Short-term Fluctuations in Hospital Demand: Implications for Admission, Discharge, and Discriminatory Behavior

Abstract This paper develops a framework for examining how short-term fluctuations in demand affect hospitals' admission and discharge behavior. We develop a new test for discriminatory admissions practices from utilization data that, under certain circumstances, does not require control for underlying differences in treatment seeking behavior and health of different patient groups. We further show that regression or other analyses of differences in mean effects can contain logical flaws and are ill suited to detect discrimination when incentives to discriminate are created by limited capacity. Analysis of Oregon inpatient data indicates that patients are discharged earlier than expected on high demand days relative to low demand days. Consistent with discriminatory behavior, admissions and discharges for Medicaid patients are affected by capacity constraints

The COVID-19 pandemic and primary care appointment availability by physician age and gender

Using data generated through simulated patient calls to a national random sample of primary care physicians between February and July 2020, we examine the effects of the first wave of COVID-19 on the availability of the U.S. primary care physician workforce for routine new patient appointments. As states enacted stay-at-home orders, physicians overall became less selective by insurance, and there was a 7 percentage-point increase in acceptance of patient insurance. Telemedicine appointment offers increased 10.2 percentage points from near zero. However, relative to younger counterparts, physicians older than the sample mean (53.1 years) became 18.1 percentage points less likely to offer appointments and decreased their estimated appointment duration by 7.1 min. Compared to male physicians, female physicians became 10 percentage points more likely to accept new patients. These insights into appointment offers during the first wave of COVID-19 may help policymakers seeking to ensure an adequate physician workforce during future crises

Interpretative and predictive modelling of Joint European Torus collisionality scans

Transport modelling of Joint European Torus (JET) dimensionless collisionality scaling experiments in various operational scenarios is presented. Interpretative simulations at a fixed radial position are combined with predictive JETTO simulations of temperatures and densities, using the TGLF transport model. The model includes electromagnetic effects and collisions as well as □(→┬E ) X □(→┬B ) shear in Miller geometry. Focus is on particle transport and the role of the neutral beam injection (NBI) particle source for the density peaking. The experimental 3-point collisionality scans include L-mode, and H-mode (D and H and higher beta D plasma) plasmas in a total of 12 discharges. Experimental results presented in (Tala et al 2017 44th EPS Conf.) indicate that for the H-mode scans, the NBI particle source plays an important role for the density peaking, whereas for the L-mode scan, the influence of the particle source is small. In general, both the interpretative and predictive transport simulations support the experimental conclusions on the role of the NBI particle source for the 12 JET discharges

Insurance, Race/Ethnicity, and Sex in the Search for a New Physician

We employed simulated patient calls to a national random sample of primary care physicians to assess appointment availability for adults who differed by insurance, race/ethnicity, and sex. The disparities we found are much larger than those reported in previous assessments, highlighting the importance of including race/ethnicity and sex in such researc

A Clarification of Theories and Evidence on Supplier-Induced Demand for Physicians' Services

This article both simplifies and extends the literature on physician-induced demand. It shows that inducement should be expected in all imperfectly competitive markets that are also characterized by incomplete agency relationships. More important, it argues that confusion over the extent of the inducement phenomenon has been created by several contributions that fail to distinguish between the effects of changes in physician-population ratios on changes in the individual physician's output, and the effects on per-capita utilization. In particular, it demonstrates that, by confounding units of analysis, the major empirical results found in recent articles by Rossiter and Wilensky are contradicted by their model. Their evidence, however, together with findings from other studies, are reinterpreted to suggest that physicians are even more constrained, than is generally believed, in being able to induce increases in demand.

Monopoly Power, Ownership Control, and Corporate Performance

The performance criterion receiving the closest attention in the literature on "managerialism" is the rate of return on stockholders' equity. It is argued here that of more immediate concern to the shareholder is the rate of return on his investment in the stock of the firm. The determinants of ex post stock return are examined for evidence of managerial discretion. When the means by which managerial discretion may be manifested is correctly specified, the results show that the decisions of executives of management-controlled firms have conflicted with the interests of these firms' shareholders. Shareholders of owner-controlled firms have been provided with a significantly higher rate of return than shareholders of management-controlled firms.