I spent a week in the bay area about two weeks ago. I had a blast. It was the first time I really got to explore San Francisco and vicinity in some depth. Special thanks to Maheer and my folks for taking me to all the cool joints. In the event you might find yourself in the area, this post can serve as a useful starting point to plan your time/journey. Enjoy!
1. When in San Francisco, be sure to visit ritzy malls and take arty photographs.
Here, Maheer's shadow is seen in the uber shiny floor tiles, as if superimposed on the pattern in the rotunda.
2. When in Rome, do as Romans do. When in Alcatraz...
Re-enact your favorite scene from The Rock.
3. Visit less well known monuments and make them famous by advertising to your friends on your partially eponymous blog.
This is probably one of two things that are actually worth seeing in Sunnyvale. I call it the "Sunnyvale Pyramid", but in reality it has something to do with the Summer and Winter Solstices (Solsti?). In any case, I think I look good in this picture.
4. Wine Country is guaranteed to be fun.
That is to say, if it's not initially, the likelihood that you will find it fun by the end of your stay is increasing in the number of free samples you consume (though the function probably reaches some max and is strictly decreasing thereafter - as you can see, I did not sample optimally).
5. If you must go to the opera, bring friends.
A few of us went to this opera called Appomattox, about the Civil War surrender and its aftermath. It was in English and, while at times moving, really funny and ridiculous. Imagine this exchange in sung in the Opera style:
President Lincoln: "What is the aim of General Lee?"
Ulysses S Grant: "I don't know."
This actually happened. I think I reached my cultured-ness maximum very early on: I spent the first half hour giggling. Luckily, my friends Maheer and Vivian found it equally ridiculous and probably had a good chuckle here and there themselves. This is why its good to bring friends: you don't feel bad for finding serious things funny if your buddies do, too. Simple social acceptance. On the other hand, I tend to laugh when other people do, so I think we fed off each others giggling.
6. On second thought, don't go with friends.
7. Eat at the following restaurants.
Recommended by Maheer, taste tested and confirmed by me.
La Tacqueria
Mitchell's Ice Cream
Zazie's
Chez Maman
Burma Superstar
Dottie's True Blue Cafe (breakfast)
Saigon Sandwiches
Truly Mediterranean
Little Star
Ganim's
Citrus Club
Chaat Paradise
We also went to some yogurt bar (forgot the name) which is very well known for its excellent yogurt and fresh ingredients. I had a basic yogurt with fresh mango and raspberry topping. Possible the greatest food item I've ever had.
Welcome! This is a blog that generally covers issues related to health and development economics. Feel free to visit and comment as often as you'd like.
Wednesday, October 31, 2007
Sunday, October 28, 2007
Behavioral Economics in the News Today
Here's some educational Sunday morning fun for you:
1. Check out this ESPN article about sports fans trying to work some action at a distance to help out their teams. This reflects how people mistakenly and irrationally believe that they have some kind of influence over external events that don't directly involve them.
2. This morning's Foxtrot, about using framing to obtain more candy on Halloween.
1. Check out this ESPN article about sports fans trying to work some action at a distance to help out their teams. This reflects how people mistakenly and irrationally believe that they have some kind of influence over external events that don't directly involve them.
2. This morning's Foxtrot, about using framing to obtain more candy on Halloween.
Saturday, October 27, 2007
Wildfires, Pollution and Health (And Other Interesting Links)
I was watching an interesting report on CNN this morning about how many Southern California residents have reported various respiratory symptoms, likely due to wildfire induced particulate matter in the air. It's probably obvious to most people that forest fire related smoke will have adverse health consequences. Even so, its worth trying to get a sense of whether this holds up in the data and what the magnitude of the effect really is.
Some interesting research on the 1997 forest fires in Indonesia provides insight into these issues. This paper by Seema Jayachandran suggests that the fire led to a 17% increase in childhood (here under-2) mortality rates. The effect was larger in poor Indonesian districts, again something that most would expect a priori. Frankenberg and co-authors find effects among adults as well. Exposed individuals had more difficulty with activities of daily-living and were more likely to report respiratory symptoms.
A quick, but important digression: Forest fires are a good way to study the effects of pollution on health. First, variation in forest fire intensity is plausibly exogenous. The location and intensity of forest fires are essentially "random" conditional on typical region and individual level controls. Second, for more recent events, there are usually very good atmospheric measurements of particulate matter, which allows the economist/epidemiologist/statistician to directly estimate the effect on salient pollution factors on health.
I think the existing research can be extended on several margins. For example, what are the long term effects of those exposed in utero. That is, how do kids who survive the insult do later in childhood and later in life? What is the biology behind this? Another interesting question stems from Jayachandran's finding that the impacts of pollution decline with increasing regional wealth. It's worth trying to tease apart why this is so: What is it about richer regions that shields their residents from the effects of dirty air? Do the wealthy live in houses with better ventilation? Are they more mobile?
More stuff: how much does an individual's productivity decline as a result of pollution? Finally, conditional on income, can we use information on the choices people make to avoid exposure to pollution say something about an individual's own valuation of his/her health status?
As unfortunate as the So-Cal fires are, perhaps some good can come out of the fact that it can generate some rich research. I'll be interested to see how the current state of the pollution literature will be advanced.
Other Interesting Links:
1) Kenneth Chay and Michael Greenstone have written some of the seminal papers on pollution and infant health. You can find some of them here and here. I like these papers because they are extremely rigorous. That kind of stuff makes for good graduate student reading.
2) Interesting post at the Freakonomics blog about the potentially substantial benefits to malaria eradication on health and economic outcomes.
