dying to win olympic gold medals and longevity abstract this paper compares mortality between gold and silver medalists in olympic track and field to study how achievement influences health contrary to conventional wisdom winners die over one year earlier than losers i find strong evidence of differences in earnings and occupational choices as a mechanism losers pursued higher paying occupations than winners according to individual census records i find no evidence consistent with selection or risk taking how people respond to success or failure in pivotal life events may produce long lasting consequences for health

high public debt the italian experience introduction is there a public debt problem in italy luigi spaventa the end of large public debts alberto alesina monetary and fiscal policy coordination with a high public debt guido tabellini the management of public debt and financial markets marco pagano capital controls and public finance the experience in italy alberto giovannini public debt and households demand for monetary assets in italy andrea bollino and nicola rossi

the social basis of interdependent preferences abstract most economists are sympathetic to the idea that concerns for relative position are an important aspect of many economic problems there has traditionally been a reluctance to include such concerns primarily because models that included them often allow such a broad range of behavior that there are few if any restrictions on equilibrium behavior and hence such models would have little or no predictive power in this paper we discuss how reduced form models may naturally give rise to utility functions that depend in part on relative standing there are several advantages of modelling concern for relative standing in reduced form utility functions even when there is no similar concern in the deep preferences it provides structure and constraints on the way that relative standing affects utility and further it can yield testable implications about the way that changes in the underlying environment affect the concern for relative standing we discuss the advantages and disadvantages of modelling social concerns in this way and provide examples that illustrate how concerns for relative standing can affect savings investment and labor choice decisions

the effect of entry regulation in the health care sector the case of home health the consequences of government regulation in the post acute care sector are not well understood we examine the effect of entry regulation on quality of care in home health care by analyzing the universe of hospital discharges during 2006 for publicly insured beneficiaries about 4 5 million and subsequent home health admissions to determine whether there is a significant difference in home health utilization hospital readmission rates and health care expenditures in states with and without certificate of need laws con regulating entry we identify these effects by looking across regulated and nonregulated states within hospital referral regions which characterize well defined health care markets and frequently cross state boundaries we find that con states use home health less frequently but system wide rehospitalization rates overall medicare expenditures and home health practice patterns are similar removing con for home health would have negligible system wide effects on health care costs and quality

quality incentives in a regulated market with imperfect information and switching costs capitation in general practice we model a system akin to the british national health service nhs in which general practictioners gps are paid by capitation from general taxation gps are horizontally and vertically differentiated and compete for patients via their imperfect observed quality we show that for any given capitation fee quality is lower and the incentive effects of the fee on quality are smaller when there is imperfect information there are diminishing welfare gains from improving patient information but increasing welfare gains from reducing switching costs gps do not act efficiently to improve patient information via advertising or to reduce the costs of switching

the nonprofit sector and industry performance abstract despite the importance of nonprofit industries in the economy little analysis has been conducted as to whether the behavior of such industries differs from that of for profit industries extending previous firm level analyses we propose a neoclassical theory with an endogenous nonprofit sector our analysis implies that nonprofit firms have a competitive advantage over for profit firms so that marginal changes in the industry operate through the for profit sector as such marginal industry behavior is identical to that of a for profit industry and nonprofit regulations may have a limited impact or even no impact on overall industry performance our theory has the methodological advantage that standard for profit analysis applies directly to nonprofit firms because they can be analyzed as for profit firms with lower costs we discuss aspects of the empirical literature that test this theory of nonprofit activity

the impact of hospital market structure on patient volume average length of stay and the cost of care a variety of recent proposals rely heavily on market forces as a means of controlling hospital cost inflation sceptics argue however that increased competition might lead to cost increasing acquisitions of specialized clinical services and other forms of non price competition as means of attracting physicians and patients using data from hospitals in 1972 we analyzed the impact of market structure on average hospital costs measured in terms of both cost per patient and cost per patient day under the retrospective reimbursement system in place at the time hospitals in more competitive environments exhibited significantly higher costs of production than did those in less competitive environments

the democratic advantage institutional foundations of financial power in international competition despite their presumed liabilities institutions associated with democracy serve as a source of power in prolonged international competition by increasing the financial resources that states can bring to bear the theory of sovereign debt suggests that a state s ability to raise money through public borrowing is enhanced when debtholders have mechanisms for sanctioning state leaders in the event of default institutions associated with liberal government provide such mechanisms all other things being equal states that possess these institutions enjoy superior access to credit and lower interest rates than do states in which the sovereign has more discretion to default unilaterally liberal states can not only raise more money from a given economic base but can also pursue tax smoothing policies that minimize economic distortions the ability to finance competition in a manner that is consistent with long term economic growth generates a significant advantage in prolonged rivalries these claims are explored by analyzing the anglo french rivalry 1688 1815 and the cold war

