Showing papers by "Urban Institute published in 1997"

Does neighborhood matter? Assessing recent evidence

Abstract: This article synthesizes findings from a wide range of empirical research into how neighborhoods affect families and children. It lays out a conceptual framework for understanding how neighborhoods may affect people at different life stages. It then identifies methodological challenges, summarizes past research findings, and suggests priorities for future work. Despite a growing body of evidence that neighborhood conditions play a role in shaping individual outcomes, serious methodological challenges remain that suggest some caution in interpreting this evidence. Moreover, no consensus emerges about which neighborhood characteristics affect which outcomes, or about what types of families may be most influenced by neighborhood conditions. Finally, existing studies provide little empirical evidence about the causal mechanisms through which neighborhood environment influences individual outcomes. To be useful to policy makers, future empirical research should tackle the critical question of how and ...

Did Medicaid Expansions For Pregnant Women Crowd Out Private Coverage

Abstract: This paper documents the changing picture of health insurance coverage for pregnant women in the four-year period following Medicaid expansion and assesses the extent to which the crowding-out phenomenon may have influenced the observed trends. The report documents the distribution of insurance coverage for pregnant women in the post-expansion period and describes demographic characteristics of women covered under Medicaid. It examines the rate at which Medicaid-eligible women enroll in the program and addresses the crowding-out issue by comparing the trend in employer-sponsored coverage among poor and near-poor pregnant women with those among nonpregnant women and men of similar ages and incomes.

Race, Socioeconomic Status, and Health: Accounting for Race Differences in Health

Abstract: This article uses the Asset and Health Dynamics Among the Oldest Old (AHEAD) study to examine the extent to which observed differences in the prevalence of chronic conditions and functional limitations between Black and White adults (aged 70+) in the United States can be attributed to differences in various aspects of socioeconomic status (SES) between these groups. We use linear and logistic regression techniques to model the relationships between health outcomes and SES. Our findings indicate that race differences in measurable socioeconomic characteristics indeed explain a substantial fraction, but in general not all, of Black/White differences in health status. While our findings do not suggest that low SES directly ?causes? poor health, any more than being Black does so, they do suggest that research and policy intended to address the deficit in health status among Blacks (when compared to Whites) in the U.S. would be well-served to begin with the deficit in wealth, education, and other SES measures. (Journals of Gerontology (B): Psychological Sciences and Social Sciences 1997 May; 52: 61-73).

Age differences between minors who give birth and their adult partners

Abstract: The role of adult men in adolescent childbearing has received heightened attention in recent years, and a new policy efforts have focused on statutory rape laws as a way to reduce adolescent childbearing. Analyses of the 1988 National Maternal and Infant Health Survey indicate, however, that these policies would not apply to most teenage births. Among mothers aged 15-17 who had a child in 1988, 27% had a partner at least five years older than themselves. In addition, since 23% of minors with older partners were married at the time of the infant's birth, 21% of babies born to unmarried minors were fathered by substantially older men. While births to young mothers and older men raise social concerns, these births make up a small share of all teenage childbearing: Only 8% of all births to 15-19-year-olds are to unmarried minors with a partner five or more years older.

The growing American Indian population 1960-1990: beyond demography.

Abstract: Since 1960, the Native American population has exhibited explosive growth, increasing from 552,000 to 1,959,000, or 255 percent. The average annual growth rate of 4.3 percent, extending over a 30-year period, is demographically impossible without immigration – in fact, of the 1.4 million growth only 762,000 comes from natural increase, whereas 645,000 comes from non-demographic factors. This paper expands on previous work to illustrate with demographic techniques how such extraordinary growth was achieved through changing patterns of racial self-identification on the part of people with only partial or distant American Indian ancestry, coupled with relatively high fertility and improving mortality. It also provides some basic demographic background on the size, growth, and geographic structure of the American Indian population, while exploring both demographic and geographic underpinnings of the changing population. Data on race from the 1970, 1980, and 1990 Censuses are based on self-identification. A person choosing the American Indian racial response does not have to provide any substantiation or documentation. While this method aids overall census taking by permitting respondents to fill out their own census forms, self-identification adds a temporal component to the data because responses elicited from the same individual (or group of individuals) may change over time in reaction to social, political, or economic conditions or variations in question wording. New identities may emerge or old ones may disappear. This effect has had a noteworthy impact on data for American Indians. Analysts and other data users must be aware of underlying response patterns to interpret changes correctly.

