New evidence on the role of remittances on healthcare expenditures by Mexican households

Using Mexico’s 2002 wave of the Encuesta Nacional de Ingresos y Gastos de los Hogares (ENIGH), we find that international remittances raise health care expenditures. Approximately 6 pesos of every 100 peso increment in remittance income are spent on health. The sensitivity of health care expenditures to variations in the level of international remittances is almost three times greater than their sensitivity to changes in other sources of household income. Furthermore, health care expenditures are less responsive to remittance income among lower-income households. Since the lower responsiveness may be partially due to participation of lower-income households in public programs like PROGRESA (now called Oportunidades), we also analyze the impact of remittances by health care coverage. As expected, we find that households with some kind of health care coverage—either through their jobs or via participation in PROGRESA—spend less of remittance income increments on health care than households lacking any health care coverage. Hence, remittances may help equalize health care expenditures across households with and without health care coverage.     

Protective service unions’ political activities and department expenditures

This paper examines how police and firefighter unions’ political activities influence departmental expenditures. Unlike prior research, we measure unions’ political activity independently of union bargaining power. Results indicate that a protective service union’s electoral activities positively affect departmental expenditures, and these effects are attributable to union political power rather than multilateral collective bargaining power. The authors thank Steve Blumenfeld, Wally Hendricks, Asghar Zardkoohi, and an anonymous referee for their excellent comments and suggestions.     

A dynamic model of public sector employer response to unionization

We model the response of public sector employers to unionization using the response of public school boards to teacher unionization as an example. While it is generally believed that public sector employers pay unionized workers more than nonunion workers, there is less consensus about where the money comes from. We model two cases which are possible employer reactions to unionization: re-allocating resources among types of expenditures and modifying the way in which services are provided. The model contains a political equilibrium that determines the union’s preferences and an economic equilibrium that reflects labor market conditions. We compare the predictions of the two cases regarding the effect of unionization on wages, turnover, allocation of expenditures, and productivity. We interpret existing empirical research on public sector unionization in light of these predictions and make recommenda-tions for future empirical work.     

Expenditure Flows Near Widowhood

Using data from the 1980–2001 Consumer Expenditure Surveys, we investigate how impending widowhood affects households’ expenditure patterns. We find that total annual expenditures are $4,027 higher for about-to-be-widowed households compared to otherwise comparable continuously married couples. Within subcategories, expenditures average $4,108 higher for the miscellaneous subcategory which includes expenditures on funerals/burials. We conclude that differences in the needs-adjusted incomes of married and widowed households may be partly a function of pre-widowhood differences in their expenditure patterns that lead about-to-be-widowhood households to draw down on financial wealth.     

Pension Participation: Do Parents Transmit Time Preference?

A wide range of economic and health behaviors are influenced by individuals’ attitudes toward the future—including investments in human capital, health capital and financial capital. Intergenerational correlations in such behaviors suggest an important role the family may play in transmitting time preferences to children. This article presents a model of parental investment in future-oriented capital, where parents shape their children’s time preference rates. The research identifies a dual role for a parent’s time preference rate in the process of shaping the offspring’s attitude toward the future, and discusses paths through which parents may socialize children to be patient. The model’s implications are studied by investigating the parent–child correlation in pension participation using data from the Panel Study of Income Dynamics     

Saving for Children’s College Education: An Empirical Analysis of the Trade-off Between the Quality and Quantity of Children

This paper examines the effect of children’s college expenses on household savings. The theoretical model introduces life-cycle savings into the quality–quantity model of fertility and derives predictions for the impact of expected expenses on parents’ savings. Using the actual amount of parents’ financial support reported in the Survey of Consumer Finances, the empirical model estimates the expected expenditures on children’s college education and investigates the effect of expected expenditures on parents’ savings. The results show that parents’ support for each of their children’s college expenses decreases with the number of children. The results are consistent with the predictions of the life-cycle theory of saving and consumption that households save in advance for expected expenses to smooth their consumption.

