Quality Improvement in Health Care: A Framework for Price and Output Measurement

The durability of health care treatment, the substantial technical change in health care treatment, and the prevalence of third-party payment interact to create substantial difficulty in measuring the price and output of health care. This paper provides a framework for analyzing the demand for health care taking into account these difficulties. It then suggests how this framework might be used to improve measurement of health care prices and output.

Alternative strategies for aggregating prices in the CPI

Consumer price indexes ; Prices

A homoleptic phosphine adduct of Tl(I)

A homoleptic phosphine adduct of thallium(I) supported by a tris(phosphino)borate ligand has been isolated and structurally characterized

The effect of organic versus chemical fertilizers on insect pathogens

Insects such as the black cutworm are a major pest of seedling corn in Corn Belt states. Both the nematode Steinernema carpocapsae and the fungus Beauveria bassiana are potential biological control agents of this pest Because their survivability depends on moisture and they are affected adversely by nitrogen compounds, this project studied the effects of various fertilizers (fresh cow manure, composted cow manure, and urea) on these insect-killing organisms. Results showed that S. carpocapsae is more active in soils with no fertilizer amendment or with composted manure than with fresh manure or chemical fertilizer; B. bassiana is adversely affected by fresh manure. Investigation of factors that may enhance dispersal (which in turn may be a determining factor in the success of biological control) found that dispersal of two species of insect-killing nematodes was increased in the presence of earthworms

Individual Canine Airway Response Variability to a Deep Inspiration

In healthy individuals, a DI can reverse (bronchodilation) or prevent (bronchoprotection) induced airway constriction. For individuals with asthma or COPD, these effects may be attenuated or absent. Previous work showed that the size and duration of a DI affected the subsequent response of the airways. Also, increased airway tone lead to increased airway size variability. The present study examined how a DI affected the temporal variability in individual airway baseline size and after methacholine challenge in dogs using High-Resolution Computed Tomography. Dogs were anesthetized and ventilated, and on 4 separate days, HRCT scans were acquired before and after a DI at baseline and during a continuous intravenous infusion of methacholine (Mch) at 3 dose rates (17, 67, and 200 μg/min). The Coefficient of Variation was used as an index of temporal variability in airway size

Generating Non-Standard Multivariate Distributions with an Application to Mismeasurement in the CPI

This paper shows how to generate the joint distribution of correlated random variables with specified marginal distributions. For cases where the marginal distributions are either normal or lognormal, it shows how to calculate analytically the correlation of the underlying normal distributions to induce the desired correlation between the variables. It also provides a method for calculating the joint distribution in the case of arbitrary marginal distributions. The paper applies the technique to calculating the distribution of the overall bias in the consumer price index. The technique should also be applicable to estimation by simulated moments or simulated likelihoods and to Monte Carlo analysis.

Alternative Strategies for Aggregating Prices in the CPI

The Consumer Price Index does not take into account the fact that consumers alter the composition of their purchases in response to changes in relative prices. This substitution effect will cause the CPI to grow faster than the cost of living. This paper presents new estimates showing that this bias in the CPI averaged 0.3 percentage points per year between December 1986 and December 1995. This bias could be eliminated by using a superlative index to aggregate prices across the item-area strata of the CPI. The paper discusses the practical difficulties in implementing such a calculation and suggests a method for overcoming them. In particular, it shows how to construct an accurate approximation to a superlative price index that can be published with the same timeliness as the CPI.

Mismeasurement in the Consumer Price Index: An Evaluation

A number of analysts have claimed recently that the consumer price index overstates the annual increase in the cost of living. This paper develops a framework for studying measurement problems in the consumer price index and systematically analyzes the available evidence concerning the magnitude of these problems. It concludes that the CPI overstates increases in the cost of living. The evidence suggests that the bias is centered on 1.0 percentage point per year. The extent of this bias is not known exactly. To take into account this uncertainty, the estimated bias is presented in terms of a probability distribution rather than a point estimate or range. We estimate that there is a 10 percent chance that the bias is less than 0.6 percentage point and a 10 percent chance that it is greater than 1.5 percentage points per year. CPI procedures overstate the rate of inflation for medical procedures that are subject to technological improvement. To illustrate this point and to show how better to measure medical care prices, the paper presents a prototypical price index for cataract surgery. This price index grows much more slowly than a price index for cataract surgery constructed using the methodology of the CPI. The paper discusses implications of CPI mismeasurement for monetary and fiscal policy as well as for other official statistics. It also offers some suggestions for improving the CPI.