Journal of Policy Analysis and Management最新文献

{"title":"Regulating malpractice risk and medical decision-making: Evidence from births","authors":"Alice J. Chen,&nbsp;Michael R. Richards,&nbsp;Rachel Shriver","doi":"10.1002/pam.70044","DOIUrl":"10.1002/pam.70044","url":null,"abstract":"<p>The literature remains mixed on the extent to which medical malpractice reforms affect physician overuse of procedures (i.e., “defensive medicine”). We bring new evidence to this discourse by examining a recent reform in North Carolina that introduced caps on noneconomic damages. We focus on a setting where malpractice risk is high and service intensity is strongly subject to physicians’ discretion: obstetrics care. Comparing discharge data from North Carolina to Florida, we show that caps on noneconomic damages causally reduce the likelihood of a cesarean delivery by, on average, 5%, with the effect size nearing 7% five years post-policy implementation. Physicians also substitute away from other intensive procedures such as vacuum and forceps deliveries but maintain control over the timing of births by increasing medical inductions. Our findings suggest that the reduction in cesarean deliveries due to North Carolina's damage caps can reduce annual spending by approximately $4.6 million.</p>","PeriodicalId":48105,"journal":{"name":"Journal of Policy Analysis and Management","volume":"44 4","pages":"1194-1210"},"PeriodicalIF":2.4,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144898403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"管理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Notes from the Editor","authors":"","doi":"10.1002/pam.70050","DOIUrl":"10.1002/pam.70050","url":null,"abstract":"","PeriodicalId":48105,"journal":{"name":"Journal of Policy Analysis and Management","volume":"44 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144898406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"管理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"","doi":"10.1002/pam.70046","DOIUrl":"https://doi.org/10.1002/pam.70046","url":null,"abstract":"","PeriodicalId":48105,"journal":{"name":"Journal of Policy Analysis and Management","volume":"44 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145122634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"管理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Counterpoint","authors":"Kent Smetters","doi":"10.1002/pam.70039","DOIUrl":"10.1002/pam.70039","url":null,"abstract":"&lt;p&gt;Federal debt can grow over time but not faster than GDP in the long run. Revenue must cover spending plus interest owed on the debt. Calculating the tax increase required to stabilize the debt-GDP ratio after 30 years requires estimating primary deficits (not including interest payments), borrowing rates &lt;i&gt;r&lt;/i&gt; and growth rate &lt;i&gt;g&lt;/i&gt; for many years after the Congressional Budget Office's (CBO, &lt;span&gt;2025a&lt;/span&gt;) 30-year projection. CBO never reported a stabilizing rate. I am sure that Edelberg et al. (&lt;span&gt;2025&lt;/span&gt;) reasonably extrapolated CBO data to estimate their 3% GDP value. But modest changes in assumptions create large differences: A 100% debt-GDP ratio and a 300% debt-GDP ratio could both be reasonably estimated to require the same future 3% of GDP, or even 6% or 9%.1 Using a microsimulation (not OLG) model, where the first decade was purposely aligned to CBO's (including CBO's no growth of discretionary spending2), Gokhale and Smetters (&lt;span&gt;2024&lt;/span&gt;) estimated a permanent 6.6% GDP shortfall in 2024 when the debt-GDP ratio was 98%.3 The Government Accountability Office (GAO, &lt;span&gt;2024&lt;/span&gt;) projected a debt-to-GDP ratio of 229% by 2054. CBO (&lt;span&gt;2025b&lt;/span&gt;) projected ratios “exceeding” 250% by 2055 under assumptions that are reasonable and even more consistent with the reduced-form literature.&lt;/p&gt;&lt;p&gt;Uncertainty is common in long-term projections, and debates over reduced-form parameter values can be endless. Moreover, a standard insight from the field of finance is that more probability weight should be placed on worse outcomes.4 Otherwise, eliminating the tax system altogether would be optimal.5&lt;/p&gt;&lt;p&gt;But let me pinpoint what I think is the specific disagreement between Louise and me. The risk-free rate itself is &lt;i&gt;under-identified&lt;/i&gt; in reduced-form models like CBOLT.6 The modeler picks a time path of interest rates—maybe based on yet another reduced-form estimation7—instead of computing the rate required for bond market demand to equal government supply at each point in time. My sense is that Louise seems fine with that; I am not. We agree with using simple models to study stimulus during short-term disruptions like COVID-19.8 But I disagree that reduced-form models are sensible for longer-term analysis where forward-looking trillion-dollar capital markets require that asset demand and supply add up (equilibrium). If simple statistical relationships, estimated at historical lower levels of debt, applied to an increasing debt path, debt crises would not exist. Even CBO has a limited appetite for this simplicity, capping their reported debt-GDP projections at 250%, which is easily achievable in 30 years with reasonable assumptions.