Philosophy of Nursing Science Associated with Hemodialysis and Cardiac Issues

Introduction The unexpected demise of a patient in the course of hemodialysis is an unusual happening. The occurrence of cardiac arrest in the course of dialysis is approximated to be seven people out of one-hundred thousand sessions of hemodialysis.Advertising We will write a custom essay sample on Philosophy of Nursing Science Associated with Hemodialysis and Cardiac Issues specifically for you for only $16.05 $11/page Learn More Out of the cases of cardiac arrests that emerge, about 13 per cent of them end up in deaths in the dialysis facility and 47 per cent pass away on their way to the hospital. The reason for death in most of these instances lies in cardiac arrhythmias, which is taken to be the main frequent cause (Booth, Pinney, Davenport, 2010). Cardiac arrest has as well occurred in the course of dialysis secondary to the unusual incidences of emboli, serious hemodialysis, and difficulties associated with improper dialysate handling. Pericardi al effusions are common in patients undergoing hemodialysis. However, they are normally associated with uremia or the utilization of minoxidil. The medical presentation handles the range from the establishment of resultant symptomless outburst on echocardiograph to cardiac tamponage with demise. The first instance of deadly hemopericardium emanating from holes in the vena cava was accounted in 1981. Perforations in either the vena cava or atrium dextrum in the course of hemodialysis as witnessed in 1981 is an unusual source of cardiac tamponage. This paper discusses the philosophy of nursing discipline associated with hemodialysis and cardiac issues. Area of interest Apparently, person-to-person or patient-centered care is related to the excellence of care. Significant research can make it possible for the nurses to learn and adapt patient-centered care. Research by Jablonski (2007) provides three important themes.Advertising Looking for essay on philosophy? Let's see if we can help you! Get your first paper with 15% OFF Learn More These themes are affiliation between the relations of patient with providers of medical care, organizations and their personal experience of disease and heath, the degree to which the organizations attempt to satisfy the requirements of patients, and integration of the views of the patients on the excellence of healthcare as offered by health care givers and devisers. In his article, Jablonski evaluated the theoretical as well as experiential studies, examined the dimensions of patients having hemodialysis and efforts of doctors and nurses with respect to cardiac issues and quality of health care (Jablonski, 2007). Research affirms that the relations between nurses and patients having hemodialysis are vital for successful use of patient-centered care. In accordance with these attempts, the area of interest for this paper investigates the practice of patient-centered care perception. After the investigation, an explanat ion of its relevance follows the various constructs for realizing patient-centered care. From around 1970, different health care groups, strategy makers, and research groups have approved and held the concept of patient-centered care. A number of studies define patient-centered care as the concern that reveres and acts in response to the needs of each patient while making sure that decisions by health care providers satisfy the ideals of patients. Patient-centered care could have significant advantages for patients via enhanced relations, suitable involvement, increased satisfaction, and quality of the health care (Booth, Pinney, Davenport, 2010). Research has revealed that the greatest hindrance to successful execution of patient-centered care is the uncertainty of its designation and major constituents. Patient-centered care entails individualized care of patients anchored in particular information of each patient instead of concentrating solely on the illness.Advertising We will write a custom essay sample on Philosophy of Nursing Science Associated with Hemodialysis and Cardiac Issues specifically for you for only $16.05 $11/page Learn More Individualized care generates an inclusive healthcare advance where the doctor attempts to view the sickness through the point of view of the patient, and is quick to respond to the requirements and inclinations of the patient. The perception of individualized care encompasses several subclasses like relations, admittance, and quality of health care (Booth, Pinney, Davenport, 2010). For minorities on hemodialysis and cardiac concerns, the execution of individualized care has as well brought about a reduction of period of stay, enhanced satisfaction of patients, and successful and excellent treatment that translates to reduced costs of health care. From the point of view of nurses, through first-rate individualized care, health institutions are capable of creating a mark that retains its c lients and gains reputation. Therefore, individualized care representation is progressively identified as significant for the assurance of excellent care (Booth, Pinney, Davenport, 2010). Even if many people consider that hospitals are set to satisfy the requirements of patients, there are significant chances to boost their individualized (person-to-person) care by offering medical care to each patient. In a bid to operationalize the individualized care