William F. Ford

Implementing electronic lab order entry management in hospitals: Incremental strategies lead to better productivity outcomes

This paper evaluates the impact of varying implementation of electronic lab order entry management (eLAB) system strategies on hospitals’ productivity in the short run. Using the American Hospital Associations Annual Surveys for 2005–2008, we developed hospital productivity measures to assess facilities’ relative performances upon implementing eLAB systems. The results indicate that different eLAB system implementation strategies were systematically related to changes in hospitals’ relative productivity levels over the years studied. Hospitals that partially implemented an eLAB system without completing the roll-out experienced negative impacts on productivity. The greatest loss in short-term productivity was experienced by facilities that moved from having no eLAB system to a complete implantation in one year—a strategy called the “Big Bang”. The hybrid approach of a limited introduction in one period followed by complete roll-out in the next year was the only eLAB system implementation strategy associated with significant productivity gains. Our findings support a very specific strategy for eLAB system implementation where facilities began with a one-year pilot program immediately followed by an organization-wide implementation effort in the next period.

The Unemployment Effects of Proposed Changes in Social Security's “Normal Retirement Age”

This paper identifies and analyzes an inherent conflict between some proposed U. S. Social Security reform measures, which would encourage delayed retirement decisions, and the objective of minimizing the economys unemployment rate. Using recent demographic trends in the age composition of the U.S. labor force, the study suggests that such proposed U.S. Social Security reform measures may actually increase the economys unemployment rate. It concludes that measures to encourage older workers would relieve labor market pressures (while also helping the Social Security system) if and only if unemployment was persistently near the non-accelerating inflation rate of unemployment (NAIRU). However, in an economy with above NAIRU unemployment, which has been the case most often in recent years, the opposite Social Security policy logic would apply.

Realizing the Value Proposition: A Longitudinal Assessment of Hospitals’ Total Factor Productivity

U. S. hospitals are under continual pressure both to increase productivity and to improve quality through the use of Health Information Technology. This paper analyzes 3,187 US hospitals, using data reported to the American Hospital Association, to assess changes in productivity over a five-year period (2002-2006). The Malmquist Indices derived indicate that Total Factor Productivity (TFP) and Efficiency Change (EFFCH) both increased during that timeframe. The low Technological Change (TC) index indicates that improvements to organizational processes did not contribute substantially to productivity. A secondary analysis examined the use of Computerized Physician Order Entry (CPOE) in relationship to the three indices. TFP trended positively for those hospitals further into the CPOE implementation process.

Has a quarter-trillion-dollar settlement helped the tobacco industry?

This paper builds on a growing body of literature analyzing the economic effects of the so-called Master Settlement Agreement (MSA) between the “big four” tobacco companies and the State Attorneys General. Because the marginal cost imposed by the settlement is a function of the market sales of the original four participants, subsequent participating firms will most likely be at a disadvantage. Consistent with increased market power for the original signers, the data since the settlement show increased price overshifting of taxes. Additionally, price undershifting is shown to have occurred prior to the MSA, which would be a rational response of a firm facing a settlement that imposes marginal costs inversely related to sales volume at the time of the agreement. These results suggest that efficiency evaluations may overstate the social benefits of the agreement and the persistent profitability of the industry may be due to the MSA.