&lt;/p&gt;&lt;p&gt;The OLG model with aggregate uncertainty requires that prices, including interest rates, follow supply and demand. In words, things must add up. The OLG model can also incorporate future demographic changes from a microsimulation model. This responsiveness of the OLG model to de","PeriodicalId":48105,"journal":{"name":"Journal of Policy Analysis and Management","volume":"44 4","pages":"1502-1504"},"PeriodicalIF":2.4,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/pam.70039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144920982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"管理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shifting tax incidence: Evidence from the Washington State cannabis market","authors":"Benjamin Hansen, Kendall Houghton, Keaton Miller, Caroline Weber","doi":"10.1002/pam.70041","DOIUrl":"https://doi.org/10.1002/pam.70041","url":null,"abstract":"We study how prices respond when a 25% gross receipts tax remitted by cannabis manufacturers was eliminated in Washington state and the retail excise tax was simultaneously increased from 25% to 37%. Standard theory suggests that this change should have increased welfare for manufacturers, retailers, and consumers; instead, our analysis shows that the reform unexpectedly shifted benefits toward manufacturers at the expense of retailers and consumers, who faced higher tax‐inclusive prices post‐reform. We hypothesize that this outcome was driven by behavioral factors such as anchoring and loss aversion. Our findings add to a growing body of evidence that tax reforms can affect market outcomes in ways not predicted by standard economic models, offering a cautionary lesson for policymakers considering similar reforms.","PeriodicalId":48105,"journal":{"name":"Journal of Policy Analysis and Management","volume":"190 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144898409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"管理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public health insurance expansions and non‐physician providers: Evidence from Certified Nurse Midwives","authors":"Sukriti Beniwal, Lauren Hoehn‐Velasco, Diana R. Jolles","doi":"10.1002/pam.70032","DOIUrl":"https://doi.org/10.1002/pam.70032","url":null,"abstract":"This study considers whether the Affordable Care Act (ACA) Medicaid expansions resulted in changes in the use of non‐physician providers. Medicaid expansions may have impacted both payments to providers as well as insurance availability for patients. Using U.S. birth certificate records, we analyze whether the ACA Medicaid expansions influenced the trade‐off between physicians and certified nurse‐midwives (CNMs/CMs) for obstetric care. Our findings indicate that the ACA Medicaid expansions led to an increase in the utilization of CNMs/CMs and a decrease in physician‐reported deliveries. This shift from physicians to CNMs/CMs is particularly noticeable in states with Medicaid reimbursement parity for CNMs/CMs. These results suggest that health insurance expansions may increase the use of non‐physician providers, but only in cases where non‐physician providers are reimbursed similarly to physicians.","PeriodicalId":48105,"journal":{"name":"Journal of Policy Analysis and Management","volume":"26 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144778393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"管理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of center‐based child care on disadvantaged children: Evidence from a randomized research design","authors":"Chris M. Herbst","doi":"10.1002/pam.70033","DOIUrl":"https://doi.org/10.1002/pam.70033","url":null,"abstract":"This paper uses the random assignment of poor families to treatment and control conditions in the Comprehensive Child Development Program (CCDP) to estimate the effects of center‐based child care enrollment on child well‐being. Implemented in the early‐1990s, the CCDP aimed to improve child development and family functioning by offering those in the treatment group 5 years of high‐quality child care along with case management. As a result, treated children were substantially more likely to be enrolled in center‐based programs throughout the preschool‐age years, and I use this variation to estimate the impact of center care on children's language and social skills as well as health. I uncover mixed results: More time spent in center‐based settings improves language skills but reduces social skills in the short run, and both effects fade out for most children within 1 to 2 years. I also find that early center care use is strongly predictive of later Head Start enrollment, indicating that a more deliberate “family