1. "Cost Efficiency in Medicaid Long-term Care: The Role of Home and Community Based Services Waivers," (with Arpita Chattopadhyay and Yang Fan)

Abstract: This paper evaluates the cost efficiency of Long-term Care services (LTC) provided by state Medicaid agencies and its association with Home and Community Based Service (HCBS) use. The study uses data from all 50 states on state-wise Medicaid LTC costs and number of clients in HCBS and institutional care for the years 1999-2007 from CMS Form-64, Kaiser Commission and UCSF analysis of CMS Form 372 and CMS MSIS data submitted by states matched with data from the Census Bureau, US department of Health and Human Services, National Conference of State Legislatures and the National Pace Association. The study applies the stochastic frontier analysis to estimate cost frontiers and associated technical efficiencies for each state and year. Cross-sectional and temporal variations in efficiency estimates were used to study the effect of the relative size of HCBS programs compared to institutional LTC on the efficiency score using Panel regression method. Efficiency implications of state funded HCBS programs are compared with HCBS under the federal waiver programs. Models control for population size, per-capita income, and unemployment rate and state fixed effects. The study finds that states vary greatly in the cost efficiency of their LTC programs, but all states show improvement over time related to increase in HCBS users. An increase in 1 percentage point in the share of the non-institutional participants in a state results in an increase in cost-efficiency by 0.29%. However, a 1 percentage point rise in the proportion of HCBS participants that are in state funded programs results in 0.21% decrease in cost-efficiency. Other state policy variables had small impact on efficiency. Finally, the study finds that Increasing HCBS services targeted at “high need” population via Waivers would increase the efficiency in LTC services, than broad based delivery of HCBS.

2. "Do Smart Growth Strategies Have a Role in Curbing Vehicle Miles Traveled in California? A Further Assessment Using Household Level Survey Data"

Abstract: This paper draws on McFadden’s location choice theory and incorporates households’ residential choice decisions as a hierarchical process in a structural travel demand model. The paper argues that such an approach can effectively tackle the common problems of self selection in community choice and multicollinearity. Empirical application reveals that the elasticities of certain smart growth features are much larger than those found in previous studies. A comparative analysis of the smart growth and fuel tax policies suggests that the former has better returns. Finally, a simulation based on California suggests that smart growth policies can substantially reduce household travel demand.

3. "Does Spending More on Tobacco Control Programs Make Economic Sense? An Incremental Benefit-Cost Analysis using Panel Data," (with David Piper)

Abstract: This paper presents a benefit-cost analysis of the ongoing, state level tobacco prevention and control programs in the United States. Using state level panel data for the years 1991-2007, the study applies several variants of econometric modeling approaches to estimate the state level tobacco demand. The paper finds a statistically significant evidence of a sustained and steadily increasing long-run impact of the tobacco control program spending on cigarette demand in states. The study also shows that, if individual states follow the Best Practices funding guidelines, potential future annual benefits of the tobacco control program can be as high as 14 to 20 times the cost of program implementation.