Showing papers by "Urban Institute published in 2004"
TL;DR: A technical working group met to resolve previously published inconsistencies across national surveys in trends in activity limitations among the older population and found consistent declines on the order of 1%–2.5% per year for two commonly used measures in the disability literature.
Abstract: In September 2002, a technical working group met to resolve previously published inconsistencies across national surveys in trends in activity limitations among the older population. The 12-person panel prepared estimates from five national data sets and investigated methodological sources of the inconsistencies among the population aged 70 and older from the early 1980s to 2001. Although the evidence was mixed for the 1980s and it is difficult to pinpoint when in the 1990s the decline began, during the mid- and late 1990s, the panel found consistent declines on the order of 1%-2.5% per year for two commonly used measures in the disability literature: difficulty with daily activities and help with daily activities. Mixed evidence was found for a third measure: the use of help or equipment with daily activities. The panel also found agreement across surveys that the proportion of older persons who receive help with bathing has declined at the same time as the proportion who use only equipment (but not personal care) to bathe has increased. In comparing findings across surveys, the panel found that the period, definition of disability, treatment of the institutionalized population, and age standardizing of results were important to consider. The implications of the findings for policy, national survey efforts, and further research are discussed.
327 citations
TL;DR: Frequent ED users do not appear to use the ED as a substitute for their primary care but, in fact, are a less healthy population who need and use more care overall.
Abstract: This paper uses the 1997 and 1999 National Survey of America?s Families to explore how insurance coverage and access to care, along with other individual characteristics, are related to the large differences in Emergency Department (ED) use among the general population. People are classified into three ED use levels based on the number of visits over the 12 months prior to the survey: non-ED users (zero visits), occasional users (one or two visits), or frequent users (three or more visits). People in fair/poor health are 3.74 times more likely than others to be frequent ED users as compared to non-users. The uninsured and the privately insured adults have the same risk of being frequent users, but publicly insured adults are 2.08 times more likely to be frequent users. Adults who made three or more visits to doctors are 5.05 times more likely to be frequent ED users than those who made no such visits. It seems hard to blame the overcrowding of EDs on the uninsured. Instead, the publicly insured are over-represented of among ED users. Frequent ED users do not appear to use the ED as a substitute for their primary care and, in fact, are a less healthy population who need and use more care overall. (Medical Care 42(2): 176?82, February 2004.)
256 citations
TL;DR: The IHS partially offsets lack of insurance for some uninsured AIANs, but important needs were potentially unmet, and among the low-income population,AIANs with only IHS access fared better than uninsured AIans and as well as insured Whites for key measures but received less preventive care.
Abstract: Objectives. We compared access and utilization of health services among American Indians/Alaska Natives (AIANs) with that among non-Hispanic Whites. Methods. We used data from the 1997 and 1999 National Survey of America’s Families to estimate odds ratios for several measures of access and utilization and the effects of Indian Health Service (IHS) coverage. Results. AIANs had less insurance coverage and worse access and utilization than Whites. Over half of low-income uninsured AIANs did not have access to the IHS. However, among the low-income population, AIANs with only IHS access fared better than uninsured AIANs and as well as insured Whites for key measures but received less preventive care. Conclusions. The IHS partially offsets lack of insurance for some uninsured AIANs, but important needs were potentially unmet.
239 citations
TL;DR: The trend's underlying components using data from the 1984-1999 National Long-Term Care Surveys are examined to better understand the reasons for the declines and potential implications for acute and long-term care.
Abstract: Recent research indicates declining age-adjusted chronic disability among older Americans, which might moderate health care costs in the coming decades. This study examines the trend's underlying components using data from the 1984-1999 National Long-Term Care Surveys to better understand the reasons for the declines and potential implications for acute and long-term care. The reductions occurred primarily for activities like financial management and shopping. Assistance with personal care activities associated with greater frailty fell less, and independence with assistive devices rose. Institutional residence was stable. More needs to be known about the extent to which these declines reflect environmental improvements allowing greater independence at any level of health, rather than improvements in health, before concluding that the declines will mean lower costs.
238 citations
TL;DR: In this article, the authors examined the relationship between collective efficacy and high school student achievement in a state with an accountability system heavily focused on achievement, measured by mandatory assessments in multiple content areas.
