An empirical examination of cost-adjusting in outpatient clinics

This paper presents an empirical methodology for examining cost-adjusting in relation to multiple-output health care providers. The methodology is subsequently implemented using a sample of California outpatient clinics. The empirical evidence is that these clinics do cost-adjust; that is, the clinics respond to low Medicare reimbursement by using lower quality to control the marginal costs of those patient groups not insured under a government-sponsored plan. In addition, clinics do not cost-adjust with respect to Medi-Cal patients, implying that various government reimbursement systems have different effects on a provider’s cost-adjusting behavior.     

An Empirical Examination of Quality Certification in a "Lemons Market"

This article examines the effect third-party certification has on a market characterized by adverse selection. Using an original data set from the market for young thoroughbreds, we show that certification alleviates problems of adverse selection by examining the effect certification has on breeder decisions to retain or sell horses and the effect these decisions have on observed prices. Data on the racetrack performance of the horses confirm the results.     

A simple estimator for a shared frailty regression model

Summary. We propose a simple estimation procedure for a proportional hazards frailty regression model for clustered survival data in which the dependence is generated by a positive stable distribution. Inferences for the frailty parameter can be obtained by using output from Cox regression analyses. The computational burden is substantially less than that of the other approaches to estimation. The large sample behaviour of the estimator is studied and simulations show that the approximations are appropriate for use with realistic sample sizes. The methods are motivated by studies of familial associations in the natural history of diseases. Their practical utility is illustrated with sib pair data from Beaver Dam, Wisconsin.     

A non-profit approach to addressing the effects of urbanization in the Lake Pontchartrain Basin, Louisiana

The Lake Pontchartrain Basin in southeast Louisiana is an estuarine watershed encompassing New Orleans, Baton Rouge, and wetlands that are an integral part of Louisiana's unique culture. In recent decades rapid growth and poorly planned development have resulted in a decrease in water quality and habitat loss, especially in St. Tammany Parish on the north shore of Lake Pontchartrain. In 1989, the Lake Pontchartrain Basin Foundation (LPBF), an environmental, non-profit organization, was formed to address and rectify environmental issues in the Basin. LPBF accomplishes its mission through programs addressing water quality, habitat protection, geographic information science, public access, and education.LPBF used the recent, rapid development occurring in St. Tammany Parish as a case study to examine the relationship between land use, water quality, and development in the Basin by investigating habitat change/urbanization, development in flood plains, and water quality. Through the integration of LPBF programs, it was found that urbanization is having a devastating impact on the parish's natural habitats and severely degrading water quality. Using these results, LPBF is educating Basin citizens on the protection of their habitats and water quality to insure that these resources may be available for future generations.     

Organizational Compatibility and Workplace Drug Testing: Modeling the Adoption of Innovative Social Control Practices

Few researchers have examined organizational variation in the adoption of workplace drug testing, but innovation theory suggests that adoption is more likely when it is compatible with an organization's values, previously introduced ideas, and needs. Using data from the 1997 National Employee Survey, this research models the effects of organizational compatibility, industry, and establishment size on the adoption of drug testing. The data reveal that compatibility, as measured by an organization's rules orientation, presence of an employee assistance program, and mechanization, is associated with the adoption of drug testing. As predicted, the adoption of drug testing varies across industries and by establishment size.     

Land Ownership as a Determinant of Temporary Migration in Nang Rong, Thailand

In this study I consider landownership as a determinant of temporary migrationin a rural area of Thailand. Previous researchon rural areas in developing countries hasfocused on the use of migration to diversifyhousehold incomes across economic sectors andacross geographic areas. I combine thisliterature with economic theories of migrationto understand the effect of land ownership ontemporary migration of household members inNang Rong, Thailand. I estimate regressionmodels predicting the probability of ahousehold having any temporary migrants, andpredicting the number of male or femaletemporary migrants in the household. I findthat households with smaller landholdings arediversifying through migration in order tosupplement rural income, while households withlarger landholdings are diversifying in orderto overcome the absence of accessible credit inthe village.     

Profile of Some Patients Who Prematurely Terminate Analysis

This paper is concerned with cases in which patients who have been well established in treatment decide to end it prematurely. In examining the issue among my patients who left against my advice, I isolated in some of them a number of common traits, of which the existence of a long-standing idealizing transference was central. Four of these cases are presented, including two in which the resistance was successfully penetrated and two in which it was not and the patient left treatment. The definition of premature termination is seen in the context of that of a complete analysis.