Abstract:This paper replicates Gruber, Kim, and Mayzlin's (1999) analysis of the effect of physician financial incentives on cesarean delivery rates, using their data, sample selection criteria, and specification. Coincident trends explain much of their estimated positive relation between fees and cesarean utilization, which also falls somewhat upon the inclusion of several childbirth observations that had been inadvertently excluded from their estimation sample. The data ultimately indicate that a $1000 increase, in current dollars, in the reimbursement for a cesarean section increases cesarean delivery rates by about one percentage point, one-quarter of the effect estimated originally. JEL Codes: I11; I18Keywords: cesarean section; financial incentives; HCUPThe cesarean section is one of the most common surgical procedures, and one of those most studied by economists, for good reasons: it absorbs billions of dollars of health care resources annually, is used with widely varying frequency across regions and across providers, and is potentially responsive to a variety of economic forces, including source of payment, malpractice liability, and financial incentives.Yet there are few studies of the last of these, financial incentives. One of the most recent and most expansive, by Gruber, Kim, and Mayzlin (1999, hereafter GKM) The accessible data, simple design, and striking conclusions of this study make it a suitable candidate for replication. Accordingly, we obtained the same data used by GKM originally and attempted to reproduce their results, generously assisted by the original authors, who shared their data assembly programs with us. In addition, as standard empirical practice in panel studies of this type has evolved somewhat since the original study was published, we also explored the effect of some of these changes on the findings-particularly the inclusion of state trends, which are clearly 2observable in the data, in the regression specification. These trends and, to a lesser degree, data assembly issues, are both important. We ultimately conclude that financial incentives may influence cesarean utilization in these data, but, if so, the effect is much smaller than originally advertised. This analysis related the probability of a cesarean delivery to the Medicaid physician cesarean fee premium (cesarean fee -vaginal fee) in that state in that year, FEEDIFF; state and year fixed effects, : and J; and controls for maternal demographics, hospital characteristics, and clinical indicators for cesarean section, X. Estimated using a logit model, the specification is as follows: where i, s, and t index individuals, states, and time; C is a dummy that equals one if individual i's delivery was performed by cesarean section and zero otherwise; 7 is the logistic distribution 3 function; and $ and ( are regression coefficients. We are mostly interested in the value of (. The effect of fee changes was predicted using the marginal effect of a one unit change in FEEDIFF at the mean of the independent variables. The model...

A 1991 study by Paul Beaudry and John DiNardo found evidence of internal labor markets that augment incumbent workers' wages when the external labor market is tight (when unemployment is low) and shield their wages when it is slack. Current wages, they found, depend on the tightest labor market conditions observed since a worker was hired, not current labor market tightness or labor market tightness at the time of hiring. This paper replicates and extends that research using data from six cohorts of the National Longitudinal Surveys that together span more than three decades, as well as an estimation framework more robust than that in the original study. The author finds strong support for Beaudry and DiNardo's key prediction.Supplementary regressions confirm other implications of the theory as well. Recently, at least, the effect of implicit contracting on wages has been similar for men and women.[Does] the business cycle affect all employees similarly, or is there evidence that incumbent employees become part of an internal labor market that shields them from external market effects? This is a central question that has received surprisingly little attention. Baker, Gibbs, and Holmstrom (1994)One of the few studies to compare the importance of internal labor markets and external market effects in wage determination over the business cycle was Beaudry and DiNardo (1991). These authors nested three wage-setting models into a simple regression equation.The three models are as follows: a spot market, in which skill-adjusted wages co-move with the current degree of labor market tightness; a full-

This study examines the influence of malpractice claims on the practice behavior of a panel of obstetricians in Florida during the period 1992–1995 to determine whether physicians respond to malpractice events by performing more cesareans, consistent with the notion that cesarean sections are employed as “defensive medicine.” Findings indicate that clinical events resulting in claims that lead to substantial indemnity payments have a significant, modest effect on physician practice behavior: physicians experiencing those claims increase their risk-adjusted cesarean rates by about one percentage point. Malpractice experience does not appear to affect patient mix, but claims with large payouts may affect patient volume.

This article descriptively assesses how physicians are disciplined by state medical boards throughout the United States, drawing on a nationwide database of sanctions delivered during the period 1994-2002. We identify the frequency and severity of disciplinary actions, the offenses leading to actions, and the degree to which sanctioned physicians are subsequently sanctioned again in the future. The most significant finding is that there are a very large number of repeat offenders among physicians who have received board sanctions, indicating a possible need for greater monitoring of disciplined physicians or less reliance upon rehabilitative sanctions.

"By 1998, all states had passed laws lowering the legal blood alcohol content for drivers under 21 to effectively zero. Theory shows these laws have ambiguous effects on overall fatalities and economic efficiency, and the data show they have little effect on driver behavior. A panel analysis of the 1988-2000 Fatality Analysis Reporting System indicates that zero tolerance laws have no material influence on the level of fatalities, while quantile regression reveals virtually no change in the distribution of blood alcohol content among drivers involved in fatal accidents." ("JEL": I18, K32, D11) Copyright (c) 2009 Western Economic Association International.