File this under the "duh!" category: research suggests relationship issues reduce the quality of sleep, and poor quality of sleep reduces relationship issues. This is an example of the famous "sleep fights" made famous in my circles by a couple that, er, wasn't immune to relationship issues.
The other remark is that married women seem to have better-quality sleep than those who are never married, widowed, etc. You would think the latter comparison would be best made between currently married women and widows several years after the widowing, with the hope that ideally the widowing death would have been basically random and not long-lasting in its inducing of insomnia. Maybe never-married people don't get married because they can't sleep!
Wednesday, June 10, 2009
Politics intrude: Regional variations in health spending II
An article on June 8 discussed political reactions to the New Yorker piece I blogged about last week. Apparently the article got the attention of White House policymakers.
It is absolutely right that the Dartmouth Health Atlas research to which many folks (not the article so much) refer doesn't yet offer a positive result. All it points out is that there are vast differences between cities, counties, and states in Medicare spending. Gawande offers a suggestion about what he thinks may be driving it: the profitability to individual doctors of running more tests and getting reimbursed.
It seems to me that vast harm could descend from policies that seek to level the spending field while not attacking root-level reasons. Suppose we capped Medicare payments. If it's an annual cap, it's clear that profit-seeking doctors would just accelerate their procedures and claims to be the first to be reimbursed. Same probably for a monthly cap. If it's a per-hospital cap, that sounds more watertight, but it wouldn't prevent doctors from closing up shop and moving elsewhere, presumably under the radar once again.
If it's an evidence-based cap with data on initial underlying health conditions and outcomes, that would seem like a better solution. Sicker populations ought to get more spending and would under such a system. (This leaves aside the sticky question of whether you're maximizing life years, in which case you might not necessarily want to spend more on the sick, or pursuing social justice.) But the data and reporting requirements for such a cap would be large, and there's no guarantee doctors and hospitals would report it accurately.
It is absolutely right that the Dartmouth Health Atlas research to which many folks (not the article so much) refer doesn't yet offer a positive result. All it points out is that there are vast differences between cities, counties, and states in Medicare spending. Gawande offers a suggestion about what he thinks may be driving it: the profitability to individual doctors of running more tests and getting reimbursed.
It seems to me that vast harm could descend from policies that seek to level the spending field while not attacking root-level reasons. Suppose we capped Medicare payments. If it's an annual cap, it's clear that profit-seeking doctors would just accelerate their procedures and claims to be the first to be reimbursed. Same probably for a monthly cap. If it's a per-hospital cap, that sounds more watertight, but it wouldn't prevent doctors from closing up shop and moving elsewhere, presumably under the radar once again.
If it's an evidence-based cap with data on initial underlying health conditions and outcomes, that would seem like a better solution. Sicker populations ought to get more spending and would under such a system. (This leaves aside the sticky question of whether you're maximizing life years, in which case you might not necessarily want to spend more on the sick, or pursuing social justice.) But the data and reporting requirements for such a cap would be large, and there's no guarantee doctors and hospitals would report it accurately.
Tuesday, June 9, 2009
Macroeconomics and politics in Iran
Today's New York Times includes an article reporting on the macroeconomic conditions in Iran, which are mixed. Back in February, the New Yorker ran an article about economics in Iran.
As forecast by the IMF, Iranian GDP growth in 2009 sounds relatively high at 3.2 percent. But population growth is around 1.5 percent, dragging per capita income growth down to 1.7.
Inflation has been a larger concern for some time. The Iranian Central Bank reports CPI inflation running 15.5% over a year earlier. I think the Times article cites the difference between annual averages in (roughly) 2007 and 2008, which is a figure more like 25.4%, up from 18.4% the previous year.
The last time inflation approached 20% was in the U.S. was in early 1947.
As forecast by the IMF, Iranian GDP growth in 2009 sounds relatively high at 3.2 percent. But population growth is around 1.5 percent, dragging per capita income growth down to 1.7.
Inflation has been a larger concern for some time. The Iranian Central Bank reports CPI inflation running 15.5% over a year earlier. I think the Times article cites the difference between annual averages in (roughly) 2007 and 2008, which is a figure more like 25.4%, up from 18.4% the previous year.
The last time inflation approached 20% was in the U.S. was in early 1947.
Monday, June 8, 2009
An update on Sen's "missing women"
A recent article cites a new study by Siwan Anderson and Debraj Ray on missing women around the world, following in the footsteps of Amartya Sen, who famously remarked about the trend back in the 1990s.
