Short-term and Long-term Racial Disparities in VA and non-VA Hospital Outcomes

This research used VA and Medicare data to examine racial patterns in short- and long-term mortality outcomes for elderly male black and white patients hospitalized for heart attack, stroke, hip fracture, congestive heart failure, gastrointestinal bleeding, and pneumonia from 1998 to 2002. The researchers found that at 30 days after admission for five of the six conditions, racial patterns in mortality outcomes were similar in VA and non-VA settings, with black patients having a survival advantage. Among Medicare patients, relative to the mortality outcomes for whites, mortality outcomes for black patients deteriorated over time until black Medicare patients had worse 2-year mortality for all conditions except congestive heart failure. In contrast, among VA patients, the relative decline in mortality for blacks was less marked and statistically significant only for hip fracture and stroke. These findings suggest that factors unrelated to hospital care play important roles in longer term mortality rates for the examined conditions. The findings also suggest that the integrated health care delivery system of the VA may attenuate racial disparities in health by mitigating the environmental factors that contribute to mortality for up to two years after hospitalization

The future of laboratory medicine - A 2014 perspective.

Predicting the future is a difficult task. Not surprisingly, there are many examples and assumptions that have proved to be wrong. This review surveys the many predictions, beginning in 1887, about the future of laboratory medicine and its sub-specialties such as clinical chemistry and molecular pathology. It provides a commentary on the accuracy of the predictions and offers opinions on emerging technologies, economic factors and social developments that may play a role in shaping the future of laboratory medicine

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.

Measuring the Effects of Workloss on Productivity With Team Production

Using data from a survey of 800 managers in 12 industries, we find empirical support for the hypothesis that the cost associated with missed work varies across jobs according to the ease with which a manager can find a perfect replacement for the absent worker, the extent to which the worker functions as part of a team, and the time sensitivity of the worker's output. We then estimate wage multipliers' for 35 different jobs, where the multiplier is defined as the cost to the firm of an absence as a proportion (often greater than one) of the absent worker's daily wage. The median multiplier is 1.28, which supports the view that the cost to the firm of missed work is often greater than the wage.

Taxed Structured Settlements

Congress has granted a tax subsidy to physically injured tort plaintiffs who enter into structured settlements. The subsidy allows these plaintiffs to exempt the investment yield imbedded within the structured settlement from federal income taxation. The apparent purpose of the subsidy is to encourage physically injured plaintiffs to invest, rather than presently consume, their litigation recoveries. Although the statutory subsidy by its terms is available only to physically injured tort plaintiffs, a growing structured settlement industry now contends that the same tax benefit of yield exemption is available to plaintiffs’ lawyers and nonphysically injured tort plaintiffs under general, common-law tax principles. If the structured settlement industry is correct, then all tort plaintiffs and their lawyers may invest their litigation proceeds in a tax-free manner simply by using structured payment arrangements. Structured arrangements, therefore, would be far superior to traditional tax-favored retirement accounts (e.g., 401(k)s, IRAs), which provide the same tax benefit of yield exemption but are subject to significant constraints. Accordingly, if proponents of structured arrangements are correct in their interpretation of the tax law, these arrangements can be described as “super-IRAs” because they provide full yield exemption without any corresponding limitations or restrictions. This Article examines the taxation of structured payment arrangements, ultimately concluding that the structured settlement industry’s positions are unpersuasive. Nevertheless, because of the muddled state of the tax law on the issue, this Article recommends legislative and administrative action to close the yield-exemption loophole with respect to its unintended beneficiaries

The Magnitude and Nature of Risk Selection in Employer-Sponsored Health Plans

Most existing studies of risk selection in the employer-sponsored health insurance market are case studies of a single employer or of an employer coalition in a single market. We examine risk selection in the employer-sponsored market by applying a switcher' methodology to a national, panel data set of enrollees in employer-sponsored health plans. We find that people who switched from a non-HMO to an HMO plan used 11 percent fewer medical services in the period prior to switching than people who remained in the non-HMO plan, and that this relatively low use persists once they enroll in an HMO. Furthermore, people who switch from an HMO to a non-HMO plan used 18 percent more medical services in the period prior to switching than those who remained in an HMO plan. HMOs would most likely continue to experience favorable risk selection if employers adjusted health plan payments based on enrollees' gender and age because the selection appears to occur based on enrollee characteristics that are difficult to observe such as preferences for medical care and health status.

