Did the HMO Revolution Cause Hospital Consolidation?

During the 1990s US healthcare markets underwent a significant transformation. Managed care rose to become the dominant form of insurance in the private sector. Also, a wave of hospital consolidation occurred. In 1990, the mean population-weighted hospital Herfindahl-Hirschman Index (HHI) in a Health Services Area (HSA) was .19. By 2000, the HHI had risen to .26. This paper explores whether the rise in managed care caused the increase in hospital concentration. We use an instrumental variables approach with 10-year differences to identify the relationship between managed care penetration and hospital consolidation. Our results strongly imply that the rise of managed care did not cause the hospital consolidation wave. This finding is robust to a number of different specifications.

The Welfare Consequences of Hospital Mergers

In the 1990s the US hospital industry consolidated. This paper estimates the impact of the wave of hospital mergers on welfare focusing on the impact on consumer surplus for the under-65 population. For the purposes of quantifying the price impact of consolidations, hospitals are modeled as an input to the production of health insurance for the under-65 population. The estimates indicate that the aggregate magnitude of the impact of hospital mergers is modest but not trivial. In 2001, average HMO premiums are estimated to be 3.2% higher than they would have been absent any hospital merger activity during the 1990s. In 2003, we estimate that because of hospital mergers private insurance rolls declined by approximately .3 percentage points or approximately 695,000 lives with the vast majority of those who lost private insurance joining the ranks of the uninsured. Our estimates imply that hospital mergers resulted in a cumulative consumer surplus loss of over $42.2 billion between 1990 and 2001. It is estimated that all but a modest$95.4 million of the loss in consumer surplus is transferred from consumers to providers.

The Welfare Consequences of Hospital Mergers

In the 1990s the US hospital industry consolidated. This paper estimates the impact of the wave of hospital mergers on welfare focusing on the impact on consumer surplus for the under-65 population. For the purposes of quantifying the price impact of consolidations, hospitals are modeled as an input to the production of health insurance for the under-65 population. The estimates indicate that the aggregate magnitude of the impact of hospital mergers is modest but not trivial. In 2001, average HMO premiums are estimated to be 3.2% higher than they would have been absent any hospital merger activity during the 1990s. In 2003, we estimate that because of hospital mergers private insurance rolls declined by approximately .3 percentage points or approximately 695,000 lives with the vast majority of those who lost private insurance joining the ranks of the uninsured. Our estimates imply that hospital mergers resulted in a cumulative consumer surplus loss of over $42.2 billion between 1990 and 2001. It is estimated that all but a modest$95.4 million of the loss in consumer surplus is transferred from consumers to providers

‘We should change ourselves, but we can’t’: accounts of food and eating practices amongst British Pakistanis and Indians with type 2 diabetes

Objective(s). To look at food and eating practices from the perspectives of Pakistanis and Indians with type 2 diabetes, their perceptions of the barriers and facilitators to dietary change, and the social and cultural factors informing their accounts.Method. Qualitative, interview study involving 23 Pakistanis and nine Indians with type 2 diabetes. Respondents were interviewed in their first language (Punjabi or English) by a bilingual researcher. Data collection and analysis took place concurrently with issues identified in early interviews being used to inform areas of investigation in later ones.Results. Despite considerable diversity in the dietary advice received, respondents offered similar accounts of their food and eating practices following diagnosis. Most had continued to consume South Asian foods, especially in the evenings, despite their perceived concerns that these foods could be \u27dangerous\u27 and detrimental to their diabetes control. Respondents described such foods as \u27strength-giving\u27, and highlighted a cultural expectation to participate in acts of commensality with family/community members. Male respondents often reported limited input into food preparation. Many respondents attempted to balance the perceived risks of eating South Asian foodstuffs against those of alienating themselves from their culture and community by eating such foods in smaller amounts. This strategy could lead to a lack of satiation and is not recommended in current dietary guidelines.Conclusions. Perceptions that South Asian foodstuffs necessarily comprise \u27risky\u27 options need to be tackled amongst patients and possibly their healthcare providers. To enable Indians and Pakistanis to manage their diabetes and identity simultaneously, guidelines should promote changes which work with their current food practices and preferences; specifically through lower fat recipes for commonly consumed dishes. Information and advice should be targeted at those responsible for food preparation, not just the person with diabetes. Community initiatives, emphasising the importance of healthy eating, are also needed.<br /

Urbanization effects on leaf mining densities and leaf damage of white oak (Quercus alba) in Guilford County, North Carolina

