Category Archives: Health

Multitasking: Productivity Effects and Gender Differences

Posted on by
3

We examine how multitasking affects performance and check whether women are indeed better at multitasking. Subjects in our experiment perform two different tasks according to three treatments: one where they perform the tasks sequentially, one where they are forced to multitask, and one where they can freely organize their work. Subjects who are forced to multitask perform significantly worse than those forced to work sequentially. Surprisingly, subjects who can freely organize their own schedule also perform significantly worse. Finally, our results do not support the stereotype that women are better at multitasking. Women suffer as much as men when forced to multitask and are actually less inclined to multitask when being free to choose.

By: Thomas Buser (University of Amsterdam)
Noemi Peter (University of Amsterdam)
URL: http://d.repec.org/n?u=RePEc:dgr:uvatin:20110044&r=exp

The future of economic productivity inducing economic reform

Posted on by
4

Saul Eslake asked a bunch of people for comments on the recent Grattan Institute study of productivity and I sent him back a long email which I reproduce with some editing here. Nothing very surprising for people who are regular visitors here, but perhaps worth posting in case it provokes any thoughts.

  • We’ve done a lot of micro-economic reform in basic goods and services and it’s driven productivity up.
  • There’s only a bit more to do here.
  • What we do to follow up on that brings in sectors like health, education, government services of various kinds.

 
These areas are different in a variety of ways:

  • They are areas in which government is much more inextricably involved than they are in lots of the more easily ‘privatisable’ areas.
  • They’re areas in which it’s not nearly as clear how to reform things (though there are admittedly some self evidently destructive things that one can reform – like egregious incentives to cost shift in health).
  • They’re areas in which it is difficult and sometimes essentially impossible to measure productivity.
  • Indeed, I was intrigued by a blog post I recently blogged about myself that many of these sectors are not just producers of ‘credence goods’ to a substantial extent, which is to say they produce goods which the customer may never know the quality of (even after consuming them). They are goods where the practitioners are feeling their way also. A teacher for instance often doesn’t know what works but plugs away doing the best they can.
  • There’s a sense in the paper that ‘reform’ is fairly unproblematic, and I think the well of unproblematic problems is drying up. This amounts to more than saying that the low hanging fruit has been picked – though it has mostly been picked. It also means that further progress requires a lot more thought – not just action and bemoan  – or to change the metaphor the low hanging fruit has to a substantial extent been picked.
  • That having been said there are many areas of potential micro-economic reform that have barely been spoken about.  To give just one example, our legal system is a ramshackle mess requiring people to bet their life savings on resolving disputes, many of which could be solved much more fairly, quickly and cheaply by a better designed system.  That would have huge benefits for many other areas of economic activity where a range of rigidities exist simply because the legal system is so dysfunctional.  Anyway I’ve set out some possible areas in the attached piece I did for Crikey a while back.

Regulatory reform is currently virtually useless. 
Continue reading →

A clever index tells us we’re pretty healthy

Posted on by
22

How could you compare the health systems of the world in terms of outcomes with plausible verisimilitude, in other words by making assumptions that don’t just give you junk? I was sceptical when I read of this index, but think it’s a pretty good, though like any such exercise it’s not hard to see that it’s not perfect.  Anyway, Bob Hahn and Peter Passell’s regulation2point0 newsletter drew my attention to this paper. And this is how they explain the methodology.

In order to provide a more precise measure of the outcomes that may legitimately be attributed to health care interventions, researchers have developed the concept of “mortality amenable to health care”. Amenable  mortality  is  generally  defined  as  premature  deaths  that  should  not  occur  in  the  presence  of effective and timely care. It takes into account premature deaths for a list of diseases, for which effective health interventions are deemed to exist and might prevent deaths before a certain age limit (usually 75, though sometimes lower).
And here’s what the methodology – in two versions – says. I’ve not yet read the paper.

Legalise it?

Posted on by
17

Not so long ago economist Paul Frijters mused about drug legalisation here at Troppo.

It seems that Paul is an international trendsetter.  Now economist elder statesman Gary Becker and the world’s most prolific judge/legal academic Richard Posner are musing on the same topic at their joint blog.  Becker is unequivocally pro-legalisation though not especially analytical, while Posner attempts an economic analysis based on a recent paper by Miron and Waldock resulting in a couple of reservations and a proposed field study to resolve them:

Most important, the authors also do not consider the possible social benefits of prohibition. Prohibition reduces the consumption of mind-altering drugs. Of course there are mind-altering drugs that are not prohibited, and many of these are close substitutes. These include the numerous prescription drugs that have mind-altering effects very similar to those of the illegal drugs, and of course there is alcohol and cigarettes. Moreover, a tax on legalized drugs would raise the price to the consumer and thus moderate the effect of legalization on consumption. But if the tax is too high, it will result in reviving the illegal industry. And the authors probably underestimate the increased consumption that would result from a lower price or even the same price (brought about by a particularly stiff excise tax) because they don’t mention concerns with impurities and with the stigma of being a “drug addict” that are created by the prohibition and would be substantially reduced by its repeal.

