Will Medicare beneficiaries switch physicians? A test of economic competition.

We assess the potential of increased economic competition by examining whether Medicare beneficiaries are willing to switch to physicians who agree to accept all services on assignment. Data come from a survey of Medicare beneficiaries conducted in November 1988. Our principal finding is that beneficiaries are not sensitive to price when making decisions about whether or not to switch physicians. Less than one-half of 1 percent of the sample had switched physicians for economic reasons in the year prior to the survey. Furthermore, willingness to switch was not correlated with ability to pay. We conclude that policies aimed at altering consumer demand may not be the most effective way to control Medicare costs.     

An operational definition of prior criminal record

A variety of measures of prior criminal record is used to explain differences in incarceration for defendants arrested in New York State. The analysis suggests that (1) measures based upon arrest, conviction, or incarceration data are equally effective at explaining differences in incarceration percentages; (2) measures based upon counts do better in their logarithmic than in their arithmetic scales; (3) prior record is more closely related to incarceration for moderately serious than for serious or minor crimes; and (4) prior record is more closely related to incarceration for crimes that have a theft component than for crimes that do not. A composite prior record measure is developed that combines arrest and conviction data. It is easy to compute, yet it is as effective at explaining variation in incarceration as the most elaborate measures examined.     

Interest group demand for taxation

Researchers have typically ignored the determinants of the tax structure of the public sector. Political scientists have concentrated their analyses on the expenditure side of the public ledgers while economists have avoided the issue by assuming that taxes are exogenously determined. In this paper we have shown that a behavioral model of political interest groups can be employed to gain insights into the political selection of taxes. The theory provides a general complement to the well-documented analysis of special interest demand for public expenditures.Our analysis raises several important policy questions. First, is the influence of interest groups on the determination of tax systems desirable from a public policy perspective? For example, special interest groups dominated by high and middle income individuals may prefer regressive tax systems which reduce their own tax burden. Certainly the impact of interest groups on the well-known regressivity of state and local tax systems is an area worthy of additional investigation.     

Hospital-sponsored group practice

Henry Ford Hospital, a 1,000-bed institution in central Detroit, is being developed into a "center of excellence" with expansion of ambulatory care to suburban satellite clinics. A hospital-based HMO has been started in an effort to cut costs, decentralize care, and provide an alternative to Blue Cross. It has been successful and is now being considered as a solution to Michigan's Medicaid problems. Background and analysis follow.