The validity of self-reported drug use data: the accuracy of responses on confidential self-administered answered sheets.

Abstract: Official records offer a relatively inexpensive, nonintrusive strategy for checking on the accuracy of self-reported drug use. Responses of a small sample (N = 67) of former drug treatment clients interviewed using procedures exactly modeled on the National Household Survey on Drug Abuse were compared to their clinic records. The accuracy of reports compared to clinic records varied by drug, with the percentage of known users reporting their use highest for marijuana, followed by cocaine and hallucinogens, and lowest for heroin. Almost half of this sample of former treatment clients denied ever receiving drug treatment.

The changing of the guard: Top management characteristics, organizational strain, and antitrust offending

Abstract: From within an organizational strain perspective, this paper examines the effects of managerial succession, CEO background, decentralized management, and product dominant strategies on the reported corporate antitrust offending levels of 43 basic manufacturing companies over a 22-year period. In the aggregate, findings suggest that past illegal involvement predicts future offending; companies headed by finance and administrative CEOs have higher offending levels than do firms headed by CEOs from other backgrounds; a turnover in top management generally decreases offending levels; the pursuit of product dominant strategies increases the number of anticompetitive acts; and offending levels are unrelated to whether new leaders are recruited from within or outside the firm, whether the CEO is also Chair of the Board of Directors, or whether management is centralized or decentralized. The effects of some variables on corporate offending interact with firm performance.

Teacher Identity: A Key to Increased Collaboration

Abstract: Recognizing teacher collaboration as an important component of effective teacher leadership, the study reported on in this article examines three aspects of teacher identity-representation, preparation and dedication–as barriers to increased collaboration. Conducted using oral history interviews with eight recently retired public school teachers, the study reveals how teacher interpretations of their professional identity rest on underlying assumptions and normative beliefs broadly shaped by biography. Further, when these assumptions and beliefs are not shared or acknowledged by colleagues, they lead to critical attitudes which limit trust and prohibit meaningful collaboration.

Where the rubber meets the road: Performance measurement for state and local public agencies

Abstract: Recent events that have encouraged performance measurement in local governments and local private nonprofit organizations are described in this chapter. The author discusses some obstacles managers face in measuring outcomes at the local level, and he offers successful uses of outcomes reporting to address citizen concerns.

Capital gains and the people who realize them

Abstract: ** Abstract - This paper draws on data from many sources to examine the nature of both capital gains realized by taxpayers and those taxpayers them- selves. The data show that high-income taxpayers realize the overwhelming majority of capital gains, but that, over a ten-year period, nearly a third of taxpayers report a capital gain on their tax returns. Even a larger percentage own assets that might generate capital gains. Sales of corporate stock account for more gains than sales of any other asset. Most capital gains arise from returns with many sales and large capital gains. After adjustment for inflation, most capital gains disappear.

Disability and Medicare Costs of Elderly Persons

Abstract: Rapidly growing Medicare expenditures, which are already expected to exceed revenues by the year 2002, are likely to accelerate as a result of the increasing numbers of very old beneficiaries (85+ years), who are particularly at risk of being disabled. The concern for Medicare is that elderly persons with disabilities incur higher than average health care costs because of the underlying causes of their disability, which are usually chronic medical conditions (Manton and Stallard 1992). Such conditions often require long-term care, but they also tend to induce illnesses requiring acute care. This study analyzed data from the Medicare Current Beneficiary Survey to examine the relationship between disability and Medicare costs. It examined relations between levels of disability and costs, interactions between disability and other beneficiary characteristics, and changes in the level of disability and costs. (The Milbank Quarterly 1997 December; 75(4): 461-493).

