THE EFFECT OF DIRECT TO CONSUMER TELEVISION ADVERTISING ON THE TIMING OF TREATMENT

We examine how direct to consumer advertising affects the delay between diagnosis and pharmacological treatment for patients suffering from a common chronic disease. The primary data for this study consist of patients diagnosed with osteoarthritis (N = 18,235) taken from a geographically diverse national research network of 72 primary care practices with 348 physicians in 27 states over the 1999–2002 time period. Brand‐specific advertising data were collected for local and network television at the monthly level for the nearest media markets to the practices. Results of duration models of delay to treatment suggest advertising does affect the length of time that patients and physicians wait to initiate therapy. This evidence suggests that these effects may be welfare enhancing in that advertising tends to encourage more rapid adoption among patients who are good clinical candidates for the therapy and leads to less rapid adoption among some patients who are poor clinical candidates. (JEL D12, I11)     

NEW TRENDS IN THE DOCTOR-PATIENT RELATIONSHIP: IMPACTS OF MANAGED CARE ON THE GROWTH OF A CONSUMER PROTECTIONS MODEL

Managed care is prompting a large revision not only in the ways doctors are employed and paid but also in the essence of the relationship between doctors and patients. In medical sociology, a discipline with a long-standing focus on scrutinizing the role of both the physician and the patient, there has already been discussion of a shift from the doctor as more all knowing to a less dominant position vis-a-vis both the patient and delivery of care. Patients are aware of shifts that place physicians in an environment characterized by new roles and responsibilities, such as acting as a gatekeeper. Limitations on health care coverage and the rethinking of roles have led to a depiction of the patient as the consumer of care and the managed care plan's becoming the commercial enterprise from which a service is obtained. The model of the patient as consumer of medically related goods and services appears to be growing, as does a model of the physician as one who contracts for a specified range of services for specific patients. In this article, trends in and problems with contemporary managed care are raised. Calls for patients' rights legislation may be among the health trends of the new millennium.     

ESSENTIAL ELEMENTS OF A FAMILY PSYCHOEDUCATION PROGRAM IN THE AFTERCARE OF SCHIZOPHRENIA*

This paper describes a psychoeducation program designed for families and caregivers of patients who suffer from schizophrenia on an inpatient ward of an acute care hospital in a major metropolitan city. It is based on 10 years of experience working with over 600 relatives and caregivers. It discusses the research pertinent to developing such a program, the five elements the authors consider necessary to its success, and the stages of the actualprogram. The five elements include universal service, crisis intervention, social functioning of patient and famly, 2 years continuity of care postdischarge, and the role of the family clinician. It addresses issues raised by working as a muultidisciplinary team and problems in service delivery. A case history illustrates the process.     

THE EFFECT OF PARENTAL INVOLVEMENT LAWS ON YOUTH SUICIDE

Using state‐level data on suicides from the period 1987 to 2003, we find that the adoption of a law requiring a parent's notification or consent before a minor can obtain an abortion is associated with an 11%–21% reduction in the number of 15‐ through 17‐year‐old females who commit suicide. In contrast, the adoption of a parental involvement law is not associated with a reduction in the number of older females who commit suicide or in the number of 15‐ through 17‐year‐old males who commit suicide. These results are consistent with the hypothesis that parental involvement laws represent an increase in the expected cost of having unprotected sex, and, as a consequence, serve to protect young females from depression and what have been termed “stressful life events” such as conflict with a parent or an abortion. (JEL I18, I10, J13)     

CARBON GEOGRAPHY: THE POLITICAL ECONOMY OF CONGRESSIONAL SUPPORT FOR LEGISLATION INTENDED TO MITIGATE GREENHOUSE GAS PRODUCTION

Over the last 5 years, the U.S. Congress has voted on several pieces of legislation intended to sharply reduce the nation's greenhouse gas emissions. Given that climate change is a world public bad, standard economic logic would predict that the United States would “free ride” and wait for other nations to reduce their emissions. Within the Congress, there are clear patterns to who votes in favor of mitigating greenhouse gas emissions. This paper presents a political economy analysis of the determinants of “pro‐green” votes on such legislation. Conservatives consistently vote against such legislation. Controlling for a representative's ideology, representatives from richer districts and districts with a lower per‐capita carbon dioxide footprint are more likely to vote in favor of climate change mitigation legislation. Representatives from districts where industrial emissions represent a larger share of greenhouse gas emissions are more likely to vote no. (JEL Q54, Q58, R50)     

