Factor Substitution and Unobserved Factor Quality in Nursing Homes

This paper studies factor substitution in one important sector: the nursing home industry. Specifically, we measure the extent to which nursing homes substitute materials for labor when labor becomes relatively more expensive. From a policy perspective, factor substitution in this market is important because materials-intensive methods of care are associated with greater risks of morbidity and mortality among nursing home residents. Studying longitudinal data from 1991-1998 on nearly every nursing home in the United States, we use the method of instrumental variables (IV) to address the potential endogeneity of nursing home wages. The results from the IV models are consistent with the theory of factor substitution: higher nursing home wages are associated with lower staffing, greater use of materials (specifically, physical restraints), and a higher proportion of residents with pressure ulcers. A comparison of OLS and IV results suggests that empirical studies of factor substitution should take into account unobserved heterogeneity in factor quality.

THE PHYSICIAN LABOR MARKET IN A MANAGED CARE-DOMINATED ENVIRONMENT

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74586/1/j.1465-7295.1999.tb01430.x.pd

Workplace drug abuse policy: A comment

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31290/1/0000196.pd

The clinical and economic impact of alternative staging strategies for adenocarcinoma of the pancreas

Several innovative imaging modalities, including endoscopic ultrasound, have increased the number of available preoperative staging methods in patients with adenocarcinoma of the pancreas. Our goal was to estimate the clinical outcomes and cost-effectiveness of alternative staging strategies for pancreatic adenocarcinoma. METHODS : Decision analysis was used to simulate alternative staging strategies. Cost inputs were based on Medicare reimbursements; clinical inputs were obtained from the available literature. Model endpoints of interest were cost per curative resection and appropriateness of treatment allocation based on pathological stage. RESULTS : Endoscopic ultrasound followed by laparoscopy yielded the lowest cost per curative resection ($37,600) and minimized the number of unnecessary surgical explorations (5.4 per 100 patients staged). Requiring angiographic confirmation when endoscopic ultrasound demonstrated an unresectable tumor yielded an intermediate cost-effectiveness ratio and virtually eliminated the risk of overstaging. Laparoscopy alone maximized the resection rate, but each additional resection would cost approximately$2 million relative to a strategy employing both endoscopic ultrasound and angiography. CONCLUSIONS : Staging strategies incorporating endoscopic ultrasound may improve treatment allocation and are cost-effective relative to angiography-based strategies. A staging protocol that does not incorporate an imaging modality to detect vascular invasion dramatically increases the cost per additional curative resection compared with more comprehensive staging protocols.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74623/1/j.1572-0241.2000.02191.x.pd

Long‐Term Health Spending Persistence among the Privately Insured in the US

There is little current information regarding the long‐term persistence of health spending in the United States, in particular among the population aged under 65 (pre‐Medicare eligibility). We describe and model the extent of persistence over a six‐year period (2003–08) using medical and pharmacy claims for over 3 million employees, retirees and dependants derived from the Truven Health MarketScan database. Overall, substantial persistence in spending exists, particularly at the extremes of the distribution and for pharmaceutical spending. Error components models are estimated to separate transient from persistent variation in spending, and dynamic probit models are estimated to assess the predictive power of demographic and co‐morbid conditions and prior high spending in determining the likelihood of future high spending. A better understanding of the persistence of health spending can inform the selection and evaluation of appropriate interventions to address high costs, and can help forecast the likelihood and severity of adverse selection in public and private programmes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134842/1/fisc12120_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134842/2/fisc12120.pd

Guaranteed renewability in insurance

We propose a guaranteed renewability (GR) insurance in which a sequence of premiums would enable insurers to break even and would be chosen by both low- and high-risk buyers, whether or not they had suffered a loss. The premium schedule would continually decline over time, as the insurer collects more information to determine who the low-risk buyers are. The highest premiums are charged initially to protect the insurer if low-risk individuals leave for the spot market. The concluding portion of the article discusses the limitations of a GR policy in the health and environmental liability area, the most serious being instability in estimates of underlying loss trends.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47916/1/11166_2005_Article_BF01083557.pd

Impacts of Geographic Distance on Peritoneal Dialysis Utilization: Refining Models of Treatment Selection

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/136011/1/hesr12489.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/136011/2/hesr12489-sup-0001-AuthorMatrix.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/136011/3/hesr12489_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/136011/4/hesr12489-sup-0002-Appendix.pd

WP 2019-397

Nursing home care is arguably the largest financial risk for the elderly without private or social insurance coverage. The annual out-of-pocket expenditure can easily exceed $70,000. Despite the substantial financial burdens on the elderly, the understanding of nursing home self-pay prices is rather sparse due to data limitation. To bridge the gap in the literature, we collected a unique and longitudinal price dataset from eight states, spanning from 2005 to 2010, to advance the understanding of the determinants and geographical variations of nursing home price and price growth. Overall, nursing home prices have consistently outpaced the inflation of consumer prices, particularly in California and Oregon. We also see faster price growth in markets where they face stricter capacity constraints and have higher for-profit market shares. Organizational structures are also significantly associated with price variations. We find that nonprofit nursing homes have higher prices than for-profit nursing homes and that chain-affiliated nursing homes charge higher prices than nonchains counterparts.U.S. Social Security Administration through the University of Michigan Retirement Research Center, award RRC08098401-09https://deepblue.lib.umich.edu/bitstream/2027.42/151935/1/wp397.pdfDescription of wp397.pdf : Working pape

Elastic constants and volume changes associated with two high-pressure rhombohedral phase transformations in vanadium

We present results from ab initio calculations of the mechanical properties of the rhombohedral phase (beta) of vanadium metal reported in recent experiments, and other predicted high-pressure phases (gamma and bcc), focusing on properties relevant to dynamic experiments. We find that the volume change associated with these transitions is small: no more than 0.15% (for beta - gamma). Calculations of the single crystal and polycrystal elastic moduli (stress-strain coefficients) reveal a remarkably small discontinuity in the shear modulus and other elastic properties across the phase transitions even at zero temperature where the transitions are first order.Comment: 6 pages, 3 figure

Persistent Variation in Medicare Payment Authorization for Home Hemodialysis Treatments

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142984/1/hesr12650-sup-0001-AppendixSA1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142984/2/hesr12650.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142984/3/hesr12650_am.pd