Competitive hospitals as a virtue of the Singapore health care system
I won’t recap my earlier discussion, but rather here I will point out another feature of the system which makes it work and which keeps costs down: competition among hospitals.
Singapore has nine general hospitals, eight community hospitals, and twelve specialist hospitals, many of which are owned by the government. (The public hospitals are usually bigger than the private hospitals, so the public hospitals serve about 80% of the market.) To put that in proper perspective, Singapore is about the size of a U.S. county. That’s 274.1 square miles, noting that most people do not live on the fringes of the territory.
The publicness of the public hospitals is not their most important feature. Their most important feature is that they compete. They do not merge, for instance.
Not every Singaporean public hospital is a contender to treat every kind of ailment. And not every hospital is within convenient reach in a country where many people do not have cars. Still, that’s a lot of competition by American standards.
To put matters in perspective, Fairfax plus Arlington counties have two hospital chains of significance, Virginia Hospital Center and Inova FFX hospital, and that is in a reasonably densely populated (by American standards) elite region. Yes DC and Maryland may beckon (Sibley, Suburban, Children’s Hospital — what else is good?), but still ask yourself how many Americans can choose from a comparable number of hospitals as one can in Singapore?
One lesson is that urbanization is good for your health care system. That is another reason to deregulate urban density.
A second lesson is that congestion prices for your roads make it easier for hospitals to compete. Driving north on the Beltway to a Maryland hospital, from Fairfax, isn’t so great, especially if you are really sick.
A third lesson concerns the Hayek-Lange debate on managed competition as a potential solution to the socialist calculation debate. The government-owned hospitals in Singapore would appear to be implementing one version of Lange’s proposal, namely that they are told to compete and they do. Very successfully, so successfully that they are often cited as an example by market-oriented economists. No, this could not work for an entire economy, and yes, in most other places public choice considerations would be a bigger problem than they are in Singapore. Still, Lange’s proposal, viewed in light of the Singapore hospital system, looks a bit better than it used to.
Addendum: Here is Reihan on the monopoly power of U.S. hospitals.
Amazon markets in everything
The cash-short United States Postal Service, which has failed to win congressional approval to stop delivering mail on Saturdays to save money, has struck a deal with the online retailer Amazon.com to deliver the company’s packages on Sundays — a first for both, with obvious advantages for each.
There is more here. And here is an example of the trouble Amazon can get you into.
How large is the control premium?
Cass Sunstein on Twitter directs us to this paper (AEA gate), by David Owens, Zachary Grossman, and Ryan Fackler, entitled “The Control Premium: A Preference for Payoff Autonomy.” The abstract is here:
We document individuals’ willingness to pay to control their own payoff . Experiment participants choose whether to bet on themselves or on a partner answering a quiz question correctly. Given participants’ beliefs, which we elicit separately, expected-money maximizers would bet on themselves in 56.4 percent of the decisions. However, participants actually bet on themselves in 64.9 percent of their opportunities, reflecting an aggregate control premium. The average participant is willing to sacrifice 8 percent to 15 percent of expected asset-earnings to retain control. Thus, agents may incur costs to avoid delegating and studies inferring beliefs from choices may overestimate their results on overconfidence.
There are ungated versions here.
Mt. Kisco, New York dining bleg
That’s Westchester County, right? I will have time for one meal there, before a trip to IBM Watson. Where should I eat?
Assorted links
1. Did the 2009 Card Act work?
2. Has the Great Recession had a “productivity cleansing” effect?
3. The automated burger is coming to DC. I’ll actually bet against that one.
4. Claims about Chinese cities (unconfirmed, I would say, but interesting).
6. The culture that is Russia (I am not convinced, by the way, that all of those will be ineffective as personal ads, quite the contrary).
What do we know about the easing of malaria burdens?
There are some new and interesting results from Lena Huldén, Ross McKitrick and Larry Huldén. Here is the abstract:
Malaria has disappeared in some countries but not others, and an explanation for the eradication pattern has been elusive. We show that the probability of malaria eradication jumps sharply when average household size in a country drops below four persons. Part of the effect commonly attributed to income growth is likely due to declining household size. The effect of DDT usage is difficult to isolate but we only identify a weak role for it. Warmer temperatures are not associated with increased malaria prevalence. We propose that household size matters because malaria is transmitted indoors at night, so the fewer people are sleeping in the same room, the lower the probability of transmission of the parasite to a new victim. We test this hypothesis by contrasting malaria incidence with dengue fever, another mosquito-borne illness spread mainly by daytime outdoor contact.