Factors associated with phosphodiesterase type 5 inhibitor treatment satisfactions: results of patient interrogation

Introduction. Phosphodiesterase type 5 (PDE5) inhibitor therapy is an efficacious means of treatment for erectile dysfunction (ED). PDE5 inhibitors supply penile erection by inhibiting the hydrolysis of cGMP and therefore relaxing the corpus cavernosum. In this study, retrospective evaluation of those patients who were admitted to our clinic with the complaint of ED and who were recommended on PDE5 inhibitor treatment in terms of follow-up results and patient satisfaction were aimed.

Method. The patients were called by phone and after informing about the study and taking the informed consent, patient satisfaction with the treatment, purposes of withdrawal, treatment alterations and partner satisfaction were investigated.

Results. Interviews were made with 345 patients, who accepted to enroll in the study and the mean patient age was 56 ± 11.2 years. Of the patients 66.4% were learned to be satisfied with the treatment. It was determined that 10.7% of the patients have never used the medication and 50% could not continue because of high drug cost. It was recognised that 50.2% of the patients who are not satisfied with the treatment tried another PDE5 inhibitor. The success rate of the treatment was found to be higher in the followed-up group than those losses to follow-up.

Conclusion. Therapy with PDE5 inhibitors is an effective means of ED treatment. The importance of doctor-patient communication should be considered, and the patient should be advised for adaptation to follow-up program. High drug cost is a significant predictor of patient compliance to treatment continuation.     

MORE INFORMATION IS NOT ALWAYS BETTER: THE CASE OF VOLUNTARY PROVISION OF ENVIRONMENTAL QUALITY

We use a new U.S. survey on pro‐environmental behaviors, attitudes, and knowledge and find that individuals engage in activities that they believe are more effective in reducing carbon emissions, regardless of whether or not these beliefs are accurate. We find that low provision of the public good is greater among people who believe they cannot do much for the environment and do not consider themselves environmentalists. A policy implication of our results is that the effect of more accurate information on the provision of the public good is ambiguous. (JEL Q50, Q54, C10)     

THE EFFECTS OF AUTOMOBILE RECALLS ON THE SEVERITY OF ACCIDENTS

The number of automobile recalls in the United States has substantially increased over the last two decades, and after a record of over 30 million cars recalled in 2004, in the last few years it has consistently reached between 15 and 17 million, and in 2010 alone 20 million cars were recalled. Toyota's recall crisis in 2010 illustrates how recalls can affect a large number of American drivers and the defects connected to them can result in loss of life and serious accidents. However, in spite of the increase in public concern over recalls and the loss of property and life attached to them, there is no empirical evidence of the effect of vehicle recalls on safety. This paper investigates whether vehicle recalls reduce accidental harm measured by the severity of injuries in vehicle accidents. The results of our analysis show that if a recall for a new‐year model is issued, then the severity of injuries of accidents continuously diminishes during the first year after the recall, something we do not find among cars not subject to recalls. This is because defects are repaired over time but also because drivers react by driving more carefully until the defects are fixed. To minimize the losses attached to having dangerously defective cars on our roads, both quick and timely recall issuance are needed and more detailed information on defects should be delivered to owners of defective vehicles. The latter can be made possible through simple but important policy changes by the U.S. government regarding recall information sharing with drivers and insurance companies. (JEL L51, L62)     

THE EFFECT OF INSURANCE COVERAGE ON PREVENTIVE CARE

Despite the growth in health insurance products that differentially cover preventive care and nonpreventive care, little is known about how preventive care utilization responds to targeted changes in coverage. Using administrative data from a large company, this paper examines the implementation of an insurance benefit design which differentially increased the price of nonpreventive care while decreasing the price of prevention. Leveraging a difference‐in‐differences research strategy, we find that preventive care utilization did not increase and even declined due to the differential price change. This evidence indicates a meaningful negative cross‐price effect, suggesting that nonpreventive care and preventive care are complements. (JEL I13, I11)     