The Development and Challenges in Health Care Policy and Health Care Financing in Contemporary China

China’s market-oriented reform has had great success in the past few decades. Along with the rapid economic growth of the country, the economic development also influenced various aspects of China’s social, economical, and political life. Recent debate has criticized the overheated market reform in social provision, thus arguing for the return of government interventions. However, in the health care sector, it is inappropriate to attribute all distortions to market imperfection. It is rather the design of the health care system and the lack of government interventions in regulating the health care market that obstruct the functions of health care provision. To examine the proposed hypotheses, the paper focuses on China’s medical care provision, evaluating the actual performance of China’s medical care provision in the environment of economic transition from a multidimensional analysis, hence providing forward-looking suggestions for the design of China’s health care provision. Findings from this study indicate that government interventions are indispensable in regulating the health care market as well as ensuring health care delivery.      

Parents’ Health and Adult Children’s Subsequent Working Status: A Perspective of Intergenerational Transfer and Time Allocation

This paper frames how parents’ health problems may affect a child’s subsequent working status. Parental health problems occurring in their prime working years undermine an adult child’s resources and tend to affect the child’s preferences over time-allocations among leisure, market- and non-market-labor. Empirical applications in this paper focus on a situation with pervasive health problems, lack of social safety network, and a substantial gender gap in labor market return. Exploiting Russia Longitudinal Monitoring Survey (RLMS) for the period 1994–2004, empirical results indicate that a father’s poor health status is a significant predictor of lowering a daughter’s educational attainment and working probability during her subsequent, adulthood years.     

Unions and private wage supplements

Private wage supplements are an important part of total compensation. A model of workers’ supplement expenditures is developed which shows that, although the expenditure determinants sometimes differ between broad industry/occupation subsamples, earnings, price effects of preferential tax treatment and economies of group purchase, unionization, the product market power of the firm, and worker age are usually significant determinants of supplement expenditures. The firm’s goal of reducing turnover costs as well as demographic, locational, and industry variables also systematically affect supplement expenditures. Supplements usually increase progressively with wages, indicating that often made proportionality assumptions are invalid. This work is based on a portion of my doctoral dissertation “An Economic Analysis of the Determinants of Private Wage Supplements.” An anonymous referee made many useful suggestions and criticisms. The Center for the Study of American Business at Washington University provided some of the computer funding. The remaining errors are my responsibility.     

Health,Health Insurance,and Decision to Exit from Farming

The purpose of this paper is to study the influence of health and health insurance on farmers’ exit decision-making process. Using data from 2000 to 2007 Medical Expenditure Panel Survey, we tested the following three hypotheses: (1) Health condition affects farmers’ exit decision; (2) Having health insurance discourages farmers from exiting; (3) Obtaining health insurance helps farmers with physical health problems to continue farming. Empirical results indicated that having health insurance has a positive effect on encouraging farmers to continue farming regardless of health condition. The study results also suggested that farmer’s health condition and access to health insurance have noticeably larger marginal impacts on farmer’ exit decision than income and other commonly-considered socio-economic and demographic variables.     

Career or family: What choices do college women have?

Much has been written about the problems of combining job and family. Among the best-known scholarly works is Goldin’s (1997) study in which she found that only 12–17 percent of college-educated women managed to attain both a career and a family. We re-examine these conclusions, first duplicating Goldin’s definitions of career but using a somewhat older group, then using alternate definitions of career. We reach far more optimistic conclusions about what lies ahead for today’s college women.     

Parental Employment,Shared Parent–Child Activities and Childhood Obesity

We examine the effect of parental employment on child health as measured by children’s percentile body mass index (pBMI). Our investigation reveals that hours of parental employment are important determinants of child health. We find a highly significant role for the influence of fathers’ hours of work on the pBMI. Given that work hours of both mothers and fathers impact child health, ignoring parents’ joint decision making in child health production may lead to biased results. Additionally, we conclude that parental work hours may impact both the quality and quantity of time that parents spend with their children. Specifically, we find that shared parent–child activities such as building or repair work, and reading influence childhood obesity.     

Appropriate Therapeutic Care for Families with Pre-Pubescent Transgender/Gender-Dissonant Children

In recent years, a new phenomenon has been observed in U.S. culture, that of pre-pubescent children transitioning socially from one gender role to another, with the support of their families. As this phenomenon becomes more widespread, families, schools and other institutions will turn to mental health care professionals for guidance in navigating new territory. Such children have often been assessed for gender identity disorder; the traditional treatment plan for those so diagnosed included attempts to steer their gender behavior in more “gender-appropriate” directions. Allowing such children to self-actualize, viewing their behavior as indicative of innate identity, is a relatively new approach. This paper will focus on the social worker’s or therapist’s role in helping pre-pubescent children and their families, should the families decide identity actualization is the path they would prefer.     

