Showing papers by "Urban Institute published in 1988"

Access to Kidney Transplantation: Has the United States Eliminated Income and Racial Differences?

Abstract: • We analyzed the effect of patient and dialysis unit characteristics on access to kidney transplantation using several different approaches, including an analysis of individual patient data from a systematic random sample of 2900 new dialysis patients from each year 1981 to 1985 (14721 patients total). Additional analyses focused on the composition of transplant waiting lists and aggregate data from a 1984 census of 1133 dialysis and transplant units. White, male, young, nondiabetic, high-income patients treated in smaller units are more likely to receive a cadaver transplant under Medicare than are other kidney patients. Profit status of the dialysis unit was not found to be correlated to access to transplantation, although size of the unit may be correlated to access. Future analysis should focus on whether patient access has been inappropriately compromised. Possible factors unexplored in this analysis include differential patient preferences and medical suitability, as well as differential medical access. (Arch Intern Med1988;748:2594-2600)

Coping Strategies and Recovery from Rape

Abstract: A substantial body of research has developed in recent years documenting the immediate and short-term (up to one year) symptomatic reactions to a rape experience.’.’ Much less work has been done on long-term patterns of response, and even less research has directly addressed the coping strategies women use as they struggle to come to terms with the rape experience over the years after acute symptoms wane, or the relationship between coping efforts and the recovery process. Burgess and Holmstrom’s work”‘ is a rare exception; Meyer and Taylor’ have recently published results of a new study that adds to our understanding of coping patterns following rape. In this paper we present a set of coping scales derived from our research data on the coping patterns found in 113 women who are 1 to 14 years postrape; initial reports of these data have previously been presented. The selection of items for our questionnaire, as well as our interpretation of results, are informed by previous theoretical and empirical research, some of which we will review. Our primary interest lies in systematically documenting the real patterns that are observed in women as they cope with rape over time, and specifically as their recovery progresses. Doing so should enable us to identify the most adaptive coping approaches and to utilize this information in counseling rape victims. In addition, this information will add to our understanding of the dynamics of the recovery process. In studying coping efforts, it is important to define what we are talking about. We view “coping” as comprising efforts made in response to stimuli experienced as threatening or stressful-efforts aimed both at reducing the anxiety that those stimuli create and at reducing the interference of the stimuli with one’s capacity to function. Lazarus and Folkman’ divide coping strategies into two large domains-problemfocused and emotion-focused coping. Problem-focused coping is directed at helping the person manage or solve the problem, and can involve strategies directed at the environment (e.g., altering environmental pressures, barriers, resources, procedures) and also strategies directed inward (e.g., learning new skills, developing new standards of behavior, or changing one’s level of aspiration). Women who have been raped may have used problem-focused coping strategies during the rape itself, and may also define the process of recovery in such a way that the future represents a series of tasks to get through or accomplish. Cast in the light of problem-focused coping, recovery is seen largely as a performance to be achieved. Emotion-focused coping strategies are directed at helping the individual accept or

Implications of boundary choice for the measurement of residential mobility.

Abstract: Analyses of residential mobility are usually conditioned on a system of geography in which territory is divided into discrete units. Types of movement are defined in terms of these units, the most important distinction being that between local mobility and migration. Here we examine explicitly the implications of the choice of the migration-defining boundary in the U.S. over the 1940–1980 period. We demonstrate how boundary choice influences the extent and character of selectivity of the mobile population by using demographic and social characteristics. It appears that over time the state line may be replacing the county line in distinguishing kinds of migrants. Further, our results point to a growing fraction of footloose migrants, not tied to local territory, identified by their migration history rather than demographic characteristics.

HMO enrollment and Medicaid. Survival analysis with a Weibull function.

Abstract: This paper analyzes the length of enrollment in Health Maintenance Organizations (HMOs) by performing secondary data analysis. It estimates a Weibull survival function using only simple regression. For middle-class enrollees in one HMO, the hazard rate (the disenrollment rate for the remaining members of a cohort) falls sharply with the length of enrollment. For medicaid beneficiaries allowed to remain in the fee-for-service sector, the hazard rate in another HMO is much greater but falls less sharply. Limiting the choice of Medicaid beneficiaries to HMOs would increase their length of enrollment, lowering a major barrier to HMOs' participation in Medicaid.

Evaluation of College Level Coursework for the Gifted Adolescents: An Investigation of Epistemological Stance, Knowledge Gain and Generalization

Abstract: The investigation evaluated the proximal and distal effects of an innovative course of study, a college level Introductory Psychology course which was offered to precocious adolescents in a three-w...

Crash costs and safety investment

Abstract: Injury crashes cost society more than $34 billion annually. Expending up to $2.3 million to prevent one fatal crash appears to be rational public policy, although the crash costs society only $500,000. Prevention of severe, nonfatal head and spinal cord injuries warrants even larger expenditures. The estimated rational investment to prevent an average nonfatal injury crash is $22,000, while society's cost is $8,000. Rational investment levels for increased safety are estimated by summing the amount individuals typically pay for small increases in their safety and the cost the rest of society bears when someone is killed or injured, including transfer payments.

Kinship patterns and household composition: older unmarried Hungarian women, 1984.

Abstract: Household composition of older unmarried women in Hungary is analyzed using data from the 1984 microcensus. The principal determinants of household composition investigated are kin availability — the number of living children, siblings, and parents — health status, marital status, age, and income. A multinomial logit model distinguishing among five household types reveals that number of children, severe disabilities, age and income are all strongly related to household composition. Trends in fertility and mortality patterns suggest that kinship patterns will change in coming years; these results imply that household composition will, in turn, change as well.

The impact of alternative hospital payment systems on Medicaid costs.

Abstract: From 1982 onward, 25 states adopted three broad strategies to control their Medicaid hospital costs: multiple-payer rate setting, Medicaid-only prospective payment, and selective contracting. In this analysis of the three approaches, I found that the multiple-payer systems were particularly effective at controlling Medicaid payments because of their ability to control statewide hospital costs. The Medicaid-only prospective payment systems were also successful, but appear to be effective only in the short term. California's Medicaid-only selective contracting program was also successful, largely because of the simultaneous implementation of cost-control incentives for all hospitals in the state. I also found sharp reductions in Medicaid admissions where rates were set low relative to costs, as well as a shift in Medicaid admissions to public hospitals in Medicaid-only prospective payment states.

Human organ transplantation

Abstract: Human organ transplantation: Societal, medical‐legal, regulatory, and reimbursement issues. Edited by Cowan, D., Kantorowitz, J., Moskowitz, J., and Rhein‐Stein, P. (Health Administration Press, Ann Arbor, Michigan, 1987), 458 pages, $34.00.