Showing papers by "Urban Institute published in 1994"

Attitudes toward male roles among adolescent males: A discriminant validity analysis.

Abstract: This study investigates the discriminant validity of a measure of attitudes toward male roles, i.e., beliefs about the importance of men adhering to cultural defined standards for masculinity. Using data from the 1988 National Survey of Adolescent Males, the Male Role Attitude Scale (MRAS) is evaluated in terms of (1) its independence from measures of attitudes toward female roles, and of attitudes toward gender roles and relationships, and (2) its differential correlates with and incremental ability to explain variance in criterion variables compared to measures of these two other gender-related attitudes. As predicted, the MRAS is unrelated to attitudes toward the female role, but is significantly associated with attitudes toward gender roles and relationships. As further predicted, the MRAS, but not attitudes toward women or attitudes toward gender roles and relationships, is associated with homophobic attitudes toward male homosexuality and with traditional male procreative attitudes. In addition, the MRAS explains significant incremental variance in these criterion measures when attitude toward female roles and attitude toward gender roles and relationships are controlled for. These results support the theoretical argument that attitudes toward male roles are conceptually distinct from the other gender-related attitudes examined here.

The dynamics of young men's condom use during and across relationships.

Abstract: According to data from the 1991 National Survey of Adolescent Males condom use is likely to be highest at the beginning of relationships and to decline as the relationship continues. The proportion of sexually active men aged 17-22 who used a condom with their most recent partner declined from 53% the first time they had intercourse with that partner to 44% at the most recent episode. Condom use also decreases with age; 59% of 17-18 year olds used a condom the first time they had intercourse with their most recent partner compared with 56% of 19-20 year olds and 46% of 21-22 year olds. However the probability that the female partner used the pill the first time that the couple had sex increased with the mans age--from 21% among 17-18 year olds to 35% among 21-22 year olds. Young men were more likely to have used a condom if they thought their partner was sexually inexperienced and less likely to have done so if they suspected their partner was at high risk for an STD. (authors)

The relationship between physicians' malpractice claims history and later claims. Does the past predict the future?

Abstract: Objective. —To investigate whether an association exists between physicians' past and subsequent claims of medical malpractice, particularly whether a history of even unpaid claims ($0) or small claims ( Data. —All medical malpractice claims closed in the state of Florida from January 1975 through August 1988 (N= 20 016,92% involving physicians), matched with the American Medical Association's Physician Masterfile on all practicing physicians in the state of Florida during that period. Claims history was automated into physician-year claims files, then partitioned into a baseline period (1975 through 1980) and a subsequent period (1981 through 1983). Inconsequential claims were excluded, ie, cases closed without a named claimant and without expense for investigation (30.4% of raw claims). Methods. —Descriptive analysis of all physician claims; odds ratio analysis of physicians in practice throughout both periods (N=8247), comparing claims experience in baseline vs subsequent period, adjusted for specialty of practice. Results. —Fro all consequential physician claims, 60% were unpaid claims, 17% were small paid claims, and 23% were large paid claims. The 8247 continuously practicing physicians had a total of 6614 claims, averaging 0.9 per year, but 59.2% of physicians had no claims in 9 years, only 13.4% had any paid claims, and 7.2% had multiple paid claims. Less than 8% of physicians had any large paid claims during the baseline period, and less than 7% had any in the subsequent period. Physicians with any baseline claims (whether paid or unpaid, small or large, single or multiple) had elevated odds of subsequent claims (whether defined as any claims, any paid claims, any large claims, or multiple claims) relative to physicians with no baseline claims. With a baseline of all small claims, the adjusted odds ratio for any subsequent claim was 2.84 (95% confidence interval [CI], 2.32 to 3.49), for any subsequent paid claim was 2.97 (95% CI, 2.34 to 3.77), for all large subsequent claims was 2.42 (95% CI, 1.76 to 3.33), and for subsequent multiple claims was 2.83 (95% CI, 2.08 to 3.86). Even having a single unpaid baseline claim approximately doubled the odds. Conclusions. —Claims history had predictive value, even with only unpaid claims. Small paid claims were better predictors than unpaid claims, large paid claims were better predictors than small paid claims, and multiple paid claims were better predictors than single paid claims. Claims history of all kinds is a reasonable statistical measure, eg, for the screening purposes of the National Practitioner Data Bank. ( JAMA . 1994;272:1421-1426)

Risk of entering nursing homes for long versus short stays.

