Showing papers by "Urban Institute published in 1989"
TL;DR: New data from the 1988 National Survey of Adolescent Males indicate that 60 percent of never-married young men ages 15-19 are sexually active, and rates of condom use were significantly lower than average among young men who had ever used drugs intravenously or whose partners had done so, young menwho had ever had sex with a prostitute and those who had had five sexual partners or more in the past year.
Abstract: New data from the 1988 National Survey of Adolescent Males indicate that 60 percent of never-married young men ages 15-19 are sexually active Among 17-19-year-old males living in metropolitan areas, the rate of sexual activity reported in 1988 was 15 percent higher than that reported in 1979 This increase encompasses a rise of 23 percent among black males and 13 percent among nonblack males Slightly more than half of the sexually active males in the 1988 survey reported that they had used a condom the last time they had had intercourse Among both black and nonblack youths aged 17-19 living in metropolitan areas, rates of reported condom use at last intercourse more than doubled between 1979 and 1988 Conversely, reported reliance on ineffective methods of contraception or use of no method at last intercourse was 60 percent lower When first intercourse occurred within two years of the 1988 survey, the odds of using a condom were increased by 110 percent over the odds when intercourse occurred between 1975 and 1982, after controlling for the effects of age at first intercourse, race and ethnicity The young men in the sample were very knowledgeable about how the human immunodeficiency virus is transmitted, and over three-quarters of the sample did not dismiss the disease as uncommon, nor did they think that using condoms to prevent the spread of AIDS was too much trouble The rates of condom use were significantly lower than average, however, among young men who had ever used drugs intravenously or whose partners had done so, young men who had ever had sex with a prostitute and those who had had five sexual partners or more in the past year
328 citations
TL;DR: In this paper, the authors present descriptive data for single women and women with children, and contrast it to parallel data of single homeless men, with implications for both the probable causes of their homelessness and preventive and ameliorative efforts.
Abstract: This article presents descriptive data for homeless single women and women with children, and contrasts it to parallel data for single homeless men. It explores demographic characteristics (race, age, marital status, household composition and education), length of current spells of homelessness and joblessness, income and income sources, history of personal problems (mental illness, chemical dependency, criminal justice involvement), patterns of utilization of soup kitchens and shelters, and diet adequacy. The data base for these comparisons is 1,704 in-person interviews from the first national study of homeless individuals that uses probability sampling, and therefore has the capacity to develop generalizations about a known universe of the homeless that transcends unique conditions in single cities. The study's population is homeless adults who use soup kitchens and shelters in U.S. cities of 100,000 or more. The results indicate that homeless single women, homeless women with children, and homeless men differ significantly on many variables, with implications for both the probable causes of their homelessness and preventive and ameliorative efforts.
222 citations
TL;DR: The authors used data from the Survey of Income and Program Participation to estimate durations of poverty spells and to determine whether temporarily poor families have sufficient assets to cover the shortfall of their incomes below poverty-their personal poverty gaps.
Abstract: This paper uses data from the Survey of Income and Program Participation to estimate durations of poverty spells and to determine whether temporarily poor families have sufficient assets to cover the shortfall of their incomes below poverty-their personal poverty gaps. If poverty is measured using monthly rather than annual income data, four times as many persons enter poverty, but most spells are short: the median duration is between four and six months. More than one-third of all poverty spells are eliminated if financial assets are used to fill poverty gaps, but remaining poverty spells are longer. Separate estimates are made for the elderly and for families with children.
90 citations
TL;DR: The 1981-1982 National Long-Term Care Channeling Demonstration Project data revealed that the mean annual cost per capita for home and institutional care for cognitively impaired persons was +18,500, whereas the equivalent figure for Cognitively intact persons was -16,650.
Abstract: The 1981-1982 National Long-Term Care Channeling Demonstration Project data revealed that the mean annual cost per capita for home and institutional care for cognitively impaired persons was +18,500. The equivalent figure for cognitively intact persons was +16,650. Cognitively impaired persons used nursing homes at twice the rate of cognitively intact persons. Use differences for other health services were slight. A pre- and post-nursing home admission analysis indicated that for the cognitively impaired the annual cost of community care was +11,700, whereas the cost of nursing home care was +22,300.
