Showing papers by "RAND Corporation published in 1997"
TL;DR: The combination of this new research textbook with Johan Mouton's understanding of Social Research is the solution for research in the caring professions of social sciences.
Abstract: The combination of this new research textbook with Johan Mouton's understanding of Social Research is the solution for research in the caring professions of social sciences.
*Please note: This is a reduced version of the abstract. Please refer to PDF for full text.
1,018 citations
TL;DR: Examination of the impact of 4 health measures on wages of urban workers in Brazil suggests that health produces a substantial return in the formal sector of Brazilian labor markets.
557 citations
TL;DR: Among those with chronic diseases, African Americans and Hispanics reported worse function than Whites, and socioeconomic status, including wealth, accounts for much of the difference in functional status associated with these chronic diseases.
Abstract: Objectives. This study examined the relationships between wealth and income and selected racial and ethnic differences in health. Methods. Cross-sectional data on a national sample of 9744 men and women aged 51 through 61 from the 1992 Health and Retirement Survey were analyzed to examine the association between socioeconomic status and racial and ethnic differences in functional status among those with hypertension, diabetes, a heart condition, and arthritis. Results. Compared with Whites, African Americans report higher rates of hypertension, diabetes, and arthritis, while Hispanics report higher rates of hypertension and diabetes and a lower rate of heart conditions. Accounting for differences in education, income, and wealth had little effect on these prevalence differences. In general, among those with chronic diseases, African Americans and Hispanics reported worse function than Whites. This disadvantage was eliminated in every case by controlling for socioeconomic status. Conclusions. While socioeconomic status, including wealth, accounts for much of the difference in functional status associated with these chronic diseases, it plays a relatively small role in explaining differences in the prevalence of chronic disease, possibly reflecting different causal pathways.
361 citations
TL;DR: The study provides unusually detailed data on cognition, family structure and transfers, and assets, and plans for future waves of AHEAD are described, including a next-of-kin interview for decreased respondents.
Abstract: This chapter provides background information for the study of Asset and Health Dynamics Among the Oldest Old (AHEAD), a prospective panel survey of persons born in 1923 or earlier who were residing in the community at the time of the 1993 baseline. Interviews were sought with both spouses in married households, and an overall total of 8,222 were completed. We review the interdisciplinary scientific issues that motivated the study, describe the fundamental design decisions that structured AHEAD, and summarize the content in the core and experimental modules. The study provides unusually detailed data on cognition, family structure and transfers, and assets. Data are presented on sample selections, response rates, and oversamples of minority groups. Basic descriptive data on the demographic, health, and socioeconomic attributes of respondents also are presented. Plans for future waves of AHEAD are described, including a next-of-kin interview for decreased respondents.
320 citations
TL;DR: There is a learning curve for laparoscopic-assisted colectomy with respect to intraoperative and postoperative outcomes, and surgeons who perform higher volumes of laparoscopically have lower rates of intraoperativeand postoperative complications.
Abstract: Background: Laparoscopic-assisted colectomy is an emerging technology for patients with cancer, polyps, inflammation, and other types of pathologic conditions. While previous studies have shown better outcomes for laparoscopic cholecystectomies when surgeons perform more procedures, there is no information on the relationship between surgeon volume and outcomes for laparoscopic-assisted colectomy. Objective: To evaluate whether better clinical outcomes are found for surgeons who perform higher numbers of laparoscopic-assisted colectomies and whether such a relationship, if it exists, applies to both intraoperative and postoperative outcomes. Design: Analysis of a data set of 1194 patients, operated on by 114 surgeons, from a prospective registry sponsored by the American Society of Colon and Rectal Surgeons, from May 1991 to October 1994. Main Outcome Measures: Completion rate, intraoperative and postoperative complications, and length of hospital stay. Results: In 75% of cases, surgery was completed laparoscopically, with no difference between high-volume surgeons (≥40 cases) and low-volume surgeons. Length of stay (average, 6 days) did not vary according to surgeon volume. Postoperative complications occurred in 15% of cases, with a significantly lower rate for high-volume surgeons (10% vs 19%; P P =.04) and postoperative complications (adjusted odds ratio, 0.48; 95% confidence interval, 0.34-0.68; P Conclusions: There is a learning curve for laparoscopic-assisted colectomy with respect to intraoperative and postoperative outcomes. As with other laparoscopic procedures, surgeons who perform higher volumes of laparoscopic-assisted colectomy have lower rates of intraoperative and postoperative complications. Arch Surg. 1997;132:41-44
308 citations
TL;DR: In this paper, an empirical model that allows for both bidder collusion and supply effects and in which they control for demand conditions is presented. But collusion is still dominant in determining the winning bids in the market.
