physician induced demand for surgery following up the earlier findings by fuchs on surgeon induced demand this paper makes numerous data and econometric improvements in conducting a test of neoclassical and inducement theories a simultaneous equation model is used to estimate physician demand and equilibrium fees for surgery from a sample of 350 psus over the 1969 76 period the results provide definite support for the notion of competitive market failure particularly in large metropolitan areas other things equal fees and utilization are higher in surgeon rich areas although our estimated shift elasticities were only about one third those found by fuchs a statistically significant albeit small price elasticity of demand for surgery was also obtained in contrast to fuchs increasing monopoly and disequilibrium models are also tested without altering the basic findings where surgeons were in short supply their availability significantly affected surgery rates although a small supply effect was found in plentiful areas as well

does a minimum job search requirement reduce time on unemployment payments evidence from the jobseeker diary in australia this study examines the impact of thejobseeker diary jsd a program designed to increase the job search effort of unemployed persons in australia the jsd program is distinguished by combining a focus on work search verification with large scale imple mentation applying a quasi experimental matching method to data on unemployment spells occurring in 1997 98 the authors find that jsd participation was associated with an increased rate of exit from unemployment payment recipiency and a shorter total time spent on payments payment receipt duration is estimated to have fallen for about one half of jsd participants the largest effects of the jsd occurred for payment recipients for whom labor demand conditions were the most favorable cost benefit analysis suggests a fairly large net societal gain per program participant this study examines a large scale interven tion intended to increase job search ef fort of unemployed persons in australia the intervention the jobseeker diary jsd is a work search verification program that re quires unemployment payment recipients to complete a fortnightly biweekly diary in which details of a specified minimum number of job applications must be recorded the scale of the jsd program and its focus on work search verification make it unique in the international context

the medicaid notch labor supply and welfare participation evidence from eligibility expansions i assess the impact of losing public health insurance on labor market decisions of women by examining a series of medicaid eligibility expansions targeted toward young children these targeted expansions severed the historical tie between afdc and medicaid eligibility the reforms allowed a mother s earnings to increase without losing public health insurance for her young children increasing the income limit for medicaid resulted in a decrease in afdc participation and an increase in labor force participation among these women the effects were large for ever married women and negligible for never married women

a coevolutionary framework for analysing a transition to a sustainable low carbon economy this paper proposes a coevolutionary framework for analysing a transition to a sustainable low carbon economy based on the coevolution of ecosystems technologies institutions business strategies and user practices within a multi level micro meso macro perspective this builds on and develops previous coevolutionary analyses of long term technological and industrial change and recent renewed interest within ecological economics on coevolutionary approaches previous work has analysed how the coevolution of technologies and institutions has led to the lock in of current high carbon energy systems and how the coevolution of physical and social technologies and business strategies has brought significant material and welfare benefits to the minority of the world s population living in industrialised countries the coevolutionary framework proposed here may be used to undertake 1 detailed empirical analyses at a micro meso level of the challenges relating to the innovation and adoption of particularly low carbon technologies 2 as a framework for analysing the multi level interaction of social and technological elements within potential transition pathways to a low carbon energy system 3 to assess the implications for economic growth and prosperity of a transition to a low carbon economy and 4 to assist in the development of more formal multi level evolutionary economic models

dynamic capacity planning using strategic slack valuation in this paper we analyze a particular aspect of capacity planning that is concerned with the active trading of production facilities for a homogenous product market we provide a theoretical rationale for the valuation and trading of these assets based on a metric of strategic slack we show that trading production assets with non additive portfolio profitability involves complex coordination with multiple equilibria and that these equilibria depend on the foresight in the planning horizon using the concept of strategic slack we have analyzed the dynamics of market structure the impact of asset trading on the level of production of the industry and to derive boundaries on the value of the traded assets moreover through computational learning the formulation is applied to a large oligopolistic electricity market showing that plant trading tends to lead to increased market concentration high prices lower production and a decrease in consumer surplus

