With the rising middle class, increasing purchasing power and a better functioning used car market, the number of households owning a vehicle in Chennai has increased dramatically since my last visit (2004). This was one of the first things I noticed upon landing here a few weeks back.
Unfortunately, both the roads (number and quality) and parking spots (number) have not kept pace with these changes. As a result, its a real hassle to find parking in the city centers. People end up parking anywhere they please and that disrupts the already unruly traffic.
In this situation, what is completely baffling is the fact that the city-set price for parking has not changed appreciably in a very long time. In most areas of Chennai it is free and in some of the city centers, its about Rs. 10 for an entire day (less than $1 in purchasing power terms). In a normal functioning market, you'd expect the price of parking to increase since supply has remained the same and demand has increased. (I would also argue that the market clearing price of parking should reflect externalities conferred on other drivers, such as the annoyance of having to walk an extra two blocks to get to the Music Academy and the disruption of traffic on the still-thin roadways).
At some point, the city government needs to charge more for parking. Rs 10 is well below the market clearing price and it really sucks right now to park, drive, get anywhere in the city.
Tuesday, July 31, 2007
Thursday, July 26, 2007
On Height
In Blink, Malcolm Gladwell points out that men over six feet tall are more than disproportionately represented among the ranks of Fortune 500 CEOs. He attributes this to something called the “Warren Harding Error,” where individuals make a positive or negative snap-judgment based on physical attributes. In this case, Gladwell claims that we subconsciously attach positive attributes - competence, bravery and other niceties - to height. (The Warren Harding reference speaks to the fact that these snap judgments can be quite wrong. At least with respect to height, for every James Hudspeth there is a Warren Harding. The former is one sharp bloke; the latter was the one of the worst presidents the
Wednesday, July 25, 2007
Review: Icky Thump, White Stripes
Jack White, why do you make such great music? Meg White, ...
Never mind.
Icky Thump is the latest offering in the series of earnest, stripped-down, fun rock-n-roll albums put out by the Stripes. Do you like primal drumbeats, power chords, great lyrics and good variety? How about all that with bagpipes? If you answered yes to the above, you need to listen to this album!
I've been through about 10 listens of this album so far, in locations as diverse as Heathrow airport, the metro in Copenhagen, during a run on Chennai beach, and while getting lost and traversing through an urban slum. For some reason, Thump provided an appropriate soundtrack for each of these experiences, though there is no a priori reason why anyone would think this would be possible.
I think part of the reason Thump works so well is the combination of deep lyrics and the variety. The latter is simply remarkable. Heavy-ish songs like Bone Broke, Little Cream Soda, Rag and Bone are both up-tempo and introspective all at once. These are set against equally introspective but considerably lighter versions, the favorites of mine being 300 MPH Torrential Outpour Blues and Prickly Thorn, But Sweetly Worn. The latter sounds like a Scottish folk-tune.
Of course, the title song, describing an interesting trip through Mexico (see the youtube video!) is phenomenal. My favorite verse is the following:
Well, Americans: What, nothin' better to do?
Why don't you kick yourself out?
You're an immigrant too.
Who's usin' who?
What should we do?
Well you can't be a pimp
And a prostitute too
One could easily imagine this being directed at those curmudgeony and ultimately silly Senate Republicans who oppose the President's stance on immigration.
I give this album 8.5/10. Go listen to it....NOW!
Never mind.
Icky Thump is the latest offering in the series of earnest, stripped-down, fun rock-n-roll albums put out by the Stripes. Do you like primal drumbeats, power chords, great lyrics and good variety? How about all that with bagpipes? If you answered yes to the above, you need to listen to this album!
I've been through about 10 listens of this album so far, in locations as diverse as Heathrow airport, the metro in Copenhagen, during a run on Chennai beach, and while getting lost and traversing through an urban slum. For some reason, Thump provided an appropriate soundtrack for each of these experiences, though there is no a priori reason why anyone would think this would be possible.
I think part of the reason Thump works so well is the combination of deep lyrics and the variety. The latter is simply remarkable. Heavy-ish songs like Bone Broke, Little Cream Soda, Rag and Bone are both up-tempo and introspective all at once. These are set against equally introspective but considerably lighter versions, the favorites of mine being 300 MPH Torrential Outpour Blues and Prickly Thorn, But Sweetly Worn. The latter sounds like a Scottish folk-tune.
Of course, the title song, describing an interesting trip through Mexico (see the youtube video!) is phenomenal. My favorite verse is the following:
Well, Americans: What, nothin' better to do?
Why don't you kick yourself out?
You're an immigrant too.
Who's usin' who?
What should we do?
Well you can't be a pimp
And a prostitute too
One could easily imagine this being directed at those curmudgeony and ultimately silly Senate Republicans who oppose the President's stance on immigration.
I give this album 8.5/10. Go listen to it....NOW!
Monday, July 23, 2007
Harry Potter and the Ruined Suspense
I ended up giving my copy of the 7th Harry Potter book to my cousin for his birthday, thus renewing my pledge to wait till September to read the American version of the novel. Of course, the very day the books comes out, I have the entire story recited to me by several individuals even after I requested that this not be done. No spoilers in this entry, but here are some things that definitely did not happen in the 7th installment:
-Harry gets bored of saving the world and decides to become a professional quidditch player in the United States. He does a commercial with Lebron James, marries a supermodel and gets blue contact lenses. Sadly, he no longer has his mother's eyes.
-Hermione decides she is way too good for Ron and unceremoniously dumps him for Harry. Harry refuses and Hermione becomes the Prime Minister of England.
-Voldemort beats Harry and uses the spoils of war to fund a huge NGO that distributes ARVs to HIV/AIDS patients in Africa.
I figured that, even if the ending was spoiled for me, I'd still be excited read the book. After all, I can watch the same Super Bowl over and over and over even though I know the outcome and score. For some reason though, I am completely indifferent now as to when I read this book. Yuck.
-Harry gets bored of saving the world and decides to become a professional quidditch player in the United States. He does a commercial with Lebron James, marries a supermodel and gets blue contact lenses. Sadly, he no longer has his mother's eyes.
-Hermione decides she is way too good for Ron and unceremoniously dumps him for Harry. Harry refuses and Hermione becomes the Prime Minister of England.
-Voldemort beats Harry and uses the spoils of war to fund a huge NGO that distributes ARVs to HIV/AIDS patients in Africa.
I figured that, even if the ending was spoiled for me, I'd still be excited read the book. After all, I can watch the same Super Bowl over and over and over even though I know the outcome and score. For some reason though, I am completely indifferent now as to when I read this book. Yuck.
Friday, July 20, 2007
Kanchipuram Saris, Child Labor and Development
My aunt recently spoke to a sari salesman/weaver of the famous Kanchipuram silk saris about his trade. Some background: Tamil Nadu is one of the fastest growing states in India both in terms of economic and human development. Improvements in the latter - which include better population health and nutrition, lower fertility and increased (reduced) school enrollment (dropout) rates - really gained velocity about 20-25 years back.
