Measuring and testing for gender discrimination in professions: the case of English family doctors

In 2004 the income of female GPs was 70%, and their wages (income per hour) were 91%, of those of male GPs. We compare estimates of gender discrimination from Oaxaca decompositions using models of wages (income/hours), OLS and 2SLS models of income, and propensity score matching. We propose a new direct test for within workplace gender discrimination based on a comparison of the differences in income of female and male GPs in practices in which all GPs are of the same gender with the differences in male and female income in mixed gender practices. We find that the coefficients on log hours in the log income models are positive but significantly less than 1, so that log wage models are misspecified. Discrimination, as measured by the unexplained difference in mean log income varied between 21% to 28%. However, our direct tests could not reject the null hypothesis of no within workplace gender discrimination.Gender discrimination. Professions. Family doctors. Propensity score matching.

Measuring quality of care with routine data: avoiding confusion between performance indicators and health outcomes

Objective To investigate the impact of factors outside the control of primary care on performance indicators proposed as measures of the quality of primary care. Design Multiple regression analysis relating admission rates standardised for age and sex for asthma, diabetes, and epilepsy to socioeconomic population characteristics and to the supply of secondary care resources. Setting 90 family health services authorities in England, 1989-90 to 1994-5. Results At health authority level socioeconomic characteristics, health status, and secondary care supply factors explained 45% of the variation in admission rates for asthma, 33% for diabetes, and 55% for epilepsy. When health authorities were ranked, only four of the 10 with the highest age-sex standardised admission rates for asthma in 1994-5 remained in the top 10 when allowance was made for socioeconomic characteristics, health status, and secondary care supply factors. There was also substantial year to year variation in the rates. Conclusion Health outcomes should relate to crude rates of adverse events in the population. These give the best indication of the size of a health problem. Performance indicators, however, should relate to those aspects of care which can be altered by the staff whose performance is being measured

S15RS SGFB No. 10 (Union Seating)

A FINANCE BILL To allocate a maximum of seven thousand seven hundred fifty-seven dollars and ninety-three cents ($7,757.93) from the Student Government Senate General Contingency Account to fund nine new round tables and thirty new chairs for the LSU Student Union

Does Hospital Competition Improve Efficiency? The Effect of the Patient Choice Reform in England

We use the 2006 relaxation of constraints on patient choice of hospital in the English NHS to investigate the effect of hospital competition on dimensions of efficiency including indicators of resource management (admissions per bed, bed occupancy rate, proportion of day cases, and cancelled elective operations) and costs (reference cost index for overall and elective activity, cleaning services costs, laundry and linen costs). We employ a quasi differences-in-differences approach and estimate seemingly unrelated regressions and unconditional quantile regressions with data on hospital trusts from 2002/03 to 2010/11. Our findings suggest that increased competition had mixed effects on efficiency. An additional equivalent rival increased admissions per bed by 1.1%, admissions per doctor by 0.9% and the proportion of day cases by 0.38 percentage points, but it also increased the number of cancelled elective operations by 2.5%

Doctor behaviour under a pay for performance contract : Further evidence from the quality and outcomes framework

Since 2003, 25% of UK general practitioners’ income has been determined by the quality of their care. The 65 clinical quality indicators in this scheme (the Quality and Outcomes Framework) are in the form of ratios, with financial reward increasing linearly with the ratio between a lower and upper threshold. The numerator is the number of patients for whom an indicator is achieved and the denominator is the number of patients the practices declare are suitable for the indicator. The number declared suitable is the number of patients with the relevant condition less the number exception reported by the practice for a specified range of reasons. Exception reporting is designed to avoid harmful treatment resulting from the application of quality targets to patients for whom they were not intended. However, exception reporting also gives GPs the opportunity to exclude patients who should in fact be treated in order to achieve higher financial rewards. This is inappropriate use of exception reporting or ‘gaming’. Practices can also increase income if they are below the upper threshold by reducing the number of patients declared with a condition (prevalence), or by increasing reported prevalence if they were above the upper threshold. This study examines the factors affecting delivered quality (the proportion of prevalent patients for indicators were achieved) and tests for gaming of exceptions and for prevalence reporting being responsive to financial incentives

A mixed integer linear programming model for optimal sovereign debt issuance

Copyright @ 2011, Elsevier. NOTICE: this is the author’s version of a work that was accepted for publication in the European Journal of Operational Research. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version is available at the link below.Governments borrow funds to finance the excess of cash payments or interest payments over receipts, usually by issuing fixed income debt and index-linked debt. The goal of this work is to propose a stochastic optimization-based approach to determine the composition of the portfolio issued over a series of government auctions for the fixed income debt, to minimize the cost of servicing debt while controlling risk and maintaining market liquidity. We show that this debt issuance problem can be modeled as a mixed integer linear programming problem with a receding horizon. The stochastic model for the interest rates is calibrated using a Kalman filter and the future interest rates are represented using a recombining trinomial lattice for the purpose of scenario-based optimization. The use of a latent factor interest rate model and a recombining lattice provides us with a realistic, yet very tractable scenario generator and allows us to do a multi-stage stochastic optimization involving integer variables on an ordinary desktop in a matter of seconds. This, in turn, facilitates frequent re-calibration of the interest rate model and re-optimization of the issuance throughout the budgetary year allows us to respond to the changes in the interest rate environment. We successfully demonstrate the utility of our approach by out-of-sample back-testing on the UK debt issuance data