DESIGNED TO FAIL: THE MEDICARE AUCTION FOR DURABLE MEDICAL EQUIPMENT

We examine the theoretical properties of the auction for Medicare Durable Medical Equipment. Two unique features of the Medicare auction are (1) winners are paid the median winning bid and (2) bids are nonbinding. We show that median pricing results in allocation inefficiencies as some high‐cost firms potentially displace low‐cost firms as winners. Further, the auction may leave demand unfulfilled as some winners refuse to supply because the price is set below their cost. We also introduce a model of nonbinding bids that establishes the rationality of a lowball bid strategy employed by many bidders in the actual Medicare auctions and recently replicated in Caltech experiments. We contrast the median‐price auction with the standard clearing‐price auction where each firm bids true costs as a dominant strategy, resulting in competitive equilibrium prices and full efficiency. (JEL D44, I11, H57)     

Understanding perceptions of substance use education in social work: an analysis of survey responses from MSW program leaders

ABSTRACT

This article details the findings of a series of analyses regarding how the institutional leaders of Master of Social Work Programs (MSW) in the United States form their perceptions on the role and implementation of substance use concepts in social work education. Five statistical tests were performed on data collected from a 2017 substance use education (SUE) survey of MSW program leaders, and the analyses were used to explore how program leaders form their perceptions on: the importance of SUE to social work, the need for regulatory measures for SUE in social work, the SUE needs of individual MSW programs, the implementation of substance use course content, and graduating students’ substance use intervention capacities. Significant findings from the analyses showed that: the amount of foundational course emphasis on clinical SUE within individual programs is a significant predictor of program leader perceptions on students’ clinical substance use intervention capacities; different categories of substance use intervention preparedness have interconnected effects among domains of preparedness; and perceptions on the importance of SUE to social work have a significant impact on program leaders’ opinions regarding regulatory measures for SUE in social work.     

Exposure to Community Violence,Suicidality, and Psychological Distress Among African American and Latino Youths: Findings From the CDC Youth Violence Survey

The present investigation explored risk and protective factors for suicidal ideation and behavior in a sub-sample of African American and Latino adolescents (n = 2,626) who participated in the 2004 Centers for Disease Control Youth Violence Survey. Structural equation modeling was used to explore exposure to violence at the community level as a contextual factor that could potentially influence depressive symptomatology, substance abuse, parental support, social support, and suicidality among study participants. Findings indicated that exposure to violence at the community level was not directly related to suicidality among this population of urban adolescents. However, it was directly related with several other variables under study in the model, which in turn were directly related with suicidality. Tests of invariance revealed several across-group differences, particularly by race and gender, in how the identified risk and protective factors in the model related to suicidality. Implications for research and practice with urban, ethnic minority, adolescent populations are discussed.     

Managing Money in Marriage: Multilevel and Cross‐National Effects of the Breadwinner Role

We examine whether institutionalized practices and beliefs regarding breadwinning roles are associated with the choice of more or less equal money management strategies in marriage. Using cross‐national data from 21 country contexts in the International Social Survey Programme and multilevel modeling, we find that in contexts of shared breadwinning, there is a greater likelihood of shared management of money, controlling for the relative income contribution of each spouse. We also find some evidence that the effect of spouses’ relative income contributions diminishes in contexts of shared breadwinning. Our analysis comparing women’s and men’s money management is consistent with previous research indicating that women’s management may be more work than power.     

Improving Cancer Dose–Response Characterization by Using Physiologically Based Pharmacokinetic Modeling: An Analysis of Pooled Data for Acrylonitrile-Induced Brain Tumors to Assess Cancer Potency in the Rat

Historically, U.S. regulators have derived cancer slope factors by using applied dose and tumor response data from a single key bioassay or by averaging the cancer slope factors of several key bioassays. Recent changes in U.S. Environmental Protection Agency (EPA) guidelines for cancer risk assessment have acknowledged the value of better use of mechanistic data and better dose–response characterization. However, agency guidelines may benefit from additional considerations presented in this paper. An exploratory study was conducted by using rat brain tumor data for acrylonitrile (AN) to investigate the use of physiologically based pharmacokinetic (PBPK) modeling along with pooling of dose–response data across routes of exposure as a means for improving carcinogen risk assessment methods. In this study, two contrasting assessments were conducted for AN-induced brain tumors in the rat on the basis of (1) the EPA's approach, the dose–response relationship was characterized by using administered dose/concentration for each of the key studies assessed individually; and (2) an analysis of the pooled data, the dose–response relationship was characterized by using PBPK-derived internal dose measures for a combined database of ten bioassays. The cancer potencies predicted for AN by the contrasting assessments are remarkably different (i.e., risk-specific doses differ by as much as two to four orders of magnitude), with the pooled data assessments yielding lower values. This result suggests that current carcinogen risk assessment practices overestimate AN cancer potency. This methodology should be equally applicable to other data-rich chemicals in identifying (1) a useful dose measure, (2) an appropriate dose–response model, (3) an acceptable point of departure, and (4) an appropriate method of extrapolation from the range of observation to the range of prediction when a chemical's mode of action remains uncertain.     