The resurgence of selective contracting restrictions.

Abstract: The spread of managed care organizations' (MCOs?) selective networks reduced patient access to services, along with provider access to paying patients, so many providers have lobbied for laws to force plans to contract with any willing provider and give patients freedom of choice. In opposition are MCOs, which want full freedom to contract selectively to control prices and utilization. This article comprehensively described laws in all 51 jurisdictions, classified by relative strength, and assessed the policy implications. Most enactments are relatively weak, and all are limited in application by ERISA and the Federal HMO Act. An associative multivariate analysis also showed that states with laws also have higher HMO penetration and higher physician density, but smaller rural populations. This paper concluded that the strongest laws overly restrict the management of care, to the likely detriment of cost control. But where market power is rapidly concentrating, unrestrained selective contracting could diminish patient access to care and long-term competition. In the face of uncertainty about the impact of these laws, an intermediate approach may be better than all or nothing. States should consider mandating that plans offer point-of-service options, for a separate premium. This option guarantees patient choice of plans at the time of enrollment and of providers at the time of care, yet maintains plan ability to control core providers. (Journal of Health Politics, Policy and Law 1997 October; 22(5): 1133-1189).

Crowding Out: How Big A Problem?

Abstract: Although they use different methods, both David Cutler and Jonathan Gruber and Lisa Dubay and Genevieve Kenney find that the crowding out of private insurance is a serious issue for Medicaid expansions that cover children and pregnant women, particularly those that extend coverage to persons with incomes above the federal poverty line. Analyzing this issue is difficult because it is hard to control for the secular and business cycle–induced declines in employersponsored coverage. Thus, it is not surprising that the authors’ estimates differ. However, both studies seem to agree that the potential for crowding out is great, especially for the near-poor. Here, I comment on themeaning of these results. n Access to private coverage. Although at least 17 percent and possibly as much as 50 percent of the added coverage attributable to Medicaid expansions to cover low-income children and pregnant women might be offset by directly related reductions in private coverage, the rest of the expanded coverage would not be offset. For the most part, during the late 1980s and early 1990s, Medicaid extended coverage to persons who otherwise would be uninsured. By 1994 Medicaid covered 5.2 million children and pregnant women under poverty-related expansions. Based on the results by Cutler and Gruber and by Dubay and Kenney, 80 percent of the new enrollees, or four million Americans, would have been uninsured in the absence of the expansions. Cutler and Gruber’s results suggest a spillover effect in which persons not eligible for Medicaid would have dropped private coverage. If all of the Medicaid enrollment increases that occurred during this period, including growth in the Aid to Families with Dependent Children (AFDC) and disabled populations, had not occurred, there would be even more uninsured low-income Americans. Between 1988 and 1993 nine million enrollees were added to Medicaid; most of them were below poverty and therefore were unlikely to have had access to private coverage. n Employer-sponsored coverage. Employer-sponsored coveragewas declining during this period for all groups, even persons with higher incomes. These declines likely were caused by factors other than crowding out, such as large increases in insurance premiums relative to the compensation increases that businesses could afford. Medicaid crowding out had a small effect on the decline in employer-sponsored coverage. Between 1988 and 1993 the percentage of nonelderly persons with employer-sponsored coverage fell from 67 percent to 61 percent. If the proportion with employer-sponsored coverage had stayed at 67 percent, 13.3 million more persons would have had coverage in 1993. If 50 percent of the increase in Medicaid enrollment during this period resulted in crowding out, then 4.5 million persons declined private coverage because of the availability of Medicaid. If only 20 percent of the increase in Medicaid resulted in crowding out, then 1.8 million low-income persons gave up private

The Role of Survey Data in Microsimulation Models for Social Policy Analysis

Abstract: Questions about the impact of social policies cannot be answered solely on the basis of official statistics made available in tabular format. The access to microdata allows policy analysts to answer these questions with a larger set of analytical tools, in particular microsimulation models. This paper examines the interface between survey data and microsimulation models. We review different types of microsimulation models (static and dynamic) and their data requirements. We then restrict the attention to survey-based microdata, and examine issues in survey design, questionnaire content, data quality, and dissemination policy that are important from the perspective of microsimulation.

