We estimate the education and earnings returns to enrolling in technical 2‐year degree programs at community colleges in Missouri. A unique feature of the Missouri context is the presence of a highly regarded, nationally ranked technical college: State Technical College of Missouri (State Tech). We find that enrolling in a technical program in Missouri increases the likelihood of associate degree attainment and post‐enrollment earnings, but that the positive effects statewide are driven largely by students who attend State Tech. These findings demonstrate the potential for a high‐performing community college to change students' education and labor market trajectories. At the same time, they exemplify the potential for substantial institutional heterogeneity in the returns to postsecondary education.
我们估算了密苏里州社区学院两年制技术学位课程的教育和收入回报。密苏里州的一个独特之处在于，该州有一所在全国排名靠前、备受推崇的技术学院，即密苏里州立技术学院（State Technical College of Missouri）：密苏里州立技术学院（State Tech）。我们发现，在密苏里州就读技术专业会增加获得副学士学位的可能性和入学后的收入，但在全州范围内产生积极影响的主要是就读于州立技术学院的学生。这些研究结果表明，表现出色的社区学院有可能改变学生的教育和劳动力市场轨迹。与此同时，这些研究还证明了中学后教育的回报可能存在巨大的机构异质性。
{"title":"Institutional heterogeneity in the education and earnings returns to postsecondary technical education: Evidence from Missouri","authors":"Maxwell J. Cook, Cory Koedel, Michael Reda","doi":"10.1002/soej.12711","DOIUrl":"https://doi.org/10.1002/soej.12711","url":null,"abstract":"We estimate the education and earnings returns to enrolling in technical 2‐year degree programs at community colleges in Missouri. A unique feature of the Missouri context is the presence of a highly regarded, nationally ranked technical college: State Technical College of Missouri (State Tech). We find that enrolling in a technical program in Missouri increases the likelihood of associate degree attainment and post‐enrollment earnings, but that the positive effects statewide are driven largely by students who attend State Tech. These findings demonstrate the potential for a high‐performing community college to change students' education and labor market trajectories. At the same time, they exemplify the potential for substantial institutional heterogeneity in the returns to postsecondary education.","PeriodicalId":47946,"journal":{"name":"Southern Economic Journal","volume":"25 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141167463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Substance use disorders are a prevalent and growing problem across the United States, especially for households that rely on publicly funded healthcare insurance plans. State Certificate‐of‐Need (CON) laws for substance use disorder (SUD) treatment facilities can worsen outcomes for these patients by restricting the supply of facilities and beds, leading to spillovers into the general hospital system. We present a choice theory for treatment facility patient admission and model the outcome as a function of the patient's insurance type. We then combine two datasets on state CON laws for SUD treatment facilities with Medicaid patient data from 2017 to 2020 to test the model using a three‐stage least squares design and provide some of the first evidence on Medicaid patient outcomes under CON laws for SUD treatment facilities. We find significant evidence that state CON laws for SUD treatment facilities are associated with higher rates of hospital bed utilization, increases in the number of infants born with Neonatal Abstinence Syndrome, and higher rates of emergency department visits. Our findings are robust to several specification tests, including a model of conditional mixed method endogeneity and incorporating timing of the Affordable Care Act.