The sari salesman pointed out that these developments may have had adverse impacts on his trade. Sari weaving skills are passed down from generation to generation. However, for the youngest generation, the opportunity cost for investing in sari weaving skills has become very high: jobs in the service and growing manufacturing sector are growing in number and offer better lifetime returns to human capital investments. Because such jobs require schooling, the incidence of child labor in the state has declined as well, since returns to education, real or perceived, have increased. Because much of the Kanchipuram silk industry relies on child labor, this is bad for the trade.
It's an interesting story about how traditional arts and skills are fundamentally affected by economic development. The sari salesman seemed to think that, within a few years, Kanchipuram saris would cease to exist. I'm not so sure how this will play out, but here are a few thoughts:
-I wonder if sari manufacturers are offering higher wages to draw in labor. Similarly, I wonder if these costs are being passed on to consumers.
-How do we value the loss of traditional values and arts in the context of economic development? If people begin to value these goods less through the market and as a result of development, is there anything to worry about? Should these aspects be included in computing an overall development GDP in the same way various parties suggest we include improvements in life expectancy or happiness?
The sari salesman pointed out that these developments may have had adverse impacts on his trade. Sari weaving skills are passed down from generation to generation. However, for the youngest generation, the opportunity cost for investing in sari weaving skills has become very high: jobs in the service and growing manufacturing sector are growing in number and offer better lifetime returns to human capital investments. Because such jobs require schooling, the incidence of child labor in the state has declined as well, since returns to education, real or perceived, have increased. Because much of the Kanchipuram silk industry relies on child labor, this is bad for the trade.
It's an interesting story about how traditional arts and skills are fundamentally affected by economic development. The sari salesman seemed to think that, within a few years, Kanchipuram saris would cease to exist. I'm not so sure how this will play out, but here are a few thoughts:
-I wonder if sari manufacturers are offering higher wages to draw in labor. Similarly, I wonder if these costs are being passed on to consumers.
-How do we value the loss of traditional values and arts in the context of economic development? If people begin to value these goods less through the market and as a result of development, is there anything to worry about? Should these aspects be included in computing an overall development GDP in the same way various parties suggest we include improvements in life expectancy or happiness?
Praise
I found out yesterday that Joe Theismann (of the NFL and ESPN fame) reads the blog! Here is what he had to say:
"I think 'Dar he Blogs' is one of the best blogs I've ever seen. Nobody is blogging this often and this well right now. I recently talked to some of the pioneers of blogging and they agreed.
Also, I think the font used in 'Dar he Blogs' is the best font ever. I recently talked to Gutenberg, the guy who made type-set fonts possible, and he agreed that very few blogs use fonts so effectively. I really love this blog."
(credit to the Sportsguy)
"I think 'Dar he Blogs' is one of the best blogs I've ever seen. Nobody is blogging this often and this well right now. I recently talked to some of the pioneers of blogging and they agreed.
Also, I think the font used in 'Dar he Blogs' is the best font ever. I recently talked to Gutenberg, the guy who made type-set fonts possible, and he agreed that very few blogs use fonts so effectively. I really love this blog."
(credit to the Sportsguy)
Harry Potter Mania
Before coming to India, I resolved that I would wait till September to purchase and read the American version of the new Harry Potter book. That resolution didn't last too long. After being bombarded with advertisements for "Deathly Hollows," I decided to brave the lines this morning and attempt to purchase a copy of the book. I figure the British and American versions can't be too different.
It turns out that I succeeded. There are a few large bookstores here, with Landmark and Higginbotham's among the most popular. Anticipating huge lines, I scouted out smaller bookstores and found a Higginbotham's satellite store about 0.5 km from where I am staying. A few days of observation revealed that crowds (on a typical day) were minimal. I found my target.
I got up this morning around 6 AM to go wait in line for the book. I head to the store and....no line. Not only that, I was the only one in the store! Everyone else had pre-ordered their copies and I was able to get an unclaimed copy for myself..it was almost too easy.
There is one small disappointment: I was kind of looking forward to exchanging elbows with Indian parents and their children while fighting for a coveted copy of the book.
(Ed: I will NOT talk about the 7th book until Jan 2008, so as not to spoil the ending for anyone. See? We at the blog care about YOU)
It turns out that I succeeded. There are a few large bookstores here, with Landmark and Higginbotham's among the most popular. Anticipating huge lines, I scouted out smaller bookstores and found a Higginbotham's satellite store about 0.5 km from where I am staying. A few days of observation revealed that crowds (on a typical day) were minimal. I found my target.
I got up this morning around 6 AM to go wait in line for the book. I head to the store and....no line. Not only that, I was the only one in the store! Everyone else had pre-ordered their copies and I was able to get an unclaimed copy for myself..it was almost too easy.
There is one small disappointment: I was kind of looking forward to exchanging elbows with Indian parents and their children while fighting for a coveted copy of the book.
(Ed: I will NOT talk about the 7th book until Jan 2008, so as not to spoil the ending for anyone. See? We at the blog care about YOU)
Thursday, July 19, 2007
A Day in the Life
Doing research in India is both exhilarating and frustrating. There are times when I feel like dropping this whole PhD nonsense and going back to the toil of med school. Then there are times when I feel completely motivated to push forth and continue the "quest." Luckily, in any given day, I go through those emotions in that order, so at the end of the day I'm stoked for what lies ahead.
Yesterday was a typical day. I started off at the Government of Tamil Nadu, oscillating between the Department of Social Welfare, Planning Commission and World Bank ICDS (Integrated Child Development Services) offices. The great thing about Tamil Nadu is that high-level officials are extremely accessible. I literally walked into the Secretary of Social Welfare's and Member Secretary of the Planning Commissions' offices yesterday to ask a few questions! Imagine trying to do that in a typical U.S. state goverment. Heck, I probably couldn't drop in on the Town of Clifton Park Supervisor's office that easily!
I think a lot of this comes from the recent nationwide push to make government more accessible/accountable to the people. In fact, the Right to Information Act which I am using for leverage in getting data is another initiative in this broader scheme.
Everyone in government is nice and willing to help. Unfortunately, it is still difficult to extract the needed historical information. Apparantly, it is computerized somewhere...but not really. And each official claims that the other one has the information I need....but when I head to that individual, I get returned to sender.
All in all, I think I shuttled between departments three times yesterday, taking the city train back and forth. Like a fool, I didn't take a bottle of water with me, and paid the price for being out in the sun later at night when my body completely shut down.
The afternoon session was much better. I visited the Institute for Financial and Management Research (IFMR) on a tip from Santosh Anagol (do visit his blog, "Brown Man's Burden"), and found it absolutely exhilarating. They are doing all sorts of interesting research there, much of it in conjunction with U.S. economists. A lot of their work has to do with coming up with various poverty reduction schemes and testing these in the real world using randomized experiments. Because its applied, the research is policy relevant and useful for public and private organizations alike. In addition, the investigators try to incorporate questions in their survey that will allow the measurement of outcomes and behaviors that are useful in testing/building economic theory.
