Is the Impact of Health Shocks Cushioned by Socioeconomic Status? The Case of Low Birthweight by Janet Currie and Rosemary Hyson. Published in volume 89, issue 2, pages 245-250 of American Economic Review, May 1999

This paper examines the impact of collective-bargaining legislation on dispute costs and wages using a panel of Canadian public-sector contracts. The authors' results suggest that policymakers designing collective-bargaining legislation face a trade-off between reducing dispute costs and increasing wages. Dispute costs are lower under compulsory arbitration than under the right to strike or when no collective-bargaining legislation exists. Hence, a switch to compulsory arbitration could potentially make both the union and the employer better off by reducing dispute costs. However, the authors find that wages are higher under compulsory arbitration than under other legal structures.

It is generally recognized that possible gains from cooperation are not always realized because negotiating parties sometimes fail to reach agreement. Such negotiation failures are ex post inefficient and have long defied economist's attempts to explain them. In this paper we discuss breakdowns in collective bargaining when disputes are resolved by compulsory arbitration. We argue that the study of arbitration offers insights into the nature of negotiation failures which may be of general interest.(This abstract was borrowed from another version of this item.)

Many mental health disorders start in adolescence, and appropriate initial treatment may improve trajectories. But what is appropriate treatment? We use a large national database of insurance claims to examine the impact of initial mental health treatment on the outcomes of adolescent children over the next 2 years, where treatment is either consistent with US Food and Drug Administration guidelines, consistent with looser guidelines published by professional societies (gray area prescribing), or inconsistent with any guidelines (red-flag prescribing). We find that red-flag prescribing increases self-harm, use of emergency rooms, and health care costs, suggesting that treatment guidelines effectively scale up good treatment in practice.

We review theoretical explanations for in-kind transfers in light of the limited empirical evidence. After reviewing the traditional paternalistic arguments, we consider explanations based on imperfect information and self-targeting. We then discuss the large literature on in-kind programs as a way of improving the efficiency of the tax system and a range of other possible explanations, including the “Samaritan's Dilemma,” pecuniary effects, credit constraints, asymmetric information amongst agents, and political economy considerations. Our reading of the evidence suggests that paternalism and interdependent preferences are leading overall explanations for the existence of in-kind transfer programs but that some of the other arguments may apply to specific cases. Political economy considerations must also be part of the story.

Expert performance is often evaluated assuming that good experts have good outcomes. We examine expertise in medicine and develop a model that allows for two dimensions of physician performance: decision making and procedural skill. Better procedural skill increases the use of intensive procedures for everyone, while better decision making results in a reallocation of procedures from fewer low-risk to high-risk cases. We show that poor diagnosticians can be identified using administrative data and that improving decision making improves birth outcomes by reducing C-section rates at the bottom of the risk distribution and increasing them at the top of the distribution.

We examine the impact of air pollution on infant death in California over the 1990s. Our work offers several innovations: First, many previous studies examine populations subject to far greater levels of pollution. In contrast, the experience of California in the 1990s is clearly relevant to current debates over the regulation of pollution. Second, many studies examine a few routinely monitored pollutants in isolation, generally because of data limitations. We examine four criteria pollutants in a common framework. Third, we develop an identification strategy based on within zip code variation in pollution levels that controls for potentially important unobserved characteristics of high pollution areas. Fourth, we use rich individual-level data to investigate effects of pollution on infant mortality, fetal deaths, low birth weight and prematurity in a common framework. We find that the reductions in carbon monoxide (CO) and particulates (PM10) over the 1990s in California saved over 1,000 infant lives. However, we find little consistent evidence of pollution effects on fetal deaths, low birth weight or short gestation.

In the 1980s and 1990s many states adopted tort reforms. It has been argued that these reforms have reduced the practice of defensive medicine arising from excess tort liability. We find that this does not appear to be true for a large and important class of cases—childbirth in the United States. Using data from national vital statistics natality files on millions of individual births from 1989 to 2001, we ask whether specific tort reforms affect the types of procedures that are performed, and the health outcomes of mothers and their infants. We find that reform of the Joint and Several Liability rule (or the “deep pockets rule”) reduces complications of labor and procedure use, whereas caps on noneconomic damages increase them. We show that these results are consistent with a model of tort reform that explicitly allows for variations in patient condition.

Socioeconomic Status and Child Health: Why Is the Relationship Stronger for Older Children? by Janet Currie and Mark Stabile. Published in volume 93, issue 5, pages 1813-1823 of American Economic Review, December 2003