Kidney Exchange coming to Spain (and liver exchange in HK)

Spain, which has the highest per-capita recovery rate of deceased donor organs in the world, is looking to expand its capacity for live donor kidney transplantation, by starting to use kidney exchange. Adn.es reports: España hará un trasplante cruzado de riñón.
"The first cross-kidney donation done in Spain will take place between two couples in June. "

HT to Flip Klijn

Update: for those who didn't click on the wonderful comment, here it is:
denisec said...
The first liver exchange in Hong Kong occurred a few weeks ago. It was described as "heaven sent" in the media: I save your hubby, you save my brother-in-law , and here it is (with a photo) in a Chinese newspaper

Further Update, June 2023: the above links didn't survive the passage of more than a decade, but you can get a little closer to the Hong Kong story at this Singapore link

I save your hubby, you save my brother-in-law [ARTICLE+ILLUSTRATION]

Page 16

I save your hubby, you save my brother-in-law Two lives saved in a donor “swop”atHong Kong hospital HEwasalreadycountingdowntohislastbreath.Mr So Wai Lun, 36, had acute liver failure, but there was no suitable organ donor inHongKong. His sister-in-law, 26, was willing to donate part of her liver, but she couldn’t as she

Market for health care: no law of one price

The Boston Globe ran a story about healthcare costs at different Boston area hospitals, in which fees are negotiated between insurers and individual hospitals: A healthcare system badly out of balance

""The same service delivered the same way with the same outcome can vary in cost from one provider to the next by as much as 300 percent," said Charles Baker, president of the state's second-largest health insurer, Harvard Pilgrim Health Care. "There is no other sector of the economy anywhere in this country in which that kind of price variability with no appreciable difference in service or product quality can sustain itself over time.""

Pricing certainly serves different function in health care than in other parts of the economy, and tertiary care teaching hospitals do more than provide simple patient services (e.g. they also train future docs, about which see my previous post today, on Orthopaedic surgeons). So, as the healthcare system is brought into better balance, some attention will have to be paid to paying for some of the things that now may be paid for with hidden cross-subsidies.


HT Paul Kominers (younger brother of the remarkable if less cool SK)

Market for Orthopaedic surgeons

I recently broke an ankle in Maastricht and flew home for surgery in Boston. In both places I visited the emergency room. In both cases the orthopaedic surgery resident who I was treated by in the ER was a young woman.

In Boston, I remarked that, when I was much younger, orthopaedic surgeons were almost all men, and that back then they claimed that orthopaedic surgery had a lot in common with carpentry, and required significant upper body strength. The resident told me that the situation had indeed changed, she had senior mentors who were women.

When she and her colleagues apply for subspecialty fellowships, they will face not only a more gender-integrated market but also a much more orderly market than in the recent past.

A "match" (a centralized clearinghouse) is coming for Orthopaedic surgery subspecialties--see the following preparatory study by two economists (Muriel Niederle and myself) and seven surgeons. (As it happens--small world--the surgeon who put in the many new titanium parts I now am growing new bone around had heard me give an Orthopaedic Surgery Grand Rounds on this subject.)

Harner, Christopher D., Anil S. Ranawat, Muriel Niederle, Alvin E. Roth, Peter J. Stern, Shepard R. Hurwitz, William Levine, G. Paul DeRosa, Serena S. Hu, "Current State of Fellowship Hiring: Is a universal match necessary? Is it possible?," Journal of Bone and Joint Surgery, 90, 2008,1375-1384.

Market for electric cars

Before there's a very big market for all-electric cars, there would have to be a way to take long trips in them. For gas-powered cars, there's an extensive infrastructure of filling stations around the world's network of roadways. The NY Times reports on one company's plans to initiate such a network of stations, where you could change your depleted battery for a full one: Mapping a Global Plan for Car Charging Stations

"Mr. Agassi said the first 50 stations would be built in Israel by the end of 2010, the same time Renault’s electric cars would be introduced there, and followed by installations in Denmark, Hawaii and elsewhere. "

Israel and Hawaii seem like natural places to get electric cars started. Both of them are islands as far as auto traffic is concerned: very few people drive out of either one of them. So it should be possible to serve all the driving needs with a small, dense network. Denmark will be harder, since although many car trips that begin in Denmark remain in Denmark, Danes also can drive to Germany and Sweden, and from there on to the wide world, so a Dane with an electric car would, at least for a while, be more limited than one with a gas-powered car.

