Offering a unifying theoretical perspective not readily available in any other text, this innovative guide to econometrics uses simple geometrical arguments to develop students' intuitive understanding of basic and advanced topics, emphasizing throughout the practical applications of modern theory and nonlinear techniques of estimation. One theme of the text is the use of artificial regressions for estimation, reference, and specification testing of nonlinear models, including diagnostic tests for parameter constancy, serial correlation, heteroscedasticity, and other types of mis-specification. Explaining how estimates can be obtained and tests can be carried out, the authors go beyond a mere algebraic description to one that can be easily translated into the commands of a standard econometric software package. Covering an unprecedented range of problems with a consistent emphasis on those that arise in applied work, this accessible and coherent guide to the most vital topics in econometrics today is indispensable for advanced students of econometrics and students of statistics interested in regression and related topics. It will also suit practising econometricians who want to update their skills. Flexibly designed to accommodate a variety of course levels, it offers both complete coverage of the basic material and separate chapters on areas of specialized interest.

Estimation and Inference in Econometrics

What makes organizations so similar? We contend that the engine of rationalization and bureaucratization has moved from the competitive marketplace to the state and the professions. Once a set of organizations emerges as a field, a paradox arises: rational actors make their organizations increasingly similar as they try to change them. We describe three isomorphic processes-coercive, mimetic, and normative—leading to this outcome. We then specify hypotheses about the impact of resource centralization and dependency, goal ambiguity and technical uncertainty, and professionalization and structuration on isomorphic change. Finally, we suggest implications for theories of organizations and social change.

The iron cage revisited: Institutional isomorphism and collective rationality in organizational fields (Chinese Translation)

Background. Many state Medicaid programs limit the number of reimbursable medications that a patient can receive. We hypothesized that such limitations may lead to exacerbations of illness or to admissions to institutions where there are no caps on drug reimbursements. Methods. We analyzed 36 months of Medicaid claims data from New Hampshire, which had a three-drug limit per patient for 11 of those months, and from New Jersey, which did not. The study patients in New Hampshire (n = 411) and a matched comparison cohort in New Jersey (n = 1375) were Medicaid recipients 60 years of age or older who in a base-line year had been taking three or more medications per month, including at least one maintenance drug for certain chronic diseases. Survival (defined as remaining in the community) and time-series analyses were conducted to determine the effect of the reimbursement cap on admissions to hospitals and nursing homes. Results. The base-line demographic characteristics of the cohorts were nearly ide...

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Effects of Medicaid drug-payment limits on admission to hospitals and nursing homes.

Objectives The authors examined the relationships between different types of nursing home staffing and nursing home deficiencies to test the hypothesis that fewer staff hours would be associated with higher numbers of deficiencies. Methods Data were from the On-Line Survey, Certification, and Reporting System for all certified nursing homes in the United States. Regression models examined total deficiencies, quality of care, quality of life, and other deficiencies. Results Fewer registered nurse hours and nursing assistant hours were associated with total deficiencies and quality of care deficiencies, when other variables were controlled. Fewer nursing assistant staff and other care staff hours were associated with quality of life deficiencies. Fewer administrative staff hours were associated with other deficiencies. Facilities that had more depressed and demented residents, that were smaller, and that were nonprofit or government-owned had fewer deficiencies. Facilities with more residents with urinary incontinence and pressure sores and with higher percentages of Medicaid residents had more deficiencies, when staffing and resident characteristics were controlled. Discussion Facility characteristics and states were stronger predictors of deficiencies than were staffing hours and resident characteristics. Because only a small portion of the total variance in deficiencies could be explained, much work remains to explore factors that influence deficiencies.

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Nursing Home Staffing and Its Relationship to Deficiencies

The Cambridge Handbook of Age and Ageing, first published in 2005, is a guide to the body of knowledge, theory, policy and practice relevant to age researchers and gerontologists around the world. It contains almost 80 original chapters, commissioned and written by the world's leading gerontologists from 16 countries and 5 continents. The broad focus of the book is on the behavioural and social sciences but it also includes important contributions from the biological and medical sciences. It provides comprehensive, accessible and authoritative accounts of all the key topics in the field ranging from theories of ageing, to demography, physical aspects of ageing, mental processes and ageing, nursing and health care for older people, the social context of ageing, cross cultural perspectives, relationships, quality of life, gender, and financial and policy provision. This handbook will be a must-have resource for all researchers, students and professionals with an interest in age and ageing.

The Cambridge handbook of age and ageing

The origins and influence of social science perspectives have conditioned theoretical and empirical developments in the field of gerontology. Yet little systematic examination has been afforded to the role of social science in the production of gerontological knowledge in providing the underlying rationale for American social policy for the aged. This paper examines the dominant U.S. social science perspectives or paradigms and discusses the reasons for their centrality in American gerontological thought. The paper concludes with a proposal for an alternative line of inquiry — a political economy of ageing — which takes as problematic the effects of social history, the world economy, capitalism and social class on the ageing process and the aged and the policy interventions designed for them.

