Recent Publications
Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach
Scheffler, R.M., J.X. Liu, Y. Kinfu, and M.R. Dal Poz. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” The Bulletin of the World Health Organization 86:7 (July 2008): 516-523.
The world health report 2006: working together for health has brought renewed attention to the global human resources required to produce health.1 It estimated that 57 countries have an absolute shortage of 2.3 million physicians, nurses and midwives. These shortages suggest that many countries have insufficient numbers of health professionals to deliver essential health interventions, such as skilled attendance at birth and immunization programmes. However, these estimates do not take into account the ability of countries to recruit and retain these workers, nor are they specific enough to inform policy-makers about how, and to what extent, health workforce investment should be channelled into training of different professions.
This paper focuses on physicians, who serve a key role in health-care provision. Using the most updated information on the supply of physicians over a 20-year period, we project the size of the future global need for, demand for and supply of physicians to year 2015, the target date for the Millennium Development Goals (MDGs).2 Needs-based estimates use an exogenous health benchmark to judge the adequacy of the number of physicians required to meet MDG targets. Demand estimates are based on a country’s economic growth and the increase in health-care spending that results from it, which primarily goes towards worker salaries. We then compare the needs-based and demand-based estimates to the projected supply of physicians, extrapolated based on historical trends. Our results point to dramatic shortages of physicians in the WHO African Region by 2015. We provide estimates of shortages by country in Africa and discuss their implications for different workforce policy choices.
Distributional Impacts of the Self Sufficiency Project
Hoynes, Hilary. Distributional Impacts of the Self Sufficiency Project, Journal of Public Economics, Volume 92, Issues 3-4, pages 748-765, April 2008 (with Marianne Bitler and Jonah Gelbach).
A large literature has been concerned with the impacts of recent welfare reforms on income, earnings, transfers, and labor-force attachment. While one strand of this literature relies on observational studies conducted with large survey-sample data sets, a second makes use of data generated by experimental evaluations of changes to means-tested programs. Much of the overall literature has focused on mean impacts. In this paper, we use random-assignment experimental data from Canada's Self-Sufficiency Project (SSP) to look at impacts of this unique reform on the distributions of income, earnings, and transfers. SSP offered members of the treatment group a generous subsidy for working full time. Quantile treatment effect (QTE) estimates show there was considerable heterogeneity in the impacts of SSP on the distributions of earnings, transfers, and total income; this heterogeneity would be missed by looking only at average treatment effects. Moreover, these heterogeneous impacts are consistent with the predictions of labor supply theory. During the period when the subsidy is available, the SSP impact on the earnings distribution is zero for the bottom half of the distribution. The quantiles of the SSP earnings distribution are higher for much of the upper third of the distribution except at the very top, where the quantiles of the earnings distribution are the same under either program or possibly lower under SSP. Further, during the period when SSP receipt was possible, the impacts on the quantiles of the distributions of transfer payments (Income Assistance plus the subsidy) and total income (earnings plus transfers) are also different at different points of the distribution. In particular, positive impacts on the quantiles of the transfer distribution are concentrated at the lower end of the transfer distribution, while positive impacts on the quantiles of the income distribution are concentrated in the upper end of the income distribution. Impacts of SSP on these distributions were essentially zero after the subsidy was no longer available.
The Benefits of Knowing What You Know (And What You Don’t): Fact-Finders Rely on Others Who Are Well
Tenney, E. R., Spellman, B. A., & MacCoun, R. J. (2008). The benefits of knowing what you know (and what you don’t): Fact-finders rely on others who are well calibrated. Journal of Experimental Social Psychology.
People tend to believe, and take advice from, informants who are highly confident. However, people use more than a mere ‘‘confidence heuristic.” We believe that confidence is influential because—in the absence of other information—people assume it is a valid cue to an informant’s likelihood of being correct. However, when people get evidence about an informant’s calibration (i.e., her confidence–accuracy relationship) they override reliance on confidence or accuracy alone. Two experiments in which participants choose between two opposing witnesses to a car accident show that neither confidence nor accuracy alone explains judgments of credibility; rather, whether a person is seen as credible ultimately depends on whether the person demonstrates good calibration. Credibility depends on whether sources were justified in believing what they believed.
