Job Stability in the United States

Two key attributes of a job are its wage and its duration. Much has been made of changes in the wage distribution in the 1980s, but little attention has been given to job durations since Hall (1982). We fill this void by examining the temporal evolution of job retention rates in U.S. labor markets, using data assembled from the sequence of Current Population Survey job tenure supplements. In contrast to the distribution of wages, which clearly changed in the 1980s, we find that job retention rates have remained stable.

The Burden of Health Care Costs for Working Families

Health care spending represents a growing share of our national income, and based on current projections, will increase from 16% of the gross domestic product today to 20% by 2018. What does this mean for typical working families with private health insurance, who shoulder the financial burden of maintaining the current system? In this Issue Brief, Polsky and Grande construct a typical health care budget for working families of various income levels, calculate the percentage of total compensation devoted to health care over time, and project how rising health care costs will affect standards of living in the future. Their findings remind us that what works today also has to work tomorrow. Sustainability depends critically on successful cost containment

Mutational Heterogeneity in Melanoma: An Inconvenient Truth

Identification of oncogenic BRAF mutations in primary and metastatic melanomas supports a linear model of clonal evolution in cancer. Some mutational studies, however, have failed to identify BRAF mutations in metastatic tumors from patients with BRAFmutant primary melanomas. Using a combination of methods, Riveiro-Falkenbach et al. (2015) assert that technical issues, and not clonal heterogeneity, may explain prior discordant mutational results

Integration and Task Allocation: Evidence From Patient Care

Using the universe of patient transitions from inpatient hospital care to skilled nursing facilities and home health care in 2005, we show how integration eliminates task misallocation problems between organizations. We find that vertical integration allows hospitals to shift patient recovery tasks downstream to lower-cost organizations by discharging patients earlier (and in poorer health) and increasing post-hospitalization service intensity. Although integration facilitates a shift in the allocation of tasks and resources, health outcomes either improved or were unaffected by integration on average. The evidence suggests that integration solves coordination problems that arise in market exchange through improvements in the allocation of tasks across care settings

Integration and Task Allocation: Evidence from Patient Care

We develop a formal model to show how integration solves task allocation problems between organizations and test the predictions of the model, using a large and rich patient-level dataset on hospital discharges to nursing homes and home health care. As predicted by the theory, we find that vertical integration allows hospitals to shift patient recovery tasks downstream to lower cost delivery systems by discharging patients earlier and in poorer health, and integration leads to greater post-hospitalization service intensity. While integration facilitates a shift in the allocation of tasks, health outcomes are no worse when patients receive care from an integrated provider. The evidence suggests that by improving the allocation of tasks, integration solves coordination problems that arise in market exchange.

The Effect of Entry Regulation in the Health Care Sector: The Case of Home Health

The consequences of government regulation in the post-acute care sector are not well understood. We examine the effect of entry regulation on quality of care in home health care by analyzing the universe of hospital discharges during 2006 for publicly insured beneficiaries (about 4.5 million) and subsequent home health admissions to determine whether there is a significant difference in home health utilization, hospital readmission rates, and health care expenditures in states with and without Certificate of Need laws (CON) regulating entry. We identify these effects by looking across regulated and nonregulated states within Hospital Referral Regions, which characterize well-defined health care markets and frequently cross state boundaries. We find that CON states use home health less frequently, but system-wide rehospitalization rates, overall Medicare expenditures, and home health practice patterns are similar. Removing CON for home health would have negligible system-wide effects on health care costs and quality

Clinical significance of BRAF mutations in metastatic melanoma

Forty to eighty percent of melanoma tumors have activating mutations in BRAF although the clinical importance of these mutations is not clear. We previously reported an analysis of BRAF mutations in metastatic melanoma samples from 68 patients. In this study, we correlated patient baseline characteristics, prognostic factors, and/or clinical outcomes with the presence of BRAF mutations. No significant differences were observed in age, gender, location of primary melanoma, stage at the diagnosis, and depth of primary tumor between patients with and without BRAF mutations. Melanomas harboring BRAF mutations were more likely to metastasize to liver (P = 0.02) and to metastasize to multiple organs (P = 0.048). Neither time to progression to stage IV nor overall survival were associated with BRAF mutations. In conclusion, we observed no significant differences in clinical characteristics or outcomes between melanomas with or without BRAF mutations. Although there was an increased frequency of liver metastasis and tendency to metastasize to multiple organs in tumors with BRAF mutations, there was no detectable effect on survival. Future prospective studies should include analysis of whether BRAF mutations in melanoma tumors correlate with an increased tendency to metastasize to liver or to multiple organs

Racial Disparities in Geographic Access to Primary Care in Philadelphia

Although Philadelphia has an adequate supply of primary care providers overall, spatial analysis shows wide variation across neighborhoods, with stark racial disparities. This study identifies six low-access areas within the city that warrant attention

Has Job Stability Declined Yet? New Evidence for the 1990's

In earlier work we examined the temporal evolution of job stability in U.S. labor markets through the 1980's, using data assembled from a sequence of Current Population Survey tenure supplements. We found little or no change in aggregate job stability in the U.S. economy. In addition, older and more-tenured workers experienced increases in job stability in the" latter part of the 1980's. In this paper we update the evidence on changes in job stability through the mid-1990's, using recently-released CPS data for 1995 that parallel the earlier job tenure supplements. Updating the evidence from systematic random samples of the population and workforce through this period is especially important because the media have painted a particularly stark picture of declining job stability in the 1990's. In the aggregate, there is some evidence that job stability declined modestly in the first half of the 1990's. Moreover, the relatively small aggregate changes mask rather sharp declines in stability for workers with more than a few years of tenure. Nonetheless, the data available to this point do not support the conclusion that the downward shift in job stability for more-tenured workers stability, reflect long-term trends.