Time-Inconsistency and Welfare

Self-control devices, such as rehabilitation programs, group commitment, and informal fines, can make time-inconsistent smokers better off. Health economists have used this result to argue in favor of cigarette taxes that restrain smoking. However, taxes alone are not Pareto-improving overall, because they benefit today's smoker at the expense of her future selves, who have less demand for self-control. We suggest an alternative class of taxation policies that provide selfcontrol and benefit a smoker at every point in life. Smokers could be allowed to purchase smoking licenses' when they start to smoke, and in exchange commit their future selves to face compensated cigarette taxes. We show that this scheme which could be made voluntary improves the welfare of current and future smokers, generates positive revenue for the government, and can be made incentive-compatible. Similar schemes can also be envisioned to address problems of timeinconsistency in other contexts.

Opportunities and Benefits as Determinants of the Direction of Scientific Research

Scientific research and private-sector technological innovation are different in terms of objectives, constraints, and organizational forms. For example, the for-profit objective that drives private-sector innovation is absent from much of scientific research, and individual researchers have many times more control in scientific research than in private-sector innovation. These differences and the lack of any obvious objective that would drive the direction of scientific research raise the possibility that the direction of scientific research is exogenous in the sense that it may not be influenced by factors such as the quality of research opportunities and the expected benefit from research that not only drive private-sector innovation but also in part determine the socially optimal allocation of research. Alternatively, some--yet largely unexplored--mechanisms drive also the direction of scientific research to respond to these factors. In this paper we test these two competing hypotheses of scientific research. In particular, we examine whether the composition of medical research responds to changes in disease prevalence and research opportunities. The extent of inventive activity is measured from the MEDLINE database on 16 million biomedical publications. We match these data with data on disease prevalence. We develop and apply a method for estimating the quality of research opportunities from structural productivity parameters. Our results show that the direction of medical research responds to changes in disease prevalence and research opportunities.

Does Medicare Benefit the Poor? New Answers to an Old Question

Previous research has found that Medicare benefits flow primarily to the most economically advantaged groups and that the financial returns to Medicare are consequently higher for the rich than for the poor. Taking a different approach, we find very different results. According to the Medicare Current Beneficiary Survey, the poorest groups receive the most benefits at any given age. In fact, the advantage of the poor in benefit receipt is so great that it easily overcomes their higher death rates. This leads to the result that the financial returns to Medicare are actually much higher for poorer groups in the population and that Medicare is a highly progressive public program. These new results appear to owe themselves to our measurement of socioeconomic status at the individual level, in contrast to the aggregated measures used by previous research.

Do Instrumental Variables Belong in Propensity Scores?

Propensity score matching is a popular way to make causal inferences about a binary treatment in observational data. The validity of these methods depends on which variables are used to predict the propensity score. We ask: "Absent strong ignorability, what would be the effect of including an instrumental variable in the predictor set of a propensity score matching estimator?" In the case of linear adjustment, using an instrumental variable as a predictor variable for the propensity score yields greater inconsistency than the naive estimator. This additional inconsistency is increasing in the predictive power of the instrument. In the case of stratification, with a strong instrument, propensity score matching yields greater inconsistency than the naive estimator. Since the propensity score matching estimator with the instrument in the predictor set is both more biased and more variable than the naive estimator, it is conceivable that the confidence intervals for the matching estimator would have greater coverage rates. In a Monte Carlo simulation, we show that this need not be the case. Our results are further illustrated with two empirical examples: one, the Tennessee STAR experiment, with a strong instrument and the other, the Connors' (1996) Swan-Ganz catheterization dataset, with a weak instrument.

Market Evidence of Misperceived Prices and Mistaken Mortality Risks

We construct and implement a test of rational consumer behavior in a highstakes financial market. In particular, we test whether consumers make systematic mistakes in perceiving their mortality risks. We implement this test using data from secondary life insurance markets where consumers with a lifethreatening illness sell their life insurance policies to firms in return for an up-front payment. We compare predictions from two models: one with consumers who correctly perceive their mortality risk, and one with consumers who are misguided about their life expectancy, and find that our data are most consistent with the predictions made by the second model.

Technology, Monopoly, and the Decline of the Viatical Settlements Industry

The viatical settlement industry provides an opportunity for terminally-ill consumers, typically HIV patients, to exploit a previously untapped source of equity in existing life insurance contracts to finance consumption and medical expenses. The 1996 introduction and dissemination of effecive anti-HIV medication reduced AIDS mortality, but also reduced viatical settlement prices, even holding fixed changes in life expectancy. Using Freedom of Information Act requests to state insurance regulatory agencies, we have assembled a unique dataset of over twelve thousand viatical transactions from firms licensed in states that regulate viatical settlement markets. We distinguish two explanations for falling prices---an increase in market power, and a change in market expectations about the likelihood of further improvements in HIV care. We find that both explanations have contributed to diminishing settlement prices over the last decade, but increased market power has been the more important driver in the most recent years. Our estimates imply that the increase in market power of firms reduced the value of life insurance holdings of HIV persons by about $1.0 billion.

The Link Between Public and Private Insurance and HIV-Related Mortality

As policymakers consider expanding insurance coverage for HIV+ individuals, it is useful to ask if insurance has any affect on health outcomes; and, if so, whether public insurance is as efficacious as private insurance in preventing premature deaths among HIV+ patients. Using data from a nationally representative cohort of HIV-infected persons receiving regular medical care, we estimate the impact of different types of insurance on mortality in this population. We find that ignoring observed and unobserved health status leads one to conclude (misleadingly) that insurance may not be protective for HIV patients. After accounting for observed and unobserved heterogeneity, insurance does protect against premature death, but private insurance is more effective than public coverage. The better outcomes associated with private insurance are attributable to the more restrictive prescription drug policies of Medicaid.

Seven Foundational Principles of Population Health Policy

In 2016, Keyes and Galea issued 9 foundational principles of population health science and invited further deliberations by specialists to advance the field. This article presents 7 foundational principles of population health policy whose intersection with health care, public health, preventive medicine, and now population health, presents unique challenges. These principles are in response to a number of overarching questions that have arisen in over a decade of the authors\u27 collective practice in the public and private sectors, and having taught policy within programs of medicine, law, nursing, and public health at the graduate and executive levels. The principles address an audience of practitioners and policy makers, mindful of the pressing health care challenges of our time, including: rising health-related expenditures, an aging population, workforce shortages, health disparities, and a backdrop of inequities rooted in social determinants that have not been adequately translated into formal policies or practices among the key stakeholders in population health. These principles are meant to empower stakeholders—whether it is the planner or the practitioner, the decision maker or the dedicated caregiver—and inform the development of practical tools, research, and education