dominant reason for increasing costs, particularly in developing countries. Alternative explanations for rising higher education costs include Bowen's revenue theory of cost, reduced public subsidies for education, administrative bloat, the commercialization of higher education, increased demand for higher education, the easy availability of federal student loans, difficulty comparing prices of different universities, technological change, and lack of a central mechanism to control price increases. Healthcare The Baumol effect has been applied to the rising cost of healthcare, as the healthcare industry has long had low productivity growth. Empirical studies have largely confirmed the large role of the Baumol effect in the rising cost of healthcare in the United States, although there is some disagreement. Likewise, a 2021 study determined that "Baumol's cost disease ha[s] a significant positive impact on health expenditure growth" in China. However, a paper by economists Bradley Rossen and Akhter Faroque on healthcare costs in Canada found that "the cost disease...is a relatively minor contributor [in the growth of health-care spending in Canada], while technical progress in health care and growth in per capita incomes are by far the biggest contributors". Despite substantial technological innovation and capital investment, the healthcare industry has struggled to significantly increase productivity. As summarized by the economists Alberto Marino, David Morgan, Luca Lorenzoni, and Chris James: "Technological advancements, capital investments and economies of scale do not make for a cumulative rise in output that is on par with progressive sectors of the economy...[A]utomation and better technology generally do not allow for large productivity increases. A health professional is difficult to substitute, in particular by using new technologies, which may actually also bring an increase in volume (e.g. faster diagnostic tests). Increases in volume likely brought about by new technology will also drive up expenditure, since new health professionals will have to be hired to treat everyone. Moreover, new technologies require more specialised training for say [sic] doctors, driving wages up further since more years of experience are required." Service industry Baumol's cost disease is often used to describe consequences of the lack of growth in productivity in the quaternary sector of the economy and public services, such as public hospitals and state colleges. Labor-intensive sectors that rely heavily on non-routine human interaction or activities, such as health care, education, or the performing arts, have had less growth in productivity over time. As with the string quartet example, it takes nurses the same