Abstract: This study examined the relationship between collective efficacy and high school student achievement in a state with an accountability system heavily focused on achievement, measured by mandatory assessments in multiple content areas. Using social cognitive theory, a theoretical model was developed linking school context and collective efficacy to differences among schools in 12th grader student achievement. Structural equation modeling was used to test the fit of the model to data drawn from students and teachers in 96 state high schools. Collective efficacy was positively influenced by past mastery experience and negatively related to school socioeconomic disadvantage. Additionally, after accounting for the influence of several aspects of school context, collective efficacy remained a significant positive predictor of student performance across all content areas tested by the state. The authors discuss the implications of these findings for social cognitive theory and school improvement in an era of sch...
209 citations
TL;DR: In this article, the authors used neo-institutional theory and social capital theory to explore the finding that younger organizations are more likely to close or disband than older organizations, and they derived hypotheses from these perspectives and test them on a panel of nonprofit organizations in Minneapolis-St Paul using event history analysis.
Abstract: Ecological studies have consistently reported that younger organizations are more likely to close or disband than older organizations. This article uses neo-institutional theory and social capital theory to explore this finding. We derive hypotheses from these perspectives and test them on a panel of nonprofit organizations in Minneapolis-St Paul (USA) using event history analysis. We find that larger organizations and organizations more dependent upon private donations are less likely to close, and government funding reduces the age effect on mortality; that is, older and younger publicly funded organizations are equally likely to survive or fail. However, among older organizations, not having government funding increases chances of survival. In contrast, volunteer staffing accentuates the age effect. Older organizations that were more dependent on volunteers had a lower likelihood of closure than younger organizations dependent on volunteers, while age had no effect on closure for organizations not depe...
188 citations
TL;DR: In this paper, the authors present important evidence from two systematic, multicity studies on how the original residents of HOPE VI developments have been affected by this radical new approach to public housing and raise critical questions about whether the transformation of public housing will achieve its potential as a powerful force for improving the lives of low-income families.
Abstract: During the 1990s, the federal government dramatically changed its policy on housing the poor. Under the HOPE VI (Housing Opportunities for People Everywhere) Program, the U.S. Department of Housing and Urban Development intended to address the concentration of troubled low‐income households in public housing by moving away from its reliance on project‐based assistance and promoting instead the construction of mixed‐income housing and the use of housing subsidies. This article presents important evidence from two systematic, multicity studies on how the original residents of HOPE VI developments have been affected by this radical new approach to public housing. While many residents have clearly benefited, the findings raise critical questions about whether the transformation of public housing will achieve its potential as a powerful force for improving the lives of low‐income families.
147 citations
TL;DR: After slow growth during much of the 1990s, Medicaid physician fees increased, on average, by 27.4 percent between 1998 and 2003, and were associated with primary care physicians' greater willingness to accept new Medicaid patients.
Abstract: After slow growth during much of the 1990's, Medicaid physician fees increased, on average, by 27.4 percent between 1998 and 2003. The greatest growth occurred for primary care fees. States with the lowest relative fees in 1998 increased their fees the most, but almost no states changed their position relative to other states or Medicare. Physicians in states with the lowest Medicaid fees were less willing to accept most or all new Medicaid patients in both 1998 and 2003. However, large fee increases were associated with an increased willingness of primary care physicians to accept new Medicaid patients (Health Affairs Web Exclusive, June 23, 2004.)
143 citations
TL;DR: A recent roundtable of researchers, practitioners, policy makers, and community leaders to inform national discussions about youth reentry was organized by the Urban Institute as discussed by the authors, which identified some promising research and policy directions that emerged from the meeting.
Abstract: The transition of young people ages 24 and younger from juvenile and adult correctional settings back into schools, families, communities, and society at large--a process termed youth reentry--is one of the critical justice policy issues currently confronting the United States, yet research addressing this topic is limited. We therefore know little about the unique challenges, including the role of youth development, involved in youth reentry or how best to effectively assist this population to become contributing members of society. For this reason, the Urban Institute convened a roundtable of researchers, practitioners, policy makers, and community leaders to inform national discussions about youth reentry. In this introduction to the special issue, we summarize the findings and issues raised at the meeting, presenting highlights from the paper presentations and discussions. We then identify some of the promising research and policy directions that emerged from the meeting.
