We measure organizational concentration-the distribution of a patient's healthcare across organizations-to examine how firm boundaries affect healthcare efficiency. First, when patients move to regions where outpatient visits are typically concentrated within a small set of firms, their healthcare utilization falls. Second, for patients whose PCPs exit the market, switching to a PCP with 1 standard deviation higher organizational concentration reduces utilization by 21%. This finding is robust to controlling for the spread of healthcare across providers. Increases in organizational concentration predict improvements in diabetes care and are not associated with greater use of emergency department or inpatient care.
{"title":"The Impact of Organizational Boundaries on Healthcare Coordination and Utilization.","authors":"Leila Agha, Keith Marzilli Ericson, Xiaoxi Zhao","doi":"10.1257/pol.20200841","DOIUrl":"10.1257/pol.20200841","url":null,"abstract":"<p><p>We measure <i>organizational concentration</i>-the distribution of a patient's healthcare across organizations-to examine how firm boundaries affect healthcare efficiency. First, when patients move to regions where outpatient visits are typically concentrated within a small set of firms, their healthcare utilization falls. Second, for patients whose PCPs exit the market, switching to a PCP with 1 standard deviation higher organizational concentration reduces utilization by 21%. This finding is robust to controlling for the spread of healthcare across providers. Increases in organizational concentration predict improvements in diabetes care and are not associated with greater use of emergency department or inpatient care.</p>","PeriodicalId":48093,"journal":{"name":"American Economic Journal-Economic Policy","volume":"15 3","pages":"184-214"},"PeriodicalIF":5.6,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10403257/pdf/nihms-1868896.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10013011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael Lawrence Barnett, Andrew Olenski, Adam Sacarny
Efforts to raise US health-care productivity have proceeded slowly, potentially due to the fragmentation of payment across insurers. Each insurer’s efforts to improve care could influence how doctors practice for other insurers, leading to unvalued externalities. We study a randomized letter intervention by Medicare to curtail overuse of antipsychotics. The letters did not mention private insurance but reduced prescribing to these patients by 12 percent, much like the 17 percent effect in Medicare. We cannot reject onefor-one spillovers, suggesting that physicians use similar medical practice styles across insurers. Our findings establish that insurers can affect health care well outside their direct purview. (JEL D24, G22, I11, I13, I18)
{"title":"Common Practice: Spillovers from Medicare on Private Health Care","authors":"Michael Lawrence Barnett, Andrew Olenski, Adam Sacarny","doi":"10.1257/pol.20200553","DOIUrl":"https://doi.org/10.1257/pol.20200553","url":null,"abstract":"Efforts to raise US health-care productivity have proceeded slowly, potentially due to the fragmentation of payment across insurers. Each insurer’s efforts to improve care could influence how doctors practice for other insurers, leading to unvalued externalities. We study a randomized letter intervention by Medicare to curtail overuse of antipsychotics. The letters did not mention private insurance but reduced prescribing to these patients by 12 percent, much like the 17 percent effect in Medicare. We cannot reject onefor-one spillovers, suggesting that physicians use similar medical practice styles across insurers. Our findings establish that insurers can affect health care well outside their direct purview. (JEL D24, G22, I11, I13, I18)","PeriodicalId":48093,"journal":{"name":"American Economic Journal-Economic Policy","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134951732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A reform increasing the full retirement age (FRA) by one year leads to larger than expected delays in pension claiming and retirement, while making late claiming more lucrative leads to a smaller than expected delay in pension claiming. Survey evidence shows people view the FRA as the “normal” retirement age and prefer to couple pension claiming and retirement decisions together, even though these two decisions are not coupled through social security provisions. Two mechanisms are at work: reference dependence with loss aversion in pension claiming, and spillovers from pension claiming on retirement choices. The FRA increase leads to large government savings. (JEL H55, J26)
{"title":"How Social Security Reform Affects Retirement and Pension Claiming","authors":"R. Lalive, Arvind Magesan, S. Staubli","doi":"10.1257/pol.20200686","DOIUrl":"https://doi.org/10.1257/pol.20200686","url":null,"abstract":"A reform increasing the full retirement age (FRA) by one year leads to larger than expected delays in pension claiming and retirement, while making late claiming more lucrative leads to a smaller than expected delay in pension claiming. Survey evidence shows people view the FRA as the “normal” retirement age and prefer to couple pension claiming and retirement decisions together, even though these two decisions are not coupled through social security provisions. Two mechanisms are at work: reference dependence with loss aversion in pension claiming, and spillovers from pension claiming on retirement choices. The FRA increase leads to large government savings. (JEL H55, J26)","PeriodicalId":48093,"journal":{"name":"American Economic Journal-Economic Policy","volume":"113 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84323285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I study optimal carbon taxation in an analytic quantitative integrated assessment model (IAM) that links IAM components, parametric assumptions, and calibration approaches directly to their policy impacts. I show how temperature’s tax impact differs from that of previously analytically modeled carbon dynamics. Novel to analytic IAMs are a general economy, energy sectors including capital, varying degrees of substitutability across energy sources, an approximation of capital persistence, objective functions that include CES preferences and population weighting, and an explicit model of the greenhouse effect and ocean-atmosphere temperature dynamics. The paper enables economists to develop better-informed opinions about the social cost of carbon. (JEL H23, H43, Q54, Q58)
