Rush Limbaugh doesn't like oral contraception. At least, he doesn't think health insurers should have to pay it ('Dar He Blogs will keep this debate academic and avoid any "pot-kettle-black" type comments). I'm guessing he wasn't aware of a new study by Martha Bailey and co-authors illustrating the large, positive labor market effects "The Pill" has provided for women:
Decades of research on the U.S. gender gap in wages describes its correlates, but little is known about why women changed their career paths in the 1960s and 1970s. This paper explores the role of “the Pill” in altering women’s human capital investments and its ultimate implications for life-cycle wages. Using state-by-birth-cohort variation in legal access to contraception, we show that younger access to the Pill conferred an 8-percent hourly wage premium by age fifty. Our estimates imply that the Pill can account for 10 percent of the convergence of the gender gap in the 1980s and 30 percent in the 1990s.
Why would birth control pills enable women to earn more? By allowing more control over the reproductive cycle, this would reduce uncertainty in the timing of certain events, such as pursuing college, job training opportunities, and entering the workforce. One could easily imagine how providing women with relative certainty could lead to more investment in their "human capital" because it is now easier to do so and the returns become more predictable.
Another way oral contraceptives can help in the labor market has to do with absenteeism due to menstruation. In a really neat study, Andrea Ichino and Enrico Moretti show that work absences for young women follow a 28 day cycle, whereas those for women over the age of 45, and men of any age, do not. They suggest that this pattern is due to menstruation and go on to calculate that lost work days on the account of the cycle may explain 14% of the gender differential in earnings seen in their Italian dataset.
Monday, March 26, 2012
Thursday, March 22, 2012
Shortening Medical Training? Yes, Please!
Those who want to become a doctor in the United States stare at a very long road: 4 years of college, 4 years of medical school, 3-7 years of residency and, potentially, fellowship to finish it all off. (Some crazies additionally tack on another 1-5 years to do this in pursuing a joint degree, as well). But does it really require all this time to create a doctor well-equipped to fight disease in our current times?
None another than Ezekiel Emanuel and Victor Fuchs (one of the Founding Fathers of health economics) think that the answer is "no." In a recent piece in the Journal of the American Medical Association, they state that the current educational system for physicians is, in fact, wasteful. They point out that a physician today cannot credibly be the superhero, one-man-band of master clinician, penetrating researcher, community pillar, and public intellectual that she/he was expected to be up through the 1980s. The state that the complexity of medicine today requires a team based approach where doctors are relative specialists. Emanuel and Fuchs illustrate how physicians today are now more likely to take on the one (or two) of these archetypical roles that fit with their comparative strengths while letting other members of the larger team fulfill the other roles. In contrast to this new reality of medicine, our current system of medical education is wasteful because it still aims to produce one-man-band types.
So how can medical education be shortened? Emanuel and Fuchs suggest the following:
-Loosen requirements that undergraduate degrees be mandatory (there are plenty of six or seven year combined undergrad-MD programs that produce equally good doctors)
-Cut the pre-clinical years of medical school from 2 to 1.5 years (UPenn and Duke have shortened versions of the classroom years)
-Cut the clinical years from 24 to 15 months (Harvard is currently doing this, quite successfully I might add)
-Eliminate research requirements in residency and fellowship for those who do not want to do them (this, for example, would shave off 2 of the 7 years to become a general surgeon)
-Eliminate "leadership years" (for example, in internal medicine, the third year is to lead teams and has little value added in the education production function)
I am 100% behind this. Much of our current system persists because of historical considerations from nearly a century ago. In the same way that some of our antiquated mechanisms to finance health care (for example, employer sponsored health insurance) don't make much sense anymore, neither does making people spend a great deal of time in training where up to a third of it has little marginal benefit in turning people into good doctors.
If we are concerned with cost and efficiency in the health care system, we ought to paying as much attention to being efficient in how we train doctors as we are in figuring out how to pay them.
