What did Medicare do? The initial impact of Medicare on mortality and out of pocket medical spending

We study the impact of the introduction of one of the major pillars of the social insurance system in the United States: the introduction of Medicare in 1965. Our results suggest that, in its first 10 years, the establishment of universal health insurance for the elderly had no discernible impact on elderly mortality. However, we find a substantial reduction in the elderly's exposure to out of pocket medical expenditure risk. Specifically, we estimate that the introduction of Medicare was associated with a 40% decline in out of pocket spending for the top quartile of the out of pocket spending distribution. A stylized expected utility framework suggests that the welfare gains from such reductions in risk exposure alone may be sufficient to cover almost two-fifths of the costs of Medicare. These findings underscore the importance of considering the direct insurance benefits from public health insurance programs, in addition to any indirect benefits from an effect on health.     

Exports, Returns to Scale, and Total Factor Productivity: The Case of Taiwanese Manufacturing Industries

The paper examines the relevance of international scale economies and international market efficiency of trade based on the firm-level data of Taiwanese manufacturing industries. The author first constructs a simple analytical framework to measure the extent of scale economies and total factor productivity for each firm. The measurements of scale economies and total factor productivity are then used to investigate the relationships among exports, scale economies, and productivity. Significant external scale economies associated with exports and a strong positive relationship between the individual firm's productivity and its own export intensity are observed.     

Explaining the Recent Decline in Domestic Violence

According to the Department of Justice (DOJ), the incidence of domestic violence decreased during the 1990s. Understanding the causes of this decline could offer important insight into designing effective policies to continue this trend. This article uses the Area-Identified National Crime Victimization Survey (NCVS), the same data used to generate the DOJ's national estimates, merged with county-level variables, to examine the determinants of women reporting abuse. The results indicate that there are three important factors that likely contribute to the decline: (1) the increased provision of legal services for victims of intimate partner abuse, (2) improvements in women's economic status, and (3) demographic trends, most notably the aging of the population.     

Developing a tool to measure pharmacoeconomic outcomes of post-surgical pain management interventions

Background:

Financial pressures have limited the ability of providers to use medication that may improve clinical outcomes and patient satisfaction. New interventions are often fraught with resistance from individual cost centers. A value realization tool (VRT) is essential for separate cost centers to communicate and comprehend the overall financial and clinical implications of post-surgical pain management medication interventions (PSMI). The goal was to describe development of a VRT.

Methods:

An evaluation of common in-patient PSMI approaches, impacts, and costs was performed. A multidisciplinary task force guided development of the VRT to ensure appropriate representation and relevance to clinical practice. The main outcome was an Excel-based tool that communicates the overall cost/benefit of PSMI for the post-operative patient encounter.

Results:

The VRT aggregated input data on costs, clinical impact, and nursing burden of PSMI assessment and monitoring into two high-level outcome reports: Overall Cost Impact and Nurse & Patient Impact. Costs included PSMI specific medication, equipment, professional placement, labor, overall/opioid-related adverse events, re-admissions, and length of stay. Nursing impact included level of practice interference, job satisfaction, and patient care metrics. Patient impact included pain scores, opioid use, PACU time, and satisfaction. Reference data was provided for individual institutions that may not collect all variables included in the VRT.

Conclusions:

The VRT is a valuable way for administrators to assess PSMI cost/benefits and for individual cost centers to see the overall value of individual interventions. The user-friendly, decision-support tool allows the end-user to use built-in referenced or personalized outcome data, increasing relevance to their institutions. This broad picture could facilitate communication across cost centers and evidence-based decisions for appropriate use and impacts of PSMI.     

Are optimistic expectations keeping the Chinese happy?

In this paper we study the effect of optimistic income expectations on life satisfaction amongst the Chinese population. Using a large scale household survey conducted in 2002 we find that the level of optimism about the future is particularly strong in the countryside and amongst rural-to-urban migrants. The importance of these expectations for life satisfaction is particularly pronounced in the urban areas, though also highly significant for the rural area. If expectations were to reverse from positive to negative, we calculate that this would have doubled the proportion of unhappy people and reduced proportion of very happy people by 48 per cent. We perform several robustness checks to see if the results are driven by variations in precautionary savings or reverse causality.     

