We draw on macroeconomic models of diffusion and productivity to explain empirical patterns of survival gains in heart attacks. Using Medicare data for 2.8 million patients from 1986 to 2004, we find that hospitals rapidly adopting cost-effective innovations such as beta blockers, aspirin, and reperfusion had substantially better outcomes for their patients. Holding technology adoption constant, the marginal returns to spending were relatively modest. Hospitals increasing the pace of technology diffusion (“tigers”) experienced triple the survival gains compared to those with diminished rates (“tortoises”). In sum, small differences in the propensity to adopt effective technology lead to wide productivity differences across hospitals.

Abortion legalization in the early 1970s led to dramatic changes in fertility. Some research has suggested that it altered cohort outcomes, but this literature has been limited and controversial. In this paper, we provide a framework for understanding selection mechanisms and use that framework to both address inconsistent past methodological approaches and provide evidence on the long-run impact on cohort characteristics. Our results indicate that lower-cost abortion brought about by legalization altered young adult outcomes through selection. In particular, it increased likelihood of college graduation, lower rates of welfare use, and lower odds of being a single parent.