the effectiveness of active labour market policies a meta analysis this paper provides a meta analysis of microeconometric evaluation studies on the effectiveness of active labor market policies the analysis is built upon a systematically assembled data set of causal impact estimates from 57 experimental and quasi experimental studies providing 654 estimates published between january 1990 and december 2017 we distinguish between the short and longer term impacts in our analysis at 6 12 24 and 36 months after program start after correcting for publication bias and country specific macroeconomic characteristics subsidized labor and public employment programs have negative short term impacts which gradually turn positive in the longer run schemes with enhanced services including job search assistance and training programs do not have these negative short term effects and stay positive from 6 until 36 months after program start

equality efficiency and market fundamentals the dynamics of international medical care reform public opinion surveys uniformly show low support for medical care systems in developed countries the longstanding conflict between equal access to care and efficient service provision partly explains this dissatisfaction but the trade off is particularly acute in medical care as new technologies developed over time have increased the cost of care and made the equity commitment even more expensive countries first dealt with rising costs by maintaining equal access and restricting total spending efficiency suffered however as a result many countries are considering a move away from spending controls and toward incentive based medical care reform

a guide to health care reform there are four rationales for health care reform increasing the efficiency of health delivery reforming the market for health insurance providing universal coverage and reducing the federal deficit these goals are reflected in most reform proposals achieving these goals involves several problems however paying for universal coverage may lead to labor supply or demand reductions in addition reform involves large federal risks that must be dealt with through deficit financing reduced benefits or lower subsidies

endogenous cost effectiveness analysis and health care technology adoption abstract increased health care spending has placed pressure on public and private payers to prioritize spending cost effectiveness ce analysis is the main tool used by payers to prioritize coverage of new therapies we argue that reimbursement based on ce is subject to a form of the lucas critique the goals of ce policies may not materialize when firms affected by the policies respond optimally to them for instance because costs in ce analysis reflect prices set optimally by firms rather than production costs observed ce levels will depend on how firm pricing responds to ce policies observed ce is therefore endogenous when ce is endogenously determined policies aimed at lowering spending and improving overall ce may paradoxically raise spending and lead to the adoption of more resource costly treatments we empirically illustrate whether this may occur using data on public coverage decisions in the united kingdom

the need for policy to address the food system lock in a case study of the finnish context abstract the introduction of synthetic fertilizers transformed the food system into the one we know today in the western world the present paper argues that this transformation has become an irreversible self feeding process referred to as food system lock in which threatens planetary boundaries of nitrogen and phosphorus hence the food security in the future a system in a lock in state can undermine its own existence by deteriorating the capacity to cope with upcoming crises of resource scarcity and environmental instability in this paper the roots of lock in are explored and empirically grounded in the historical narrative of the food system transition in finland in the past 60 years the theoretical framework builds on socio technical studies and the economic theory of increasing returns the aim of the paper is to identify through an evolutionary analysis the processes of increasing returns that have become path inefficient and have reinforced the lock in in the food system three separate but interdependent processes in the production in the policy and institutions and in the supply chain create systematic resistance towards sustainability transition these findings indicate that more attention should be paid at the public policies that are currently too narrow in their scope and do not effectively bridge the entire system from food production to consumption public intervention is critical for the unlocking but individuals in the various parts of the food system are those who create new paths

effects of tax reform on labor supply investment and saving the u s tax system received two major overhauls during the 1980s the tax cuts of 1981 and the tax reform act of 1986 supporters of both reforms argued that major changes in tax policy could boost saving investment labor supply and entrepreneurship eventually it was argued such changes could reverse the slowdown in economic growth that began in the early 1970s and spur improvements in american living standards the aim of this paper is to assess whether the goals of increased labor supply and capital formation were achieved

technological clusters with a knowledge based principle evidence from a delphi investigation in the french case of the life sciences abstract recent works in the theory of technical change show the effect of irreversibility and lock in on the diffusion and creation of innovation processes which are able to stop the development of a generic technology therefore industrial policies play a major role in selecting and supporting the innovative process the purpose of this paper is to prove the possibility to derive a typology of future innovations in terms of generic technology from a delphi type technology survey thus it is possible to get a better understanding of the industrial dynamics and to design an interesting tool for industrial policies or for firm strategies as far as they aim at developing stable technological trajectories this is applied to the french case of the life sciences the paper suggests interesting explanatory trajectories in order to fight against diseases such as cancer alzheimer or schizophrenia