The question would then be whether the external costs of increased consumption of mind-altering drugs would exceed the savings in law enforcement costs from legalization. It seems doubtful that marijuana consumption generates significant social costs, but legalizing it would generate only modest cost savings–$8.7 billion a year, according to the authors’ estimates. But cocaine, especially the crack form, along with heroin, ecstasy, LSD, methamphetamines, and perhaps others, may induce behavioral changes that cause social damage. Most leaders of black communities believe that rampant drug usage is highly destructive to their communities, and not only because of the gang activity that prohibition induces. Drug gangs would disappear with legalization and that would reduce the violence in those communities, but the effect might be more than offset by the effects of greater drug use.

Concern with the huge budget deficits of our federal, state, and local governments may gain the authors a more sympathetic reading than advocacy of repealing the drug laws usually does. From a budgetary standpoint, the authors are estimating an annual savings of almost $90 billion. But without an estimate of the social costs of increased drug usage, the path to repeal is blocked. It would a step in the right direction if the Justice Department would take the position that it will not enforce a federal drug law in any state that repeals its parallel prohibition of that drug; that way we might obtain experimental evidence of the social costs of illegal drugs.

NSW government criminologist Don Weatherburn addressed these questions in a recent address to the Medico-Legal Society of NSW.  It’s relatively short anyway but I’ve extracted the most relevant passages over the fold:

Continue reading →

Do Nurses Strikes Kill? (‘fraid so – as you’d expect)

Posted on by
4

From the NBER digest.

U.S. hospitals were excluded from collective bargaining laws for three decades longer than other sectors because of fears that strikes by nurses might imperil patients’ health. Today, while unionization has been declining in general, it is growing rapidly in hospitals, with the number of unionized workers rising from 679,000 in 1990 to nearly one million in 2008. In Do Strikes Kill? Evidence from New York State (NBER Working Paper No. 15855), co-authors Jonathan Gruber and Samuel Kleiner carefully examine the effects of nursing strikes on patient care and outcomes.

The researchers match data on nurses’ strikes in New York State from 1984 to 2004 to data on hospital discharges, including information on treatment intensity, patient mortality, and hospital readmission. They conclude that nurses’ strikes were costly to hospital patients: in-hospital mortality increased by 19.4 percent and hospital readmissions increased by 6.5 percent for patients admitted during a strike. Among their sample of 38,228 such patients, an estimated 138 more individuals died than would have without a strike, and 344 more patients were readmitted to the hospital than if there had been no strike. “Hospitals functioning during nurses’ strikes do so at a lower quality of patient care,” they write.

Still, at hospitals experiencing strikes, the measures of treatment intensity — that is, the length of hospital stay and the number of procedures performed during the patient’s stay — show no significant differences between striking and non-striking periods. Patients appear to receive the same intensity of care during union work stoppages as during normal hospital operations. Thus, the poor outcomes associated with strikes suggest that they might reduce hospital productivity.

These poor health outcomes increased for both emergency and non-emergency hospital patients, even as admissions of both groups decreased by about 28 percent at hospitals with strikes. The poor health outcomes were not apparent either before or after the strike in the striking hospitals, suggesting that they are attributable to the strike itself. And, the poor health outcomes do not appear to do be due to different types of patients being admitted during strike periods, because patients admitted during a strike are very similar to those admitted during other periods.

Hiring replacement workers apparently does not help: hospitals that hired replacement workers performed no better during strikes than those that did not hire substitute employees. In each case, patients with conditions that required intensive nursing were more likely to fare worse in the presence of nurses’ strikes.
“From Evidence on the Effects of Nurses’ Strikes” By Jonathan Gruber and Samuel A. Kleiner

Not-so-great Expectations

Posted on by
3

Ostensibly, Rudd’s reform package is about centralising funding and decentralising control. It may be that Rudd is drinking his own koolaid on this one. Previously I thought it was a package set up from the start in order to provide either to kill the Insulation Ignition Program or to provide a useful glittery centrepiece for the next election campaign when the premiers shot it down.