The "economics" of sports concussions
Yesterday's Times included an article about sports concussions among people under age 18 that highlighted the behavioral economics of the condition. While a majority of neurologists recommended strict rules that prohibit the return of athletes to the playing field following a concussion, a minority of them pointed out that such rules also encapsulate a perverse incentive for the athlete, namely not to report or admit having a concussion so as to avoid benching.
An additional likelihood is that an athlete suffering a concussion would probably be a little less capable of rational thought, but I imagine that would only increase the chance that he or she would decide to conceal the condition when possible.
An additional likelihood is that an athlete suffering a concussion would probably be a little less capable of rational thought, but I imagine that would only increase the chance that he or she would decide to conceal the condition when possible.
Wednesday, June 3, 2009
Macroeconomics in theory vs. practice
Greg Mankiw writes about business school vs. econ department macroeconomists in response to a question from David Brooks, while Steve Levitt criticizes the subdiscipline for choosing to take the mathematical route toward understanding the macroeconomy, when it isn't apparent that's the best way.
It's always seemed a little strange to me how theoretical microeconomics gets its own field in Ph.D studies, sometimes just called "theory," while there are many more applied micro fields. In macro, you have both types of folks crushed together all under one tent. It's arguably much more difficult to do either job well in macro anyway; Levitt points out that there's just less macro data (which is probably why a lot of "macro" folks actually use individual-level data these days), and the whole economy is a lot harder to model theoretically than just a part of it.
Several years ago, Greg Mankiw wrote a very nice piece in the J. Econ Perspectives about the dual roles or two types of macroeconomist, discussing along the way how they came to be quite so distinct.
I'd like to see a renaming of "macroeconomics" in which we are clearer about what we often really mean: "banks, money, and fiscal policy" or something similar. There are macroeconomists in all kind of other subfields whose research is less directly relevant for macroeconomic policy per se. Like health and demography, just to take a totally random example.
It's always seemed a little strange to me how theoretical microeconomics gets its own field in Ph.D studies, sometimes just called "theory," while there are many more applied micro fields. In macro, you have both types of folks crushed together all under one tent. It's arguably much more difficult to do either job well in macro anyway; Levitt points out that there's just less macro data (which is probably why a lot of "macro" folks actually use individual-level data these days), and the whole economy is a lot harder to model theoretically than just a part of it.
Several years ago, Greg Mankiw wrote a very nice piece in the J. Econ Perspectives about the dual roles or two types of macroeconomist, discussing along the way how they came to be quite so distinct.
I'd like to see a renaming of "macroeconomics" in which we are clearer about what we often really mean: "banks, money, and fiscal policy" or something similar. There are macroeconomists in all kind of other subfields whose research is less directly relevant for macroeconomic policy per se. Like health and demography, just to take a totally random example.
Monday, June 1, 2009
Another look at the sources of health care cost increases
I guarantee you'll feel more like a communist --- and I mean that in a good way --- after you read Atul Gawande's latest piece in the New Yorker. He argues that patterns of considerably higher medical costs and higher rates of cost inflation in one Texas border county as compared with a neighboring county suggest that the economic motivation of hospitals and doctors are key.
Some usual suspects, at least that produce higher cost levels but not necessarily growth rates, are sicker populations and differences in medical training. The latter is kind of what Gawande is talking about, because he cites the Mayo clinic and other organizations that put physicians on salaries and then "team-heal" their patients, which is similar to the style of practice one would learn in medical school. This in contrasted with the model in which physicians order procedures and tests for patients and then pocket whatever Medicare or insurance reimburses themselves individually --- what Gawande believes is driving higher costs in one border county.
It's hard to believe the problem would be attributable to just one element of caregiving, but Gawande makes a pretty impressive case for it. What I found interesting was his vignette about how his own (New England) training was for more cautious, perhaps unfoundedly so, medicine than what he and his family received while on vacation in another part of the country. He didn't really address how important that might be, and one certainly suspects that it might be important for high-cost but also probably low-profit areas like New York City.
Some usual suspects, at least that produce higher cost levels but not necessarily growth rates, are sicker populations and differences in medical training. The latter is kind of what Gawande is talking about, because he cites the Mayo clinic and other organizations that put physicians on salaries and then "team-heal" their patients, which is similar to the style of practice one would learn in medical school. This in contrasted with the model in which physicians order procedures and tests for patients and then pocket whatever Medicare or insurance reimburses themselves individually --- what Gawande believes is driving higher costs in one border county.
It's hard to believe the problem would be attributable to just one element of caregiving, but Gawande makes a pretty impressive case for it. What I found interesting was his vignette about how his own (New England) training was for more cautious, perhaps unfoundedly so, medicine than what he and his family received while on vacation in another part of the country. He didn't really address how important that might be, and one certainly suspects that it might be important for high-cost but also probably low-profit areas like New York City.
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