efficiently, hospitals should aspire to assist the characteristics of individualized care via teaching, collective information, incorporated and group management, and easy availability of important information. This aspect stresses the requirement for critical adjustments in the health care structures by tackling or incorporating major issues like inequality in medical care, increased costs of health care, cardiac issues on patients having hemodialysis, and access to medical care.Advertising Looking for essay on philosophy? Let's see if we can help you! Get your first paper with 15% OFF Learn More Epistemological and ontological correspondence (worldviews) Studies affirm that fibrosis with no necroinflammatory substance at the point of perforation indicates chronic trauma instead of infection-associated erosion because of recent cause of illness. The symptoms of cardiac tamponage encompass the following Dyspnea Epigastric ache Muddiness Nausea Retrosternal ache Uneasiness (Jablonski, 2007, p.25). The majority of difficulties encountered by people undergoing hemodialysis are linked to their lack of abidance by the treatment prescriptions. Moreover, unsuitable consumption of foods and too much fluid by the patients could bring about undesirable effects that rarify their situations. For instance, they could encounter tremors due to failure to limit the intake of potassium. They could as well experience itching and bone aches due to unsuitable phosphate levels. In addition, too much intake of sodium and fluid could bring about undue weight increase. Intake of too much sodium co uld lead to oedema particularly near the ankles, hypertension, and problems with breathing (Jablonski, 2007). Additionally, excessive consumption of protein intensifies destruction of the kidney. Therefore, it is clear that abidance by the dietary and fluid limits will not just decrease the dangers of symptoms and health difficulties, but will as well better the quality of life of the patients. Different studies have examined the extent to which patents going through dialysis comply with the prescriptions. The results of the studies reveal substantial proof disclosing that excellent treatment with resulting kidney disease is directly associated with conformity, taking into account dietary restrictions, prescription given, and fluid limitation (Jablonski, 2007). Nevertheless, there are researches showing that these patients fail to adhere to the prescribed diet and fluid intake and given medicines. In essence, patients going through hemodialysis encounter disparate hardships in beari ng with their status and normally ignore the requirement for a remedial diet. This scenario persists until the bad effects of lack of compliance arise and turn out to be intolerable. When patients are accustomed to the effects of infringing dietary as well as fluid checks and when they deem the effects fatal, then there is a possibility that they will be extra mindful of their medical condition. Since self-regard is a learnt conduct, knowledge and teaching are precious practices that can help patients to deal with their intricate medical prescriptions. Nevertheless, when they are taught to comprehend the justification for their health prescriptions, as well as the causes and effects of their selections with regard to what they consume and drink, they are capable of coming up with wise judgments concerning whether or not to comply with the commendations. Therefore, it appears that lack of knowledge is the greatest aspect leading to non-adherence with the medical prescriptions (Booth, Pinney, Davenport, 2010). The prescriptions are particularly fluid and food limitations that consequently may cause worsening of the sickness. Incongruence The necessity of sufficient teaching and learning programs concerning medical prescriptions, specifically with a focus on fluid and food prescriptions for patients taking hemodialysis, has been under discourse in different nursing studies. Nevertheless, the incongruence involving different kinds of educational techniques and their efficiency on food and fluid adherence requires further evaluation. Oral education encompassing a person-to-person patient education in the company of a nephrology nurse is among the techniques employed for educating patients that undergo hemodialysis. Oral teaching via group education program is just as efficient as person-to-person education (Booth, Pinney, Davenport, 2010). Moreover, patients have declared that group teaching is very helpful in directing them for suitable self-care. Nonetheless, a number of researchers consider that patient teaching via oral teaching programs is normally concise and do not offer a sufficient information basis, while video teaching could have a number of merits and carry out a significant task in the education process. It is clear that the application of video creates a more consequential teaching substance. Through the pictorial illustration to patients on the way they should eat and drink and other knowledge applicable to self-care, it could be anticipated that patients can keep hold of this information in a better way. More to the incongruence, there is no research that has been conducted to examine the contribution of video teaching for patients that have chronic health situations particularly with regard to renal illnesses and resulting cardiac issues for those having hemodialysis. The majority of past assessments