Here is an example of an applied problem they work with. Imagine two neighboring farmers. Neither is rich enough, or has enough access to credit, to make a capital investment in a bore-well that could be used for irrigation. Collectively they do have enough to carry this out. However, despite generations of their family living and tilling that land, no contract or transaction is made between the two parties to undertake this investment. It seems that farmers are unwilling to enter joint-liability situations (where would the bore-well be placed, does placement matter in who is in charge of upkeep, etc?). Rather, they are more willing to buy water from a neighboring farmer who already has a bore-well; that too, not through a long-term agreement, but through daily spot transactions. How can we encourage efficient investment and low-opportunity cost financial contracts? What sort of financial instruments are appropriate for this situation? These are the sorts of questions the IFMR deals with.
My visit was to find out more about what they do in the public health and micro-healthinsurance areas. I won't know about that until next week, when I visit another branch of the IFMR. I'm excited for the next visit and will surely keep you informed.
Yesterday was a typical day. I started off at the Government of Tamil Nadu, oscillating between the Department of Social Welfare, Planning Commission and World Bank ICDS (Integrated Child Development Services) offices. The great thing about Tamil Nadu is that high-level officials are extremely accessible. I literally walked into the Secretary of Social Welfare's and Member Secretary of the Planning Commissions' offices yesterday to ask a few questions! Imagine trying to do that in a typical U.S. state goverment. Heck, I probably couldn't drop in on the Town of Clifton Park Supervisor's office that easily!
I think a lot of this comes from the recent nationwide push to make government more accessible/accountable to the people. In fact, the Right to Information Act which I am using for leverage in getting data is another initiative in this broader scheme.
Everyone in government is nice and willing to help. Unfortunately, it is still difficult to extract the needed historical information. Apparantly, it is computerized somewhere...but not really. And each official claims that the other one has the information I need....but when I head to that individual, I get returned to sender.
All in all, I think I shuttled between departments three times yesterday, taking the city train back and forth. Like a fool, I didn't take a bottle of water with me, and paid the price for being out in the sun later at night when my body completely shut down.
The afternoon session was much better. I visited the Institute for Financial and Management Research (IFMR) on a tip from Santosh Anagol (do visit his blog, "Brown Man's Burden"), and found it absolutely exhilarating. They are doing all sorts of interesting research there, much of it in conjunction with U.S. economists. A lot of their work has to do with coming up with various poverty reduction schemes and testing these in the real world using randomized experiments. Because its applied, the research is policy relevant and useful for public and private organizations alike. In addition, the investigators try to incorporate questions in their survey that will allow the measurement of outcomes and behaviors that are useful in testing/building economic theory.
Here is an example of an applied problem they work with. Imagine two neighboring farmers. Neither is rich enough, or has enough access to credit, to make a capital investment in a bore-well that could be used for irrigation. Collectively they do have enough to carry this out. However, despite generations of their family living and tilling that land, no contract or transaction is made between the two parties to undertake this investment. It seems that farmers are unwilling to enter joint-liability situations (where would the bore-well be placed, does placement matter in who is in charge of upkeep, etc?). Rather, they are more willing to buy water from a neighboring farmer who already has a bore-well; that too, not through a long-term agreement, but through daily spot transactions. How can we encourage efficient investment and low-opportunity cost financial contracts? What sort of financial instruments are appropriate for this situation? These are the sorts of questions the IFMR deals with.
My visit was to find out more about what they do in the public health and micro-healthinsurance areas. I won't know about that until next week, when I visit another branch of the IFMR. I'm excited for the next visit and will surely keep you informed.
Tuesday, July 17, 2007
Midday Meals
It's definitely great to be back in Chennai, India after three years. A lot has changed here and I'll certainly keep you posted on that in the coming weeks.
I'm here for the purposes of my dissertation. I'm writing three papers on "The Economics of Child Health" and one of these will be on studying the health and education effects of large scale nutritional programs in developing countries. One of the most famous programs is administered right here in the state of Tamil Nadu. In 1982, motivated by a mixture of compassion (hopefully) and electoral populism (more likely), then Chief Minister MG Ramachandran put in place a program designed to offer a free lunch to all children aged 2-9, 365 days of the year. A year later, this program was extended to children 10-15 and elderly pensioners.
The anecdotal success of the program has spurred the Government of India at large to mandate all states to implement similar programs. (As yet, not all states have instituted such programs - the political economy of this policy lag is another paper waiting to be written perhaps). In addition, the Tamil Nadu Midday Meals program has motivated other countries to think about developing similar schemes, as well. This is a big deal both politically and fiscally: in Tamil Nadu, at least, this program takes up a sizeable chunk of the social welfare budget. However, there is little empirical evidence documenting the causal effects of the program on nutrition and schooling. Whatever few studies exist have trouble distinguishing between program effects and secular trends in economic development in the state (increase per capita income, better infrastructure, etc).
The aim of my project is to investigate this question more thoroughly. For a variety of reasons, this is going to be very challenging:
-The program is not a randomized experiment, and was implemented all at once across the state. Hence, there is little cross-sectional (i.e., spatial) variation that can be used to identify treatment effects.
-Data on program availability by village is almost necessary in order to develop convincing evidence. Unfortunately, either this evidence does not exist, or it is impossible to get thanks to politics (see below).
My main approach is to milk discontinuities in age eligibility and the timing of the program in order to estimate the causal effects. For example, individuals between the age of 1.5-2 are not eligible for the program, while those aged 2-2.5 are. One can use this information to compare kids in each age group to see if there is a nutritional effect. Of course, if families redistribute resources amongst kids, this comparison becomes much more complicated. Another example: I can look at long term effects, using the fact that individuals of different birth years were exposed to varying lengths of the treatment. This is true because the program came into existence in 1982, and eligibility requirements were changed in different years.
Because its so hard to get data on program center locations, I also have some backup questions, which involve studying the effects of meal programs at an all-India level (much easier from the econometrics point of you), and studying a different health and nutrition program aimed at children aged 0-6 for which there is ample cross-sectional and time series variation both within Tamil Nadu and at the all India level.
About getting data: I went over to the Tamil Nadu Planning Commission and the Department of Social Welfare offices to make my data request. Through the 2005 Right to Information Act, any information request must be addressed within 30 days. Of course, when I went over, I was told that the task was impossible and that the data I need doesn't exist, even at a district (equiv to counties in the U.S) level. I know that this is not true because other researchers (who don't like to share) have used the district level information. I was told later by an academic contact that because the program is heavily politicized, government officials are loathe to give out detailed information. I am making another attempt today, so we'll see.