Barter and illiquidity in Russia

The NY Times reports that in Russia, where rubles are getting scarce but prices are remaining sticky, there's a growing interest in barter exchanges:
Have Car, Need Briefs? In Russia, Barter Is Back .

"Advertisements are beginning to appear in newspapers and online, like one that offered “2,500,000 rubles’ worth of premium underwear for any automobile,” and another promising “lumber in Krasnoyarsk for food or medicine.” A crane manufacturer in Yekaterinburg is paying its debtors with excavators.
And one of Russia’s original commodities traders, German L. Sterligov, has rolled out a splashy “anti-crisis” initiative that he says will link long chains of enterprises in a worldwide barter system.
All this evokes a bit of déjà vu. In the mid-1990s, barter transactions in Russia accounted for an astonishing 50 percent of sales for midsize enterprises and 75 percent for large ones."
...
"Among the most upbeat of [the proponents of barter] is Mr. Sterligov, who, just as the credit crunch brought most business deals to a halt, shoveled $13 million into the Anti-Crisis Settlement and Commodity Center.
...He plans to use a computer database to create chains of six or seven enterprises having difficulty selling their products for cash, in which the last firm on the chain would pay the first in a single cash transaction.
It is the kind of multiparty barter that rose to prominence in the 1990s, when managers of factories across Russia devised complex barter chains to keep the maximum number of enterprises in business when none had cash to pay their bills. A computer, he said, can do the same job faster and more efficiently. "

Loyal followers of this blog will note the resemblance to some kinds of kidney exchange (most notably list exchange chains and altruistic donor chains).

Market for art: Brandeis, continued

When I earlier wrote about Brandeis University's decision to close its art museum and sell its art, I noted that many of the reactions to this announcement treated the selling of (donated) art by a museum as a repugnant transaction. Now, Brandeis is reconsidering: Brandeis president issues an apology: Laments museum announcement. "Reinharz's effort yesterday to soothe a fractured Brandeis community followed last week's surprise announcement that the school planned to close the museum and sell off its artwork as it confronts a financial crisis. That decision had incited protests on campus as well as a firestorm of criticism from the art and philanthropic worlds.... "As for the art, Reinharz said that the university does not intend to put all 7,180 works on the auction block. Only a "minute number" would be sold "if and when it is necessary," he said in Wednesday's interview.... "Reinharz released the letter following a rebuke from faculty late Wednesday, urging him to suspend any final decisions on the museum. His administration's abrupt announcement last week had created a "crisis of confidence" among faculty members, the faculty said in a letter to the president." Letters to the NY Times on the subject eloquently express strong, conflicting opinions. E.g., on the one hand, "In a meeting with alumni leaders in the fall, Jehuda Reinharz, president of Brandeis, stated that he would not allow a student to drop out because his or her parents could no longer afford tuition. I thought that was a wonderful position, and it made me prouder of my university than any work by Jasper Johns or Andy Warhol ever did....No one thinks selling art is desirable. But allowing students to have to leave school is not an acceptable alternative. " And on the other, "On Jan. 20, I stood on the Mall and watched as President Obama said, “We reject as false the choice between our safety and our ideals.” He continued, “Those ideals still light the world, and we will not give them up for expedience’s sake.” Six days later I discovered that my alma mater had done just that, when Brandeis University’s board and president traded the Rose Art Museum for a short-term fiscal fix. Of the university that ignited my intellectual curiosity and helped to instill in me a lifelong love of the arts, I ask: If you do not stand for the arts when it would be easier not to, did you ever really stand for them at all? "

Market for electricity: Information and consumption behavior

One set of market design decisions involves what kind of information to provide to participants about other participants. Now that regulated utilities often have an interest in helping customers conserve electricity, one strategy has been to issue electricity bills that let customers compare their usage with the average of their neighbors, and with their most 'efficient' neighbors: Utilities Turn Their Customers Green, With Envy .

