Fred Goldman

An assessment of the benefits of air pollution control: The case of infant health☆☆☆

This paper contains estimates of the impacts of air pollutants on race-specific neonatal mortality rates based on data for heavily populated counties of the U.S. in 1977. Unlike previous research in this area, these estimates are obtained from awell specified behavioral model of the production of health, which is estimated with the appropriate simultaneous equations techniques. The results suggest that sulfur dioxide is the dominant air pollutant in newborn survival outcomes. There is also evidence that an increase in sulfur dioxide raises the neonatal mortality rate by raising the percentage of low-birth weight births. Based on marginal-willingness-to-pay computations, we estimate that the benefits of a 10 percent reduction insulfur dioxide levels range between

Determinants of Interest Rates on Tax-Exempt Hospital Bonds

54 million and

Health Care Capital Financing Agencies: The Intergovernmental Roles of Quasi-Government Authorities and the Impact on the Cost of Capital

1.09 billion in 1977 dollars.

The Impact of Public Health Policy: The Case of Community Health Centers

The aim of this paper is to examine the determinants of interest rates on tax-exempt hospital bonds. The results highlight the potential and actual roles of Federal and state policy in the determination of these rates. The shift to a Prospective Payment System under Medicare has subsidized the borrowing costs of some hospitals at the expense of others. The selection of underwriters by negotiation rather than by competitive bidding results in higher interest rates. The Federal tax act of 1986 raised the cost of hospital debt by encouraging bond issues to contain call features.

The Production and Cost of Ambulatory Medical Care in Community Health Centers

During the decade 1983-1992, approximately 1.4 trillion dollars of municipal bonds were sold in 87 thousand separate issues, primarily to finance capital projects for education, electric power, transportation, health care, housing and other public and private purpose activities. Approximately two-thirds of these financings were originated by financing authorities, quasi-government agencies which are the creation of state legislatures. Despite the growing role played by quasi-public authorities in capital finance, their impacts have not been studied systematically. We first describe the issuers of tax-exempt debt in the health sector and then derive measures for describing the mix of issuers between state and local levels, and between both government and quasi-government sectors. We present abbreviated test results of the impact that different mixes have on the cost of capital. First, competition is good: using a Herfindahl index analysis we show that states with less concentrated issuers have a lower cost of capital than those with a more concentrated market, including state-level finance monopolies. On the other hand, we cannot assert unequivocally that market deconcentration in and of itself should be a goal. For instance, there are economies of scale in the health care finance industry that allow larger (often state-level) issuers to lower the cost of capital.