To measure nurses’ rankings of their electronic medical records (EMRs) on their job satisfaction ... more To measure nurses’ rankings of their electronic medical records (EMRs) on their job satisfaction over time, a retrospective analysis of a set of cross sectional data from a survey conducted by the United States’ California Registered Nursing Board in 2008, 2010, 2012, 2014, and 2016. Approximately 4,500 nurses ranked the usefulness of their EMRs in each of the five years. The EMR rankings increased steadily between 2008 and 2016 but the changes are small and the rates of change are very slow, suggesting that the problems with EMRs have been difficult to solve. The results show EMRs have a large impact: a one category increase in EMR rankings increased job satisfaction by as much as or slightly more than one-third for hospital and non-hospital nurses. The size of the effects and their persistence over eight years imply a substantial loss from poorly designed EMRs, and one which could have been avoided had EMR designs more closely matched nurses’ day to day work. The reductions in job...
we examine the influence of nursing demographics and four groups of self-reported determinants of... more we examine the influence of nursing demographics and four groups of self-reported determinants of nursing career-choice decisions: FAMILY CONCERNS (childcare, other family concerns, moving, and non-job illness), ECON (salary and benefits), STRESS (job stress, job illness, other job dissatisfaction, nurse job dissatisfaction, and lay off concerns), and OTHER group (travel, another occupation, and school). For nurses leaving for at least one year of absence and then returning to nursing, the FAMILY CONCERNS were consistently rated most important by nurses, followed by a distant second by the equivalent STRESS and OTHER group influencers. The ECON group rated least important. The nurses permanently leaving the health care profession, FAMILY CONCERNS were once again rated most important during the first three years of our sample (2008, 2010, 2012), but then faded as STRESS and OTHER factors took over in relative importance.
Health Economics & Outcome Research: Open Access, 2016
Objectives:We examine the use of emergency departments for non-urgent care, comparing children wh... more Objectives:We examine the use of emergency departments for non-urgent care, comparing children who received recommended EPSDT services to those who do not, analyzing differences between Hispanic and Non-Hispanic children, controlling for differences in their characteristics. Methods: A retrospective, longitudinal study of a cohort of approximately 6,000 children during the years from 1999-2009 using data from hospital and emergency department (ED) claims, paediatric office visits and claims data from Medicaid (AHCCCS) and SCHIP. Three different versions of an econometric model are presented. The estimates also include the effects of health insurance coverage and the lack thereof by evaluating the records of all children age 0-19 in Yuma County who met any of the following criteria: insured by Medicaid or SCHIP at any time; or used the emergency department (ED) or any other participating provider during the ten years; or were immunized. We test if the provision of recommended EPSDT services by age two, affected the subsequent number of nonurgent care visits to hospital's ED. Results: Children without continuous health insurance coverage are twice as likely as continuously insured children to use and ED for non-urgent care. Controlling for health insurance coverage and demographics, the receipt of recommended EPSDT care by age two significantly reduces non-urgent care visits to the ED for Hispanic children. In some instances the likelihood of such visits is cut in half. Conclusion: The results suggest that the provision of EPSDT services to the growing number of Hispanic children can yield significant benefits.
This paper explores a particularly simple model of choice under risk, based on geometric means an... more This paper explores a particularly simple model of choice under risk, based on geometric means and entropy. Despite its simplicity, it satisfies various prudence and risk aversion conditions, is consistent with the Allais paradox, and generates various insurance-related results. Within a portfolio framework with compounded reinvestments, our index fits the risks/rewards data from post-war US stock market returns and recent international markets, at least as well as does the standard deviation measures more typically used. It also generates returns that are consistent with the equity premium puzzle.
This paper examines the impact of a monumental change in tort liability law, the Federal Employer... more This paper examines the impact of a monumental change in tort liability law, the Federal Employers' Liability Act (FELA) of 1908. This shift from common law, by changing the way injured workers were compensated and the compensating wage differentials for risk bearing, set the stage for workers' compensation and other no-fault systems. Focusing on the New Jersey railroad system, the authors examine three periods: the pre-FELA years of 1900–1908; 1909–11, when the FELA laws were the only changes in the common laws affecting some railroad workers; and 1912–16, when both FELA and workers' compensation laws affected railroad workers. They find that as liability shifted to railroad companies, accident rates fell for three occupational groups who worked outdoors, but rose for railroad “craft” employees (who worked indoors in shops). They also find that wages shifted for all four of the major occupational groups as predicted by their model.