THE GENERALIZED ALCHIAN–ALLEN THEOREM: A SLUTSKY EQUATION FOR RELATIVE DEMAND

We generalize the Alchian–Allen theorem so as to account for income and endowment effects and provide two versions of a Generalized Alchian–Allen theorem: one for a unit cost component and one for a proportional cost component. Both versions provide a decomposition of an uncompensated change in the demand ratio of two goods into a substitution effect and an income‐endowment effect—and may thus be regarded as extensions of the familiar Slutsky equation for relative demand. Finally, we apply our results to the choice of real estates and to parental time allocation decisions, the latter providing implications for child care policies. (JEL D11, H21, J22, R21)     

THE CHARITY OF THE EXTREMELY WEALTHY

In this article, we show that, compared to billionaires who have inherited their wealth, billionaires who have made their own wealth are more likely to sign the Giving Pledge and more likely to be in the Million Dollar Gifts list or the Philanthropy Top 50 list of big givers. If they give, self‐made billionaires also tend to donate more money. We explore several possible explanations for this correlation between the origin of billionaires' wealth and their charitable giving, and present evidence that suggests that self‐made billionaires tend to spend more money, both by giving money away and by buying expensive items. (JEL D03, H40)     

Does Providing Extended Relapse Prevention Bibliotherapy to Problem Gamblers Improve Outcome?

Relapse rates among pathological gamblers are high with as many as 75% of gamblers returning to gambling shortly after a serious attempt to quit. The present study focused on providing a low cost, easy to access relapse prevention program to such individuals. Based on information collected in our ongoing study of the process of relapse, a series of relapse prevention booklets were developed and evaluated. Individuals who had recently quit gambling (N = 169) were recruited (through media announcements) and randomly assigned to a single mailing condition in which they received one booklet summarizing all of the relapse prevention information or a repeated mailing condition in which they received the summary booklet plus 7 additional booklets mailed to them at regular intervals over the course of a year period. Gambling involvement over the course of the 12-month follow-up period, confirmed by family or friends, was compared between the two groups. Results indicated that participants receiving the repeated mailings were more likely to meet their goal, but they did not differ from participants receiving the single mailing in frequency of gambling or extent of gambling losses. The results of this project suggest that providing extended relapse prevention bibliotherapy to problem gamblers does not improve outcome. However, providing the overview booklet may be a low cost, easy to access alternative for individuals who have quit gambling.     

THE BEHAVIOR OF INEXPERIENCED BIDDERS IN INTERNET AUCTIONS

In Internet auctions, bidders alter their strategies as they gain market experience. While inexperienced bidders bid the same high amounts regardless of the seller’s reputation, experienced bidders bid substantially less if the seller has yet to establish a reputation and raise their bids as reports are filed that the seller has treated bidders well in the past. Experienced bidders also wait until much closer to the end of the auction to place their bids, although it takes very little experience to learn that waiting to submit one’s bid is a superior strategy. (JEL L14, L15, D83, D12)     

DESPERATION OR DESIRE? THE ROLE OF RISK AVERSION IN MARRIAGE

Because of the uncertainty inherent in searching for a spouse and the uncertainty of the future quality and state of the marriage itself, risk attitudes likely directly impact the timing of marriage. The effect of an individual’s risk aversion, measured via a series of hypothetical gambles over income on time to marriage, is examined using survival analysis. I find risk aversion significantly affects time to marriage, with more risk averse respondents marrying sooner than their more risk‐loving counterparts. Within‐family analyses using sibling data reveal a similar pattern. In addition, the effect of risk aversion on time to marriage is larger in magnitude and more statistically significant for men. One possible explanation for the different results between the sexes is that women value risk aversion as a desirable trait in potential mates. (JEL J10, J11, J12, J16)     

“Where Have All the Good Men Gone?” Gendered Interactions in Online Dating

This article explores gendered patterns of online dating and their implications for heterosexual union formation. Using 6 months of online dating data from a midsized Southwestern city (N = 8,259 men, 6,274 women), the authors found that men and women tend to send messages to the most socially desirable alters in the dating market regardless of their own desirability levels. They also found that male initiators connect with more desirable partners than men who wait to be contacted, but female initiators connect with equally desirable partners as women who wait to be contacted. Female‐initiated contacts are also more than twice as likely as male‐initiated contacts to result in a connection, but women send 4 times fewer messages than men. Finally, the authors compared partner desirability levels over repeated exchanges and concluded that couple similarities are more likely to result from relationship termination (i.e., nonreciprocity) than initial homophilous preferences.     

