Fiscal Shenanigans, Targeted Federal Health Care Funds, and Patient Mortality

The federal government spends billions of dollars each year on programs designed to increase the resources available to hospitals that serve the poor. This paper explores the intended and unintended effects of such targeted funds. First, how do these funds distort the behavior of state and local governments who wish to appropriate the funds for other uses? Second, to the extent that these funds do increase resources in the targeted hospitals, do patients benefit? We use the rapid and uneven growth in Medicaid Disproportionate Share Hospital (DSH) payments across states and hospitals to answer these questions. We identify states that were most able to appropriate DSH funds and show that, while DSH payments to public hospitals in these states were systematically diverted, DSH payments to other hospitals and in other states were not diverted. Additional resources that were made available to hospitals (rather than appropriated by the state) were associated with significant declines in infant and post-heart attack mortality. A range of evidence suggests that these improvements were due to better hospital care. Overall, our analysis implies that public subsidies can be an effective mechanism for improving medical care and outcomes for the poor, but that the impact is limited by the ability of state and local government to divert the targeted funds.

Matrix approach to the Shapley value and dual similar associated consistency

Replacing associated consistency in Hamiache's axiom system by dual similar associated consistency, we axiomatize the Shapley value as the unique value verifying the inessential game property, continuity and dual similar associated consistency. Continuing the matrix analysis for Hamiache's axiomatization of the Shapley value, we construct the dual similar associated game and introduce the dual similar associated transformation matrix $M_\lambda^{DSh}$ as well. In the game theoretic framework we show that the dual game of the dual similar associated game is Hamiache's associated game of the dual game. For the purpose of matrix analysis, we derive the similarity relationship $M_\lambda^{DSh}=QM_\lambda Q^{-1}$ between the dual similar associated transformation matrix $M_\lambda^{DSh}$ and associated transformation matrix $M_\lambda$ for Hamiache's associated game, where the transformation matrix $Q$ represents the duality operator on games. This similarity of matrices transfers associated consistency into dual similar associated consistency, and also implies the inessential property for the limit game of the convergent sequence of repeated dual similar associated games. We conclude this paper with three tables summarizing all matrix results

Radiographic measurements of the trachea in domestic short haired and Persian cats

Tracheal diameter can be assessed from a thoracic radiograph, with assessment of tracheal diameter in dogs based on ratios between tracheal diameter and a skeletal measurement – however reference ranges are not available for the cat. Tracheal narrowing may cause significant clinical problems, although tracheal hypoplasia in dogs may be clinically silent, and is rarely reported in cats (both mesati- and brachycephalic). The tracheal diameter and trachea:thoracic inlet and trachea:rib ratios were calculated for populations of Domestic Short Haired (DSH) (n=68) and Persian (n=40) cats. This gave reference ranges for radiographic tracheal measurements in these breeds. It is proposed that the tracheal diameter in a normal DSH cat should be 18% of the diameter of the thoracic inlet, and compared to 20% in Persian cats

Atypicality of Most Few-Body Observables

The eigenstate thermalization hypothesis (ETH), which dictates that all diagonal matrix elements within a small energy shell be almost equal, is a major candidate to explain thermalization in isolated quantum systems. According to the typicality argument, the maximum variations of such matrix elements should decrease exponentially with increasing the size of the system, which implies the ETH. We show, however, that the typicality argument does not apply to most few-body observables for few-body Hamiltonians when the width of the energy shell decreases at most polynomially with increasing the size of the system.Comment: 6 pages, 2 figures (supplementary material: 16 pages, 3 figures

Higher Readmissions at Safety-Net Hospitals and Potential Policy Solutions

The Hospital Readmissions Reduction Program (HRRP), established by the Affordable Care Act, ties a hospital's payments to its readmission rates -- with penalties for hospitals that exceed a national benchmark -- to encourage hospitals to reduce avoidable readmissions. This new Commonwealth Fund analysis uses publicly reported 30-day hospital readmission rate data to examine whether safety-net hospitals are more likely to have higher readmission rates, compared with other hospitals. Results of this analysis find that safety-net hospitals are 30 percent more likely to have 30-day hospital readmission rates above the national average, compared with non-safety-net hospitals, and will therefore be disproportionately impacted by the HRRP. Policy solutions to help safety-net hospitals reduce their readmission rates include targeting quality improvement initiatives for safety-net hospitals; ensuring that broader delivery system improvements include safety-net hospitals and care delivery systems; and enhancing bundled payment rates to account for socioeconomic risk factors