CEPR Discussion Paper | The Impact of Competition on Management Quality: Evidence from Public Hospitals

June 30, 2010

Nicholas Bloom , Carol Propper , Stephan Seiler , John Van Reenen The Impact of Competition on Management Quality: Evidence from Public Hospitals. Center for Economic Policy Discussion Paper DP7880. June 2010.

In this paper we examine the causal impact of competition on management quality. We analyze the hospital sector where geographic proximity is a key determinant of competition, and English public hospitals where political competition can be used to construct instrumental variables for market structure. Since almost all major English hospitals are government run, closing hospitals in areas where the governing party has a small majority is rare due to fear of electoral punishment. We find that management quality – measured using a new survey tool – is strongly correlated with financial and clinical outcomes such as survival rates from emergency heart attack admissions (AMI). More importantly, we find that higher competition (as indicated by a greater number of neighboring hospitals) is positively correlated with increased management quality, and this relationship strengthens when we instrument the number of local hospitals with local political competition. Adding another rival hospital increases the index of management quality by one third of a standard deviation and leads to a 10.7% reduction in heart-attack mortality rates.

via CEPR Discussion Paper Abstracts.

Heritage Foundation | Revitalizing Federalism: The High Road Back to Health Care Independence

June 30, 2010

Robert Moffit. Revitalizing Federalism: The High Road Back to Health Care Independence. Heritage Foundation Backgrounder, June 30, 2010.

Abstract: The Patient Protection and Affordable Care Act represents more than a federal takeover of health care; it is a direct threat to federalism itself. Never before has Congress exercised its power under Article I, Section 8 of the Federal Constitution to force American citizens to purchase a pri­vate good or a service. Congress is also intruding deeply into the internal affairs of the states, commandeering their offic­ers, specifying in minute detail how they are to arrange health insurance markets within their borders, and deter­mining the products that will be sold to their citizens. If allowed to stand, this unprecedented concentration of polit­ical power in Washington will reduce the states to mere instruments of federal health policy. State legislatures and sympathetic Members of Congress should consider (among other actions) crafting a constitutional amendment to guar­antee the personal liberty of every citizen in the area of health care. Given the trajectory of federal policy, state offi­cials should take the lead in the next phase of the national health care debate, reclaim their rightful authority, and change the facts on the ground for Congress and the White House. More at The Heritage Foundation.

RealClearPolitics | Health Bill, Oil Spill Change Perceptions of Obama

June 30, 2010

Earlier this month, Resurgent Republic — an independent public-opinion-research group headed by former Republican National Committee chairman Ed Gillespie — conducted focus groups in five key House districts, measuring how independent voters and, separately, self-identified tea-party members felt about the direction of the country. Bad news for President Obama and congressional Democrats is common these days, but these results unveiled Tuesday are simply dismal. Asked to compare Obama to a car, one Iowan chose an Edsel: “Something that had a lot of hype, but failed to live up to expectations.” More

Report to Congress. Fiscal Year 2011 Objectives | National Taxpayer Advocate

June 30, 2010

National Taxpayer Advocate. Report to Congress. Fiscal Year 2011 Objectives. June 30, 2010.

TAS Will Examine the Administrative Challenges Presented By New Information Reporting Requirements

A provision in the Patient Protection and Affordable Care Act (PPACA), enacted in March of this year, added a new information reporting requirement that may present significant administrative challenges to taxpayers and the IRS. In particular, businesses will have to issue Forms 1099 for goods purchased after 2011, regardless of the corporate form of the vendor.48 The Office of the Taxpayer Advocate is concerned that the new reporting burden, particularly as it falls on small businesses, may turn out to be disproportionate as comparedwith any resulting improvement in tax compliance. More at TAS Report, p. 9.

TAS Will Continue to Work with the IRS to Implement Health Care Reform

Earlier this year, the President signed into law significant legislation that reforms America’s health care system.  Under the new law, the IRS has been given a large role to play in implementing these reform efforts.

Although most Americans do not typically interact with the IRS in connection with their health insurance, many provisions in the new law will require IRS involvement at some point. Specifically, some of the major provisions requiring IRS participation include:

  • Premium Assistance Credit;
  • Small Business Tax Credit;
  • Individual Mandate;
  • Employer Assessment.

