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 EFFECT OF PROVIDER CONTROL OF BLUE SHIELD PLANS ON HEALTH CARE MARKETS

Blue Shield plans often are granted regulatory advantages by the states in which they operate. Run efficiently, such not-for-profit firms should use these lower costs to eliminate their less advantaged rivals, the commercial insurers. However, these higher-cost commercial providers have been able to offer insurance coverage at prices competitive with the Blues, as evidenced by the fact that Blue plans have, on average, less than 50 percent market share. Similar prices with lower overall costs implies that economic rents are being earned, rents which a not-for-profit firm cannot distribute to owners. In this paper we argue that when there are competing goals among the groups controlling the Blue Shield plans, the different possible "uses" of the regulatory advantage become endogenously determined, necessitating the use of simultaneous equation estimation. Testing this model we find the major effect of doctor-control of Blue Shield plans is to raise doctors' fees while lowering the amount of rents captured by both consumers and administrators.     

THE HOME MARKET EFFECT IN INTERNATIONAL ARMS TRADE

I show that military spending contributes to international arms proliferation through a push effect: large demand encourages production growth in the domestic market if transport costs are non‐negligible. Under increasing returns to scale, the country can then supply weapons on the global market at low prices. This is a manifestation of the home market effect (HME), which states that countries with higher demand for a differentiated good will be net exporters of that good. I construct a monopolistic competition model of international trade that accounts for differences in demand across countries, and test its predictions using post‐Cold War data. (JEL F1, H5, R1)     

JUST A MINUTE: THE EFFECT OF EMERGENCY DEPARTMENT WAIT TIME ON THE COST OF CARE

Wait times are rising in U.S. emergency departments (EDs). The longer a patient waits to be seen, the more their condition may worsen. Notably, patients in worse condition can cost more to care for. This study estimates the effect of ED wait time on the cost of care by exploiting the quasi-random assignment of patients to triage nurses in an instrumental variables framework. The results suggest that prolonging the wait of a patient who arrives with a serious condition by 10 minutes will increase the hospital's cost to care for the patient by an average of 6%. The magnitude of this effect dissipates (fading to zero) among patients who arrive with less serious conditions.(JEL D24, H41, I10)     

THE MEANING OF WORK AND HOME

In contemporary society, work and home represent the two most significant domains in the life of a working individual. Changes in family structures and technological changes (e.g. mobile phones and portable computers) that enable job tasks to be performed in a variety of locations have blurred the boundaries between work and home. This all suggests that the meaning that people may have attached to these domains has changed also. The present research uses in-depth qualitative interviews with 10 employees from an Information Technology company to explore the meaning of each persons work and home domain, and the ways in which they interact. Interviews were transcribed into text documents and analysed. Frequency of word use provided a socio-linguistic profile of the words that participants used when asked to talk about their work and home domains. Content analysis of the sentences relating to work and home provided a measure of how frequently respondents talked about their home-life when asked about work, and vice versa. In addition, each participant filled out an adapted version of the PANAS, which assessed affective state in both the work and home domains specifically. Results are discussed in relation to the generation of future hypotheses.     

THE ELDERLY VICTIM OF HOMICIDE:

This study attempts to resolve some of the disparity between lifestyle/routine activities theory and empirical findings concerning the elderly victim of homicide. Analysis of Canadian data leads to the conclusion that the elderly are disproportionately victims of theft-based homicide, a finding not consistent with the routine activity approach. A reformulation of the theory resolves the theory/data gap.     