在美国，药物使用障碍是一个普遍存在且日益严重的问题，尤其是对于依赖公共医疗保险计划的家庭而言。各州针对药物使用障碍（SUD）治疗机构的需求证明（CON）法律会限制治疗机构和床位的供应，从而恶化这些患者的治疗效果，导致外溢效应进入综合医院系统。我们提出了治疗机构收治病人的选择理论，并将结果模拟为病人保险类型的函数。然后，我们将有关各州针对药物滥用治疗设施的 CON 法律的两个数据集与 2017 年至 2020 年的医疗补助患者数据相结合，使用三阶段最小二乘法设计对模型进行了检验，并提供了有关药物滥用治疗设施 CON 法律下医疗补助患者治疗结果的一些首创证据。我们发现，有重要证据表明，各州针对药物滥用治疗机构的 CON 法律与较高的医院床位使用率、新生儿酗酒综合征婴儿出生数量的增加以及较高的急诊就诊率有关。我们的研究结果经受住了多种规格检验，包括条件混合法内生性模型和《平价医疗法案》时间的检验。
{"title":"The effect of Certificate‐of‐Need laws on substance use disorder care for vulnerable populations","authors":"Alicia Plemmons, Darwyyn Deyo, Sarah Drain","doi":"10.1002/soej.12696","DOIUrl":"https://doi.org/10.1002/soej.12696","url":null,"abstract":"Substance use disorders are a prevalent and growing problem across the United States, especially for households that rely on publicly funded healthcare insurance plans. State Certificate‐of‐Need (CON) laws for substance use disorder (SUD) treatment facilities can worsen outcomes for these patients by restricting the supply of facilities and beds, leading to spillovers into the general hospital system. We present a choice theory for treatment facility patient admission and model the outcome as a function of the patient's insurance type. We then combine two datasets on state CON laws for SUD treatment facilities with Medicaid patient data from 2017 to 2020 to test the model using a three‐stage least squares design and provide some of the first evidence on Medicaid patient outcomes under CON laws for SUD treatment facilities. We find significant evidence that state CON laws for SUD treatment facilities are associated with higher rates of hospital bed utilization, increases in the number of infants born with Neonatal Abstinence Syndrome, and higher rates of emergency department visits. Our findings are robust to several specification tests, including a model of conditional mixed method endogeneity and incorporating timing of the Affordable Care Act.","PeriodicalId":47946,"journal":{"name":"Southern Economic Journal","volume":"43 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140935481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Certificate‐of‐Need (CON) laws limit the supply of healthcare services in about two‐thirds of U.S. states. The regulations require those who wish to open or expand their facilities to first prove that their services are needed. Once encouraged by the federal government, Congress eliminated the inducement in the 1980s and since then several states have either pared their CON programs back or eliminated them altogether. To date, there have been 128 academic assessments of CON laws and together these papers contain over 450 tests. In this paper, I review this literature, organizing the results around the most common rationales for CON laws. The accumulated evidence is overwhelming that CON laws do not achieve their purpose. Instead, the balance of evidence suggests that these regulations increase spending, reduce access to care, undermine quality, and fail to ensure care for underserved populations.
在美国约三分之二的州，需求证明（CON）法限制了医疗服务的供应。这些法规要求那些希望开设或扩大其设施的人首先证明其服务是必需的。联邦政府曾一度鼓励这种做法，但美国国会在 20 世纪 80 年代取消了这一鼓励措施，此后，一些州要么缩减了 CON 计划，要么将其完全取消。迄今为止，学术界已对 CON 法律进行了 128 次评估，这些论文共包含 450 多项测试。在本文中，我回顾了这些文献，并围绕 CON 法律最常见的理由对结果进行了整理。积累的大量证据表明，CON 法并未实现其目的。相反，大量证据表明，这些法规增加了开支，减少了医疗服务的可及性，损害了医疗质量，并且无法确保为得不到充分服务的人群提供医疗服务。
{"title":"Certificate‐of‐Need laws in healthcare: A comprehensive review of the literature","authors":"Matthew D. Mitchell","doi":"10.1002/soej.12698","DOIUrl":"https://doi.org/10.1002/soej.12698","url":null,"abstract":"Certificate‐of‐Need (CON) laws limit the supply of healthcare services in about two‐thirds of U.S. states. The regulations require those who wish to open or expand their facilities to first prove that their services are needed. Once encouraged by the federal government, Congress eliminated the inducement in the 1980s and since then several states have either pared their CON programs back or eliminated them altogether. To date, there have been 128 academic assessments of CON laws and together these papers contain over 450 tests. In this paper, I review this literature, organizing the results around the most common rationales for CON laws. The accumulated evidence is overwhelming that CON laws do not achieve their purpose. Instead, the balance of evidence suggests that these regulations increase spending, reduce access to care, undermine quality, and fail to ensure care for underserved populations.","PeriodicalId":47946,"journal":{"name":"Southern Economic Journal","volume":"66 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140935483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Scholars who study political corruption typically assume that it is a pathology. This assumption gives rise to certain problems. On the one hand, scholars who conceive corruption as a principal‐agent problem yield anti‐corruption policies with disappointing results. On the other hand, political economists who grasp the functionality of corruption within inefficient institutions are torn between embracing the functionality of corrupt actions and eradicating them. These issues result from the assumption that corruption is a pathology. Philosophy operates at the level of assumptions, offering a potential avenue for addressing these issues. This paper puts forward a non‐ideal theory of corruption, in which partial compliance with the law is not always seen as a pathology; sometimes corruption includes information about the quality of the law. A non‐ideal theory of corruption puts forward the idea that some cases of corruption result from defective laws rather than defective people.
