Is HIT a hit? The impact of health information technology on inpatient hospital outcomes

In an effort to eliminate inefficiencies in the US health care sector, policymakers have made a concerted effort to encourage hospitals and physicians to adopt health information technology (HIT) systems. Using a unique data set on HIT adoption and health outcomes in New York State, we conduct a hospital-level analysis identifying the impact of adopting HIT on inpatient outcomes (rates of adverse drug events and severity-adjusted mortality). Unlike previous studies, the patient population is not restricted to Medicare patients, but covers all ages and insurance types. After controlling for unobserved hospital quality and endogenous HIT adoption, our results suggest that a hospital’s severity-adjusted mortality decreases by 0.3 percentage points. When restricted to the Medicare patients, we find HIT adoption lowers a hospital’s severity-adjusted mortality rate by 0.5 percentage points. We find HIT to have no significant effect on the rate of ADEs.     

Layout problem for an aircraft maintenance company tool room

A tool room of an aircraft maintainance company with 10000 tools is considered. These tools are borrowed by the mechanics when needed and must be returned before the end of shift. About 400 in-out transactions are handled by the storekeepers of the room. However, since the room is usually crowded with mechanics at their shift start/end times, the storekeepers are overloaded and significant productive manpower is held up in waiting for the tools. Therefore, the racks and tools in the tool room are required to be rearranged so that the handling time of the in/out transactions can be reduced.The racks are rearranged by heuristics and then tools are allocated to the racks according to request probabilities, which are estimated by the proportion of each tool's on-loan frequency to the total on-load frequency during December 1992. Effectiveness is measured by comparing the total rectilinear distance travelled to fetch the tools requested during 11–15 January 1993 based on the proposed changes, to that based on existing rack and tool arrangement. It was found that improvement by tool allocation according to the request probabilities could reach up to 39% with the existing rack arrangement. Furthermore, minor rearrangement on the racks could also reduce the distance travelled by 12%.     

The relative importance of time and dollar values in new product introduction decisions

This study investigates managerial sensitivity to timing differences in new product introduction decisions. Using a case scenario as the research setting, the study finds that in managerial decisions involving a choice between two-attribute alternatives (dollar value and time), respondents shifted their emphasis between attributes when they were personally affected by the decision outcome. Specifically, it was found that an additive constant manipulation (adding a constant to the dollar amount of each alternative) caused respondents to place more emphasis on the time attribute, and a multiplicative constant manipulation (multiplying the dollar amount of each alternative by a constant) caused them to place more emphasis on the dollar-value attribute.The study asks 108 subjects to assume the role of product manager in a case scenario and choose from among three two-attribute alternatives proposed by the case. The personal relevance of the decision was manipulated by telling respondents that the CEO in the decision scenario had stated publicly that the career of the decision maker would be (would not be) affected. The results show that the additive constant and multiplicative constant effects were only found when the decision outcomes would affect the respondents' career.     

The Coming Slavery: The Determinism of Herbert Spencer

Herbert Spencer (1820–1930) believed that Victorian Britain was moving toward a society of total regimentation (slavery). This movement was part of a cosmic process of evolution and dissolution. While the long-run (but not ultimate) destination of society was a higher form of social organization based on voluntary and complex interpersonal relationships, the immediate tendency was retrograde—a movement away from the liberation of mankind from the bondage of previous eras. This Article explores (1) the reasons for the retrograde movement, (2) its inevitability, and (3) the role of ideas in the process. The general conclusion is that in an effort to explain the general movement of social institutions and practices, Spencer develops a mechanical and deterministic approach which undermines his ability to pass normative judgements on changes in society.     

Cost comparison of radiofrequency catheter ablation versus cryoablation for atrial fibrillation in hospitals using both technologies

Objective: The objective of this study was to compare the cost of radiofrequency (RF) ablation vs cryoablation (Cryo) for atrial fibrillation (AF).

