A change in the audition procedures of symphony orchestras--adoption of "blind" auditions with a "screen" to conceal the candidate's identity from the jury--provides a test for sex-biased hiring. Using data from actual auditions, in an individual fixed-effects framework, we find that the screen increases the probability a woman will be advanced and hired. Although some of our estimates have large standard errors and there is one persistent effect in the opposite direction, the weight of the evidence suggests that the blind audition procedure fostered impartiality in hiring and increased the proportion women in symphony orchestras.

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Orchestrating Impartiality: The Impact of “Blind” Auditions on Female Musicians

This chapter seeks to set out what Economists have learned about the effects of early childhood influences on later life outcomes, and about ameliorating the effects of negative influences. We begin with a brief overview of the theory which illustrates that evidence of a causal relationship between a shock in early childhood and a future outcome says little about whether the relationship in question biological or immutable. We then survey recent work which shows that events before five years old can have large long term impacts on adult outcomes. Child and family characteristics measured at school entry do as much to explain future outcomes as factors that labor economists have more traditionally focused on, such as years of education. Yet while children can be permanently damaged at this age, an important message is that the damage can often be remediated. We provide a brief overview of evidence regarding the effectiveness of different types of policies to provide remediation. We conclude with a list of some of (the many) outstanding questions for future research. Hard-copy subscribers may access the tables for this paper here.

Human Capital Development Before Age Five

This chapter seeks to set out what economists have learned about the effects of early childhood influences on later life outcomes, and about ameliorating the effects of negative influences. We begin with a brief overview of the theory which illustrates that evidence of a causal relationship between a shock in early childhood and a future outcome says little about whether the relationship in question is biological or immutable. We then survey recent work which shows that events before five years old can have large long term impacts on adult outcomes. Child and family characteristics measured at school entry do as much to explain future outcomes as factors that labor economists have more traditionally focused on, such as years of education. Yet while children can be permanently damaged at this age, an important message is that the damage can often be remediated. We provide a brief overview of evidence regarding the effectiveness of different types of policies to provide remediation. We conclude with a list of some of the many outstanding questions for future research.

/pdf/human-capital-development-before-age-five-20au2t3jf3.pdf

The Patient Protection and Affordable Care Act: Impact on Mental Health Services Demand and Provider Availability

Objective. Early diagnosis of children with autism spectrum disorders (ASD) is critical but often delayed until school age. Few studies have identified factors that may delay diagnosis. This study attempted to identify these factors among a community sample of children with ASD. Methods. Survey data were collected in Pennsylvania from 969 caregivers of children who had ASD and were younger than 21 years regarding their service experiences. Linear regression was used to identify clinical and demographic characteristics associated with age of diagnosis. Results. The average age of diagnosis was 3.1 years for children with autistic disorder, 3.9 years for pervasive developmental disorder not otherwise specified, and 7.2 years for Asperger9s disorder. The average age of diagnosis increased 0.2 years for each year of age. Rural children received a diagnosis 0.4 years later than urban children. Near-poor children received a diagnosis 0.9 years later than those with incomes >100% above the poverty level. Children with severe language deficits received a diagnosis an average of 1.2 years earlier than other children. Hand flapping, toe walking, and sustained odd play were associated with a decrease in the age of diagnosis, whereas oversensitivity to pain and hearing impairment were associated with an increase. Children who had 4 or more primary care physicians before diagnosis received a diagnosis 0.5 years later than other children, whereas those whose pediatricians referred them to a specialist received a diagnosis 0.3 years sooner. Conclusion. These findings suggest improvements over time in decreasing the age at which children with ASD, especially higher functioning children, receive a diagnosis. They also suggest a lack of resources in rural areas and for near-poor families and the importance of continuous pediatric care and specialty referrals. That only certain ASD-related behaviors, some of which are not required to satisfy diagnostic criteria, decreased the age of diagnosis suggests the importance of continued physician education.

/pdf/factors-associated-with-age-of-diagnosis-among-children-with-5d6stva9l9.pdf

Factors associated with age of diagnosis among children with autism spectrum disorders.