None another than Ezekiel Emanuel and Victor Fuchs (one of the Founding Fathers of health economics) think that the answer is "no." In a recent piece in the Journal of the American Medical Association, they state that the current educational system for physicians is, in fact, wasteful. They point out that a physician today cannot credibly be the superhero, one-man-band of master clinician, penetrating researcher, community pillar, and public intellectual that she/he was expected to be up through the 1980s. The state that the complexity of medicine today requires a team based approach where doctors are relative specialists. Emanuel and Fuchs illustrate how physicians today are now more likely to take on the one (or two) of these archetypical roles that fit with their comparative strengths while letting other members of the larger team fulfill the other roles. In contrast to this new reality of medicine, our current system of medical education is wasteful because it still aims to produce one-man-band types.
So how can medical education be shortened? Emanuel and Fuchs suggest the following:
-Loosen requirements that undergraduate degrees be mandatory (there are plenty of six or seven year combined undergrad-MD programs that produce equally good doctors)
-Cut the pre-clinical years of medical school from 2 to 1.5 years (UPenn and Duke have shortened versions of the classroom years)
-Cut the clinical years from 24 to 15 months (Harvard is currently doing this, quite successfully I might add)
-Eliminate research requirements in residency and fellowship for those who do not want to do them (this, for example, would shave off 2 of the 7 years to become a general surgeon)
-Eliminate "leadership years" (for example, in internal medicine, the third year is to lead teams and has little value added in the education production function)
I am 100% behind this. Much of our current system persists because of historical considerations from nearly a century ago. In the same way that some of our antiquated mechanisms to finance health care (for example, employer sponsored health insurance) don't make much sense anymore, neither does making people spend a great deal of time in training where up to a third of it has little marginal benefit in turning people into good doctors.
If we are concerned with cost and efficiency in the health care system, we ought to paying as much attention to being efficient in how we train doctors as we are in figuring out how to pay them.
Sunday, March 18, 2012
Thank You, Affordable Care Act!
I've come across quite a few patients now in their early 20s presenting with the first symptoms of what may be a serious chronic illness. Many of these individuals happen to be without health insurance for one reason or another. Thankfully, in Massachusetts, the combination of Mass Health (Medicaid), Commonwealth Care and coverage options for young adults under 26 allows many of these individuals to get much needed care. On the other hand, my patients from neighboring states do not necessarily have access to these luxuries, which is were the Patient Protection Affordable Care Act (PPACA) comes in.
The PPACA has quite a few moving parts, some of which are in place and others not (see here and here). One piece that has gone into effect mandates that health plans that cover children of the enrollee to now cover said children up to the age of 26. For several of my patients, this has allowed them to get access to health care as they bridge to their late 20s and eventually find their own care options. As their doctor, this has been huge: it prevents my patients from deferring care for a serious condition that would most certainly result in large short-term and long-term economic and health consequences.
Interestingly, I'm not sure if too many people know about this aspect of the health care law. I told one self-identified Republican, a young man who would go on to benefit from the extension of parental insurance, about it and he seemed shocked: "For real? You mean, this is President Obama's idea? Wow, he's looking out for us."
I wonder now if much of the resistance to the PPACA has to do with similarly placed ignorance. If that is the case, the Republicans should be credited for obfuscating the national debate around the law in their favor and the Democrats chastised for allowing this to happen.
I'm not saying I'm a PPACA homer or anything. The act certainly has some issues. That said, as a new primary care doctor, I just can't imagine practicing in a time where such options were not available. Really, it's incredible that that time was literally a year or so ago. Imagine holding off treatment for newly diagnosed active and fulminant Crohn's disease because of lack of access: would that happen in a just, advanced society? Thankfully, not anymore.
The PPACA has quite a few moving parts, some of which are in place and others not (see here and here). One piece that has gone into effect mandates that health plans that cover children of the enrollee to now cover said children up to the age of 26. For several of my patients, this has allowed them to get access to health care as they bridge to their late 20s and eventually find their own care options. As their doctor, this has been huge: it prevents my patients from deferring care for a serious condition that would most certainly result in large short-term and long-term economic and health consequences.
