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National Bureau of Economic Research

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Measuring the Effects of Healthcare Systems

research spotlight

A growing fraction of US medical care is delivered through integrated healthcare systems that include many medical providers, ranging from primary care physicians to acute care hospitals. A team led by Research Associate David Cutler of Harvard University and Nancy Beaulieu of Harvard Medical School, supported by a multiyear grant to the NBER from the federal Agency for Healthcare Research and Quality, has studied the rise of healthcare systems and their impact on the delivery of care. The findings, just published in the Journal of the American Medical Association, suggest that the quality of care is marginally better when provided through a system, but the cost is substantially greater.

A research summary from the monthly NBER Digest

What Accounts for the Proliferation of Billion Dollar Startups?


Unicorns — startup businesses that are valued at at least $1 billion before going public — essentially did not exist before the 2000s. Their numbers have recently surged. These firms break with the traditional startup trajectory by going public later and at valuations far above those of other startups. They also attract late-stage funding not from venture capitalists but from large institutional investors who are more patient, more open to raising the large sums necessary for the firm to keep growing, and more willing to allow company founders and initial shareholders to cash out before the initial public offering (IPO). 

In The Unicorn Puzzle (NBER Working Paper 30604), Daria Davydova, Rüdiger Fahlenbrach, Leandro Sanz, and René M. Stulz find that of the 639 US startup...

From the NBER Bulletin on Health

College Vaccine Mandates Reduced Local COVID Infections and Deaths


When colleges and universities reopened in the fall of 2021, only 47 percent of 18-to-24-year-olds in the United States were fully vaccinated against COVID-19. At institutions that required students to be vaccinated, however, the vaccination rates were much higher. In The Effect of Vaccine Mandates on Disease Spread: Evidence from College COVID-19 Mandates (NBER Working Paper 30303), Riley K. Acton, Wenjia Cao, Emily E. Cook, Scott A. Imberman, and Michael F. Lovenheim show that the health benefits of these…

From the NBER Bulletin on Retirement and Disability

The figure is an event-study chart titled, "Paid Family Leave and Job Retention following Household Health Shock."  The y-axis, which ranges from -25 to 10 percentage points, shows the change in likelihood of women leaving their job to care for home or family following a spousal health shock, relative to the year before implementation.  In the years following implementation, the probability declines by about 10 percentage points.  Source: Researchers’ calculations using data from the Medical Expenditure Pan

The Impact of Paid Family Leave on Families with Health Shocks


The US is one of the few countries worldwide that does not have a federal paid family leave (PFL) policy. In the absence of a federal policy, some states have adopted PFL policies, starting with California in 2004 and now including 11 states and the District of Columbia. These PFL policies provide paid time off for workers who need to care for a newborn or a newly adopted child (parental leave) or for an ill or temporarily disabled family member (caregiving leave). 

While there is extensive research on the use of PFL for parental leaves, based on the experience of California and other early adopting states, much less is known about the use of PFL for caregiving leaves. The imbalance in empirical evidence for the two types of leaves may contribute to the higher level of public support and greater consensus among…

From the NBER Reporter: Research, program, and conference summaries

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Mechanisms and Impacts of Innovation Policy


The importance of innovation to job creation and economic growth — especially in young, high-growth firms — is widely accepted among economists as well as members of the business and policy communities. There is also a recognition that, at least at some times or in certain settings, the private sector underinvests in innovation, creating an opportunity for the public sector to step into the breach.

The longstanding problem is how. What tools are most effective?

There are myriad opportunities for government programs to fail. For example, if a program subsidizes only the “best projects,” those that would likely have gone forward with private capital regardless of…

From the NBER Bulletin on Entrepreneurship

The graph is a bar chart titled "Spillovers to Neighboring Startups by Proximity and Access to Common Areas."    It shows the percentage point increase in the probability of startups adopting peer web technology by physical proximity to neighboring startups and whether startups have access to a common area shared with another startup.  For startups within 20 meters of each other, and for those both with and without a common area, the increase in probability is between around 3 and 3.5 percentage points. How

Startup Chemistry and the Coworking Environment


Startups located in coworking hubs can benefit from knowledge spillovers from their startup neighbors.  In (Co-)Working in Close Proximity: Knowledge Spillovers and Social Interactions (NBER Working Paper 30120), Maria P. Roche, Alexander Oettl,  and Christian Catalini find that knowledge spillovers are greatest among startup workers who socialize but are in moderately dissimilar enterprises.

The researchers studied one of the five largest technological coworking hubs in the nation, where 251 startups were randomly assigned office space in a five…

Featured Working Papers

Using publication and citation data for elite chemistry researchers, Shumin QiuClaudia Steinwender and Pierre Azoulay find that after controlling for measures of research quality, Chinese-authored articles receive 28 percent fewer citations in articles from the US compared to articles from other countries.   

The Federal Reserve’s QE4 program did not have any notable effect in reducing term premiums, and is likely to reduce the Federal Reserve’s remittance to the US Treasury by about $760 billion over the next 10 years, Andrew T. LevinBrian L. Lu and William R. Nelson find.

The abnormal return associated with a stock being added to the S&P 500 has fallen to 0.8 percent over the past decade due to an increase in migrations over time from the S&P MidCap Index and an overall increase in the market’s ability to provide liquidity to index changes, Robin Greenwood and Marco C. Sammon find.

Leveraging state lottery wins between 2000 and 2019, George BulmanSarena Goodman and Adam Isen find that greater financial resources generate persistent increases in homeownership and new marriages but have little effect on total fertility.

Native workers in local labor markets that experienced higher rates of immigration are more likely to work day shifts. They also receive a lower compensating differential for nighttime work, according to research by Timothy N. BondOsea Giuntella and Jakub Lonsky.

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Books & Chapters

Through a partnership with the University of Chicago Press, the NBER publishes the proceedings of four annual conferences as well as other research studies associated with NBER-based research projects.

Research Spotlights

NBER researchers discuss their work on subjects of wide interest to economists, policymakers, and the general public. Recordings of more-detailed presentations, keynote addresses, and panel discussions at NBER conferences are available on the Lectures page.
Research Spotlight
Research Spotlight
Research Spotlight
The COVID-19 pandemic has affected different subgroups of the population, based on race, ethnicity, and income, in...
Research Spotlight
The COVID-19 pandemic affected businesses in different industries in disparate ways.  Those in customer contact...
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