International Journal of Statistics in Medical Research, 2016
In medical research, frequently other important determinants, correlated with the key treatment v... more In medical research, frequently other important determinants, correlated with the key treatment variable, are omitted from the analysis. This omission yields biased and inconsistent estimates. For example, leaving out correlated (with, say, ) determinants of Y from regressions yield biased estimates of key parameters (say ). Instrumental variable estimation solves this problem by constructing similar triangles to retrieve consistent estimates. This article illustrates the geometry of correlated regressor bias, and the simple IV geometric solution.
In financial risk management, whether for national and international entities, or within a firm, ... more In financial risk management, whether for national and international entities, or within a firm, it is important to be able to decide what risks are altered by past experience (or intervention of a central banker at the national level, or a firm's risk manager at the employer level) and what risks do not vary over time (risks from intrinsic heterogeneity). Policies aimed at changing intrinsic risk will obviously not be cost effective, though tools for identifying such unchanging risks may help to minimize losses associated with those risks. This paper outlines a simple test that allows the researcher to distinguish these alternative risk types. We present our test in the context of patterns of workers' compensation lost day claims to test whether past experience explains repeated claims for some individuals, or whether some individuals exhibit an innate heterogeneity in claims-filing propensities. We find that a previous claim significantly increases claim probabilities in the future using easy to estimate and interpret "runs" tests on the claims. This suggests, for the risk management problem examined here, that early intervention to limit the effects of the first lost time claim may produce significant disability-cost savings with respect to future claims.
To determine the association between prescription nonadherence and the health of older adults wit... more To determine the association between prescription nonadherence and the health of older adults with 1 or more of 5 chronic conditions. Analysis of the correlation between prescription nonadherence and the health of older adults. Data were from a 7-year panel with information on healthcare encounters and prescriptions. We used fixed-effects Cox duration regression models and fixed-effects Poisson count regression models to control for time-invariant factors specific to each subject when examining the impact of nonadherence on time to an emergency department (ED) visit (Cox regression) or number of ED visits (Poisson count regression). Nonadherence was associated with subsequent ED visits for hypertension, chronic heart disease, diabetes, and hypercholesterolemia. No significant short-term effects of nonadherence on chronic obstructive pulmonary disease (COPD) were detected. However, long-term effects of nonadherence (using the count regression model with lagged counts) were detected f...
Journal of Occupational and Environmental Medicine, 2007
To quantify the influence that workers' satisfaction with the firm's treatment of their disabilit... more To quantify the influence that workers' satisfaction with the firm's treatment of their disability claim and their health care provider has on workers' return to work (RTW) following onset of occupational LBP. Methods: Using a prospective survey on back pain, medical treatment, and workers' satisfaction, we employ nonparametric and logistic analyses to see how satisfaction affects RTW. Results: Workers' satisfaction with their employer's treatment of their disability claim is more important in explaining RTW than satisfaction with health care providers or expectations about recovery. Dissatisfied workers have worse return to work outcomes because they are more likely to have time lost claims and are more likely to have multiple spells of joblessness. Conclusions: Workers' RTW is more responsive to their satisfaction with how the firm treated their disability claim than with their satisfaction with the health care provider. Satisfaction of both types plays an important role in determining RTW.
In this paper we review and extend the analysis of moral hazard response in two relatively unexam... more In this paper we review and extend the analysis of moral hazard response in two relatively unexamined empirical directions: (1) how insurance changes in one program affects employee participation in other programs at a point in time (inter-program moral hazard), and (2) how the consumption of program benefits now tends to affect employees behavior over time (benefits consumption capital). We develop a formal model of inter-program moral hazard based on workers' compensation with programs overlapping it (including sick leave, health insurance, and unemployment insurance), and review evidence concerning this overlap response. We also provide new evidence on benefits consumption capital concerning workers' compensation using data from one large private employer in the US.