{"title":"What philosophy can teach political economy about corruption: A non‐ideal theory","authors":"Mario I. Juarez‐Garcia","doi":"10.1002/soej.12692","DOIUrl":"https://doi.org/10.1002/soej.12692","url":null,"abstract":"Scholars who study political corruption typically assume that it is a pathology. This assumption gives rise to certain problems. On the one hand, scholars who conceive corruption as a principal‐agent problem yield anti‐corruption policies with disappointing results. On the other hand, political economists who grasp the functionality of corruption within inefficient institutions are torn between embracing the functionality of corrupt actions and eradicating them. These issues result from the assumption that corruption is a pathology. Philosophy operates at the level of assumptions, offering a potential avenue for addressing these issues. This paper puts forward a non‐ideal theory of corruption, in which partial compliance with the law is not always seen as a pathology; sometimes corruption includes information about the quality of the law. A non‐ideal theory of corruption puts forward the idea that some cases of corruption result from defective laws rather than defective people.","PeriodicalId":47946,"journal":{"name":"Southern Economic Journal","volume":"17 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140615368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vitor Melo, Liam Sigaud, Elijah Neilson, Markus Bjoerkheim
Certificate‐of‐Need (CON) laws require that healthcare providers receive approval from a state board before offering additional services in a given community. Proponents of CON laws claim that these laws are needed to prevent the oversupply of healthcare services in urban areas and to increase access in rural areas, which are predominantly underserved. Yet, the policy could lower rural access if used by incumbents to limit entry from competitors. We explore the repeal of these regulations in five U.S. states to offer the first estimate of the causal effects of CON laws on rural and urban healthcare access. We find that repealing CON laws causes a substantial increase in hospitals in both rural and urban areas. We also find that the repeal leads to fewer beds and smaller hospitals on average, suggesting an increase in entry and competition in both rural and urban areas.
需求证明（CON）法要求医疗服务提供者在特定社区提供额外服务前必须获得州委员会的批准。需求证明法的支持者声称，需要通过这些法律来防止城市地区医疗服务供过于求，并增加农村地区的就医机会，因为农村地区的医疗服务主要不足。然而，如果在位者利用该政策来限制竞争者的进入，则可能会降低农村地区的医疗服务可及性。我们探讨了美国五个州废除这些法规的情况，首次估算了 CON 法律对农村和城市医疗服务获取的因果效应。我们发现，废除 CON 法会导致农村和城市地区的医院数量大幅增加。我们还发现，废除该法会导致床位减少，医院规模平均变小，这表明农村和城市地区的医院进入和竞争都会增加。
{"title":"Rural healthcare access and supply constraints: A causal analysis","authors":"Vitor Melo, Liam Sigaud, Elijah Neilson, Markus Bjoerkheim","doi":"10.1002/soej.12686","DOIUrl":"https://doi.org/10.1002/soej.12686","url":null,"abstract":"Certificate‐of‐Need (CON) laws require that healthcare providers receive approval from a state board before offering additional services in a given community. Proponents of CON laws claim that these laws are needed to prevent the oversupply of healthcare services in urban areas and to increase access in rural areas, which are predominantly underserved. Yet, the policy could lower rural access if used by incumbents to limit entry from competitors. We explore the repeal of these regulations in five U.S. states to offer the first estimate of the causal effects of CON laws on rural and urban healthcare access. We find that repealing CON laws causes a substantial increase in hospitals in both rural and urban areas. We also find that the repeal leads to fewer beds and smaller hospitals on average, suggesting an increase in entry and competition in both rural and urban areas.","PeriodicalId":47946,"journal":{"name":"Southern Economic Journal","volume":"4 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140572298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We investigate how substance use Certificate‐of‐Need (CON) laws influence access to substance use disorder treatment facilities in the United States. We use the National Directory of Drug and Alcohol Abuse Treatment Facilities data set, which lists all federal, state, and local government facilities and private facilities that provide substance use treatment services in 2020. Based on the locations of these facilities, we develop a novel access index to substance use disorder treatment facilities that accounts for driving distance and duration to measure the ease of reaching these facilities for individuals living at the population‐weighted county centroids. We find that counties in states with CON laws that border counties without such laws have nearly 10% less spatial accessibility to substance use disorder treatment facilities at a 5% level of significance.