3) Do grants increase research productivity? Check out this paper if you are interested in finding out the answer.
Some interesting research on the 1997 forest fires in Indonesia provides insight into these issues. This paper by Seema Jayachandran suggests that the fire led to a 17% increase in childhood (here under-2) mortality rates. The effect was larger in poor Indonesian districts, again something that most would expect a priori. Frankenberg and co-authors find effects among adults as well. Exposed individuals had more difficulty with activities of daily-living and were more likely to report respiratory symptoms.
A quick, but important digression: Forest fires are a good way to study the effects of pollution on health. First, variation in forest fire intensity is plausibly exogenous. The location and intensity of forest fires are essentially "random" conditional on typical region and individual level controls. Second, for more recent events, there are usually very good atmospheric measurements of particulate matter, which allows the economist/epidemiologist/statistician to directly estimate the effect on salient pollution factors on health.
I think the existing research can be extended on several margins. For example, what are the long term effects of those exposed in utero. That is, how do kids who survive the insult do later in childhood and later in life? What is the biology behind this? Another interesting question stems from Jayachandran's finding that the impacts of pollution decline with increasing regional wealth. It's worth trying to tease apart why this is so: What is it about richer regions that shields their residents from the effects of dirty air? Do the wealthy live in houses with better ventilation? Are they more mobile?
More stuff: how much does an individual's productivity decline as a result of pollution? Finally, conditional on income, can we use information on the choices people make to avoid exposure to pollution say something about an individual's own valuation of his/her health status?
As unfortunate as the So-Cal fires are, perhaps some good can come out of the fact that it can generate some rich research. I'll be interested to see how the current state of the pollution literature will be advanced.
Other Interesting Links:
1) Kenneth Chay and Michael Greenstone have written some of the seminal papers on pollution and infant health. You can find some of them here and here. I like these papers because they are extremely rigorous. That kind of stuff makes for good graduate student reading.
2) Interesting post at the Freakonomics blog about the potentially substantial benefits to malaria eradication on health and economic outcomes.
3) Do grants increase research productivity? Check out this paper if you are interested in finding out the answer.
Wednesday, October 24, 2007
What's that 'Racquet'?
Exactly 10 years ago, I was starting my senior year in high-school. More than SATs and the usual college application stress, I had one thing on my mind: our tennis team winning the New York State Section II crown after years of looking like the second iteration Cleveland Browns.
I was pretty crazy about tennis then, and my interests in the sport ranged from strategy to equipment. I was especially fanatic about the latter: I spent hours reading the yearly racquet- issue in Tennis magazine. This special issue was about twice as thick as a normal issue and catalogued every new stick released in the last year and some of the more popular sticks from years past. Each description had a picture of the racquet, its specs (swing weight, balance, string pattern, stiffness, etc), and a description of what the magazine staff thought of the stick. I think I was drawn to this because it was kind of science-y. Indeed, several of the descriptions would feature comments from an MIT engineering professor.
I bought two racquets during my high school tennis career: the Head Pro Tour 280 and the Head Radical Tour. The former is perhaps the best racquet I have ever played with: it truly felt like an extension of my right arm. I felt like I could do anything with the ball, short of cooking it and putting it in a sandwich. Kick serves, sharply angled backhands, low volleys, and funky slices were all within my reach. Sadly, this wonderful blue stick was discontinued just two years after being introduced into the market and mine was destroyed within two years of its purchase over a trip to India, where my little cousins used it as a trampoline, thus deadening the string bed/frame nexus. The Head Radical Tour was bought as the closest replacement I could find for the 280.
I've gotten some good mileage out of my Radical, but its been frustrating. In the back of my mind I knew that I had already found the perfect racquet for me and, the Head corporation's marketing decisions notwithstanding, I hadn't done enough to cultivate a continuing relationship with that particular piece of equipment. After all, I could have bought two (or three) racquets instead of one. Or I could have been more vigilant in keeping it out of the hands of unwitting toddlers. Regrets, regrets: I could have tried so much harder!
A few weeks ago, after having played only sporadically in college, medical and grad school, I decided to get serious about tennis again. While playing with one of my mates, my trusty but ultimately unexciting Radical broke, the butt cap coming free from the handle. I took it to the pro shop to see if I could get it fixed but deep down I knew the thing was dead.
Given the inevitable, I was now racquet-less. I did the first thing I could think of: I went to eBay and some of the online tennis wholesalers to see if I could find a still unused Pro Tour 280. No luck. I lamented to the pro shop proprieter. He told me to get over it, dry my eyes, and move on. Racquet technology has really improved and perhaps I'll find a good fit in some of the new stuff?
One thing led to another, and I ended up joining his demo program. This is basically like a tennis racquet library: you borrow two racquets at a time and try them out. Based on what you tell the pro, he'll set you up with sticks that might work for your style of play (swing speed, court positioning, weaknesses, etc). I went home with the Babolat Aero Storm and Head Radical Tour Pro Microgel.
I was skeptical. My first impression was that racquet demo-ing was that this was like speed dating (which I have never tried - this is not the first time in this blog where I've discussed something I know nothing about): you get a few moments to make a decision on whether you want another go with the person or racquet. On the one hand, a few moments sounds like a crock: what if you happen to have an unusually great day when you hit with a racquet thats not quite right? On the other hand, Malcolm Gladwell talks about the power of first impressions in Blink, where even 30 seconds might be plenty of time to distill the situation and figure things out.