This seems to have a good effect. The article suggests that a big component of this effect is the competitive impulse. Of course there may also be a pure information effect; when you realize that people with similar size houses use less electricity, it may let you know that there may be ways to conserve energy that you aren't yet utilizing. (It might be hard to separate these effects in field data.)

Networks and high school athletes

While the NCAA regulates the communication between high school and college coaches, it has more trouble regulating third-party networkers, the NY Times reports: College Recruiting’s Thin Gray Line. It isn't entirely clear who is extracting information rents from whom, but one worries about the high school players.

"“Recruiting for college football is obviously changing,” Prince said in a telephone interview. “It’s become much more like the basketball model. When that happens, you then have people who are intermediaries ...”"

HT Muriel Niederle

Networks and labor markets: Internships

The British government is promoting internships as one entryway into the labor market, and as a way to increase social mobility. But the Times of London notes: Sharp middle-class elbows are winning the intern wars

"Even the Labour party is not above calling in favours from chums. Euan Blair, son of the former prime minister, did two stints as an intern in the US Congress. He also worked as a production runner on a film set in the Houses of Parliament, and had work experience at a Paris radio station owned by Bernard Arnault, France’s richest man. "

Aside from personal connections, there are starting to be some market institutions:

"Parents with less exalted connections have little choice but to stump up cash. Work experience has become a popular prize at charity auctions: just before Christmas a week’s unpaid work at ITV Productions fetched £1,260."
"Work experience has always been tricky to come by, but at the moment demand vastly outstrips supply. Wexo, Work Experience Online, whose web address is www.wexo.co.uk, is a Facebook-style website that matches employers with people looking for work experience. It currently has 200 companies on its books – including Armani and Sony Music – and about 2,000 young people hoping to be interns. According to Robin Kennedy, the site’s co-creator, there are more applications towards more glam sectors like marketing, fashion, and entertainment. Don’t, though, think all work experience is so exciting. The company named last year as best work experience provider was Shetland Seafood Auctions, whose seven staff provide an electronic auction service at Lerwick fish market. "

Sex and violence on TV: US and Europe

Some transactions are more repugnant than others, and the difference is different in different places. What can be broadcast on TV (or seen in a theatre or sports venue) is different in the US and Europe. I'm reminded of this by a recent NY Times editorial blog post The Disturbing Rise of Ultimate Fighting.

It concludes:
"The rise of ultimate fighting, which is becoming a staple of cable television, is a tribute to the large amounts of money to be made — and to the nation’s bizarre double standard about violence and sex.
If there is a “wardrobe malfunction,” and a usually covered body part is briefly shown, the government reacts swiftly and punitively. If a young man bashes another young man’s face into a bloody pulp, well, that’s entertainment."

Some years ago, a European postdoc told me that he couldn't understand why American movies were much more censored for sex than European movies, but nevertheless had much more violence. I told him that sex was much more natural in Europe, since without it there wouldn't be any Europeans. Americans, on the other hand, come from immigration...

Market for soldiers: the Ghurkas

The hiring of mercenaries is widely repugnant (the Geneva Conventions sharply distinguish between soldiers and mercenaries: “A mercenary shall not have the right to be a combatant or a prisoner of war.”). A notable exception is the long standing relationship between the British Army and the Nepalese Ghurkas. Recently the British courts have required the army to treat retired Ghurkas somewhat more like regular Army retirees, and two articles in the London Times explore the story.

Nepal’s middle classes steal a march on path to riches reports that
"The problem is that the benefits of the job now outstrip the average in Nepal’s private sector by so much that even relatively wealthy members of the urban middle class are queuing up to enlist. The recruits used to come mainly from poor villages in the hills, where a Gurkha salary and pension, though less than those paid to the rest of the British Army until recently, were enough to support a large family for life. That started to change in 2007, when the British Government accepted the Gurkhas’ demands for the same terms and conditions as the rest of the Army. "...
"The most obvious effect in Nepal is that dozens of private Gurkha training schools have sprung up in the main recruiting areas to help to give prospective recruits a competitive edge. The schools typically charge would-be male recruits about 3,000 rupees (£27) a month for classes in maths and English and physical training. Women pay 1,000 rupees for a two-hour early-morning workout, six days a week, for three months. "...