Dominant and Competing Paradigms in Gerontology: Towards a Political Economy of Ageing

Many studies have documented the importance of nursing staff in both the process and the outcomes of nursing home care (Aaronson, Zinn, and Rosko 1994; Bliesmer et al. 1998; Carter and Porell 2003; USCMS 2001; Grabowski 2001a, b; Harrington et al. 2000; Schnelle et al. 2004; Spector and Takada 1991; Zhang and Grabowski 2004). A recent study identified a threshold for registered nurses (RNs) and total nurse staffing levels (RNs, licensed vocational nurses [LVNs] and nursing assistants [NAs]) necessary to protect the health and safety of residents (USCMS 2001). Over 90 percent of the nation's nursing homes had staffing levels below this level (USCMS 2001).

As the evidence accumulates about the importance of higher levels of staffing for improving the quality of nursing home care, the Institute of Medicine (IOM) (1996, 2001, 2003) called for increasing the federal regulatory requirements for nursing home staffing in three separate reports. In spite of these recommendations, total average nursing home staffing levels have remained relatively steady since 1994, although there was a 25 percent decline in RN staffing levels since passage of the Balanced Budget Act in 1997 (Harrington et al. 2003; Konetzka et al. 2004).

Nursing facilities (NFs) vary widely in the amount and type of nursing service they provide to residents (Zinn 1993a; IOM 1996, 2001; Harrington et al. 1998; 2000; 2003). The variation is based in part upon decisions that nursing facility managers/owners make about the amount and type of staff they want to provide. Some nursing facility owners and managers may make strategic decisions to provide higher levels of total staffing or more RN staff, even though this would increase facility costs, as a means of competing for residents or competing for the Medicare and private pay market (with higher reimbursement rates), and/or as a service to residents. Other NFs may target the Medicaid market (with lower reimbursement rates) in order to ensure a stable resident population. In this latter situation, facilities may elect to keep staffing levels low in order to keep expenditures under their Medicaid revenues (United States General Accounting Office [USGAO] 2000; USCMS and Scully 2003).

In 2002, Medicaid and other public payers paid for 51 percent of the nation's total $103 billion in nursing home expenditures, while Medicare paid for 12.5 percent, private insurance paid for 7 percent, and consumers paid the remaining costs (Levit et al. 2004). Because Medicaid pays for 67 percent of all nursing home residents in the United States (Harrington et al. 2003), the Medicaid reimbursement rates and methods are central to understanding nursing home staffing levels (IOM 2001). State cost containment efforts have resulted in substantially lower Medicaid reimbursement rates (an average of $115 per day across the nation in 2000) than Medicare rates ($269 for freestanding facilities in 2000) (USCMS and Scully 2003; USGAO 2000; 2002a, b). Low Medicaid reimbursement rates can result in low staffing and quality (Cohen and Dubay 1990; Zinn 1993b; Aaronson, Zinn, and Rosko 1994; Cohen and Spector 1996; Grabowski 2001a, b).

This study examined the relationship of nurse staffing and state Medicaid reimbursement rates in U.S. NFs in 2002, using nurse staffing data from the federal On-line Survey Certification and Reporting (OSCAR) system, in a two-stage regression model. Although previous studies have shown the relationship between Medicaid reimbursement rates and staffing, they have not taken into account the complex relationship of staffing with other factors (Cohen and Dubay 1990; Zinn 1993b; Aaronson, Zinn, and Rosko 1994; Cohen and Spector 1996; Grabowski 2001a, b). Building on the work of Harrington and Swan (2003) for California, this study specifically examined the relationship of RN (and total) staffing hours per resident day with two endogenous measures: (1) state Medicaid reimbursement rates and (2) facility resident case mix. The study should be useful to policy makers as they consider changes that would improve nurse staffing levels and quality of care.

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Nurse staffing levels and Medicaid reimbursement rates in nursing facilities.

Parenting stress and mothers of young children with chronic illness: a cross-cultural study.

OBJECTIVES This study examined the effects of state certificate of need and/or moratorium requirements on the change in nursing home bed growth in states over a 13-year period. METHODS Data were collected from five telephone surveys of state officials about state certificate of need and moratorium policies, state Medicaid nursing home reimbursement rates, and the licensed nursing home beds in each state for the 1979 through 1993 period. Two-stage least squares regression analysis treated certificate of need and/or moratorium and Medicaid reimbursement rates as endogenous variables in predicting the change in nursing home beds per aged population in states. RESULTS States that had a certificate of need and/or moratorium did have significant reductions in the growth in nursing home beds but Medicaid nursing home reimbursement rates were not related to change in bed stock. The percentage of the population living in a metropolitan area, the personal income per 1,000 population, the percent unemployed, a state's tax effort, and time were positively associated with change in nursing home beds. The ratio of nursing home beds per 1,000 aged population in the previous year was a negative predictor of change in bed stock in a given year. CONCLUSIONS State regulatory policies have an effect on bed growth in contrast to reimbursement policies.

James H. Swan

Papers

Dominant and Competing Paradigms in Gerontology: Towards a Political Economy of Ageing

Nurse staffing levels and Medicaid reimbursement rates in nursing facilities.

Parenting stress and mothers of young children with chronic illness: a cross-cultural study.

The Effect of Certificate of Need and Moratoria Policy on Change in Nursing Home Beds in the United States

When parenting becomes caregiving: Caring for the chronically ill child.