The urban habitat is the fastest growing ecosystem on Earth. Some organisms may respond to urbanization negatively by becoming locally extinct, while others respond positively and increase in numbers or densities. Leaf miners are insects whose larvae eat and live inside the leaves of plants until they pupate and emerge as adults. White Oak (Quercus alba) trees are common hardwood trees in Guilford County, and are well known hosts of leaf miners. In this study, the effects of urbanization on leaf miners and leaf damage by other herbivorous insects on white oak trees was examined. Six urban and rural parks were selected for investigation. In each park, three trees were selected and 50 leaves were picked at random for analysis. I hypothesized that leaf damage will be lower and leaf miner density will be higher in urban than rural areas. Leaf damage was significantly lower in urban areas than rural areas. Leaf miner abundance was lower in urban areas, but not significantly so. The mechanisms for lower leaf damage and possibly lower leaf miner densities in urban areas should be examined more in detail. The different type of leaf damage (e.g., chewers, skeletonizers, sap feeders, etc.) should also be investigated to test if urbanization differently affects insect feeding guilds

Phylogenetic analysis and molecular evolution of the dormancy associated MADS-box genes from peach

BACKGROUND: Dormancy associated MADS-box (DAM) genes are candidates for the regulation of growth cessation and terminal bud formation in peach. These genes are not expressed in the peach mutant evergrowing, which fails to cease growth and enter dormancy under dormancy-inducing conditions. We analyzed the phylogenetic relationships among and the rates and patterns of molecular evolution within DAM genes in the phylogenetic context of the MADS-box gene family. RESULTS: The peach DAM genes grouped with the SVP/StMADS11 lineage of type II MIKC(C )MADS-box genes. Phylogenetic analyses suggest that the peach SVP/StMADS11-like gene family, which contains significantly more members than annual model plants, expanded through serial tandem gene duplication. We found evidence of strong purifying selection acting to constrain functional divergence among the peach DAM genes and only a single codon, located in the C-terminal region, under significant positive selection. CONCLUSION: Because all DAM genes are expressed in peach and are subjected to strong purifying selection we suggest that the duplicated genes have been maintained by subfunctionalization and/or neofunctionalization. In addition, this pattern of selection suggests that the DAM genes are important for peach growth and development

Crowdfunding: Geography, Social Networks, and the Timing of Investment Decisions

We examine a crowdfunding platform that connects artists with funders. Although the Internet reduces many distance-related frictions, local and distant funders exhibit different funding patterns. Local funders appear less responsive to information about the cumulative funds raised by an artist. However, this distance effect appears to proxy for a social effect: it is largely explained by funders who likely have an offline social relationship with the artist (“friends and family”). Yet, this social effect does not persist past the first investment, suggesting that it may be driven by an activity like search but not monitoring. Thus, although the platform seems to diminish many distance-sensitive costs, it does not eliminate all of them. These findings provide a deeper understanding of the abilities and limitations of online markets to facilitate transactions and convey information between buyers and sellers with varying degrees of social connectedness

Local and regional ecological morphology of dung beetle assemblages across four biogeographic regions

Aim Niche partitioning within species assemblages is thought to influence species packing and/or total niche space occupied. The evolution of dung beetles (Scarabaeinae) is likely to have been strongly influenced by inter-specific competition, leading to niche partitioning. We consider whether local-scale processes leave a signature in regional patterns of functional diversity in dung beetle assemblages, and investigate the correlation between total exploited ecomorphological space and density of species packing with increased species richness. We test whether ecomorphological space occupied by local assemblages reflects that of their regional species pool, and the extent to which ecomorphological space is convergent or divergent within functional groups across regional pools. Location Neotropics, Africa, Australia and Madagascar. Methods Dung beetle assemblages were collected in a standardized manner from four biogeographic regions. Ecomorphological similarity among the assemblages was assessed by multivariate analysis of 19 linear measurements for 300 species and three functional nesting types (roller, tunneller or dweller), firstly on a local level within the Neotropics and Afrotropics, and then between the regional species pools. Results Key body measurements, in particular the hind tibia, separated rollers and tunnellers into largely non-overlapping entities along the first three axes of the shape analysis. Three Neotropical assemblages, which vary widely in species numbers, each harboured a similar amount of morphometric variation, resulting in increasingly dense species packing with greater species richness. Similar findings were obtained in two South African assemblages. Assemblages in the four biogeographic regions showed largely similar distributions of ecomorphological variation, including the separation of rollers and tunnellers, despite their distant phylogenetic relationships. Ecomorphological similarity among regions was particularly high in tunnellers, whilst the rollers exhibited greater regional differentiation. Main conclusions Local assemblages evidently represent the full diversity of functional groups available in the regional pool, even in species-poor assemblages. There is a strong trend towards convergence in morphology separating tunnellers and rollers in phylogenetically independent lineages. The ecomorphological similarity of regional assemblages suggests that morphological convergence is the result of common selective forces active within the assemblages themselves. This lends support to the widely hypothesized effect of inter-specific interactions and niche partitioning in determining assemblage composition and lineage evolution in the Scarabaeinae. © 2011 Blackwell Publishing Ltd