the insurance value of medical innovation abstract economists think of medical innovation as a valuable but risky good producing health benefits but increasing financial risk for consumers and healthcare payers this perspective overlooks how innovation can lower physical risks borne by healthy patients facing the prospect of future disease we present an alternative framework that accounts for all these sources of value and links them to the value of healthcare insurance we show that any innovation worth buying reduces overall risk and generates positive insurance value on its own we conduct a stylized numerical exercise to assess the potential empirical significance of our insights our calculations suggest that conventional methods meaningfully understate the value of historical health gains and disproportionately undervalue treatments for the most severe illnesses where physical risk to consumers is the costliest these calculations also suggest that the value of physical insurance from new technologies may exceed the financial spending risk that they pose

the impact of youth unemployment on adult unemployment in the ncds using the national child development survey this paper looks at cumulated experience of unemployment highlighting how unemployment experience is concentrated on a minority of the workforce over extended periods low educational attainment ability not captured by education financial deprivation and behavioural problems in childhood raise a person s susceptibility to unemployment there is strong evidence of structural dependence induced by early unemployment experience for men but only minor persistence for women attacking low educational achievement and preventing the build up of substantial periods in unemployment as youths may reduce the extent to which a minority of men spend a large part of their working lives unemployed

on the marginal welfare cost of taxation this paper develops a rigorous partial equilibrium analysis of the determinants of margin al welfare cost mwc of taxes on labor earnings it shows that four key parameters interact to determine the magnitude of mwc using aggregate data and plausible ranges of values for the parameters mwc can vary from under 10 percent to more than 300 percent of marginal tax revenue intermediate parameter values sugge st mwc is in the 25 50 percent range however the more extreme estimates cannot be ruled out on the basis of available evidence suggesting that mwc cannot yet be copyright 1987 by american economic association

medical care costs how much welfare loss hardly a week goes by without a front page newspaper article on rising health care costs and the uninsured in this article i focus mainly on costs arguing that the issue has been somewhat misconceived while the level of medical care spending in the u s is a cause for concern the welfare losses associated with rises in that level of spending may not be as large as the public rhetoric can make them seem in fact cost containment may not be as urgent as is widely supposed and some proposed cost containment policies may result in welfare losses for the insured and even increase the number of uninsured

aggregate health care expenditures and national income is health care a luxury good it is well known that a strong relationship exists between national expenditures on health care and national income this has been used to suggest that health care is a luxury good and that factors such as the type of health care delivery system in a country are of little importance in determining expenditure levels this paper argues that these implications rely upon the application of microeconomic analysis to macroeconomic data and that this is not appropriate as well as raising questions about the inferences drawn from previous studies new empirical evidence is presented which casts some doubts on previous findings international comparisons are based on purchasing power parity rather than exchange rate conversions underlining the importance of prices as well as quantities in the relationship and leading to the conclusion that the aggregate data show health care to be if anything a necessity rather than a luxury good

insurance and incentives for innovation in medical care economists have frequently pointed to the distorting effects of health insurance as a major contributor to rapidly increasing health costs relatively little is known however about the influence of changing medical technology on expenditures if increases in expenditures are in part the result of development of costly but worthwhile new technologies a common view among noneconomists failure to take account of this may lead to over statement of the distortive effects of insurance on the other hand some observers have questioned whether the benefits derived from expensive medical innovations always exceed the costs 18 others have suggested that resources devoted to the development of very expensive technologies might be better used for other kinds of medical research 16 3 in light of these arguments it appears that the relationships between medical insurance and technological change may be quite important if the extent of insurance coverage influences the rate and direction of technological change in medicine then the long run welfare effects of insurance are more complex than current models 5 6 allow it is sometimes argued informally that such an influence existsthat the presence of insurance biases the system toward innovations that expand capabilities while increasing expenditures and away from those that reduce costs 15 20 such a hypothesis has however never been developed as an implication of a formal economic model even the term bias in the argument is unclear it appears to be used in a normative sense but it has not been explained clearly why such a bias if it exists leads to welfare losses even if it is true for example that the presence of insurance leads to the adoption of a more costly mix of medical innovations than would otherwise occur this is not obviously undesirable to facilitate the purchase of costly but beneficial medical care is the purpose of insurance this paper defines bias in technological change in a normative sense it employs a simple model of insurance and profit maximizing innovators and develops sufficient

