intergenerational equity and sustainability abstract this paper explores the limitations of conventional economic analysis of intergenerational problems and examines some of the alternatives suggested in the literature it is argued that proper consideration of future generations has at least three requirements first when future costs and benefits are considered it should be taken into account that they are to be enjoyed by different generations second the sustainability requirement should be adopted this represents an equity commitment to the future and implies the recognition that future generations have the right to nondeteriorated ecological and economic capacity the paper studies the ways in which the recognition of these rights might be incorporated into economic evaluation and management third an appropriate institutional network to enforce the recognition of these rights in decision making processes should be constituted its design and necessary functions are also analyzed

sickness and death economic consequences and coping strategies of the urban poor in bangladesh summary we investigate the economic consequences of sickness and death and the manner in which poor urban households in bangladesh respond to such events based on panel data we assess the effects of morbidity and mortality episodes on household income medical spending labor supply and consumption we find that despite maintaining household labor supply serious illness exerts a negative effect on income for the poor however the estimates do not reject consumption smoothing the most prominent responses to finance current needs are increasing household debt through borrowing and depleting productive assets both of which have detrimental effects on future consumption

don t let the easy be the enemy of the good returns from art investments what is wrong with it abstract although geometric hedonic price indexes are widely used in the hedonic literature on non standard investments it is well known that portfolios of assets have values that are related to the arithmetic not geometric average of prices this paper explores the implications of the use of arithmetic hedonic price indexes for art investments log linear predictions are retransformed back to the original scale by performing a modified version of the duan s smearing factor this procedure is illustrated with an analysis of the returns from 10 459 surrealist paintings sold worldwide during the pre crisis period 1990 2007 findings show significant differences between the arithmetic versus geometric price indexes while emphasising the caution that should be exercised in interpreting the hedonic index prices of non standard investments as they are typically computed for academic and business applications

the price effects of liquidity shocks a study of the sec s tick size experiment abstract do stock prices of publicly listed companies respond to changes in transaction costs using the sec s pilot program that increased the tick size for approximately 1 200 randomly chosen stocks we find a stock price decrease between 1 75 and 3 2 for small spread stocks affected by the larger tick size relative to a control group we find that the increase in the present value of transaction costs accounts for a small percentage of the price decrease we study channels of price variation due to changes in expected returns information risk investor horizon and liquidity risk the evidence suggests that trading frictions affect the cost of capital

supply side and demand side cost sharing in deregulated social health insurance which is more effective abstract microeconomic theory predicts that if patients are fully insured and providers are paid fee for service utilization of medical services exceeds the efficient level moral hazard effect in switzerland both demand side and supply side cost sharing have been introduced to mitigate this problem analyzing a panel dataset of about 160 000 adults we find both types of cost sharing to be effective in curtailing the use of medical services however when moral hazard mitigation is traded off against risk selection the minimum deductible supply side cost sharing option ranks first followed by the medium deductible demand side alternative making the supply side option somewhat more effective

gender and the demand for medical care the consumption of a set of diverse medical services is analysed in an effort to determine the sources of high utilization by women unlike previous studies of gender and the demand for medical services the range of services investigate allows us to draw conclusions about the influence of physicians as agents we use a modified version of the almost ideal demand model in the emperical analysis which unlike the double log quadratic or linear demand models is consistent with constraints imposed by economic theory through decomposition of the variance it was found that if women reported the same series of health indicators as men their use of most services would fall below that of men

ageing the great challenge to health care reform abstract this contribution is an attempt to analyze an issue that seems to be frequently skirted over when discussing reforms of today s health care systems practitioners of health insurance point out the fact that a major share of medical care services goes to the uppermost age brackets who are believed to be unresponsive to the financial incentives such as cost sharing and bonuses for no claims that are being considered as innovations in the financing of health care at the same time rapid growth in the numbers of the old and very old is predicted for virtually all oecd countries acting in combination these two factors appear to undercut the rationale of conventional cost containment strategies in health care a closer look at the matter even reveals that a major part of lifetime health resources are spent during the last few months of human life economists are therefore challenged to explain a puzzle why is it that such a great deal of resources is dedicated to investments that will in all likelihood be characterized by a very short payoff period in an attempt at answering this question the decision situations facing the dying patient and his family treating physicians and politicians acting as agents of the population at large will be examined in turn of course no easy way out can be expected to result from this exercise nevertheless economic analysis can be counted upon to provide at least cues concerning the incentives that have to be built into future insurance contracts physician payment schemes and modes of hospital finance for dealing with the challenge to the health care system posed by a rapidly ageing population

insurer hospital bargaining negotiated discounts in post deregulation connecticut this paper uses unique data from the state of connecticut to examine discounting patterns in the state s hospital industry for the years following deregulation 1995 1998 the data provide a rare opportunity to study payer level differences in negotiated discounts for hospital services in addition to presenting descriptive evidence on how discounts vary across payers payer types and hospital types this study uses matched revenue data to analyze the economic determinants of discount magnitudes payer size appears to affect bargaining power but the economic significance of the effect is small the data exhibit patterns consistent with a bargaining explanation in which discount magnitudes depend critically on payers abilities to channel patients to hospitals with which favorable discounts have been negotiated

two stage residual inclusion estimation addressing endogeneity in health econometric modeling the paper focuses on two estimation methods that have been widely used to address endogeneity in empirical research in health economics and health services research two stage predictor substitution 2sps and two stage residual inclusion 2sri 2sps is the rote extension to nonlinear models of the popular linear two stage least squares estimator the 2sri estimator is similar except that in the second stage regression the endogenous variables are not replaced by first stage predictors instead first stage residuals are included as additional regressors in a generic parametric framework we show that 2sri is consistent and 2sps is not results from a simulation study and an illustrative example also recommend against 2sps and favor 2sri our findings are important given that there are many prominent examples of the application of inconsistent 2sps in the recent literature this study can be used as a guide by future researchers in health economics who are confronted with endogeneity in their empirical work

