Nicole Nestoriak

Changing mix of medical care services: Stylized facts and implications for price indexes

The utilization of health care services has undergone several important shifts in recent years that have implications for the cost of medical care. We empirically document the presence of these shifts for a broad list of medical conditions and assess the implications for price indexes. Following the earlier literature, we compare the growth of two price measures: one that tracks expenditures for the services actually provided to treat conditions and another that holds the mix of those services fixed over time. Using retrospective claims data for a sample of commercially insured patients, we find that, on average, expenditures to treat diseases rose 11% from 2003Q1 to 2005Q4 and would have risen even faster, 18%, had the mix of services remained fixed at the 2003Q1 levels. This suggests that fixed-basket price indexes, as are used in the official statistics, could overstate true price growth significantly.

Product Market Competition and Human Resource Practices: An Analysis of the Retail Food Sector

The rise of super-centers and the entry of Wal-Mart into food retailing have dramatically altered the competitive environment in the industry. This paper explores the impact of such changes on the labor market practices of traditional food retailers. We use longitudinal data on workers and firms to construct new measures of compensation and employment, and examine how these measures evolve within and across firms in response to changes in product market structure. An additional feature of the analysis is to combine rich case study knowledge about the retail food industry with the new matched employer-employee data from the Census Bureau.

Policy makers will need a way to update bundled payments that reflects highly skewed spending growth of various care episodes.

Bundled payment entails paying a single price for all services delivered as part of an episode of care for a specific condition. It is seen as a promising way to slow the growth of health care spending while maintaining or improving the quality of care. To implement bundled payment, policy makers must set base payment rates for episodes of care and update the rates over time to reflect changes in the costs of delivering care and the components of care. Adopting the fee-for-service paradigm of adjusting payments with uniform update rates would be fair and accurate if costs increased at a uniform rate across episodes. But our analysis of 2003 and 2007 US commercial claims data showed spending growth to be highly skewed across episodes: 10 percent of episodes accounted for 82.5 percent of spending growth, and within-episode spending growth ranged from a decline of 75 percent to an increase of 323 percent. Given that spending growth was much faster for some episodes than for others, a situation known as skewness, policy makers should not update episode payments using uniform update rates. Rather, they should explore ways to address variations in spending growth, such as updating episode payments one by one, at least at the outset.

Product Market Competition and Human Resource Practices in the Retail Food Sector

In the wake of Wal-Mart and other mass merchandisers’ entry into food retailing, the nature of competition in the industry has changed radically. Using longitudinal data on workers and firms to construct measures of compensation and churning for traditional food retailers, this paper examines how these measures change in response to mass merchandiser entry. While there is considerable heterogeneity across retail food establishments, human resource practices are persistent even in the face of new external competition.

How Do Employees Fare in Private Equity Buyouts? Evidence from Workplace Safety Records

This paper presents evidence that workplace injury rates decline substantially after private equity buyouts. The decline holds for buyouts of public firms but not private firms, and is greater for public firms likely facing more pressure pre-buyout to deliver short-term performance, suggesting that alleviating pressure on managers to make short-sighted decisions can improve workplace safety. There is some evidence that high levels of buyout debt lessen the decline in injury rate. Finally, employment after buyouts declines more at relatively safe establishments, though this effect is small relative to the injury rate decline within establishments.

Private Equity Buyouts and Workplace Safety

This paper presents evidence that workplace injury rates decline substantially after private equity buyouts. The decline holds for buyouts of public firms but not private firms, and is greater for public firms likely facing more pressure pre-buyout to deliver short-term performance, suggesting that alleviating pressure on managers to make short-sighted decisions can improve workplace safety. There is some evidence that high levels of buyout debt lessen the decline in injury rate. Finally, employment after buyouts declines more at relatively safe establishments, though this effect is small relative to the injury rate decline within establishments.

How Do Employees Fare in Leveraged Buyouts? Evidence from Workplace Safety Records

This paper presents evidence that workplace injury rates decline substantially after private equity buyouts. The decline holds for buyouts of public firms but not private firms, and is greater for public firms likely facing more pressure pre-buyout to deliver short-term performance, suggesting that alleviating pressure on managers to make short-sighted decisions can improve workplace safety. There is some evidence that high levels of buyout debt lessen the decline in injury rate. Finally, employment after buyouts declines more at relatively safe establishments, though this effect is small relative to the injury rate decline within establishments.