I'm here for the purposes of my dissertation. I'm writing three papers on "The Economics of Child Health" and one of these will be on studying the health and education effects of large scale nutritional programs in developing countries. One of the most famous programs is administered right here in the state of Tamil Nadu. In 1982, motivated by a mixture of compassion (hopefully) and electoral populism (more likely), then Chief Minister MG Ramachandran put in place a program designed to offer a free lunch to all children aged 2-9, 365 days of the year. A year later, this program was extended to children 10-15 and elderly pensioners.
The anecdotal success of the program has spurred the Government of India at large to mandate all states to implement similar programs. (As yet, not all states have instituted such programs - the political economy of this policy lag is another paper waiting to be written perhaps). In addition, the Tamil Nadu Midday Meals program has motivated other countries to think about developing similar schemes, as well. This is a big deal both politically and fiscally: in Tamil Nadu, at least, this program takes up a sizeable chunk of the social welfare budget. However, there is little empirical evidence documenting the causal effects of the program on nutrition and schooling. Whatever few studies exist have trouble distinguishing between program effects and secular trends in economic development in the state (increase per capita income, better infrastructure, etc).
The aim of my project is to investigate this question more thoroughly. For a variety of reasons, this is going to be very challenging:
-The program is not a randomized experiment, and was implemented all at once across the state. Hence, there is little cross-sectional (i.e., spatial) variation that can be used to identify treatment effects.
-Data on program availability by village is almost necessary in order to develop convincing evidence. Unfortunately, either this evidence does not exist, or it is impossible to get thanks to politics (see below).
My main approach is to milk discontinuities in age eligibility and the timing of the program in order to estimate the causal effects. For example, individuals between the age of 1.5-2 are not eligible for the program, while those aged 2-2.5 are. One can use this information to compare kids in each age group to see if there is a nutritional effect. Of course, if families redistribute resources amongst kids, this comparison becomes much more complicated. Another example: I can look at long term effects, using the fact that individuals of different birth years were exposed to varying lengths of the treatment. This is true because the program came into existence in 1982, and eligibility requirements were changed in different years.
Because its so hard to get data on program center locations, I also have some backup questions, which involve studying the effects of meal programs at an all-India level (much easier from the econometrics point of you), and studying a different health and nutrition program aimed at children aged 0-6 for which there is ample cross-sectional and time series variation both within Tamil Nadu and at the all India level.
About getting data: I went over to the Tamil Nadu Planning Commission and the Department of Social Welfare offices to make my data request. Through the 2005 Right to Information Act, any information request must be addressed within 30 days. Of course, when I went over, I was told that the task was impossible and that the data I need doesn't exist, even at a district (equiv to counties in the U.S) level. I know that this is not true because other researchers (who don't like to share) have used the district level information. I was told later by an academic contact that because the program is heavily politicized, government officials are loathe to give out detailed information. I am making another attempt today, so we'll see.
Sunday, July 15, 2007
Celebrity sightings and pics
As some of you know, I've had some incredible luck with celebrity sightings over the last year. Apparently, some of that good fortune has carried over to this summer. While casually listening to my iPod (using that term in the same way everyone calls facial tissue 'kleenex') at the Bombay airport, I spotted Bollywood star Aamir Khan walking by about 10 feet away surrounded by a swarm of body guards. He kind of reminded me of Frodo.
What is it that draws celebrities to me? My 'Italian good looks'? Incredible charisma? Random chance?
The world may never know.
What is it that draws celebrities to me? My 'Italian good looks'? Incredible charisma? Random chance?
The world may never know.
Copenhagen IV - Conference
I've had a few days to reflect on the health econ conference I just went to and had a few thoughts. I have to say that I definitely got more out of this conference than I did in 2005, when it was held in Barcelona. Thats saying a lot since some of the stuff I started thinking about in Barcelona will form the basis for my dissertation. I think there are a few reasons for this:
-After two years of grad schools and qualifiers, I know a little bit more about health economics than I did in '05.
-I now have a better sense of my interests and made sure to attend sessions relevant to these. As a result, I got more out of a given presentation and made tons of contacts.
-I suspect that the average conference paper was stronger in '07 than '05, though this might be confounded by the first two reasons.
I think my own presentation went off well. I gave a talk based on a joint paper with Brian Fried (political science grad student, and fellow '02 Blue Devil) on fuel markets, prices and child health in Guatemala. Indoor air pollution (IAP), which is associated with acute respiratory illness, is one of the leading causes of death among children in the developing world. The level of household IAP is associated with choice of cooking fuel, where biomass fuels (wood, cow dung, crop residues) are the worst as they generate a lot of particulate matter. Clean fuels, such as liquid petroleum gasoline, kerosene or electricity, are preferred, but can be expensive. The goal of our work is to look at how fuel prices and availability influence household fuel choice and, consequently, child health. This is actually trickier than it sounds since:
-prices are measured with error
-prices and fuel availability might be correlated with other determinants of health that we cannot observe, thus making it hard to recover a causal effect
Our preliminary findings are that prices measured at the community level reflect a wide variety of unobserved factors, and that a better measure of fuel prices might be world oil prices at the time of survey interacted with the region of household residence. We find that this measure has better properties as far as inferring causality and also allows us to link decisions on fuel choice and child health to worldwide changes in commodity prices. In short, as world oil prices increase, so do child respiratory symptoms. Poorer and rural households are more sensitive to prices (as expected).
This is definitely a work in progress, and we got some great comments at the conference about how to proceed. I'll definitely keep you posted as this evolves.
-After two years of grad schools and qualifiers, I know a little bit more about health economics than I did in '05.
-I now have a better sense of my interests and made sure to attend sessions relevant to these. As a result, I got more out of a given presentation and made tons of contacts.
-I suspect that the average conference paper was stronger in '07 than '05, though this might be confounded by the first two reasons.
I think my own presentation went off well. I gave a talk based on a joint paper with Brian Fried (political science grad student, and fellow '02 Blue Devil) on fuel markets, prices and child health in Guatemala. Indoor air pollution (IAP), which is associated with acute respiratory illness, is one of the leading causes of death among children in the developing world. The level of household IAP is associated with choice of cooking fuel, where biomass fuels (wood, cow dung, crop residues) are the worst as they generate a lot of particulate matter. Clean fuels, such as liquid petroleum gasoline, kerosene or electricity, are preferred, but can be expensive. The goal of our work is to look at how fuel prices and availability influence household fuel choice and, consequently, child health. This is actually trickier than it sounds since:
-prices are measured with error
-prices and fuel availability might be correlated with other determinants of health that we cannot observe, thus making it hard to recover a causal effect
Our preliminary findings are that prices measured at the community level reflect a wide variety of unobserved factors, and that a better measure of fuel prices might be world oil prices at the time of survey interacted with the region of household residence. We find that this measure has better properties as far as inferring causality and also allows us to link decisions on fuel choice and child health to worldwide changes in commodity prices. In short, as world oil prices increase, so do child respiratory symptoms. Poorer and rural households are more sensitive to prices (as expected).