The gated published version is here. A six-page author summary is here.
For pointers I thank Aaron C. Chmielewski and Gregory Rehmke.
Does reading books change your mind?
All you authors out there, read this carefully and recall the words of Samuel Johnson:
Reading a book can change your mind, but only some changes last for a year: food attitude changes in readers of The Omnivore’s Dilemma.
Source
Department of Psychology, University at Albany, State University of New York Albany, NY, USA.
Abstract
Attitude change is a critical component of health behavior change, but has rarely been studied longitudinally following extensive exposures to persuasive materials such as full-length movies, books, or plays. We examined changes in attitudes related to food production and consumption in college students who had read Michael Pollan’s book The Omnivore’s Dilemma as part of a University-wide reading project. Composite attitudes toward organic foods, local produce, meat, and the quality of the American food supply, as well as opposition to government subsidies, distrust in corporations, and commitment to the environmental movement were significantly and substantially impacted, in comparison to students who had not read the book. Much of the attitude change disappeared after 1 year; however, over the course of 12 months self-reported opposition to government subsidies and belief that the quality of the food supply is declining remained elevated in readers of the book, compared to non-readers. Findings have implications for our understanding of the nature of changes in attitudes to food and eating in response to extensive exposure to coherent and engaging messages targeting health behaviors.
Hat tip goes to Neuroskeptic.
Assorted links
1. More on old vs. new Keynesianism.
2. An old style socialist analysis of racism in Madison, Wisconsin. And what are the whitest job categories in America? #1 is veterenarian.
3. Can we unwind wealth illusions without pain?
4. Polygamy over space and time.
5. How Twitter marries man and machine. And Ten Questions Consumers Should Ask When Choosing a Robo-Adviser.
6. A caustic piece on the fundamental political flaw behind Obamacare.
Google patents a throat tattoo with a built-in lie-detecting mobe microphone
Maybe your boss (or spouse?) will want you to wear it:
And then there’s the lie-detector feature. “Optionally,” the filing muses, “the electronic skin tattoo can further include a galvanic skin response detector to detect skin resistance of a user. It is contemplated that a user that may be nervous or engaging in speaking falsehoods may exhibit different galvanic skin response than a more confident, truth telling individual.”
There is more information here. The pointer is from Charles C. Mann.
When will pitch-tracking technology displace baseball umpires?
This is a fascinating article by Ben Lindbergh, and it does not require interest in baseball, here is one bit:
“The goal, of course, is no error, or as close to that ideal as we can possibly come. And so the best solution might be a hybrid approach that combines tradition with technology. Not robot umps, but regular umps with input from robot brains.”
Here is another good bit of many:
Over time, players have internalized some of the idiosyncrasies of the strike zone as it’s currently called. The zone called against left-handed hitters is shifted a couple inches away relative to righties. The size of the zone fluctuates depending on the count — expanding dramatically on 3-0 and shrinking severely on 0-2 — and according to the base-out state, velocity of the pitch, and many other factors. Yes, these are all arguments in support of standardizing the strike zone, assuming you like to see pitches called according to code. They’re also reasons to exercise caution. “Because it’s always worked this way” isn’t a good reason not to do something different, but it is a reason to think through the possible ramifications before making a major change that could upset the delicate batter-pitcher balance. Players will adjust to whatever the zone looks like, but it’s in baseball’s best interests to make those adjustments smooth.
McKean cautions that instituting an automatic zone “would ruin the game,” which makes him the latest in a long line of thus-far-incorrect critics who’ve warned that something would be the end of baseball. “If you told the pitchers to try and throw that ball with an automatic strike zone, which means it has to hit some part of that plate or be in some part of that strike zone, heck, the games would go on for five, six hours,” he says. My guess is that he has the direction of the effect right, but the magnitude wrong. Automating the strike zone would probably make it slightly smaller, on the whole, and more predictable for the hitter. That could increase scoring and perhaps lead to longer games, but not to such an extent that the sport would be broken.
However, standardizing the zone would remove a level of interplay between batter, pitcher, catcher, and umpire that many fans find compelling.
Interesting throughout, and for the pointer I thank Hamp Nettles.