giving voice to the future in sustainability retrospective assessment to learn prospective stakeholder engagement abstract there is a broad understanding that intergenerational equity is a necessary if not sufficient condition for sustainability likewise there is a growing consensus that sustainability science requires stakeholder engagement to be successful these two ideas demand some meaningful way of engaging the future as a stakeholder if sustainability is to be operationalized rawls theory of justice provides a model for how this might be accomplished yet there are both conceptual and practical problems with a rawlsian approach we propose using retrospective assessment as a means of learning how to approach future stakeholder engagement in sustainability

nonlinearity in medical expenditures a new semiparametric approach research in empirical health economics has found that the relationship between medical expenditures and age income and other variables can be highly nonlinear moreover men and women can have quite different medical expenditure patterns due to their differences in life expectancy thus it may be difficult to find an appropriate parametric model to capture the highly complicated nonlinearity in medical expenditures and introducing a simple gender dummy variable in a parametric model may not reveal all the medical expenditure differences between men and women this study takes a semiparametric approach in particular an additive partially linear specification is employed to study the relationship between medical expenditures and age income gender and other individual characteristics using data from the national medical expenditure survey the results indicate that the semiparametric approach taken in this study is very promising they confirm that medical expenditures are nonlinear in income and age

assessing incentives for service level selection in private health insurance exchanges even with open enrollment and mandated purchase incentives created by adverse selection may undermine the efficiency of service offerings by plans in the new health insurance exchanges created by the affordable care act using data on persons likely to participate in exchanges drawn from five waves of the medical expenditure panel survey we measure plan incentives in two ways first we construct predictive ratios improving on current methods by taking into account the role of premiums in financing plans second relying on an explicit model of plan profit maximization we measure incentives based on the predictability and predictiveness of various medical diagnoses among the chronic diseases studied plans have the greatest incentive to skimp on care for cancer and mental health and substance abuse

moral hazard in health insurance what we know and how we know it we describe research on the impact of health insurance on healthcare spending moral hazard and use this context to illustrate the value of and important complementarities between different empirical approaches one common approach is to emphasize a credible research design we review results from two randomized experiments as well as some quasi experimental studies this work has produced compelling evidence that moral hazard in health insurance exists that is individuals on average consume less healthcare when they are required to pay more for it out of pocket as well as qualitative evidence about its nature these studies alone however provide little guidance for forecasting healthcare spending under contracts not directly observed in the data therefore a second and complementary approach is to develop an economic model that can be used out of sample we note that modeling choices can be consequential different economic models may fit the reduced form but deliver different counterfactual predictions an additional role of the more descriptive analyses is therefore to provide guidance regarding model choice

sustainability in natural resource management abstract sustainability is the objective that many disciplines indicate as being essential to the resolution of environmental degradation although there is no agreement about what this term exactly means this study defines environmental problems as externalities most of these occurring between different generations we analyze the reasons why traditional solutions for externalities do not work in the intergenerational context our conclusions are on the one hand that traditional methods for evaluating the costs and benefits affecting different generations should be improved secondly an intergenerational redistribution of natural resource property rights is essential to guarantee equality of opportunities for all generations and therefore to ensure sustainability adequate redistribution of property rights will depend on the type of resource as well as on other factors such as the rate of return on its exploitation and the current generations propensity to consume in all cases however sustainability is sufficiently guaranteed by conceding property rights as a whole to the future

censored quantile instrumental variable estimates of the price elasticity of expenditure on medical care efforts to control medical care costs depend critically on how individuals respond to prices i estimate the price elasticity of expenditure on medical care using a censored quantile instrumental variable cqiv estimator cqiv allows estimates to vary across the conditional expenditure distribution relaxes traditional censored model assumptions and addresses endogeneity with an instrumental variable my instrumental variable strategy uses a family member s injury to induce variation in an individual s own price across the conditional deciles of the expenditure distribution i find elasticities that vary from 0 76 to 1 49 which are an order of magnitude larger than previous estimates

why trading speed matters a tale of queue rationing under price controls we show that queue rationing under price controls is one driver of high frequency trading uniform tick sizes constrain price competition and create rents for liquidity provision particularly for securities with lower prices the time priority rule allocates rents to high frequency traders hfts because of their speed advantage an increase in relative tick size defined as uniform tick sizes divided by security prices increases the fraction of liquidity provided by hfts but harms liquidity we find that the message to trade ratio is a poor cross sectional proxy for hfts liquidity provision stocks with more liquidity provided by hfts have lower message to trade ratios received september 15 2015 editorial decision october 7 2017 by editor robin greenwood

tick size share prices and stock splits minimum price variation rules help explain why stock prices vary substantially across countries and other curiosities of share prices companies tend to split their stock so that the institutionally mandated minimum tick size is optimal relative to the stock price a large relative tick size provides an incentive for dealers to make markets and for investors to provide liquidity by placing limit orders despite its placing a high floor on the quoted bid ask spread a simple model suggests that idiosyncratic risk firm size and visibility of the firm affect the optimal relative tick size and thus the share price in stock markets around the world the average price per share differs substantially the median u s stock for example sells for about 40 a typical london stock sells for about 5 7 50 and a typical hong kong share is about 2 furthermore when stock prices rise above a country s usual trading range firms often split their stocks to restore prices to that range why are these price ranges so different among countries these trading ranges can be remarkably stable over time during the half century from 1943 to 1994 the s p composite index increased over 1 500 percent yet the average new york stock exchange nyse share price was