"The Nepalese Government has backed away from a pledge to ban the country’s citizens from serving in a foreign army, which it described until recently as humiliating, but is concerned about a potential brain drain. "

Another story recounts some of the history of the Gurkhas:
"The Gurkhas fought the British in the 1814-16 Gurkha War. They impressed their enemy and later agreed to become British mercenaries "

The story also includes a remark on the changing technology of warfare:
"Their trademark is the kukri knife, which tradition demands must draw blood every time that it is unsheathed. Gurkhas say that today, however, the knife is used more often in cooking "

Credit cards, data mining, incentives

Two recent stories point to the fact that banks, seeking to control their lending, are selectively suspending credit cards or cutting credit limits, based on data about individuals' credit card use. This introduces some interesting incentive problems, quite different from usual credit card decisions.

The NY Times story, American Express Kept a (Very) Watchful Eye on Charges , reports
"In some instances, if it didn’t like what it was seeing, the company has cut customer credit lines. It laid out this logic in letters that infuriated many of the cardholders who received them. “Other customers who have used their card at establishments where you recently shopped,” one of those letters said, “have a poor repayment history with American Express.”
"It sure sounded as if American Express had developed a blacklist of merchants patronized by troubled cardholders. But late this week, American Express told me that wasn’t the case. The company said it had also decided to stop using what it has called “spending patterns” as a criteria in its credit line reductions. "...

"American Express wouldn’t have been the first company to try cordoning off certain industries. Last year, CompuCredit, a subprime lender, got in trouble with the Federal Trade Commission for failing to disclose that it could reduce customers’ credit lines for using their cards at various establishments.
What was on CompuCredit’s no-go list? Marriage counselors, tire retreading and repair shops, bars and nightclubs, pool halls, pawnshops and massage parlors, among others. "

The Globe story, Lenders abruptly cut lines of credit, focuses on customers who have had their cards suspended.

"Many of the credit lines being taken away or reduced have not been used recently, according to people who track the business. Dennis Moroney of TowerGroup, a Needham research firm, called it the "kitchen drawer" syndrome because some consumers keep cards they don't need or don't use often. Card issuers are trying to rein in such accounts before they get tapped for emergencies in the slumping economy, Moroney said."...

"...if you have a card you haven't used in a while that you want to keep, ... "Buy something inexpensive and pay it off that month." "

Market for legal services: changing incentives?

The NY Times reports that more corporate legal work by outside law firms may be starting to be on a fixed fee or performance basis, rather than by the number of hours worked: Billable Hours Giving Ground at Law Firms.

"Clients have complained for years that the practice of billing for each hour worked can encourage law firms to prolong a client’s problem rather than solve it. But the rough economic climate is making clients more demanding, leading many law firms to rethink their business model."...

"Many smaller firms and solo practitioners have long offered to perform services, like mortgage closings, for flat fees. Plaintiff lawyers also often work on a contingency basis, receiving a percentage of any awards."...

"In litigation, firms that charge by the hour can suffer if they are too successful and end a lawsuit — and the stream of payments from continuing work — too quickly. One law firm that recently collapsed, Heller Ehrman, was hurt in part because a number of cases had settled."

If there is indeed a change in how corporate law is bought and sold, it will be interesting to see if this affects the number of cases that are settled without going to trial.

Academic marketplace: Reactions to the recession

The Globe reports: Despite crunch, some colleges go on hiring spree.

"Amid the gloom of hiring freezes across much of academia, some New England colleges are seizing on the opportunity to scoop up the brightest newly minted PhDs to bolster their faculty ranks and gain ground on their competition.
"A few are recruiting tenure-track faculty in droves even as the majority of colleges, most notably Harvard, have curtailed faculty searches as part of belt-tightening measures. Northeastern is conducting a search for 46 professors in fields ranging from nanotechnology to public health. Tufts is moving forward with 52 faculty searches. Others, including Emerson, Holy Cross, and Amherst, have created teaching positions." (emphasis added:(

Open access journals

To continue yesterday's discussion about the Market for ideas, academic journals present an interesting set of institutions. The Chronicle of Higher Ed reports on the open access journal movement: Physicists Set Plan in Motion to Change Publishing System (and, permanently, here for subscribers). The story concerns SCOAP3 - Sponsoring Consortium for Open Access Publishing in Particle Physics, which seeks to set up a non-profit organization that will fund cooperating journals.