我们调查了药物使用需求证明（CON）法律如何影响美国药物使用障碍治疗机构的使用。我们使用了《全国药物和酒精滥用治疗设施目录》数据集，该数据集列出了 2020 年提供药物使用治疗服务的所有联邦、州和地方政府设施以及私人设施。根据这些设施的位置，我们开发了一种新型的药物使用障碍治疗设施访问指数，该指数考虑了驾驶距离和持续时间，以衡量居住在人口加权县中心的个人到达这些设施的难易程度。我们发现，在 5%的显著性水平下，在有 CON 法律的州与没有此类法律的州接壤的县，药物使用障碍治疗设施的空间可达性要低近 10%。
{"title":"The effect of substance use Certificate‐of‐Need laws on access to substance use disorder treatment facilities","authors":"Shishir Shakya, Christine Bretschneider‐Fries","doi":"10.1002/soej.12689","DOIUrl":"https://doi.org/10.1002/soej.12689","url":null,"abstract":"We investigate how substance use Certificate‐of‐Need (CON) laws influence access to substance use disorder treatment facilities in the United States. We use the National Directory of Drug and Alcohol Abuse Treatment Facilities data set, which lists all federal, state, and local government facilities and private facilities that provide substance use treatment services in 2020. Based on the locations of these facilities, we develop a novel access index to substance use disorder treatment facilities that accounts for driving distance and duration to measure the ease of reaching these facilities for individuals living at the population‐weighted county centroids. We find that counties in states with CON laws that border counties without such laws have nearly 10% less spatial accessibility to substance use disorder treatment facilities at a 5% level of significance.","PeriodicalId":47946,"journal":{"name":"Southern Economic Journal","volume":"47 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140572313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There is concern, especially in certain feminist circles, that capitalism disfavors women. This could take many forms, for example, lower wages for the same work, reduced career opportunities, disparities in ownership, and the upholding of traditional gender roles, and it could result in capitalism conferring more life satisfaction on men than on women. We test empirically whether this concern is justified. Using the epidemiological approach to rule out reverse causality, we first confirm previous findings that most areas of economic freedom (legal quality in particular, but also monetary stability, openness, and regulation) are beneficial for general life satisfaction. When looking at women and men separately, we find virtually no statistically significant differences, and in the cases we do, the estimates reveal a more beneficial outcome for women. Hence, we conclude that capitalism does not seem to favor men more than women in terms of life satisfaction.