too much ado about two part models and transformation comparing methods of modeling medicare expenditures many methods for modeling skewed health care cost and use data have been suggested in the literature this paper compares the performance of eight alternative estimators including ols and glm estimators and one and two part models in predicting medicare costs it finds that four of the alternatives produce very similar results in practice it then suggests an efficient method for researchers to use when selecting estimators of health care costs

health insurance and the demand for medical care instrumental variable estimates using health insurer claims data this paper takes a different approach to estimating demand for medical care that uses the negotiated prices between insurers and providers as an instrument the instrument is viewed as a textbook cost shifting instrument that impacts plan offerings but is unobserved by consumers the paper finds a price elasticity of demand of around 0 20 matching the elasticity found in the rand health insurance experiment the paper also studies within market variation in demand for prescription drugs and other medical care services and obtains comparable price elasticity estimates

a nation of gamblers real estate speculation and american history the great housing convulsion that buffeted america between 2000 and 2010 has historical precedents from the frontier land boom of the 1790s to the skyscraper craze of the 1920s but this time was different there was far less far less real uncertainty about fundamental economic and geographic trends making the convulsion even more puzzling during historic and recent booms sensible models could justify high prices on the basis of seemingly reasonable projections about stable or growing prices the recurring error appears to be a failure to anticipate the impact that elastic supply will eventually have on prices whether for cotton in alabama in 1820 or land in las vegas in 2006 buyers don t appear to be irrational but rather cognitively limited investors who work with simple heuristic models instead of a comprehensive general equilibrium framework low interest rates rarely seem to drive price growth under priced default options are a more common contributor to high prices the primary cost of booms has not typically been overbuilding but rather the financial chaos that accompanies housing downturns

how big is the crowding out effect of user fees in the rural areas of ethiopia implications for equity and resources mobilization summary using a nested multinomial logit model this study investigates the demand reduction and diversion effects of user fees in rural areas of ethiopia the results reveal that an increase in user fees of public clinics which are the most widely used alternative can have a significant demand reduction effect on the poorest of the poor this implies that despite cost recovery has been advocated as an alternative means of health care financing in most of the developing world increasing user fees may drive the poorest segment of the population out of the health care market unless some protective measures are taken

an econometric model of the two part decision process in the demand for health the decision to contact a physician and the decision about how often to contact a physician are determined by different decisionmakers we introduce a negative binomial distributed hurdle model that specifies the two stages of the decisionmaking process as different stochastic processes while at the same time taking care of the discrete nature of the data empirical results are based on a cross section of the west german socioeconomic panel specification tests reveal that the two stages of the process need to be treated as two distinct processes this in turn implies that ignoring this distinction leads to serious misinterpretation

estimating the tradeoff between risk protection and moral hazard with a nonlinear budget set model of health insurance insurance induces a tradeoff between the welfare gains from risk protection and the welfare losses from moral hazard empirical work traditionally estimates each side of the tradeoff separately potentially yielding mutually inconsistent results i develop a nonlinear budget set model of health insurance that allows for both simultaneously nonlinearities in the budget set arise from deductibles coinsurance rates and stoplosses that alter moral hazard as well as risk protection i illustrate the properties of my model by estimating it using data on employer sponsored health insurance from a large firm

the impact of patient cost sharing on low income populations evidence from massachusetts greater patient cost sharing could help reduce the fiscal pressures associated with insurance expansion by reducing the scope for moral hazard but it is possible that low income recipients are unable to cut back on utilization wisely and that as a result higher cost sharing will lead to worse health and higher downstream costs through increased use of inpatient and outpatient care we use exogenous variation in the copayments faced by low income enrollees in the massachusetts commonwealth care program to study these effects we estimate separate price elasticities of demand by type of service overall we find price elasticities of about 0 16 for this low income population similar to elasticities calculated for higher income populations in other settings these elasticities are somewhat smaller for the chronically sick especially for those with asthma diabetes and high cholesterol these lower elasticities are attributable to lower responsiveness to prices across all categories of service and to some statistically insignificant increases in inpatient care

competition among hospitals we examine competition in the hospital industry in particular the effect of ownership type for profit not for profit government we estimate a structural model of demand and pricing in the hospital industry in california then use the estimates to simulate the effect of a merger california hospitals in 1995 face an average price elasticity of demand of 4 85 not for profit hospitals face less elastic demand and act as if they have lower marginal costs their prices are lower than those of for profits but markups are higher we simulate the effects of the 1997 merger of two hospital chains in san luis obispo county where the merger creates a near monopoly prices rise by up to 53 and the predicted price increase would not be substantially smaller were the chains not for profit

catering through nominal share prices we propose and test a catering theory of nominal stock prices the theory predicts that when investors place higher valuations on low price firms managers respond by supplying shares at lower price levels and vice versa we confirm these predictions in time series and firm level data using several measures of time varying catering incentives more generally the results provide unusually clean evidence that catering influences corporate decisions because the process of targeting nominal share prices is not well explained by alternative theories in frictionless and efficient stock markets there is no optimal nominal pershare stock price a firm s board of directors may choose to split to manage the nominal share price and number of shares outstanding but cannot change its overall market value through these means yet boards typically do manage their firms nominal share price rather than watch it passively drift with returns theories offered to explain share price management include arguments that trading costs depend on nominal prices dolley 1933 angel 1997 that splits signal inside information brennan and copeland 1988 asquith healy and palepu 1989 and ikenberry rankine and stice 1996 or that prices in certain ranges simply constitute a market norm from which there is little gain to deviating rozeff 1998 weld et al 2009 in this paper we propose a catering theory of nominal share prices we define catering as the managerial behavior of increasing the supply of a characteristic that investors appear to be paying a premium for even though that characteristic does not increase fundamental value the catering theory of nominal share prices thus posits that the supply of securities of different price ranges is partly a response to investor demand for securities of different price ranges managers increase the supply of low priced securities

