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volume 137, issue 2, may 2022
1. title: diagnosing physician error: a machine learning approach to low-value health care
authors: sendhil mullainathan, ziad obermeyer
abstract: we use machine learning as a tool to study decision making, focusing specifically on how physicians diagnose heart attack. an algorithmic model of a patient�s probability of heart attack allows us to identify cases where physicians' testing decisions deviate from predicted risk. we then use actual health outcomes to evaluate whether those deviations represent mistakes or physicians� superior knowledge. this approach reveals two inefficiencies. physicians overtest: predictably low-risk patients are tested, but do not benefit. at the same time, physicians undertest: predictably high-risk patients are left untested, and then go on to suffer adverse health events including death. a natural experiment using shift-to-shift testing variation confirms these findings. simultaneous over- and undertesting cannot easily be explained by incentives alone, and instead point to systematic errors in judgment. we provide suggestive evidence on the psychology underlying these errors. first, physicians use too simple a model of risk. second, they overweight factors that are salient or representative of heart attack, such as chest pain. we argue health care models must incorporate physician error, and illustrate how policies focused solely on incentive problems can produce large inefficiencies.
2. title: selection with variation in diagnostic skill: evidence from radiologists
authors: david c chan, matthew gentzkow, chuan yu
abstract: physicians, judges, teachers, and agents in many other settings differ systematically in the decisions they make when faced with similar cases. standard approaches to interpreting and exploiting such differences assume they arise solely from variation in preferences. we develop an alternative framework that allows variation in preferences and diagnostic skill and show that both dimensions may be partially identified in standard settings under quasi-random assignment. we apply this framework to study pneumonia diagnoses by radiologists. diagnosis rates vary widely among radiologists, and descriptive evidence suggests that a large component of this variation is due to differences in diagnostic skill. our estimated model suggests that radiologists view failing to diagnose a patient with pneumonia as more costly than incorrectly diagnosing one without, and that this leads less skilled radiologists to optimally choose lower diagnostic thresholds. variation in skill can explain 39% of the variation in diagnostic decisions, and policies that improve skill perform better than uniform decision guidelines. failing to account for skill variation can lead to highly misleading results in research designs that use agent assignments as instruments.
3. title: why do people stay poor?
authors: clare balboni, oriana bandiera, robin burgess, maitreesh ghatak, anton heil
abstract: there are two broad views as to why people stay poor. one emphasizes differences in fundamentals, such as ability, talent, or motivation. the poverty traps view emphasizes differences in opportunities that stem from access to wealth. to test these views, we exploit a large-scale, randomized asset transfer and an 11-year panel of 6,000 households who begin in extreme poverty. the setting is rural bangladesh, and the assets are cows. the data support the poverty traps view�we identify a threshold level of initial assets above which households accumulate assets, take on better occupations (from casual labor in agriculture or domestic services to running small livestock businesses), and grow out of poverty. the reverse happens for those below the threshold. structural estimation of an occupational choice model reveals that almost all beneficiaries are misallocated in the work they do at baseline and that the gains arising from eliminating misallocation would far exceed the program costs. our findings imply that large transfers, which create better jobs for the poor, are an effective means of getting people out of poverty traps and reducing global poverty.
4. title: old boys� clubs and upward mobility among the educational elite
authors: valerie michelman, joseph price, seth d zimmerman
abstract: this article studies how exclusive social groups shape upward mobility and whether interactions between low- and high-status peers can integrate the top rungs of the economic and social ladders. our setting is harvard university in the 1920s and 1930s, where new groups of students arriving on campus encountered a social system centered on exclusive old boys� clubs. combining archival and census records, we first show that students from prestigious private feeder schools are overrepresented in old boys� clubs, while academic high achievers and ethnic minorities are almost completely absent. club members earn |$32\%$| more than other students and are more likely to work in finance and join country clubs, both characteristic of the era�s elite. we use random variation in room assignment to show that exposure to high-status peers expands gaps in college club membership, adult social club membership, and finance careers by high school type, with large positive effects for private school students and zero or negative effects for others. to conclude, we turn to more recent cohorts. we show that the link between exclusive college clubs and finance careers persists across the twentieth century even as harvard diversifies, and that elite university students from the highest-income families continue to outearn their peers.