Health care reform will likely be the most extensive social benefit program the IRS has been asked to implement in recent history. Given the scope of the program and its potential impact on taxpayers and the IRS, it is critical that the IRS take a holistic, research-based
approach toward implementation. More at TAS Report, p. 27.

Poll: Favorable views of health reform law increasing among Americans | David S. Hilzenrath: Washington Post

June 30, 2010

The health-care overhaul gained popularity from May to June, according to a new tracking poll.

The results suggest that the Obama administration’s promotion of the legislation may be paying off or that the public may be warming to the law as early provisions take effect. More at Washington Post

RealClearPolitics | Why Liberals Think U.S. Health Care is Inferior

June 29, 2010

Dennis Prager. Why Liberals Think U.S. Health Care is Inferior. June 29, 2010.

If you believe that Americans have lousy health care, it is probably not because you have experienced inferior heath care. It is probably because you were told America has lousy health care. More…

Health-care overhaul will improve insurance options for part-time workers | Michelle Andrews: Washington Post

June 29, 2010

Fewer than a third of employers that offer health insurance make it available to their part-time workers, according to the Kaiser Family Foundation. (Kaiser Health News is a program of the foundation.) And even if health insurance benefits are offered, part-timers, who often work in lower-paid retail, restaurant and service jobs, may not be able to afford them.

The health-care overhaul will greatly improve insurance prospects for part-time workers — but not right away.

via More at Washington Post

Urban Institute | What Is the Evidence on Health Reform in Massachusetts and How Might the Lessons from Massachusetts Apply to National Health Reform?

June 28, 2010

Sharon K. Long. What Is the Evidence on Health Reform in Massachusetts and How Might the Lessons from Massachusetts Apply to National Health Reform? Washington, DC: Urban Institute. June 2010.  [Full Text (pdf)]

The Patient Protection and Affordable Care Act (PPACA) is in many ways patterned after the Massachusetts 2006 reforms. These reforms provided for an expansion of public programs, income related subsidies, health insurance exchanges, and an individual mandate. This paper reviews the evidence from Massachusetts and shows that there was a substantial increase in coverage, little crowding out of employer-sponsored insurance, high levels of compliance with individual mandate, improvement to access and use of health care services, and reduced financial burdens from health reform. The paper concludes by considering issues of provider capacity and health care costs that were not directly a focus of the legislation and but now being addressed.

NBER | Inequality and Infant and Childhood Mortality in the United States in the Twentieth Century

June 28, 2010

Michael R. Haines. Inequality and Infant and Childhood Mortality in the United States in the Twentieth Century. National Bureau of Economic Research Working Paper No. 16133. [Full Text]

This paper deals with the issue of using infant and childhood mortality as an indicator of inequality. The case is that of the United States in the 20th century. Using microdata from the 1900 and 1910 Integrated Public Use Microsamples (IPUMS), published data from the Birth Registration Area in the 1920s, results from a number of surveys, and the Linked Birth Infant Death Files from the National Center for Health Statistics for 1991, infant and child mortality can be related to such other variables as occupation of father or mother, education of father or mother, family income, race, ethnicity, and residence. The evidence shows that, although there have been large absolute reductions in the level of infant and child mortality rates and also a reduction in the absolute levels of differences across socioeconomic groups, relative inequality has not diminished over the 20th century.

via Google Reader (1000+).

NBER | Binge Drinking & Sex in High School

June 28, 2010

Jeffrey S. DeSimone Binge Drinking & Sex in High School. NBER Working Paper No. 16132. June 2010. [Full Text]

This paper estimates the impact of binge drinking on sexual activity among a nationally representative set of high school students during the 1990s and 2000s. The main innovations are explicitly controlling for time-invariant preferences regarding sexual behavior and alcohol use, and eliminating non-drinkers from the comparison group. I find that binge drinking significantly increases participation in sex, promiscuity, and the failure to use birth control, albeit by amounts considerably smaller than implied by merely conditioning on exogenous factors. For all outcomes, impacts rise substantially with binge drinking frequency. Results are similar using alternative comparison groups defined by excluding those who do not exhibit other risky behaviors, and by gender and race/ethnicity, but vary by grade level and over time in different ways for engaging in sex than protective behavior. Effects are much larger for the small fraction of students that has not been taught about AIDS/HIV infection in school.

via Binge Drinking & Sex in High School.