Becker's model of discrimination is extended to the case where men exhibit distastes for working ... more Becker's model of discrimination is extended to the case where men exhibit distastes for working under female managers. The distribution of women in the resulting occupational hierarchy depends on the number of women in lower occupations, the wages of male workers in lower occupations, and male distastes for female management. Thus, there exists an occupational sorting function, related to wages, that determines the occupational distribution of women. We integrate this sorting function into a standard wage equation to derive a new decomposition of male-female wage differentials and apply it to a sample of insurance industry workers from the 1988 CPS.
Little is known about the sick-leave experiences of workers who make a workers' compensation clai... more Little is known about the sick-leave experiences of workers who make a workers' compensation claim for back pain. Our objective is to describe the 1-year patterns of sick-leave and the health outcomes of a cohort of workers who make a workers' compensation claim for back pain. We studied a cohort of 1,831 workers from five large US firms who made incident workers' compensation claims for back pain between January 1, 1999 and June 30, 2002. Injured workers were interviewed 1 month (n = 1,321), 6 months (n = 810) and 1 year (n = 462) following the onset of their pain. We described the course of back pain using four patterns of sick-leave: (1) no sick-leave, (2) returned to worked and stayed, (3) multiple episodes of sick-leave and (4) not yet returned to work. We described the health outcomes as back and/or leg pain intensity, functional limitations and health-related quality of life. We analyzed data from participants who completed all followup interviews (n = 457) to compute the probabilities of transition between patterns of sick-leave. A significant proportion of workers experienced multiple episodes of sick-leave (30.2%; 95% CI 25.0-35.1) during the 1-year follow-up. The proportion of workers who did not report sick-leave declined from 42.4% (95% CI 39.0-46.1) at 1 month to 33.6% (28.0-38.7) at 1 year. One year after the injury, 2.9% (1.6-4.9) of workers had not yet returned to work. Workers who did not report sick-leave and those who returned and stayed at work reported better health outcomes than workers who experienced multiple episodes of sick-leave or workers who had not returned to work. Almost a third of workers with an incident episode of back pain experience recurrent spells of work absenteeism during the following year. Our data suggest that stable patterns of sick-leave are associated with better health.
International Journal of Statistics in Medical Research
While there is a rich literature regarding hospital quality in general, research examining trends... more While there is a rich literature regarding hospital quality in general, research examining trends in hospital quality using regression analysis of trends are relatively rare. In the presence of the increasing digitalization of hospital data, the wide accessibility of regression software, and the need for real time feedback on ongoing quality of medical care outcomes, this paper presents simple-to-implement techniques for analyzing the quality of health care outcomes. We present graphical illustrations of the techniques discussed, and we also include a SAS appendix with the code to estimate all the models discussed, including a proposed new regression index: the Exchange index. We employ data from Arizona's acute care hospitals to illustrate uses of our new index.
Rating the digital help: electronic medical records, software providers, and physicians
International journal of health economics and management, 2016
To separate the effects of physicians' characteristics on the perceived productivity of EMRs ... more To separate the effects of physicians' characteristics on the perceived productivity of EMRs from the effects of limitations on usability inherent in EMR design, a multivariate regression model is used to estimate the factors influencing physicians' rankings of five attributes of their EMRs, namely; ease of use and reliability; the EMRs effect on physician and staff productivity and the EMRs performance vs. vendor's promises. We divide the factors influencing the rankings into three groups: physician characteristics, EMR characteristics and practice characteristics (type of practice, size, and location). The data are from approximately 1800 practicing physicians in Arizona. Physician's characteristics influence perceived ease of use and physicians' productivity, but not staff productivity, reliability or vendors' promised performance. Practice type and EMR characteristics affect perceived productivity, reliability and performance versus vendors' promises....
Using a sample of one job type from one firm (to hold job tasks and sick leave/disability policy ... more Using a sample of one job type from one firm (to hold job tasks and sick leave/disability policy constant), we estimate the effect of demographic variables, job performance warnings, and workers' compensation benefits on the propensity to file a carpal tunnel syndrome (CTS) loss work-time claim. We find that disciplinary notices increase the employees' propensity to file a CTS claim. State maximum workers' compensation benefits are also positively related to CTS claim frequency, however, the relationship is not statistically significant. CTS claimants respond differently than other sprain/strain claimants to benefits and to gender. In particularly, women have relatively more CTS claims, while men have relatively more other sprain/strain claims in our sample. The estimates here underscore the importance of psychosocial factors in the filing of occupational CTS and sprain injuries claims.
