Although significant research has examined the effect of enterprise information systems on the behavior and careers of employees, the majority of this work has been devoted to the study of blue and grey collar workers, with little attention paid to the transformative effect IT may have on high status professionals. In this paper, we begin to bridge this gap by examining how highly skilled professionals react to the increasing presence of technology within their organizations. Specifically, we investigate how the implementation of electronic health record systems (EHRs) affects physician mobility and the decision to continue practicing at their current hospital. Results from a census of physicians in the state of Florida suggest that when these enterprise systems create complementarities for the physician, their tenure at the focal organization increases significantly. However, when technologies are disruptive to the physician’s routines, there is a pronounced exodus from the organization. Interestingly, despite recent claims, results do not suggest that such technology adoption is associated with accelerated retirement on the part of physicians or strategic poaching of talent on the part of competing hospitals. Theoretical and practical implications are discussed within.
Just What the Doctor Ordered? Physician Mobility after the Adoption of Electronic Health Records by Brad N. Greenwood, Kartik K. Ganju, Corey M. Angst :: SSRNJanuary 18, 2017
Maybe ‘Honor Thy Father and Thy Mother’: Uncertain Family Aid and the Design of Social Long Term Care Insurance by Chiara Canta, Helmuth Cremer, Firouz Gahvari :: SSRNJanuary 18, 2017
We study the role and design of private and public insurance programs when informal care is uncertain. Children’s degree of altruism is randomly distributed over some interval. Social insurance helps parents who receive a low level of care, but it comes at the cost of crowding out informal care. Crowding out occurs both at the intensive and the extensive margins. We consider three types of LTC policies: (i) a topping up (TU) scheme providing a transfer which is non exclusive and can be supplemented; (ii) an opting out (OO) scheme which is exclusive and cannot be topped up and (iii), a mixed policy combining these two schemes. TU will involve crowding out both at the intensive and the extensive margins, whereas OO will crowd out informal care solely at the extensive margin. However, OO is not necessarily the dominant policy as it may exacerbate crowding out at the extensive margin. The distortions of both policies can be mitigated by using an appropriately designed mixed policy.
Looking at History to Reduce Current Healthcare Costs by James D. Byrd, Douglas L. Smith, Marilyn M. Helms :: SSRNJanuary 18, 2017
When the history of healthcare and insurance in the US is examined, it is clear the patient has become more and more removed from the payment process. Insurers including Medicare moved to pay providers more quickly and eliminated pre-payment by the insured customer beyond a typical small co-payment. The patient is not clear regarding costs and lacks incentives to control spending. The payment process has deviated so far from the traditional accounting three-way payment match that fraud and other issues have surfaced in billing and payment error. This article presents suggestions from accounting’s three-way match process used in purchasing to carefully outline problems and challenges in US healthcare. Discussion and ways to adapt the popular accounting framework for healthcare are presented within the historical context of the changing healthcare reimbursement and payment process. Areas for future research are also included.
Anchoring Biases in International Estimates of the Value of a Statistical Life by W. Kip Viscusi, Clayton J. Masterman :: SSRNJanuary 18, 2017
U.S. labor market estimates of the value of a statistical life (VSL) were the first revealed preference estimates of the VSL in the literature and continue to constitute the majority of such market estimates. The VSL estimates in U.S. studies consequently may have established a reference point for the estimates that researchers analyzing data from other countries are willing to report and that journals are willing to publish. This article presents the first comparison of the publication selection biases in U.S. and international estimates using a sample of 68 VSL studies with over 1,000 VSL estimates throughout the world. Publication selection biases vary across the VSL distribution and are greater for the larger VSL estimates. The estimates of publication selection biases distinguish between U.S. and international studies as well as between government and non-government data sources. Empirical estimates that correct for the impact of these biases reduce the VSL estimates, particularly for studies based on international data. This pattern of publication bias effects is consistent with international studies relying on U.S. estimates as an anchor for the levels of reasonable estimates. U.S. estimates based on the Census of Fatal Occupational Injuries constitute the only major set of VSL studies for which there is no evidence of statistically significant publication selection effects. Adjusting a baseline biasadjusted U.S. VSL estimate of $9.6 million using estimates of the income elasticity of the VSL may be a sounder approach to generating international estimates of the VSL than relying on direct estimates from international studies.
The Life-Cycle Benefits of an Influential Early Childhood Program by Jorge Luis García, James J. Heckman, Duncan Ermini Leaf, María José Prados :: SSRNJanuary 18, 2017
This paper estimates the long-term benefits from an influential early childhood program targeting disadvantaged families. The program was evaluated by random assignment and followed participants through their mid-30s. It has substantial beneficial impacts on health, children’s future labor incomes, crime, education, and mothers’ labor incomes, with greater monetized benefits for males. Lifetime returns are estimated by pooling multiple data sets using testable economic models. The overall rate of return is 13.7% per annum, and the benefit/cost ratio is 7.3. These estimates are robust to numerous sensitivity analyses.
Both Affordable Care Act (ACA) opponents and supporters tended to exaggerate how much immediate harm Trump would do to the outgoing Obama administration’s legacy healthcare program.
The new president certainly “could” swing a wrecking ball against what remains of the troubled effort to expand insurance coverage under tighter federal government control and substantial taxpayer subsidies. His toolkit of potential executive branch actions is large and varied, but it is not unlimited. The more important questions involve how Trump wants to utilize those powers, and for what objectives.
Jini Kim’s relationship with Medicaid is business and personal.
Her San Francisco start-up, Nuna, while working with the federal government, has built a cloud-computing database of the nation’s 74 million Medicaid patients and their treatment.Medicaid, which provides health care to low-income people, is administered state by state.
Extracting, cleaning and curating the information from so many disparate and dated computer systems was an extraordinary achievement, health and technology specialists say. This new collection of data could inform the coming debate on Medicaid spending.