Abstract: Allegations of Bidder collusion at Forest Service timber sales in the Pacific Northwest were common in the 1970s. Of course, prices may be low for reasons other than collusion. We formulate an empirical model that allows for both bidder collusion and supply effects and in which we control for demand conditions. Noncooperative behavior in which a single unit is sold (the standard auction model) is a special case: it is found to be definitively outperformed by a model of collusion. We also find that supply effects are dominated by collusion in determining the winning bids in the market.
303 citations
TL;DR: In this paper, the authors examine disparities in the ability to function among older Americans and find that there exist strong contemporaneous and long-run feedbacks from health to economic status, which is important to distinguish among alternative sources of income and the recipient of income in the household.
Abstract: In this paper we examine disparities in the ability to function among older Americans. We place special emphasis on two goals: (I) understanding the quantitatively large socioeconomic status-health gradient, and (2) the persistence in health outcomes over long periods. We find that there exist strong contemporaneous and long-run feedbacks from health to economic status. In light of these feedbacks, it is important to distinguish among alternative sources of income and the recipient of income in the household. This research also demonstrates that health outcomes at old age are influenced by health attributes of past, concurrent, and future generations of relatives. Finally, we find that the demographic and economic differences that exist among them explain functional health disparities by race and ethnicity, but not by gender.
299 citations
TL;DR: The leading health status instruments in human immunodeficiency virus (HIV) research are based on the pool of items developed as part of the Medical Outcomes Study (MOS), and there is substantial evidence for their reliability, construct and predictive validity and responsiveness.
Abstract: The leading health status instruments in human immunodeficiency virus (HIV) research are based on the pool of items developed as part of the Medical Outcomes Study (MOS). The measures include the SF-20, MOS-HIV, SF-36, SF-12, SF-56, SF-38 (Patient Reported Status and Experience Survey (PARSE)), SF-21 and HIV Cost and Service Utilization Study (HCSUS) questionnaires. The instrument length ranges from 12 to 56 items, covering two to 11 dimensions. Completion requires from 2 to 14 minutes. Subscales are scored on a 0-100 scale (a higher score indicates better health); physical and mental health or overall summary scores are available for most of the measures. Three of the instruments are available in multiple languages. The instruments have been administered to over 20,000 persons with HIV in descriptive studies and clinical trials and there is substantial evidence for their reliability, construct and predictive validity and responsiveness. In several studies the measures have shown important differences between treatments. Although existing measures do not assess all domains relevant to HIV disease, additional subscales are available from the MOS pool. Some of the subscales may be prone to floor and ceiling effects. However, summary scales that encompass all of the subscales reduce this issue. Selection among MOS measures should be dictated by specific questions, the balance of available time and resources, and practical concerns.
269 citations
TL;DR: Data on time and money transfers between generations in Malaysia is used to explore hypotheses about motives for intergenerational transfers within the family and finds evidence supporting the hypotheses that children are an important source of old age security and that old ageSecurity is, in part, children s repayment for parental investments in their education.
Abstract: In this paper we discuss a number of hypotheses about motives for intergenerational transfers within the family. We use data on time and money transfers between generations in Malaysia, where there is neither Social Security nor Medicare, to explore these hypotheses empirically. We find evidence supporting the hypotheses that children are an important source of old age security and that old age security is, in part, children s repayment for parental investments in their education. This repayment is partly a function of the children’s in come and, in the case of females, a function of their spouse’s in come. We also find evidence supporting the hypotheses that parents and children engage in the exchange of time help for money.
249 citations
TL;DR: Teenage violence typically coexists with additional emotional and behavioral problems and programs must consider the broader public health context in which violence occurs.