Several explanations of why mutual insurers choose to demutualize their businesses are examined w... more Several explanations of why mutual insurers choose to demutualize their businesses are examined with a recent survey of mutual insurers. This study adds to the literature by surveying mutual insurers' executives on those factors that would lead them to demutualize their companies. Both univariate and multivariate techniques are applied to analyze those responses. Demutualization is most strongly influenced by access to capital markets, increased organizational flexibility, and the chance for company officers to increase their pay, as prior literature has suggested. MUTUAL INSURANCE REORGANIZATION Joe Belth, in his The Insurance Forum, suggests four reasons a mutual insurer would demutualize: access to capital, organizational flexibility, avoidance of the income tax setback, and aligning the interests of managers with those of company shareholders. Demutualization provides insurers with access to external capital sources that are currently not available to them. A mutual company's only means of access to capital markets is through the issuance of surplus contribution notes (Dumm and Hoyt, 1999). Moreover, the issuance of surplus notes is restricted by regulatory requirements. It is subject to "the prior approval of the regulator in the company's state of domicile, interest and principal payments are subject to the regulator's prior approval, and surplus notes are subordinate to the issuing insurance company's obligations to policy
Increasing claims for soft tissue injuries in workers' compensation: Cost shifting and moral hazard
Journal of Risk and Uncertainty, 1996
During the last decade, the distribution of workers' compensation claims has exhi... more During the last decade, the distribution of workers' compensation claims has exhibited a marked shift towards soft tissue injuries such as sprains, strains, and low back claims. There are three possible explanations for this trend; (1) safety incentives induced by workers compensation or OSHA may have reduced other, traumatic claims; (2) the movement away from heavy manufacturing and the 1980
To measure nurses’ rankings of their electronic medical records (EMRs) on their job satisfaction ... more To measure nurses’ rankings of their electronic medical records (EMRs) on their job satisfaction over time, a retrospective analysis of a set of cross sectional data from a survey conducted by the United States’ California Registered Nursing Board in 2008, 2010, 2012, 2014, and 2016. Approximately 4,500 nurses ranked the usefulness of their EMRs in each of the five years. The EMR rankings increased steadily between 2008 and 2016 but the changes are small and the rates of change are very slow, suggesting that the problems with EMRs have been difficult to solve. The results show EMRs have a large impact: a one category increase in EMR rankings increased job satisfaction by as much as or slightly more than one-third for hospital and non-hospital nurses. The size of the effects and their persistence over eight years imply a substantial loss from poorly designed EMRs, and one which could have been avoided had EMR designs more closely matched nurses’ day to day work. The reductions in job...
we examine the influence of nursing demographics and four groups of self-reported determinants of... more we examine the influence of nursing demographics and four groups of self-reported determinants of nursing career-choice decisions: FAMILY CONCERNS (childcare, other family concerns, moving, and non-job illness), ECON (salary and benefits), STRESS (job stress, job illness, other job dissatisfaction, nurse job dissatisfaction, and lay off concerns), and OTHER group (travel, another occupation, and school). For nurses leaving for at least one year of absence and then returning to nursing, the FAMILY CONCERNS were consistently rated most important by nurses, followed by a distant second by the equivalent STRESS and OTHER group influencers. The ECON group rated least important. The nurses permanently leaving the health care profession, FAMILY CONCERNS were once again rated most important during the first three years of our sample (2008, 2010, 2012), but then faded as STRESS and OTHER factors took over in relative importance.
