Finding a lasting cure for U.S. health care

In "Making Competition in Health Care Work" (July-August 1994), Elizabeth Olmsted Teisberg, Michael E. Porter, and Gregory B. Brown ask a question that has been absent from the national debate on health care reform: How can the United States achieve sustained cost reductions while at the same time maintaining quality of care? The authors argue that innovation driven by rigorous competition is the key to successful reform. A lasting cure for health care in the United States should include four basic elements: corrected incentives to spur productive competition, universal insurance to secure economic efficiency, relevant information to ensure meaningful choice, and innovation to guarantee dynamic improvement. In this issue's Perspectives section, eleven experts examine the current state of the health care system and offer their views on the shape that reform should take. Some excerpts: "On the road to innovation, let us not forget to develop the tools that allow physicians, payers, and patients to make better decisions." I. Steven Udvarhelyi; "Health care is not a product or service that can be standardized, packaged, marketed, or adequately judged by consumers according to quality and price." Arnold S. Relman; "Just as antitrust laws are the wise restraints that make competition free in other sectors of the economy, so the right kind of managed competition can work well in health care." Edward M. Kennedy "Biomedical research should be considered primarily an investment in the national economic well-being with additional humanitarian benefits." Elizabeth Marincola.     

The Environmental Benefits of Organic Wine: Exploring Consumer Willingness-to-Pay Premiums?

Consumers and the producers have shown interest in organics, but there exist gaps in their common interest. Producers require premiums for their products based on the peculiarity of their production circumstances and the perceived benefits inherent in their products. Predicting consumer willingness to pay a premium for the environmental benefits of organics (WTPe) is a challenge and is of interest in this study. The contingent valuation method was used to gather information on WTPe from a sample that yielded 2,099 surveys. The econometric test ordered probit regression and other analyses were carried out. On average, respondents indicated WTP 23% premium. The proposed hypotheses were tested, and all were accepted except social demographic variables that presented a mixed outcome. The results have implications for consumer sensitization and enlightenment programs of the wine industry, wine market segmentation, and government’s climate change policy. This study is exploratory and has presented a snapshot scenario. Confirmatory and longitudinal studies are recommended to validate this study’s outcomes.     

OPTIMAL INVESTMENT STRATEGIES FOR CONTROLLING DRAWDOWNS

We analyze the optimal risky investment policy for an investor who, at each point in time, wants to lose no more than a fixed percentage of the maximum value his wealth has achieved up to that time. In particular, if M _t is the maximum level of wealth W attained on or before time t , then the constraint imposed on his portfolio choice is that W_tα M _t, where α is an exogenous number betweenα O and 1. We show that, for constant relative risk aversion utility functions, the optimal policy involves an investment in risky assets at time t in proportion to the "surplus" W _t - α M _t. the optimal policy may appear similar to the constant-proportion portfolio insurance policy analyzed in Black and Perold (1987) and Grossman and Vila (1989). However, in those papers, the investor keeps his wealth above a nonstochastic floor F instead of a stochastic floor α M _t. the stochastic character of the floor studied here has interesting effects on the investment policy in states of nature when wealth is at an all-time high; i.e., when Wt = M _t. It can be shown that at W _t= M _t, α M _t is expected to grow at a faster rate than W _t, and therefore the investment in the risky asset can be expected to fall. We also show that the investment in the risky asset can be expected to rise when W _t is close to α M _t. We conjecture that in an equilibrium model the stochastic character of the floor creates "resistance" levels as the market approaches an all-time high (because of the reluctance of investors to take more risk when W _t= M _t).     

Divorce and female labor force participation: Evidence from times-series data and cointegration

The divorce rate in the United States has increased over the last 40 years. This increase was accompanied both by growing female labor force participation and rising female income. These changes were accompanied by a significant reduction in the birth rate for married women. This article uses time-series data and cointegration techniques to determine the direction of causality between these variables. Analysis of the impulse functions show that the divorce rate will increase if either female labor force participation or income increases. Positive innovations to the divorce rate increase the labor force participation rate of married women. Rising levels of income lead to greater female participation in the labor market.