tortoises and hares choice among technologies of unknown merit recent work in the area of competing technologies and increasing returns has largely been concerned with the effectiveness of the market in delivering optimal outcomes the existence of inefficient market outcomes suggests that there might be a place for intervention in the technology choice process this paper develops a model of sequential choice in which the choice process is subject to centralized control the model is used to show that intervention can increase the expected present value of the technology adoption process it remains however that one technology and not necessarily the best will come to dominate the market copyright 1991 by royal economic society

libre software turning fads into institutions the article presents an economic analysis of libre software and of its sustainability as a new economic model for software we underline the role of libre software development communities and analyze incentives for both kernel and obscure developers we emphasize the role of the so called public licenses to provide an appropriate institutional framework we show that several features of libre software also allow it to improve faster than proprietary software and therefore to achieve strong market performance when competing against existing standards even when proprietary software producers react we illustrate our point using a simple local and global interaction model to study the technological competition between linux and windows on the server operating system os market we finally argue that if sufficient initial momentum could be created through public intervention libre software could turn from a fad into an efficient economic institution to correct inefficiencies due to network externalities

pricing profits and technological progress in the pharmaceutical industry the decades old debate over pharmaceutical industry prices profits and innovation has again intensified a number of events coalesced to refocus public interest on pharmaceuticals contributing to public concern were bureau of labor statistics price index increases for pharmaceuticals far outpacing those for the products of other industries another prominent characteristic of the pharmaceutical industry has been its extraordinarily high reported profitability this article examines the phenomena that precipitated the current pharmaceuticals debate their historical antecedents and the principal questions at issue in the author s considered judgment a pell mell march toward regulation of pharmaceutical industry pricing could seriously impair the industry s incentives for investment in new products

medical insurance technological change and welfare concerns have been expressed about the welfare effects of expensive innovations in medical care financed largely through medical insurance this paper develops a model which considers such issues it is shown that even if insurance is purchased optimally subject to a plausible constraint on the form of the contract innovations may be adopted that have the effect of reducing expected welfare the question of how the benefits of medical innovations ought to be measured in the presence of insurance is also explored

health insurance and the demand for medical care evidence from a randomized experiment we estimate how cost sharing the portion of the bill the patient pays affects the demand for medical services the data come from a randomized experiment a catastrophic insurance plan reduces expenditures 31 percent relative to zero out of pocket price the price elasticity is approximately 0 2 we reject the hypothesis that less favorable coverage of outpatient services increases total expenditure for example by deterring preventive care or inducing hospitalization

national systems of innovations are x efficient and x effective why some are slow learners the growing literature on national systems of innovations nsis are creating a crucial new perspective on the institutional infrastructure of the knowledge based economy however this literature tends to be somewhat optimistic it often takes for granted that nsis are sets of institutions facilitating learning particularly about technology and organization this paper reconsiders the efficiency of nsis it suggests that nsis are x inefficient and x effective it develops some of the major factors explaining inefficiencies and proposes methods to measure the efficiency and effectiveness of nsis it offers some examples of inefficiencies from a comparison between selected nsis and suggests indicators of efficiency and effectiveness 2002 elsevier science b v all rights reserved

average marginal tax rates from social security and the individual income tax we extend previous estimates of the average marginal tax rate from the federal individual income tax to include social security our computations consider the tax rates on employers employees and the self employed the income that accrues to persons with earnings below the ceiling and the effective deductibility of employers social security contributions from workers taxable income the next effect of social security on the average marginal tax rate is below 02 until 1966 but then rises to 03 in 1968 04 in 1973 05 in 1974 06 in 1979 and 07 in 1982 this abstract was borrowed from another version of this item

symposium on health care reform the papers in this symposium focus on two major issues of health economics in the context of president clinton s health security act cost containment and labor market effects of financing insurance the act proposes to limit public and private spending a key issue is the extent to which without a limit but with a standardized basic plan supplementary insurance will exist to allow scope for individual choice the act s financing will have an ambiguous effect on labor supply but will encourage formation of small low wage firms several features including community rating and standardization of dependent coverage imply substantial redistribution