"Here's the pitch. Libraries would stop paying for subscriptions to journals in high-energy physics. Instead, each library or government agency would pay a set amount every year to the new nonprofit group. Each journal publisher would then apply for a portion of that money, submitting a bid spelling out how much it would cost them to review, edit, and publish their articles that year (building in some profit as well). To win a bid, the journals would commit to publishing their articles free online for anyone to see."

"Several factors make high-energy physics an ideal field for this experiment. For one thing, it is a relatively small and tight-knit research area, where almost all major papers appear in just six journals. "

There are clearly obstacles in the path of this plan. But Arxiv, the physics/math working paper archive now hosted at Cornell, seems to have had somewhat more success than the similar effort in Economics at WUSTL, pioneered by Bob Parks, so it will bear watching.

(On the subject of working papers in economics, RePEc and SSRN have filled some of that space in economics, and there are a growing number of open access journals, among them Theoretical Economics.) See also Ted Bergstrom's Journal Pricing Page for a discussion of other proposals for redesigning the market for scientific publishing.

Market for ideas

Joshua Gans and Scott Stern sent me a fascinating market design paper called Is there a market for ideas?, which performs some admirable intellectual arbitrage. They seek to combine modern insights on the unusual properties of intellectual property with some of the recent conclusions from market design.

In particular, they take seriously my proposal here that many market failures have to do with a failure to make the market thick, to deal with congestion, or to make it safe to participate in the marketplace, together with the fact that some transactions are regarded as repugnant.

They argue that some of the properties of ideas themselves make it difficult to organize successful markets for ideas along conventional lines: e.g. "...a key property of ideas - the potential for expropriation - limits the potential for market thickness and lack of congestion identified by Roth."

Among the particular examples they discuss of market designs that try to solve these problems and make markets for ideas are the scientific incentive system ("Open Science"), open source efforts such as Wikipedia, and commercial projects such as Ocean Tomo (which runs auctions for IP assets), and Innocentive (which runs a marketplace in which companies can post Challenges in need of solutions).

Here's the abstract:
"This paper draws on recent work in market design to evaluate the conditions under which a market for ideas or technology (MfTs) will emerge and operate in an efficient way. While most research on MfT have focused primarily on bilateral exchanges, market design principles suggest that any single transaction takes place in the shadow or all other potential transactions. As highlighted by Roth (2007), effective market design must ensure four basic principles: market thickness, lack of congestion, market safety, and avoidance of “repugnance.” Taken together, these conditions ensure that participants in a market have opportunities to trade with a wide range of potential transactors (market thickness), that the market is rapid enough (relative to the speed of transactions) that market participants can feasibly turn down offers in order to seek better matches (lack of congestion), potential market participants have a high incentive to participate in the market and avoid strategic interaction which might undermine allocative efficiency and social welfare (market safety), and that market trade is not undermined by other social values which limit the ability to charge positive prices for a good (avoidance of repugnance). This paper provides a critical examination of these criteria for MfT. Our analysis suggests that microeconomic, strategic, and institutional factors likely inhibit the allocative efficiency of MfT in most circumstances. For example, Arrow’s disclosure problem suggests that the value of a given idea to any one buyer may be decreasing in the number of other potential buyers who have been able to evaluate the idea (due to information leakages in the valuation process). As a result, a key property of ideas - the potential for expropriation - limits the potential for market thickness and lack of congestion identified by Roth. At the same time, key institutional developments such as the development of formalized IP exchanges and increased attention on how to design the patent system to facilitate technology transfer suggest that effective market design may be possible for some innovation markets. Perhaps most intriguingly, our analysis suggests that markets for ideas are beset by the “repugnance” problem: from the perspective of market design, Open Science is an institution that places normative value on “free” disclosure and so undermines the ability of ideas producers to earn market-based returns for producing even very valuable “pure” knowledge. "

Market for stem cell researchers

Not all stem cell researchers are celebrating the Obama reversal of the Bush ban: Canada's Globe and Mail headlines a story As U.S. emerges from dark age, Canada's scientific edge fades .

