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Year: 2018 Publisher: National Bureau of Economic Research
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Year: 2018 Publisher: Cambridge, Mass. National Bureau of Economic Research
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Many observers have argued that giving parents freedom to choose schools would improve education (Friedman, 1955). We review the evidence, and find little indication that households systematically prefer higher value added schools. We show that this can be explained using a competitive labor market model that takes into account both student and employer choice. The setup implies that households will often rationally prefer schools with high absolute achievement rather than high value added. As a result, school choice can exacerbate inequality without improving opportunities for the most disadvantaged students.
Digital
Year: 2018 Publisher: Cambridge, Mass. National Bureau of Economic Research
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Faulty physician decision making has been blamed for everything from medical errors to excessive procedure use and wasteful spending. Yet medical treatment is often complex, requiring a sequence of decisions that may involve trade offs between selecting the choice with the highest expected value or selecting a choice with higher possible payoffs. We show that the best choice depends on a physician's diagnostic skill so that the optimal treatment can vary even for identical patients. Bringing the model to patient claims data for depression, we show that doctors who experiment more with drug choice achieve better patient outcomes, except when physician decisions violate professional guidelines for drug choice.
Book
Year: 2018 Publisher: Cambridge, Mass. National Bureau of Economic Research
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Friedman (1955) argued that giving parents freedom to choose schools would improve education. His argument was simple and compelling because it extended results from markets for consumer goods to education. We review the evidence, which yields surprisingly mixed results on Friedman's prediction. A key reason is that households often seem to choose schools based on their absolute achievement rather than their value added. We show this can be rational in a model based on three ingredients economists have highlighted since Friedman worked on the issue. First, education is an investment into human capital (Becker, 1964). Second, labor markets can feature wage premia: individuals of a given skill level may receive higher wages if they match to more productive firms (Card et al., 2018). Third, distance influences school choice and the placements schools produce (Abdulkadiroglu et al., 2017, Weinstein, 2017). These imply that choice alone is too crude a mechanism to ensure the effective provision of schooling.
Book
Year: 2018 Publisher: Cambridge, Mass. National Bureau of Economic Research
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Treatment for depression is complex, requiring decisions that may involve tradeoffs between exploiting treatments with the highest expected value or experimenting with treatments with higher possible payoffs. Using patient claims data, we show that among skilled doctors, using a broader portfolio of drugs predicts better patient outcomes, except in cases where doctor's decisions violate loose professional guidelines. We introduce a behavioral model of decision making guided by our empirical observations. The model's novel feature is that the tradeoff between exploitation and experimentation depends on the doctor's diagnostic skill. The model predicts that higher diagnostic skill leads to greater diversity in drug choice and better matching of drugs to patients even among doctors with the same initial beliefs regarding drug effectiveness. Consistent with the finding that guideline violations predict poorer patient outcomes, simulations of the model suggest that increasing the number of possible drug choices can lower performance.
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