Relational Incentive Contracts Levin, Jonathan
The American economic review,
06/2003, Volume:
93, Issue:
3
Journal Article
Peer reviewed
Open access
Standard incentive theory models provide a rich framework for studying informational problems but assume that contracts can be perfectly enforced. This paper studies the design of self-enforced ...relational contracts. I show that optimal contracts often can take a simple stationary form, but that self-enforcement restricts promised compensation and affects incentive provision. With hidden information, it may be optimal for an agent to supply the same inefficient effort regardless of cost conditions. With moral hazard, optimal contracts involve just two levels of compensation. This is true even if performance measures are subjective, in which case optimal contracts terminate following poor performance.
The platform design, the process that helps potential buyers on the internet navigate toward products they may purchase, plays a critical role in reducing search frictions and determining market ...outcomes. We study a key trade-off associated with two important roles of efficient platform design: guiding consumers to their most desired product while also strengthening seller incentives to lower prices. We use simple theory to illustrate this, and then combine detailed browsing data from eBay and an equilibrium model of consumer search and price competition to quantitatively assess this trade-off in the particular context of a change in eBay’s marketplace design.
Objective
To test the association between vertical integration of primary care providers (PCPs) and adherence rates for anti‐diabetics, renin angiotensin system antagonists (RASA), and statins.
Data ...Sources
Medicare Part B outpatient fee‐for‐service claims and Medicare Part D event data from 2014 to 2017.
Study Design
We estimated difference‐in‐differences regressions, comparing changes in adherence among patients with PCPs who converted from independent to integrated to changes among patients whose PCPs remained independent or integrated during the study period. To test for heterogenous impacts by patient demographics, we estimated triple difference regressions that included additional interaction terms by comorbidity rates, age group, and race/ethnicity.
Extraction Methods
We extracted Medicare claims for adults with continuous enrollment in Parts B and D during the study period.
Principal Findings
The proportion of patients who had a vertically integrated PCP increased by approximately 23% over the study period. Changes in adherence did not differ significantly between patients based on whether their PCP became integrated (Statins: 0.18, 95% CI −0.13, 0.49; RASA: −0.13, 95% CI −0.46, 0.19; Anti‐Diabetics: −0.20, 95% CI −0.78, 0.38). Among patients with PCPs who became integrated, there were significant decreases in adherence for patients who were Black, Asian, Hispanic, or Native American, above 80 years old, and had greater comorbidities for all three classes.
Conclusions
While there were no average changes in adherence following vertical integration of PCPs, health equity worsened, with significant declines in adherence for Black, Asian, Hispanic, and Native American patients, patients over 80 years old, and patients with greater comorbidities. These findings suggest that integration may reduce clinicians’ incentives to compete based on the quality of care delivered. Given the price increases associated with integration, integration may be a net welfare loss.
The inadequate dietary diversity of pregnant women in low- and middle-income countries, including Rwanda, is rising and leading to macro and micronutrient deficiencies. The extent of dietary ...diversity and the factors contributing to it are unknown in Rwanda. This cross-sectional study, with 612 women who attended antenatal care services in Rwanda's Southern Province, identified determinants of dietary diversity among pregnant women. A multistage sampling scheme was used in which four districts were sampled, thereafter one urban and one rural health centre was sampled in each district and finally, a systematic sample of pregnant women was selected in each sampled health centre. Dietary diversity was measured using Minimum Dietary Diversity for Women (MDD-W), and multiple logistic regression models were fitted to identify factors associated with dietary diversity. Only 44.1% (95% confidence interval (CI) of 40.1%, 48.0%) of participants had adequate dietary diversity. Approximately 95.4% of participants consumed grains, white roots, and tubers. The food groups that were the least consumed consisted of eggs (n = 99, 16.4%), as well as those consisting of milk and milk products (n = 112, 18.5%). The factors which were positively associated with dietary diversity were owning a radio (adjusted odds ratio aOR = 1.90 95% CI 1.27, 2.85), maternal education (aOR = 1.85 95% CI 1.28, 2.65), having a kitchen garden (aOR = 1.69 95% CI 1.11, 2.57) and nutrition knowledge score (aOR = 1.45 95% CI 1.21, 1.74) for a five-point increase in nutrition knowledge score. The factors negatively associated with dietary diversity include food insecurity, which reduced the odds of dietary diversity (aOR = 0.19 0.07, 0.50) per five-unit increase in food insecurity. Furthermore, the odds of adequate dietary diversity were lower among urban residents than rural residents (aOR = 0.69 0.47, 1.03). The household size was associated with dietary diversity with the odds of dietary diversity decreasing by 12% for a five-unit increase in household size (aOR = 0.88 0.79; 0.99). 23% had poor nutritional status, indicated by their mid-upper arm circumference (MUAC; < 23 cm). Enhanced nutritional education is needed to improve the nutritional knowledge of this population with particular emphasis on the consumption of animal-source foods. Sensitisation activities promoting ownership of kitchen gardens and radios could improve dietary diversity among Rwanda's pregnant women.
This study examined whether the COVID-19 pandemic was associated with changes in new selective serotonin reuptake inhibitor (SSRI) prescription fills.
Using IQVIA Xponent data on new SSRI fills in ...Los Angeles (L.A.) County from March 2019 to June 2021, the authors implemented an interrupted time series analysis comparing the monthly volume and trend of overall fills and fills by age and gender from before to after the pandemic declaration.
The rate of new SSRI prescription fills briefly decreased after the pandemic declaration but then consistently increased through the rest of the study period. These increases were primarily driven by women, young adults (i.e., 18–39 year-olds), and those under 18 years old.
Sample is limited to one county and may not be generalizable to other municipalities.