5. title: the costs of employment segregation: evidence from the federal government under woodrow wilson
authors: abhay aneja, guo xu
abstract: we link newly digitized personnel records of the u.s. government for 1907�1921 to census data to study the segregation of the civil service by race under president woodrow wilson. using a difference-in-differences design around wilson�s inauguration, we find that the introduction of employment segregation increased the black-white earnings gap by 3.4�6.9 percentage points. this increasing gap is driven by a reallocation of existing black civil servants to lower-paid positions, lowering their returns to education. importantly, the negative effects extend beyond wilson�s presidency. using census data for 1900�1940, we show that segregation caused a relative decline in the home ownership rate of black civil servants. moreover, by comparing children of black and white civil servants in adulthood, we provide suggestive evidence that descendants of black civil servants who were exposed to wilson�s presidency exhibit lower levels of education, earnings, and social mobility. our combined results thus document significant short- and long-run costs borne by minorities during a unique episode of state-sanctioned discrimination.
6. title: correlation made simple: applications to salience and regret theory
authors: giacomo lanzani
abstract: i offer an axiomatization of risk models where the choices of the decision maker are correlation sensitive. by extending the techniques of conjoint measurement to the nondeterministic case, i show that transitivity is the von neumann-morgenstern axiom that has to be relaxed to allow for these richer patterns of behavior. to illustrate the advantages of the modeling choice, we provide a simple axiomatization for the salience theory model in our general framework. this approach leads to clear comparison to popular preexisting models, such as regret and reference dependence, and allows one to single out the ordering property as the feature that brings salience theory outside the prospect theory realm.
7. title: the macroeconomics of sticky prices with generalized hazard functions
authors: fernando alvarez, francesco lippi, aleksei oskolkov
abstract: we give a full analytic characterization of a large class of sticky-price models where the firm�s price-setting behavior is described by a generalized hazard function. such a function allows for a vast variety of empirical hazards to be fitted. this setup is microfounded by random adjustment costs, as in caballero and engel (1999), or by information frictions, as in woodford (2009). we establish two main results. first, we show how to identify all the primitives of the model, including the distribution of the fundamental adjustment costs and the implied generalized hazard function, using the distribution of price changes. second, we derive a sufficient statistic for the aggregate effect of a monetary shock: given an arbitrary generalized hazard function, the cumulative impulse response of output to a once-and-for-all monetary shock is proportional to the ratio of the kurtosis of the steady-state distribution of price changes over the frequency of price adjustment. we prove that calvo�s model yields the upper bound and golosov and lucas�s model the lower bound on this measure in the class of random menu cost models.
8. title: marginal effects of merit aid for low-income students
authors: joshua angrist, david autor, amanda pallais
abstract: financial aid from the susan thompson buffett foundation (stbf) provides comprehensive support to a student population similar to that served by a host of state aid programs. in conjunction with stbf, we randomly assigned aid awards to thousands of nebraska high school graduates from low-income, minority, and first-generation college households. randomly assigned stbf awards boost bachelor�s (ba) degree completion for students targeting four-year schools by about 8 points. degree gains are concentrated among four-year college applicants who would otherwise have been unlikely to pursue a four-year program. degree effects are mediated by award-induced increases in credits earned toward a ba in the first year of college. the extent of initial four-year college engagement explains differences in impact by target campus and across covariate subgroups. the projected lifetime earnings effect of awards exceeds marginal educational spending for all of the subgroups examined in the study. projected earnings gains exceed funder costs for urban students and for students with relatively weak academic preparation.
