Economics

Hospital Performance, the Local Economy, and the Local Workforce: Findings from a US National Longitudinal Study

Hospital Performance, the Local Economy, and the Local Workforce: Findings from a US National Longitudinal Study
PLoS Med 7(6): e1000297. doi:10.1371/journal.pmed.1000297

Blustein, J., Borden, W.B., Valentine, M.
06/29/2010

Abstract

Background: Pay-for-performance is an increasingly popular approach to improving health care quality, and the US government will soon implement pay-for-performance in hospitals nationwide. Yet hospital capacity to perform (and

improve performance) likely depends on local resources. In this study, we quantify the association between hospital performance and local economic and human resources, and describe possible implications of pay-for-performance for socioeconomic equity.

Methods and Findings: We applied county-level measures of local economic and workforce resources to a national sample of US hospitals (n = 2,705), during the period 2004–2007. We analyzed performance for two common cardiac conditions (acute myocardial infarction [AMI] and heart failure [HF]), using process-of-care measures from the Hospital Quality Alliance [HQA], and isolated temporal trends and the contributions of individual resource dimensions on performance, using multivariable mixed models. Performance scores were translated into net scores for hospitals using the Performance Assessment Model, which has been suggested as a basis for reimbursement under Medicare’s ‘‘Value-Based Purchasing’’ program. Our analyses showed that hospital performance is substantially associated with local economic and workforce resources. For example, for HF in 2004, hospitals located in counties with longstanding poverty had mean HQA composite scores of 73.0, compared with a mean of 84.1 for hospitals in counties without longstanding poverty (p,0.001). Hospitals located in counties in the lowest quartile with respect to college graduates in the workforce had mean HQA composite scores of 76.7, compared with a mean of 86.2 for hospitals in the highest quartile (p,0.001). Performance on AMI measures showed similar patterns. Performance improved generally over the study period. Nevertheless, by 2007—4 years after public reporting began—hospitals in locationally disadvantaged areas still lagged behind their locationally advantaged counterparts. This lag translated into substantially lower net scores under the Performance Assessment Model for hospital reimbursement.

Conclusions: Hospital performance on clinical process measures is associated with the quantity and quality of local economic and human resources. Medicare’s hospital pay-for-performance program may exacerbate inequalities across regions, if implemented as currently proposed. Policymakers in the US and beyond may need to take into consideration the balance between greater efficiency through pay-for-performance and socioeconomic equity.

Please see later in the article for the Editors’ Summary.

Estimating the Intergenerational Persistence of Lifetime Earnings with Life Course Matching: Evidence from the PSID

Estimating the Intergenerational Persistence of Lifetime Earnings with Life Course Matching: Evidence from the PSID
Labour Economics, Vol. 17, no. 3 (Jun 2010), pp. 592-597. doi:10.1016/j.labeco.2009.04.009

Gouskova, E., N. Chiteji, and F. Stafford
06/01/2010

Why do estimates of the intergenerational persistence in earnings vary so much for the United States? Recent research suggests that lifecycle bias may be a major factor [Grawe, N., Lifecycle bias in estimates of intergenerational earnings persistence. Labour Economics 2006, 13:551–570; Haider, S., and Solon, G., Life-cycle variation in the association between current and lifetime earnings. American Economic Review 2006, 96(4):1308–1320.]. In this paper we estimate the intergenerational correlation in lifetime earnings by using sons' and fathers' earnings at similar ages in order to account for lifecycle bias. Our estimate based on earnings measured at 35–44 for both fathers and sons is similar to that for the age range 45–54.

The Economics of Microfinance, 2nd edition

The Economics of Microfinance, 2nd edition
Cambridge, MA: MIT Press.

Beatriz Armendáriz and Jonathan Morduch
06/01/2010

Contents:

1 Rethinking Banking 

2 Why Intervene in Credit Markets? 

3 Roots of Microfinance: ROSCAs and Credit Cooperatives

4 Group Lending

5 Beyond Group Lending

6 Savings and Insurance

7 Gender

8 Commercialization and Regulation

9 Measuring Impacts

10 Subsidy and Sustainability

11 Managing Microfinance 

Economic Development Impacts of High-speed Rail

Economic Development Impacts of High-speed Rail
RCWP 10-007 June, 2010

Levinson, David
06/01/2010

High-speed rail lines have been built and proposed in numerous countries throughout the world. The advantages of such lines are a higher quality of service than competing modes (air, bus, auto, conventional rail), potentially faster point-to-point times depending on specific locations, faster
loading and unloading times, higher safety than some modes, and lower labor costs. The disadvantage primarily lies in higher fixed costs, potentially higher energy costs than some competing modes, and higher noise externalities. Whether the net benefits outweigh the net costs is an empirical question that awaits determination based on location specific factors, project costs, local demand, and network effects (depending on what else in the network exists). The optimal network design problem is hard (in the mathematical sense of hard, meaning optimal solutions are hard to find because of the combinatorics of the possible different network configurations), so heuristics and human judgment are used to design networks.