A Response to <Emphasis Type="BoldItalic">No One Ever Asked Us</Emphasis>: A Review of Children’s Experiences in Out-of-Home Care

Recent research on children in out-of-home care has highlighted their demographic characteristics, their physical and mental health status, and case outcomes, yet the body of literature examining children’s perspectives on care is relatively limited. This review provides an overview of almost two dozen studies examining children’s experiences of care. Findings from studies involving interviews with current and former foster youth are reviewed in relation to four child welfare goals: (1) protecting children from harm; (2) fostering children’s well-being; (3) supporting children’s families; and (4) promoting permanence. Implications for improved child welfare practice are offered.     

The effect of limited search ability on the quality of competitive rent-seeking clubs

A competitive rent-seeking club (CRSC) offers its members the chance of winning a prize (status, position, privilege) by being selected, typically, by a civil servant or a politician. The selector replaces in our setting the usual contest success function; instead of determining the winner on the basis of the club-members’ efforts, he selects the winner on the basis of quality. This article focuses on the effect of incomplete search of the selector on the efficiency of democratic self-governing and decentralized RSC’s that control admittance to the club and its transparency, assuming that quality of their members is fixed. The incomplete search of the selector is assumed to take the simple form of fixed random sampling of the contestants—the members of the CRSC. Our results imply that, even when active rent-seeking expenditures are disregarded, the decisions of CRSC’s regarding their composition and transparency tend to reduce quality and are therefore inefficient.     

Relationships between Borda voting and Zermelo ranking

There are many situations wherein a group of individuals (e.g., voters, experts, sports writers) must produce an ordered list of ‘best’ alternatives selected from a given group of alternatives (e.g., candidates, proposals, sports teams). Two long established mechanisms that have been used for this task are ‘Zermelo’s Ranking Method’ (1929) and ‘Borda’s Voting Scheme’ (1781). The main purpose of this paper is to point out that they are, under certain common circumstances, identical. We then show that Zermelo’s Method can be used in situations that Borda’s Method is not designed to handle.     

Households’ precautionary behaviors—the effects of the introduction of National Health Insurance in Taiwan

By reducing risk of large out-of-pocket medical expenses, comprehensive social health insurance may reduce households’ motivation to engage in precautionary behaviors such as saving, procurement of private insurance, and spousal labor-force participation. We use the natural experiment provided by the 1995 introduction of National Health Insurance in Taiwan to examine these effects, using pre-existing differences in access to health insurance (tied to the household head’s and spouse’s joint employment status) to identify the effects of increasing insurance coverage. We find that comprehensive health insurance has a statistically significant and large effect on household savings, but no significant effects on purchase of private accident insurance and spousal employment.

Ethics of resource allocation: instruments for rational decision making in support of a sustainable health care

Objective: In all western countries health care budgets are under considerable constraint and therefore a reflection process has started on how to gain the most health benefit for the population within limited resource boundaries. The field of “ethics of resource allocation” has evolved only recently in order to bring some objectivity and rationality in the discussion. In this article it is argued that priority setting is the prerequisite of ethical resource allocation and that for purposes of operationalization, instruments such as “need assessment” and “health technology assessment (HTA)” are essential worktools for making more rational decisions. Thresholds (deduced from the need assessment and HTA) are—within this context—guiding but not binding principles. Method: Discussion of theoretical concepts of not only priority setting, need assessment and HTA complemented by practical examples for showing the challenges and the need, but also the chances of a more explicit and transparent policy of resource allocation in health care. Results: Priority setting in health care is based on the values of equity, justice and solidarity. Health packages decisions are determined from medical need (the severity of the condition) and/or the appropriateness of medical interventions (their cost-effectiveness). With growing awareness that originally effective and cost-effective services and programmes are eventually provided inappropriately, the focus is shifting towards the organisational aspects of provision and application. Therefore, need assessment is based on the distinction of health care needs from demand, supply, or actual care. Additionally HTA provides the evidence on health care interventions in a way that it becomes obvious who benefits from an intervention and who definitely does not benefit, but eventually is harmed. Conclusions: Health services research on effective and cost-effective interventions and research/monitoring of performance that the effective and cost-effective services are provided appropriately are of increasing importance for guiding the decision-making process on priority setting and need assessment. Effective healthcare for all is sustainable, if we start to put expenditures in perspective and focus health policies and research strategies on managing expectations through patient information and a more realistic notion of medical advancements and, on the other hand, on encouraging need-based and cost-effective innovations.