9. title: firm organization with multiple establishments
authors: anna gumpert, henrike steimer, manfred antoni
abstract: we show theoretically and empirically that the managerial organization of multiestablishment firms is interdependent across establishments. to derive our result, we study the effect of geographic frictions on firm organization. in our model, we assume that a ceo�s time is a resource in limited supply, shared across headquarters and establishments. geographic frictions increase the costs of accessing the ceo. hiring middle managers at one establishment substitutes for ceo time, which is reallocated across all establishments. consequently, geographic frictions between the headquarters and one establishment affect the organization of all establishments of a firm. our model is consistent with novel facts about multiestablishment firm organization that we document using administrative data from germany. we exploit the opening of high-speed railway routes to show that not only the establishments directly affected by faster travel times but also the other establishments of the firm adjust their organization. our findings imply that local conditions propagate across space through firm organization.
10. title: origins of the opioid crisis and its enduring impacts
authors: abby alpert, william n evans, ethan m j lieber, david powell
abstract: overdose deaths involving opioids have increased dramatically since the 1990s, leading to the worst drug overdose epidemic in u.s. history, but there is limited empirical evidence about the initial causes. in this article, we examine the role of the 1996 introduction and marketing of oxycontin as a potential leading cause of the opioid crisis. we leverage cross-state variation in exposure to oxycontin's introduction due to a state policy that substantially limited the drug's early entry and marketing in select states. recently unsealed court documents involving purdue pharma show that state-based triplicate prescription programs posed a major obstacle to sales of oxycontin and suggest that less marketing was targeted to states with these programs. we find that oxycontin distribution was more than 50% lower in �triplicate states� in the years after the drug's launch. although triplicate states had higher rates of overdose deaths prior to 1996, this relationship flipped shortly after the launch and triplicate states saw substantially slower growth in overdose deaths, continuing even 20 years after oxycontin's introduction. our results show that the introduction and marketing of oxycontin explain a substantial share of overdose deaths over the past two decades.
11. title: evidence on job search models from a survey of unemployed workers in germany
authors: stefano dellavigna, j�rg heining, johannes f schmieder, simon trenkle
abstract: the job-finding rate of unemployment insurance (ui) recipients declines in the initial months of unemployment and then exhibits a spike at the benefit exhaustion point. a range of theoretical explanations have been proposed, but those are hard to disentangle using data on job finding alone. to better understand the underlying mechanisms, we conducted a large text-message-based survey of unemployed workers in germany. we surveyed 6,349 ui recipients twice a week for four months about their job search effort. the panel structure allows us to observe how search effort evolves in individuals over the unemployment spell. we provide three key facts: (i) search effort is flat early on in the ui spell, (ii) search effort exhibits an increase up to ui exhaustion and a decrease thereafter, (iii) ui recipients do not appear to time job start dates to coincide with the ui exhaustion point. a standard search model with unobserved heterogeneity struggles to explain the second fact, and a model of storable offers is not consistent with the third fact. the patterns are well captured by a model of reference-dependent job search or by a model with duration dependence in search cost.
12. title: war, socialism, and the rise of fascism: an empirical exploration
authors: daron acemoglu, giuseppe de feo, giacomo de luca, gianluca russo
abstract: the recent ascent of right-wing populist movements in several countries has rekindled interest in understanding the causes of the rise of fascism in the interwar years. in this article, we argue that there was a strong link between the surge of support for the socialist party after world war i and the subsequent emergence of fascism in italy. we first develop a source of variation in socialist support across italian municipalities in the 1919 election based on war casualties from the area. we show that these casualties are unrelated to a battery of political, economic, and social variables before the war and had a major effect on socialist support (partly because the socialists were the main antiwar political movement). our main result is that this boost to socialist support (that is �exogenous� to the prior political leaning of the municipality) led to greater local fascist activity as measured by local party branches and fascist political violence, and to significantly larger vote share of the fascist party in the 1921 and 1924 elections. we provide evidence that landowner associations and greater presence of local elites played an important role in the rise of fascism. finally, we find greater likelihood of jewish deportations in 1943�45 and lower vote share for christian democrats after world war ii in areas with greater early fascist activity.
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