In any case, my skepticism probably came out of some need to make excuses for not wanting to try something new: I already found the right racquet years ago, and now its no longer possible to purchase that particular stick. Whats the point of working so hard to find something that I believe won't be as good? Why go through the disappointment? I even ignored the fact that I made my decision to buy the Pro Tour 280 with even less information: my choice was purely based on a quarter page blurb in Tennis that I read over and over.
Well, I'm happy to report that the Babolat Aero Storm has blown me away. Its 98 square inches and 11.7 ounces of ridiculously good control and spin. I can sit back and swing away, and still keep everything in the court. My volleys are crisp and the slices stay low. I absolutely love the stick. I am currently testing out the Technofibre Tfight 325 and some gimmicky Prince racquet that I can't stand. I kind of like the Technofibre, too, but I think the Babolat's the one.
So, over 10 years later, I finally found a racquet that really works (and is popular enough not to be discontinued). I'm really looking forward to the winter season, where I plan on playing team tennis. Who knows: maybe I'll get back to a solid 4.5-5.0 and enter tournaments again. Right now, though, its just nice to know that, after so many years, I found a stick that jives with me.
I was pretty crazy about tennis then, and my interests in the sport ranged from strategy to equipment. I was especially fanatic about the latter: I spent hours reading the yearly racquet- issue in Tennis magazine. This special issue was about twice as thick as a normal issue and catalogued every new stick released in the last year and some of the more popular sticks from years past. Each description had a picture of the racquet, its specs (swing weight, balance, string pattern, stiffness, etc), and a description of what the magazine staff thought of the stick. I think I was drawn to this because it was kind of science-y. Indeed, several of the descriptions would feature comments from an MIT engineering professor.
I bought two racquets during my high school tennis career: the Head Pro Tour 280 and the Head Radical Tour. The former is perhaps the best racquet I have ever played with: it truly felt like an extension of my right arm. I felt like I could do anything with the ball, short of cooking it and putting it in a sandwich. Kick serves, sharply angled backhands, low volleys, and funky slices were all within my reach. Sadly, this wonderful blue stick was discontinued just two years after being introduced into the market and mine was destroyed within two years of its purchase over a trip to India, where my little cousins used it as a trampoline, thus deadening the string bed/frame nexus. The Head Radical Tour was bought as the closest replacement I could find for the 280.
I've gotten some good mileage out of my Radical, but its been frustrating. In the back of my mind I knew that I had already found the perfect racquet for me and, the Head corporation's marketing decisions notwithstanding, I hadn't done enough to cultivate a continuing relationship with that particular piece of equipment. After all, I could have bought two (or three) racquets instead of one. Or I could have been more vigilant in keeping it out of the hands of unwitting toddlers. Regrets, regrets: I could have tried so much harder!
A few weeks ago, after having played only sporadically in college, medical and grad school, I decided to get serious about tennis again. While playing with one of my mates, my trusty but ultimately unexciting Radical broke, the butt cap coming free from the handle. I took it to the pro shop to see if I could get it fixed but deep down I knew the thing was dead.
Given the inevitable, I was now racquet-less. I did the first thing I could think of: I went to eBay and some of the online tennis wholesalers to see if I could find a still unused Pro Tour 280. No luck. I lamented to the pro shop proprieter. He told me to get over it, dry my eyes, and move on. Racquet technology has really improved and perhaps I'll find a good fit in some of the new stuff?
One thing led to another, and I ended up joining his demo program. This is basically like a tennis racquet library: you borrow two racquets at a time and try them out. Based on what you tell the pro, he'll set you up with sticks that might work for your style of play (swing speed, court positioning, weaknesses, etc). I went home with the Babolat Aero Storm and Head Radical Tour Pro Microgel.
I was skeptical. My first impression was that racquet demo-ing was that this was like speed dating (which I have never tried - this is not the first time in this blog where I've discussed something I know nothing about): you get a few moments to make a decision on whether you want another go with the person or racquet. On the one hand, a few moments sounds like a crock: what if you happen to have an unusually great day when you hit with a racquet thats not quite right? On the other hand, Malcolm Gladwell talks about the power of first impressions in Blink, where even 30 seconds might be plenty of time to distill the situation and figure things out.
In any case, my skepticism probably came out of some need to make excuses for not wanting to try something new: I already found the right racquet years ago, and now its no longer possible to purchase that particular stick. Whats the point of working so hard to find something that I believe won't be as good? Why go through the disappointment? I even ignored the fact that I made my decision to buy the Pro Tour 280 with even less information: my choice was purely based on a quarter page blurb in Tennis that I read over and over.
Well, I'm happy to report that the Babolat Aero Storm has blown me away. Its 98 square inches and 11.7 ounces of ridiculously good control and spin. I can sit back and swing away, and still keep everything in the court. My volleys are crisp and the slices stay low. I absolutely love the stick. I am currently testing out the Technofibre Tfight 325 and some gimmicky Prince racquet that I can't stand. I kind of like the Technofibre, too, but I think the Babolat's the one.
So, over 10 years later, I finally found a racquet that really works (and is popular enough not to be discontinued). I'm really looking forward to the winter season, where I plan on playing team tennis. Who knows: maybe I'll get back to a solid 4.5-5.0 and enter tournaments again. Right now, though, its just nice to know that, after so many years, I found a stick that jives with me.
Monday, October 22, 2007
Elementary, My Dear Watson
Nobel Prize winner James Watson created quite the ruckus this past week thanks to his comments on race and intelligence. His basic thesis is pretty easy to distill:
The scientist, who won the Nobel prize for his part in discovering the structure of DNA, was quoted in an interview in The Sunday Times saying he was “inherently gloomy about the prospect of Africa” because “all our social policies are based on the fact that their intelligence is the same as ours - whereas all the testing says not really.”