62 citations
TL;DR: 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.
53 citations
TL;DR: In this article, the authors used census tract data to examine recent trends in residential segregation by race and found that the growing tendency toward more segregated living patterns, which characterized most of the postwar period, has been reversed.
50 citations
TL;DR: It appears that reimbursements may be sufficient only in nursing homes that specialize in Medicare beneficiaries, and access of Medicare beneficiaries to the nursing homes will remain limited unless reimbursements are brought in line with costs.
45 citations
01 Jan 1989
TL;DR: The authors showed that the intrinsic structure of population dynamics may also induce the positive association between rates of in-migration and outmigration across locations, and developed a formal model of this process.
Abstract: A positive association between rates of in-migration and out-migration across locations has long been observed. This apparent paradox has usually been attributed to the impact of in-migration on population composition. We argue here that the intrinsic structure of population dynamics may also induce this effect, and we develop a formal model of this process. Empirical analyses using migration data for states in the U.S. over 1955–1960, 1965–1970, and 1975–1980 show that the intrinsic mechanism may swamp the compositional effect.
32 citations
28 citations
TL;DR: Data from the 1982 and 1984 National Long-Term Care Surveys were used to track a cohort of disabled elderly persons residing in the community in 1982 over the 2 years that followed, and persons who entered nursing homes had a 4- to 5-fold risk of spending down to Medicaid eligibility.
Abstract: Presented are results of a descriptive analysis of the effects of nursing home use on Medicaid eligibility status. Data from the 1982 and 1984 National Long-Term Care Surveys were used to track a cohort of disabled elderly persons residing in the community in 1982 over the 2 years that followed. Although 12% spent some time in nursing homes between 1982 and 1984, about 40% was for short stays. In contrast to persons who did not use nursing homes, persons who entered nursing homes had a 4- to 5-fold risk of spending down to Medicaid eligibility.
25 citations
TL;DR: Two promising approaches for dealing with ANDs are increasing nursing home reimbursement rates, and adjusting Medicare payments for exceptionally long-staying patients or those requiring exceptionally intensive care in hospitals.
Abstract: Days that a patient remains in a hospital due to inability to secure nursing home placement are termed administratively necessary days (ANDs). Some hospitals under Medicare's prospective payment system have incurred discharge delays of this kind. Nursing home bed supply is one major problematic factor; others include adequacy of Medicare nursing home reimbursement rates relative to nursing home costs in an area, the willingness of facilities in an area to serve those needing skilled care, and stringency of relevant Medicaid reimbursement policy. Two promising approaches for dealing with ANDs are increasing nursing home reimbursement rates, and adjusting Medicare payments for exceptionally long-staying patients or those requiring exceptionally intensive care in hospitals.
TL;DR: Significant differences in behavior are found according to region of residence, educational level, age, degree of disability, work experience, and pension receipt, which indicates the importance of family as a source of help and/or co-residence in situations of need.
Abstract: Population aging in Italy is, as in many other industrialized countries, disproportionately a phenomenon associated with unmarried women, mainly widows. This paper examines the extent to which older unmarried women live alone, and the extent to which they receive help in everyday tasks from others outside their households, using data from a large Italian household sample survey conducted in 1983. Older women can either live alone or with others, and may or may not receive external help in either case; thus there are four distinct combinations of outcomes analyzed. In both descriptive, bivariate analysis and a multivariate model of the outcomes we find pronounced differences in behavior according to region of residence, educational level, age, degree of disability, work experience and pension receipt. The findings indicate the importance of family as a source of help and/or coresidence in situations of need.
TL;DR: In this article, the authors argue that the United States has entered a new era of competitive federalism with federal, state and local governments locked in a competitive struggle for taxpayer resources and support.
