Showing papers by "Urban Institute published in 1984"

Variation in the Growth and Incidence of Medical Malpractice Claims

Abstract: This study analyzes the incidence of medical malpractice claims since 1976, using data drawn from the 1982 core survey of the American Medical Association's Socioeconomic Monitoring System. The data show that, on average, physicians incurred twice as many claims per year in the years 1976 to 1981 as they did during their careers prior to that period. Using Tobit analysis, we find the annual frequency of claims to be greater among surgeons, obstetricians and gynecologists (OBGs), physicians in group practice, and physicians in states which apply the legal doctrine of informed consent. In addition, we find that the number of years since medical residency is positively related to physicians' claims incidence during the first 27 years of practice, and that OBGs and medical specialists who spend more time with their patients per office visit incur fewer claims.

Poor People and Poor Hospitals: Implications for Public Policy

Abstract: In 1980, while most hospitals were in reasonably good financial health, hospitals heavily involved in serving the poor ran a considerable risk of financial trouble. Fewer than 9 percent of the nation's hospitals accounted for 40 percent of the nation's total care to the poor. These hospitals, almost half of which were in the 100 largest cities, not only devoted more of their care to the poor than other hospitals, they also served substantially smaller proportions of privately-insured patients. The result was that one-third of these hospitals--by themselves accounting for over 15 percent of all care to the poor--ran deficits in 1980. Using data from a 1980 survey of nonfederal, nonprofit hospitals, this paper examines the fiscal situation of hospitals heavily involved in serving the poor. The analysis shows that it is insufficient revenues, not inefficiency or underuse, that creates these hospitals' financial problems. The article concludes with an assessment of several policies that could be adopted to alleviate this financial pressure and sustain care to the poor.

Housing Older America

Abstract: An underlying goal of government involvement in the housing sector is to promote the well-being of the population. This goal, which became a legislative mandate with the call for “a decent, safe, and sanitary dwelling for every American” in the 1937 Housing Act, is based on the presumption that housing conditions have significant effects on the health and welfare of the citizenry. The implied logic of this relationship is that if deleterious conditions are identified, government programs can be developed to eliminate or counteract them. Efforts to achieve this goal have taken many forms. Two prominent examples are construction and rehabilitation programs to improve housing conditions and rent subsidy programs that reduce the burden of housing costs for the poor.

Changes in the Housing Situation of the Elderly

Abstract: This paper presents results of a careful examination of the changes in the housing circumstances of the elderly over the 1974-79 period, using data from the Annual Housing Survey. The focus is on both the quality of housing occupied and the level of income devoted to housing. The outcomes show that among elderly households there has been substantial and widespread improvement in housing quality especially the incidence of serious structural defects. Improvements in housing quality appear to be achieved by the elderly expending more of their incomes for housing. This however may be a temporary problem due to several factors. Stabilized energy prices, reduced inflation, and a rental building surge fostered by the provisions of the Economic Tax Recovery Acy of 1981 may offer some relief.

Comment on Mitra’s generalization

Abstract: In a recent article in this journal, Mitra (1983) extended work by Espenshade, et al. (1982) who examined the long-run implications for population size and composition if below-replacement fertility rates remain fixed in the face of a constant influx of immigrants. By differentiating the fundamental renewal equation for annual births, Mitra developed a unified framework for studying the existence of long-term equilibrium solutions when constant annual immigration is combined with fertility rates that are below, at, or above replacement. When fertility is below replacement, Mitra confirmed the conclusion reached by Espenshade et al. showing that a stationary population is the long-run outcome. He showed that annual births, and therefore total population, grow linearly if fertility is at replacement. For fertility above replacement, Mitra found that population growth rates tend asymptotically to the intrinsic rate they would exhibit in the absence of immigration. In the case where fertility is below replacement, it would be more accurate to say that Espenshade et al. have generalized Mitra's results. Mitra assumes that immediately upon their arrival, immigrant women adopt the fertility behavior of native born women. Espenshade et al. have shown that a stationary population will materialize in the long run even if immigrant women and successive generations of their descendants have fertility above replacement. All that is needed for a stationary population to result is that, at some point in the chain of immigrant descendants, one generation and all those following it must adopt belowreplacement fertility. Moreover, in the case where fertility is at replacement and a constant number of immigrants is assumed to enter the population each year, Ansley Coale (1972) preceded Mitra in showing that population growth will be linear in equilibrium. In the last part of his paper, Mitra studies a population with two homogeneous groups, one having fertility rates above replacement and one with fertility rates below replacement. He then examines "the mechanisms by which the growing population may adopt the reproductive norms of the declining population to result in the eventual stationarity of both groups" (113). It is not entirely clear how this section of Mitra's paper relates to his previous results on immigration. To link the two, it is useful to introduce migration explicitly into the analysis. To do so, imagine a closed population of females divided into two separate geographic regions. Suppose that women with below-replacement fertility reside in the north and those with fertility above replacement live in the south. Let mH(a) and mL(a) be the age-specific fertility schedules of the high and low fertility women, respectively. Assume that both regions are characterized by the same force of mortality schedule, yd(a). Assume further that women from the south can migrate to the north (but not vice versa), and that they migrate at a rate which is constant through time, but not necessarily across age. Once in the north, these migrant females take on the fertility schedule mL(a). The rate at which women move from the high fertility area to the low fertility one is formally equivalent to Mitra's concept of the rate at which high fertility women adopt the reproductive norms of the other group. Suppose we represent the rate of out-