122 citations
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TL;DR: This paper examined the provision of family public goods using experimental economics methods and found that parents and children contributed more to a public good when in groups with family members than when they were alone with strangers.
Abstract: We examine the provision of family public goods using experimental economics methods. With sufficient altruism and shared resource arrangements, families can provide the efficient level of family public goods. Becker's Rotten Kid Theorem asserts that transfers from altruistic parents will induce children to maximize family income even if children are not altruistic toward other family members. Consistent with altruism, parents and children contributed more to a public good when in groups with family members than when in groups with strangers. In contrast to the predictions of the Rotten Kid Theorem, however, children's behavior fell short of maximizing family income.
106 citations
TL;DR: CSHCN are more likely to have insurance coverage, but among low-income CSHCN, lack of insurance remains a problem and the burden on families is greater, yet coverage purchased is not always adequate to meet the needs of many children and places addition burdens on families to pay directly for care.
Abstract: Objective To update national estimates of insurance coverage for children with special health care needs (CSHCN) to reflect better the current economic and policy environment and to examine the burden on families and adequacy of coverage. Methods I analyzed data on children who were aged 0 to 17 and included in the sample child files of the 2000 and 2001 National Health Interview Survey (NHIS). CSHCN were identified using a noncategorical approach. Various measures of insurance coverage type, premium contributions, unmet need for care, and out-of-pocket spending were compared for CSHCN and children without special needs across all incomes and stratified by poverty status. Results Compared with other children, CSHCN had higher rates of public insurance (29.8% vs 18.5%), lower rates of private insurance (62.5% vs 69.1%), and a smaller percentage without insurance (8.1% vs 11.5%). More than 13% of low-income CSHCN were uninsured. Most (78.1%) families of CSHCN contributed to private insurance premiums. Family premium contributions for employer-sponsored insurance plans averaged 2058 dollars, or 4.4% of income; premiums for private nongroup insurance were higher (3593 dollars) and consumed a larger percentage of income (6.6%). For children with insurance, rates of unmet need for specific services were relatively low, suggesting that insurance coverage was adequate. However, almost 20% of low-income CSHCN experienced some form of unmet need and of out-of-pocket spending was significantly higher for families with CSHCN compared with those without CSHCN. Conclusions CSHCN are more likely to have insurance coverage, but among low-income CSHCN, lack of insurance remains a problem. In addition, the burden on families of CSHCN to provide insurance is greater, yet coverage purchased is not always adequate to meet the needs of many children and places addition burdens on families to pay directly for care.
TL;DR: The authors examine the cross-national effects of inequality and trust on social expenditures and find that as the rich become more distant from the middle and lower classes, they find it easier to opt out of public programs and to buy substitutes in the private market.
Abstract: We assemble data from several different sources to examine the cross-national effects of inequality and trust on social expenditures. We find that the inequality between the middle classes and the poor (as measured by the 50/10 percentile ratio) has a small, positive impact but inequality between the ends of the distribution and middle class (measured by the 90/50 percentile ratio) has a large and negative impact on social spending. Different measures of trust are shown to have a large and positive impact on spending, implying that more cohesive, trusting societies are more willing to share economic resources with others not so fortunate. Our results therefore suggest that as the "rich" become more distant from the middle and lower classes, they find it easier to opt out of public programs and to buy substitutes in the private market. This implies that over time rising inequality will erode support for social institutions and social support that provides insurance against income loss, upward mobility and equal opportunity.
TL;DR: The authors found that the introduction of charters in Arizona has increased pupil-teacher ratios in traditional public schools by 6 percent and reduced the proportion of white non-Hispanic students by 2 percent.
TL;DR: The authors contribute to the development of empirical methods for measuring the impacts of place-based local development strategies by introducing the adjusted interrupted time-series approach, which estimates a more precise counterfactual scenario, thus offering a stronger basis for drawing causal inferences about impacts.
