Robert J. Town

Are All the Good Men Married? Uncovering the Sources of the Marital Wage Premium

A longstanding and yet unsettled question in labor economics is: does marriage cause mens wages to rise? Cross-sectional wage studies consistently find that married men earn significantly higher wages than do men who are not currently married. However, it is well-known that inferring causal relationships from crosssectional analysis is inappropriate because of the biases introduced by unobserved heterogeneity. As a means of circumventing this problem, this paper uses data on identical twins to control for unobserved heterogeneity. Our estimates suggest that marriage increases mens wages by as much as 27%, and that little, if any, of the cross-sectional relationship between marriage and wages is due to selection. In addition, we find little evidence that the marital-wage premium is a consequence of household specialization.

National health care costs of peripheral arterial disease in the Medicare population

Abstract Lower extremity peripheral arterial disease (PAD) is prevalent in the Medicare population and is associated with high rates of myocardial infarction, stroke, amputation, and death. Nevertheless, national health expenditures for PAD are not known. We hypothesized that PAD-related costs are high, increase with age, and that treatment rates would be less than known PAD prevalence. The objective was to determine national health care expenditures for PAD in the United States. PAD-related treatment costs were calculated in the elderly, non-disabled Medicare population. The cost analysis relied on the 5% control population for the linked SEER-Medicare data and Medicare claims for the calendar year 2001, identifying PAD cases based on diagnosis and procedure codes. Costs were aggregated separately for inpatient and outpatient treatment and estimates adjusted to reflect the Medicare population. A total of

Hospital competition in HMO networks

4.37 billion was spent on PAD-related treatment and 88% of expenditures were for inpatient care. Medicare program outlays totaled

Estimating the Quality of Care in Hospitals Using Instrumental Variables

3.87 billion, while enrollees (or their supplemental insurance) spent the remaining

The Welfare Impact of Medicare HMOs

500 million. In total, 6.8% of the elderly Medicare population received treatment for PAD. Treatment increased with age at rates of 4.5%, 7.5%, and 11.8% for individuals aged 65–74, 75–84, and >85 years, respectively. PAD-related costs accounted for approximately 13% of all Medicare Part A and B expenditures for the PAD-treated cohort, and 2.3% of total Medicare Part A and B expenditures. In conclusion, US national PAD-related costs are high, associated with inpatient care, and increase with age. PAD is treated at rates lower than the known PAD prevalence as only approximately one-third of the population with known PAD had detectable PAD-related health care costs in our analysis. The potential impact of earlier PAD detection and use of outpatient preventive strategies on total national PAD health care costs is unknown.

The Effects of Race and Worker Productivity on Performance Evaluations

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 hospitals 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.

Assessing the Influence of Incentives on Physicians and Medical Groups

Mortality rates are a widely used measure of hospital quality. A central problem with this measure is selection bias: simply put, severely ill patients may choose high quality hospitals. We control for severity of illness with an instrumental variables (IV) framework using geographic location data. We use IV to examine the quality of pneumonia care in Southern California from 1989 to 1994. We find that the IV quality estimates are markedly different from traditional GLS estimates, and that IV reveals different determinants of quality. Econometric tests suggest that the IV model is appropriately specified, that the GLS model is inconsistent.

Managed care and medical expenditures of Medicare beneficiaries

We estimate the welfare associated with the Medicare HMO program, now known as Medicare+Choice (M+C). We find that the creation of the M+C program resulted in approximately

Outcomes after open versus laparoscopic gastric bypass.

15.6 billion in consumer surplus and

Regionalization versus competition in complex cancer surgery

52 billion in profits from 1993 to 2000 (in 2000 dollars). This program most likely generated significant net social welfare. However, we find that consumer surplus is geographically unevenly distributed. Prescription drug coverage accounts for approximately 45% of the estimated consumer surplus for 2000. Consumer surplus increases in the number of plans in a county, and most of the increase in welfare is due to increased premium competition.