Abstract: OBJECTIVES: This study examined the prevalence of various violent behaviors among high school-age adolescents, the co-occurrence of teenage violence with other public health problems, and gender differences in violence. METHODS: Longitudinal data for more than 4500 high school seniors and dropouts from California and Oregon were used to develop weighted estimates of the prevalence of violent behavior and its co-occurrence with other emotional and behavioral problems. RESULTS: More than half the sample had engaged in violence during the last year, and one in four had committed predatory violence. Boys were more likely than girls to engage in most types of violence, but both were equally prone to violence within the family. Violent youth were more likely than their peers to have poor mental health, use drugs, drop out of school, and be delinquent. Violent boys were more likely than violent girls to commit nonviolent felonies and sell drugs, but less likely to have poor mental health or become a parent. Prev...
239 citations
TL;DR: It is concluded that fatalistic beliefs are among the factors that negatively influence Latinas' use of Pap smears and that it is important for health care professionals to address those beliefs.
TL;DR: In this article, a summary of the publication of the same title is presented, where the authors look at the personal and societal benefits of making e-mail accessible to the general public.
Abstract: E‐mail has swept the communications and information world. Can it be made accessible to everyone? If so, at what cost? And what would be the personal and societal benefits? This article, which is the summary of the publication of the same title, looks at these issues and is used by permission of the authors and the Rand Corporation. Although the issues looked at are within the context of research in the USA, there are international implications, and also the conclusions may well apply in many countries worldwide. References in the article to various ‘Chapters’ are to chapters in the full publication, details of which will be found in the Media Reviews section of this journal. francais: Le courrier electronique a envahi le monde des communications et de l'information. Peut‐il etre accessible a tous? Si oui, a quel prix? Et quels en seraient les benefices sociaux et personnels? Cet article est le resume de la publication portant le meme titre et utilise avec l'autorisation des auteurs et l...
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TL;DR: In this article, the authors used within-state variation in taxes over the 1989-1992 time period to test whether maternal smoking and birth outcomes are responsive to higher state cigarette taxes.
Abstract: This study uses within-state variation in taxes over the 1989-1992 time period to test whether maternal smoking and birth outcomes are responsive to higher state cigarette taxes. Data on the outcomes of interest are taken from the Natality Detail files, generating a sample of roughly 10.5 million births. The results indicate that smoking participation declines when excise taxes are increased. The elasticity of demand for cigarettes is estimated to be appro- ximately -0.25. In addition, estimates of two-part models suggest that taxes only alter the probability a mother smokes and not average daily consumption conditional on smoking. Reduced-form models also indicate that higher excise taxes translate into higher birth weights. These two sets of results can be used to form an instrumental variables estimate of the impact of smoking on birth weight. This estimate indicates that maternal smoking reduces average birth weight by 367 grams, which is remarkably close to estimates from random assignment clinical trials. It is important to note that as a policy tool to improve birth outcomes, cigarette taxes are a blunt instrument. Taxes will be imposed on all smokers, but the benefits received and costs imposed extend beyond the targeted population. Under the naive assumption that the only benefits of the tax are received in the form of improved birth outcomes, we find that an increase in the cigarette tax is not as cost effective in preventing low birth weight as other more targeted public policies such as the Medicaid expansions of the late 1980's.
TL;DR: In this paper, the authors describe the intellectual development and the empirical implications of the literature on the economics of fertility as it applies to fertility behavior in developed economies and discuss various solutions to the fundamental identification problems that arise in assessing the impact of prices and income on both lifetime and lifecycle fertility behavior.
Abstract: Publisher Summary This chapter describes the intellectual development and the empirical implications of the literature on the economics of fertility as it applies to fertility behavior in developed economies The chapter reviews the literature on dynamic models of fertility behavior over the parents' life cycle, and outlines the ways in which these models extend the static models and the implications that they provide for dimensions of fertility behavior The chapter also discusses various solutions to the fundamental identification problems that arise in assessing the impact of prices and income on both lifetime and lifecycle fertility behavior The theory and econometric methods are better developed than the empirical literature The challenge is to find plausibly exogenous variation in proxies for the price and income concepts appearing in the theories The chapter provides a taxonomy of possible identifying information and gives hope that additional progress can be made in advancing the empirical understanding of fertility behavior
TL;DR: The model is applied to an analysis of the covariates of child survival using survey data from northeast Brazil collected via a hierarchically clustered sampling scheme and finds that family and community frailty effects are fairly small in magnitude but are of importance because they alter the results in a systematic pattern.