optimal diversity increasing returns versus recombinant innovation abstract choices regarding diversity play an important role in economics and innovation management but often remain implicit once made explicit the objectives of efficiency and diversity are usually posed as in conflict as efficiency relates positively and diversity negatively to various increasing returns to scale in markets such a perspective however neglects the benefits of diversity in terms of realizing system improvements through recombinant innovation or spillovers the latter implies a contribution of diversity to long term efficiency dominant economic approaches that address diversity such as option value and real options theories regard benefits of diversity as exogenous this paper proposes a simple model of variable endogenous diversity to analyse the optimal balance between increasing returns to scale and recombinant innovation it is discussed under which conditions one of four solutions is optimal complete specialization regardless of which option complete specialization in one specific option symmetric diversity perfect balance and asymmetric diversity the results give rise to a number of policy insights

is energy intensity important for the productivity growth of eet adopters abstract energy efficient technologies eet have attracted strong interest because of their role in reducing environmental damage their adoption however remains rather low while their impact on productivity is substantial and differentiating with respect to technological characteristics energy intensity being such an obvious characteristic could be employed to classify eet adopters thus giving rise to two heterogeneous technologies i e those corresponding to firms of low and high energy consumption hence this paper examines the impact of energy intensity on the productivity growth of firms adopting eet in varying time intervals through a metafrontier based framework while also decomposing that impact in terms of technical efficiency and scale efficiency changes the analysis is complemented by examining the role of firm specific characteristics on the productivity growth through linear regression

the demand for episodes of treatment in the health insurance experiment abstract this paper analyzes claims data from the rand health insurance experiment which were grouped into episodes of treatment the insurance plans in the experiment have coinsurance and a cap on out of pocket spending using new statistical techniques to adjust for the increased sickliness of those who exceed the cap the effects of coinsurance on cost per episode and number of episodes are estimated cost sharing reduced the number of episodes but had little effect on cost per episode people in the experiment responded myopically as their current insurance status changed through the year the price elasticity of spending was about 0 2 throughout the range of coinsurance studied when data permit it the study of episodes complements analyses of annual medical spending by revealing more about how decisions to spend are made within the year

national and international tests of the new drug cost offset theory the new drug cost offset theory argues that new drugs pay for themselves by keeping people out of expensive medical facilities however few studies have tested this theory at the macroeconomic level to determine if system wide savings actually accrue this article provides two tests of the new drug cost offset theory by examining the impact of new drugs on aggregate medical care costs using time series data for the united states and also by using a panel data set of countries belonging to the organization for economic cooperation and development in support of the new drug cost offset theory the results from both tests imply the typical new drug slows the growth of overall medical care spending

employment based health insurance and job mobility is there evidence of job lock the majority of privately insured americans obtain their health insurance through their own or a family member s employment the rationale for employers to provide health insurance is straightforward by pooling the risks of individuals employers can reduce adverse selection and lower administrative expenses in addition they benefit from tax laws allowing businesses to deduct their health insurance costs these advantages of employer provision however must be weighed against the distortions they may generate in individual labor market decisions in particular health insurance may distort job mobility if employees decide to keep jobs they would rather leave for fear of losing coverage for preexisting conditions a possibility that has been termed job lock this paper attempts to quantify the effect of employer provided health insurance on the labor market mobility of individuals the link between employer provided health insurance and

the economics of networks a survey of the empirical literature network effects the increase in value of consuming a product if many other consumers use the same product are a feature of many markets and in particular of many high technology products this paper surveys the burgeoning empirical literature that has developed especially during the last years after theoretical work dominated the earlier years of research in this area newer research has combined theoretical models with empirical studies and applied work with direct implications for public policy marketing and company strategies furthermore insights from the study of social networks have been applied to analyse how consumers interact with each other the paper argues that a closer analysis of the network structure of consumer interaction promises fruitful future research avenues and advances in our understanding of how network effects operate copyright 2009 blackwell publishing ltd