Watson recently clarified his statements, probably in an attempt to address the tidal wave of criticism hurled in his direction. His new material, while sticking to his main point, sounds less inflammatory:
-"If I said what I was quoted as saying, then I can only admit that I am bewildered by it."
-"We do not yet adequately understand the way in which the different environments in the world have selected over time the genes which determine our capacity to do different things."
-"This is not a discussion about superiority or inferiority, it is about seeking to understand differences, about why some of us are great musicians and others great engineers."
I'm not going to call Watson a racist or anything like that: it would be scientifically unproductive and irrelevant to do so. Instead, I'd like to address the merits of his hypotheses. Here is what I think:
1) Unless humans evolved independently in more than one location, all of us have descended from the same human line and, therefore, some specific geographic location. Obviously, as human migrated away from each other differential selection pressures helped generate different traits (like skin color, facial morphology, etc). In that sense, its not hard to imagine that different population groups might vary across a set of traits. However, it is harder to imagine that something like intelligence would be selected on differently across space: I would expect the returns to being smart to be relatively similar across different populations, especially in the days around and prior to the agricultural revolution.
You might think that this argument is as tenuous as Watson's. You are right. However, my point is to apply the "huh" test to his reasoning. When one does that, the whole thing seems somewhat shaky.
2) Here is a stronger argument: racial gaps in ability might be explained primarily by differences in childhood investments and early life environments. Indeed, there is a great deal of scientific evidence that indicates that this may be the case. I'll pick one of my favorites as an example. In an earlier post, I talked about a paper by Douglas Almond and Ken Chay, looking at the impact of Civil Rights movement induced hospital integration on the intergenerational transfer of health status among black individuals. The authors found that the children of women born just after hospital integration report higher birthweights, better apgar scores, and lower infant mortality. Here's the kicker: they also find that the black-white test score gap among this advantaged cohort is much thinner.
It's no stretch to posit that the effects of environment are large, powerful and very real. Given how salient these factors are, it makes a great deal of sense to try and understand the process of cognitive development and its relevant inputs before resorting to blanket genetic statements. Indeed, other papers suggest that the entirity of the ability gap can be explained by early-life socioeconomic factors. Check out this post by Steven Levitt for some information on his interesting work.
3) Uncovering the determinants of ability should command a great deal of research attention. All credible hypotheses should be taken seriously and addressed with the best scientific methods. On that note, I do not believe that Watson's hypotheses are very compelling, and perhaps this is not where we should be focusing our attention when it comes to future research.
The scientist, who won the Nobel prize for his part in discovering the structure of DNA, was quoted in an interview in The Sunday Times saying he was “inherently gloomy about the prospect of Africa” because “all our social policies are based on the fact that their intelligence is the same as ours - whereas all the testing says not really.”
Watson recently clarified his statements, probably in an attempt to address the tidal wave of criticism hurled in his direction. His new material, while sticking to his main point, sounds less inflammatory:
-"If I said what I was quoted as saying, then I can only admit that I am bewildered by it."
-"We do not yet adequately understand the way in which the different environments in the world have selected over time the genes which determine our capacity to do different things."
-"This is not a discussion about superiority or inferiority, it is about seeking to understand differences, about why some of us are great musicians and others great engineers."
I'm not going to call Watson a racist or anything like that: it would be scientifically unproductive and irrelevant to do so. Instead, I'd like to address the merits of his hypotheses. Here is what I think:
1) Unless humans evolved independently in more than one location, all of us have descended from the same human line and, therefore, some specific geographic location. Obviously, as human migrated away from each other differential selection pressures helped generate different traits (like skin color, facial morphology, etc). In that sense, its not hard to imagine that different population groups might vary across a set of traits. However, it is harder to imagine that something like intelligence would be selected on differently across space: I would expect the returns to being smart to be relatively similar across different populations, especially in the days around and prior to the agricultural revolution.
You might think that this argument is as tenuous as Watson's. You are right. However, my point is to apply the "huh" test to his reasoning. When one does that, the whole thing seems somewhat shaky.
2) Here is a stronger argument: racial gaps in ability might be explained primarily by differences in childhood investments and early life environments. Indeed, there is a great deal of scientific evidence that indicates that this may be the case. I'll pick one of my favorites as an example. In an earlier post, I talked about a paper by Douglas Almond and Ken Chay, looking at the impact of Civil Rights movement induced hospital integration on the intergenerational transfer of health status among black individuals. The authors found that the children of women born just after hospital integration report higher birthweights, better apgar scores, and lower infant mortality. Here's the kicker: they also find that the black-white test score gap among this advantaged cohort is much thinner.
It's no stretch to posit that the effects of environment are large, powerful and very real. Given how salient these factors are, it makes a great deal of sense to try and understand the process of cognitive development and its relevant inputs before resorting to blanket genetic statements. Indeed, other papers suggest that the entirity of the ability gap can be explained by early-life socioeconomic factors. Check out this post by Steven Levitt for some information on his interesting work.
3) Uncovering the determinants of ability should command a great deal of research attention. All credible hypotheses should be taken seriously and addressed with the best scientific methods. On that note, I do not believe that Watson's hypotheses are very compelling, and perhaps this is not where we should be focusing our attention when it comes to future research.
Thursday, October 11, 2007
What Does Small Area Variation Actually Say About Health Care in the US?