the increasingly mixed proportional hazard model an application to socioeconomic status health shocks and mortality we introduce a duration model that allows for unobserved cumulative individual specific shocks which are likely to be important in explaining variations in duration outcomes such as length of life and time spent unemployed the model is also a useful tool in situations where researchers observe a great deal of information about individuals when first interviewed in surveys but little thereafter we call this model the increasingly mixed proportional hazard imph model we compare and contrast this model with the mixed proportional hazard mph model which continues to be the workhorse of applied single spell duration analysis in economics and the other social sciences we apply the imph model to study the relationships among socioeconomic status health shocks and mortality using 19 waves of data drawn from the german socio economic panel soep the imph model is found to fit the data statistically better than the mph model and unobserved health shocks and socioeconomic status are shown to play

why are stabilizations delayed when a stabilization has significant distributional implications e g tax increases to eliminate a large budget deficit socioeconomic groups may attempt to shift the burden of stabilization onto other groups the process leading to stabilization becomes a war of attrition each group attempting to wait the others out and stabilization occurring only when one group concedes and bears a disproportionate share of the burden the authors solve for the expected time of stabilization in a model of rational delay and relate it to several political and economic variables they motivate this approach and its results by comparison to historical and current episodes copyright 1991 by american economic association

budgetary deficits and ricardian equivalence the case of india 1950 1986 abstract in this paper we analyze the validity of the ricardian equivalence re theorem for a less developed country ldc i e india for the period 1950 1986 the re theorem states that it is inconsequential whether a government deficit is financed by debt issue or by tax increases since under certain conditions the effect of government consumption on aggregate demand is orthogonal to the mode of financing fiscal deficits because rational economic agents consider today s deficit financing as tomorrow s tax liabilities the use of multicointegration analysis and estimation of the rational expectations model both invalidate the re hypothesis in india there are significant crowding out effects on private consumption but such effects on private investment are insignificant because they are expected to be already included in the effect of interest rates

italy the real effects of inflation and disinflation over the past 15 years the italian economy has experienced rather uncommon developments by comparison with the rest of europe these developments have been described alternatively in terms of near collapses miracles or impending bankruptcy such dramatic characterizations are of little help in understanding what happened yet they somehow reflect a history of large and often unexpected changes and a sequence of policy turn arounds from a distance the italian experience still raises some issues of general interest regarding the means and the timing of an adjustment process in italy return to profitability was pursued before macroeconomic stabilization instead of resulting from it as happened elsewhere it is indeed our contention that this evolution is sometimes commendable adjustment in italy was quicker and less costly in terms of output investment and employment

fiscal policy debt management and exchange rate credibility lessons from the recent italian experience abstract this paper explores some potential determinants of exchange rate credibility with reference to the italian experience of the 1990s the analysis relies on a nonlinear framework emphasizing shifts between credible and non credible states and assuming a significant degree of persistence in the above regimes almost all fiscal and debt management indicators display significant effects on devaluation expectations the main policy implications of the paper are that a restrictive fiscal stance a lengthening of average debt maturity and an increase in the share of foreign denominated debt are crucial to stabilize the lira exchange rate and to qualify italy in the former group of countries which will join emu

default risk and optimal debt management the role of movements in real rates in explaining the relationship between long and short term interest rates is explored within a model of optimal government debt management the government s incentives to resort in the future to inflation and ex post debt taxation in order to reduce the real value of its nominal liabilities have an impact on term premia and hence on the short long spread in particular default risk and consequently long term interest rates increase with the size of outstanding debt and the level of real rates in the presence of short maturities indexed debt and anti inflationary governments optimal maturity either lengthens or shortens with inflation risk depending on the time profile of government expenditure while it always lengthens with default risk however when the stock of debt is extremely large the compensation for default risk required by the agents on long term bonds may be so high that only shortterm debt can be issued the implications of this model are consistent with the observed behavior of risk premia in some highly indebted countries 2000 elsevier science b v all rights reserved jel classification h63 h43

competition and efficiency in the end stage renal disease program abstract estimated coefficients for medical service production or cost functions are subject to a competitive amenity bias which may result in the failure to identify factors that affect economic efficiency our investigation of productivity of dialysis facilities did indeed indicate both the likelihood of bias and some qualitative results these results suggest that it will be difficult to estimate cost and that variation in the level of reimbursement will in competitive markets affect the level of amenity delivered to patients incurred cost amenity and patient well being will all vary positively with the reimbursement level determining the right level of reimbursement requires a policy decision on how much total amenity society wishes to deliver to beneficiaries of public programs

assessing competition in hospital care markets the importance of accounting for quality differentiation quality differentiation is especially important in the hospital industry where the choices of medicare patients are unaffected by prices unlike previous studies that use geographic market concentration to estimate hospital competitiveness this article emphasizes the importance of quality differentiation in this spatially differentiated market i estimate a random coefficients discrete choice model that predicts patient flow to different hospitals and find that demand responses to both distance and quality are substantial the estimates suggest that patients do not substitute toward alternative hospitals in proportion to current market shares implying that geographic market concentration is an inappropriate measure of hospital competitiveness

