Debra Sabatini Dwyer

Estimating Peer Effects in Sexual Behavior among Adolescents.

In this paper we seek to empirically quantify the role of peer social networks in influencing sexual behavior among adolescents. Using data of a nationally representative sample of adolescents we utilize a multivariate structural model with school-level fixed effects to account for the problems of contextual effects, correlated effects and peer selections to purge the potential biases from the estimates of peer influence. Our peer group measures are drawn not only from the nomination of close friends, but also from classmates. Controlling for parent level characteristics, and other demographic parameters, we find that a 10% increase in the proportion of close friends who initiates sex increases the probability that an individual chooses to initiate sex by 5% and a 10% increase in number of sexual partners among close friends increases an individuals sexual partner by 5%. The influence of classmates however, diminishes in magnitude after accounting for unobserved environmental confounders.

Expectations in Micro Data: Rationality Revisited

An increasing number of longitudinal data sets collect expectations information regarding a variety of future individual level events and decisions, providing researchers with the opportunity to explore expectations over micro variables in detail. We present a theoretical framework and an econometric methodology to use that type of information to test the Rational Expectations (RE) hypothesis in models of individual behavior. This RE assumption at the micro level underlies a majority of the research in applied fields in economics, and it is the common foundation of most work in dynamic models of individual behavior. We present tests of three different types of expectations using two different panel data sets that represent two very different populations. In all three cases we cannot reject the RE hypothesis. Our results support a wide variety of models in economics, and other disciplines, that assume rational behavior.

Adolescent propensity to engage in health risky behaviors: the role of individual resilience.

In this paper we create indices of resilience to identify adolescents at risk of smoking, drinking alcohol, and using illegal drugs. Using data from the National Longitudinal Study of Adolescent Health, three manifestations of resilience were identified: overall-resilience, self/family-resilience, and self-resilience. Our analysis reveals that the overall-resilient were less likely to engage in risky behaviors. The self/family resilient were more likely to engage in risky behaviors, but consumed less. The self-resilient had reduced risk for smoking and drinking alcohol but elevated risk for using illegal drugs and being in an addictive stage of smoking and drinking, if participating.

Expectation formation of older married couples and the rational expectations hypothesis

This paper tests the Rational Expectations (RE) hypothesis regarding retirement expectations of married older American couples, controlling for sample selection and reporting biases. In prior research we found that individual retirement expectation formation was consistent with the Rational Expectation hypothesis, but in that work spousal considerations were not analyzed. In this research we take advantage of panel data on expectations to test the RE hypothesis among married individuals as well as joint expectations among couples. We find that regardless of whether we assume that married individuals form their own expectations taking spouse’s information as exogenous, or the reports of the couple are the result of a joint expectation formation process, their expectations are consistent with the RE hypothesis. Our results support a wide variety of models in economics that assume rational behavior for married couples.

What to Expect when you are Expecting Rationality: Testing Rational Expectations using Micro Data

This paper tests the Rational Expectations (RE) hypothesis regarding retirement expectations, controlling for sample selection, reporting biases, and unobserved heterogeneity. We find that retirement expectations in the Health and Retirement Study (HRS) are consistent with the RE hypothesis. We also examine how a wide array of factors, such as wealth, income, health insurance, pensions, and health status influence retirement expectations formation using panel data from all available waves of the HRS. We further analyze how new information affects the evolution of retirement expectations and discover that, on average, individuals correctly anticipate most uncertain events when planning their retirement, except for some health conditions and economic factors. Our results have important implications for a wide variety of models in economics that assume rational behavior.

A Dynamic Model of Retirement and Social Security Reform Expectations: A Solution to the New Early Retirement Puzzle

The need for Social Security Reform in the next years is hardly a matter of debate. Therefore, the widespread believe among Americans that Social Security will not be able to pay benefits in the long run at the level that was anticipated, does not come as a surprise. The government acknowledges the situation, and predicts that substantial benefits cuts will be necessary, yet no legislation has been passed to tackle the problem. Researchers, however, have rarely modeled the uncertainty over Social Security reform and benefit levels, and how they affect claiming behavior and retirement. The purpose of this paper is to assess the extent to which these perceptions of future cuts might explain the puzzle of earlier take-up despite bigger penalties to doing so in the presence of increasing longevity. By introducing a small amount of uncertainty (based on self-reported responses to questions regarding expectations over future cuts) of a relatively small cut (compared with what the government reports as necessary to solve the crisis) in a dynamic life-cycle model of retirement, we are able to match the claiming behavior observed in the data, without relying on heterogeneous preferences. Our results support the hypothesis that expectations over future benefits are affecting current behavior. We find that a mis-specified dynamic retirement model would erroneously predict that an increase in the NRA would delay claiming behavior and increase labor supply at older ages. Once the appropriate earnings test incentives are modeled, and we account for the probability of reforms to the system, an increase in the NRA has little effect on claiming behavior, and it can even increase the proportion of individuals claiming before the NRA.