were for surgical pre-adjustment or teaching after surgery, rape, self-assessment or prevention of sexually transmitted disea ses. In this regard, it is crucial that future research study the effects of video teaching on food and fluid adherence in patients that have taken hemodialysis (Booth, Pinney, Davenport, 2010). Instances from studies Adjustable risk factors connected with cardiac arrest for patients having hemodialysis Sudden cardiac arrest denotes the most usual reason for death of patients taking hemodialysis. Although the patient is capable of being saved after the sudden cardiac arrest, there is very little possibility of lasting survival. Therefore, the major challenge in dealing with patients having end-stage kidney disease (ESKD) and that need hemodialysis is the way to offer a life-sustaining health care while decreasing the risk experience for sudden cardiac arrest (SCA). The best advance to this difficulty is to identify the status of patients with severe chronic kidney illness and that are specifically susceptible to sudden cardiac arrest. Research affirms that merely a decrease of glom erular filtration rate adds onto the risk of sudden cardiac arrest. Nevertheless, it is clear that experience of hemodialysis as well increases the risk (Booth, Pinney, Davenport, 2010). Definitely, a greater chance of cardiac risk aspects like age, diabetes, and heart diseases amid patients having chronic kidney disease (CKD) is seen amid patients having chronic kidney disease; however, if these aspects predict sudden cardiac arrest during hemodialysis is not yet comprehensible. A section of the unfavorable effects of hemodialysis possibly emanates from non-physiological character of fast drink and electrolyte swings that arise in the course of a hemodialysis session (Green et al., 2011). In reality, epidemiological studies stress that the risk of sudden cardiac arrest is increased during hemodialysis and a noteworthy fraction of all instances of sudden cardiac arrest arise in the hemodialysis clinics. In spite of this proof, it is not clear as to whether the rise in the risk of s udden cardiac arrest is due to adjustable dialysis- explicit aspects or to the worsening of a cardiac issue. Acute cardiac issues in hemodialysis in cases of no previous cardiac sign Cardiac issues brought about by coronary artery disease signify a key reason behind death in patients having CKD taking hemodialysis. Jefferies et al. (2011) illustrated this model in their research by suggesting that coronary artery disease was higher in people having lasting sustenance hemodialysis, since coronary artery disease was evident in the majority of patients without previous signs of cardiac issues prior to start of hemodialysis. In fact, cardiac issues and deaths arise with a higher incidence in lasting sustenance hemodialysis (Jefferies et al., 2011). In different researches, long-term incidences of hemodialysis were not related to an augment in the risk of mortality rate cardiac issues. Additionally, acute myocardial infarction was highly probable to arise in a short instance after the st art of hemodialysis as compared to an extended instance of hemodialysis. The aforementioned outcomes propose that cardiac issues are highly developed and the possibility of death from cardiac issues is already high prior to having hemodialysis that could seem improbable in it to worsen cardiac issues (Jefferies et al., 2011). The aforementioned concern can be dealt with through the determination of the incidence rate of an early Major Adverse Cardiac Event (MACE). MACE is powerfully linked to coronary artery disease and the incidences of deaths because of cardiac issues in new patients having hemodialysis and lacking both cardiac signs and any proof of insufficient cardiac function in the course of chronic kidney disease. Since the screening for coronary artery disease is not normally conducted at the start of hemodialysis, the baseline for coronary artery disease and other aspects was evaluated between patients with and without subsequent cardiac issues happening after the start of hemodialysis. Philosophical insinuations Educational involvements through either oral or video teaching could have an influence on the food and fluid compliance of the patient. The significance of compliance is highlighted in studies, which affirm that the excellent medical treatments are of no value if a patient decides not to abide by the directions of the health care providers. Conventionally, there is no particular structure or principle for assessing adherence to the hemodialysis therapy as directed. Currently, adherence is described by different considerations like failure to attend a hemodialysis session, individualized care, and serum electrolytes. It has been found out that many adherence measures are likened to results of the acre to the patient. There are emphases that adherence measures must be quantifiable, confirmable, and perfect (Wanek et al., 2012). In essence, adherence measures must be significant for patients having hemodialysis and the cause of the disease must be isolated from other aspects and be associated with the significant outcomes. Consequently, fluid and food adherence is normally settled on by evaluating serum electrolytes among other factors. The results got from some research demonstrate that the majority of patients were acquiescent with regard to calcium, potassium, weight increase