NBER Working Papers by David Meltzer

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Working Papers

May 2010Coordination, Switching Costs and the Division of Labor in General Medicine: An Economic Explanation for the Emergence of Hospitalists in the United States
with Jeanette W. Chung: w16040
General medical care in the United States has historically been provided by physicians who care for their patients in both ambulatory and hospital settings. Care is now increasingly divided between physicians specializing in hospital care (hospitalists) and ambulatory-based care primary care physicians. We develop and find strong empirical support for a theoretical model of the division of labor in general medicine that views the use of hospitalists as balancing the costs of coordinating care across physicians in the hospitalist model against physicians’ costs switching between ambulatory and hospital settings in the traditional model. Our findings suggest opportunities to improve care.
November 2009The Impact of Minimum Wage Rates on Body Weight in the United States
with Zhuo Chen: w15485

Published: The Impact of Minimum Wage Rates on Body Weight in the United States, David O. Meltzer, Zhuo Chen. in Economic Aspects of Obesity, Grossman and Mocan. 2011

Growing consumption of increasingly less expensive food, and especially “fast food”, has been cited as a potential cause of increasing rate of obesity in the United States over the past several decades. Because the real minimum wage in the United States has declined by as much as half over 1968-2007 and because minimum wage labor is a major contributor to the cost of food away from home we hypothesized that changes in the minimum wage would be associated with changes in bodyweight over this period. To examine this, we use data from the Behavioral Risk Factor Surveillance System from 1984-2006 to test whether variation in the real minimum wage was associated with changes in body mass index (BMI). We also examine whether this association varied by gender, education and income, and used quant...
January 2001Effects of Competition under Prospective Payment on Hospital Costs among High and Low Cost Admissions: Evidence from California, 1983 - 1993
with Jeanette Chung: w8069


  • Garber, Alan M. (ed.) Frontiers in Health Policy Research, Volume 5. Cambridge, MA: MIT Press, 2002. ,
  • Meltzer, David and Jeanette Chung. "Effects Of Competition Under Prospective Payment On Hospital Costs Among High- And Low-Cost Admissions: Evidence From California, 1983 And 1993," Forum for Health Economics and Policy, 2002, v5, Article 4.

Competition and prospective payment systems have been widely used to attempt to control health care costs. Though much of the increase in medical costs over the past half-century has been concentrated among a few high-cost users of health care,prospective payment systems may provide incentives to selectively reduce expenditures on high-cost users relative to low-cost users and this pressure may be increased by competition. We use data on hospital charges and cost-to-charge ratios from California in 1983 and 1993 to examine the effects of competition on costs for high and low cost admissions before and after the establishment of the Medicare Prospective Payment System (PPS). Comparing persons above and below age 65 before and after the establishment of PPS, we find that competition is assoc...
February 1997Accounting for Future Costs in Medical Cost-Effectiveness Analysis

Published: Journal of Health Economics, Vol.16, no.1 (1997): 33-64.

Most medical cost-effectiveness analyses include future costs only for related illnesses but this approach is controversial. This paper demonstrates that cost-effectiveness analysis is consistent with lifetime utility maximization only if it includes all future medical and non-medical expenditures. Estimates of the magnitude of these future costs suggest that they may substantially alter both the absolute and relative cost-effectiveness of medical interventions intervention increases length of life more than quality of life. In older populations, current methods overstate the cost-effectiveness of interventions which extend life compared to" interventions which improve the quality of life.

Contact and additional information for this authorAll papers and publicationsWorking Papers onlyWorking Papers with publication info


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