 

Time-preference, Non-cognitive Skills and Well-being across the Life Course: Do Non-cognitive Skills Encourage Healthy Behavior?

Time-preference, Non-cognitive Skills and Well-being across the Life Course: Do Non-cognitive Skills Encourage Healthy Behavior?
American Economic Review, May, Volume 100(2): 200-204

Chiteji, N.
05/01/2010

No abstract available.

Minimum Parking Requirements, Transit Proximity and Development in New York City

Minimum Parking Requirements, Transit Proximity and Development in New York City
RCWP 10-004 Furman Center for Real Estate and Urban Policy

McDonnell, Simon, Josiah Madar and Vicki Been
04/01/2010

New York City policymakers are planning for a city of over 9 million residents by 2030, a large increase from today. A central goal of City officials is to accommodate this increase while simultaneously improving the City’s overall environmental performance, addressing externalities arising from traffic congestion and providing increased access to affordable housing. The requirement in the City’s zoning code that new residential construction be accompanied by a minimum number of off-street parking spaces, however, may conflict with this goal. This paper combines a theoretical discussion of parking requirements in New York City with a quantitative analysis of how they relate to transit and development opportunity. It draws direct relations between minimum parking requirements with the rise in housing prices and the reduction of density.

Half the World is Unbanked

Half the World is Unbanked
Financial Access Initiative Report, October 2009. Feature in McKinsey Quarterly, March 2010

Jonathan Morduch, Alberto Chaia, Aparna Dalal, Tony Goland, Maria Jose Gonzalez, and Robert Schiff
03/01/2010

Limited information on the size and nature of the global population using financial services limits policy makers’ abilities to identify what’s working and what’s not, and it limits financial services providers’ abilities to identify where the opportunities lie and where they could learn from current successes.

A new report, “Half the world is unbanked,” provides an improved estimate of the size and nature of the global population that does and does not use formal (or semiformal) financial services.

This paper builds on a data set compiled from existing cross-country data sources on financial access and socioeconomic and demographic characteristics to generate an improved estimate of the size and nature of the global population that does and does not use formal (or semiformal) financial services.

How much should we invest in preventing childhood obesity?

How much should we invest in preventing childhood obesity?
Health Aff (Millwood). 2010 Mar-Apr;29(3):372-8.

Trasande L
03/01/2010

Policy makers generally agree that childhood obesity is a national problem. However, it is not always clear whether enough is being spent to combat it. This paper presents nine scenarios that assume three different degrees of reduction in obesity/overweight rates among children in three age groups. A mathematical model was then used to project lifetime health and economic gains. Spending $2 billion a year would be cost-effective if it reduced obesity among twelve-year-olds by one percentage point. The analysis also found that childhood obesity has more profound economic consequences than previously documented. Large investments to reduce this major contributor to adult disability may thus be cost-effective by widely accepted criteria.

Welcome to the Neighborhood: What Can Regional Science Contribute to the Study of Neighborhoods?

Welcome to the Neighborhood: What Can Regional Science Contribute to the Study of Neighborhoods?
JOURNAL OF REGIONAL SCIENCE, VOL. 50, NO. 1, 2010, pp. 363-379

Ellen, I.G. & O'Regan, K.
01/13/2010

We argue in this paper that neighborhoods are highly relevant for the types of issues at the heart of regional science. First, residential and economic activity takes place in particular locations, and particular neighborhoods. Many attributes of those neighborhood environments matter for this activity, from the physical amenities, to the quality of the public and private services received. Second, those neighborhoods vary in their placement in the larger region and this broader arrangement of neighborhoods is particularly important for location choices, commuting behavior and travel patterns. Third, sorting across these neighborhoods by race and income may well matter for educational and labor market outcomes, important components of a region's overall economic activity. For each of these areas we suggest a series of unanswered questions that would benefit from more attention. Focused on neighborhood characteristics themselves, there are important gaps in our understanding of how neighborhoods change - the causes and the consequences. In terms of the overall pattern of neighborhoods and resulting commuting patterns, this connects directly to current concerns about environmental sustainability and there is much need for research relevant to policy makers. And in terms of segregation and sorting across neighborhoods, work is needed on better spatial measures. In addition, housing market causes and consequences for local economic activity are under researched. We expand on each of these, finishing with some suggestions on how newly available data, with improved spatial identifiers, may enable regional scientists to answer some of these research questions.

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