much ado about two reconsidering retransformation and the two part model in health econometrics in health economics applications involving outcomes y and covariates x it is often the case that the central inferential problems of interest involve e y x and its associated partial effects or elasticities many such outcomes have two fundamental statistical properties y 0 and the outcome y 0 is observed with sufficient frequency that the zeros cannot be ignored econometrically this paper 1 describes circumstances where the standard two part model with homoskedastic retransformation will fail to provide consistent inferences about important policy parameters and 2 demonstrates some alternative approaches that are likely to prove helpful in applications

stock splits signaling or liquidity the case of adr solo splits abstract stock splits should have no effect on firm value in perfect capital markets yet stock prices increase on split announcements the two traditional explanations are information signaling and improved liquidity for shares that trade at lower prices we investigate these explanations by studying splits of american depositary receipts adrs that are not associated with splits in their home country stock and which represent unique illustrations of the effect of liquidity we interpret our findings as supportive of the liquidity explanation of stock split announcement effects

rationing and rent dissipation in the presence of heterogeneous individuals this paper discusses the implications of rationing by waiting when consumers have different time costs and personal valuations the joint distribution function of time costs and personal valuations is used to characterize market equilibrium it is argued that under certain conditions an increase in the variance of time costs will reduce the dissipation of rent furthermore it is shown that introducing a secondary market for a rationed good does not necessarily improve welfare because total surplus under rationing by waiting depends more on the variance than on the level of time costs and personal valuations the model is also used to discuss other institutions that involve rent seeking activities such as the patent system and import quotas

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

measuring market power in the ready to eat cereal industry the ready to eat cereal industry is characterized by high concentration high price cost margins large advertising to sales ratios and numerous introductions of new products previous researchers have concluded that the ready to eat cereal industry is a classic example of an industry with nearly collusive pricing behavior and intense nonprice competition this paper empirically examines this conclusion in particular i estimate price cost margins but more importantly i am able empirically to separate these margins into three sources i that which is due to product differentiation ii that which is due to multi product firm pricing and iii that due to potential price collusion the results suggest that given the demand for different brands of cereal the first two effects explain most of the observed price cost margins i conclude that prices in the industry are consistent with noncollusive pricing behavior despite the high price cost margins leading firms are able to maintain a portfolio of differentiated products and influence the perceived product quality it is these two factors that lead to high price cost margins

estimating price elasticities of convalescent care programmes this study is the first to estimate price elasticities of demand for convalescent care programmes in 1997 the german legislature more than doubled the daily co payments for the publicly insured from 6t o 13 the measure caused the overall demand for convalescent care treatments to fall by 20 to 25 i estimate the price elasticity for medical rehabilitation programmes aimed at preventing work disability to be about 0 3 whereas the elasticity for medical rehabilitation programmes for recovery from accidents at work lies around 0 5 the demand for preventive treatment at health spas is elastic and less than 1 how does the demand for medical care change when prices change since the early days of the profession of health economics the question of the price elasticity for health services has been central joseph p newhouse one of the founders of the field of health economics has published more than 100 articles alone on health care demand newhouse was also the leader of the rand group that designed and directed the famous rand health insurance experiment that focused on the impact of costsharing on the demand for medical care not only newhouse but also many other economists have devoted a great deal of attention to this topic

the rand health insurance experiment three decades later we re present and re examine the analysis from the famous rand health insurance experiment from the 1970s on the impact of consumer cost sharing in health insurance on medical spending we begin by summarizing the experiment and its core findings in a manner that would be standard in the current age we then examine potential threats to the validity of a causal interpretation of the experimental treatment effects stemming from different study participation and differential reporting of outcomes across treatment arms finally we re consider the famous rand estimate that the elasticity of medical spending with respect to its out of pocket price is 0 2 emphasizing the challenges associated with summarizing the experimental treatment effects from non linear health insurance contracts using a single price elasticity

mergers when prices are negotiated evidence from the hospital industry in recent years many hospitals have merged in part to gain bargaining leverage with managed care organizations mcos we investigate the price impact of hospital mergers by formulating and estimating an equilibrium bargaining model between hospital systems and managed care health insurers over prices for inpatient services we estimate the parameters of the model using claims and discharge data from northern virginia in 2006 inova health system proposed to acquire prince william hospital we nd that this merger would have raised prices signicantly and that the remedy of separate bargaining imposed by the ftc in a separate hospital case would have resulted in a larger price increase

hospital utilization in mixed public private system evidence from australian hospital data this article investigates whether patients who used a mixture of private and public hospital care have higher total hospital utilization than those who exclusively used either public or private hospital care using australian hospital administrative data of heart disease patients we found that those who used a mixture of private and public care had the highest total hospital utilization our findings are robust to how utilization is measured and endogeneity between utilization and hospital type choice