Abstract: This article challenges the prevailing view of increasing political and fiscal centralization in the federal government. Since 1978, the authors argue, the nation has entered a new era of “Competitive Federalism” with federal, state and local governments locked in a competitive struggle for taxpayer resources and support. The new era has emerged largely because of the loss of the tremendous fiscal advantage held by the federal government during its centralization period, 1929 to 1978. Although “deregulated” and free to move into any area of domestic policy, the federal government is constrained by necessary budget pressures and a “reformed” income tax structure. Competitive Federalism has emerged as a new balancing force between Washington, D.C. and the fifty state-local governments and will govern the federal system for the foreseeable future.
TL;DR: In this paper, the determinants of the likelihood of recent home purchasers actually obtaining a loan from a formal finance institution were analyzed and it was found that buyers in rural areas are much less likely to obtain such loans than those in urban areas.
Abstract: The role of housing finance in actualizing housing demand is widely appreciated. Many developing nations have established special institutions in an attempt to assure that adequate volumes of financing are made available. Jordan offers an especially interesting case because the Jordan Housing Bank has the resources to serve almost any number of applicants at highly competitive rates. In addition, several other formal lenders make mortgage loans as do some government programs. This paper analyzes the determinants of the likelihood of recent home purchasers actually obtaining a loan from a formal finance institution. We find that purchasers in rural areas are much less likely to obtain such loans. In urban areas, the probability of using formal finance rises steadily with income. Also in urban areas, a household that purchases a unit that is an addition to an existing structure is much more likely to obtain formal financing than an otherwise similar household.
Journal Article•
TL;DR: In this article, the authors suggest that the Federal Employees Health Benefits Program (FEHBP) should self-insure, competitively select third-party administrators (TPAs), one for each region of the country, aggressively manage program costs through pre-admission certification and DRGs, and allow Medicare-eligible annuitants to enroll in Medicare HMOs and receive the government contribution.
Abstract: The Federal Employees Health Benefits Program (FEHBP) needs to contain its costs. This paper recommends reforms of FEHBP that would substantially lower costs. As a first step, FEHBP should offer each employee a high and low option from a single conventional carrier, plus several HMO alternatives. FEHBP's practice of offering employees a choice of conventional carriers is virtually unheard of in the private sector. Cost control is more likely when carriers compete for employment groups rather than for individual employees. In addition, my analysis suggests that FEHBP should self-insure, competitively select third-party administrators (TPAs), one for each region of the country, aggressively manage program costs through preadmission certification and DRGs, and allow Medicare-eligible annuitants to enroll in Medicare HMOs and receive the government contribution. All of these reforms have been successfully implemented elsewhere, either by private employers or state or federal governments. These reforms would yield savings of at least $500 million annually for taxpayers and additional savings for federal employees.
TL;DR: In this article, the authors examine the sources of support for services for the homeless and delineate the extensive role of the private sector in both funding and actually delivering shelter, meal, and other services.
Abstract: This article examines the sources of support for services for the homeless. It delineates the extensive role of the private sector in both funding and actually delivering shelter, meal, and other services for the homeless. It also indicates the extent to which certain states are providing financial support for homeless services, and the relation of new federal efforts through programs funded by the Stewart B. McKinney Homeless Assistance Act to state and private activities.
Journal Article•
TL;DR: Improvements in the location adjustment now used in Medicare's payment formula to HMOs are considered, which suggests modifying the current payment by having one payment rate for the core of each metropolitan area and another for the ring.
Abstract: This article considers improvements in the location adjustment now used in Medicare's payment formula to HMOs. Average Medicare expenditure increases with metropolitan area population size and is higher in the urban core of a metropolitan area than in the suburbs. Input prices rather than the health or poverty status of residents appear to be the major cause of these patterns. At present Medicare payment to HMOs varies by county and is proportionate to Medicare fee-for-service expenditures there. The article suggests modifying the current payment, which depends on the county unit, by having one payment rate for the core of each metropolitan area and another for the ring. In areas where HMO penetration is large, payment should be based on Medicare expenditures in areas with similar characteristics, such as population size and wages. Because these proposals are incremental, they are politically feasible.