Robustness of Approaches to ROC Curve Modeling under Misspecification of the Underlying Probability Model

A variety of statistical regression models have been proposed for the comparison of ROC curves for different markers across covariate groups. Pepe developed parametric models for the ROC curve that induce a semiparametric model for the market distributions to relax the strong assumptions in fully parametric models. We investigate the analysis of the power ROC curve using these ROC-GLM models compared to the parametric exponential model and the estimating equations derived from the usual partial likelihood methods in time-to-event analyses. In exploring the robustness to violations of distributional assumptions, we find that the ROC-GLM provides an extra measure of robustness.     

Whither the virtuous cycle? Past and future trends in black-white inequality in educational attainment

The inequality in the relative years of education between blacks and whites has diminished dramatically over the 20th century. One possible explanation for this convergence is a virtuous cycle of parents passing on educational advantage, from one generation to the next, leading to an overall educational upgrading. In this paper we test the virtuous cycle hypothesis by estimating the three way interaction of cohort, race, and family background. We find that the convergence in educational attainment between blacks and whites over the past century was driven by processes unrelated to family background.     

The social context of Welsh-medium bilingual education in anglicised areas

Principal component analysis of indicators from the 1991 Census was used to characterise the social context of school age Welsh speakers in South East Wales. The area had been largely anglicised by the Census of 1971, but the growth of Welsh-medium education was responsible for net gains in numbers of younger Welsh/English bilinguals. Doubts as to whether young people will remain active bilinguals after leaving school have been raised. The inter-relationships between figures for Welsh speaking in the Census and other social indicators were examined. Being categorised as a young Welsh speaker was found to cut across an economic advantage/disadvantage dimension, and so was a matter of life style rather than a by-product of parental choices unrelated to language resurgence. Probing life styles by means of interviews where Welsh-medium and English-medium schools could be matched on the economic advantage/disadvantage dimension showed that deciding for Welsh-medium education was embedded in authentic local life styles. Although networks of people at more local spatial scales were involved in Welsh-medium education, they were linked to wider scale networks establishing domains for Welsh language use in the public sector and local government.     

Procurement with Reverse Auction and Flexible Noncompetitive Contracts

This article investigates a hybrid procurement mechanism that combines a reverse auction with flexible noncompetitive contracts. A buyer adopts such mechanism to procure multiple units of a product from a group of potential suppliers. Specifically, the buyer first offers contracts to some suppliers who, if accepting the contract, do not participate in the auction while committing to selling a unit to the buyer at the price of the subsequent auction. For the suppliers rejecting the offers, they can join the subsequent auction with the other suppliers to compete on the remaining units. When the buyer offers only one flexible noncompetitive contract, we find that the selected supplier may accept the offer regardless of whether he knows his exact cost information. Meanwhile, the buyer can benefit from offering such a contract, as opposed to solely conducting a regular reverse auction or offering a noncompetitive contract that does not allow suppliers declining offers to join the subsequent auction. Moreover, we find that the suppliers' information about their own costs has a significant impact on the buyer's decision. When the buyer makes multiple offers, we analyze the resulting game behavior of the selected suppliers and demonstrate that the buyer can benefit more than just offering one such contract. Therefore, the hybrid procurement mechanism can be mutually beneficial for both the buyer and the selected suppliers.     

A Texas Peasantry? Black Smallholders in the Texas Sugar Bowl, 1865–1890

This article examines a small community of former slaves in Texas's leading sugar-producing county and argues that local conditions fostered the growth of a Caribbean-style ‘reconstituted peasantry’. Using local sources to compile a database of 79 African American landowners, it traces the postwar decline of the sugar plantations, the process of black land acquisition and the smallholders' strategies for survival. The smallholders' position, however, was precarious, and most lost their lands at the close of the nineteenth century. The piece concludes by suggesting that more intensive local research into former-slave communities may force a reconsideration of the notion that all American slaves became landless wage labourers.