No abstract

Many public health groups also support increasing cigarette prices the old-fashioned way-by raising state and federal excise taxes. The American Public Health Association recently adopted a policy statement favoring legislation to "substantially and repeatedly raise the tax on cigarettes" (American Public Health Association 1999, p. 435). The Healthy People 2010 objectives for the nation call for the average federal and state tax on cigarettes to be more than doubled to $2.00 per pack (U.S. Department of Health and Human Services 2000a). Reliance on higher prices as a way to discourage youth smoking has widespread support among researchers as well. In an interview on National Public Radio (September 29, 1997), Kenneth E. Warner concluded that "among people who have studied various policy measures to influence tobacco consumption, there would be nearly universal agreement that price is the single most important policy lever we can pull to influence youth smoking." During the debate on the proposed national tobacco settlement, policy analysts at the U.S. Treasury Department (1998, p. 14) suggested that "a consensus view is that for every ten percent rise in price, at today's prices, seven percent fewer youths will smoke," that is, that the price elasticity of participation in youth smoking is around Ϫ0.7. The suggested consensus for the price elasticity of participation in youth smoking is in line with several other reviews (

This study exploits a natural experiment in the province of Ontario, Canada, to identify the impact of pay-for-performance (P4P) incentives on the provision of targeted primary care services and whether physicians' responses differ by age, size of patient population, and baseline compliance level. We use administrative data that cover the full population of Ontario and nearly all the services provided by primary care physicians. We employ a difference-in-differences approach that controls for selection on observables and selection on unobservables that may cause estimation bias. We implement a set of robustness checks to control for confounding from other contemporaneous interventions of the primary care reform in Ontario. The results indicate that responses were modest and that physicians responded to the financial incentives for some services but not others. The results provide a cautionary message regarding the effectiveness of employing P4P to increase the quality of health care.

In this paper, we develop a new direct measure of state anti-smoking sentiment and merge it with micro-data on youth smoking in 1992 and 2000. The empirical results from the cross-sectional models show two consistent patterns: after controlling for differences in state anti-smoking sentiment, the price of cigarettes has a weak and statistically, insignificant influence on smoking participation, and state anti-smoking sentiment appears to have a potentially important influence on youth smoking participation. The cross-sectional results are corroborated by results from the discrete time hazard models of smoking initiation that include state-fixed effects. However, there is evidence of price-responsiveness in the conditional cigarette demand by youth and young adult smokers.