Latino Neighborhoods and Latino Neighborhood Poverty

Abstract: To present a national socioeconomic portrayal of Latino neighborhoods, this study examines 1980 and 1990 census tracts that are at least 50 percent Latino. It investigates the determinants of poverty rates and transitions into and out of poverty concentration. A special focus in this analysis is the relationship between immigration and poverty.

The promise of integrated representative surveys about sexually transmitted diseases and behavior.

Abstract: Background: It has been difficult to conduct representative surveys measuring both sexually transmitted disease prevalence and behavioral data. This article reviews the literature, describes a recent pretest of the feasibility of integrated surveys, and discusses the potential implications. Methods: Several national surveys are reviewed, including the National Health and Nutrition Examination Surveys, National Health and Social Life Survey, and National Survey of Adolescent Males. The 1994 pretest of the National Survey of Adolescent Males collected urine specimens of male respondents, which were tested forChlamydia trachomatisusing ligase and polymerase chain reaction tests. Results: There have not been any prior national surveys that collect clinical measures of STD infection and detailed behavioral data. In the pretest, 85% of the eligible interview respondents provided a urine specimen. Of those tested, 6% were positive forC. trachomatis. Conclusions: Combining behavioral surveys with collection of urine specimens for STD testing in representative samples is feasible. However, STD testing adds new operational and ethical challenges to the conduct of household surveys.

Monitoring Russia's Experience with Housing Allowances

Abstract: This paper reports the results of an initial assessment of a housing allowance program in two Russian cities. The assessment focuses on the extent to which income-eligible households knew about the program, their participation rates, and their experiences as recipients of program benefits. A brief description of the Soviet legacy and the first reforms initiated in the early 1990s are also included.

The Evolving Housing Market in Moscow: Indicators of Housing Reform:

Abstract: With the Russian housing reform underway for several years, this is an appropriate time to review the progress made towards the stated goal of creating a market-oriented housing sector. From the fundamental shift towards private ownership to the supporting legislation, substantial progress has been made towards the realisation of this goal. One of the most significant elements of the housing reform is the law on privatisation of the housing stock passed by the Supreme Soviet in June 1991. Subsequent legislation passed in December 1992 further spurred the reform process. The most far-reaching of these measures was the law On Fundamentals of Housing Policy in the Russian Federation, which addressed the overall orientation of housing policy. This paper examines the results of the housing policy reforms in terms of their effects on private ownership, residential mobility, housing conditions and housing affordability. Longitudinal data on these four characteristics of the Moscow housing sector document the lar...

Trends: The Slowdown In Medicaid Spending Growth

Abstract: New forecasts—including Congressional Budget Office estimates revised in February 1997—show that Medicaid's growth in spending will be much lower than predicted just a year ago.

Why Don't Schools and Teachers Seem to Matter?: Assessing the Impact of Unobservables on Educational Productivity

Abstract: In this paper, we use data drawn from the National Educational Longitudinal Study of 1988, which allows students to be linked to particular teachers and classes, to estimate the impact of observable and unobservable schooling characteristics on student outcomes. A variety of models show some schooling resources (in particular, teacher qualifications) to be significant in influencing tenth grade mathematics test scores. Unobservable school, teacher, and class characteristics are important in explaining student achievement but do not appear to be correlated with observable variables in our sample. Thus, our results suggest that the omission of unobservables does not cause biased estimates in standard educational production functions.