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

estimating demand elasticities using nonlinear pricing abstract nonlinear pricing is prevalent in industries such as health care public utilities and telecommunications however this pricing scheme introduces bias into estimating elasticities for welfare analysis or policy changes i develop a local elasticity estimation method that uses nonlinear price schedules to isolate consumers expenditure choices from selection and simultaneity biases this method improves over previous approaches by using commonly available observational data and requiring only a single general monotonicity assumption using claims level data on health insurance with two nonlinearities i am able to measure two separate elasticities and find that elasticity declines from 0 26 to 0 09 by the second nonlinearity these estimates are then used to calculate moral hazard deadweight loss this method enables estimation of many policies with nonlinear pricing which previous tools could not address

the effect of time price on the demand for medical care services this paper analyzes the effect of time price on medical care demand and describes use of a reservation wage question from a household survey to develop a measure of time price for obtaining medical care a comprehensive three equation model of the demand for female medical care services examines choice of provider entry demand and the demand for physician visits results show that provider choice is based primarily on economic factors and that an expected high time price discourages women from choosing a public provider and from seeking gynecological maternal health or family planning services during the year yet does not influence the number of visits made once care is used the estimated model shows that medical care demand equations should control for the type of provider chosen and the opportunity cost of time for alternative activities when testing for a negative time price effect of obtaining medical care

contraception as development new evidence from family planning in colombia there has been considerable debate in the last decade about whether or not family planning programmes in developing countries reduce fertility or improve socio economic outcomes this article provides new evidence by studying the expansion of one of the worlds oldest and largest family planning organisations profamilia of colombia it finds that family planning explains less than 10 of colombias fertility decline during its demographic transition as in wealthy countries however lowering the costs of first birth postponement produced important socio economic gains enabling young women to obtain more education and to work more and live independently later in life

exploring the variability of patient costs in disease management programs a hierarchical modelling approach disease management programs include a wide variation of patients with different chronic diseases and different health care utilization the aim of this article was to identify factors on patient level and organizational level that explain the variability in costs of patients with different chronic diseases enrolled in a dmp by employing a rigorous analytical model a generalized linear mixed model glmm was specified to perform a multi level analysis of cross sectional hierarchical data from 16 dmps in the netherlands multiple imputation sub group analysis per disease and analysis from both the health care and the societal perspectives were also performed our model showed that age the presence of cardiovascular disease multi morbidity and payments on top of the payment for the usual care had positive relation with costs while better quality of life was associated with lower health care costs in the copd sample physical activity and employment were associated with health care costs our study show

an institutional analysis of methods for environmental appraisal abstract this paper focuses on a set of issues when choosing between methods for environmental appraisal approaches like cost benefit analysis contingent valuation multicriteria analysis and deliberative methods are based on very different assumptions concerning the characteristics of environmental resources the capacities of the individuals involved and the role the methods play in framing the process the present paper views environmental appraisal methods as institutional structures they are seen as rules concerning a who should participate and in which capacity b what is considered data and which form data should take and c rules about how a conclusion is reached specifically the choice of method defines the logic of the appraisal process and next influences the output while cost benefit analysis is based on the assumption of individual rationality deliberative methods assume that individuals can act according to social rationality the first part of the paper is devoted to clarifying what institutions are and their role in the valuation process second the main features of environmental or ecosystem services and the demands they raise for decision making are described a general framework for evaluating appraisal methods is then developed finally this structure is elaborated in more detail as a basis for deciding over the choices of methods in the case of evaluating ecosystem services a set of unresolved issues are identified especially related to how the choice of appraisal methods themselves should be instituted

the oregon health insurance experiment evidence from the first year in 2008 a group of uninsured low income adults in oregon was selected by lottery to be given the chance to apply for medicaid this lottery provides an opportunity to gauge the effects of expanding access to public health insurance on the health care use financial strain and health of low income adults using a randomized controlled design in the year after random assignment the treatment group selected by the lottery was about 25 percentage points more likely to have insurance than the control group that was not selected we find that in this first year the treatment group had substantively and statistically significantly higher health care utilization including primary and preventive care as well as hospitalizations lower out of pocket medical expenditures and medical debt including fewer bills sent to collection and better self reported physical and mental health than the control group

price elasticity of expenditure across health care services policymakers in countries around the world are faced with rising health care costs and are debating ways to reform health care to reduce expenditures estimates of price elasticity of expenditure are a key component for predicting expenditures under alternative policies using unique individual level data compiled from administrative records from the chilean private health insurance market i estimate the price elasticity of expenditures across a variety of health care services i find elasticities that range between zero for the most acute service appendectomy and 2 08 for the most elective psychologist visit moreover the results show that at least one third of the elasticity is explained by the number of visits the rest is explained by the intensity of each visit finally i find that high income individuals are five times more price sensitive than low income individuals and that older individuals are less price sensitive than young individuals

selection on moral hazard in health insurance economic analysis of market failure in insurance markets tends to analyze selection and moral hazard as distinct phenomena in this paper we explore the potential for selection on moral hazard in insurance markets by this we mean the possibility that moral hazard effects are heterogenous across individuals and that individuals selection of insurance coverage is affected by their anticipated behavioral response to coverage we examine these issues empirically in the context of employer provided health insurance in the united states specifically we break down the general

trade execution costs and market quality after decimalization this study assesses trade execution costs and market quality for nyse and nasdaq stocks before and after the 2001 change to decimal pricing several theoretical predictions are confirmed quoted bid ask spreads declined substantially on each market with the largest declines for heavily traded stocks the percentage of shares receiving price improvement increased on the nyse but not on nasdaq however those trades completed at prices within or outside the quotes were improved or disimproved by smaller amounts after decimalization and trades completed outside the quotes saw the largest reductions in trade execution costs as a class effective bid ask spreads as a percentage of share price arguably the most relevant measure of execution costs for smaller trades averaged 0 33 on a volume weighted basis after decimalization for both nyse and nasdaq stocks there is no evidence of systematic intraday reversals of quote changes on either market as would be expected if decimalization had damaged liquidity supply

health care demand elasticities by type of service we estimate within year price elasticities of demand for detailed health care services using an instrumental variable strategy in which individual monthly cost shares are instrumented by employer year plan month average cost shares a specification using backward myopic prices gives more plausible and stable results than using forward myopic prices using 171 million person months spanning 73 employers from 2008 to 2014 we estimate that the overall demand elasticity by backward myopic consumers is 0 44 with higher elasticities of demand for pharmaceuticals 0 44 specialists visits 0 32 mris 0 29 and mental health substance abuse 0 26 and lower elasticities for prevention visits 0 02 and emergency rooms 0 04 demand response is lower for children in larger firms among hourly waged employees and for sicker people overall the method appears promising for estimating elasticities for highly disaggregated services although the approach does not work well on services that are very expensive or persistent