STRATEGIC EXCLUSION OF THE HIGHEST‐VALUED BIDDERS IN WHOLESALE AUTOMOBILE AUCTIONS

By restricting bidders to be qualified dealers, wholesale automobile auctions exclude the bidders who place the highest value on the vehicles: consumers. This article provides an explanation for this puzzling entry restriction by modeling the inventory‐management decisions of a firm. If an automobile dealer has more vehicles in inventory than is optimal, it cannot reduce its inventory by selling directly to consumers without impacting the demand for the automobiles that remain. However, if the dealer sells his/her excess inventory to a competitor, the demand for his/her remaining vehicles increases as the competitor responds by acquiring fewer additional vehicles. We demonstrate that for any market demand function and any cost of the competitor acquiring additional vehicles, a dealer with excess inventory does better by selling a subset of its vehicles to a competitor rather than directly to consumers. We discuss the market for wholesale automobiles in relation to other markets where goods are also auctioned but where entry is not restricted to qualified dealers. Doing so allows us to compare our inventory‐management explanation to common explanations provided by industry practitioners. We find that intuitive alternative stories do not consistently explain practices across markets. (JEL D44, L11, L62)     

LAW ENFORCEMENT LEADERS AND THE RACIAL COMPOSITION OF ARRESTS

This paper introduces a novel avenue of study for understanding the mechanisms behind racial discrimination in law enforcement. I exploit a new 25‐year panel history of the race of every U.S. sheriff to shed light on the potentially important role of managers who make hiring decisions and set departmental priorities. Comparing agencies that experience racial transitions to agencies with overlapping jurisdictions reveals that the ratio of Black‐to‐White arrests is significantly higher under White sheriffs. Heterogeneity analysis indicates that the effects are driven by arrests for less‐serious offenses and by targeting Black crime types. (JEL J15, K42, M54, H76)     

THE MATCHING OF HETEROGENEOUS FIRMS AND POLITICIANS

We use a Chinese firm‐director panel dataset to examine the matching of heterogeneous firms and politicians. On the basis of 36,308 detailed biographies, we identify individuals who previously held bureaucratic positions and classify the rank of each position in the Chinese political hierarchy. Using this direct measure of political capital, we examine how firms with heterogeneous productivity match politicians with different political strength. Our results indicate a positive assortative matching in the political capital market. More productive firms are paired with more powerful politicians. Furthermore, the preference for political capital relative to conventional human capital increases in firms' dependence on external financing and the inefficiency of local governments. Conditional on the endogenous matching, new hires with political capital receive more compensation than their co‐workers in the same cohort. The marginal effect of a one‐step rise on the political ladder significantly exceeds the marginal effect of raising education attainment from, for example, high school to college. (JEL D21, D73, J24, J31, O12)     

HORIZONTAL MERGERS IN THE PRESENCE OF CAPACITY CONSTRAINTS

We examine a merger between two competitors in a Bertrand‐Edgeworth model. We find that the effects of merger depend on the tightness of capacity constraints. The combination of two firms has no price effect if and only if the capacity constraints of all firms are binding both before and after the merger. However, a merger may turn a binding capacity constraint into a slack one, which results in higher prices. In an industry where excess capacity drives the premerger prices of all firms to the marginal cost, a merger may cause prices to rise even though aggregate capacity remains constant. (JEL L13, L40)     

“THE WAR FOR THE FARE”: HOW DRIVER COMPENSATION AFFECTS BUS SYSTEM PERFORMANCE

Prior to 2007, two systems of bus driver compensation coexisted in Santiago, Chile: one paid drivers per passenger transported, while the other paid a fixed wage. Per‐passenger drivers engaged in “The War for the Fare,” altering their driving patterns to compete for passengers. Examining these systems on similar routes in Santiago, we observed two key findings. Compared with the fixed‐wage system, the per‐passenger system leads to (1) 13% shorter passenger wait times, via reduced bunching of buses and (2) 67% more accidents per kilometer driven, via more aggressive driving. We discuss implications for the design of incentives in public transit. (JEL L92, M52, R41)