Immigration and county employment growth

Abstract: Prior literature has found that immigrants have no effect on the wages and employment of natives. However, this literature has not accounted for the possibility that immigrants contribute to employment growth in the areas where they locate. Research on internal migration has found that internal migrants contribute to local area employment growth. In this paper I compare the effects of natives and immigrants on county employment. Results show that the overall immigrant population contributes more to increases in employment than the overall native population. Recent immigrants and recent internal in-movers have similar effects on employment growth. The net contribution of immigrants to employment growth is confined to nonmanufacturing employment.

Alternative Strategies for Increasing Employment

Abstract: As states reform their welfare systems to emphasize work and self-sufficiency, they can draw on significant past experience with efforts to promote employment. Work and training programs for welfare recipients and other disadvantaged individuals have been operating in every state for nearly 30 years. This article summarizes findings from key evaluations of strategies to increase the employment and earnings of individuals. The article also reviews lessons about program design and management drawn from studies of program outcomes and implementation. Evaluations of net impact typically measure outcomes for randomly selected individuals who participated in programs, and compare those with outcomes for individuals who did not receive the treatment. Studies of program outcome and implementation analyze the effectiveness of entire programs in real-world operational settings. The evidence from net-impact evaluations shows that programs that encourage, help, or require welfare recipients to find jobs or participate in training or work-related activities can increase employment and earnings and in some cases reduce welfare costs. Even the most successful programs, however, yield only small gains in earnings that do not move most former welfare recipients out of poverty. The article also discusses critical policy and implementation issues that influence the effectiveness of welfare-to-work programs overall. It focuses on strategies for increasing rates of participation in the programs, for improving implementation, and for strengthening links with the local labor market, which ultimately determines the success or failure of any welfare-to-work program.

Winners and losers under medical savings accounts.

Abstract: As legislators wait to see how the MSA approach to health care reform plays out in the laboratory of the states, authors Marilyn Moon, Len M. Nichols and Susan Wall have put the numbers to work. The researchers simulated the effects of introducing MSAs into the health insurance market. What they found is what critics of MSAs suspected: As the young and healthy shift to MSAs, the premiums for those left in the remaining insurance pool will escalate. However, the authors conclude that if you are male, young and healthy, you stand to gain a lot from the MSA experiment.

The malpractice premium costs of obstetrics.

Abstract: This study examined, in 1992, the variation in the level of malpractice premiums, and the incremental malpractice premium costs associated with the practice of obstetrics for family practitioners and obstetricians. On average, in 1992 obstetricians and family practitioners providing obstetric services paid malpractice premiums of roughly $44,000 and $16,000, respectively. The incremental increase in malpractice premium costs represented roughly 70% of the premium the physicians would have paid had they not provided obstetric services. These results suggest that for both family practitioners and obstetricians, there is a considerable premium penalty associated with providing obstetric services which may have implications for women's access to obstetric services. Moreover, the results make it clear that physicians practicing in different states, and different specialists within a state, may face very different malpractice premium costs.

The Effect of U.S. Supreme Court Ruling Sullivan v. Zebley on Child SSI and AFDC Enrollment

Abstract: In 1990, in the case of Sullivan v. Zebley, the U.S. Supreme Court relaxed the criteria whereby children became eligible for Supplemental Security Income (SSI) benefits. Since that ruling, the number of children covered by SSI has almost tripled; nearly 1 million American children are receiving cash and medical benefits through SSI. Many of those new enrollees were not previously eligible for cash and Medicaid benefits. Other new eligibles had already been receiving cash and Medicaid through AFDC. This paper examines the extent of spillovers between the SSI and AFDC programs using the Sullivan v. Zebley expansion in child SSI enrollment to identify spillovers between the programs. We describe how a family's decision to participate in AFDC or SSI is likely to depend on the level of AFDC and SSI supplementation payments in a state. If the likelihood of SSI participation increases with the net financial gain of SSI relative to AFDC, child SSI participation over the period affected by Zebley is likely to be highest in states with low AFDC payments and high state SSI supplementation payments. Using difference-in-difference estimates based on state-level data, we find that the increase in child SSI participation was significantly larger in low-AFDC states than in high-AFDC states. For SSI adults (a group unaffected by the Zebley decision), we find no effect of state AFDC payments on the increase in SSI participation over this period. We use state-level data pre- and post-Zebley to obtain state fixed-effects estimates of the effects of the decision on SSI participation, AFDC participation, and total program participation and find that Zebley increased SSI participation and total participation by children. We find that Zebley increased child SSI more in states with lower AFDC payments and higher state SSI supplementation payments.