"...the United States Friday became the first country in the world to approve a clinical trial of embryonic stem cells in human patients.
But in Canada's research community, Mr. Obama's plans have sparked anxiety that if this country fails to keep pace, it will have a tougher time recruiting smart people and convincing talent not to flock south. In short, Canada could lose its competitive edge to the Obama advantage."

Market for art

One of the unusual things about the art market is that the "velocity" of art that becomes acknowledged as important, i.e. the rate at which it changes hands, is low. This is particularly so for art that is acquired by museums; it is often much harder for museums to sell art ("deaccession" it) than to buy it; many people think that museums should not sell art, particularly when it is acquired by donation. (Tax laws cause a lot of art to be donated to museums, as does the desire to maintain the integrity of particular collections.) All of this is on display following the decision of Brandeis University to close its art museum and sell all of its art: Ailing Brandeis will shut museum, sell treasured art. The university needs both to cut its budget and replenish its endowment, but the decision to do it this way has aroused at least a little repugnance. Some quotes from the Globe article: "The move shocked local arts leaders and drew harsh criticism from Rose supporters and the Association of College and University Museums and Galleries. " "While museums regularly deaccession individual pieces, the wholesale sell-off of a collection of the Rose's stature is unprecedented. Codes of practice common among museums stress that art should not be sold to cover operating expenses." ""I'm in shock," said Mark Bessire, the recently named director of the Portland Museum Of Art. "This is definitely not the time to be selling paintings, anyway. The market is dropping. I'm just kind of sitting here sweating because I can't imagine Brandeis would take that step."" ... ""This art was never given to the museum for those purposes," he said. "It should be a last resort. I can't understand how Brandeis is in such dire straits." "There's a history of the Rose, a beautiful history in the annals of contemporary art that is not understood by the president or any of the board of trustees," said Lee. "What they’re doing is a travesty.""

Taxing a repugnant transaction?

Nevada's legal brothels are asking to be taxed by the state, as a hedge against a change in sentiment that might make prostitution illegal once more in Nevada, as it is in other states: Brothels Ask to Be Taxed, but Official Sees a Catch

"The industry’s lobbyist, George Flint, director of the Nevada Brothel Association, has been approaching the Legislature’s leadership for months about creating an entertainment tax that would require the state’s 25 legal brothels to give the state some money on a per-transaction basis. ..."
"Nevada is the only state where prostitution is legal, but by state law it also is restricted to counties with fewer than 400,000 residents. That outlaws it in two counties, Clark, which contains Las Vegas, and Washoe, which contains Reno. There are about 225 women licensed by the state as prostitutes; no county allows brothels to have men who sell sexual services." (emphasis added; I guess some repugnancies are stronger than others)
"Still, since 1971, when prostitution was legalized, Nevada has added more than two million residents and become significantly more socially conservative. The state has also lost much of its frontier mentality, so Mr. Flint acknowledges that the tax effort is “something of an insurance policy” against the Legislature’s deciding one day to do away with the industry.
“Anytime you’re going to take tax money, the state’s not going to view you as a relic of a past time and put you out of business,” explained Mr. Flint, who said he was gaining traction for a brothel tax in 2003 until he made the faux pas of joking to a reporter that he would commit to putting the governor’s portrait in every prostitute’s lair along with a note reading, “Don’t forget the governor’s share.” "

Market for processed food

The task of tracking down a salmonella outbreak having to do with peanuts casts some light on just how many suppliers are involved in the production of some of the food we eat. List of Tainted Peanut Butter Items Points to Complexity of Food Production

Investigators have now focused on products from a particular manufacturer:
"The plant also produced peanut paste, a more concentrated product used in candy, crackers and many other kinds of foods. Tracking how the paste travels through the food supply can be challenging, because several companies can be involved in making the final food. For example, one manufacturer might coat the paste in chocolate and make a peanut butter cup, which is then sold to another company that mixes it into ice cream that may or may not also contain peanut butter. A grocery chain might buy that ice cream and sell it under a private label."

In the meantime, the Girl Scouts have issued a statement that their peanut butter cookies are safe.