This is definitely a work in progress, and we got some great comments at the conference about how to proceed. I'll definitely keep you posted as this evolves.
Friday, July 13, 2007
Copenhagen III - The City
Ok, so I am in India now, but am behind in blogging. Hence you'll hear about Copenhagen today and more about the conference in the next post before any India stuff.
Unfortunately, because the conference was so time consuming (in a good, fun kind of way) I really didn't get to soak in Copenhagen as much as I would have liked. Even so, here are some quick thoughts:
-It seems like everyone in Copenhagen is friendly. Usually, with most cities you run into a real jerk within an hour of getting in to town. Not so here! Right from the airline to the taxi to the store owners, everyone seemed genuinely happy to see and help you. Rock on.
-Walking and biking is highly institutionalized. Seriously, there are separate bike and pedestrian lanes with their own respective signals. And its super easy to bike around since:
-You can rent a city bike for 20 DKK (about $3.50), ride it around, and recover your money when you are done. Let's just say I took full advantage of this and went on a Hudspethian adventure the day the conference ended.
-The prevalence of obesity is low. This is probably because of the first three points. After all low stress, easy and cheap to walk and bike make a person health, wealthy and wise....or something like that.
-Harbor cities with canals are beautiful. I'll put up the canonical Copenhagen picture in the next post. Monarchies help, too, as the palaces are often striking.
-Copenhagen is expensive! Finally, a negative! One survey ranks Copenhagen 8th among all world cities in cost of living. With the plummeting dollar (or the strengthening Euro or DKK) you get flummoxed if you are an American
-If you haven't eaten at the Addis Mesob Etiopisk Restaurant on the corner of Ryesgade and Fredensgade, you haven't eat Ethiopian food. No joke. Its cheap, all you can eat and the owner, Abdullah, is a nice bloke with a keen business sense.
-Almost all taxis in Copenhagen are Mercedes. There are several cab companies. The taxi drivers buy their own cars at a subsidized price (I think they pay significantly less VAT) and are able to sell their cars back two years later at the market price (which is often more than what they payed initially). I don't know why I put that in there, but it was interesting to me.
Unfortunately, because the conference was so time consuming (in a good, fun kind of way) I really didn't get to soak in Copenhagen as much as I would have liked. Even so, here are some quick thoughts:
-It seems like everyone in Copenhagen is friendly. Usually, with most cities you run into a real jerk within an hour of getting in to town. Not so here! Right from the airline to the taxi to the store owners, everyone seemed genuinely happy to see and help you. Rock on.
-Walking and biking is highly institutionalized. Seriously, there are separate bike and pedestrian lanes with their own respective signals. And its super easy to bike around since:
-You can rent a city bike for 20 DKK (about $3.50), ride it around, and recover your money when you are done. Let's just say I took full advantage of this and went on a Hudspethian adventure the day the conference ended.
-The prevalence of obesity is low. This is probably because of the first three points. After all low stress, easy and cheap to walk and bike make a person health, wealthy and wise....or something like that.
-Harbor cities with canals are beautiful. I'll put up the canonical Copenhagen picture in the next post. Monarchies help, too, as the palaces are often striking.
-Copenhagen is expensive! Finally, a negative! One survey ranks Copenhagen 8th among all world cities in cost of living. With the plummeting dollar (or the strengthening Euro or DKK) you get flummoxed if you are an American
-If you haven't eaten at the Addis Mesob Etiopisk Restaurant on the corner of Ryesgade and Fredensgade, you haven't eat Ethiopian food. No joke. Its cheap, all you can eat and the owner, Abdullah, is a nice bloke with a keen business sense.
-Almost all taxis in Copenhagen are Mercedes. There are several cab companies. The taxi drivers buy their own cars at a subsidized price (I think they pay significantly less VAT) and are able to sell their cars back two years later at the market price (which is often more than what they payed initially). I don't know why I put that in there, but it was interesting to me.
Wednesday, July 11, 2007
Copenhagen II: End of Life Care and the University of Chicago
(Note: I have enabled anonymous comments. If the requirement to register discouraged you from chiming in, your concerns have been addressed!)
The main plenary session at the IHEA conference involved a discussion on end of life (EOL) care. EOL care is a huge issue in the United States (and other OECD countries as well) given that a disproportionately large portion of total health care expenditures are spent on interventions and services rendered to those who are within a few months of death. Many health policy experts agree that such spending is inefficient: why spend this much money on those who are going to die anyway? Perhaps this money is better spent elsewhere. Also, some argue that prolonging life is actually reduces patient happiness by extending pain and frustration. There is a huge movement to incentivize the use of palliative care and hospice in lieu of medical interventions for individuals near the end of their innings.
Implicit in the efficiency argument is a cost benefit calculation. Essentially, those who argue that current EOL spending is wasteful note that: (life years saved)*(value of life) < expenditure of EOL care. That is, the benefits accruing from a dollar of end of life spending (particularly on non-palliative or hospice interventions) are less than the costs.
It is (relatively) straightforward (but certainly not easy - lest I invoke the wrath of health finance and cost-effectiveness researchers!) to calculate life years saved and expenditures. What about the value of life? This number is derived in a variety of ways. The main idea is to use individual and institution behaviors that reveal his/her/their internal valuation of life. Here is an example: lets say we have a population of individuals who can choose to work in two sectors, one safe and the other dangerous. Some individuals will choose riskier jobs (higher risk of death or injury) in exchange for higher wages, or a compensating differential. Here the value of life can be computed by dividing the wage premium by the difference in mortality risk between the two jobs. Clearly, this can be generalized across multiple employment sectors. Other means to calculate the value of life include using legal settlements (in the case of injury or wrongful death)
and the amount individuals are willing to pay for safety devices of various sorts.
(Aside: Note that we simply do not ask individuals how much they value their own lives or how much they would pay for an additional value of life. Every time I ask someone why this can't be done, I get some answer to the effect of: well, how can anyone give a reasonable answer to that question? Fair enough. But I wonder if this renders estimates from revealed preference studies useless. If individuals cannot adequately get their head around the value of their own life, how are the implicitly valuing this when rationally deciding to take the risky versus safe job? Let me know if you have any insight on this.)
The main thrust of the plenary talk, given by Tomas Philipson of the University of Chicago, is that the value of life estimates used to declare that EOL care is inefficient may not be appropriate for the situation at hand for a variety of reasons. The big picture point is that value of life estimates are derived from observations on healthy people, and those at the end of their innings may be drastically different in the following ways:
-Individuals at the end of life might value an additional unit of survival time more because they have less of it left. This is the old diminishing marginal utility argument. Everyone loves the first hot dog, but each additional hot dog confers less and less utility (maybe this doesn't apply to Kobeyashi).