In the 1970s, John Wennberg and Alan Gittelsohn noted something very peculiar about health care delivery in the United States: they found a great deal of variation within a sample New England towns in the rates of various surgical procedures. For example, the rates of hysterectomies and tonsillectomies in Vermont varied wildly across hospital service areas, with most intense areas sporting 3 and 10 times the number of procedures per capita as the least intense areas, respectively!
Since Wennberg and Gittelsohn's original paper, a great deal of work has been done on this phenomenon, coined "small area variation." This research has shown that (a) county/area level demographics, per capita income and other socioeconomic variables do not always explain away the cross-area variations and (b) variation in service delivery persists even today. (For a sense of (b), check out the Dartmouth Atlas of Health Care, a great resource and a fun way to spend a half hour or so.)
As you can probably imagine, the small-area variation literature created a huge health policy firestorm, whose echoes continue to reverberate in the present day. Basically, policymakers concluded the following things from this literature:
1) Wide variation in service delivery reflects uncertainty among physicians about what best practices are. This suggests that either physicians don't know as much as originally assumed, that information about best practices does not diffuse quickly among doctors or both.
2) In addition to (1), it may be that physicians in certain areas are more likely to get their patients to agree to certain procedures. The technical term for this is supplied-induced demand.
3) Areas that have higher rates of various procedures and, therefore, ostensibly spend more do not have better health outcomes. This suggests that the high intensity areas are wasteful. The empirical finding of no association between treatment rates/spending and outcomes lends even more support to (1) and (2).
Not surprisingly, small-area variation is widely seen as both a cause and symptom of very messy U.S. health care system, its existence viewed as indicative of pernicious processes that need to be curbed.
However, are there other explanations behind the empirical findings in the small area variations literature? Let's start with the question of why small area variation exists in the first place. Are there other theories besides supplied-induced demand and poor diffusion of information in the context of area-specific norms that can explain these empirical observations?
In a recent paper in the Journal of Political Economy, economists Amitabh Chandra and Douglas Staiger suggest the answer is "yes." In particular, the propose a theory where the key feature is that the benefit of a single procedure over another is contingent on the number of other patients receiving that procedure in the same area. How could this happen? First, since doctors learn from each other, a physician becomes more productive with a given procedure if he/she has more peers in the area doing the same thing. Second, support services in area hospitals that make a given procedure more productive might arise due to various historic factors. Third, doctors may self-select and practice in areas with different treatment intensities. Regardless of the relative importance of these factors, the key point is that these "productivity spillovers" are plausibly less icky than more "evil" stories like uninformed and tricky docs.
Chandra and Staiger test their theory in the data, looking at treatment patterns for heart attacks (intensive-surgical versus non-intensive-pharmacological) among a sample of Medicare patients, and find a very good fit. From a grad student perspective, the beauty of this paper is how the authors use their theory not only to explain the existing facts in the small-area variation literature, but also to generate further predictions that can be tested in the data. This is the key: what differentiates one theory from the other are the predictions it makes and, as a result, the only way to tease apart the underlying driving forces are to focus on predictions unique to each theory.
What about the consequences of small-area variation? Past research exploited this variation to conclude that increased treatment intensity and increased expenditure have no effect on health outcomes. Some recent research, however, suggests that this may be wrong. In a recent working paper (thanks to Brian Elbel for the reference), Joseph Doyle notes that past estimates of expenditure effects might be plagued by omitted variable bias: more money might be spent in areas where health outcomes are worse, thus biasing the relationship between the two towards zero. Here is how he gets around this:
The main innovation in this paper compares outcomes of patients who are exposed to different health care systems that were not designed for them: patients who are far from home when a health emergency strikes. The universe of emergencies in Florida from 1996-2003 is considered, and visitors who become ill in high-spending areas have significantly lower mortality rates compared to similar visitors in lower-spending areas. The results are robust across different types of patients and within groups of destinations that appear to be close demand substitutes.
Of course, the main threat to inference in this strategy is that richer tourists or visitors might self select to go into richer counties. Doyle has a variety of robustness checks to address this hypothesis. Check out the paper and see if you buy it.
I think this finding is interesting. Many people think that the U.S. is wasteful with its health care dollars and this might be true in some contexts. However, as the trajectory of the small-area variations literature illustrates, it is worth having a fresh look at our priors before making sweeping policy statements. Things may not be as bad as they seem.
Since Wennberg and Gittelsohn's original paper, a great deal of work has been done on this phenomenon, coined "small area variation." This research has shown that (a) county/area level demographics, per capita income and other socioeconomic variables do not always explain away the cross-area variations and (b) variation in service delivery persists even today. (For a sense of (b), check out the Dartmouth Atlas of Health Care, a great resource and a fun way to spend a half hour or so.)
As you can probably imagine, the small-area variation literature created a huge health policy firestorm, whose echoes continue to reverberate in the present day. Basically, policymakers concluded the following things from this literature:
1) Wide variation in service delivery reflects uncertainty among physicians about what best practices are. This suggests that either physicians don't know as much as originally assumed, that information about best practices does not diffuse quickly among doctors or both.
2) In addition to (1), it may be that physicians in certain areas are more likely to get their patients to agree to certain procedures. The technical term for this is supplied-induced demand.
3) Areas that have higher rates of various procedures and, therefore, ostensibly spend more do not have better health outcomes. This suggests that the high intensity areas are wasteful. The empirical finding of no association between treatment rates/spending and outcomes lends even more support to (1) and (2).
Not surprisingly, small-area variation is widely seen as both a cause and symptom of very messy U.S. health care system, its existence viewed as indicative of pernicious processes that need to be curbed.