Welfare Reform and Indirect Impacts on Health
Hoynes, Hilary. "Welfare Reform and Indirect Impacts on Health, in Making Americans Healthier: The Effects of Social and Economic Policy on Health, R. Schoeni, J. House, G. Kaplan, and H. Pollack, editors, Russell Sage Press, 2008. (with Marianne Bitler)
Universities, the US High Tech Advantage, and the Process of Globalization
Research universities throughout the world are part of a larger effort by nation-states to bolster science and technological innovation and compete economically. The US remains highly competitive as a source of High Tech (HT) innovation because of a number of market positions, many the result of long term investments in institutions such as research universities and in R&D funding, and more broadly influenced by a political culture that has tended to support entrepreneurs and risk taking. In essence, the US was the first mover in pursuing the nexus of science and economic policy. The following essay places universities within this larger political and policy environment by discussing market factors that have influenced knowledge accumulation and HT innovation in the US, their current saliency in the face of globalization, and the growing market position of competitors, such as the EU. The paper also provides observations on major US state-based HT initiatives intended to create or sustain Knowledge Based Economic Areas (KBEA’s). Thirteen variables are used to assess the overall comparative ability for creating KBEA’s, including the vitality of regional and national research universities, patterns of R&D investment, access to venture capital, intellectual property laws, educational attainment levels of the workforce, access and retention of global labor force, and political interest and forms of government support for promoting science and technology.
Among the papers conclusions: There is a large disconnect in US policy related to promoting KBEA’s and national competitiveness. Few policymakers, or even the higher education community are aware of stagnant and, in some states, real declines in higher education access and graduation rates relative to economic competitors, that the US is no longer a net importer of high tech goods, or that the US is no longer the number one destination for international students. Combined with global changes in the market for S&T talent, and the significant and increasingly successful effort of competitors to increase the educational attainment of their population, the US’s HT advantage is eroding – although there remain a number of strengths, chiefly related to an entrepreneurial culture, more conducive tax advantages for business, a cadre of elite research universities, and the highest concentration of venture capital in the world. But even here, these advantages may wane over the next decade as the world becomes more economically, and educationally, competitive. The US generally lacks a broadly conceived strategy for retaining America’s high tech advantage.
The Negative Impacts of Starting Middle School in Sixth Gtrade
Cook, P., MacCoun, R. J., Muschkin, C., & Vigdor, J. (2008). The negative impacts of starting middle school in sixth grade. Journal of Policy Analysis and Management, 27, 104-121. This paper received the 2008 Raymond Vernon Memorial Prize from the Association for Public Policy Analysis and Management.
Using administrative data on public school students in North Carolina, we find that sixth grade students attending middle schools are much more likely to be cited for discipline problems than those attending elementary school. That difference remains after adjusting for the socioeconomic and demographic characteristics of the students and their schools. Furthermore, the higher infraction rates recorded by sixth graders who are placed in middle school persist at least through ninth grade. An analysis of end-of-grade test scores provides complementary findings. A plausible explanation is that sixth graders are at an especially impressionable age; in middle school, the exposure to older peers and the relative freedom from supervision have deleterious consequences. These findings are relevant to the current debate over the best school configuration for incorporating the middle grades. Based on our results, we suggest that there is a strong argument for separating sixth graders from older adolescents. © 2008 by the Association for Public Policy Analysis and Management.
Prostitutes and Brides?
(with R. Arunachalam), American Economic Review Papers & Proceedings, May 2008, 98(2), 516-522.
Juries and the Leniency Bias
Kerr, N. L., & MacCoun, R. J. (2008). Juries and the leniency bias. In B. L. Cutler (Ed.), The Encyclopedia of Psychology and Law.