just to mention a few. The outcomes of compliance were significant since many patients are believed to have trouble in managing their sodium intake and salt being a key constituent of the majority of foods, thus suggesting little salt intake does not augur well with patients. The relationship between weight increase and activity shows that patients that spend their entire days while working as well as the ones carrying out part-time activities experienced hardships in managing their weight between hemodialysis sessions. This observation shows that employed patients find it hard to adhere to their nutritional prescriptions. The foods they often tak e contain high levels sodium thus causing them to feel thirsty and as a result take large volumes of fluids (Barnett et al., 2008). There are as well indications that education levels are related to the adherence of patients with the prescriptions. Nevertheless, some studies suggest that there is no correlation between education and adherence. As earlier stated, high levels of potassium intake could bring about instant and fatal consequences like cardiac arrest and high death rate. Therefore, patients should be more conscious and keen to control their intake of potassium. Contrary to potassium, high levels of phosphate can lead to severe consequences like bone illnesses with patients will realize these effects just after living with it for a long time (Barnett et al., 2008). Hence, patients have a tendency of believing that the effects are less noteworthy and less frightening. Even though it is reported that video teaching provides more benefits as compared to oral teaching, video t eaching does not offer adequate depiction to permit a superb conclusion with respect to calcium. Future studies In this paper, benefits of individualized care, the results of two education programs on food and fluid adherence in patients taking hemodialysis, and arising of cardiac issues have been discussed. In this study, the lasting consequences of oral teaching against video teaching on the results were not adequately discussed. In addition, the effect of patient counseling on their understanding was not examined, and this element should be discussed in future studies. Moreover, it should be discussed in details to highlight the association between understanding of information and other health results, in addition to various features of oral and video teaching and the excellence of hemodialysis care. Finally, quality of existence in patients that have undertaken hemodialysis and its relationship with teaching involvements is another key concern that future studies will need to ad dress (Albert, Buchsbaum, Li, 2007). Conclusion Effective treatment of patients with end-stage kidney disease necessitates the adherence of patients with intricate and fundamentally significant medical prescriptions. Research states that the relationship between nurses and patients taking hemodialysis are imperative for successful exploit of patient-centered care. The area of attention for this paper considers the practice of individualized care. After the examination, an elucidation of its application follows the diverse constructs for realizing individualized care. Enhancing the understanding of information of patients taking hemodialysis should be an essential section of treatment. It is fundamental that nurses highlight adherence with sodium intake to prevent the severe consequences like hypertension, weight increase, and oedema. Reference List Albert, N., Buchsbaum, R., Li, J. (2007). Randomized study of the effect of video education on heart failure healthcare utilization, s ymptoms, and self-care behaviors. Patient Education and Counseling, 69(1), 129–139. Barnett, T., Li Yoong, T., Pinikahana J., Si-Yen, T. (2008). Fluid compliance among patients having haemodialysis: can an educational program make a difference? Journal of Advanced Nursing, 61, 300–306. Booth, J., Pinney, J., Davenport, A. (2010). N-terminal proBNP—marker of cardiac dysfunction, fluid overload, or malnutrition in hemodialysis patients. Clinical Journal of the American Society of Nephrology, 5(6), 1026-1040. Green, D., Roberts, R., New, I., Kalra, A. (2011). Sudden cardiac death in hemodialysis patients: an in-depth review. American Journal of Kidney Diseases, 57(6), 921-929. Jablonski, A. (2007). The multidimensional characteristics of symptoms reported by patients on hemodialysis. Nephrology Nursing Journal, 34(1), 22-29. Jefferies, H., Virk, B., Schiller, B., Moran, J., McIntyre, C. W. (2011). Frequent hemodialysis schedules are associated with reduced leve ls of dialysis-induced cardiac injury (myocardial stunning). Clinical Journal of the American Society of Nephrology, 6(6), 1326-1332. Wanek, R., Horn, E., Elapavaluru, S., Baroody, C., Sokos, G. (2012). Safe use of hemodialysis for dabigatran removal before cardiac surgery. The Annals of Pharmacotherapy, 46(9), 21-25. This essay on Philosophy of Nursing Science Associated with Hemodialysis and Cardiac Issues was written and submitted by user Mat Moth to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