Abstract: The authors contribute to the development of empirical methods for measuring the impacts of place-based local development strategies by introducing the adjusted interrupted time-series (AITS) approach. It estimates a more precise counterfactual scenario, thus offering a stronger basis for drawing causal inferences about impacts. The authors applied the AITS approach to three community development initiatives using single-family home prices as the outcome indicator and found that it could measure impacts on both the base level of prices and the rate of price appreciation. The authors also found a situation in which the method appears unreliable, however. The AITS approach benefits from more recurrent data on outcomes during the pre-and post-intervention periods, with an intertemporal pattern that avoids great volatility. The AITS approach to measuring effects of community development initiatives holds strong promise, with caveats.
TL;DR: In this article, negative binomial models are used to examine the relationship between a variety of factors that have been linked theoretically and empirically to the frequency of offending and individual characteristics.
Abstract: In recent years, much attention has been devoted to developing appropriate analytical methods to model criminal careers. Largely ignored in this methodological debate is the study of how the criminal behavior patterns of active offenders are related to individual characteristics. This article presents an analysis of the postrelease offending patterns of two cohorts of male youth released by the California Youth Authority in 1981 to 1982 and 1986 to 1987. The focus of the analysis is the frequency of arrest during the first three years following release. Negative binomial models are used to examine the relationship between a variety of factors that have been linked theoretically and empirically to the frequency of offending. Results suggest that measures of individual and geographic characteristics can be used to predict the average arrest frequencies and their variation among paroled youthful offenders. These findings suggest that there may be useful distinctions to be made among offending populations.
TL;DR: It is feasible to use existing questions in the NHIS to identify a population of CSHCN that is substantially similar to children identified through other algorithms or through use of a screening instrument imbedded in a household survey.
Abstract: Objective
To test the feasibility of using the National Health Interview Survey (NHIS) to identify children with chronic illness through a noncategorical approach, as exemplified by the Children with Special Health Care Needs (CSHCN) screener. The ability to use the NHIS to identify CSHCN will permit analyses of the effects of welfare reform and public insurance eligibility expansions during the late 1990s on CSHCN.
09 Jun 2004
TL;DR: In this paper, the authors describe a proposal to combine three approaches that will enable research access to high quality data while preserving confidentiality, including developing synthetic microdata which can be accessed at a restricted access site (a virtual Research Data Center), together with access to the "gold standard" analytical data set through a RDC network.
Abstract: This paper describes a proposal to combine three approaches that will enable research access to high quality data while preserving confidentiality. These approaches are: developing synthetic microdata which can be accessed at a restricted access site (a virtual Research Data Center), together with access to the “gold standard” analytical data set through a Research Data Center network. It also describes the promise of the development of other datasets – particularly multiple public use files that can be created from the same underlying data that can be targeted at different audiences
TL;DR: The results indicate that only a specific subset of children with special needs present difficulties for low-income parents' work, and suggests that policies to help low- Income single parents ofChildren with disabilities move into work should target this specific subset.
Abstract: Objectives: To better understand the impact of having a child with special health care needs (CSHCN), on low-income parents' employment decisions. Methods: Using data from the 1999 and 2000 National Health Interview Survey (NHIS), we estimate multivariate statistical regressions (logit and tobit models) to estimate the relationship between having a CSHCN and the likelihood of employment and hours of employment for a sample-of low-income single parents. Results: Controlling for differences in demographic and family characteristics, we find no significant association between having a CSHCN and the probability of work or the number of hours worked among low-income single-parent families. Separate analysis of different dimensions of special health care needs shows that parents of children with activity limitations are significantly less likely to work and work fewer hours. This result does not hold true for the group of children defined based on elevated or special service use, or for the group of children with specific chronic conditions. Conclusions: These results indicate that only a specific subset of children with special needs present difficulties for low-income parents' work. This suggests that policies to help low-income single parents of children with disabilities move into work should target this specific subset of children with special health care needs.
TL;DR: In this article, regression analysis of Community Development Block Grant (CDBG) spending in 17 large cities reveals strong statistical associations between spending from 1994 to 1996 and changes in three indicators of neighborhood conditions: the home purchase mortgage approval rate, the median amount of the home loan originated, and the number of businesses.
