Essays on information and career concerns in organizations

The aim of my thesis is to investigate the role of information and career concerns in organizations. To that end, I submit three papers, each of which addresses a unique aspect of a firm’s organizational problem. In the first chapter I investigate the incentives of a firm to reveal strategic information to the market in order to make its leader more conservative as regards early decisions. The firm may do so to achieve coordination between different levels of the firm’s hierarchy or to improve adaptation to the firm’s environment. I give conditions on employees’ career concerns that make the firm voluntarily disclose information concerning its strategic decisions. In chapter 2 I ask why rational voters would knowingly re-elect a politician who has expropriated public funds. In this model, the presence of non-strategic (‘impressionable’) voters means that even welfare-minded politicians occasionally raid the public purse in order to increase their chances of re-election. Being aware of this dynamic, rational voters opt to reward politicians whose misbehavior is solely due to career concerns. Chapter 3 changes tack somewhat to analyze the optimal decision-making protocol for a committee when one member of the committee is overconfident. I show that overconfidence leads an uninformed committee member to respond to his private information, which causes a better-informed member to stop using her private information. This leads to a loss of efficiency under majority rule, and changes the optimal voting rule for the committee to unanimity

Limited indications of tax stamp discordance and counterfeiting on cigarette packs purchased in tobacco retailers, 97 counties, USA, 2012

Increasing the per-unit cost of tobacco products is one of the strongest interventions for tobacco control. In jurisdictions with higher taxes in the U.S., however, cigarette pack litter studies show a substantial proportion of littered packs lack the appropriate tax stamp. More limited but still present counterfeiting also exists. We sought to examine the role of tobacco retailers as a source for untaxed and counterfeit products. Data collectors pur- chased Newport Green (menthol) or Marlboro Red cigarette packs in a national probability-based sample of tobacco retailers (in 97 counties) from June–October 2012. They made no effort to buy counterfeit or untaxed cigarettes. In this cross-sectional study, we assessed the presence, tax authority, and type (low-tech thermal vs. encrypted) of cigarette pack tax stamps; concordance of tax stamps with where the pack was purchased; and, for Marlboro cigarettes, publicly available visible indicators of counterfeiting. We purchased 2147 packs of which 2033 had tax stamps. Packs missing stamps were in states that do not require them. We found very limited discordance between store location and tax stamp(s) (< 1%). However, a substantial minority of cigarette packs had damaged tax stamps (13%). This occurred entirely with low-tech tax stamps and was not identified with encrypted tax stamps. We found no clear evidence of counterfeit products. Almost all tax stamps matched the location of purchase. Litter studies may be picking up legal tax avoidance instead of illegal tax evasion or, alternatively, purchase of illicit products requires special request by the purchaser

Estimates of effectiveness and reach for ‘return on investment’ modelling of smoking cessation interventions using data from England

Background and aims: Estimating ‘return on investment’ (ROI) from smoking cessation interventions requires reach and effectiveness parameters for interventions for use in economic models such as the EQUIPT ROI tool (http://roi.equipt.eu). This paper describes the derivation of these parameter estimates for England that can be adapted to create ROI models for use by other countries. Methods: Estimates were derived for interventions in terms of their reach and effectiveness in: 1) promoting quit attempts, and 2) improving the success of quit attempts (abstinence for at least 12 months). The sources were systematic reviews of efficacy supplemented by individual effectiveness evaluations and national surveys. Findings: Quit attempt rates were estimated to be increased by the following percentages (with reach in parentheses): 20% by tax increases raising the cost of smoking 5% above the cost of living index (100%); 10% by enforced comprehensive indoor public smoking bans (100%); 3% by mass media campaigns achieving 400 gross rating points (100%); 40% by brief opportunistic physician advice (21%); and 110% by use of a licensed nicotine product to reduce cigarette consumption (12%);. Quit success rates were estimated to be increased by the following ratios: 60% by single-form nicotine replacement therapy (NRT) (5%); 114% by NRT patch plus a faster acting NRT (2%);124% by prescribed varenicline (5%); 60% by bupropion (1%); 100% by nortriptyline (0%), 10) 298% by cytisine (0%); 40% by individual face-to-face behavioural support (2%); 37% by telephone support (0.5%); 88% by group behavioural support (1%); 63% by text messaging (0.5%); and 19% by printed self-help materials (1%). There was insufficient evidence to obtain reliable, country-specific estimates for interventions such as websites, smartphone apps and e-cigarettes. Conclusions: Tax increases, indoor smoking bans, brief opportunistic physician advice, and use of nicotine replacement therapy (NRT) for smoking reduction can all increase population quit attempt rates. Quit success rates can be increased by provision of NRT, varenicline, bupropion, nortriptyline, cytisine and behavioural support delivered through a variety of modalities. Parameter estimates for the effectiveness and reach of these interventions can contribute to return on investment estimates in support of national or regional policy decisions