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However, since the returns of blind bid theater owners are more volatile, she concludes risk averse theater owners are worse off under blind bidding, legitimizing their efforts to pass anti-blind bidding laws. Forsythe, Isaac, and Palfrey (1989) model the behavior of n buyers and one seller in a sealed-bid, first-price auction. They conclude that the anti-blind bidding laws were unnecessary as buyers would learn that a seller withholds information when it is unfavorable. A seller would abandon blind bidding once all buyers learn that withholding information was in the seller‘s best interest and not theirs. I find that practices in the motion picture industry were not consistent with this prediction, because the movie companies trade screened unfavorable films and blind bid highly anticipated films. Blumenthal (1988) justifies theater owners‘ rationale to seek relief from blind bidding by showing that they experience lower utility in blind-bid environments than preview ones. The author uses generalized least squares to test three hypotheses about film bids or film returns for blind-bid and trade screen theaters using the rental terms of 18 films from a national theater chain in 1982. First, she hypothesizes that theater owners in blind-bid states submit lower bids, because in accordance with economic theory, bidders reduce their bids on average in an auction where there is uncertainty about the value of a product. Second, blind-bid theater owners place a greater emphasis on the limited information contained in a bid letter. Therefore, bid letter information will explain a larger percentage of the variance for bids in blind-bid theaters than trade screen ones. Third, mean returns are higher for blind-bid theaters, but they experience greater volatility than trade screen theaters. Depending on the hypothesis in question, the dependent variable is either film bids or film returns. 1 She includes film budget and saturation as predictor variables, since higher budgeted films and wider released films would be an indication of larger expected returns by the movie companies. Other independent variables include theater operating expenses, an indicator variable signifying theaters in blind bid states, and the number of movie theaters located within the metropolitan area. The Film returns are the box office revenue less the price paid for the film. blind bidding dummy variable was interacted with film budget and saturation to test the second hypothesis. The author finds theater owners submit lower average bids in blind bidding states than in trade screen ones. With regards to the second hypothesis, blindbid theater owners place a greater emphasis on bid letter information: for every million dollar increase in film cost, blind bid theater owners bid an additional $8,900 while trade screen ones bid an additional $5,100. Regarding the final hypothesis, Blumenthal models utility as a function of the mean and variance of film returns which measures the degree of risk aversion among theater owners. In terms of utility, risk averse theater owners are worse off, because higher revenues are accompanied by greater volatility. Theater owners are unable to reduce their bids enough to offset the extra volatility because of competitive forces. Using a laboratory experiment in several markets, Forsythe, Isaac, and Palfrey (1989) consider the anti-blind bidding laws unnecessary. They find an equilibrium where buyers learn to assume the worst about a seller‘s decision to blind bid items causing most items to no longer be blind bid. The game has a single seller versus n buyers, and the former must decide whether to reveal information about the item to all buyers. A seller reveals his information to buyers if the news is favorable, and does not if it is unfavorable. A seller obtains the highest bid if he reveals his information. The auctioned item has both a common value and private value component. After a seller decides whether to reveal their information, the item is auctioned in a sealed bid first price auction. Several possible Nash equilibria are considered in the game, but the authors focus on the ? assume the worst? solution, because all other outcomes cannot be obtained so long as the auction follows a sequential equilibrium. This type of equilibrium occurs when buyers make conjectures about a seller‘s motives when they adopt a strategy which is consistent with the seller‘s best interest. To obtain an ?assume the worst? solution, a seller continues to blind bid items as long as there is at least one unsophisticated buyer: a buyer who bids the average of all quality levels, rather than assumes the worst about no revealed information. With the passage of time, buyers learn that when a seller withholds information it is not in their interest, forcing sellers to reveal information for lower quality levels. Eventually, the market reaches a point where no items are blind bid. In five of the six blind-bid auctions, the average winning bid declines over time. Although blind bidding is not eliminated by the conclusion of the auctions, it is practiced less frequently and buyers dramatically lower their expectations for the value for the auctioned item. The authors conclude the anti-blind bidding laws are unnecessary, because with the passage of time, blind bidding would have been phased out completely. These two studies offer two important insights. Although Blumenthal (1988) concludes theater owners are worse off under blind bidding, she does not consider that theater owners can diversify the risk of films by converting to the multiplex theater. In this manner, theater owners can pool the risk of mediocre and blockbuster films rather than run the risk of exhibiting a single inferior film. Regarding Forsythe, Isaac and Palfrey (1989), if the movie companies did not reveal their information for blockbuster films, they were not obtaining the highest auction price. Since the movie companies must have acted in their own self-interest, I assume blind bidding provided some cost benefits which outweighed the decision to trade screen films. 