The Health Effects of Medicare for the Near-Elderly Uninsured

We study how the trajectory of health for the near-elderly uninsured changes upon enrolling into Medicare at the age of 65. We find that Medicare increases the probability of the previously uninsured having excellent or very good health, decreases their probability of being in good health, and has no discernable effects at lower health levels. Surprisingly, we found Medicare had a similar effect on health for the previously insured. This suggests that Medicare helps the relatively healthy 65 year olds, but does little for those who are already in declining health once they reach the age of 65. The improvement in health between the uninsured and insured were not statistically different from each other. The stability of insurance coverage afforded by Medicare may be the source of the health benefit suggesting that universal coverage at other ages may have similar health effects.

Missing.... presumed at random: cost-analysis of incomplete data

When collecting patient-level resource use data for statistical analysis, for some patients and in some categories of resource use, the required count will not be observed. Although this problem must arise in most reported economic evaluations containing patient-level data, it is rare for authors to detail how the problem was overcome. Statistical packages may default to handling missing data through a so-called complete case analysis, while some recent cost-analyses have appeared to favour an available case approach. Both of these methods are problematic: complete case analysis is inefficient and is likely to be biased; available case analysis, by employing different numbers of observations for each resource use item, generates severe problems for standard statistical inference. Instead we explore imputation methods for generating replacement values for missing data that will permit complete case analysis using the whole data set and we illustrate these methods using two data sets that had incomplete resource use information

Neural competition via lateral inhibition between decision processes and not a STOP signal accounts for the antisaccade performance in healthy and schizophrenia subjects

A commentary on Re-starting a neural race: anti-saccade correction by Noorani, I., and Carpenter, R. H. S. (2014). Eur. J. Neurosci. 39, 159–164. doi: 10.1111/ejn.12396 Decision making is the process of accumulating evidence about the world and the utility of possible outcomes (Cutsuridis, 2010). A paradigm often used by behavioral neuroscientists to investigate decision processes is the antisaccade paradigm (see Figure 1A; Hallett, 1978). In the antisaccade paradigm subjects are required to suppress an erroneous saccade (error prosaccade) toward a peripheral stimulus and instead make an eye movement to a position in the opposite hemifield (antisaccade). The response repertoire of a subject performing the antisaccade task has been reported to be: (1) the subject makes an erroneous response (i.e., looking toward the peripheral stimulus), (2) the subject makes the antisaccade (i.e., looking in the opposite direction of the peripheral stimulus, and (3) the subject makes an erroneous response followed by a corrected antisaccade (Evdokimidis et al., 2002)

Heterogeneity in Residential Yard Care: Evidence from Boston, Miami, and Phoenix

The management of residential landscapes occurs within a complex socio-ecological system linking household decision-making with ecological properties, multi-scalar human drivers, and the legacy effects of past management. Conventional wisdom suggests that resource-intensive turf grass yards are the most common landscaping outcome, resulting in a presumed homogeneous set of residential landscaping practices throughout North America. We examine this homogenization thesis through an interview-based, cross-site study of residential landscape management in Boston, Phoenix, and Miami. Counter to the homogeneity thesis, we find that yard management practices often exhibit heterogeneity, for example, in groundcover choice or use of chemical inputs. The degree of heterogeneity in management practices varies according to the scale of analysis, and is the outcome of a range of constraints and opportunities to which households respond differently depending on their existing yard and landscaping preferences. This study highlights the importance of multi-scalar and cross-site analyses of decision-making in socio-ecological systems, and presents opportunities for longitudinal and cross-site research to examine the extent to which homogeneity is actually present in the management of residential landscapes over time and in diverse places