Abstract: This article presents a multivariate hazard model for survival data that are clustered at two hierarchical levels. The model provides corrected parameter estimates and standard errors, as well as estimates of the intragroup correlation at both levels. The model is estimated using the expectation-maximization (EM) algorithm. We apply the model to an analysis of the covariates of child survival using survey data from northeast Brazil collected via a hierarchically clustered sampling scheme. We find that family and community frailty effects are fairly small in magnitude but are of importance because they alter the results in a systematic pattern.
TL;DR: In this paper, the authors investigate the role of private transfers in the transfer of resources among family members and friends in the context of government redistribution policies, and show that if public transfers merely supplant private transfers, they only increase the income of family members or friends who would have otherwise provided greater private support.
Abstract: Within the family workers are born goods are produced tastes are formed decisions to work are made and resources are redistributed. This paper investigates the last of these roles that is the transfer of resources (money and time help) among family members and friends. We are interested in private transfers because first they provide a means through which individuals can transmit their well-being to others. Second private transfers have potential consequences for the effectiveness of government redistribution policies. For example if publicly provided benefits to an individual become more generous then that individuals family members and friends may respond by decreasing the amount of private assistance they give to the individual. If public transfers merely supplant private transfers then in the extreme public transfers do nothing to alter the income of a program participant they only increase the income of family members or friends who would have otherwise provided greater private support. (excerpt)
TL;DR: It is concluded that if a generic measure of HRQOL is desirable for a given study of multiple sclerosis, additional information will be gained by supplementing that measure with selected scales.
TL;DR: It is suggested that the urban advantage in child survival does not simply reflect underlying differences in socioeconomic and behavioral characteristics at the individual and household levels; rather, community variables appear to play an independent and important role.
TL;DR: Analysis of variance supported the associations between readiness to obtain screening and opinions about mammography previously found in research using smaller samples from another geographic region, and it is recommended that future research examine whether opinions regarding the cons of mammography are more individually specific than the pros.
Abstract: This investigation extends prior research to apply decision-making constructs from the transtheoretical model (TTM) of behavior change to mammography screening. Study subjects were 8,914 women ages 50-80, recruited from 40 primarily rural communities in Washington State. Structural equation modeling showed that favorable and unfavorable opinions about mammography (i.e., pros and cons) fit the observed data. Analysis of variance supported the associations between readiness to obtain screening (i.e., stage of adoption) and opinions about mammography (i.e., decisional balance) previously found in research using smaller samples from another geographic region. This report extends these earlier studies by using structural equation modeling, opinion scales based both on principal component analyses and on a priori definitions, a developmental sample and a confirmatory sample, and by sampling from a different geographic region. It is recommended that future research examine whether opinions regarding the cons of mammography are more individually specific than the pros.
TL;DR: Assumptions used in last year's policy debate overstate actual managed care costs by a factor of 4 to 8, and the cost consequences of improved coverage under managed care, which by now accounts for most private insurance, are relatively minor.
Abstract: Objectives. —To study costs, access, and intensity of mental health care under managed care carve-out plans with generous coverage; compare with assumptions used in policy debates; and simulate the consequences of removing coverage limits for mental health care as required by the Mental Health Parity Act. Design. —Claims data from 1995 and 1996 for 24 managed care carve-out plans; all plans offered unlimited mental health coverage with minimal co-payments. Outcome Measures. —Probability of care, intensity of care, and total costs broken down by service type and type of enrollee. Results. —Assumptions used in last year's policy debate overstate actual managed care costs by a factor of 4 to 8. In the plans studied, costs are lower owing to reduced hospitalization rates, a relative shift to outpatient care, and reduced payments per service. However, access to mental health specialty care increased (7.0% of enrollees) compared with the preceding fee-for-service plans (6.5%) or free care in the RAND Health Insurance Experiment (5.0%). Removing an annual limit of $25000 for mental health care, which is the average among plans currently imposing limits, will increase insurance payments only by about $1 per enrollee per year. Children are the main beneficiaries of expanded benefits. Conclusions. —Concerns about costs have stifled many health system reform proposals. However, policy decisions were often based on incorrect assumptions and outdated data that led to dramatic overstimates. For mental health care, the cost consequences of improved coverage under manged care, which by now accounts for most private insurance, are relatively minor.