Chat with James Pethokoukis on *Average is Over*
Here is one of several interesting bits:
Well the Brynjolfsson and McAffee book, “Race Against the Machine,” that’s a great book. It’s influenced my thinking. I just read their second forthcoming book, “The Second Machine Age.” They focus more on automation than I do and less on inequality and much less on social issues. But I think of myself as thinking along the same lines as they do. But they and I, we differ a lot about the past. So they don’t think the past has been a great stagnation. I agree with them a lot about the future, but disagree with them a lot about the past.
Gordon, I disagree with him about the future, but agree with him about the past. So Gordon, like me, sees a great stagnation. And he thinks it will never ever end. I think that’s crazy. Even if it were true, how would you know? But I see a lot of areas, not only artificial intelligence, but medicine and genomics, where the advances are not on the table now. But it’s hard to believe there’s not going to be a lot more coming. Science is very healthy. There’re new discoveries all the time. The lags are much longer than we’d like to think, but absolutely progress is not over, and we’re about to see a new wave of progress over the lifetimes of our children.
The full dialog is here.
The future of work, and those new service sector jobs
Via Angus, here is a new report on those new service sector jobs:
As AI and globalization chew up good jobs for the non-elites, there is a bright spot on the career horizon. The market for household staff is booming.
According to the WSJ, “A good housekeeper earns $60,000 to $90,000 a year. A lady’s maid can make $75,000 a year. A butler may start at $80,000 a year and can earn as much as $200,000.”
And, there are openings, “Demand for the well-staffed home is on the rise, according to agencies and house managers alike. Clients are calling for live-in couples, live-out housekeepers, flight attendants for private jets, stewards for the yachts and chefs for the summer house. In San Francisco, Town and Country Resources, a staffing agency for domestic help, has seen demand for estate managers and trained housekeepers grow so fast the agency is going to offer its own training programs in subjects like laundry, ironing and spring cleaning starting in 2014. Claudia Kahn, founder of The Help Company, a staffing agency based in Los Angeles, says she used to get one call a month for a butler but has gotten three in the past week alone.”
If your skill set is more exotic, don’t despair:
“She will also be bringing with her the two animal trainers who come seven days a week to care for Prince Mikey, a white-faced capuchin monkey. Prince Mikey’s trainers work with him five to six hours a day during the week and three hours a day on weekends. The annual cost is in the six figures”
Here is a related blog post from Annie Lowrey. I leave it as an exercise for the reader to deduce the implications for the finances of higher education in this country.
Diane Coyle’s new publishing venture
She writes to me:
This is a quick note about a new publishing initiative of mine, Perspectives, a series of short books on aspects of economics and technology. The first four are out later this month – Jim O’Neill on the urgent need for changes in global governance, Julia Unwin on how emotion shapes our views on poverty, Andrew Sentance on why it will be painful to regain a higher growth rate, and Bridget Rosewell on how London can reshape itself post-financial crisis.
http://londonpublishingpartnership.co.uk/perspectives-series/
They are the kind of book I like to read myself: authoritative, outside the usual ruts of policy debate, and short. Kate Barker on planning policy and Dave Birch on the new technology of money coming up.
Assorted links
1. The culture that is Pankration? Exaggerated or not? Also from the world of tabloids, here is where the French seat ugly people.
2. What are some top cities for low rent? That is taken from a more general index of which are the best cities for Millenials. The cheapest marijuana seems to be out West.
3. The average length of dissertation across fields. Biostatistics has the shortest average dissertation, economics is third shortest.
4. …”a ship-shipping ship, shipping shipping ships.”
5. The rise and fall of InTrade. And RePec Fantasy League for economists.
6. Starship Troopers: one of the most misunderstood movies ever.
Is a Ph.D. important for succeeding in finance?
There is a new paper by Ranadeb Chaudhuri, Zoran Ivkovich, Joshua Matthew Pollet, and Charles Trzcinka, the abstact is this:
Several hundred individuals who hold a Ph.D. in economics, finance, or others fields work for institutional money management companies. The gross performance of domestic equity investment products managed by individuals with a Ph.D. (Ph.D. products) is superior to the performance of non-Ph.D. products matched by objective, size, and past performance for one-year returns, Sharpe Ratios, alphas, information ratios, and the manipulation-proof measure MPPM. Fees for Ph.D. products are lower than those for non-Ph.D. products. Investment flows to Ph.D. products substantially exceed the flows to the matched non-Ph.D. products. Ph.D.s’ publications in leading economics and finance journals further enhance the performance gap.
For the pointer I thank Samir Varma, whose teenage daughter has a new book on iTunes here.