private health insurance and utilization of health services in chile this paper analyses the choice of private health insurance in chile and how this relates to the utilization of health services the results show the importance of some demographics on the insurance decision particularly age gender and marital status socio economic factors such as education income employment status and zone of residence all influence the probability of purchasing private insurance the relevance of these determinants is confirmed using a simulation analysis with four representative decision makers this simulation also provides evidence of a positive selection into private insurance although this would be driven by the different criteria used to set premiums under private and public insurance schemes the potential linkage between utilization of health services and private health insurance is examined using a simultaneous two equation framework two measures of utilization are estimated outpatient health services and length of stay in hospital a number of explanatory variables s

what happens when the insurer can say no assessing prior authorization as a tool to prevent high risk prescriptions and to lower costs abstract insurers are increasingly requiring physicians to obtain prior authorization before prescribing drugs that are costly or have high abuse potential these prior authorization requirements have the potential to reduce risky prescriptions and to lower prescription drug costs but little is known about their ability to do either this study estimates the effect of a prior authorization requirement for certain costly and abuse prone drugs on prescription drug use and costs for work related injuries in texas the findings indicate that the prior authorization requirement reduces the likelihood that claimants receive non preferred drugs as well as insurers spending on non preferred drugs while there is some substitution to preferred drugs i do not find evidence of large increases in spending on preferred drugs the estimated effects on average total pharmacy spending are imprecise though there is suggestive evidence that the prior authorization requirement reduces the likelihood that a claim has high prescription drug costs the results provide strong evidence that the prior authorization requirement drastically reduces the likelihood that patients receive combinations of drugs that have contributed disproportionately to the rise in prescription drug overdoses despite the success of prior authorization in lowering spending on non preferred drugs and in reducing high risk prescriptions i find little evidence that prior authorization has disproportionately large effects on the most dangerous prescription drug use and only weak suggestive evidence that it has larger effects on prescription drug use that likely arises because physicians are not fully informed suggesting that prior authorization requirements do not necessarily target the riskiest drug use

discrete pricing and market fragmentation a tale of two sided markets security trading now fragments into more than ten almost identical stock exchanges in the united states we show that discrete pricing is one economic force that prevents the consolidation of trading volume the uniform one cent tick size minimum price variation imposed by the sec s rule 612 leads to more dispersed trading for lower priced securities when a security reverse splits its price increases and relative tick size one cent divided by the price decreases we find that reverse splits consolidate trading of securities using securities with identical underlying fundamentals that do not reverse split as the control group

hospital competition in hmo networks abstract we develop a framework for analyzing bargaining relationships between hospitals and hmos under selective contracting using a unique dataset on hospitals in the los angeles area from 1990 to 1993 we estimate the determinants of actual negotiated prices paid to hospitals by two major hmos we find that a hospital s bargaining power and thus its price decrease when the hmo can readily turn to alternative networks that exclude the hospital we simulate the effect of hypothetical hospital mergers on bargaining power and find that some hospital mergers even in urban areas with many nearby hospitals can lead to significant price increases

tick size price grids and market performance stable matches as a model of market dynamics and equilibrium abstract the tick size in a financial market is the minimum allowable difference between ask and bid prices by the rules of each exchange no transactions can occur within the tick interval the impact of tick size is an ongoing controversy which we study by experimental methods whose simplicity helps distinguish among competing models of complex real world securities markets we observe patterns predicted by a matching cooperative game model because a price grid interferes with a competitive equilibrium and restrictions on order flow interfere with information aggregation the matching model provides predictions when the competitive model cannot although their predictions are the same when a competitive equilibrium does exist our experiments examine stable allocations average prices timing of order flow information flow and price dynamics larger tick size invites more speculation which in turn increases liquidity however increased speculation leads to inefficient trades that otherwise would not have occurred

on the problem of achieving efficiency and equity intergenerationally the paper compares two approaches to the problem of achieving the social goals of sustainability and intergenerational efficiency the first is a separated approach where the results of standard benefit cost analysis are later combined with intergenerational equity considerations the second in the tradition of institutional design is an integrated approach where efficiency and equity considerations are combined from the start it ap pears that several well known problems with dis counting can be avoided or mitigated by the second approach jel 02

ageing chronic conditions and the evolution of future drugs expenditure a five year micro simulation from 2004 to 2029 the healthy ageing assumptions may lead to substantial changes in paths of aggregate health care expenditure notably catastrophic expenditure of people at the end of the life but clear assessments of involved amounts are not available when we specifically consider ambulatory care as drug expenditure generally offered to chronically ill people we estimate the effects of epidemiological and life expectancy changes on french health expenditure until 2029 by applying a markovian micro simulation model from a nationally representative database the originality of these simulations holds in using an aggregate indicator of morbidity mortality capturing vital risk and making it possible to adapt the quantification of life expectancies by taking into account the presence of severe chronic pathologies we forecast future national drugs expenditure under different epidemiological scenarios of chronic morbidity trend scenario healthy ageing scenario and medical progress scenario for the population aged 25

the nominal share price puzzle the average nominal share prices of common stocks traded on the new york stock exchange have remained constant at approximately 35 per share since the great depression as a result of stock splits it is surprising that u s firms actively maintained constant nominal prices for their shares while general prices in the economy went up more than tenfold this is especially puzzling given that commissions paid by investors on trading ten 35 shares are about ten times those paid on a single 350 share we review potential explanations including signaling and optimal trading ranges and find that none of the existing theories are able to explain the observed constant nominal prices we suggest that the evidence is consistent with the idea that customs and norms can explain the nominal price puzzle

