Daniel P. Kessler

Birth Order, Family Size, and Achievement: Family Structure and Wage Determination

Do birth order and the size of ones childhood family influence environment, thereby potentially affecting future achievement? This article investigates the hypothesis that they do, presenting two major empirical findings. First, neither birth order nor childhood family size significantly influences the level or growth rate of wages, a result that is consistent with previous research. Second, family size is both a statistically and economically significant determinant of womens employment status: women from small families work less than women from large families when they are young and more than women from large families when they are more mature.

Malpractice law and health care reform: optimal liability policy in an era of managed care

Abstract Because fee-for-service health insurance insulates providers from the costs of treatment decisions, it may lead to “defensive medicine” — precautionary treatment with minimal expected medical benefit administered out of fear of legal liability. By giving providers higher-powered incentives, managed care may affect optimal liability policy. Among elderly Medicare beneficiaries with heart disease in 1984–1994, we find that liability-reducing “tort reforms” reduce defensive practices in areas with high and low managed care enrollment, but that managed care and liability reform are substitutes. We consider some implications of these results for the current debate over the appropriateness of extending malpractice liability to managed care organizations.

Does patient satisfaction affect patient loyalty

PURPOSE This paper aims to investigate how patient satisfaction affects propensity to return, i.e. loyalty. DESIGN/METHODOLOGY/APPROACH Data from 678 hospitals were matched using three sources. Patient satisfaction data were obtained from Press Ganey Associates, a leading survey firm; process-based quality measures and hospital characteristics (such as ownership and teaching status) and geographic areas were obtained from the Centers for Medicare and Medicaid Services. The frequency with which end-of-life patients return to seek treatment at the same hospital was obtained from the Dartmouth Atlas. The study uses regression analysis to estimate satisfactions effects on patient loyalty, while holding process-based quality measures and hospital and market characteristics constant. FINDINGS There is a statistically significant link between satisfaction and loyalty. Although satisfactions effect overall is relatively small, contentment with certain hospitalization experience may be important. The link between satisfaction and loyalty is weaker for high-satisfaction hospitals, consistent with other studies in the marketing literature. RESEARCH LIMITATION/IMPLICATIONS: The US hospitals analyzed are not a random sample; the results are most applicable to large, non-profit teaching hospitals in competitive markets. PRACTICAL IMPLICATIONS Satisfaction ratings have business implications for healthcare providers and may be useful as a management tool for private and public purchasers. ORIGINALITY/VALUE The paper is the first to show that patient satisfaction affects actual hospital choices in a large sample. Because patient satisfaction ratings are also correlated with other quality measures, the findings suggest a pathway through which individuals naturally gravitate toward higher-quality care.

Ownership Form and Trapped Capital in the Hospital Industry

Over the past 20 years, demand for acute care hospital services has declined more rapidly than has hospital capacity. This paper investigates the extent to which the preponderance of the nonprofit form in this industry might account for this phenomenon. We test whether rates of exit from the hospital industry differ significantly across the different forms of ownership, and especially whether secular nonprofit hospitals reduce capacity more slowly than do other types of hospitals. We estimate the effect of population changes (a proxy for changes in demand) at the zip-code level between 1985 and 1994 on changes in the capacity of for-profit, secular nonprofit, religious nonprofit, and public hospitals over the same period, holding constant metropolitan statistical area (MSA) fixed effects and other 1985 baseline characteristics of residential zip codes. We find that for-profit hospitals are the most responsive to reductions in demand, followed in turn by public and religiously affiliated nonprofit hospitals, while secular nonprofits are distinctly the least responsive of the four ownership types.

The Persuasive Effects of Direct Mail: a Regression Discontinuity Approach

During the contest for Kansas attorney general in 2006, an organization sent out 6 pieces of mail criticizing the incumbents conduct in office. We exploit a discontinuity in the rule used to select which households received the mailings to identify the causal effect of mail on vote choice and voter turnout. We find these mailings had both a statistically and politically significant effect on the challengers vote share. Our estimates suggest that a ten percentage point increase in the amount of mail sent to a precinct increased the challengers vote share by approximately three percentage points. Furthermore, our results suggest that the mechanism for this increase was persuasion rather than mobilization.

Designing Hospital Antitrust Policy to Promote Social Welfare

Applying principles of merger evaluation to the health care industry in general, and to hospital markets in particular, poses several unique challenges. Definition of relevant geographic markets and assessment of the consequences of changes in competition for patient and social welfare are complicated by asymmetric information and moral hazard due to health insurance. We suggest a new empirical approach to assessing the impact of hospital competition which addresses the shortcomings of existing methods. We then summarize our main results on the welfare consequences of competition. We conclude with an illustration of how our methods can be used to assess the welfare implications of specific hospital mergers, and with some implications of our findings for antitrust policy.

The effect of bivalirudin on costs and outcomes of treatment of ST-segment elevation myocardial infarction

BACKGROUND Bivalirudin is commonly used during percutaneous coronary intervention (PCI) rather than unfractionated heparin. The higher cost of bivalirudin may be offset if it reduces costly bleeding complications and/or length of stay. We sought to assess the effect of using bivalirudin on the costs of care among patients with ST-segment elevation myocardial infarction (STEMI) undergoing PCI. METHODS We analyzed data from 64,872 patients treated in 1 of 278 hospitals. The effect of overall hospital use of bivalirudin on clinical and economic outcomes was assessed using multivariable regression, based on average hospital use of treatments. RESULTS The use of bivalirudin among patients with STEMI treated with PCI varied widely across hospitals, with a median of 6.9% (interquartile range 2.3%-18.6%). After controlling for patient and hospital characteristics, use of bivalirudin rather than heparin and a glycoprotein IIb/IIIa inhibitor reduced bleeding (odds ratio 0.47, P < .001), length of stay (-0.47 days, P < .03), and hospital costs (-14%, P < .04). CONCLUSIONS Use of bivalirudin among patients with STEMI treated with PCI appears to reduce bleeding and overall costs.

Who Supports Health Reform

In this article, we report results from a new study that surveyed a large, national sample of American adults about their willingness to pay for health reform. As in previous work, we find that self-identified Republicans, older Americans, and high-income Americans are less supportive of reform. However, these basic findings mask three important features of public opinion. First, income has a substantial effect on support for reform, even holding political affiliation constant. Indeed, income is the most important determinant of support for reform. Second, the negative effects of income on support for reform begin early in the income distribution, at annual family income levels of

Chapter 5 Empirical Study of the Civil Justice System

25,000 to

Why is health reform so difficult

50,000. Third, although older Americans have a less favorable view of reform than the young, much of their opposition is due to dislike of large policy changes than to reform per se.