cognitive and institutional perspectives of eco efficiency the paper sketches out a theoretical framework for analysing the interplay between eco efficiency cognition and institutions it derives from analytical shortfalls of the prevailing literature which features strongly engineering and business economics by using insights from new institutional economics from cognitive science and partly from evolutionary economics it emphasises the role cognition and institutions play in the adoption of green technologies by firms a cognitive perspective derives from recent research on simple heuristics and context based rationality it is proposed that those findings can serve to analyse decision making of individual actors respectively firms and thus should complement economic analysis a second proposition is that eco efficiency and normative rules such as a factor four strongly rely upon institutions i e the ability of institutions to evolve over time and the development of those institutions that are most appropriate to enhance technological change in this regard business institutions and competition are crucial but regulatory needs remain in order to safeguard continuity of knowledge creation the framework allows for an analysis why overall adoption of eco efficiency still can be considered relatively slow and why some markets and firms are far ahead as a brief case study the article reflects upon german waste law s ability to enhance eco efficiency

an econometric analysis of health care expenditure a cross section study of the oecd countries this paper is an empirical examination of the determinants of aggregate health care expenditure the paper presents a systematic analysis of relationships across 19 oecd countries showing the effects of aggregate income institutional and socio demographic factors on health care expenditure the results indicate that institutional factors of the health systems in addition to per capita gross domestic product gdp contribute significantly to the explanation of the health care expenditure variation between countries for example the way physicians in outpatient care are paid and the mixture of public private funding and inpatient outpatient care

where do the sick go health insurance and employment in small and large firms this research was supported by a grant from the economic research initiative on the uninsured at the university of michigan

the value of life and the rise in health spending over the past half century americans spent a rising share of total economic resources on health and enjoyed substantially longer lives as a result debate on health policy often focuses on limiting the growth of health spending we investigate an issue central to this debate is the growth of health spending a rational response to changing economic conditions notably the growth of income per person we develop a model based on standard economic assumptions and argue that this is indeed the case standard preferences of the kind used widely in economics to study consumption asset pricing and labor supply imply that health spending is a superior good with an income elasticity well above one as people get richer and consumption rises the marginal utility of consumption falls rapidly spending on health to extend life allows individuals to purchase additional periods of utility the marginal utility of life extension does not decline as a result the optimal composition of total spending shifts toward health and the health share grows along with income in projections based on the quantitative analysis of our model the optimal health share of spending seems likely to exceed 30 percent by the middle of the century

active labour market policies a case of evidence based policy making the 1990s was a decade of renewed enthusiasm for active labour market policies however it is not clear that this was the result of an appreciation of the evidence on the effectiveness of different policies relatively simple and cost effective initiatives to improve matching and to enhance job search appear to have a significant impact on employment training programmes generally do not produce better outcomes there is no convincing evidence that work programmes improve employment and recruitment subsidies often suffer from low take up however a strategy appears to be emerging in the uk and the usa by design or by accident of trying to use job search focused programmes to move people into regular employment and then to subsidize households especially with children so that their net incomes can come above the poverty line most of this expenditure could be classified as good old fashioned fiscal redistribution to the poor copyright 2000 by oxford university press

walking the tightrope on medicare reform a central controversy in the debate about medicare is whether the program spends too much money or whether instead it should be expanded to cover more i consider the value of increased medicare spending i argue that on average medicare spending is worth it the health gains brought by medicare have been greater than their cost at the margin however services are overused and have low value medicare reforms need to promote the high average value of care while eliminating care of low value many of the proposed reforms fall short of this goal

sprayed to death path dependence lock in and pest control strategies theoretical literature on the economics of technology has emphasized the effects on technological trajectories of positive feedbacks in a competition among technologies that all perform a similar function the presence of increasing returns to adoptions can force all but one technology from the market furthermore the victor need not be the superior technology this paper provides an empirical study of one technological competition which illuminates this theoretical work it uses theoretical results to explain why chemical control of agricultural pests remains the dominant technology in spite of many claims that it is inferior to its main competitor integrated pest management copyright 1996 by royal economic society

new labour and the labour market the recent run of good macroeconomic news masks mounting evidence that worklessness is increasingly concentrated on selected individuals households and socio economic groups and in geographical areas these distributional aspects have been overlooked or ignored over the last 20 years but we believe they now form the most pressing labour market and social problems facing this administration we focus on what we view as the government s selected priorities the concentration of unemployment on certain individuals groups and areas increasing inactivity especially marked among less educated older men low pay persistence of low wages and its relationship with job loss and the distribution of work across households and child poverty many of these problems leave lasting scars on individuals so that successful intervention may beneficially change an individual s life chances we examine the evidence on each of these issues and the current state of policy aimed to reduce their scale or intensity copyright 2000 by oxford university press