Abstract: Regression analysis of Community Development Block Grant (CDBG) spending in 17 large cities reveals strong statistical associations between spending from 1994 to 1996 and changes in three indicators of neighborhood conditions: the home purchase mortgage approval rate, the median amount of the home purchase loans originated, and the number of businesses. However, there is no consistent association between spending and indicators of subsequent neighborhood change unless CDBG spending is sufficiently spatially targeted that it exceeds a threshold of the sample mean expenditure and is measured relative to the number of poor residents. In addition, associations vary according to neighborhood trajectories before investment and changes in the local economy. Nevertheless, even in the least hospitable contexts—highly concentrated neighborhood poverty, preexisting declines in home values, weak city job growth—our estimates are consistent with the hypothesis that above‐threshold CDBG spending produces signi...
TL;DR: Kenney, Genevieve, and Debbie Chang as mentioned in this paper examined successes and shortcomings of the SCHIP program and highlighted the inequities in access to health care for millions of children.
Abstract: This paper examines successes and shortcomings of the SCHIP program. SCHIP is a source of coverage for millions of children, improving their access to health care and sparking innovation in program design and improvements in Medicaid. Concurrently, SCHIP has added to the complexity of the insurance system and introduced new inequities in access to insurance. It is imperfectly targeting eligible uninsured children, and the financing of the program is problematic because of the block-grant funding structure and the use of SCHIP funds to cover adults. These issues need to be addressed during the SCHIP reauthorization process, which is scheduled to begin in federal fiscal year 2006. (Kenney, Genevieve, and Debbie Chang. September/October 2004. The State Children's Health Insurance Program: Successes, Shortcomings, and Challenges. Health Affairs 23(5): 51-62.)
TL;DR: Investing in Creativity: A Study of the Support Structure for U.S. Artists as mentioned in this paper provides information on the status of various dimensions of the artists' support structure, both nationally and in specific sites.
Abstract: The report presents the overall findings of Investing in Creativity: A Study of the Support Structure for U.S. Artists. A major contribution of the study is a new comprehensive framework for analysis and action, which views the support structure for artists in the U.S. as a system made up of six key dimensions of the environment in which an artist works. This builds on previous and ongoing Urban Institute work to measure characteristics of place that make a culturally vibrant community. The study provides information on the status of various dimensions of the artists' support structure--both nationally and in specific sites.
TL;DR: In this article, the authors used a Cox proportional hazards model to predict foster care reunification rates and found that work at the time a child was placed increased the likelihood of reunification and losing welfare benefits following a placement decreased the likelihood.
TL;DR: The authors examined the consequences of state welfare policies and practices on the living arrangements of low-income families with children using data from the 1997 and 1999 National Surveys of America's Families and found that more effective collection of child support and family cap policies are correlated with declines in single parenting and increases in dual parenting.
Abstract: Using data from the 1997 and 1999 National Surveys of America's Families, the authors examine the consequences of state welfare policies and practices on the living arrangements of low-income families with children. Results from a multivariate difference-in-difference-in-differences model suggest that more effective collection of child support and family cap policies are correlated with declines in single parenting and increases in dual parenting. Other policies such as sanctions and special restrictions that apply to two-parent families have no clear, consistent association with living arrangements. © 2004 by the Association for Public Policy Analysis and Management.
TL;DR: In this paper, the authors describe contributions to employer-sponsored retirement accounts, using newly available longitudinal data that combine administrative earnings records with survey data, and reveal a fair amount of individual variability in contribution rates over time.
Abstract: This paper describes contributions to employer-sponsored retirement accounts, using newly available longitudinal data that combine administrative earnings records with survey data. The results reveal a fair amount of individual variability in contribution rates over time. However, potential negative shocks to income and increases in current consumption needs do not appear to lead workers to curtail their contributions. Instead, workers appear to raise their contribution rates after they have achieved key milestones in the lifecourse, such as the birth of a child or the purchase of a home.
TL;DR: A survey of state welfare directors and in-depth case studies in 12 states found that 1996 welfare reforms provided a fertile environment to improve collaborative efforts between welfare and child welfare agencies as discussed by the authors.
TL;DR: Social Security reforms, especially those that are not tied to the current system of spousal and survivor benefits, could improve retirement security for vulnerable women, whose numbers will begin to soar when the many women who raised children outside of marriage in the 1970s retire in coming years.