2. 2 Natural Experiments In this section, I discuss three natural experiments which provide a reference for testing the effects of the anti-blind bidding laws on exit, admission prices, and delays. Natural experiments are often used to examine the effect of a policy change. A researcher examines two groups which have similar characteristics, one of which is exposed to a policy change while the other is not, and observes how the outcome differs between the two. Natural experiments are called quasi experiments, because the researcher has little or no control over the observed situation, which is in contrast to social experiments where researchers implement proper experimental design. Card and Krueger (1994), Milyo and Wardfogel (1999), and Bergen, Levy, Rubin and Zeliger (2004), conduct natural experiments assuming an exogenous change in a law. All three natural experiments assume the treatment effect is not correlated with the outcome variable and any uncontrolled independent variables correlated with it. Card and Krueger (1994) investigate the effect on employment of a 50 cent raise in the New Jersey minimum wage in the fast food industry. Milyo and Wardfogel (1999) examine the impact on prices of advertised and non-advertised items after a ban on liquor advertising is lifted in Rhode Island. The ban permitted retailers to charge higher prices which was considered especially helpful to small ? mom and pop‘ retailers that could not offer the price discounts of larger chains. Bergen et tal. (2004) investigate the net effects of item pricing laws for supermarkets which require that retailers label every item individually with a price tag to help ensure that consumers are not overcharged at the register. The three empirical studies conduct natural experiments in similar geographic regions. Card and Krueger (1994) compare the neighboring states of New Jersey and Pennsylvania. The authors use descriptive statistics from their data to argue that wages, prices, and employment measures are similar. For example, the mean starting wage for New Jersey and Pennsylvania is $4. 61 and $4. 63, respectively, before New Jersey‘s increase in the minimum wage. Bergen et tal. (2004) target a narrow tri-state region of Clifton, New Jersey, Tarrytown, New York, and Greenwich, Connecticut to study the impact of item pricing laws. Close geographic proximity is one factor for the selected towns as the greatest distance that separates the towns is only approximately 50 miles. In addition, these towns have similar population size, population densities, and access to quality public schools. Milyo and Wardforgel (1999) follow a similar strategy to Bergen et tal. (2004) by comparing adjacent states but narrowing their focus to three areas: Southern Rhode Island, Northwest Boston suburbs, and the Rhode Island and Massachusetts border. In addition, the three studies utilize multiple control groups which provide the benefit of observing how sensitive the results are to different controls. Card and Krueger (1994) compare full-time-equivalent employment (FTE) for New Jersey and Pennsylvania, but also compare FTE in New Jersey fast food stores which already paid at least the new minimum wage to those in New Jersey that paid under the new minimum. Milyo and Wardforgel (1999) compare retail prices in Rhode Island with those from Massachusetts, but also use Rhode Island wholesale prices as a second control. Bergen et tal. (2004) compare prices in New Jersey with two controls New York and Connecticut both of which have item pricing laws. However, Connecticut exempted stores from the law which installed the electronic shelf label system because it ensured that the price at the shelf was the same as the price at the register. Therefore, the authors used Connecticut stores to observe how prices differed among non item pricing law stores and those which used the electronic shelf system. I adopt the idea of multiple control groups when I examine the exit of theater owners. The Card and Krueger (1994) study has additional significance to my study because they use the difference-in-differences estimator, and I adopt this method for the analysis of admission prices. The primary benefit of this method is that the researcher is able to cancel out other industry factors which are common to the treatment and control group through second differencing. Therefore, the difference-in-differences measures the impact on the outcome solely from the policy change. These empirical studies provided some important insights on how to conduct my natural experiment on the anti-blind bidding laws. When selecting treatment and control groups, it is important to select homogenous regions so that there is a believable rationale that the control group will behave like the treatment group. Use of multiple control groups is encouraged in natural experiments to test the robustness of the results. In addition, I follow the method of Card and Krueger (1994) and use the difference-in-differences estimator to examine admission prices. Chapter 3 ADMISSION PRICES In this paper, I investigate the claims made by theater owners and movie companies about the impact of the anti-blind bidding laws on admission prices. I examine the impact of the strictest laws of Ohio and Pennsylvania, which eliminated blind bidding and placed severe restrictions on guarantees. I selected these states, because they present the strongest case for the laws having an impact according to theater owners‘ claims. I compare average admission prices in these states before and after the passage of the law with prices in two states that never had such a law. For Ohio, I compare average prices in Cleveland with those in Detroit. For Pennsylvania, I compare average prices from Philadelphia and Pittsburgh with those of Detroit. 