-Individuals at the end of life may derive additional utility from hope, thus valuing each additional unit of life more than a healthy person would. This is the Michael J. Fox/Chris Reeve phenomenon: people want to live longer in hopes that new technology might be developed that can save/improve their lives. Another way to think about it is that people will want to live longer if there is some hope for survival.
-There may be an additional social value to life: family members may derive utility from having their loved one stay around longer (unless they are in a hurry for bequests).
-Trade-offs between quantity and quality of life may not be as well-defined as originally thought. There are two offsetting effects: there is greater value to extending a healthier life. However, the amount of consumption forgone rises as the quantity of life declines.
What does this mean? Philipson contends that, if these theoretical ideas hold, those at the end of life may actually value an additional unit of life much more than a healthy individual would. This would fundamentally alter the cost-benefit calculation used to determine whether EOL spending is efficient or not.
Needless to say, this created quite the stir among the audience. I would say the reaction was a mixture of shock, indignation and awe. I talked to some of the attendees afterwards and people seemed equally split between lauding Philipson for his audacity and fresh insight into an old problem and damning him for his arrogance and his implicit belief that neoclassical economics could yield insight into "softer" phenomenon such as hope.
All of this is really interesting to me, especially in the context of this book I've been reading: The Chicago School: How the University of Chicago Assembled the Thinkers Who Revolutionized Economics and Business by Van Overtveldt. Here is a passage from the book about Gary Becker, a Nobel Laureate in economics who is best known for his work on various aspects of human capital and extending economic analysis to topics as diverse as the use of time, educational investments, divorce, marriage, polygamy, intergenerational transfers, altruism, crime, kidney transplants, etc:
"The nontraditional orientation of Becker's research has regularly stirred up emotions and given rise to comments such as this one from Robert Solow [ed: another Nobel laureate in economics]: 'There are some things that should not be analyzed as if they were subject to being bought and sold. Let's be philosophical. Call them primary things, things that are intrinsic to themselves. There are all kinds of social circumstances that are fundamentally different from economic circumstances.'"
If we follow Van Overtveldt's thesis, Philipson's talk had all the elements of the Chicago tradition: the belief that neoclassical economics works and can be applied to a wide range of phenomena, the intense desire to question and search for the truth, and the resulting controversy from the efforts.
I myself found the talk to be interesting and the points to be thought-provoking. I do have a few questions though. First, suppose that we are able to calculate a value of life that is specific to those at the end of life. What does that mean? If we find that the benefits of EOL care exceed the costs, it might imply that people are rational. But so what? Could that money still be better spent elsewhere? Second, I wonder what Philipson has to say about the burgeoning health services literature on hospice, which tends to suggests that people are often happier with palliative care than with intensive medical efforts. If people elect to prolong their lives in a rational manner, can they simultaneously be happier not doing that? Does the shift involve a change in preferences (something like coming to peace with one's fate) or is it a question of information (people have stable preferences but do not have information about alternative modes of care?
The main plenary session at the IHEA conference involved a discussion on end of life (EOL) care. EOL care is a huge issue in the United States (and other OECD countries as well) given that a disproportionately large portion of total health care expenditures are spent on interventions and services rendered to those who are within a few months of death. Many health policy experts agree that such spending is inefficient: why spend this much money on those who are going to die anyway? Perhaps this money is better spent elsewhere. Also, some argue that prolonging life is actually reduces patient happiness by extending pain and frustration. There is a huge movement to incentivize the use of palliative care and hospice in lieu of medical interventions for individuals near the end of their innings.
Implicit in the efficiency argument is a cost benefit calculation. Essentially, those who argue that current EOL spending is wasteful note that: (life years saved)*(value of life) < expenditure of EOL care. That is, the benefits accruing from a dollar of end of life spending (particularly on non-palliative or hospice interventions) are less than the costs.
It is (relatively) straightforward (but certainly not easy - lest I invoke the wrath of health finance and cost-effectiveness researchers!) to calculate life years saved and expenditures. What about the value of life? This number is derived in a variety of ways. The main idea is to use individual and institution behaviors that reveal his/her/their internal valuation of life. Here is an example: lets say we have a population of individuals who can choose to work in two sectors, one safe and the other dangerous. Some individuals will choose riskier jobs (higher risk of death or injury) in exchange for higher wages, or a compensating differential. Here the value of life can be computed by dividing the wage premium by the difference in mortality risk between the two jobs. Clearly, this can be generalized across multiple employment sectors. Other means to calculate the value of life include using legal settlements (in the case of injury or wrongful death)
and the amount individuals are willing to pay for safety devices of various sorts.
(Aside: Note that we simply do not ask individuals how much they value their own lives or how much they would pay for an additional value of life. Every time I ask someone why this can't be done, I get some answer to the effect of: well, how can anyone give a reasonable answer to that question? Fair enough. But I wonder if this renders estimates from revealed preference studies useless. If individuals cannot adequately get their head around the value of their own life, how are the implicitly valuing this when rationally deciding to take the risky versus safe job? Let me know if you have any insight on this.)
The main thrust of the plenary talk, given by Tomas Philipson of the University of Chicago, is that the value of life estimates used to declare that EOL care is inefficient may not be appropriate for the situation at hand for a variety of reasons. The big picture point is that value of life estimates are derived from observations on healthy people, and those at the end of their innings may be drastically different in the following ways:
-Individuals at the end of life might value an additional unit of survival time more because they have less of it left. This is the old diminishing marginal utility argument. Everyone loves the first hot dog, but each additional hot dog confers less and less utility (maybe this doesn't apply to Kobeyashi).
-Individuals at the end of life may derive additional utility from hope, thus valuing each additional unit of life more than a healthy person would. This is the Michael J. Fox/Chris Reeve phenomenon: people want to live longer in hopes that new technology might be developed that can save/improve their lives. Another way to think about it is that people will want to live longer if there is some hope for survival.
-There may be an additional social value to life: family members may derive utility from having their loved one stay around longer (unless they are in a hurry for bequests).
-Trade-offs between quantity and quality of life may not be as well-defined as originally thought. There are two offsetting effects: there is greater value to extending a healthier life. However, the amount of consumption forgone rises as the quantity of life declines.
What does this mean? Philipson contends that, if these theoretical ideas hold, those at the end of life may actually value an additional unit of life much more than a healthy individual would. This would fundamentally alter the cost-benefit calculation used to determine whether EOL spending is efficient or not.
Needless to say, this created quite the stir among the audience. I would say the reaction was a mixture of shock, indignation and awe. I talked to some of the attendees afterwards and people seemed equally split between lauding Philipson for his audacity and fresh insight into an old problem and damning him for his arrogance and his implicit belief that neoclassical economics could yield insight into "softer" phenomenon such as hope.