TL;DR: Having blurred vision more than once or twice a month has a detectable and significant impact on functional status and well-being, especially in role limitations due to physical health problems, as measured by the SF-36.
TL;DR: The initial number of depressive symptoms was greatest among depressed patients with comorbid anxiety and this relatively higher level persisted over two years, emphasizing the poor clinical prognosis associated with comorebid anxiety disorder.
TL;DR: Maternal age at delivery and race/ethnicity are independently and significantly associated with poor pregnancy outcomes such as low birthweight and premature births, however, young maternal age and race-ethnicity do not appear to interact in a manner that produces a differential effect on the birth outcomes assessed in this study.
TL;DR: In this article, the authors present empirical evidence from a study in technical work which challenges conventional wisdom about skills and skill requirements and has broad implications for school reform, which is relevant to our work.
Abstract: Changes in the modern workplace, brought about by technology and management innovations and by increased global competition, raise many concerns about the adequacy of workforce skills. In the US and elsewhere, these concerns have led to new ideas about skills, in particular the need for ‘generic skills’ like problem solving, teamwork, and communications. Many employers and policymakers in the US believe that these skills are necessary for work across most jobs and support school reforms to teach them. This article presents empirical evidence from a study in technical work which challenges conventional wisdom about skills and skill requirements and has broad implications for school reform.
TL;DR: It is demonstrated that, among elderly persons, insurance coverage for drugs reduces the fraction of household income spent on prescription drugs by 50 percent.
Abstract: Expenditures for prescription drugs are not covered by Medicare and are thus a potential source of large out-of-pocket expenditures for elderly persons. This study, using a new data source, the 1990 Elderly Health Supplement to the Panel Study of Income Dynamics (PSID), demonstrates that, among elderly persons, insurance coverage for drugs reduces the fraction of household income spent on prescription drugs by 50 percent. Groups most likely to benefit from insurance coverage are elderly women and those with common chronic conditions, low incomes, and rural residences.
TL;DR: A brief measure to screen for common conditions in older persons was associated with more frequent detection and follow-up assessment of hearing loss and did not appear to affect detection and intervention in regard to the other screen-included conditions, or health status at 6 months.
TL;DR: While most young Latino children in inner-city Los Angeles were eligible for Medicaid, a substantial proportion have episodic or no coverage, and insurance status and access are likely to worsen for these young children unless the wave of antiimmigration sentiments is held in check.
Abstract: Objectives. —To understand the role of parental immigration status on Medicaid enrollment and access to health services for young Latino children. Design. —A cross-sectional household survey of the parents of inner-city Latino children. Setting. —South Central and East Los Angeles, Calif, 1992. Population. —Children 12 to 36 months old and their parents from 817 Latino families. Main Outcome Variables. —Continuous Medicaid enrollment, continuity of care, deferral of care, and number of visits. Methods. —Univariate analysis, logistic and linear regression by demographic and socioeconomic characteristics, residency status, and language use. Results. —Children were primarily born in the United States (96%), but most parents were not citizens (80%). Only 40.0% of eligible children had continuous Medicaid coverage since birth, 18.6% had never been insured, and 20.7% had received episodic Medicaid coverage. Continuous Medicaid coverage was negatively associated with either the caregiver (odds ratio [OR],0.32; 95% confidence interval [CI], 0.19-0.56) or their partner (OR=0.33, 95% CI=0.20-0.55) working. Residency status, language preference, and length of US residency were not associated with continuous Medicaid enrollment. Insurance coverage was associated with more physician visits, greater continuity of care, and fewer deferrals of care. Conclusion. —While most (84%) young Latino children in inner-city Los Angeles were eligible for Medicaid, a substantial proportion (39.3%) have episodic or no coverage. Insurance status and provider type were more consistently associated with access rather than residency and language preference. In the aftermath of California's Proposition 187 and federal welfare reform, insurance status and access are likely to worsen for these young children unless the wave of anti-immigration sentiments is held in check.