Abstract: Research on the risk of nursing home use has generally not distinguished between risk for long versus short stays. This paper presents an analysis of data from the 1982–84 National Long-Term Care Surveys to identify characteristics of disabled persons that predicted one or the other type of stay. Me

Retooling Social Security for the 21st century

Abstract: Because of the imbalance between promised benefits and available taxes, some reform of Social Security is inevitable. At the same time, perceptions of Social Security are changing rapidly as it moves away from a system where all recipients--whether rich or poor--received more in benefits than they paid in taxes, and where those who were richer consistently received larger net transfers than those who were poorer. Reform is most likely to succeed if it returns to basic principles such as progressivity, equity, and efficiency. Although these principles sometime conflict, they also provide much common ground. For example, if Social Security is meant to meet the greatest needs of the elderly, then increasing the retirement age (which mainly affects the younger and richer elderly) would be preferable to removal of the cost-of-living adjustment (which mainly affects the older and poorer elderly). Efficiency and equity principles, in turn, call attention to some groups--second earners in households, those with few employee tax preferences, those who work many years, and elderly workers--whose net benefits are lower than others who should have less claim to Social Security resources.

Do Teachers' Race, Gender, and Ethnicity Matter?: Evidence from Nels88

Abstract: Our study uses a unique national longitudinal survey, the National Educational Longitudinal Study of 1988 (NELS), which permits researchers to match individual students and teachers, to analyze issues relating to how a teacher's race, gender, and ethnicity, per se, influence students from both the same and different race, gender, and ethnic groups. In contrast to much of the previous literature, we focus both on how teachers subjectively relate to and evaluate their students and on objectively how much their students learn. On balance, we find that teachers' race, gender, and ethnicity, per se, are much more likely to influence teachers' subjective evaluations of their students than they are to influence how much the students objectively learn. For example, while white female teachers do not appear to be associated with larger increases in test scores for white female students in mathematics and science than white male teachers 'produce', white female teachers do have higher subjective evaluations than their white male counterparts of their white female students. We relate our findings to the more general literature on gender, race, and ethnic bias in subjective performance evaluations in the world of work and trace their implications for educational and labor markets.

State regulations and child care choice

Abstract: While government regulations are designed to safeguard the health and well-being of children, they may also alter the cost and availability of child care, thus affecting parental use of such services. This paper investigates the total effects of regulation on parental choice of child care and the indirect effects of regulation through the price, quality, and availability of care. In our analysis of data from the National Child Care Survey 1990 we find strong evidence that state regulations requiring center-based providers to be trained are associated with a lower probability that parents choose a center, while state inspections are associated with more parental choice of center and home care. We end by discussing the policy implications of our findings.

Effect of Race on Access to Recombinant Human Erythropoietin in Long-term Hemodialysis Patients

Abstract: Objective. —To quantify access to recombinant human erythropoietin (EPO) among patients with dialysis-dependent end-stage renal disease (ESRD). Design. —National random sample of hemodialysis patients from a random sample of dialysis units, using data abstracted from patients' medical records. Setting. —All US hemodialysis units. Participants. —A total of 4024 Medicare-entitled in-center hemodialysis patients. Main Outcome Measures. —The relative odds that black patients received EPO (compared with white patients). Results. —There was no evidence in this national study that black hemodialysis patients were more or less likely to receive EPO than white patients (P=.74) Conclusions. —Three years after Food and Drug Administration approval and Medicare coverage of EPO, there was no evidence of racial disparity in access to EPO among Medicare patients with ESRD who were receiving long-term hemodialysis. However, there was evidence of greater need for EPO among black patients. (JAMA. 1994;271:1760-1763)

COBRA qualifying events and elections, 1987-1991.

Abstract: The Consolidated Omnibus Budget Reconciliation Act (COBRA) represents the first national employer mandate to address the problems associated with lost employment-related health insurance. This paper presents findings from two unique data sets on the incidence of COBRA coverage, election rates by type of qualifying event, and the demographic and labor market characteristics of covered individuals for the period 1987-1991. An estimated 1.3 million adults, aged 40 to 64, used COBRA in 1988. Nearly two-thirds had insurance in their own names, and the remaining third were dependents. From 1987 to 1991, 22% of those experiencing qualifying events elected to use COBRA. While work-related qualifying events were more prevalent than family-related events, election rates were higher in cases of family-related events. The information gained on the use of COBRA serves as a basis for the future design of a health insurance system that allows portability of benefits across jobs.

The impact of children on the labour supply off married women: comparative estimates from European and U.S. data.