All of this is really interesting to me, especially in the context of this book I've been reading: The Chicago School: How the University of Chicago Assembled the Thinkers Who Revolutionized Economics and Business by Van Overtveldt. Here is a passage from the book about Gary Becker, a Nobel Laureate in economics who is best known for his work on various aspects of human capital and extending economic analysis to topics as diverse as the use of time, educational investments, divorce, marriage, polygamy, intergenerational transfers, altruism, crime, kidney transplants, etc:
"The nontraditional orientation of Becker's research has regularly stirred up emotions and given rise to comments such as this one from Robert Solow [ed: another Nobel laureate in economics]: 'There are some things that should not be analyzed as if they were subject to being bought and sold. Let's be philosophical. Call them primary things, things that are intrinsic to themselves. There are all kinds of social circumstances that are fundamentally different from economic circumstances.'"
If we follow Van Overtveldt's thesis, Philipson's talk had all the elements of the Chicago tradition: the belief that neoclassical economics works and can be applied to a wide range of phenomena, the intense desire to question and search for the truth, and the resulting controversy from the efforts.
I myself found the talk to be interesting and the points to be thought-provoking. I do have a few questions though. First, suppose that we are able to calculate a value of life that is specific to those at the end of life. What does that mean? If we find that the benefits of EOL care exceed the costs, it might imply that people are rational. But so what? Could that money still be better spent elsewhere? Second, I wonder what Philipson has to say about the burgeoning health services literature on hospice, which tends to suggests that people are often happier with palliative care than with intensive medical efforts. If people elect to prolong their lives in a rational manner, can they simultaneously be happier not doing that? Does the shift involve a change in preferences (something like coming to peace with one's fate) or is it a question of information (people have stable preferences but do not have information about alternative modes of care?
Tuesday, July 10, 2007
Review: Carry On, Chris Cornell; Disturbia
Carry On, Chris Cornell
It's not a stretch to say that Chris Cornell has one of the most incredible voices ever. I've recently gotten into Soundgarden, Temple of the Dog and Audioslave mainly on the strength of this guy's ridiculously good vocals.
Given all that, I rushed out to buy Cornell's latest album, the solo offering "Carry On." I heard prior to the release that it combined elements of hard rock, blues, and pop, with savvy/insightful lyrics breathed to life by Cornell's size 100 (out of 10) vocals. I got so excited by these advances (re)views that I've been advertising his summer concert tour to everyone I know even prior to listening to the album.
How do I feel about this recent offering? Let's just say I give this album a 5/10, where it gets 5 points on the strength of four songs and Cornell's voice. The opening tracks ("No Such Thing" and "Poison Eye") are quite good, building up the expectations for the next 12 tracks. Unfortunately, its pretty much downhill from there until track 6 ("Ghost") and track 14 (the Casino Royale theme). Alright, alright: there are some good moments in there, but these are few and far between.
When I take the morning shuttle to school, the driver always has this crappy adult contemporary station playing in the background. What is sad is that I could easily picture at least a third of the "Carry On" tracks being played on this station.
If you've read "The Alchemist" you'll remember that one of the main points made in the novel is that if someone has a dream or destiny, his/her friends and family should do their part and let the person go to fulfill their hearts desire. It is obvious that Cornell is excited about this new life as a mellower solo artist and this is the direction he has chosen for his music. Thus, as fans, perhaps we should let him go do his thing.
I can run with that. And while doing so, I'll load up on my doses of Soundgarden and Audioslave
Disturbia
I saw this movie on the plane. Somehow, I end up liking every movie I see on an airplane, probably because I hate air travel and any distraction is welcome. Seriously. I saw "Guess Who" starring Ashton Kutcher and Bernie Mac and thought it was the greatest movie ever.
Despite this huge advantage, Disturbia failed to capture my attention. One major positive: Shia LeBouf. That guy can flat out act.
It turns out LeBouf is going to play Harrison Ford's son in the fourth Indiana Jones movie. I only realized what a great move when I saw Disturbia: LeBouf does an incredible "Harrison Ford face." You know, the look he gives in every movie where he looks angry/frustrated and heavily exhales?
Like father, like son.
It's not a stretch to say that Chris Cornell has one of the most incredible voices ever. I've recently gotten into Soundgarden, Temple of the Dog and Audioslave mainly on the strength of this guy's ridiculously good vocals.
Given all that, I rushed out to buy Cornell's latest album, the solo offering "Carry On." I heard prior to the release that it combined elements of hard rock, blues, and pop, with savvy/insightful lyrics breathed to life by Cornell's size 100 (out of 10) vocals. I got so excited by these advances (re)views that I've been advertising his summer concert tour to everyone I know even prior to listening to the album.
How do I feel about this recent offering? Let's just say I give this album a 5/10, where it gets 5 points on the strength of four songs and Cornell's voice. The opening tracks ("No Such Thing" and "Poison Eye") are quite good, building up the expectations for the next 12 tracks. Unfortunately, its pretty much downhill from there until track 6 ("Ghost") and track 14 (the Casino Royale theme). Alright, alright: there are some good moments in there, but these are few and far between.
When I take the morning shuttle to school, the driver always has this crappy adult contemporary station playing in the background. What is sad is that I could easily picture at least a third of the "Carry On" tracks being played on this station.
If you've read "The Alchemist" you'll remember that one of the main points made in the novel is that if someone has a dream or destiny, his/her friends and family should do their part and let the person go to fulfill their hearts desire. It is obvious that Cornell is excited about this new life as a mellower solo artist and this is the direction he has chosen for his music. Thus, as fans, perhaps we should let him go do his thing.
I can run with that. And while doing so, I'll load up on my doses of Soundgarden and Audioslave
Disturbia
I saw this movie on the plane. Somehow, I end up liking every movie I see on an airplane, probably because I hate air travel and any distraction is welcome. Seriously. I saw "Guess Who" starring Ashton Kutcher and Bernie Mac and thought it was the greatest movie ever.
Despite this huge advantage, Disturbia failed to capture my attention. One major positive: Shia LeBouf. That guy can flat out act.
It turns out LeBouf is going to play Harrison Ford's son in the fourth Indiana Jones movie. I only realized what a great move when I saw Disturbia: LeBouf does an incredible "Harrison Ford face." You know, the look he gives in every movie where he looks angry/frustrated and heavily exhales?
Like father, like son.
Monday, July 9, 2007
Conference Part I: "Am I Irrelevant?" and the Baseball Hall of Fame
I'm now here in Copenhagen for the International Health Economics Association's (IHEA) 6th World Congress in Health Economics. Yesterday marked the opening and today the first proceedings of this conference. Just as a bit of background, the IHEA conference typically involves over 2000 health economists in one of the ultimate playgrounds for nerds. There is economics everywhere, both in the form of excellent sessions and presentations as well as horrible jokes about supply-and-demand and marginal utility (seriously). On both counts, I feel right at home.
I have to say though that the opening plenary remarks to kick of the conference were particularly depressing, especially for a grad student. The speaker, a Swedish academic, posed a very simple question: for a policymaker interested in reforming a given health system, what can he/she draw from the health economics literature that can be useful in determining what actions to take?
