John McLaren, 11 August 2020

In the US, COVID-19 tends to magnify inequalities by disproportionately hitting minorities, particularly African Americans, who suffer from higher COVID-19 mortality rates. Higher rates of infection appear to be the cause rather than factors related to treatment. Using an indirect approach, this column uses census data to identify the socioeconomic factors that cause different racial groups to be differentially exposed to the virus. Very strong racial disparities in COVID-19 mortality rates are seen for African-American and First Nations populations. Occupation, income, poverty rates, or access to healthcare insurance appears to matter little. Pre-COVID-19 use of public transport, however, may be a significant factor.

Kritee Gujral, 10 June 2020

A quarter of all rural US hospitals, most of which are highly essential to their communities, are at high risk of closing.Hospital closures may increase transport time and delay treatment. This column examines hospital closures in California from 1995 to 2011 to assess the effects of rural and urban hospital closures on inpatient mortality. Mortality increases after a rural hospital closure not only in the local rural area but in the neighbouring urban areas as well. This adverse effect is larger for Medicaid patients and racial minorities.

Jeffrey Clemens, Parker Rogers, 10 March 2020

Why has medical innovation brought cost-increasing enhancements to quality, rather than cost-reducing advances in productivity? The column uses a new dataset drawn from patents for prosthetic devices to show that the design of incentives for innovators can have substantial effects on these margins. Fixed-price procurement arrangements induce greater effort to reduce production costs than cost-plus procurement arrangements. Procurement models may therefore inadvertently lead to 'missing innovations'.

Michele Fioretti, Hongming Wang, 19 January 2020

As health spending continues to rise globally, pay-for-performance can be an attractive policy tool for promoting high-quality services at lower costs. But there are concerns that it weakens the finances of poor-performing hospitals in low-income areas. This column examines the efficiency and equity consequences of the introduction of pay-for-performance in the Medicare insurance programme in the US. It finds that after the payment reform, high-quality insurers selected healthier enrollees, shifting the distribution of high-quality insurance to the healthiest counties and worsening regional disparities in healthcare access.

Timothy J. Layton, Nicole Maestas, Daniel Prinz, Boris Vabson, 17 October 2019

There is much debate, and nowhere more than in the US, about whether public services such as healthcare should be provided by private companies, which may offer greater efficiencies but which are more susceptible to moral hazard and adverse selection of consumers. This column uses evidence from a provision change in Texas to show that contracting healthcare provision out to private companies increased the level of care patients received, but increased overall costs for the government.

Shari Eli, Trevon Logan, Boriana Miloucheva, 20 August 2019

The mortality gap between blacks and whites in the US has been well documented, but there is still considerable debate over why the gap has remained so large and why it has persisted over the last century. This column explores these questions using unique data on black and white Civil War veterans to measure one of the earliest known incidences of physician bias against African Americans. It shows that physician bias had large effects on income and longevity of blacks relative to whites and considers the ways in which doctor attitudes still contribute to the racial mortality gap today. 

Michael Keane, 26 May 2019

Launched in 2006, Medicare Part D allows beneficiaries to enrol in subsidised drug coverage plans sold by private insurers, but navigating the different plans can be complex and lead to sub-optimal choices. This column uses Medicare administrative data for 2006-2010 to understand the quality of consumer decision-making in the Part D marketplace. It finds that the vast majority of elderly place too much weight on premiums relative to out-of-pocket costs, care a great deal about the particular combination of plan features, and are highly likely to choose the same plan every year regardless of changes in prices and alternatives.

David Bloom, Alyssa Lubet, 29 April 2019

As baby boomers get older, many high-income countries face challenges in the provision of pensions and healthcare. The column argues that the US has particularly acute problems arising from its ageing population, high healthcare costs, and high inequality in maternal mortality and other health indicators. It will take deep social policy and health system reforms to address these inequalities.

Molly Frean, Mark V. Pauly, 08 January 2019

Both healthcare spending levels and growth in the US have exceeded other developed countries for many years. With healthcare costs rising at an unsustainable pace, a greater percentage of workers in the US are being enrolled in high-deductible health plans. This column estimates the relationship between high deductibles and the growth in total healthcare spending on all medical goods and services. It finds that deductible levels have a considerable effect on spending growth, and suggests that the natural next step is to explore whether or how that affects health outcomes.

Damian Clarke, Hanna Mühlrad, 12 November 2018

Women’s health is frequently cited when debating the merits of abortion legislation. However, the arguments are often based on evidence which is correlational or drawn from small or non-representative samples of women. This column explores the impacts of abortion legislation on women’s health using the universe of health records from Mexico, where abortion was legalised in the Federal District of Mexico while sanctions on abortion were increased in other regions of the country. It documents immediate reductions in rates of hospitalisation of women with the legalisation of abortion.