Health Economics & Outcome Research: Open Access, 2016
Objectives:We examine the use of emergency departments for non-urgent care, comparing children wh... more Objectives:We examine the use of emergency departments for non-urgent care, comparing children who received recommended EPSDT services to those who do not, analyzing differences between Hispanic and Non-Hispanic children, controlling for differences in their characteristics. Methods: A retrospective, longitudinal study of a cohort of approximately 6,000 children during the years from 1999-2009 using data from hospital and emergency department (ED) claims, paediatric office visits and claims data from Medicaid (AHCCCS) and SCHIP. Three different versions of an econometric model are presented. The estimates also include the effects of health insurance coverage and the lack thereof by evaluating the records of all children age 0-19 in Yuma County who met any of the following criteria: insured by Medicaid or SCHIP at any time; or used the emergency department (ED) or any other participating provider during the ten years; or were immunized. We test if the provision of recommended EPSDT services by age two, affected the subsequent number of nonurgent care visits to hospital's ED. Results: Children without continuous health insurance coverage are twice as likely as continuously insured children to use and ED for non-urgent care. Controlling for health insurance coverage and demographics, the receipt of recommended EPSDT care by age two significantly reduces non-urgent care visits to the ED for Hispanic children. In some instances the likelihood of such visits is cut in half. Conclusion: The results suggest that the provision of EPSDT services to the growing number of Hispanic children can yield significant benefits.
This paper explores a particularly simple model of choice under risk, based on geometric means an... more This paper explores a particularly simple model of choice under risk, based on geometric means and entropy. Despite its simplicity, it satisfies various prudence and risk aversion conditions, is consistent with the Allais paradox, and generates various insurance-related results. Within a portfolio framework with compounded reinvestments, our index fits the risks/rewards data from post-war US stock market returns and recent international markets, at least as well as does the standard deviation measures more typically used. It also generates returns that are consistent with the equity premium puzzle.
This paper examines the impact of a monumental change in tort liability law, the Federal Employer... more This paper examines the impact of a monumental change in tort liability law, the Federal Employers' Liability Act (FELA) of 1908. This shift from common law, by changing the way injured workers were compensated and the compensating wage differentials for risk bearing, set the stage for workers' compensation and other no-fault systems. Focusing on the New Jersey railroad system, the authors examine three periods: the pre-FELA years of 1900–1908; 1909–11, when the FELA laws were the only changes in the common laws affecting some railroad workers; and 1912–16, when both FELA and workers' compensation laws affected railroad workers. They find that as liability shifted to railroad companies, accident rates fell for three occupational groups who worked outdoors, but rose for railroad “craft” employees (who worked indoors in shops). They also find that wages shifted for all four of the major occupational groups as predicted by their model.
International Journal of Statistics in Medical Research, 2016
In medical research, frequently other important determinants, correlated with the key treatment v... more In medical research, frequently other important determinants, correlated with the key treatment variable, are omitted from the analysis. This omission yields biased and inconsistent estimates. For example, leaving out correlated (with, say, ) determinants of Y from regressions yield biased estimates of key parameters (say ). Instrumental variable estimation solves this problem by constructing similar triangles to retrieve consistent estimates. This article illustrates the geometry of correlated regressor bias, and the simple IV geometric solution.
In financial risk management, whether for national and international entities, or within a firm, ... more In financial risk management, whether for national and international entities, or within a firm, it is important to be able to decide what risks are altered by past experience (or intervention of a central banker at the national level, or a firm's risk manager at the employer level) and what risks do not vary over time (risks from intrinsic heterogeneity). Policies aimed at changing intrinsic risk will obviously not be cost effective, though tools for identifying such unchanging risks may help to minimize losses associated with those risks. This paper outlines a simple test that allows the researcher to distinguish these alternative risk types. We present our test in the context of patterns of workers' compensation lost day claims to test whether past experience explains repeated claims for some individuals, or whether some individuals exhibit an innate heterogeneity in claims-filing propensities. We find that a previous claim significantly increases claim probabilities in the future using easy to estimate and interpret "runs" tests on the claims. This suggests, for the risk management problem examined here, that early intervention to limit the effects of the first lost time claim may produce significant disability-cost savings with respect to future claims.