rural electrification and household labor supply evidence from nigeria in nigeria the most populated african country rural electrification is a critical issue because of the low household electrification rate and the poor quality of the grid this energy poverty has harmful economic and social consequences in rural areas such as low productivity lack of income generating opportunities and poor housing conditions in this paper we consider electrification as a technical shock that may affect household time allocation using the 2010 2011 general household survey we investigate how electrification affects female and male labor supply decisions within rural households in nigeria focusing on husband wife data we consider potential dependence in spouses labor supply decisions and address the challenge of zero hours of work using a recent copula based bivariate hurdle model deb et al 2013 in addition an instrumental variable strategy helps identify the causal effect of elec trification our results underline that this dependence in spouses labor supply decisions is critical to consider when assessing the impact of electrification on these outcomes electrifi cation increases the working time of both spouses in the separate assessments but the joint analysis emphasizes only a positive effect of electrification on husbands working time in line with the household labor supply approach our findings highlight that within the household the labor supply decisions of one spouse significantly affect those of the other spouse thus if we neglect the effect of electrification on the spouse of the individual examined we may fail to assess how this individual has been actually affected by this common shock on both spouses our results suggest that these within household relationships promote husbands working time at the expense of wives working time

health status and the demand for health results on price elasticities the relationship between measured health status and the elasticity of demand for ambulatory physician services is estimated using data from the national medical care utilization and expenditure survey nmcues although the theoretical relationship between health status and demand elasticity is ambiguous results obtained in this study suggest that declines in health reduce the elasticity of the initial decision to seek care but have no discernible effect on the elasticity of demand at mean levels of consumption these results are consistent with the findings of rand s hie and suggest that consumer price sharing has little effect on initial access to physicians for those in poor health

trust law sustainability and responsible action abstract the problem of managing for sustainability is marked by the need to make decisions on behalf of others and by the uncertainties that attend such decisions however the economic literature on sustainability has paid scant attention to how decisions on behalf of others might differ from decisions on behalf of oneself and when risk has been modeled explicitly the expected utility hypothesis has generally been used a generation acts sustainably if the expected value of the next generation s utility is not less than the present s this paper investigates how we think about responsibly acting on another s behalf by looking to the united states law of trusts because in important respects the current generation views its responsibility to the future as a trust relationship trust law illuminates responsible decision making under both risk and uncertainty even under conditions of risk more conservative action than would be suggested by the expected utility hypothesis is warranted because it emphasizes preservation of trust principal and disavows profit maximization trust doctrine indicates that special caution should be exercised in conditions of uncertainty finally resource economic concepts of strong sustainability the precautionary principle and the safe minimum standard of conservation are interpreted according to trust principles

simultaneous equations bias in disaggregated econometric models with the language of econometrics agents may be said to take prices as exogenously given which suggests that prices are econometrically exogenous in individual behavioural equations this involves semantic confusion between different meanings of the word exogenous simultaneity problems cannot generally be dispelled by working with disaggregated data in particular nothing is gained by disaggregating the dependent variable in a regression equation if the micro and macro equations use the same regressors however there may be substantial gains from disaggregation of the regressors in the theory of competitive markets agents act as if they do not affect equilibrium market prices by analogy with the language of econometrics agents may be said to take prices as exogenously given having thus stated the price taking assumption it may seem that prices are econometrically exogenous in behavioural equations for individual agents such as labour demand curves this involves semantic confusion between two different meanings of the word exogenous for example even if each buyer has a negligible influence on the market price there may still be an important correlation between the price and the disturbance in an individual demand equation so that treating price as econometrically exogenous gives biased coefficient estimates the price taking assumption has been used to justify ols estimates of import demand functions for small countries leamer and stern 1970 pointed out that the estimated slope in an import demand function is generally an average of the slopes of the demand and supply functions for imports but

heterogeneous effect of coinsurance rate on healthcare expenditure generalized finite mixtures and matching estimators the article proposes a combination of finite mixture models and matching estimators to account for heterogeneous and nonlinear effects of the coinsurance rate on healthcare expenditure the analysis with panel data for adult japanese consumers in 2008 2010 and for female consumers in 2000 2010 demonstrates the presence of subpopulations with high medium and low healthcare expenditure and subpopulation membership is explained by lifestyle variables generalized finite mixtures provide adequate fit compared to loglinear model conditional average treatment effect estimations reveal the existence of nonlinear effects of the coinsurance rate in the subpopulation with high expenditure

estimates of the demand for medical care under different functional forms we estimate price and income elasticities from a linear log linear and the almost ideal demand model with and without an adjustment for selectivity bias in an effort to show that special attention should be paid to the underlying assumptions of consumer behaviour when estimating a medical care demand model the literature on medical care utilization is extended by incorporating two major components of spending as separate demands in a system of medical care spending we find that estimates of elasticities vary depending on the functional form of the estimating equation thus questioning the usefulness for policy purposes of single estimates of elasticities

what to expect when you are expecting are health care consumers forward looking a fundamental question in health insurance markets is how do health care consumers dynamically optimize their medical utilization under non linear insurance contracts our paper tests the neoclassical prediction that a fully forward looking agent only responds to their expected end of year price our unique identification strategy studies families during the year of childbirth who will likely satisfy their annual deductible thereby knowing their expected end of year price we find that during the year of a childbirth fathers increase medical spending by 11 per month after their deductible is satisfied rejecting the null of fully forward looking consumers this behavior cannot be explained by fathers increasing utilization in response to the childbirth itself furthermore this myopia translates to a 21 24 decrease in total annual medical spending relative to the counterfactual of fully forward looking behavior and is concentrated in elective procedures we find no response in low value or urgent care our findings suggest the need for modeling non linear incentives while accounting for myopic behavior when studying the medical utilization responses to health insurance