However, are there other explanations behind the empirical findings in the small area variations literature? Let's start with the question of why small area variation exists in the first place. Are there other theories besides supplied-induced demand and poor diffusion of information in the context of area-specific norms that can explain these empirical observations?
In a recent paper in the Journal of Political Economy, economists Amitabh Chandra and Douglas Staiger suggest the answer is "yes." In particular, the propose a theory where the key feature is that the benefit of a single procedure over another is contingent on the number of other patients receiving that procedure in the same area. How could this happen? First, since doctors learn from each other, a physician becomes more productive with a given procedure if he/she has more peers in the area doing the same thing. Second, support services in area hospitals that make a given procedure more productive might arise due to various historic factors. Third, doctors may self-select and practice in areas with different treatment intensities. Regardless of the relative importance of these factors, the key point is that these "productivity spillovers" are plausibly less icky than more "evil" stories like uninformed and tricky docs.
Chandra and Staiger test their theory in the data, looking at treatment patterns for heart attacks (intensive-surgical versus non-intensive-pharmacological) among a sample of Medicare patients, and find a very good fit. From a grad student perspective, the beauty of this paper is how the authors use their theory not only to explain the existing facts in the small-area variation literature, but also to generate further predictions that can be tested in the data. This is the key: what differentiates one theory from the other are the predictions it makes and, as a result, the only way to tease apart the underlying driving forces are to focus on predictions unique to each theory.
What about the consequences of small-area variation? Past research exploited this variation to conclude that increased treatment intensity and increased expenditure have no effect on health outcomes. Some recent research, however, suggests that this may be wrong. In a recent working paper (thanks to Brian Elbel for the reference), Joseph Doyle notes that past estimates of expenditure effects might be plagued by omitted variable bias: more money might be spent in areas where health outcomes are worse, thus biasing the relationship between the two towards zero. Here is how he gets around this:
The main innovation in this paper compares outcomes of patients who are exposed to different health care systems that were not designed for them: patients who are far from home when a health emergency strikes. The universe of emergencies in Florida from 1996-2003 is considered, and visitors who become ill in high-spending areas have significantly lower mortality rates compared to similar visitors in lower-spending areas. The results are robust across different types of patients and within groups of destinations that appear to be close demand substitutes.
Of course, the main threat to inference in this strategy is that richer tourists or visitors might self select to go into richer counties. Doyle has a variety of robustness checks to address this hypothesis. Check out the paper and see if you buy it.
I think this finding is interesting. Many people think that the U.S. is wasteful with its health care dollars and this might be true in some contexts. However, as the trajectory of the small-area variations literature illustrates, it is worth having a fresh look at our priors before making sweeping policy statements. Things may not be as bad as they seem.
Monday, October 8, 2007
I paid $0.02
A few days back I talked about the new Radiohead album and the band's innovative "pay-what-you-want" pricing scheme. I also went ahead and asked people what they would shell out for the new tracks. While my sample was very small (thank you Maheer and James), I believe it is fairly representative: most people on various other blogs also commented that they would pay well above the $0.02 minimum for In Rainbows.
After a great deal of thought, I went ahead and officially purchased the new album today. I decided to pay the minimum price, which actually worked out to about $1.00 thanks to credit-card related transaction costs (45 pence). Why did I pay so little? My reasons were the following:
1) I am a poor student
2) I will probably end up spending $100+ for concert tickets and another $15+ for the official disc version of In Rainbows (which will feature an additional 8 tracks, including the sensational "Bangers 'N Mash")
3) If they are allowing me to spend next to nothing, why not? I can collect on all that extra consumer surplus.
What's even more interesting was how guilty I felt right after the transaction was processed. Here were my post-purchase thoughts in the order that they happened:
1) Man, I am a really bad Radiohead fan.
2) Other people will think I am a bad Radiohead fan when they find out how much I paid for this album.
3) I feel like I'm stealing: I would have paid so much more in the store. Another way of saying this: I paid far, far less than my personal valuation of the good.
I'm willing to bet that a lot of people would go through this reaction, conditional on what they paid for the album. After all, I think it is for the above reasons that people were willing to pay more than the required minimum in the first place, why we overtip waiters and waitresses, why we donate $15 instead of $5 for entry into a large public museum, etc. In this case, from the standpoint of a standard economic model, there is no rational reason to pay more, so the psychology behind this behavior must be quite rich. This is a long way of saying that aspects like signalling to other consumers (2) and guilt (3) play a large role in these decisions.
Any thoughts?
After a great deal of thought, I went ahead and officially purchased the new album today. I decided to pay the minimum price, which actually worked out to about $1.00 thanks to credit-card related transaction costs (45 pence). Why did I pay so little? My reasons were the following:
1) I am a poor student
2) I will probably end up spending $100+ for concert tickets and another $15+ for the official disc version of In Rainbows (which will feature an additional 8 tracks, including the sensational "Bangers 'N Mash")
3) If they are allowing me to spend next to nothing, why not? I can collect on all that extra consumer surplus.
What's even more interesting was how guilty I felt right after the transaction was processed. Here were my post-purchase thoughts in the order that they happened:
1) Man, I am a really bad Radiohead fan.
2) Other people will think I am a bad Radiohead fan when they find out how much I paid for this album.
3) I feel like I'm stealing: I would have paid so much more in the store. Another way of saying this: I paid far, far less than my personal valuation of the good.