Abstract: Objectives. Many single mothers are likely to face special economic challenges in old age, because they often have limited employment histories and cannot rely on husbands for financial support. This article examines the economic status of these women in later life. Methods. The analysis uses nationally representative data from the Health and Retirement Study to estimate multivariate models of income, assets. and poverty rates for women aged 65-75 in 1999. Results. Controlling for education, current marital status, and race and ethnicity, the models indicate that women who spent ≥ 10 years raising dependent children outside of marriage are 55% more likely to live in poverty at ages 65-75 than women who were always married when their children were young. Discussion. The financial difficulties confronting single mothers raising children persist into later life. Social Security reforms, especially those that are not tied to the current system of spousal and survivor benefits, could improve retirement security for these vulnerable women, whose numbers will begin to soar when the many women who raised children outside of marriage in the 1970s retire in coming years.
TL;DR: In this article, tax-preferred saving incentives provide the largest benefits to households with income between $75,000 and $500,000, roughly the 80th to 99th percentile of the income distribution, and the top 20 percent of tax filing units by income will receive 70 percent of the tax benefits from new contributions to defined contribution plans and almost 60 percent of IRA tax benefits.
Abstract: This paper incorporates retirement saving incentives into the Tax Policy Center microsimulation model and analyzes the distributional effects of current tax preferences for saving. As a share of income, tax-preferred saving incentives provide the largest benefits to households with income between $75,000 and $500,000, roughly the 80th to 99th percentile of the income distribution. In 2004, the top 20 percent of tax filing units by income will receive 70 percent of the tax benefits from new contributions to defined contribution plans and almost 60 percent of IRA tax benefits.
TL;DR: In this paper, the impact of population aging on the labor market and changes over time in work capacity at older ages is discussed, and it is shown how movement toward hybrid pension plans, among other types of private and public retirement plan reforms and redesigns, can be used to increase work incentives for older adults.
Abstract: Employers are beginning to search for ways to elicit more labor supply from older adults as the population ages, the ability to work in later life increases, and younger workers become relatively scarce. Many employers are turning to hybrid pension plans, such as cash balance plans and pension equity plans. Whereas traditional defined benefit plans often subsidize workers who retire early and penalize those who remain at work beyond the plan's retirement age, most hybrid plans reward work at older ages. This paper documents the impact of population aging on the labor market and changes over time in work capacity at older ages. It then shows how movement toward hybrid pension plans, among other types of private and public retirement plan reforms and redesigns, can be used to increase work incentives for older adults.
TL;DR: The effects of HMO enrollment on prenatal care use and smoking were confined to Cuyahoga County, Ohio's largest county, and the effects of women's own managed care status were inconsistent depending on the outcome examined.
Abstract: This paper examines the impact of mandatory HMO enrollment for Medicaid-covered pregnant women on prenatal care use, smoking, c-section use, and birth weight, using linked birth certificate and Medicaid enrollment for 10 Ohio counties. Women serve as their own controls, which helps to overcome the bias from unmeasured variables such as health beliefs and behavior. Changes in key outcomes between the first and second birth are compared between women who reside in mandatory HMO enrollment counties and those in voluntary enrollment counties. Authors found that the effects of HMO enrollment on prenatal care use and smoking were confined to Cuyahoga County, Ohio's largest county. In Cuyahoga, the implementation of mandatory enrollment was related to a significant deterioration in the timing of initiation of care, but an improvement in the number of prenatal visits. In that county also, women who smoked in their first pregnancy were less likely to smoke during the second pregnancy, compared with women in voluntary counties. Changes over time in outcomes, both positive and negative, were more pronounced for African-American women. Authors conclude that, with careful implementation and attention to women's individual differences, outcomes for pregnant women may improve with Medicaid managed care implementation. (Health Services Research 39(4), 2004.)
TL;DR: It is found that unins insurance rates have been rising for low-income parents, especially those living in poverty, and that Medicaid and SCHIP could greatly reduce uninsurance among parents and would likely increase their access to care.
Abstract: This paper examines how rates of uninsurance for low-income parents have been changing over time and the extent to which expanding coverage to parents through Medicaid and the State Children’s Health Insurance Program (SCHIP) could help them. We find that uninsurance rates have been rising for low-income parents, especially those living in poverty, and that Medicaid and SCHIP could greatly reduce uninsurance among parents and would likely increase their access to care. Such expansions would still leave many noncitizen parents uninsured and would require reaching and enrolling families whose children have remained uninsured despite being eligible for public coverage.