expenditure response to health insurance policies evidence from kinks in rural china abstract this paper utilizes administrative data to analyze expenditure responses to the health insurance policy in rural china and clear visual evidence of bunching is observed at the kink point a static response model with optimization frictions estimates that a complete elimination of the reimbursement would cause the total expenditure per visit to decrease by 34 5 and approximately one third of the studied population makes decisions with errors heterogeneous expenditure responses and optimization frictions are observed across demographic groups cost benefit and counterfactual analyses indicate that the current policy generates the greatest welfare gains

incentive and selection effects of medigap insurance on inpatient care the medicare program which provides insurance coverage to the elderly in the united states does not protect them fully against high out of pocket costs for this reason private supplementary insurance named medigap has been available to cover medicare gaps this paper studies how medigap affects the utilization of inpatient care separating the incentive and selection effects of supplementary insurance for this purpose we use two alternative estimation methods a standard recursive bivariate probit and a discrete multivariate finite mixture model we find that estimated incentive effects are modest and quite similar across models there seems to be very significant selection with the presence of both adversely and advantageously selected individuals stemming from the multidimensional nature of residual heterogeneity

patient cost sharing and hospitalization offsets in the elderly in the medicare program increases in cost sharing by a supplemental insurer can exert financial externalities we study a policy change that raised patient cost sharing for the supplemental insurer for retired public employees in california we find that physician visits and prescription drug usage have elasticities that are similar to those of the rand health insurance experiment hie unlike the hie however we find substantial offset effects in terms of increased hospital utilization the savings from increased cost sharing accrue mostly to the supplemental insurer while the costs of increased hospitalization accrue mostly to medicare

the determinants and effects of health expenditure in developed countries previous studies of international differences in health spending have been restricted to the use of relatively small samples of cross sectional data our objective here is to re examine the results of previous work using a sample of 560 pooled time series and cross section observations results confirm the importance of gdp as a determinant of health spending with an estimated income elasticity at or around unity but also suggest that oecd countries should not be regarded as a single homogeneous group the importance of some non income variables is also confirmed although the direct effect of these factors appears to be small

reviews of the 2006 economic report of the president the u s tax system in international perspective a review of the 2006 economic report of the president s tax chapter 1 alan j auerbach university of california berkeley and nber april 12 2006 what can you say about a tax reform proposal that died this was the challenge facing the writers of the chapter on taxation for the 2006 economic report of the president hereafter erp one year ago the erp included a chapter entitled options for tax reform that began with the section heading why do we need tax reform and proceeded to lay out the available options that it suggested could make the u s tax system simpler more equitable and efficient in making the case for tax reform that chapter set the stage for the impending work of the president s advisory panel on tax reform while being careful to leave the president s options open until the panel reported the 2005 chapter twice included the phrase the president has not endorsed any specific proposal and this chapter does not advocate the adoption of any particular prototype for reform in case the reader didn t get the message the first two times the chapter concluded with a reminder that the president has not endorsed any specific proposal 2 that was then in november 2005 the tax reform panel issued its report so one might have anticipated a follow up chapter in this year s erp evaluating the panel s i am grateful to rosanne altshuler bill gale kevin hassett and joel slemrod for comments on an earlier draft slemrod 2005 provides a critical evaluation of the 2005 chapter

the share price puzzle we document substantial variation in the prices of common stocks in u s markets due to firms selecting particular price ranges for their shares cross sectional evidence indicates that variables consistent with merton s model of capital market equilibrium explain roughly two thirds of this variation in share prices in addition measures of trading range and share price appreciation predict stock splits and the investor base of firms that split their stock increases compared to other firms we conclude that firms manage share price levels to increase the value of the firm

a comparison of alternative models for the demand for medical care we have tested alternative models of the demand for medical care using experimental data the estimated response of demand to insurance plan is sensitive to the model used we therefore use a split sample analysis and find that a model that more closely approximates distributional assumptions and uses a nonparametric retransformation factor performs better in terms of mean squared forecast error simpler models are inferior either because they are not robust to outliers e g anova anocova or because they are inconsistent when strong distributional assumptions are violated e g a two parameter box cox transformation

health care is an individual necessity and a national luxury applying multilevel decision models to the analysis of health care expenditures health care is neither a necessity or a luxury it is both since the income elasticity varies with the level of analysis with insurance individual income elasticities are typically near zero while national health expenditure elasticities are commonly greater than 1 0 the debate over whether health care is or is not a luxury good arises primarily from the failure to specify levels of analysis clearly so as to distinguish variation within groups from variation between groups apparently contradictory empirical results are shown to be consistent with a simple nested multilevel model of health care spending

intertemporal substitution in health care demand evidence from the rand health insurance experiment abstract nonlinear cost sharing in health insurance encourages intertemporal substitution because patients can reduce their out of pocket costs by concentrating spending in years when they hit the deductible we develop a test for intertemporal substitution and apply it to data from the rand health insurance experiment where people were randomly assigned either to a free care plan or to a cost sharing plan which had coinsurance up to a maximum dollar expenditure mde hitting the mde leading to an effective price of zero has a bigger effect on health care demand than does being in free care because people who hit the mde face low current prices but high future prices and so stock up on health care as a result short lasting price changes induce nearly twice as big a response as do long lasting changes these findings help reconcile disparate estimates of the price elasticity of demand for health care in the existing literature failing to account for intertemporal substitution can lead researchers to overstate cost savings from high deductible health plans by 20 or more