hospital quality choice and market structure in a regulated duopoly this paper analyzes the optimal structure of a regulated health care industry in a model in which the regulator cannot enforce what hospitals do unverifiable quality of health or does not know what hospitals know incomplete information about production costs or both we show that if quality is unverifiable the choice between monopoly and duopoly does not change with respect to the verifiable case but if there are fixed costs assumed to be quality dependent and the monopoly is the optimal market structure the quality level of the operative hospital decreases asymmetry of information introduces informational rents that can be reduced by increasing the most efficient hospital s market share a monopoly is chosen more often

is hospital competition socially wasteful we study the consequences of hospital competition for medicare beneficiaries heart attack care from 1985 to 1994 we examine how relatively exogenous determinants of hospital choice such as travel distances influence the competitiveness of hospital markets and how hospital competition interacts with the influence of managed care organizations to affect the key determinants of social welfare expenditures on treatment and patient health outcomes in the 1980s the welfare effects of competition were ambiguous but in the 1990s competition unambiguously improves social welfare increasing hmo enrollment over the sample period partially explains the dramatic change in the impact of hospital competition

the role of social security in an economy with asymmetric information and financial intermediaries abstract we study an overlapping generations model with production asymmetric information and competitive financial intermediaries social security may be beneficial even when it should not be used under full information unless credit rationing emerges with pooling contracts in this case social security could be welfare reducing even when the safe rate of return falls short of population growth we provide a full characterization of constrained pareto efficient allocations and prove that when the expected marginal product exceeds population growth and high risk firms have a low probability of default no tax transfer policy can support these allocations as competitive equilibria when equilibria are constrained inefficient optimal contracts are pooling and the optimal stock market value is zero

healthy bodies and thick wallets the dual relation between health and economic status there is abundant evidence of a quantitatively large association between many measures of economic status including income and wealth and a variety of health outcomes such as mortality or morbidity however considerable and often heated debate remains especially across disciplines about the direction of causation and about why the association arises although medical scientists are often convinced that the dominant if not exclusive pathway is that variation in socioeconomic status produces health disparities they are increasingly debating among themselves about why low economic status might lead to poor health at least for modern industrial countries 1 the old standby arguments the less well to do have access to less or lower quality medical care or a stronger pattern of deleterious personal behaviors have been rejected as insufficient instead a series of intriguing competing theories have arisen that emphasize long term impacts of early childhood or even inter uterine environmental factors the cumulative effects of prolonged exposures to individual stressful events or reactions to macro societal factors such as rising levels of income inequality a common link is that each theory attempts to document the physiological processes through which low economic status leads to poorer health while these scientific questions are extremely important this research has taken place with little input from economists economists are now making contributions about the alternative pathway the impact poor health may have on economic resources poor health may restrict a family s capacity to earn income or to accumulate assets by limiting work or by raising medical expenses at a minimum this work should provide a caution against exaggerating the magnitude of causation from economic status to health outcomes but the potential contribution runs deeper as people age the evolving variation in individual health outcomes may offer additional statistical information to estimate parameters of household savings and consumption behavior that so far have proven to be somewhat elusive thus incorporating health uncertainty and risk into economic models should eventually enrich our understanding of basic tenets of household behavior the first section of this paper documents the size of the association between health and one prominent economic status measure household wealth section two deals with how health influences economic status by sketching out reasons why health may alter household savings and eventually wealth and then providing estimates of the empirical magnitude of these effects section three shifts attention to the alternative pathway the links between economic status and health and summarizes 2major controversies and evidence surrounding these issues

rank as an inherent incentive evidence from a field experiment abstract money is the prime incentive considered in economic models however recent evidence indicates that people are also greatly concerned about their social rankings is this solely because rank brings tangible benefits or because in addition people have an inherent preference for high rank this paper deployed a field experiment that provides evidence for an inherent preference in the experiment vietnamese students enrolled in an english course performed significantly better on the official standardized international final test when they were told their rankings on practice tests than when they were not this result held even when this ranking information could not be reliably communicated thus severely attenuating the potential to bring tangible or status benefits

veblen effects in a theory of conspicuous consumption the authors examine conditions under which veblen effects arise from the desire to achieve social status by signaling wealth through conspicuous consumption while veblen effects cannot ordinarily arise when preferences satisfy a single crossing property they may emerge when this property fails in that case budget brands are priced at marginal cost while luxury brands though not intrinsically superior are sold at higher prices to consumers seeking to advertise wealth luxury brands earn strictly positive profits under conditions that would with standard formulations of preferences yield marginal cost pricing the authors explore factors that induce veblen effects and they investigate policy implications copyright 1996 by american economic association

quality incentives for gps in a regulated market abstract this paper analyses whether gps in a capitation system have incentives to provide quality even though health is a credence good a model is developed where the quality of the service varies due to inherent differences between the gps and rational patients make choices based on the outcome of treamtent we find that it is difficult to provide appropriate incentives since the search activity of patients offsets direct effects of a change in reimbursement variation in the inherent ability of the gps is good since it increases the search activity of the patients and the optimal reimbursement scheme is inversely proportional to the dispersion in types finally we find that offering a menu of contracts can potentially increase social welfare above the level of a simple capitation regime but it tends to lead to a higher variation in quality levels