An evaluation framework for technology transfer of new equipment in high technology industry

With the rapid advancement of technology, product life cycle is shortening continuously. In order to compete against other firms in fiercely competitive global markets, a firm has to keep developing new technology to differentiate itself from others. The acquisition of new core-technology equipment is especially important for manufacturing advanced products, and the technology know-how of the equipment must be transferred completely from equipment supplier to engineers and operators of the firm to effectively utilize the equipment. The objective of this paper is to explore the technology transfer of equipment and to establish a comprehensive framework for evaluating and selecting new equipment with critical technology transfer. Influence factors for technology transfer of new equipment are first collected by literature review and interviews with related experts in the thin-film transistor liquid-crystal display (TFT-LCD) industry in Taiwan. Fuzzy Delphi method (FDM) is applied next to select the most critical factors. Then, interpretive structural modeling (ISM) is employed to determine the interrelationship among the critical factors. A fuzzy analytic network process (FANP) model is constructed to evaluate the technology transfer performance of equipment suppliers. The results of this study should provide a base for firms in evaluating the purchase of new equipment and a reference for equipment suppliers to strengthen their technology transfer process to their buyers.     

ESTIMATING WELFARE IN INSURANCE MARKETS USING VARIATION IN PRICES

We provide a graphical illustration of how standard consumer and producer theory can be used to quantify the welfare loss associated with inefficient pricing in insurance markets with selection. We then show how this welfare loss can be estimated empirically using identifying variation in the price of insurance. Such variation, together with quantity data, allows us to estimate the demand for insurance. The same variation, together with cost data, allows us to estimate how insurer's costs vary as market participants endogenously respond to price. The slope of this estimated cost curve provides a direct test for both the existence and nature of selection, and the combination of demand and cost curves can be used to estimate welfare. We illustrate our approach by applying it to data on employer-provided health insurance from one specific company. We detect adverse selection but estimate that the quantitative welfare implications associated with inefficient pricing in our particular application are small, in both absolute and relative terms.     

Why Would She? Polygyny and Women's Welfare in Ghana

This study examines whether polygynous marriages are beneficial to women in Ghana. While some scholars claim that women benefit from such marriages in terms of higher consumption or leisure time, others believe that such relationships can be oppressive for women, as compared to monogamous relationships. Using household data from the 2005/6 Ghanaian Living Standards Measurement Survey V and the 2008 Ghanaian Demographic Health Survey, this study finds little evidence to support the view that women experience economic benefits from these unions. Polygynous women in Ghana tend to be more accepting of and experience more domestic violence, and they have less decision-making power within the household than women in monogamous marriages. Thus, there seems to be more evidence to support the view of polygyny as an oppressive institution rather than the outcome of a woman's rational choice.     

Protecting Property: The Politics of Redistribution,Expropriation, and Market Openness

This paper develops a formal model to disentangle the competing political incentives for redistribution, expropriation, and market openness. Although redistribution and expropriation are both types of government extraction, redistribution re‐allocates wealth within the citizenry, while expropriation re‐allocates wealth from citizens to the government. Representative political institutions increase redistribution and reduce expropriation. Market openness changes these incentives, as foreign investors prefer reductions in both redistribution and expropriation. When political institutions are representative, the government will rely more on reducing expropriation, rather than limiting redistribution, to attract foreign investment. Under representative institutions then, openness partially reinforces the preferences of voters rather than undermining them. In addition, market liberalization occurs only when the policy changes needed to attract foreign investment are relatively small. If existing policies are satisfactory to foreign investors, moves toward openness may be accompanied by greater redistribution and expropriation, as governments are tempted by a larger base for extraction. Thus, openness has ambiguous effects on economic policy, at times encouraging and at times constraining extraction.