Methods: This retrospective cohort study used 2013–2014 records from the Premier Healthcare Database for adults with AF catheter ablation. Exclusions included non-AF ablation, surgical ablation, valve replacement or repair, or cardiac implant. Hospitals were required to perform ≥20 procedures using each technology, with the technology identifiable in at least 90% of cases. The primary endpoint was total variable visit cost, modeled separately for inpatient and outpatient visits, and adjusted for patient and hospital characteristics. Technology was categorized as RF or Cryo, with dual-technology procedures classified as Cryo. The Cryo cohort was further divided into Cryo only and Cryo with RF for sensitivity analyses. A composite adverse event endpoint was also compared.

Results: A total of 1261?RF procedures and 1276 Cryo procedures, of which 500 also used RF, met study criteria. RF patients were slightly older and sicker, and had more cardiovascular disease and additional arrhythmias. Adjusted inpatient costs were $2803 (30.0%) higher for Cryo, and adjusted outpatient costs were $2215 (19.5%) higher. Sensitivity models showed higher costs in both Cryo sub-groups compared with RF. Procedural complication rates were not significantly different between cohorts (p-values: 0.4888 inpatient, 0.5072 outpatient).

Conclusion: AF ablation using RF results in significantly lower costs compared with Cryo, despite an RF population with more cardiovascular disease. This saving cannot be attributed to a difference in complication rates.     

Identification of consumers’ preferences when their choices are unobservable

Summary. We provide conditions under which the heterogenous, deterministic preferences of consumers in a pure exchange economy can be identified from the equilibrium manifold of the economy. We extend those conditions to consider exchange economies, with two commodities, where consumers preferences are random. For the latter, we provide conditions under which consumers heterogenous random preferences can be identified from the joint distribution of equilibrium prices and endowments. The results can be applied to infer consumers preferences when their demands are unobservable.Received: 8 May 2003, Revised: 14 September 2004, JEL Classification Numbers: D12, D51.I am very grateful to an anonymous referee, Donald Brown, and Daniel McFadden for their detailed comments and insightful suggestions. Section 2 of this paper is joint work with Donald J. Brown; it is included here for publication with his permission. Those results were presented at the 1990 Workshop on Mathematical Economics at the University of Bonn, the 1992 SITE Workshop on Empirical Implications of General Equilibrium Models at Stanford University, and, more recently, at the June 2000 Conference in Honor of Rolf Mantel, in Buenos Aires, Argentina. The comments of the participants at those conferences and workshops are much appreciated. The research presented in this paper was supported by NSF Grants SES-8900291, SBR-9410182, and SES-0241858. This paper is dedicated to Marcel K. Richter, who has inspired much of my research.     

Real Convergence and European Integration: The Experience of the Less Developed EU Members

This study aims at providing an assessment about real convergence across countriesand regions in the EU, focusing more specifically on the four cohesion EU members.The results show that in the course of the last few years a process of convergence hastaken place between the per capita income levels of the EU regions and also, to a largerextent, of the Member States. Nevertheless, advances in real convergence are largelydetermined by the growth strategy implemented by the countries themselves. Lastly,our study suggests that the Community's regional policy has played a significant rolein favor of real convergence between the Member States of the EU. One importantlesson to be drawn is that the accession is likely to contribute significantly to improvingthe possibilities of the current Central and East European countries (CEECs) candidatesin aligning their per capita income levels with those of the EU members.     

Effects of Adverse Selection on a Multinational Firm’s Decision on where to Subcontract

This paper analyses the effects of adverse selection on a multinational firm’s decision on where to subcontract. Adverse selection arises since subcontractor firms have more information than the multinational concerning their production costs. The results obtained show that adverse selection confers to subcontractor firms an advantage in their relationship with the multinational, inducing the multinational to subcontract in more than one country. In this way, adverse selection modelling outcomes justify, and are coherent with, the empirical evidence such as, the diversity of countries that multinational firms subcontract and the fast production relocation between countries.