But no: he apparently wanted it to succeed this round. So a few billion dollars were promised to the premiers, and all of them accepted — except WA, possibly because they realise that they’ll be propping up the disasters in NSW, SA and the unavoidably expensive NT system.

But if Rudd believes that control will remain decentralised, he’s kidding himself. He’s forgotten the golden rule of politics: who has the gold, makes the rules. An even cursory examination of the management of higher education would make this clear. The passage of time has seen successive federal departments impose ever-more onerous regulation and stricture upon the universities. These self-governing institutions have been reduced to rather unflattering supplications in order to obtain their money-fix.

And so it will be with hospitals. Rudd has recreated everything bad about the federal higher education system: from the centralisation of power through money right down to centrally-planned price fixing.

Obama’s victory: a lesson for Rudd?

Posted on by
7

So Obama got his modest and compromised health care bill through Congress. For those who are more interested in policy than process, there’s a pretty helpful summary of the legislation here.  However, I hold the desirabilty of the reforms to be self-evident. The only serious issue is whether the timing is right, given the US Government’s fiscal problems. But if this is the country’s only window of opportunity in the foreseeable future to join the civilised world, then the risk of more macroeconomic tremors will have to be borne. The budget will just have to be sorted out later. And if the fiscal pressure hastens the Americans’ withdrawal from Afghanistan, so much the better.

Unfortunately this is one occasion when the process is more worthy of analysis than the policy, and while I have no pretensions as a commentator on US politics, there is a lesson here for the forces of enlightenment in Australia that can’t be ignored. First let’s review the salient aspects of the health care victory. Continue reading →

Krugman: another masterpiece about that strange country he lives in

Posted on by
13

Fear Strikes Out, by Paul Krugman, Commentary, NY Times

The day before Sunday’s health care vote, President Obama gave an unscripted talk to House Democrats. Near the end, he spoke about why his party should pass reform: “Every once in a while a moment comes where you have a chance to vindicate all those best hopes that you had about yourself, about this country, where you have a chance to make good on those promises that you made … And this is the time to make true on that promise. We are not bound to win, but we are bound to be true. We are not bound to succeed, but we are bound to let whatever light we have shine.”

And on the other side, here’s what Newt Gingrich, the Republican former speaker of the House — a man celebrated by many in his party as an intellectual leader — had to say: If Democrats pass health reform, “They will have destroyed their party much as Lyndon Johnson shattered the Democratic Party for 40 years” by passing civil rights legislation. …

I want you to consider the contrast: on one side, the closing argument was an appeal to our better angels, urging politicians to do what is right, even if it hurts their careers; on the other side, callous cynicism. Think about what it means to condemn health reform by comparing it to the Civil Rights Act. Who in modern America would say that L.B.J. did the wrong thing by pushing for racial equality? …

And that cynicism has been the hallmark of the whole campaign against reform. … For the most part,… opponents of reform didn’t even pretend to engage with the reality either of the existing health care system or of the moderate, centrist plan — very close in outline to the reform Mitt Romney introduced in Massachusetts — that Democrats were proposing.

Instead, the emotional core of opposition to reform was blatant fear-mongering, unconstrained either by the facts or by any sense of decency.

It wasn’t just the death panel smear. It was racial hate-mongering, like a piece in Investor’s Business Daily declaring that health reform is “affirmative action on steroids, deciding everything from who becomes a doctor to who gets treatment on the basis of skin color.” It was wild claims about abortion funding. It was the insistence that there is something tyrannical about giving young working Americans the assurance that health care will be available when they need it…

And let’s be clear: the campaign of fear hasn’t been carried out by a radical fringe, unconnected to the Republican establishment. On the contrary, that establishment has been involved and approving all the way. Politicians like Sarah Palin — who was, let us remember, the G.O.P.’s vice-presidential candidate — eagerly spread the death panel lie, and supposedly reasonable, moderate politicians like Senator Chuck Grassley refused to say that it was untrue. On the eve of the big vote, Republican members of Congress warned that “freedom dies a little bit today” and accused Democrats of “totalitarian tactics,” which I believe means the process known as “voting.”

Without question, the campaign of fear was effective… But the question was, would it actually be enough to block reform?

And the answer is no. The Democrats have done it. The House has passed the Senate version of health reform, and an improved version will be achieved through reconciliation.

This is, of course, a political victory for President Obama, and a triumph for Nancy Pelosi, the House speaker. But it is also a victory for America’s soul. In the end, a vicious, unprincipled fear offensive failed to block reform. This time, fear struck out.