Measuring Hospital Quality

Quality of care is difficult to measure. Even if you had a perfect measure of quality in terms of health outcomes, risk adjustment is imperfect. For instance, academic medical centers are often assumed to have high quality, but actual outcomes observed in the data may not be that good if they also receive the sickest,…

Is the value of a QALY constant?

Standard cost-effectiveness analysis assumes that any gain in quality-adjusted life years (QALYs) should be valued equally. This does not sound unreasonable, but is it true in practice? Consider two potential violations of constant value of QALY gains: scope insensitivity and severity independence. I define each of these below: Scope insensitivity. This assumes that individuals value…

Should pay toilets be illegal?

At first glance, John Cochrane makes a compelling case that pay toilets should not be illegal. The absence of pay toilets is in fact a delightful encapsulation of so much that is wrong with American economic policy these days. Activists decide free toilets are a human right, and successfully campaign to ban pay toilets. For…