{"title":"ACE—Analytic Climate Economy","authors":"Christian Traeger","doi":"10.1257/pol.20210297","DOIUrl":"https://doi.org/10.1257/pol.20210297","url":null,"abstract":"I study optimal carbon taxation in an analytic quantitative integrated assessment model (IAM) that links IAM components, parametric assumptions, and calibration approaches directly to their policy impacts. I show how temperature’s tax impact differs from that of previously analytically modeled carbon dynamics. Novel to analytic IAMs are a general economy, energy sectors including capital, varying degrees of substitutability across energy sources, an approximation of capital persistence, objective functions that include CES preferences and population weighting, and an explicit model of the greenhouse effect and ocean-atmosphere temperature dynamics. The paper enables economists to develop better-informed opinions about the social cost of carbon. (JEL H23, H43, Q54, Q58)","PeriodicalId":48093,"journal":{"name":"American Economic Journal-Economic Policy","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134951967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicolás Ajzenman, Tiago Cavalcanti, Daniel Da Mata
This paper investigates whether the anti-scientific rhetoric of modern populists can induce followers to engage in risky behavior. We gather electoral information, credit card expenses, and geo-localized mobile phone data for approximately 60 million devices in Brazil. After the president publicly dismissed the risks of the COVID-19 pandemic and challenged scientific recommendations, social distancing in pro-government localities declined. Consistently, credit card expenses increased immediately. Results are driven by localities with higher media penetration levels, active Twitter accounts, and a larger proportion of evangelical Christians, a critical electoral group. (JEL D72, D91, I12, I18, L82, O15, Z12)
{"title":"More than Words: Leaders’ Speech and Risky Behavior during a Pandemic","authors":"Nicolás Ajzenman, Tiago Cavalcanti, Daniel Da Mata","doi":"10.1257/pol.20210284","DOIUrl":"https://doi.org/10.1257/pol.20210284","url":null,"abstract":"This paper investigates whether the anti-scientific rhetoric of modern populists can induce followers to engage in risky behavior. We gather electoral information, credit card expenses, and geo-localized mobile phone data for approximately 60 million devices in Brazil. After the president publicly dismissed the risks of the COVID-19 pandemic and challenged scientific recommendations, social distancing in pro-government localities declined. Consistently, credit card expenses increased immediately. Results are driven by localities with higher media penetration levels, active Twitter accounts, and a larger proportion of evangelical Christians, a critical electoral group. (JEL D72, D91, I12, I18, L82, O15, Z12)","PeriodicalId":48093,"journal":{"name":"American Economic Journal-Economic Policy","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135931081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aditya Aladangady, S. Aron-Dine, David B. Cashin, W. Dunn, Laura Feiveson, Paul A. Lengermann, Katherine Richard, Claudia R. Sahm
This study explores the spending response to tax refunds for Earned Income Tax Credit recipients using a novel dataset combining transaction-based measures of retail spending with administrative IRS data on tax refunds. Our dataset allows us to exploit variation in the timing of EITC refunds, including changes related to the 2017 PATH Act, along with cross-state differences in refund magnitudes to identify spending responses. Results show EITC recipients spend about $0.30 per refund dollar ($1,150 for the average refund) within just two weeks of issuance, suggesting stimulus targeted at this population may provide a quick boost to aggregate demand. (JEL D12, E32, G51, H24, I38, K34)
{"title":"Spending Responses to High-Frequency Shifts in Payment Timing: Evidence from the Earned Income Tax Credit","authors":"Aditya Aladangady, S. Aron-Dine, David B. Cashin, W. Dunn, Laura Feiveson, Paul A. Lengermann, Katherine Richard, Claudia R. Sahm","doi":"10.1257/pol.20200590","DOIUrl":"https://doi.org/10.1257/pol.20200590","url":null,"abstract":"This study explores the spending response to tax refunds for Earned Income Tax Credit recipients using a novel dataset combining transaction-based measures of retail spending with administrative IRS data on tax refunds. Our dataset allows us to exploit variation in the timing of EITC refunds, including changes related to the 2017 PATH Act, along with cross-state differences in refund magnitudes to identify spending responses. Results show EITC recipients spend about $0.30 per refund dollar ($1,150 for the average refund) within just two weeks of issuance, suggesting stimulus targeted at this population may provide a quick boost to aggregate demand. (JEL D12, E32, G51, H24, I38, K34)","PeriodicalId":48093,"journal":{"name":"American Economic Journal-Economic Policy","volume":"38 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73151328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I analyze the effect of two corporate tax breaks, bonus depreciation and the Domestic Production Activities Deduction (DPAD), on executive compensation in publicly traded US firms. I find both tax breaks significantly increase executive compensation. For every dollar a firm benefits from the tax breaks, compensation of the firm’s top five highest-paid executives increases by $0.17 to $0.25. The tax breaks increase compensation primarily in firms with weaker governance structures, suggesting the compensation response is driven by executive rent extraction. (JEL D22, G34, H25, M12, M52)