Who’s at risk of entering Social Security Disability Insurance? A comparison of application and allowance rates for groups of at-risk individuals

BACKGROUND: The U.S. government has implemented several programs to reduce federal expenditures on Social Security Disability Insurance (DI) and help beneficiaries return to work, but the limited success of these efforts has raised interest in approaches that help workers with disabilities remain in the workforce. OBJECTIVE: This paper provides information on individuals at risk of applying for DI benefits to help build the evidence base for policies that provide workers with disabilities support to eliminate the need to apply for and receive DI benefits. METHODS: Using three panels of the Survey of Income and Program Participation matched to SSA administrative data, we describe the employment characteristics of seven groups at risk of applying for DI benefits before and after application, as well as the outcomes of their DI applications. RESULTS: New private disability insurance recipients were more likely to apply for and receive DI than members of other at-risk groups. However, individuals with high healthcare expenditures made up the largest proportion of successful applicants across the at-risk groups considered here. CONCLUSION: While it seems plausible that individuals within an at-risk group who are likely to apply for DI benefits can be identified and provided supports to help them maintain employment, focusing on a specific group to promote employment over DI benefits may have a limited effect on the DI program because applicants come from multiple groups.</jats:p

Impacts of the 2010 VA PTSD Rule Change on Participation in SSA Disability Programs

U.S. veterans who could qualify for disability benefits from both the Department of Veterans Affairs (VA) and the Social Security Administration (SSA) might view them as complementary or as substitutes for each other. For example, people who earn above a certain income lose their Social Security Disability Insurance (SSDI) benefits, whereas VA Disability Compensation (DC) benefits do not change based on income. Veterans with disabilities who wish to work may therefore prefer to receive DC over SSDI, in effect treating the two programs as substitutes. We examined how an eligibility rule change in DC affected participation in DC, SSDI, and Supplemental Security Income to understand whether veterans with disabilities increase or reduce their take-up of SSA disability benefits when access to DC increases. Using Current Population Survey data from 2009 to 2016, we studied a 2010 DC rule change that made it easier for veterans with posttraumatic stress disorder to demonstrate eligibility. After the rule change, veterans with self-reported cognitive difficulties reported increased receipt of DC, reduced receipt of SSDI, and reduced rates of work-limiting disability, seeming to treat the two benefit programs as substitutes. </jats:p

Impacts of the 2010 VA PTSD Rule Change on Veterans’ Disability Compensation and Reported Cognitive Disability

In July 2010, the Department of Veterans Affairs (VA) simplified the process of obtaining veterans’ disability compensation (DC) for veterans with posttraumatic stress disorder (PTSD) who served in combat zones but not in combat roles. In this article, we use data from the Current Population Survey (CPS) Veterans Supplement to estimate the impacts of the change in the VA PTSD rule on DC benefit receipt and self-reported cognitive disability. We hypothesize that the easing of eligibility rules led to an increase in DC receipt among veterans who served in combat zones but not in combat roles. It may also have led to reduced stigma among veterans with regard to reporting cognitive disability. Our results are consistent with these hypotheses. Self-reported rates of VA disability and DC receipt increased significantly among combat zone veterans. Self-reported VA disability rating and experience of cognitive disability also increased, but these increases were not statistically significant. During the same period, the rate of self-reported disability other than cognitive disability remained the same

Barriers to and Facilitators of Evidence-Based Decision Making at the Point of Care

Introduction: Physicians vary widely in how they treat some health conditions, despite strong evidence favoring certain treatments over others. We examined physicians’ perspectives on factors that support or hinder evidence-based decisions and the implications for delivery systems, payers, and policymakers. Methods: We used Choosing Wisely ® recommendations to create four clinical vignettes for common types of decisions. We conducted semi-structured interviews with 36 specialists to identify factors that support or hinder evidence-based decisions. We examined these factors using a conceptual framework that includes six levels: patients, physicians, practice sites, organizations, networks and hospital affiliations, and the local market. In this model, population characteristics and payer and regulatory factors interact to influence decisions. Results: Patient openness to behavior modification and expectations, facilitated and hindered physicians in making evidence-based recommendations. Physicians’ communication skills were the most commonly mentioned facilitator. Practice site, organization, and hospital system barriers included measures of emergency department throughput, the order in which test options are listed in electronic health records (EHR), lack of relevant decision support in EHRs, and payment incentives that maximize billing and encourage procedures rather than medical management or counseling patients on behavior change. Factors from different levels interacted to undermine evidence-based care. Most physicians received billing feedback, but quality metrics on evidence-based service use were nonexistent for the four decisions in this study. Conclusions and Implications: Additional research and quality improvement may help to modify delivery systems to overcome barriers at multiple levels. Enhancing provider communication skills, improving decision support in EHRs, modifying workflows, and refining the design and interpretation of some quality metrics would help, particularly if combined with concurrent payment reform to realign financial incentives across stakeholders