1 Using the difference-in-differences estimator, I find some evidence that the laws raised admission prices. Theater owners argued that admission prices were higher under blind bidding, because they had to increase their prices to cover losses incurred from inferior films and to compensate for the guarantees they paid. According to theater owners, the anti-blind bidding laws would eliminate the burden of blind bidding, and in some states also guarantees, so that lower prices would follow. Movie companies claimed initially considered comparing average Philadelphia and Pittsburgh prices with those in Manhattan. I decided against using New York City as a control because prices were consistently higher there than in any other market because of the high cost of living in the area. The laws would have the opposite effect for two reasons. Theater owners would identify blockbuster films after viewing the preview, and a bidding war would ensue. Since film rentals were bid higher, this cost would be passed along to moviegoers. In addition, movie companies claimed that the anti-blind bidding laws would cause delays in the release of films, and this cost would be passed on to consumers. 3. 1 Model I consider the claims of theater owners and movie companies about admission prices to be invalid because of what is universally accepted in economics about the demand for factor inputs. The demand for a factor input (e. g. labor or capital) is a derived demand in that demand for the factor and its price is contingent upon the demand for the final product. For example, the demand for movie stars depends not only on their current salaries, but also the total tickets sold. Movie stars would be unable to command high salaries if there is not an overwhelming demand for motion pictures. Therefore, prices charged at movie theaters, an input, are determined by demand. On the other hand, admission prices are likely to differ across cities due to costs outside the control of the industry. For example, theater owners in New York City had higher rent or mortgage payments than those in Atlanta, Georgia because of the relatively high cost of land. Another factor that varied regionally was the price of labor. Theater owners facing higher minimum wages had greater variable costs than those in states with lower minimums. I expect the anti-blind bidding laws to influence admission prices if they impacted marginal costs, or if they restrict the supply of films. Although the laws did not affect theater owners‘ marginal costs, they may have impacted the movie companies‘. Additional expenses were incurred because sales prints had to be specially made for the purposes of trade screening. This cost was not present in blind bidding states. 3. 2 Data and Methods I obtained the data from Variety, which reported theaters from 15 cities on a weekly basis. Variety sampled most cities once a month with about 10 to 20 theaters per sample. The same theaters were generally sampled, but over longer periods of time, the sample changed as some exited the marketplace. I sampled each city quarterly. On occasion, Variety reported theaters which charged one dollar for admission. These observations were dropped from the data set, since they were second-run movie houses. Table 5. 1 shows the descriptive statistics for the data. Any city sampled was a representation of the metropolitan area. Therefore, the sample contained some downtown theaters as well as many suburban theaters. For example, Detroit included downtown theaters such as the Adams, Fox, and Renaissance, and theaters such as the Dearborn, Americana West, and Macomb Mall from surrounding areas of Wayne, Oakland, and Macomb counties. During the first year that the ant-blind bidding laws were in effect, it is not clear which films were blind bid. This is because theater owners bid on films six months to one year in advance of the release date. For example, Ohio enacted the law in October 1978, but theater owners may have been bidding for films to be released in ___________________________________________________________________________ 2 According to Barry Reardon, distributional president at Warner Brothers, the additional expense to trade screen amounted to approximately $50,000 per film in Jim Robbins, ? Distribs Adapt to AntiBlind Bid Laws? , Variety, July 3, 1985, 80. 3 A sales print is a reel of film with the movie preview. April 1979 or as far away as October 1979. The Pennsylvania law became effective in May 1980. At that date, theater owners would bid on films for November 1980 up to May 1981. I address the lagged effect of an anti-blind bidding law on films by examining average admission prices using two different treatment and control groups: 1) two years before and after a law, and 2) three years before and after a law. Table 3. 