HEALTH CARE, INSURANCE, AND THE CONTRACT CHOICE EFFECT

This article explores the interdependence between the individual consumer's demand for medical care and choice of health insurance coverage, with emphasis on its implications for demand behavior and empirical analysis. We show that an increase in the price of medical care has two effects on demand, the usual response of reduced quantity demanded and a health insurance contract choice effect resulting from the consumer's incentive to change insurance plan. The contract choice effect, widely neglected in studies of medical care demand, alters both the quantitative and qualitative predictive properties of the consumer's demand for medical services. (JEL D11, D81, I11 )     

MODERNIZATION IN THE PEOPLE'S REPUBLIC OF CHINA: THE POLITICIZATION OF THE ELDERLY

The rapid modernization in the People's Republic of China (PRC) allows us to identify some of the principles that underlie the changes in State-managed economies and their affects on the elderly. Modernization theory predicts that traditionally high status of the elderly declines with industrialization. This theory's difficulties can be overcome by using the variables of the "state" and the political economy by developing a model of "bureaucratic politics" and the "state" which explains "how" the status of the elderly changes through the interplay of competing interests within the society and thus may "increase" or "decrease" as the society modernizes. This research is based on data collected in the PRC between 1981–1986. Since 1978 there have been three major reform efforts; each has consequences for the elderly: (1) economic, (2) bureaucratic, and (3) population. In order to achieve them, programming for elderly is occurring: (1) retirement pensions and medical care, (2) homes for the aged, and (3) special activities to use the "left over energy" of the elderly. The future importance of the elderly in China will depend on their consequences for (1) the developing economy, (2) the bureaucratic politics of the Party and the State, and (3) other agendas of the State the implicate the elderly.     

THE LAW OF GENIUS AND HOME RUNS REFUTED

In a lively, provocative article, DeVany claims inter alia that the size distribution of home runs follows a continuous "power law" distribution which is nested in a larger class of "stable" statistical distributions characterized by an infinite variance. He uses this putative fact about the size distribution of home runs to argue that concern about the use of steroids to enhance home run ability is necessarily misplaced. In this article, we show that the initial claim is false and argue that the subsequent claim about the potential importance of steroid use does not follow from the first. We also show that the method used to establish that the size distribution of home runs is characterized by an infinite variance is unreliable and will find evidence "consistent" with infinite variance in all but the most trivial of data sets generated by processes with finite variance. Despite a large and growing literature that spans several fields and uses methods and arguments similar to DeVany's, we argue that mere inspection of the unconditional distribution of some human phenomenon is unlikely to yield much insight. ( JEL C16, L83)     

THE SUPPLY OF CHILDREN'S TIME TO DISABLED ELDERLY PARENTS

This study develops and tests a model of supply of children's time to disabled elderly parents, using data from the National Long-Term Care Survey. The model, which assumes strategic behavior among relatives, offers predictions about effects of changes in the price of paid personal care, parent's wealth, kid's wage rates, public in-kind subsidies of personal care, and parent's relative bargaining power on care provided by children. Although several statistically significant relationships are obtained, the evidence does not generally indicate that children's provision of care to parents is guided by a strategic bequest motive.     

THE EMERGING ROLE OF THE MEDICAL SOCIOLOGIST IN PALLIATIVE CARE SETTINGS

The demographics of a rapidly aging society and the chronic nature of contemporary illness intersect in the twenty-first century to confront medicine with the challenge of reenvisioning health care at life's end. Using analytic, interpretive, and reflexive tools, the medical sociologist can assist health care teams in improving quality of life terminally ill patients and their caregivers. In this article, we explore the role of the medical sociologist in palliative care settings, discuss ways to integrate that role into the day-to-day processes of palliative medicine, and identify three areas of intervention where medical sociologists can bring a unique perspective to end-of-life settings. We conclude by examining impediments to the inclusion of the medical sociologist on the clinical team and discussing how these barriers can be addressed.     

AN ECONOMETRIC MODEL OF THE DEMAND FOR CHILD CARE

Child care denotes any arrangement used by a working parent for care of a child, including self-care. This paper is concerned with the factors that influence the demand for market modes of child care by two parent families with working mothers. An econometric model is specified that relates the demand for child care to price, income, and other economic variables. Because of the discrete nature of the child care decision, the multinomial logit probability model is used to analyze the data. The empirical results suggest that the demand for child care is sensitive to both prices and income.     