To determine the association between prescription nonadherence and the health of older adults wit... more To determine the association between prescription nonadherence and the health of older adults with 1 or more of 5 chronic conditions. Analysis of the correlation between prescription nonadherence and the health of older adults. Data were from a 7-year panel with information on healthcare encounters and prescriptions. We used fixed-effects Cox duration regression models and fixed-effects Poisson count regression models to control for time-invariant factors specific to each subject when examining the impact of nonadherence on time to an emergency department (ED) visit (Cox regression) or number of ED visits (Poisson count regression). Nonadherence was associated with subsequent ED visits for hypertension, chronic heart disease, diabetes, and hypercholesterolemia. No significant short-term effects of nonadherence on chronic obstructive pulmonary disease (COPD) were detected. However, long-term effects of nonadherence (using the count regression model with lagged counts) were detected f...
Journal of Occupational and Environmental Medicine, 2007
To quantify the influence that workers' satisfaction with the firm's treatment of their disabilit... more To quantify the influence that workers' satisfaction with the firm's treatment of their disability claim and their health care provider has on workers' return to work (RTW) following onset of occupational LBP. Methods: Using a prospective survey on back pain, medical treatment, and workers' satisfaction, we employ nonparametric and logistic analyses to see how satisfaction affects RTW. Results: Workers' satisfaction with their employer's treatment of their disability claim is more important in explaining RTW than satisfaction with health care providers or expectations about recovery. Dissatisfied workers have worse return to work outcomes because they are more likely to have time lost claims and are more likely to have multiple spells of joblessness. Conclusions: Workers' RTW is more responsive to their satisfaction with how the firm treated their disability claim than with their satisfaction with the health care provider. Satisfaction of both types plays an important role in determining RTW.
In this paper we review and extend the analysis of moral hazard response in two relatively unexam... more In this paper we review and extend the analysis of moral hazard response in two relatively unexamined empirical directions: (1) how insurance changes in one program affects employee participation in other programs at a point in time (inter-program moral hazard), and (2) how the consumption of program benefits now tends to affect employees behavior over time (benefits consumption capital). We develop a formal model of inter-program moral hazard based on workers' compensation with programs overlapping it (including sick leave, health insurance, and unemployment insurance), and review evidence concerning this overlap response. We also provide new evidence on benefits consumption capital concerning workers' compensation using data from one large private employer in the US.
Becker's model of discrimination is extended to the case where men exhibit distastes for working ... more Becker's model of discrimination is extended to the case where men exhibit distastes for working under female managers. The distribution of women in the resulting occupational hierarchy depends on the number of women in lower occupations, the wages of male workers in lower occupations, and male distastes for female management. Thus, there exists an occupational sorting function, related to wages, that determines the occupational distribution of women. We integrate this sorting function into a standard wage equation to derive a new decomposition of male-female wage differentials and apply it to a sample of insurance industry workers from the 1988 CPS.
Little is known about the sick-leave experiences of workers who make a workers' compensation clai... more Little is known about the sick-leave experiences of workers who make a workers' compensation claim for back pain. Our objective is to describe the 1-year patterns of sick-leave and the health outcomes of a cohort of workers who make a workers' compensation claim for back pain. We studied a cohort of 1,831 workers from five large US firms who made incident workers' compensation claims for back pain between January 1, 1999 and June 30, 2002. Injured workers were interviewed 1 month (n = 1,321), 6 months (n = 810) and 1 year (n = 462) following the onset of their pain. We described the course of back pain using four patterns of sick-leave: (1) no sick-leave, (2) returned to worked and stayed, (3) multiple episodes of sick-leave and (4) not yet returned to work. We described the health outcomes as back and/or leg pain intensity, functional limitations and health-related quality of life. We analyzed data from participants who completed all followup interviews (n = 457) to compute the probabilities of transition between patterns of sick-leave. A significant proportion of workers experienced multiple episodes of sick-leave (30.2%; 95% CI 25.0-35.1) during the 1-year follow-up. The proportion of workers who did not report sick-leave declined from 42.4% (95% CI 39.0-46.1) at 1 month to 33.6% (28.0-38.7) at 1 year. One year after the injury, 2.9% (1.6-4.9) of workers had not yet returned to work. Workers who did not report sick-leave and those who returned and stayed at work reported better health outcomes than workers who experienced multiple episodes of sick-leave or workers who had not returned to work. Almost a third of workers with an incident episode of back pain experience recurrent spells of work absenteeism during the following year. Our data suggest that stable patterns of sick-leave are associated with better health.