physician response to fee changes with multiple payers this paper develops a general model of physician behavior with demand inducement encompassing the two benchmark cases of profit maximization and target income behavior it is shown that when income effects are absent physicians maximize profits and when income effects are very strong physicians seek a target income the model is used to derive own and cross price expressions for the response of physicians to fee changes in the realistic context of more than one payer under the alternative behavior assumptions of profit maximization and target income behavior the implications for public and private fee policy and empirical research on physician response to fees are discussed

the economics of convention c onventions regulate much of economic and social life yet they have received surprisingly little attention from economists by a convention we mean a pattern of behavior that is customary expected and self enforcing everyone conforms everyone expects others to conform and everyone has good reason to conform because conforming is in each person s best interest when everyone else plans to conform lewis 1969 familiar examples include following rules of the road adhering to conventional codes of dress and using words with their conventional meanings conventions with direct economic implications include species of money and credit industrial and technological standards accounting rules and forms of economic contracts indeed it would scarcely be an exaggeration to say that almost all economic and social institutions are governed to some extent by convention the main feature of a convention is that out of a host of conceivable choices only one is actually used this fact also explains why conventions are needed they resolve problems of indeterminacy in interactions that have multiple equilibria indeed from a formal point of view we may define a convention as an equilibrium that everyone expects in interactions that have more than one equilibrium the economic significance of conventions is that they reduce transaction costs imagine the inconvenience if whenever two vehicles approached one another the important exceptions are sugden 1986 and ullman margalit 1977 the interested reader might also refer to the symposium on social norms that appeared in the fall 1989 issue of this journal with articles by sugden 1989 and elster 1989

organizing the health insurance market this paper presents a new approach to organizing universal health insurance first the government divides the entire population into many large groups then the government creates a federal health insurance system healthfed modeled on the federal reserve system to fill the role now played by the benefits office of a large firm the healthfed would create a short menu of alternatives solicit bids for insuring the entire group and price alternatives there would be redistribution between groups and pricing of alterna tives to reflect optimal social insurance principles there would be no connection between health insurance and employment it may seem odd that this presidential address is my first publication in health economics at the time when i might have been working on an alternative address i was chair of an expert panel for the advisory council on social security looking at issues in both retirement income and medical care 2 in the process of this work i have come up with a new approach to organizing universal health insurance that is the subject of this paper before starting on health insurance i will say a few words about a wider context offering what i will say as an example in that setting 3 a great deal of attention has been focused on the exciting issue of reorganizing economies dropping central planning commonly economists from those countries em brace capitalism or more specifically laissez faire competition with an enthusi asm which exceeds that ofwestern economists although not necessarily western businessmen yet laissez faire capitalism has received little serious support in the west for a very long time we all know the fundamental welfare theorem which shows many ways that capitalism can be imperfect we have also seen a growth in discussion and analysis of the many ways governments can mess up resource allocation the real question is the design of arrangements that try to integrate the things that each type of institution does better this is hard for two reasons one is that it is in the realm of second best with many constraints the more the constraints the harder the analysis the second is that we do not have good positive theories of government behavior good examples yes good theories no thus the analysis is more intuitive less theory driven than in our picture of private markets but also in our private market analyses we have been greatly complicating our picture recognizing all sorts of information imperfec tions that affect the way that private markets work so i will present to you a proposal for universal health insurance meant to combine something that

the dynamic implications of increasing returns technological change and path dependent inefficiency this paper addresses the issue of path dependent selection and inefficiency counterfactual methods and the empirical evidence employed in this research trajectory the general message is basically that the theoretical argument to prove path dependent inefficiency is relatively straightforward while empirical demonstrations as well as the analysis of welfare implications are much more difficult in the first section we briefly state the basic argument explaining how localized learning leads to an incomplete exploration of the variety distribution of a technology we then synthesize the most interesting historical studies which get potential regret results and ask whether these results suggest a large welfare loss to try to answer this question we start from the critical arguments of liebowitz and margolis to discuss the theoretical and empirical difficulties of establishing path dependent inefficiency