STRATEGIC OR NONSTRATEGIC: THE ROLE OF FINANCIAL BENEFIT IN BANKRUPTCY

A partial test for strategic behavior in bankruptcy filing may be formulated by testing whether consumers manipulate their debt and filing decision jointly, or not: that is, testing for endogeneity of financial benefit and the bankruptcy filing decision. Using joint maximum likelihood estimation of an extended discrete choice model, test results are consistent with nonstrategic filing: financial benefit is exogenous to the filing decision. This result is confirmed in two different datasets (Panel Study of Income Dynamics and Survey of Consumer Finances). This result is consistent with an ex ante low net gain from a bankruptcy filing; a type of “rational inattention” to rare events such as bankruptcy. (JEL D12, D14)     

THE REHABILITATION EFFECT OF PUNISHMENT

The putatively beneficial effect of punishment on criminal offenders is examined by estimating a logistic specification of a two-period model of optimal participation in illegitimate and legitimate activities. Estimates are obtained utilizing a sample of parolees released from all adult correctional institutions in the United States during 1972. The conclusion would seem to be that incarceration is not substantially effective in rehabilitation efforts and may even have a result opposite to that intended: increased punishment may increase optimal participation in crime.     

THE SOCIAL ROLE OF NOT-FOR-PROFIT ORGANIZATIONS: HOSPITAL PROVISION OF CHARITY CARE

During the 1980s the State of New York shifted from a straight block grant to a matching grant method for reimbursing hospitals, with the matching rate varying from 0 to 75 percent across years. These changes allow estimation of pure "income" and "price" effects for hospitals' supply of uncompensated care (charity and bad debts). The price efrect is positive and significant, but no income effect was found. Hospitals in more concentrated markets provide more charity care, as do teaching hospitals, and the presence of public hospitals in a market reduces private hospitals' provision of charity care.     

THE EFFECT OF UNIT FEES ON THE CONSUMPTION OF QUALITY

A law-of-demand explanation to the Alchian-Allen, or "shipping the good apples out," proposition rests on a change in the relative price of quality when a unit fee is introduced. However, the manner in which quality is consumed is crucial. In some cases, for instance, there is no substitution between the quality attribute and the priced, quantity-measured attribute. This paper shows that in these cases the relative price of quality is unchanged by a unit fee. Nevertheless, while the "unit fee" proposition fails to obtain for individual choice, it does hold in aggregate.     

HIGH SCHOOL CHOICES AND THE GENDER GAP IN STEM

Women are less likely than men to graduate with a degree in science, technology, engineering, or math (STEM). We use detailed administrative data for a recent cohort of Ontario high school students, combined with data from the province's university admission system, to analyze the sources of this gap. We show that entry to STEM programs is mediated through an index of STEM readiness that depends on end‐of‐high school courses in math and science. Most of the gender gap in STEM entry can be traced to differences in the share of college entrants who are STEM‐ready; only a small share is attributable to differences in the choice of major conditional on readiness. We then use high school course data to decompose the gender gap in STEM readiness into two channels: one reflecting the gap in the fraction of high school students with the necessary prerequisites to enter STEM, the other arising from differences in the overall fractions of females and males who enter university. The gender gap in the fraction of males and females with STEM prerequisites is small. The primary driver of the gap in STEM readiness is the low rate of university entry by nonscience‐oriented males. (JEL I21, 28, I20)     

FEAR OF CRIME AMONG THE ELDERLY AS PERSON/ENVIRONMENT INTERACTION*

Despite lower victimization, older people express greater fear of crime. The causes and consequences of such fear are investigated for a 1980 sample of 1,185 persons aged 60+. Fear of crime is a response to both personal vulnerability and locational cues. Fear reduces subjective well-being, but has little relation to activity patterns. While social resources have little bearing on fear of crime and its consequences, variations by sex and personal competence are apparent. These reflect the role of coping resources and environmental docility.