{"title":"Corporate Tax Breaks and Executive Compensation","authors":"Eric Ohrn","doi":"10.1257/pol.20210155","DOIUrl":"https://doi.org/10.1257/pol.20210155","url":null,"abstract":"I analyze the effect of two corporate tax breaks, bonus depreciation and the Domestic Production Activities Deduction (DPAD), on executive compensation in publicly traded US firms. I find both tax breaks significantly increase executive compensation. For every dollar a firm benefits from the tax breaks, compensation of the firm’s top five highest-paid executives increases by $0.17 to $0.25. The tax breaks increase compensation primarily in firms with weaker governance structures, suggesting the compensation response is driven by executive rent extraction. (JEL D22, G34, H25, M12, M52)","PeriodicalId":48093,"journal":{"name":"American Economic Journal-Economic Policy","volume":"213 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135931088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We study the long-run effects of contact with individuals from other regions in early adulthood on preferences, beliefs, and national identity. We combine a natural experiment, the random assignment of male conscripts to different locations throughout Spain, with tailored survey data. Being randomly assigned to complete military service outside of one’s region of residence fosters contact with conscripts from other regions and increases sympathy and trust toward people from the region of service, as measured decades later. We also observe a long-lasting increase in identification with Spain for individuals originating from regions with strong peripheral nationalism. (JEL D12, D83, D91, J45, R23, Z13.)
{"title":"Interregional Contact and the Formation of a Shared Identity","authors":"Manuel Bagues, Christopher Roth","doi":"10.1257/pol.20210237","DOIUrl":"https://doi.org/10.1257/pol.20210237","url":null,"abstract":"We study the long-run effects of contact with individuals from other regions in early adulthood on preferences, beliefs, and national identity. We combine a natural experiment, the random assignment of male conscripts to different locations throughout Spain, with tailored survey data. Being randomly assigned to complete military service outside of one’s region of residence fosters contact with conscripts from other regions and increases sympathy and trust toward people from the region of service, as measured decades later. We also observe a long-lasting increase in identification with Spain for individuals originating from regions with strong peripheral nationalism. (JEL D12, D83, D91, J45, R23, Z13.)","PeriodicalId":48093,"journal":{"name":"American Economic Journal-Economic Policy","volume":"1 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90206847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"经济学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The ability to speak and understand a host country’s primary language is strongly associated with measures of immigrant integration. We estimate the causal effects of English language training for adult immigrants on participants’ civic and economic outcomes using randomized enrollment lotteries from a public adult education program in Massachusetts. Participation doubles voter participation and increases annual earnings by $2,400 (56 percent). Increased tax revenue from earnings gains cover program costs over time, generating a 6 percent return for taxpayers. Ours is the first randomized evaluation of adult English language training as a standalone intervention in the United States. (JEL D72, H75, I21, I26, J15, J24, J31)
{"title":"Immigrant Integration in the United States: The Role of Adult English Language Training","authors":"Blake H Heller, Kirsten Slungaard Mumma","doi":"10.1257/pol.20210336","DOIUrl":"https://doi.org/10.1257/pol.20210336","url":null,"abstract":"The ability to speak and understand a host country’s primary language is strongly associated with measures of immigrant integration. We estimate the causal effects of English language training for adult immigrants on participants’ civic and economic outcomes using randomized enrollment lotteries from a public adult education program in Massachusetts. Participation doubles voter participation and increases annual earnings by $2,400 (56 percent). Increased tax revenue from earnings gains cover program costs over time, generating a 6 percent return for taxpayers. Ours is the first randomized evaluation of adult English language training as a standalone intervention in the United States. (JEL D72, H75, I21, I26, J15, J24, J31)","PeriodicalId":48093,"journal":{"name":"American Economic Journal-Economic Policy","volume":"70 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84458480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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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