Interestingly, I'm not sure if too many people know about this aspect of the health care law. I told one self-identified Republican, a young man who would go on to benefit from the extension of parental insurance, about it and he seemed shocked: "For real? You mean, this is President Obama's idea? Wow, he's looking out for us."
I wonder now if much of the resistance to the PPACA has to do with similarly placed ignorance. If that is the case, the Republicans should be credited for obfuscating the national debate around the law in their favor and the Democrats chastised for allowing this to happen.
I'm not saying I'm a PPACA homer or anything. The act certainly has some issues. That said, as a new primary care doctor, I just can't imagine practicing in a time where such options were not available. Really, it's incredible that that time was literally a year or so ago. Imagine holding off treatment for newly diagnosed active and fulminant Crohn's disease because of lack of access: would that happen in a just, advanced society? Thankfully, not anymore.
Saturday, March 3, 2012
Preventing HIV and STDs with Cash Transfers - Both Abroad and Here?
So on the heels of my post a few days ago comes a brand new study in The Lancet where women in Malawi randomized to receive unconditional cash transfers were less likely to contract HIV or other STDs than their unpaid counterparts. Here is a very nice summary piece on the study.
The mechanism linking cash transfers to reduced HIV may have something to do with the fact that women with access to such resources need not depend on men for the same. That is, women who are cash strapped or who lack opportunities in the labor market may need to depend on relationships where the partner can support them financially. Financial support, in turn, may reduce their ability to negotiate safe sex practices (this is the so-called "transactional sex").
Cash transfer programs of this nature may not just be useful overseas. A forthcoming article in the Journal of Adolescent Health shows that young African American women in Atlanta who have boyfriends who give them gifts are less likely to use condoms than those without such boyfriends or those with boyfriends who go on to find another source of spending money. The authors conclude that "receiving spending money from a boyfriend is common among adolescent women in populations targeted by pregnancy and sexually transmitted infection prevention interventions, and may undermine interventions' effectiveness." (HT: Paula C for the Atlanta paper).
The mechanism linking cash transfers to reduced HIV may have something to do with the fact that women with access to such resources need not depend on men for the same. That is, women who are cash strapped or who lack opportunities in the labor market may need to depend on relationships where the partner can support them financially. Financial support, in turn, may reduce their ability to negotiate safe sex practices (this is the so-called "transactional sex").
Cash transfer programs of this nature may not just be useful overseas. A forthcoming article in the Journal of Adolescent Health shows that young African American women in Atlanta who have boyfriends who give them gifts are less likely to use condoms than those without such boyfriends or those with boyfriends who go on to find another source of spending money. The authors conclude that "receiving spending money from a boyfriend is common among adolescent women in populations targeted by pregnancy and sexually transmitted infection prevention interventions, and may undermine interventions' effectiveness." (HT: Paula C for the Atlanta paper).
Friday, March 2, 2012
Aspirations and Investing in Girls
Two great posts in Development Impact (my favorite economics blog right now) on aspirations, expected returns to investments, and the advancement of women. The first reviews evidence on how increased labor market opportunities available to women lead parents to invest more in the daughter's education. The second looks at how recent quotas decreeing that a randomly chosen 1/3 of village governance seats in India be filled by women have led to increased aspirations among girls and their parents, as well as increased investments in the former. In the study they cite, the gender gap in child education (which favors boys at baseline) was decimated when a village headship was randomly assigned to a woman.
The posts, and the articles cited there in, make two powerful points. First, information on opportunities for girls that may be unknown to families (for whom the cost of obtaining such information is high because of, say, lack of access to "plugged in" social networks, media, etc) can be powerful in combating gender bias. Second, proactively breaking down institutional barriers can play an important role, too, something we saw with the Civil Rights Movement here on our shores.
The posts, and the articles cited there in, make two powerful points. First, information on opportunities for girls that may be unknown to families (for whom the cost of obtaining such information is high because of, say, lack of access to "plugged in" social networks, media, etc) can be powerful in combating gender bias. Second, proactively breaking down institutional barriers can play an important role, too, something we saw with the Civil Rights Movement here on our shores.
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