March 11, 2013
One of medicine’s open secrets is that patients routinely refuse or demand medical treatment based on the assigned physician’s racial identity, and hospitals typically yield to patients’ racial preferences. This widely practiced, if rarely acknowledged, phenomenon — about which there is new empirical evidence — poses a fundamental dilemma for law, medicine, and ethics. It also raises difficult questions about how we should think about race, health, and individual autonomy in this context. Informed consent rules and common law battery dictate that a competent patient has an almost-unqualified right to refuse medical care, including treatment provided by an unwanted physician. Yet the accommodation of patients’ racial preferences with respect to their choice of physician in the hospital context appears to violate antidiscrimination principles. How should we reconcile this apparent conflict between respect for patient autonomy and accepted notions of racial equality? Moreover, is the accommodation of patients’ racial preferences the type of invidious discrimination that civil rights laws were enacted to prevent?
This Article engages these questions through an evaluation of antidiscrimination norms, principles of medical ethics, and federal laws, including Titles II, VI, and VII of the Civil Rights Act. In so doing, the Article offers critical insights into why a form of discrimination that is prohibited in other contexts is tolerated in the hospital setting and draws important conclusions about the legal propriety and medical efficacy of this practice. The Article contends that the various titles of the Civil Rights Act offer no clear legal directive on this practice, and it makes the counterintuitive claim that although hospital accommodation of patients’ racial preferences appears to contravene antidiscrimination principles, it is not only consistent with our normative commitments to racial equality but, in fact, constitutes an effective means of alleviating race-based health disparities, improving health outcomes, and quite possibly, saving patients’ lives.
via Patients’ Racial Preferences and the Medical Culture of Accommodation by Kimani Paul-Emile :: SSRN.
March 11, 2013
This paper confirms recent studies which find little or no sustained increase in the inequality of disposable income for the U.S. population as a whole over the past 20 years, even though estimates of the top 1 percent’s share of pretax, pretransfer (market) income spiked upward in 1986-88, 1997-2000 and 2003-2007. It has become commonplace to use top 1 percent shares of market income as a shorthand measure of inequality, and as an argument for greater taxes on higher incomes and/or larger transfer payments to the bottom 90 percent. This paper finds the data inappropriate for such purposes for several reasons
via The Misuse of Top 1 Percent Income Shares as a Measure of Inequality by Alan Reynolds :: SSRN.
March 10, 2013
The phenomenon of some women losing ground appears to have begun in the late 1980s, though studies have begun to spotlight it only in the last few years.
Trying to figure out why is “the hot topic right now, trying to understand what’s going on,” said Jennifer Karas Montez, a Harvard School of Public Health sociologist who has been focused on the life-expectancy decline but had no role in the new study.
Researchers also don’t know exactly how many women are affected. Ms. Montez says a good estimate is roughly 12%.
via Study Points to Declining Life Span for Some U.S. Women – WSJ.com.
March 4, 2013
Researchers increasingly track variations in health outcomes across counties in the United States, but current ranking methods do not reflect changes in health outcomes over time. We examined trends in male and female mortality rates from 1992–96 to 2002–06 in 3,140 US counties. We found that female mortality rates increased in 42.8 percent of counties, while male mortality rates increased in only 3.4 percent. Several factors, including higher education levels, not being in the South or West, and low smoking rates, were associated with lower mortality rates. Medical care variables, such as proportions of primary care providers, were not associated with lower rates. These findings suggest that improving health outcomes across the United States will require increased public and private investment in the social and environmental determinants of health—beyond an exclusive focus on access to care or individual health behavior.
via Even As Mortality Fell In Most US Counties, Female Mortality Nonetheless Rose In 42.8 Percent Of Counties From 1992 To 2006.
March 4, 2013
We make use of a new data resource, merged birth and school records for all children born in Florida from 1992 to 2002, to study the effects of birth weight on cognitive development from kindergarten through schooling. Using twin fixed effects models, we find that the effects of birth weight on cognitive development are essentially constant through the school career; that these effects are very similar across a wide range of family backgrounds; and that they are invariant to measures of school quality. We conclude that the effects of poor neonatal health on adult outcomes are therefore set very early.
via The Effects of Poor Neonatal Health on Children’s Cognitive Development.