Abstract: This paper presents estimates of the impact of the age pattern and level of fertility on the probability of labour force participation by married and cohabiting women in twelve Eastern and Western European countries and the United States Logit models for labour force participation probabilities are estimated conditional on age, age at marriage or union, educational attainment, current parity, and number of years in parity, using data on married and cohabiting women from the United Nations Economic Commission for Europe (UNECE) Comparative Study of World Fertility Surveys The estimated models are used to simulate the age profiles of labour force participation conditional on the level and timing of fertility The simulation results are presented in a series of charts grouped according to similarities in the effects of fertility on the age profiles of labour force participation Four distinct patterns are identified that depend on the empirical significance of distinct number-of-children and age-of-youngest-child effects The role of family policies and the extent to which the labour supply reductions associated with childbearing can be interpreted as opportunity costs are considered

Tenant satisfaction with public housing management: Budapest in transition

Abstract: Poor maintenance, low rents, and high levels of occupants’ dissatisfaction with their housing have been hallmarks of state‐rental housing in Hungary and other countries in Eastern Europe. The introduction of private management has been touted as an efficient way to improve services and increase tenant satisfaction, thereby paving the way for higher rents. This paper uses a new data set for January 1992 for dwellings in Budapest which were state rentals in January 1990, the majority of which were still rentals at the time of the survey, to analyse the impact of private management on tenant satisfaction and willingness to pay. The central conclusion of this analysis is that the introduction of private management significantly improves the satisfaction with maintenance services of occupants of units owned by Budapest district governments and now typically managed by the public IKV management companies. Similar results were found for occupants of units privatised in the past two years. We take this t...

Proposals to control high-cost hospital medical staffs

Abstract: Prologue: To address the rapid growth in physician spending, Medicare reformed its payment methods with a resource-based relative value scale and national volume performance standards (VPS). Volume...

Implementing Employer and Individual Mandates

Abstract: As is true of automobile insurance, a strong case can be made for a mandate that requires individuals to purchase health insurance rather than shifting costs to others. A mandate by itself, however, is likely to be regressive. By dealing with individual needs through the back door, an employer mandate generally keeps costs hidden and raises employment problems, while an employer subsidy will be poorly targeted. An individual mandate, in turn, raises other difficult administrative issues of collection and enforcement. No employer mandate is sufficient without an individual mandate, and millions of Americans will fall outside of any mandated system.

Heuristic Algorithms for Aggregating Rail-Surface-Defect Data

Abstract: An optical inspection system has been developed to detect the presence of defects on the surface of rails. The system classifies each 6 in. (15 cm) length of railhead as defective or nondefective and generates large quantities of disaggregate, sequential condition data. Defective rail surfaces can then be corrected by grinding the surface of the rail. However, this requires that condition data be aggregated to a level suitable for making maintenance decisions, and that prior recognition be given to practical constraints such as adjusting minimum grinding length to the configuration of the particular grinding machine. Data-aggregation procedures range from rule-based techniques to mathematical optimization methods. This paper reviews these aggregation techniques and, consequently, formulates the grinding problem as a set-packing integer programming formulation. Two heuristic solution methods are proposed to solve a set-packing problem of high dimension resulting from a large number of feasible packs for rail-surface-condition data. These methods effectively moderate the computational intensiveness and time complexity associated with using existing procedures.

Explaining the growth of Puerto Rican poverty, 1970-1980

Abstract: With data from the U.S. Bureau of the Census 1970 Public Use Samples and 1980 Public Use Microdata Sample tape files for 34 metropolitan statistical areas, the authors examine cross-metropolitan variations in Puerto Rican poverty, using an instrumental variables regression model. The analyses highlight the role of residential segregation and economic restructuring on Puerto Rican poverty in 1970 and 1980. Decomposition of changes during the 1970s revealed that the primary sources responsible for increased Puerto Rican poverty rates were structural: The effects of segregation on poverty grew stronger during the decade, and the ability of manufacturing employment and self-employment to attenuate poverty grew weaker.

Comprehensive services in child-care settings: prevalence and correlates.