The answer? Apparently, very little. All the fancy theory and empirical work aside, there isn't much evidence to provide definitive answers to the simple big questions like what is the best way to pay providers or should health systems be vertically integrated or not. Abstracting a bit from the talk, even worse, there may not even be a consensus on what the big questions are!
The point was driven home in a standing room only session on the topic "Health System Economics: What is it?" The speakers were some of the all-stars in the field, and each emphasized something completely different in their definitions. Furthermore, one of the panelists pointed out that health economists need to be humble because they do not have meaningful answers, and may be better off as tourists in foreign countries rather than advisers to its ministries!
So here I am, having chosen to invest several years in my twenties (and hopefully not thirties!) in a field hoping that my work will have policy significance and that my discipline can offer something practical for society at large to use. I guess in one sense, these sessions were comforting because it seems like I will always have a job: if 40 years of modern health economics still offers little to work with, there is a lot to do! At the same time, its mostly depressing: everyone wants their work to matter and its sobering when it just might not. I'm going to wait till the end of the conference to talk about this more.
This existential crisis aside, I've had a fun day here so far. I've already been exposed to a whole bunch of papers, but I'd have to say that my favorite involved a study of life, death and the Baseball Hall of Fame. I know, I know: what a great segue from the big questions of the field to something more trivial.
Actually, its not that trivial at all. The main thrust of the paper (will provide a link when the working version is put up on the web) involves looking at how status and stress influence life expectancy. I'm sure you are aware of the studies looking at Oscar or Nobel Prize winners versus nominees, nothing that the former living longer than the latter, possibly because of the physiological benefits of knowing that you are one of the revered "big dogs" in the field.
This paper was interesting because, unlike others, the researchers (indeed everyone who reads ESPN or SI) had access to data on the number of votes nominated and accepted players received en route to the Hall of Fame. Plus, with the Baseball Hall of Fame, there is a definitive cut off in the percentage of votes (writers or veterans) needed to be received in order to make it in. To make a long story short, the authors find that slam dunk winners have the highest survival rates, while winners and non-winners right around the vote threshold appear to have lower survival rates than those nominees receiving a negligible share of votes. They suggest that, given the salience of the Hall of Fame in the life of an MLB baseball player, being on the cusp of admission confers huge stress on the body and mind. They test this proposition loosely by looking at the rate of deaths due to cardiac events among those right around the threshold. Sure enough, it is these individuals who are most likely to die from a heart attack.
So I guess that Jim Rice needs to be worried about his health in addition to his ongoing Hall of Fame candidacy saga.
I'm presenting tomorrow, so I will let you know what that is all about in my next post.
I have to say though that the opening plenary remarks to kick of the conference were particularly depressing, especially for a grad student. The speaker, a Swedish academic, posed a very simple question: for a policymaker interested in reforming a given health system, what can he/she draw from the health economics literature that can be useful in determining what actions to take?
The answer? Apparently, very little. All the fancy theory and empirical work aside, there isn't much evidence to provide definitive answers to the simple big questions like what is the best way to pay providers or should health systems be vertically integrated or not. Abstracting a bit from the talk, even worse, there may not even be a consensus on what the big questions are!
The point was driven home in a standing room only session on the topic "Health System Economics: What is it?" The speakers were some of the all-stars in the field, and each emphasized something completely different in their definitions. Furthermore, one of the panelists pointed out that health economists need to be humble because they do not have meaningful answers, and may be better off as tourists in foreign countries rather than advisers to its ministries!
So here I am, having chosen to invest several years in my twenties (and hopefully not thirties!) in a field hoping that my work will have policy significance and that my discipline can offer something practical for society at large to use. I guess in one sense, these sessions were comforting because it seems like I will always have a job: if 40 years of modern health economics still offers little to work with, there is a lot to do! At the same time, its mostly depressing: everyone wants their work to matter and its sobering when it just might not. I'm going to wait till the end of the conference to talk about this more.
This existential crisis aside, I've had a fun day here so far. I've already been exposed to a whole bunch of papers, but I'd have to say that my favorite involved a study of life, death and the Baseball Hall of Fame. I know, I know: what a great segue from the big questions of the field to something more trivial.
Actually, its not that trivial at all. The main thrust of the paper (will provide a link when the working version is put up on the web) involves looking at how status and stress influence life expectancy. I'm sure you are aware of the studies looking at Oscar or Nobel Prize winners versus nominees, nothing that the former living longer than the latter, possibly because of the physiological benefits of knowing that you are one of the revered "big dogs" in the field.
This paper was interesting because, unlike others, the researchers (indeed everyone who reads ESPN or SI) had access to data on the number of votes nominated and accepted players received en route to the Hall of Fame. Plus, with the Baseball Hall of Fame, there is a definitive cut off in the percentage of votes (writers or veterans) needed to be received in order to make it in. To make a long story short, the authors find that slam dunk winners have the highest survival rates, while winners and non-winners right around the vote threshold appear to have lower survival rates than those nominees receiving a negligible share of votes. They suggest that, given the salience of the Hall of Fame in the life of an MLB baseball player, being on the cusp of admission confers huge stress on the body and mind. They test this proposition loosely by looking at the rate of deaths due to cardiac events among those right around the threshold. Sure enough, it is these individuals who are most likely to die from a heart attack.
So I guess that Jim Rice needs to be worried about his health in addition to his ongoing Hall of Fame candidacy saga.
I'm presenting tomorrow, so I will let you know what that is all about in my next post.
Friday, July 6, 2007
Welcome!
Hi everybody,
Welcome to my blog. I'm starting this on the eve of a summer research trip going through Denmark, India and South Africa. I have a lot of strange thoughts during such trips, and figured that a blog would be a great outlet for these.
I do not have a theme for the blog as of yet and I'm hoping a natural structure emerges over time both with my own posts and your comments. I guess it might be safe to say that most of the subject matter will be related to health or development economics. However, I get interested in all sorts of things and I'd like to be able to talk about them.
A final admin note: if you can think of a better title than what I've got, please let me know.
I hope you find this interesting. I'll do my part and post as often as is possible. All that is left is for you to read, enjoy and comment.
Thanks,
Atheendar
Welcome to my blog. I'm starting this on the eve of a summer research trip going through Denmark, India and South Africa. I have a lot of strange thoughts during such trips, and figured that a blog would be a great outlet for these.
I do not have a theme for the blog as of yet and I'm hoping a natural structure emerges over time both with my own posts and your comments. I guess it might be safe to say that most of the subject matter will be related to health or development economics. However, I get interested in all sorts of things and I'd like to be able to talk about them.
A final admin note: if you can think of a better title than what I've got, please let me know.
I hope you find this interesting. I'll do my part and post as often as is possible. All that is left is for you to read, enjoy and comment.
Thanks,
Atheendar
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