TL;DR: As the nursing-home market loosens (i.e., beds per elderly increases), hospital costs fall, presumably because discharging patients to nursing homes becomes easier, and when Medicaid prospectively reimburses nursing homes, hospital costs increase.
Abstract: When patients remain in the hospital because no room can be found for them in nursing homes, the additional days are called administratively necessary. This study examines the impact of administratively necessary days on hospital operating costs. With the hospital as the unit of analysis, cost is regressed on hospital characteristics. While administratively necessary days are not measured directly, independent variables include determinants of administratively necessary days, such as nursing-home bed supply and nursing-home reimbursement. Three findings are noteworthy: 1) as the nursing-home market loosens (i.e., beds per elderly increases), hospital costs fall, presumably because discharging patients to nursing homes becomes easier; 2) when Medicaid prospectively reimburses nursing homes, hospital costs increase; and 3) having its own skilled nursing facility lowers a hospital's acute-care costs in tight nursing-home markets but not loose ones.
TL;DR: In this article, the authors describe the rental market in Indonesia based on the results of 60 semi-structured renter-related interviews and find that the typical rental property owner is less motivated by profit accumulations than by the security of a steady supplemental income and the possibility of a future unit for his children.
Abstract: Rental housing is increasingly acknowledged as a valuable housing solution in developing countries and is therefore becoming a focus for policy discussions. This paper describes the rental market in Indonesia based on the results of 60 semi-structured renter-related interviews. It appears that the rental subsector is housing a large and highly varied portion of the urban population quite effectively. The results of this survey indicate that rental units are generally produced on a small scale on or near the same property as the owner's home. The unit construction occurs in increments as funds become available and is rarely financed formally. This represents an easy and flexible form of investment for a group otherwise generally uninterested in placing savings in formal institutions. The typical rental property owner is less motivated by profit accumulations than by the security of a steady supplemental income and the possibility of a future unit for his children. As a result, tenant-landlord relationships tend to be quite casual and family-like, unlike the exploitative relationship often described. Further studies need to explore how future policy could support the activities of the Indonesian rental market and improve the quality of rental units that are being produced.
01 Jan 1989
TL;DR: The Integrated Urban Infrastructure Development Program (IUIDP) as discussed by the authors is a promising approach for urban management in the developing world, which aims to address the gap between developing countries' urban infrastructure requirements and the funds available to pay for them.
Abstract: We are all familiar with the sizeable gap that exists between developing countries’ urban infrastructure requirements and the funds those countries have available to pay for them — a gap that has certainly widened in the troubled economic environment of the 1980s. Financing, however, is not always the binding constraint. Around the world today there are many funded projects that are not moving ahead simply because there is no one available to manage them. More broadly, the lack of trained managers is constraining the expansion of all basic urban government functions in the face of the unparalleled growth of the cities and towns in the developing world. This problem is one of the major barriers to the “replicability” of innovations in urban development (Cohen, 1983) This paper assesses the scope and future of the urban management challenge and describes a promising approach now being implemented in Indonesia: the Integrated Urban Infrastructure Development Program (IUIDP).
01 Jan 1989
TL;DR: The magnitude of the housing problems in developing countries is well-known in general and in the past few years they have been quite accurately documented in about twenty nations using the Housing Needs Assessment Model developed by the US AID Office of Housing and Urban Programs as discussed by the authors.
Abstract: The magnitude of the housing problems in developing countries is well-known in general and in the past few years they have been quite accurately documented in about twenty nations using the Housing Needs Assessment Model developed by the US AID Office of Housing and Urban Programs. A recent study estimates that developing countries as a group must produce about 45 million additional units of minimally acceptable quality each year in the years immediately ahead if they are to meet their housing needs. The rough estimate of the corresponding annual investment is $130 billion or about 5.8 per cent of their combined Gross National Product. Low-income countries, as defined by the World Bank, must produce two-thirds of the housing units at a cost of about $24 billion (Struyk, 1987, Annex E).