I'm willing to bet that a lot of people would go through this reaction, conditional on what they paid for the album. After all, I think it is for the above reasons that people were willing to pay more than the required minimum in the first place, why we overtip waiters and waitresses, why we donate $15 instead of $5 for entry into a large public museum, etc. In this case, from the standpoint of a standard economic model, there is no rational reason to pay more, so the psychology behind this behavior must be quite rich. This is a long way of saying that aspects like signalling to other consumers (2) and guilt (3) play a large role in these decisions.
Any thoughts?
Thursday, October 4, 2007
The Rap on Crime
You may have heard that Congress held hearings last week focusing on profane and violent lyrics in popular rap music. The Daily Show had a great segment on straight-laced Congressmen bashfully quoting and walking through some pretty hardcore lyrics. Despite the hilarity surrounding the Representatives struggling through the profanity, the implicit message behind their words is more serious and crystal clear: violent and profane imagery in rap spurs on violence and other illegal behaviors in society at large.
While some artists (most notably Dancing with the Stars ringer Master P) agree with this, several people at the hearing (read: industry executives) pointed out that Congress may be getting the direction of causality wrong. So the question is: Does rap induce violence or simply reflect it?
I wonder if we can chip away at this question with some data. It shouldn't be hard to get yearly statistics on different kinds of crime committed, sales of rap albums, and a bunch of socioeconomic indicators (per capita income, average age, population breakdown by race, etc). With multiple years of data, one could control for state-specific effects that don't change over time.
However, this alone likely won't be enough: we still can't say whether its changes in rap album sales or changes in violence (or both) that drive the story. What we really need is a variable that predicts rap sales but does not influence violent crimes through another independent channel. I wonder if rap, like grunge, started in one part of the country and slowly diffused out. If so, it might be possible to interact geographic distance from "epicenter" and share of young and minority population to form an instrumental variable (though the epicenter argument probably applies differentially to the spread of old school rap, and thus the local average treatment effect we would derive would not be policy relevant). One might also want to look at lagged rap sales as well.
Any thoughts?
While some artists (most notably Dancing with the Stars ringer Master P) agree with this, several people at the hearing (read: industry executives) pointed out that Congress may be getting the direction of causality wrong. So the question is: Does rap induce violence or simply reflect it?
I wonder if we can chip away at this question with some data. It shouldn't be hard to get yearly statistics on different kinds of crime committed, sales of rap albums, and a bunch of socioeconomic indicators (per capita income, average age, population breakdown by race, etc). With multiple years of data, one could control for state-specific effects that don't change over time.
However, this alone likely won't be enough: we still can't say whether its changes in rap album sales or changes in violence (or both) that drive the story. What we really need is a variable that predicts rap sales but does not influence violent crimes through another independent channel. I wonder if rap, like grunge, started in one part of the country and slowly diffused out. If so, it might be possible to interact geographic distance from "epicenter" and share of young and minority population to form an instrumental variable (though the epicenter argument probably applies differentially to the spread of old school rap, and thus the local average treatment effect we would derive would not be policy relevant). One might also want to look at lagged rap sales as well.
Any thoughts?
Wednesday, October 3, 2007
Review: Better than a Killer, by Black Market Radio
After an entire summer of listening to Audioslave, Rage Against the Machine, and Soundgarden over and over, I felt ready to move on to some newer music. Having been in the mood for heavier music for the past few months, I wanted to continue on that line and find something grungy in the Soundgarden or Nirvana style, with lots of screaming, loud guitars and messy riffs.
Black Market Radio is a Seattle based group that attempts to deliver these goods. The group's frontman is Peter Cornell, who happens to be the brother of - you guessed it - Chris Cornell, of Soundgarden and Audioslave fame. Keith Mannino (bass, backing vocals and the occasional guitar) and Johnny D (drums) round out the trio.
Better than a Killer is the group's most recent album and features a decent dose of 90s style grunge for those who are nostalgic or for those who didn't listen to this stuff during middle and high school and only got into it less than a year ago (the latter is me). The title track is pretty good, but the middle of the album is where the meat is. "Link," "Big Stones," "Fight of Your Life" and "Suicide Parlour" are quite good, with introspective and oft depressing vocals combined with some heavy sounds. The rest of the 12-track album is passable. You can listen to some BMR here (definitely have a look and let me know what you think).
The main strength of the album is Peter Cornell. I guess great voices run in that family. Many other reviews note the strong resemblance in the brothers' voices. When Peter goes off in "Link":
So I raise my glass to the fallen angels...
I tip my hat to the fallen angels...
you feel like you're listening to Chris from his Badmotorfinger days.
But I think Peter has distinct and memorable moments that are very much unique to him and him alone. He cultivates his own style and works wonders across a wide variety of songs. For example, I could never imagine Chris belting out "Ghost" the way Peter does.
I'm not sure what the future will look like for Black Market Radio. I haven't seen too many reviews for this album (which released early-mid August) and the buzz hasn't picked up (yet). I definitely hope that this changes and that Peter Cornell gets noticed more than he has and ascends above the label "Chris' Brother."
In an interview early last year, Cornell claimed, "It's like [BMR is] involved in a renaissance of that [older, high quality] sound...It needs a resurgence. There's a lot of fans online that have felt neglected over the last three or four years." The band's motto then was "together we will save rock 'n roll."
Have they succeeded in that quest? I definitely think BMR's sound is, for the most part, a welcome distraction from the tired out stuff that bands like Linkin' Park put out. However, there are times when the band descends into the worn world of new school rock. Perhaps it can't be helped (unless you are the White Stripes).
I rate the album at 6.75/10.
