National Bureau of Economic Research,
October 1, 2022
Abstract
Professions play a key role in determining the division of labor and the returns to skilled work. This paper studies the productivity difference between physicians and nurse practitioners (NPs), two health care professions performing overlapping tasks but with stark differences in background, training, and pay. Using data from the Veterans Health Administration and quasi-experimental variation in the patient probability of being treated by physicians versus NPs in the emergency department, we find that, compared to physicians, NPs significantly increase resource utilization but achieve worse patient outcomes. We find evidence suggesting mechanisms relating to lower human capital among NPs relative to physicians and worker-task assignment responding to the lower skill of NPs. Counterfactual analysis suggests a net increase in medical costs with NPs, even when accounting for NPs’ wages that are half as much as physicians’. Despite large productivity differences between professions, we find even larger productivity differences within professions and substantial productivity overlap between professions. Yet there is little overlap in wages between NPs and physicians and, within professions, no significant correlation between productivity and wages.
Journal of General Internal Medicine,
September 20, 2022
Background
A population health approach to depression screening using patient portals may be a promising strategy to proactively engage and identify patients with depression.
In this JAMA Forum article by Stanford Health Policy's Michelle Mello, the professor of health policy and law writes that reports are mounting of pregnant patients being denied potentially lifesaving care in emergency departments.
Key policy takeaways from Rose Gottemoeller on why the U.S. should avoid a nuclear arms race, Michael McFaul on how Putin may try to end the war in Ukraine, Oriana Skylar Mastro on China's intentions toward Taiwan, Francis Fukuyama on political realignment in America, Renée DiResta and Samantha Bradshaw on Russian propaganda in cyberspace, and Gil Baram on the cyber war between Israel and Iran.
Child servitude is a form of economic exploitation of children around the world. We examine this phenomenon with local specificity, in Liberia, where it represents a perennial failure of the government to protect children, who are among its most vulnerable citizens. Despite its persistence and high prevalence, child servitude has not been the focus of academic research on Liberia. This paper explores the interplay of transmuted American chattel slavery and indigenous specific Liberian cultural practices of human subjugation against a backdrop of socio-economic inequalities, and their linkages to contemporary child servitude in postwar Liberia. We discuss the impacts of child servitude on victims and recommend policy measures to protect the rights of Liberian children. If postwar Liberia is to achieve its pro-poor developmental agenda, policies must be formulated that address child servitude and other forms of exploitation against Liberian children.
Graham Webster has authored a chapter in the forthcoming book from Harvard University Press, The China Questions 2: Critical Insights into US-China Relations
Key policy takeaways from Rose Gottemoeller on NATO’s new strategic concept, Francis Fukuyama on the Jan. 6 connection with the war in Ukraine, Michael McFaul on the West arming Ukraine, Amy Zegart on future U.S. cyber policy, Daniel Sneider on Japan after Shinzo Abe, and Riana Pfefferkorn on abortion and data collection.
The U.S. Centers for Disease Control and Prevention (CDC) is responsible for preventing the introduction, transmission, and spread of communicable diseases into the United States. It does this primarily through the Division of Global Migration and Quarantine (DGMQ), which oversees the federal quarantine station network. Over the past two decades, the frequency and volume of microbial threats worldwide have continued to intensify. The COVID-19 pandemic, in particular, has prompted a reevaluation of many of our current disease control mechanisms, including the use and role of quarantine as a public health tool.
The emergence of COVID-19 prompted CDC to request that the National Academies of Sciences, Engineering, and Medicine convene a committee to assess the role of DGMQ and the federal quarantine station network in mitigating the risk of onward communicable disease transmission in light of changes in the global environment, including large increases in international travel, threats posed by emerging infections, and the movement of animals and cargo. The committee was also tasked with identifying how lessons learned during COVID-19 and other public health emergencies can be leveraged to strengthen pandemic response. The report's findings and recommendations span five domains: organizational capacity, disease control and response efforts, new technologies and data systems, coordination and collaboration, and legal and regulatory authority.
Decision models can combine information from different sources to simulate the long-term consequences of alternative strategies in the presence of uncertainty. A cohort state-transition model (cSTM) is a decision model commonly used in medical decision making to simulate the transitions of a hypothetical cohort among various health states over time. This tutorial focuses on time-independent cSTM, in which transition probabilities among health states remain constant over time. We implement time-independent cSTM in R, an open-source mathematical and statistical programming language. We illustrate time-independent cSTMs using a previously published decision model, calculate costs and effectiveness outcomes, and conduct a cost-effectiveness analysis of multiple strategies, including a probabilistic sensitivity analysis. We provide open-source code in R to facilitate wider adoption. In a second, more advanced tutorial, we illustrate time-dependent cSTMs.
Key policy takeaways from Michael McFaul on helping Russians who oppose Putin; Kathryn Stoner on how Putin's War has ruined Russia; Steven Pifer on U.S.-Russia relations; Rose Gottemoeller on U.S. policy towards China in the Pacific region; David Studdert on the risks of guns in the home; Herb Lin on cybersecurity, and Hakeem Jefferson on the Jan. 6 hearings.
China’s college admission increased by five times between 1998 and 2009. While the college premium for young workers declined, that for senior workers increased in this period. In our general equilibrium model, a rising demand for skills (education and experience) explains both trends. A demand shock leads to an expansion in the elastic college enrollment, depressing the college premium for young workers. With an inelastic supply, experienced college graduates continue to enjoy a rising premium. Despite the low immediate premium, young individuals continue to flood into colleges because they foresee high lifetime returns. Simulations match empirical results well.
Millions of Americans may have asked themselves these questions, or versions of them—especially in the wake of horrific mass shootings like those in Buffalo and Uvalde. Record-breaking spikes in gun sales over the last two years, alongside surveys indicating that self-protection continues to be the dominant reason for buying guns, underscore a widely-held belief that a gun in the home has security benefits.
A new study from my research team, recently published in the Annals of Internal Medicine, shows no such benefits. We found the opposite: people living in homes with guns face substantially higher risks of being fatally assaulted.
Key policy takeaways from Francis Fukuyama on why Ukraine will win; Jean Oi on U.S.-China climate cooperation; Rose Gottemoeller on nuclear arms control in Europe; Michael McFaul on sanctions and Russia; Larry Diamond on ranked-choice voting; and Renee DiResta on hate speech on social media.
Is operating overnight associated with worse outcomes for surgical procedures performed by the attending surgeon the subsequent day? In this cross-sectional study of 498,234 daytime operations performed by 1,131 surgeons at 20 US institutions, there was no significant association between operating the previous night and the incidence of in-hospital death or major complications (sepsis, pneumonia, myocardial infarction, thromboembolic event, or stroke) for daytime operations performed the subsequent day. After adjusting for confounders, the incidence of death or major complications was 5.89% among daytime operations when the attending surgeon operated the night before compared with 5.87% among daytime operations when the attending surgeon did not. These findings suggest that operating overnight does not appear to be associated with worse outcomes when the attending surgeon continues to operate the next day.
A team of experts led by Rose Gottemoeller has produced a new report for the James Martin Center for Nonproliferation Studies on non-strategic nuclear warhead policies in Europe, particularly in light of Russia's changing status in the global nuclear community.
Key policy takeaways from Larry Diamond on the future of democracy; Rose Gottemoeller on the West, Russia and nukes; Kathryn Stoner on Putin and Kremlin tensions; Michael McFaul on the West and Putin’s threats; Francis Fukuyama on illiberalism on the left and right; Renée DiResta on LinkedIn and deepfakes; and Michelle Mello on COVID misinformation.