retention strategy” may be effective at extending children's exposure to high‐quality early education.","PeriodicalId":48105,"journal":{"name":"Journal of Policy Analysis and Management","volume":"2 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144778509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"管理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mentoring, educational preferences, and career choice: Evidence from two field experiments in Bhutan","authors":"Ryotaro Hayashi, Hyuncheol Bryant Kim, Norihiko Matsuda, Trinh Pham","doi":"10.1002/pam.70034","DOIUrl":"https://doi.org/10.1002/pam.70034","url":null,"abstract":"We evaluate two randomized controlled trials in Bhutan testing whether near‐peer mentoring can shift students’ educational preferences toward STEM and TVET pathways. Mentors provided personalized guidance, shared their own experiences, and offered information on admissions and labor market outcomes. The interventions significantly increased students’ interest and perceived knowledge, but had limited effects on actual applications or enrollment. In the STEM stream, limited follow‐through appears linked to structural constraints such as academic selectivity and limited program capacity; for TVET, social stigma and parental skepticism likely played a constraining role. These findings highlight the potential of light‐touch, scalable mentoring to shape aspirations, while underscoring the need for complementary strategies to support behavior change and enable follow‐through.","PeriodicalId":48105,"journal":{"name":"Journal of Policy Analysis and Management","volume":"29 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144778453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"管理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unwarranted racial disparity in U.S. foster care placement","authors":"E. Jason Baron, Joseph J. Doyle, Natalia Emanuel, Peter Hull","doi":"10.1002/pam.70030","DOIUrl":"https://doi.org/10.1002/pam.70030","url":null,"abstract":"Black children in the U.S. are twice as likely as white children to spend time in foster care. Such racial disparities raise concerns of discrimination, but might also reflect differences in the underlying need for intervention. This paper estimates unwarranted disparities (UDs)—racial differences in placement rates for children with the same potential for future maltreatment—in national data. We use non‐parametric bounds on the potential for future maltreatment that rely on weak and transparent assumptions. Nationwide, we find that Black children are placed into foster care at higher rates than white children with identical potential for subsequent maltreatment. UD varies across states; key predictors are the proportion of Black individuals in the population and the racial makeup of caseworkers. UD is five times larger among children with potential for subsequent maltreatment than among children without and declined from 2008 to 2020, primarily due to a declining placement rate among Black children with subsequent maltreatment potential. The concentration of UD in cases with potential for future maltreatment yields important policy implications, as it may indicate an “underplacement” of white children—with declining racial gaps suggesting an elevated risk of maltreatment for Black children.","PeriodicalId":48105,"journal":{"name":"Journal of Policy Analysis and Management","volume":"148 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"管理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Local labor market effects of nuclear power plants","authors":"Duha T. Altindag, Reem El Cheikh Taha, Jennifer U. Jones, R. Alan Seals","doi":"10.1002/pam.70029","DOIUrl":"https://doi.org/10.1002/pam.70029","url":null,"abstract":"Using a differences‐in‐differences strategy, we estimate the local economic effects of U.S. commercial nuclear power plants (NPPs). Our control group consists of locations where plant construction was planned but ultimately canceled. We find that NPP construction significantly increases local employment and wages, with effects concentrated in the construction and public utilities sectors. However, these gains dissipate once construction concludes and the plant becomes operational, as operational employment requirements are minimal. We find no significant spillover effects on neighboring towns, and commercial operations do not meaningfully impact broader labor market outcomes. Additionally, we find that NPP construction increases local government revenues and expenditures by approximately 10% to 15%, with funds primarily allocated to government administration and public works. These results suggest that while NPPs provide short‐term economic stimulus, their long‐term labor market and fiscal benefits may be limited.","PeriodicalId":48105,"journal":{"name":"Journal of Policy Analysis and Management","volume":"146 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"管理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}