Achieving a new urban diversity: What have we learned?

Abstract: Since the 1960s, many of America’s major cities have lost population while suburban jurisdictions burgeoned. Successive waves of families seeking larger homes on bigger lots, better schools, safer streets, and more amenities left the central city for new communities farther and farther from the urban core. In 1990, only about a third of the Americans who lived in metropolitan areas were central-city residents, down from more than half in 1950. Perhaps more important, most cities lost middleand upperincome residents, with those remaining behind more likely to be poor and minority. As a consequence, central cities are now substantially poorer than the suburbs that surround them. In 1990, for example, median incomes in central-city jurisdictions nationwide were almost 30 percent lower than in the suburbs. And the gap between city and suburbs is far greater in some of the largest metropolitan areas of the Northeast and Midwest.

State health reform: effects on labor markets and economic activity.

Abstract: Individual states are actively weighing health care reform proposals and their potential impacts on many levels, including states' own economies. This article considers the effects on state economies of two instruments of health reform: employer mandates and cost containment. The literature suggests that an employer mandate will reduce employees' wages in the long run. In the short run, however, to compensate for the costs associated with mandated health care insurance for their employees, firms may raise their prices to consumers, reduce the number of employees, or allow a drop in profit margins. By increasing health care spending and the number of insured persons, mandates would also increase states' levels of economic activity. Though cost containment may dampen the stimulative effects of expanded coverage, resources not spent on health care as a result of effective cost containment might be redistributed to other sectors in a state's economy.

People, Jobs, and Transportation:

Abstract: Public works officials responsible for planning and running transit systems, managing urban streets and highways, or operating special-purpose transportation systems have critical roles to play in helping to reconnect poor, inner-city communities to jobs and other opportunities throughout the metropolitan region. And they should consider the consequences of infrastructure design and management decisions on the concentration of inner-city poverty. This article focuses on emerging job-linkage strategies, which help people who live in inner-city neighborhoods find out about and commute to employment opportunities throughout the metropolitan region. These strategies offer not only the benefits of stable employment to individuals and their families, but also the potential for increased income flowing into distressed neighborhoods where it can help fuel local economic development.

Exploring the relationship between inpatient facility and physician services.

Abstract: OBJECTIVES Medicare hospitalizations involve both facility and physician services. Although several studies analyze hospital-level variations in Medicare inpatient facility and inpatient physician services per admission, few studies directly explore the relationship between these services. Theoretically, inpatient facility and physician services may be complements or substitutes. That is, an increase in facility services may lead to an increase or decrease in physician services and vice versa. This article contributes to the existing literature by exploring directly the relationship between facility and physician services. METHODS Medicare physician claims were linked to inpatient hospital stays using data from the Medicare hospital cost reports, the Medicare Patient Analysis and Review file, and the Medicare National Claims History System. RESULTS In multivariate regression analyses, the (partial) correlations between facility and physician services were positive, which is consistent with complementarity. Standardized regression coefficients indicate that physician services are the single most important determinant of facility services; however, facility services are a less important determinant of physician services. A 10% increase in physician services is associated with at least a 3.0% increase in facility services. CONCLUSIONS Proposals that reduce inpatient physician expenditures also would reduce facility expenditures in the long-run.