International Journal of Statistics in Medical Research
While there is a rich literature regarding hospital quality in general, research examining trends... more While there is a rich literature regarding hospital quality in general, research examining trends in hospital quality using regression analysis of trends are relatively rare. In the presence of the increasing digitalization of hospital data, the wide accessibility of regression software, and the need for real time feedback on ongoing quality of medical care outcomes, this paper presents simple-to-implement techniques for analyzing the quality of health care outcomes. We present graphical illustrations of the techniques discussed, and we also include a SAS appendix with the code to estimate all the models discussed, including a proposed new regression index: the Exchange index. We employ data from Arizona's acute care hospitals to illustrate uses of our new index.
Rating the digital help: electronic medical records, software providers, and physicians
International journal of health economics and management, 2016
To separate the effects of physicians' characteristics on the perceived productivity of EMRs ... more To separate the effects of physicians' characteristics on the perceived productivity of EMRs from the effects of limitations on usability inherent in EMR design, a multivariate regression model is used to estimate the factors influencing physicians' rankings of five attributes of their EMRs, namely; ease of use and reliability; the EMRs effect on physician and staff productivity and the EMRs performance vs. vendor's promises. We divide the factors influencing the rankings into three groups: physician characteristics, EMR characteristics and practice characteristics (type of practice, size, and location). The data are from approximately 1800 practicing physicians in Arizona. Physician's characteristics influence perceived ease of use and physicians' productivity, but not staff productivity, reliability or vendors' promised performance. Practice type and EMR characteristics affect perceived productivity, reliability and performance versus vendors' promises....
Using a sample of one job type from one firm (to hold job tasks and sick leave/disability policy ... more Using a sample of one job type from one firm (to hold job tasks and sick leave/disability policy constant), we estimate the effect of demographic variables, job performance warnings, and workers' compensation benefits on the propensity to file a carpal tunnel syndrome (CTS) loss work-time claim. We find that disciplinary notices increase the employees' propensity to file a CTS claim. State maximum workers' compensation benefits are also positively related to CTS claim frequency, however, the relationship is not statistically significant. CTS claimants respond differently than other sprain/strain claimants to benefits and to gender. In particularly, women have relatively more CTS claims, while men have relatively more other sprain/strain claims in our sample. The estimates here underscore the importance of psychosocial factors in the filing of occupational CTS and sprain injuries claims.
Several explanations of why mutual insurers choose to demutualize their businesses are examined w... more Several explanations of why mutual insurers choose to demutualize their businesses are examined with a recent survey of mutual insurers. This study adds to the literature by surveying mutual insurers' executives on those factors that would lead them to demutualize their companies. Both univariate and multivariate techniques are applied to analyze those responses. Demutualization is most strongly influenced by access to capital markets, increased organizational flexibility, and the chance for company officers to increase their pay, as prior literature has suggested. MUTUAL INSURANCE REORGANIZATION Joe Belth, in his The Insurance Forum, suggests four reasons a mutual insurer would demutualize: access to capital, organizational flexibility, avoidance of the income tax setback, and aligning the interests of managers with those of company shareholders. Demutualization provides insurers with access to external capital sources that are currently not available to them. A mutual company's only means of access to capital markets is through the issuance of surplus contribution notes (Dumm and Hoyt, 1999). Moreover, the issuance of surplus notes is restricted by regulatory requirements. It is subject to "the prior approval of the regulator in the company's state of domicile, interest and principal payments are subject to the regulator's prior approval, and surplus notes are subordinate to the issuing insurance company's obligations to policy
Increasing claims for soft tissue injuries in workers' compensation: Cost shifting and moral hazard
Journal of Risk and Uncertainty, 1996
During the last decade, the distribution of workers' compensation claims has exhi... more During the last decade, the distribution of workers' compensation claims has exhibited a marked shift towards soft tissue injuries such as sprains, strains, and low back claims. There are three possible explanations for this trend; (1) safety incentives induced by workers compensation or OSHA may have reduced other, traumatic claims; (2) the movement away from heavy manufacturing and the 1980
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Papers by Richard Butler