RAND Corporation

About: RAND Corporation is a nonprofit organization based out in Santa Monica, California, United States. It is known for research contribution in the topics: Health care & Population. The organization has 9602 authors who have published 18570 publications receiving 744658 citations.

The Persistence of Race and Ethnicity in the use of Long-Term Care

Abstract: We examine the use of nursing homes, formal personal care, informal Activities of Daily Living (ADL) assistance, and no care to identify racial differences in their use. Using the 1987 National Medical Expenditure Survey of both nursing homes and the community, multinominal logistic regressions controlled for predisposing, enabling, and need variables as well as other types of service use. Additional state-level variables make few changes in race/ethnicity parameters, indicating that race/ethnicity are not simply proxies for state-level variables. Older African Americans are less likely to use nursing homes than similar whites, with the lower institutionalization replaced by a higher use of paid home care, informal-only care, and no care. This suggests that formal in-home community care is not fully compensating for the racial differences in nursing home use. Persistent effects of race/ethnicity could be the result of culture, class, and/or discrimination that may impair equitable access to services.

Measurement of Acculturation in a Community Population of Mexican Americans

Abstract: A 26-item acculturation measure was administered to a probability sample of 1245 adult Mexican Americans residing in Los Angeles. This measure demonstrated high internal reliability for the total sample and for specific sex, educational, and language groups. Construct validity was supported by showing acculturation scores predicted length of exposure to U.S. culture. Data suggested that, among first generation Mexican Americans, those who were younger and male acculturated more rapidly than those who were older and female. This sex difference, but not the age difference, could be explained by educational and employment experiences. Among later generation Mexican Americans, those who were younger again had higher acculturation levels, possibly due to age differences in education and employment, or to historical factors differentially effecting age cohorts.

Theory Testing in a World of Constrained Research Design

Abstract: Because censored sampling is often unavoidable in much sociological data analysis, computationally simple corrections of censoring bias would be useful. Heckman's correction is simple to compute, w...

Reducing the societal burden of depression: a review of economic costs, quality of care and effects of treatment.

Abstract: Depression is a highly prevalent condition that results in substantial functional impairment. Advocates have attempted in recent years to make the ‘business case’ for investing in quality improvement efforts in depression care, particularly in primary care settings. The business case suggests that the costs of depression treatment may be offset by gains in worker productivity and/or reductions in other healthcare spending. In this paper, we review the evidence in support of this argument for improving the quality of depression treatment. We examined the impact of depression on two of the primary drivers of the societal burden of depression: healthcare utilisation and worker productivity. Depression leads to higher healthcare utilisation and spending, most of which is not the result of depression treatment costs. Depression is also a leading cause of absenteeism and reduced productivity at work. It is clear that the economic burden of depression is substantial; however, critical gaps in the literature remain and need to be addressed. For instance, we do not know the economic burden of untreated and/or inappropriately treated versus appropriately treated depression. There remain considerable problems with access to and quality of depression treatment. Progress has been made in terms of access to care, but quality of care is seldom consistent with national treatment guidelines. A wide range of effective treatments and care programmes for depression are available, yet rigorously tested clinical models to improve depression care have not been widely adopted by healthcare systems. Barriers to improving depression care exist at the patient, healthcare provider, practice, plan and purchaser levels, and may be both economic and non-economic. Studies evaluating interventions to improve the quality of depression treatment have found that the cost per QALY associated with improved depression care ranges from a low of $US2519 to a high of $US49 500. We conclude from our review of the literature that effective treatment of depression is cost effective, but that evidence of a medical or productivity cost offset for depression treatment remains equivocal, and this points to the need for further research in this area.