Black Market Radio is a Seattle based group that attempts to deliver these goods. The group's frontman is Peter Cornell, who happens to be the brother of - you guessed it - Chris Cornell, of Soundgarden and Audioslave fame. Keith Mannino (bass, backing vocals and the occasional guitar) and Johnny D (drums) round out the trio.
Better than a Killer is the group's most recent album and features a decent dose of 90s style grunge for those who are nostalgic or for those who didn't listen to this stuff during middle and high school and only got into it less than a year ago (the latter is me). The title track is pretty good, but the middle of the album is where the meat is. "Link," "Big Stones," "Fight of Your Life" and "Suicide Parlour" are quite good, with introspective and oft depressing vocals combined with some heavy sounds. The rest of the 12-track album is passable. You can listen to some BMR here (definitely have a look and let me know what you think).
The main strength of the album is Peter Cornell. I guess great voices run in that family. Many other reviews note the strong resemblance in the brothers' voices. When Peter goes off in "Link":
So I raise my glass to the fallen angels...
I tip my hat to the fallen angels...
you feel like you're listening to Chris from his Badmotorfinger days.
But I think Peter has distinct and memorable moments that are very much unique to him and him alone. He cultivates his own style and works wonders across a wide variety of songs. For example, I could never imagine Chris belting out "Ghost" the way Peter does.
I'm not sure what the future will look like for Black Market Radio. I haven't seen too many reviews for this album (which released early-mid August) and the buzz hasn't picked up (yet). I definitely hope that this changes and that Peter Cornell gets noticed more than he has and ascends above the label "Chris' Brother."
In an interview early last year, Cornell claimed, "It's like [BMR is] involved in a renaissance of that [older, high quality] sound...It needs a resurgence. There's a lot of fans online that have felt neglected over the last three or four years." The band's motto then was "together we will save rock 'n roll."
Have they succeeded in that quest? I definitely think BMR's sound is, for the most part, a welcome distraction from the tired out stuff that bands like Linkin' Park put out. However, there are times when the band descends into the worn world of new school rock. Perhaps it can't be helped (unless you are the White Stripes).
I rate the album at 6.75/10.
Tuesday, October 2, 2007
New Radiohead Album October 10th!
I just saw this NYT article about the new Radiohead album, "In Rainbow." Apparently, the album will be available on October 10th, and you can download it from the band's website. The price is - here is the kicker - whatever you want it to be!
This is mind-blowing on so many levels. First off, Radiohead has to be one of the most innovative bands ever, and their new album promises to be incredible. I know this because I've downloaded most of the new set they were playing live on tour last year and, even in the raw form, its amazing stuff.
Second, their pricing and distribution scheme is absolutely revolutionary. Here is an excerpt from the Times piece:
There is no maximum price, nor any other guidance, setting up what is may be the biggest experiment in digital-era music-industry pricing to date. What are people willing to pay for music? How many will pay full price? How will the average price compare to what a typical record company would likely have charged? Will people pirate it anyway?
I would love to talk more in depth about the economics of this here, but I just found out I was beaten to it: Tyler Cowen at the Marginal Revolution gives his thoughts on this new scheme here. No worries: Radiohead and econ in the same morning? Rad.
Just a few weeks ago, I saw a report that Radiohead was finished with the new album and was looking to release it mid-2008 upon finding a new label. But I knew that was bogus because, for quite some time, frontman Thom Yorke has been talking about how he wanted to use the internet as a means of music dissemination. And I was right. Three cheers to Radiohead:
Cheer 1) Your music rocks
Cheer 2) Way to embrace the digital age
Cheer 3) You just made the rest of my 2007.
So I have some questions for you readers:
1) Are you a Radiohead fan?
2) How much would you actually dish out for the new album?
Your comments on this post are so important that I will randomly choose one of them to win a hitherto unnamed prize.
Finally, I whole-heartedly thank Wisconsin-ite Nick Rhodes for putting me on to Radiohead. Nick has great taste in music, and somehow everything he does has instant street-cred. He's good people.
This is mind-blowing on so many levels. First off, Radiohead has to be one of the most innovative bands ever, and their new album promises to be incredible. I know this because I've downloaded most of the new set they were playing live on tour last year and, even in the raw form, its amazing stuff.
Second, their pricing and distribution scheme is absolutely revolutionary. Here is an excerpt from the Times piece:
There is no maximum price, nor any other guidance, setting up what is may be the biggest experiment in digital-era music-industry pricing to date. What are people willing to pay for music? How many will pay full price? How will the average price compare to what a typical record company would likely have charged? Will people pirate it anyway?
I would love to talk more in depth about the economics of this here, but I just found out I was beaten to it: Tyler Cowen at the Marginal Revolution gives his thoughts on this new scheme here. No worries: Radiohead and econ in the same morning? Rad.
Just a few weeks ago, I saw a report that Radiohead was finished with the new album and was looking to release it mid-2008 upon finding a new label. But I knew that was bogus because, for quite some time, frontman Thom Yorke has been talking about how he wanted to use the internet as a means of music dissemination. And I was right. Three cheers to Radiohead:
Cheer 1) Your music rocks
Cheer 2) Way to embrace the digital age
Cheer 3) You just made the rest of my 2007.
So I have some questions for you readers:
1) Are you a Radiohead fan?
2) How much would you actually dish out for the new album?
Your comments on this post are so important that I will randomly choose one of them to win a hitherto unnamed prize.
Finally, I whole-heartedly thank Wisconsin-ite Nick Rhodes for putting me on to Radiohead. Nick has great taste in music, and somehow everything he does has instant street-cred. He's good people.
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