The COVID-19 pandemic was associated with significant increases in new SSRI fills among women, young adults, and those under 18. These increases were relatively small compared to increases in depressive symptoms during the same time period.
•The COVID-19 pandemic was associated with an initial decrease, then a consistent increase, in new SSRI fills in L.A. County.•Increases in new SSRI fills during the pandemic were primarily among women, 18-39 year-olds, and those under 18.•Increases in new SSRI fills during the pandemic were relatively low compared to increases in depressive symptoms.
We study entry and bidding patterns in sealed bid and open auctions. Using data from the U.S. Forest Service timber auctions, we document a set of systematic effects: sealed bid auctions attract more ...small bidders, shift the allocation toward these bidders, and can also generate higher revenue. A private value auction model with endogenous participation can account for these qualitative effects of auction format. We estimate the model's parameters and show that it can explain the quantitative effects as well. We then use the model to assess bidder competitiveness, which has important consequences for auction design.
Cervical cancer is a major global public health concern, with 85% of cases occurring in low- and middle-income countries. In South Africa, it is the second most common cancer amongst women. Screening ...and treatment of cervical cancer precursor lesions is associated with a lower incidence and mortality. This research determines the associations between women's beliefs about cervical cancer and screening and the uptake of Papanicolaou (Pap) smears in Johannesburg, where cervical screening uptake is suboptimal.
This research was approved by the University of Witwatersrand Human Research Ethics Committee (Medical), clearance certificate number: M170243 and the Johannesburg District Heath Research Committee prior to conducting the study. All participants signed a consent form prior to participating in this study. This cross-sectional analytical study used an interviewer-administered validated measurement scale based on the Health Belief Model (HBM) to describe health beliefs regarding cervical cancer and screening among 280 women aged 30 years and older, attending Johannesburg primary care facilities in 2017. Logistic regression models, with robust estimation of variance to account for clustering of women within clinics, were fitted to identify health beliefs (perceived susceptibility, severity, barriers and benefit, cues to action, and self-efficacy) associated with ever having had a Pap smear (screening uptake), while controlling for knowledge of screening and potential confounders.
Of the 280 women, 177 (63.2%) had ever been screened, 180 (64.3%) were never married, 199 (71.1%) attained secondary education and 133 (47.5%) were employed full time. Women of older age (AOR = 1.6 for a 5-year increase in age; CI: 1.3-1.9; P<0.001), with higher knowledge scores (AOR = 2.5 for a 5-point increase in knowledge score; 95% CI:1.0-6.3;P = 0.051), with lower perceived barriers scores (AOR = 0.4 for a 5-point increase in barriers score; 95% CI:0.3-0.5; P<0.001) and higher perceived severity scores (AOR = 1.3 for a 5-point increase in severity score; 95% CI:1.0-1.6; P = 0.017) were more likely to have had a Pap smear.
This study shows that women who take up screening are older, more knowledgeable regarding cervical cancer and screening, less likely to perceive screening barriers, and more likely to perceive cervical cancer as a severe disease. This highlights that for public health interventions to increase screening uptake, the focus should include tailored behaviour change communication strategies that address women's beliefs regarding screening barriers and emphasize the severity of cervical cancer.
River water quality is affected by various stressors (land-uses) operating at different hydrological spatial scales. Few studies have employed a multi-scaled analyses to differentiate effects of ...natural grasslands and woodlands, agriculture, impoundments, urban and mining stressors on headwater streams. Using a multi-scaled modeling approach, this study disentangled the distinct spatial signatures and mechanistic effects of specific stressors and topographic drivers on individual water quality parameters in tributaries of the Gwathle River Catchment in the Platinum Belt of South Africa. Water samples were collected on six occasions from 15 sites on three rivers over 12-months. Physio-chemical parameters as well as major anions, cations and metals were measured. Five key water quality parameters were identified using principal components analysis: sulfate, ammonium, copper, turbidity, and pH to characterise catchment water quality conditions. Using class-level composition (PLAND) and connectedness (COHESION) metrics together with topographic data, generalized linear mixed models were developed at multiple scales (sub-basin, cumulative catchment, riparian buffers) to identify the most parsimonious model with the dominant drivers of each water quality parameter. Ammonium concentrations were best explained by urban stress, Cu increased with mining and agriculture, turbidity increased with elevation heterogeneity, agriculture, urbanisation and fallow lands all at the sub-basin scale. River pH was positively predicted by slope heterogeneity, mining cover and impoundment connectivity at the catchment scale. Sulfate increased with mining and agriculture composition in the 100 m riparian buffer. Hierarchical cluster analysis of water quality and scale-dependent parsimonious drivers separated the river sites into three distinct groups distinguishing pristine, moderately impacted, and heavily mined sites. By demonstrating stressor- and scale-dependent water quality responses, this multi-scale nested modeling approach reveals the importance of developing adaptive, targeted management plans at hydrologically meaningful scales to sustain water quality amid intensifying land use.
Display omitted
•Multi-scale modeling disentangles multiple water quality stressors.•Water quality reacts to various land uses at particular spatial scales.•Study demonstrates need for scale-specific water quality management regimes.•Study provides context for policies that address development and aquatic health.
We document some early effects of how mobile devices might change Internet and retail commerce. We present three main findings based on an analysis of eBay's mobile shopping application and core ...Internet platform. First, early adopters of mobile e-commerce applications appear to be people who already were relatively heavy Internet commerce users. Second, adoption of the mobile shopping application is associated with both an immediate and sustained increase in total platform purchasing, with little evidence of substitution from the core platform. Third, differences in user behavior across the mobile applications and the regular Internet site are not yet so dramatic.
PDF