1 provides the descriptive statistics for these variables. For the Ohio law, I calculate average prices in 1976 and 1977 (pre-treatment group) and average prices in 1979 and 1980 (post-treatment group). This measures the immediate effect of the law even though some of the admission prices in 1979 will be for films which were not trade screened. For three years before and after the law, I use average prices in 1975 and 1976 compared with those in 1980 and 1981. In this case, all films in the posttreatment group were trade screened. For the Pennsylvania law, I use the same procedure for selecting the pre and post-treatment groups. I consider the passage of the Ohio and Pennsylvania laws a natural experiment, and I proceed to measure the impact of a law by using the difference-indifferences estimator defined as the change in the population means from the treatment group less the change in population means from the control group. This method has an advantage over comparing the means of the treatment and control group after the laws because the latter assumes the treatment and control groups are identical in every way except for the law. The difference-in-differences estimator makes the weaker assumption that regardless of the overall factors affecting admission prices, they affected the treatment and control groups in the same way. In order to understand the meaning of the difference-in-differences estimator, consider the interpretation of first differences between the treatment and control. The change in price in the control group informs us how prices would have behaved in the treatment group if the law was not implemented. The change in price in the treatment group tells us how the average price behaved given the enactment of the law. By taking second differences, I obtain the difference-in-differences estimator which measures the effect of the law by taking the difference in what happened with average prices compared with what would have happened to them. 3. 3 Cleveland and Detroit Figure 5. 1 displays average admission prices for Cleveland and Detroit from 1975-1981. Detroit‘s average prices remain consistently above Cleveland‘s by approximately 59 cents throughout the observed period. I examine average admission prices over time to see if the assumption that overall factors that affect them are the same for both treatment and control groups. Unobserved factors are more likely to be different if the trend in prices diverges before the treatment effect. Average admission prices for Cleveland and Detroit remain relatively steady before the implementation of the law implying the assumption of a common trend appears valid. The results for the difference-in-differences estimator are shown in Table 3. 2. Comparing average prices two years before and after the law, I find Detroit‘s prices increase by seven cents and Cleveland‘s rise by 16 cents. The seven cent increase in average prices represents how Cleveland prices would have behaved in the absence of the anti-blind bidding law. After taking second differences, I find that the Ohio law significantly increases Cleveland‘s average prices by nine cents. Examining admission prices three years before and after the law does not produce the same conclusion. Cleveland‘s and Detroit‘s average prices increase by 20 and 21 cents, respectively. The difference-in-differences estimator shows that Cleveland‘s average prices are significantly lower by one cent. 3. 4 Philadelphia, Pittsburgh and Detroit Figure 5. 2 shows average prices in Philadelphia and Pittsburgh versus those in Detroit from 1977-1983. For the first two years, prices are nearly identical. In 1979 and 1980, the difference in average prices remains relatively steady at 10 and 15 cents, respectively. Beyond 1980, the difference in average prices increases, ranging from 36 to 41 cents. The assumption that factors have a common trend appears satisfied because the difference in average prices maintains itself in 1979 and 1980. The first and second differences for average admission prices are shown in Table 5. 3. Comparing average prices two years before and after the Pennsylvania law, I find Philadelphia‘s and Pittsburgh‘s average prices rise by 43 cents while Detroit‘s increases by 11 cents. Detroit‘s prices are assumed to be behaving like Philadelphia‘s and Pittsburgh‘s if Pennsylvania had never passed an anti-blind bidding law. The difference-in-differences estimator shows that the law results in a statistically significant 32 cent increase in admission prices. Comparing three years before and after the law produces a similar result, the law causes higher average admission prices for Philadelphia and Pittsburgh by 53 cents. 3. 5 Conclusion I examine the impact of the Ohio and Pennsylvania anti-blind bidding laws on admission prices and I find higher admission prices in Cleveland, Philadelphia, and Pittsburgh in three of the four difference-in-differences estimators. The impact of the Pennsylvania law is more robust than the Ohio law because in one case, average admission prices decline by one cent. A potential explanation for higher average admission prices is that the movie companies‘ marginal costs increased in anti-blind bidding states, because sales prints had to be produced exclusively for trade screening films.