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Zusammenfassung Ziel: In allen Ländern des Westens ist die Haushaltslage im Gesundheitswesen heute äußerst angespannt, weshalb nun ein Reflexionsprozess begonnen hat, wie mit begrenzten Haushaltsmitteln der größtmögliche gesundheitliche Nutzen für die Bevölkerung erzielt werden kann. Erst in jüngster Zeit ist die “Ethik der Mittelzuweisung” als Arbeitsgebiet entwickelt worden, mit dem Ziel, eine gewisse Objektivität und Rationalität in die Diskussion zu bringen. In diesem Artikel argumentieren wir, dass eine ethische Mittelzuweisung Prioritätssetzungen erfordert und dass Instrumente wie Bedarfeinschätzung (Need Assessment) und Bewertung medizinischer Verfahren [Health Technology Assessment (HTA)] wesentliche Arbeitswerkzeuge zur Erzielung rationaler Entscheidungen sind. Schwellenwerte (abgeleitet aus Need Assessment und HTA) dienen in diesem Zusammenhang als leitende, jedoch nicht bindende Prinzipien. Methode: Diskussion theoretischer Begriffe der Prioritätssetzung, Bedarfeinschätzung und HTA, ergänzt durch praktische Beispiele zur Darstellung der Herausforderungen des Bedarfs nach, aber auch der Chancen für eine explizitere und transparentere Politik der Mittelzuweisung im Gesundheitswesen. Ergebnisse: Prioritätssetzung im Gesundheitswesen basiert auf den Werten Gleichheit, Gerechtigkeit und Solidarität. Entscheidungen über Versorgungspakete richten sich nach der medizinischen Bedarfslage (Schwere der Erkrankung) und/oder der Angemessenheit medizinischer Eingriffe (Kosteneffektivität). Mit der wachsenden Erkenntnis, dass ursprünglich effektive und kosteneffektive Leistungen und Programme am Ende unangemessen bereitgestellt werden, richtet sich die Aufmerksamkeit mehr auf Organisationsaspekte der Bereitstellung und Anwendung. Need Assessment basiert daher auf der Unterscheidung zwischen Bedarf im Gesundheitswesen und Nachfrage, Angebot oder tatsächlicher Versorgung. HTA fasst dann die Evidenz zu Eingriffen seitens des Gesundheitswesens zusammen, sodass offenbar wird, wem ein Eingriff nützt und wem er mit Sicherheit nicht nützt, sondern am Ende schadet. Schlussfolgerungen: Forschungen der Gesundheitsdienste zu effektiven und kosteneffektiven Eingriffen sowie die Erforschung/Erfolgskontrolle einer angemessenen Bereitstellung effektiver und kosteneffektiver Dienste sind von wachsender Bedeutung für die Information des Entscheidungsprozesses zur Prioritätssetzung und Bedarfseinschätzung. Eine effektive Gesundheitsversorgung für alle bleibt tragbar, sofern wir beginnen, Ausgaben in Perspektive zu setzen und gesundheitspolitische Entscheidungen und Forschungsstrategien darauf ausrichten, Erwartungen zu lenken, indem wir die Patienten informieren und eine realistischere Einschätzung medizinischer Fortschritte fördern, und uns zugleich auf bedarfsorientierte und kosteneffektive Innovationen konzentrieren.