This study examines the effect of increased Medicaid reimbursements for primary care services in 2013 and 2014, a key provision of Affordable Care Act, on access to primary care. The researchers measured the availability of and waiting times for appointments for Medicaid enrollees and privately insured individuals in 10 states during two periods: from November 2012 through March 2013 and from May 2014 through July 2014. Between the two time periods, the availability of primary care appointments for Medicaid beneficiaries increased from 58.7 percent to 66.4 percent, while no changes were observed for the privately insured. During the same periods, waiting times to a scheduled new-patient appointment remained stable. These results suggest that increased Medicaid reimbursement to primary care providers was associated with improved appointment availability for Medicaid enrollees without generating longer waiting times.

https://www.nejm.org/doi/pdf/10.1056/NEJMsa1413299

Appointment availability after increases in Medicaid payments for primary care.

The Affordable Care Act expands Medicaid in 2014 to millions of low-income adults in states that choose to participate in the expansion. Since 2010 California, Connecticut, Minnesota, and Washington, D.C., have taken advantage of the law’s option to expand coverage earlier to a portion of low-income childless adults. We present new data on these expansions. Using administrative records, we documented that the ramp-up of enrollment was gradual and linear over time in California, Connecticut, and D.C. Enrollment continued to increase steadily for nearly three years in the two states with the earliest expansions. Using survey data on the two earliest expansions, we found strong evidence of increased Medicaid coverage in Connecticut (4.9 percentage points; p < 0.001 ) and positive but weaker evidence of increased coverage in D.C. (3.7 percentage points; p = 0.08 ). Medicaid enrollment rates were highest among people with health-related limitations. We found evidence of some crowd-out of private coverage in Co...

New Evidence On The Affordable Care Act: Coverage Impacts Of Early Medicaid Expansions

This paper assessed whether expanding public health insurance coverage to parents leads to increases in Medicaid participation among children. We find that children who reside in states that expanded coverage to parents participate in Medicaid at a rate of 20 percentage points higher than those who live in states without such expansions. Particularly noteworthy, Massachusetts's expansion in coverage to parents led to a 14 percentage point increase in Medicaid coverage among children, largely due to the reduction in uninsurance among Medicaid-eligible children. These study findings suggest that expanding coverage to parents has important spillover effects on children's participation in Medicaid. (Dubay, Lisa, and Genevieve Kenney. October 2003. Expanding Public Health Insurance to Parents: Effects on Children's Coverage under Medicaid. Health Services Research 38(5): 1283-1302.)

Expanding Public Health Insurance to Parents: Effects on Children's Coverage under Medicaid

This paper documents the changing picture of health insurance coverage for pregnant women in the four-year period following Medicaid expansion and assesses the extent to which the crowding-out phenomenon may have influenced the observed trends. The report documents the distribution of insurance coverage for pregnant women in the post-expansion period and describes demographic characteristics of women covered under Medicaid. It examines the rate at which Medicaid-eligible women enroll in the program and addresses the crowding-out issue by comparing the trend in employer-sponsored coverage among poor and near-poor pregnant women with those among nonpregnant women and men of similar ages and incomes.

Did Medicaid Expansions For Pregnant Women Crowd Out Private Coverage

This study uses a simulated patient approach to assess appointment availability and wait times for new primary care appointments in late 2012/early 2013 by insurance status and state. Although most primary care physicians are accepting new patients, access varies widely across states and insurance status. Outreach programs are needed, not only to help patients enroll but also to identify practices accepting new patients within each plan's network. Tracking new patient appointment availability over time can inform policies designed to strengthen primary care capacity and enhance the effectiveness of the coverage expansions with the Patient Protection and Affordable Care Act.

/pdf/primary-care-access-for-new-patients-on-the-eve-of-health-4emjxxcqw4.pdf

Genevieve M. Kenney

Papers

Appointment availability after increases in Medicaid payments for primary care.

New Evidence On The Affordable Care Act: Coverage Impacts Of Early Medicaid Expansions

Expanding Public Health Insurance to Parents: Effects on Children's Coverage under Medicaid

Did Medicaid Expansions For Pregnant Women Crowd Out Private Coverage

Primary care access for new patients on the eve of health care reform.