Does patient trust promote better care

Information asymmetries favouring the supplier in the production of good health have long been acknowledged as an anomaly in medical markets creating the potential for inefficiency. Such asymmetries may undermine the physician/patient relationship. And given these asymmetries, patient trust may play an important role in successful physician/patient relationships. This agency relationship has been studied for many years in the context of Fee-for-Service (FFS) reimbursement. But the market has changed considerably given the combination of an influx of information and the penetration of managed care - both of which have shifted some decision-making power away from the physician. An additional important factor in the physician/agency relationship that is also changing is patient trust. Where patient trust was implicit in the system with predicted positive effects on health outcomes when FFS was the norm, now trust itself is not a given, and its effect on the doctor–patient relationship may be evolving. We study how trust impacts patients’ perceptions about quality of care, and whether these relationships differ by health insurance type. We find that Health Maintenance Organization (HMO) patients have significantly lower trust in their primary care physicians than those with more traditional coverage. Using a multi-dimensional index of patients’ perceptions about the quality of care they receive from their physicians, we also find that trust has no significant effect on perceived quality for non-HMO patients, but significantly improves perceived outcomes for HMO patients. We conclude that trusting patients are more likely to have a better doctor-patient relationship than those who are skeptical in the HMO setting. Perhaps given lack of provider choice, it requires a level of trust in general to be compliant and satisfied with assigned physicians. In the non-HMO setting where consumers are now armed with more information and free to make choices, trust becomes less important. These results have implications for how decisions are made in the market for health services we face today and ultimately for public health policy.

Is HIT a hit? The impact of health information technology on inpatient hospital outcomes

ABSTRACT In an effort to eliminate inefficiencies in the US health care sector, policymakers have made a concerted effort to encourage hospitals and physicians to adopt health information technology (HIT) systems. Using a unique data set on HIT adoption and health outcomes in New York State, we conduct a hospital-level analysis identifying the impact of adopting HIT on inpatient outcomes (rates of adverse drug events and severity-adjusted mortality). Unlike previous studies, the patient population is not restricted to Medicare patients, but covers all ages and insurance types. After controlling for unobserved hospital quality and endogenous HIT adoption, our results suggest that a hospital’s severity-adjusted mortality decreases by 0.3 percentage points. When restricted to the Medicare patients, we find HIT adoption lowers a hospital’s severity-adjusted mortality rate by 0.5 percentage points. We find HIT to have no significant effect on the rate of ADEs.

Power and Illness: The Failure and Future of American Health Policy.

During most of this century, American health policy has emphasized caring for acute conditions rather than preventing and managing chronic illness - even though chronic illness has caused most sickness and death since the 1920s. In this provocative and wide-ranging book, Daniel Fox explains why this has been so and offers a forceful argument for fundamental change in national health care priorities. Fox discusses how ideas about illness and health care, as well as the power of special interest groups, have shaped the ways in which Americans have treated illness. Those who make health policy decisions have increased support for hospitals, physicians, and medical research, believing that people then would become healthier. This position, implemented at considerable cost, has not adequately taken into account the growing burden of chronic disabling illness. While decision makers may have defined chronic disease as a high priority in research, they have not given it such a priority in the financing of health services. The increasing burden of chronic illness is critical. Fox suggests ways to solve this problem without increasing the already high cost of health care - but he does not underestimate the difficulties in such a strategy. Advocating the redistribution of resources within hospital and medical services, he targets those that are redundant or marginally effective. There could be no more timely subject today than American health care. And Daniel Fox is uniquely able to address its problems. A historian of medicine, with knowledge of how hospitals and physicians behave and how health policy is made at government levels, he has extensively researched published and unpublished documents on health care. What he proposes could profoundly affect all Americans.

Book Review: Income and Social Security and Substandard Working Conditions: Negotiating Health Insurance in the Workplace: A Basic GuideNegotiating Health Insurance in the Workplace: A Basic Guide. By TaylorSuzanne S., Washington, D.C.: BNA Books, 1992. 335 pp. ISBN 0-97179-731-3.

Bradley Googins places this analysis of work and family conflicts within the framework offamily, government, and corporate responses and responsibilities. His primary premise is that our societys unwillingness to respond to the pressures felt by working families has resulted in a de facto assignment of responsibilities tofamilies. He argues that the slow and limited response of corporations and government has potential negative consequences not only for families, but also for the overall economic vitality of the United States. Googinss book provides a comprehensive overview of work/family conflicts. He first reviews the dimensions of work/family relations and then turns to a brief synopsis of the history of these relations in the United States. Googins and his colleagues were among the first researchers in the United States to undertake large-scale work and family surveys in major corporations. The findings from these studies are a major focal point of the book. He also deals separately with issues uch as child care, elder care, social conflicts, and societal response to these problems. Each chapter is written to be able to stand on its own. This feature of the book has obvious advantages, but it also carries the disadvantage of producing some repetition. The book is most appropriate for those who are unfamiliarwith t e broad dimensions of work/family ssues. Googinss tyle varies in the different chapters, as does the depth with which he treats each topic. For example, his treatment of the level of conflict and resistance to family policy that is generated within the three sectors (family, government, and corporation) is uneven. He devotes more space and energy to analyzing the impediments to enacting policy that are generated within and among families than to examining the impediments generated by corporations and government. The strength of his presentations and arguments, as well as their suitability for different audiences, thus vary by issue. Although more research and analysis are needed concerning the source of business resistance to work and family policy, Googinss book provides a solid contribution to the rapidly developing research base on work/family conflicts and policy.