Abstract: At the beginning of 1990, 80 000 day-care centers in the US were serving about 4 million preschool children.1 This represents threefold increase since 1976 to 1977 in the number of centers and a fourfold increase in enrollments. Approximately 118 000 regulated family day-care providers were serving about 700 000 children. There were between 550 000 and 1.1 million nonregulated family day-care homes that were serving an unknown number of children. The number of regulated family day-care homes and the number of children enrolled in those homes increased since the mid-1970s, though not as much as the number enrolled in centers. About 17% of the children enrolled in center-based programs and 5% of those enrolled in regulated family day-care homes came from families receiving public assistance. Low-income families are overrepresented in Head Start and other sponsored non-profit programs. The fact that increasing numbers of children are enrolled in early education and care programs presents an opportunity to serve the needs of disadvantaged children who may not necessarily receive nutritious meals, environmental stimulation, developmental screening, and adequate preventive health care at home. Programs such as Head Start, for example, are required to provide a comprehensive set of services in addition to a developmentally appropriate curriculum. In the first part of this paper we examine the general health and safety procedures followed by center staff and family day-care providers for sick children ill providers. The extent to which providers conform to health and safety provisions will be examined. For example, do providers maintain records, obtain medical releases, have the phone number of a physician, have an emergency medical plan, have a list of persons to whom the child may be released, and conduct fire drills?

Strategies for implementing global budgets.

Abstract: Implementing global budgets requires setting a desired level of spending as well as establishing a set of policies to assure the budget will be met. Four alternative approaches are analyzed: one relies on all-payer rate setting coupled with volume controls; the second is a system of premium regulation that controls both the levels and rates of insurance premium increase; in another system, price competition among insuring organizations limits growth in spending while incorporating a global budget that limits the aggregate costs of all premiums; finally, either managed competition or premium regulation is combined with all-payer rate setting. The fourth model is singled out for its ability to control costs. An independent policy toward capital expenditures could increase the likelihood of success under any of the strategies.

A Data Perspective on Long-Term Care

Abstract: Continuing progress in developing empirical information on different facets of long-term care service use has been possible because of improvements in the design of data sets. New generations of data sets are being developed with a recognition of the inherent nature of long-term care. Notably, long-term care implies care received over an extended period of time, thereby presenting numerous occasions for changes in the characteristics of both the services that are used and the recipients of the services. In large part, the design of the data sets has been made in response to research and policy interests in long-term care. This article highlights some observations about progress in the development of long-term care data, and the relationship between policy questions in long-term care and the design of relevant data sets.

Health Reform: The Good, The Bad, And The Bottom Line

Abstract: The Health Security Act is a pragmatic plan for achieving universal health insurance coverage for a broad package of benefits at reasonable cost. It proposes necessary and reasonable changes in insurance market practices and administrative structure. It finances the reformed system with a credible combination of achievable cost savings, mandatory private-sector payments, and limited “sin” taxes. Political constraints—the inability to tax openly or redistribute tax subsidies— result in weak incentives for consumers to choose low-cost plans and an inefficient scheme for providing subsidies to the poor. The act also unnecessarily restricts and regulates fee-for-service plans and the training of health workers. We propose changes to correct the act's weaknesses without compromising its basic objectives.

Medicare: Challenges and Future Directions in a Changing Health Care Environment

Abstract: In this GSA-sponsored Congressional Briefing Seminar, authorities from several disciplines summarize the history, rationale, strengths, weaknesses, and future challenges of the Medicare program. In the current arena of health care reform, the role of Medicare is far from certain, and it is crucial to understand and confront a multitude of issues, many of which are raised in this briefing.

The importance of public health for twenty-first-century health care: lessons from tuberculosis.

Abstract: Once epidemic, tuberculosis has re-emerged, often in newly drug-resistant forms. This public health threat calls for strong public action as well as improved private care. Action has been hampered by failures in public health infrastructure and legal-philosophical support for government intervention. Josephine Gittler's accompanying article usefully suggests rebuilding public-health agencies and adapting traditional authority and controls from the age of epidemics to take account of today's circumstances and sensibilities.

Medicare and Health Care Reform

Abstract: Although Medicare constitutes one of the most popular programs of the federal government, even its most ardent supporters would likely agree that improvements could be made and likely should be part of any package of comprehensive health care reform. While some changes could be made as stand-alone reforms. it would be better to integrate changes for the under 65-population with those for the Medicare program. For example, cost-containment strategies would work best if they applied to the population as a whole rather than creating differences that lead to cost-shifting and possible discrimination across groups. The generosity of services covered also ought to be balanced between Medicare and whatever happens elsewhere. This would allow Medicare's cost-sharing structure to be less severe in terms of hospital and skilled nursing care, for example. Finally, while it is tempting to use reductions in spending on Medicare as a means for helping to finance other expansions, the impact of such changes needs to be ...