Daniel Bauer, Darius Lakdawalla, Julian Reif, 05 November 2018

People with shorter life expectancies place more value on increases in survival than people who anticipate longer life spans. That may seem obvious, but economists have been making the opposite prediction for decades. This column demonstrates the mistake in the earlier theory and points out important policy implications, including that payers and governments are undervaluing investments in treating highly severe illnesses.

Nikhil Agarwal, Itai Ashlagi, Eduardo Azevedo, Clayton Featherstone, Omer Karaduman, 03 November 2018

National kidney exchange platforms significantly boost the number of life-saving kidney transplants by finding complicated exchange arrangements that are not possible within any single hospital. This column examines US data and finds that the majority of kidney exchanges continue to be performed within hospitals, suggesting a fragmented market that comes at a large efficiency cost. National platforms may need to be redesigned to encourage full participation, with reimbursement reform.

Daniel Barczyk, Matthias Kredler, 28 January 2018

Ageing societies and the increase in female labour force participation are putting pressure on governments to take a more active role in caring for the elderly. Using European and US data, this column investigates the responses of families to long-term care policy. The results suggest that care arrangements are strongly influenced by policy, and highlight the importance of accounting for informal care when evaluating reform proposals.

Charles Manski, 27 October 2017

In medical treatment, it is assumed that adherence to clinical practice guidelines is always preferable to decentralised clinical decision-making, yet there is no welfare analysis that supports this belief. This column argues that it would be better to treat clinical judgement as a problem of decision-making under uncertainty. In this case there would be no optimal way to make decisions, but there are reasonable ways with well-understood welfare properties.

Joan Costa-Font, Edward C. Norton, Luigi Siciliani, 12 September 2017

Long-term care services are at the forefront of a new wave of reforms extending public intervention into healthcare, but it is unclear how the government should intervene to fund and organise such services. This column suggests some strengths and weaknesses of public financing and organisation of long-term care, including its weak financial sustainability and some potential knock-on effects on saving behaviour. However, publicly funded systems deliver better equity of access. Non for profit and autonomous organisations provide better care.

Laurent Gobillon, Carine Milcent, 21 July 2017

It is widely believed that the goal of keeping health expenditures under control while increasing the quality of the healthcare system can best be achieved by giving a greater role to market forces. This column evaluates the effect of a pro-competition reform implemented in France over 2004-2008 on hospital quality. It finds that the impact on quality depends on the managerial autonomy of hospitals. And due to the French healthcare market structure, the overall effect of the reform has been limited.

Margaret Kyle, Heidi Williams, 22 May 2017

Despite higher per capita healthcare spending, US health outcomes compare poorly with other developed nations. One potential reason is that the US healthcare system creates incentives that promote the faster adoption of medical technologies with minimal benefits. This column tests this claim using data on the quality and diffusion of new pharmaceuticals in the US and four other countries. The results suggest that compared to Australia, Canada, Switzerland, and the UK, low-quality drugs diffuse more quickly in the US relative to high-quality drugs.

Travers Barclay Child, 21 May 2017

The pervasive ‘hearts and minds’ theory guiding counterinsurgency doctrine contends that military-led reconstruction reduces violence in post-conflict settings. Using rare data from Afghanistan, this column questions the theoretical and empirical basis of that perspective. Military-led projects in the health sector are found to successfully alleviate violence, whereas those in the education sector actually provoke conflict. The destabilising effects of education projects are strongest in conservative areas, where public opinion polls suggest education projects breed antipathy towards international forces.

Micael Castanheira, Carmine Ornaghi, Georges Siotis, 01 March 2017

Conventional wisdom holds that increased competition improves market outcomes. This column argues that the link from competitiveness to allocative efficiency is weaker than this wisdom would suggest. Using evidence of generic substitutes of previously patent-protected drugs, it shows that firms can use non-price instruments which affect – or even reverse – the way competitive shocks alter market outcomes, with significant welfare implications.

Michael Callen, Saad Gulzar, Muhammad Yasir Khan, Ali Hasanain, 21 August 2016

Government employee absenteeism is often a serious problem in developing countries. One potential reason is government positions being appointed as a kind of patronage to reward political loyalty. This column presents the results of an intervention designed to address government doctor absenteeism in Punjab, Pakistan. The programme provided government inspectors with a smartphone app to streamline information flows, and improved inspection rates. The results support the political patronage hypothesis and provide encouraging support for data-driven policymaking.



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