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Résumé Objectif : Dans tous les pays occidentaux, les budgets de santé publique sont soumis à de fortes contraintes, ce pourquoi un processus de réflexion a commencé sur la question de savoir comment obtenir avec des moyens limités la plus grande utilité possible pour la population en termes de santé. Ce n’est que récemment que « l’éthique de l’allocation des ressources » a été développée pour apporter une certaine part d’objectivité et de rationalisme dans la discussion. Le présent article soutient que l’attribution de priorités est la condition préalable indispensable à l’allocation des ressources et que des instruments tels que l’évaluation des besoins (need assessment) et l’évaluation des technologies de la santé (ETS/HTA) sont des outils essentiels pour parvenir à des décisions plus rationnelles. Les valeurs seuils (déduites de l’évaluation des besoins et de l’ETS) servent dans ce contexte de principes directeurs, mais non contraignants. Méthode : Discussion sur les notions théoriques d’attribution de priorités, d’évaluation des besoins et d’ETS, complétée par des exemples pratiques mettant en évidence les défis et les besoins, mais aussi les chances d’une politique d’allocation des ressources de santé plus explicite et transparente. Résultats : L’attribution des priorités dans le domaine de la santé se base sur les valeurs d’équité, de justice et de solidarité. Les décisions relatives à des ensembles thérapeutiques sont déterminées par le besoin médical (gravité de la maladie) et/ou le caractère opportun des interventions médicales (efficacité des coûts). Avec la prise de conscience que des services et des programmes initialement opérationnels et efficaces en termes de coûts sont appliqués de manière inappropriée, l’attention se porte sur les aspects organisationnels de l’attribution et de l’application. L’évaluation des besoins se base par conséquent sur la distinction entre les besoins de santé provenant de la demande, de l’offre et de l’approvisionnement effectivement fourni. L’évaluation des technologies de la santé procède à une synthèse des preuves faisant apparaître qu’une intervention de santé est utile à un patient, lui est en toute certitude inutile, voire préjudiciable. Conclusions : Les recherches des services de santé sur les interventions efficaces en termes de thérapie et de coûts, de même que la recherche/le suivi des performances sur une fourniture appropriée de services efficaces en termes de thérapie et de coûts revêtent une importance croissante pour guider le processus décisionnel sur l’attribution des priorités et l’évaluation des besoins. Une couverture de santé efficace pour tous n’est viable que si nous commençons à mettre les dépenses en perspective et à concentrer les politiques de la santé et les stratégies de recherche sur la gestion des attentes, en informant les patients et en promouvant une estimation plus réaliste des progrès médicaux, et d’autre part en encourageant les innovations fondées sur les besoins et sur le rendement des coûts.

     

The ignorant observer

We propose an extension of Harsanyi’s Impartial Observer Theorem based on the representation of ignorance as the set of all possible probability distributions over individuals. We obtain a characterization of the observer’s preferences that, under our most restrictive conditions, is a convex combination of Harsanyi’s utilitarian and Rawls’ egalitarian criteria. This representation is ethically meaningful, in the sense that individuals’ utilities are cardinally measurable and fully comparable. This allows us to conclude that the impartiality requirement cannot be used to decide between Rawls’ and Harsanyi’s positions. We thank D. Bouyssou, A. Chateauneuf, M. Cohen, M. Fleurbaey, E. Karni, J.-F. Laslier, P. Mongin, J. Moreno-Ternero and especially J. Weymark, as well as seminar audiences at University Pompeu Fabra, University of Cergy-Pontoise, the Roy Seminar and RUD 2006 for useful comments. Comments by two anonymous referees have been extremely useful to improve the paper. Financial support from an ACI grant by the French Ministry of Research is gratefully acknowledged.     

Direct and indirect effects of unionization on the wage levels of nurses: A case study of New Jersey hospitals

This study examines the determination of wage rates for nurses in hospital employment. Of particular concern is the effect of the recent increase in unionization by nurses on their wages, both directly and indirectly via threats from competing hospitals’ unionization. To improve on earlier work, the data are disaggregated and gathered from only one state to standardize for the legal, licensing, and reimbursement systems. We also look at the difference between highly skilled professional nurses, RN’s, and more general and less professional nurses, LPN’s. The results show that working conditions and competition in the market influence the wage rate as one would expect. The unionization of nurses, however, affects the wage levels differently for the two groups. We would like to thank Professors Robert Higgs and Alan Childs of Lafayette College, Professor David Fairris of Williams College, Professor James C. Luzier of Muhlenberg College, and an anonymous referee for their helpful comments and suggestions.