seventeenth‐century ‘prototypes’ of taxation were more fiscally successful than previously recognized.     

Class structure and inequality during the industrial revolution: lessons from England's social tables, 1688–1867

This article measures the size and incomes of six major social classes across the industrial revolution using social tables for England and Wales in 1688, 1759, 1798, 1846, and 1867. Lindert and Williamson famously revised these tables, and this article extends their work in three directions. First, servants are removed from middle‐ and upper‐class households in the tables of King, Massie, and Colquhoun and tallied separately. Second, estimates are made for the same tables of the number and incomes of women and children employed in the various occupations, and, third, incomes are broken down into rents, profits, and employment income. These extensions to the tables allow variables to be computed that can be checked against independent estimates as a validation exercise. The tables are retabulated in a standardized set of six social groups to highlight the changing structure of society across the industrial revolution. Gini coefficients are computed from the social tables to measure inequality. These measures confirm that Britain traversed a ‘Kuznets curve’ in this period. Changes in overall inequality are related to the changing fortunes of the major social classes.     

Terror per Capita

Studies on the correlates of terrorism usually analyze total numbers of attacks or victims per country. However, what we may ultimately care about in terms of policy recommendations is the likelihood of any individual being subject to the respective phenomenon. Thus, we propose and explore a simple alternative measure of terrorism: terror per capita. Studying terror per capita across 162 countries from 1970–2015, the associated correlates differ substantially in terms of sign, levels of statistical significance, and magnitude from those when analyzing total terror. We illustrate two cases in point, serving as proof of concept. First, democracy, often associated with more total terror, emerges as a marginally negative predictor of terror per capita. Second, a larger share of Muslims in society is associated with a positive and statistically significant link to total terror, but emerges as a negative predictor of terror per capita. We find similar changes in sign and statistical relevance for GDP per capita and language fractionalization as correlates of terrorism. Depending on the policy question, studying terror per capita can greatly enhance our understanding of terrorism drivers, especially when analyzing data across countries with vastly differing population sizes.     

Psychometric validation of anti-clot treatment scale and treatment satisfaction questionnaire for medication version II in Japanese patients with atrial fibrillation

Aims: The Anti-Clot Treatment Scale (ACTS) and Treatment Satisfaction Questionnaire for Medication version II (TSQM-II) are validated treatment satisfaction patient-reported outcome (PRO) instruments. The ACTS includes two domains: Burdens and Benefits; the TSQM-II includes four: Effectiveness, Side Effects, Convenience, and Global Satisfaction. Japanese-language versions of the ACTS and TSQM-II have been developed and linguistically validated. This study aimed to assess their psychometric properties in Japanese patients with atrial fibrillation (AF).

Materials and methods: ACTS and TSQM-II data from 534 patients with AF were collected in a Japanese post-marketing surveillance study of a direct oral-anticoagulant, rivaroxaban. Four key psychometric properties, in line with best practice guidelines from the US Food and Drug Administration, were examined using traditional psychometric methods: acceptability, scaling assumptions, reliability (i.e. internal consistency reliability, test-retest reliability), and construct validity (i.e. convergent validity and known groups).

Results: ACTS Burdens and Benefits and TSQM-II Effectiveness, Convenience, and Global Satisfaction scales were found to be acceptable (e.g. item-level missing data at baseline <4%), with all scales having good internal consistency (Cronbach’s alpha > 0.80). test-retest reproducibility intraclass correlation coefficients for the ACTS Burdens and Benefits were 0.59 and 0.65, respectively, and between 0.54–0.61 for the TSQM-II scales. Known-groups validity for the ACTS and TSQM-II was supported by differences in scale scores by positive and negative impact (p?<?0.05). Correlations between the ACTS and TSQM-II (convergent validity) were lower than expected (range r?=?0.09–0.48), but in line with the original ACTS development study.

Limitations: Evaluation of test-retest reproducibility was limited by assessment period, which was longer (3 months) than recommended guidelines (usually up to 2 weeks).

Conclusions: Overall, Japanese versions of ACTS and TSQM-II scales satisfied internal consistency reliability and traditional validity criteria. Our study supports the ACTS and TSQM-II as appropriate PRO instruments to measure satisfaction with anticoagulant treatment in Japanese patients with AF.

Trial registration: NCT01598051, clinicaltrials.gov; registered April 20, 2012.     

The Econometrics and Economics of the Employment Effects of Minimum Wages: Getting from Known Unknowns to Known Knowns

I discuss the econometrics and the economics of past research on the effects of minimum wages on employment in the United States. My intent is to try to identify key questions raised in the recent literature, and some from the earlier literature, which I think hold the most promise for understanding the conflicting evidence and arriving at a more definitive answer about the employment effects of minimum wages. My secondary goal is to discuss how we can narrow the range of uncertainty about the likely effects of the large minimum wage increases becoming more prevalent in the United States. I discuss some insights from both theory and past evidence that may be informative about the effects of high minimum wages, and try to emphasize what research can be done now and in the near future to provide useful evidence to policy‐makers on the results of the coming high minimum wage experiment, whether in the United States or in other countries.     

The Great Recession,Austerity and Inequality: Lessons from Ireland

The advent of the Great Recession and the widespread adoption of fiscal austerity policies have heightened concern about inequality and its effects. We examine how the distribution of income in Ireland—a country which experienced one of the most severe economic contractions—has evolved over the years 2008 to 2013. Standard cross‐sectional analysis of the income distribution shows broad stability in the Gini coefficient and in decile shares, with one main exception: the share of the bottom decile fell sharply, with the largest fall in average incomes being for that group. Longitudinal analysis shows that the falls in the average income for the bottom decile were not due to decreasing income for those remaining in the bottom decile, but to falls in income from those initially located in higher deciles. The extent of redistribution through taxes and transfers increased strongly, as measured by the Reynolds‐Smolensky index, which rose from 0.20 before the onset of the crisis to 0.27 in 2013. Analysis indicates that about three‐quarters of this increased redistribution is due to automatic stabilisers and one‐quarter to discretionary policy changes.