{"title":"Does capitalism disfavor women? Evidence from life satisfaction","authors":"Niclas Berggren, Christian Bjørnskov","doi":"10.1002/soej.12691","DOIUrl":"https://doi.org/10.1002/soej.12691","url":null,"abstract":"There is concern, especially in certain feminist circles, that capitalism disfavors women. This could take many forms, for example, lower wages for the same work, reduced career opportunities, disparities in ownership, and the upholding of traditional gender roles, and it could result in capitalism conferring more life satisfaction on men than on women. We test empirically whether this concern is justified. Using the epidemiological approach to rule out reverse causality, we first confirm previous findings that most areas of economic freedom (legal quality in particular, but also monetary stability, openness, and regulation) are beneficial for general life satisfaction. When looking at women and men separately, we find virtually no statistically significant differences, and in the cases we do, the estimates reveal <jats:italic>a more beneficial</jats:italic> outcome for women. Hence, we conclude that capitalism does not seem to favor men more than women in terms of life satisfaction.","PeriodicalId":47946,"journal":{"name":"Southern Economic Journal","volume":"215 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140572305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This is the first U.S. study on the causal relationship between unemployment insurance (UI) expansions during the Great Recession and the use of prescribed opioids. Using annual county‐level prescription data from 2006 to 2013 and plausibly exogenous variation in state and federal policies, we estimate that a one standard deviation increase in UI generosity ($10,800) reduces per‐capita prescription opioid use by 1.9%. We supplement our main analysis with a border discontinuity design and find a similar effect. We also find no evidence of pre‐trends in the outcome. Finally, additional analyses suggest that increased health care utilization after exposure to higher UI generosity could be a plausible explanation for the declines in opioid prescriptions.
{"title":"Unemployment insurance and opioid prescriptions during the great recession","authors":"Xiaohui Guo, Lizhong Peng","doi":"10.1002/soej.12688","DOIUrl":"https://doi.org/10.1002/soej.12688","url":null,"abstract":"This is the first U.S. study on the causal relationship between unemployment insurance (UI) expansions during the Great Recession and the use of prescribed opioids. Using annual county‐level prescription data from 2006 to 2013 and plausibly exogenous variation in state and federal policies, we estimate that a one standard deviation increase in UI generosity ($10,800) reduces per‐capita prescription opioid use by 1.9%. We supplement our main analysis with a border discontinuity design and find a similar effect. We also find no evidence of pre‐trends in the outcome. Finally, additional analyses suggest that increased health care utilization after exposure to higher UI generosity could be a plausible explanation for the declines in opioid prescriptions.","PeriodicalId":47946,"journal":{"name":"Southern Economic Journal","volume":"46 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140572311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study examines how microfinance lenders design their loan contracts to motivate borrower repayments under competition. We develop a model of an individual lending scheme in which a dynamic incentive mechanism is employed to mitigate borrower strategic defaults. We find that competition affects loan terms and borrower welfare in different ways depending on whether lenders are non‐profit or for‐profit. Non‐profits always charge the lowest feasible interest rate and show some degree of leniency toward defaulters by renewing their contracts. An increase in competition leads non‐profits to curtail leniency to a level that induces repayment, without affecting borrower welfare. In contrast, for‐profits charge the highest feasible interest rate and show no leniency to defaulters. They respond to competition by lowering the interest rate, leading to welfare gains for borrowers.
{"title":"Competition and profit orientation in microfinance","authors":"Ahadul Kabir Muyeed, Ruoning Han","doi":"10.1002/soej.12687","DOIUrl":"https://doi.org/10.1002/soej.12687","url":null,"abstract":"This study examines how microfinance lenders design their loan contracts to motivate borrower repayments under competition. We develop a model of an individual lending scheme in which a dynamic incentive mechanism is employed to mitigate borrower strategic defaults. We find that competition affects loan terms and borrower welfare in different ways depending on whether lenders are non‐profit or for‐profit. Non‐profits always charge the lowest feasible interest rate and show some degree of leniency toward defaulters by renewing their contracts. An increase in competition leads non‐profits to curtail leniency to a level that induces repayment, without affecting borrower welfare. In contrast, for‐profits charge the highest feasible interest rate and show no leniency to defaulters. They respond to competition by lowering the interest rate, leading to welfare gains for borrowers.","PeriodicalId":47946,"journal":{"name":"Southern Economic Journal","volume":"241 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140572453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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