TL;DR: The increase in uncompensated care levels after 1988 appears not to have kept pace with growth in hospital expenses or the number of uninsured, however, the trend data do not suggest a large-scale reduction of effort.
Abstract: This DataWatch examines national trends in the provision of uncompensated hospital care. It shows that rapid growth from 1983-1986 was followed by modest growth through 1990, a time during which managed care was becoming established in some regions. There was then another spurt in uncompensated care from 1991-1993, a period that corresponds to sizable increases in disproportionate-share payments. Uncompensated care growth again slowed through 1995. The increase in uncompensated care levels after 1988 appears not to have kept pace with growth in hospital expenses or the number of uninsured. However, the trend data do not suggest a large-scale reduction of effort.
TL;DR: These California primary care physicians were less satisfied with the quality of care they deliver to patients covered by capitated contracts than with thequality of careThey deliver to Patients covered by other payment sources, but those in medical group practices and with a higher percentage of capitated patients were more satisfied with capitated care.
Abstract: Context. —Managed care and capitation have placed new responsibilities on primary care physicians, including formally acting as "gatekeepers" for specialty services and tests. Previous studies have not examined whether primary care physicians who provide services to patients under many coverage arrangements feel differently about caring for patients covered under capitation vs those covered through more traditional forms of insurance. An understanding of whether California primary care physicians feel that they deliver a different level of quality to capitated patients could help signal whether variations in care for patients with different coverage forms are evolving. Objective. —To evaluate whether primary care physicians in California capitated groups report different satisfaction levels with quality of care for patients in their overall practice than for patients covered by capitated contracts and to examine whether physicians' satisfaction with capitated care quality is influenced by the characteristics of the practice setting. Design. —Cross-sectional questionnaire. Setting. —A total of 89 California physician groups with capitated contracts. Participants. —A total of 910 primary care physicians (80% response rate). Main Outcome Measure. —Satisfaction with 4 aspects of quality of care provided to patients covered by capitated contracts vs patients overall. Results. —Physicians reported lower satisfaction with all 4 aspects of care for patients covered by capitated contracts than for patients in their overall practice: 71% were very or somewhat satisfied with relationships with capitated patients (compared with 88% for overall practice), 64% were very or somewhat satisfied with the quality of care they provided to capitated patients (compared with 88% for overall practice), 51% were very or somewhat satisfied with their ability to treat capitated patients according to their own best judgment (compared with 79% for overall practice), and 50% were very or somewhat satisfied with their ability to obtain specialty referrals (compared with 59% for overall practice) (P≤.001 for all comparisons). Being in a medical group practice (vs an independent practice association) and having a larger percentage of capitated patients were independently associated by multivariate analysis with higher levels of satisfaction with capitated quality of care ( P ≤.005). Conclusions. —These California primary care physicians were less satisfied with the quality of care they deliver to patients covered by capitated contracts than with the quality of care they deliver to patients covered by other payment sources. However, those in medical group practices and with a higher percentage of capitated patients were more satisfied with capitated care. National expansion of capitation should be accompanied by efforts to ensure that the satisfaction of practicing physicians with the care they deliver does not decline.
TL;DR: Women with high parity status, a history of an infant's death, and an early first pregnancy may be at greater risk of poor health in later life.
Abstract: OBJECTIVES: This paper describes the relationship between self-reported general health status and several facets of reproductive history. METHODS: We analyzed survey data on a national probability sample of 1341 women aged 50 and older from the Panel Study of Income Dynamics. We used multivariate regression techniques to control for differences in health indices that assessed health status and functioning. RESULTS: Women with a history of six or more completed pregnancies were found to be disadvantaged in educational attainment, financial resources, and health status compared with women with no or fewer pregnancies. When current sociodemographic factors were controlled, six or more pregnancies were associated with worse general health and worse physical role functioning. When sociodemographic factors and number of births were controlled, among women with at least one delivery, women who had experienced an infant's death reported worse health as measured by all three indices. Women with a first delivery be...