February 27, 2013
Present social movements, as “Occupy Wall Street” or the Spanish “Indignados”, claim that politicians work for an economic elite, the 1%, that drives the world economic policies. In this paper we show through econometric analysis that these movements are accurate: politicians in OECD countries maximize the happiness of the economic elite. In 2009 center-right parties maximized the happiness of the 100th-98th richest percentile and center-left parties the 100th-95th richest percentile. The situation has evolved from the seventies when politicians represented, approximately, the median voter.
via Do Politicians Serve the One Percent? Evidence from OECD Countries by Pablo Torija :: SSRN.
February 20, 2013
Using household-level data from the Panel Study of Income Dynamics, we estimate the extent to which medical expenses are responsible for driving households to bankruptcy. Our results suggest that an increase of 10 percent in medical debts would cause a 27 percent increase in the filing propensity of households with primarily medical debt, and an approximately 36 percent increase in filing propensity of households where medical debts co-exist with primarily credit card debts. Studying the post- bankruptcy scenario, we find that filers are 19 percent less likely to own a home even several years after the filing, compared to non-filers. However, the consequences are less adverse for medical filers i.e. those who filed due to high medical bills compared to other filers.
via Health Expenditures and Personal Bankruptcies by Aparna Mathur :: SSRN.
February 17, 2013
This paper examines changes in after-tax income inequality among tax filers between 1991 and 2006. In particular, how changes in wages, capital income, and tax policy contribute to changes in income inequality is investigated. To examine the role of these three possible contributors to the increase in income inequality, the Gini coefficient is decomposed by income source using the method developed by Lerman and Yitzhaki (1985). The Gini coefficient of after-tax income increased by 15 percent (0.071 points) between 1991 and 2006. By far, the largest contributor to this increase was changes in income from capital gains and dividends. Changes in wages had an equalizing effect over this period as did changes in taxes. Most of the equalizing effect of taxes took place after the 1993 tax hike; most of the equalizing effect, however, was reversed after the 2001 and 2003 Bush-era tax cuts. Similar results are obtained with other inequality measures.
via Changes in Income Inequality Among U.S. Tax Filers between 1991 and 2006: The Role of Wages, Capital Income, and Taxes by Thomas Hungerford :: SSRN.
February 17, 2013
While much attention has focused on health disparities between socio-economic groups, most health inequality actually occurs within socio-economic groups. We examine trends in overall health inequality – measured by realized length-of-life inequality – through the lens of social justice, similar to traditional analysis of income inequality. We find that throughout most of the length-of-life distribution, inequality has declined dramatically over the past century. It has continued to decline even in the past 40 years, a period over which it is generally thought that income inequality has risen considerably. Most of the decline in length-of-life inequality appears to be driven by reductions in inequality within socio-economic groups. Using a reasonable estimate of the value of a quality-adjusted life year (QALY) we find that, on a lifetime basis, the least healthy individuals in society have gained more than eight times as much as the healthiest. In dollar terms, the relative gain for the 10th percentile of health is more than $400,000.
via An Alternative Perspective on Health Inequality by Benjamin Ho, Sita Slavov :: SSRN.
February 16, 2013
International differences in long-term care (LTC) use are well documented, but not well understood. Using comparable data from two countries with universal public LTC insurance, the Netherlands and Germany, we examine how institutional differences relate to differences in the choice for informal and formal LTC. While the overall LTC utilization rate is similar in both countries, use of formal care is more prevalent in the Netherlands and informal care use in Germany. Decomposition of the between-country differences in formal and informal LTC use reveals that these differences are not chiefly the result of differences in population characteristics but mainly derive from differences in the effects of these characteristics that are associated with between-country institutional differences. These findings demonstrate that system features like eligibility rules and coverage generosity and, indirectly, social preferences can influence the choice between formal and informal care. Less comprehensive coverage also has equity implications: for the poor, access to formal LTC is more difficult in Germany than in the Netherlands.
via Going Formal or Informal, Who Cares? The Influence of Public Long-Term Care Insurance by Pieter Bakx, Claudine De Meijer, Erik Schut, Eddy Van Doorslaer :: SSRN.