Showing papers by "Urban Institute published in 2006"

Family Support in the Prisoner Reentry Process: Expectations and Realities

Abstract: This paper examines the role of family in the prisoner reintegration process, exploring the views of soon-to-be-released prisoners regarding the family support they expect to receive as well as the...

Racial disparities in childhood asthma in the United States: evidence from the National Health Interview Survey, 1997 to 2003.

Abstract: OBJECTIVE. To examine differences in asthma prevalence and emergency department (ED) visits for asthma between non-Hispanic black and white children, and factors that might explain those differences, in a large, nationally representative sample covering the period 1997 to 2003. METHODS. Bivariate and multivariate regression analyses (with logit and multinomial logit methods) were conducted with a sample consisting of all non-Hispanic black and white children ( RESULTS. Being black was associated with a greater likelihood of currently having asthma and with a greater likelihood of having gone to the ED for asthma treatment in the past 1 year. Elevated asthma risks for black children were robust after controlling for a host of child and family characteristics that might explain them. CONCLUSIONS. Black children are more likely to have asthma and to experience ED visits for asthma, compared with otherwise comparable white children, and these racial disparities cannot be explained by differences in measurable child or family characteristics. These results suggest that racial disparities in asthma continue to pose risks for black children, and they point to the need for additional research into potential explanations and remedies.

No community is an island: the effects of resource deprivation on urban violence in spatially and socially proximate communities

Abstract: The link between resource deprivation and urban violence has long been explored in criminological research. Studies, however, have largely ignored the potential for resource deprivation in particular communities to affect rates of violence in others. The relative inattention is notable because of the strong theoretical grounds to anticipate influences that extend both to geographically contiguous areas and to those that, though not contiguous, share similar social characteristics. We argue that such influences—what we term spatial and social proximity effects, respectively—constitute a central feature of community dynamics. To support this argument, we develop and test theoretically derived hypotheses about spatial and social proximity effects of resource deprivation on aggregated and disaggregated homicide counts. Our analyses indicate that local area resource deprivation contributes to violence in socially proximate communities, an effect that, in the case of instrumental homicides, is stronger when such communities are spatially proximate. We conclude by discussing the implications of our findings for theories focused on community-level social processes and violence, and for policies aimed at reducing crime in disadvantaged areas.

The effects of recent welfare and immigration reforms on immigrants' access to health care

Abstract: This study investigates the impact of the Personal Responsibility and Work Opportunity Reconciliation Act and the Illegal Immigration Reform and Immigrant Responsibility Act, both passed in 1996, on the use of health-care services in immigrant communities in five Texas counties. The study presents findings of interviews with public agency officials, directors of community-based organizations, and members of 500 households during two research phases, 1997-1998 and 1998-1999. In the household sample, 20 percent of U.S. citizens and 30 percent of legal permanent residents who reported'having received Medicaid during the five years before they were interviewed also reported losing the coverage during the past year. Some lost coverage because of welfare reform restrictions on noncitizen eligibility or because of changes in income or household size, but many eligible immigrants also withdrew from Medicaid voluntarily.

Targeting Investments for Neighborhood Revitalization

Abstract: How should we allocate public resources for revitalizing low-income urban neighborhoods? Once public investments in an area reach some minimum threshold, do they leverage substantial private resour...

The impact of elder care on women's labor supply

Abstract: Adult daughters traditionally have served as primary caregivers for frail unmarried adults, but the levels of care they have provided in the past may interfere with their growing work responsibilities. This paper examines the impact of time transfers to elderly parents on labor supply at midlife. Using a sample of women ages 55 to 67 in the Health and Retirement Study, we estimate panel data models of annual hours of paid work controlling for the endogeneity of time assistance to parents. The results indicate that time help to parents strongly reduces female labor supply at midlife.

Hospital-Physicians Relations: Cooperation, Competition, Or Separation?

Abstract: Because many services performed in hospitals can safely and conveniently be performed in ambulatory settings, physicians have become owners of entities directly competing with hospitals for patients in a new medical arms race. Hospitals and medical staff physicians face growing tensions as a result of physicians' growing reluctance to take emergency department call and the consequences of hospitalists replacing physicians in the care of inpatients. Although there are increasing expectations that health system challenges will lead hospitals and physicians to collaborate, in many markets the willingness and ability for hospitals and physicians to work together is actually eroding.

Where will I sleep tomorrow? Housing, homelessness, and the returning prisoner

Abstract: This year, over 630,000 prisoners will be released from state and federal prisons across the country—more than four times as many as were released in 1980. In this article, we examine the scope of the prisoner reentry issue—what is known about the intersection of housing, homelessness, and reentry and about the barriers returning prisoners face in securing safe and affordable housing. Although the housing challenges are formidable, progress is being made on numerous fronts. We seek to frame the dynamics of the reentry housing discussion by highlighting the promising strategies that are emerging. These strategies, taken to scale, could help create a very different national policy on prisoner reentry. Ultimately, effective reentry strategies have the potential not only to reduce re‐arrest and increase public safety, but also to reduce homelessness.

Land Leasing and Land Sale as an Infrastructure-Financing Option

Abstract: Municipal land sales provide one option for financing urban infrastructure investment. In countries where land is owned by the public sector, land is by far the most valuable asset on the municipal balance sheet. Selling land or long-term leasing rights to land use while investing the proceeds in infrastructure facilities can be viewed as a type of portfolio asset adjustment. This paper shows that in China many municipalities have financed more than half of their high rates of infrastructure investment from land sales, for periods of 10 to 15 years. Much of the remaining investment has been financed by municipal borrowing against the collateral of land values. Other countries also have turned to land sales and leasing for infrastructure finance. From a local perspective, land sales have the advantage that they typically are free from the intergovernmental restrictions that require higher-level approval for increases in local tax rates or user fees and that restrict local government borrowing. However, financing municipal infrastructure investment through land sales creates special risks that are not recognized in most intergovernmental fiscal frameworks. One danger involves the use of proceeds to finance operating budgets. Risk exposure is exaggerated by the highly volatile nature of urban land markets and evidence that in some countries urban land values in 2006 reflected a real estate bubble. In the past, Hong Kong, a jurisdiction that has relied heavily on land-leasing to finance its infrastructure budget, has seen land sales fall to zero at the bottom of the real estate cycle. The greatest financial sector risk stems from municipal borrowing based on inflated land values offered as collateral to banks. Sound intergovernmental fiscal management will require tighter regulation of municipalities' financial leveraging of land assets to avoid excessive risk taking by local governments.

Health insurance and health at age 65: implications for medical care spending on new Medicare beneficiaries.

Abstract: Several recent studies have examined the consequences of uninsurance in a near-elderly population using data from the longitudinal Health and Retirement Survey (Heeringa and Conner 1995). Baker et al. (2001, 2002) found that those who were continuously or intermittently uninsured, or lost their insurance coverage over a 2–4 year period, experienced greater health declines than those who were continuously insured. McWilliams et al. (2004, 2003) found that lack of insurance was associated with significantly increased mortality, and that previously uninsured near-elderly adults who survived to age 65 increased their use of basic clinical services after they obtained Medicare coverage more than those who had been fully insured. These research findings raise two important questions. Does lack of insurance prior to age 65 result in people qualifying for Medicare in worse health than if they had been insured? If so, is public insurance spending through Medicare and Medicaid on newly enrolled beneficiaries greater than it would be if people had continuous insurance coverage prior to age 65? Our analysis extends these previous studies in several ways. As the prior studies were not specifically interested in the question of health status at entry to Medicare, they included changes in health for people as young as 57, as well as people who were older than 65 and had already aged into Medicare coverage. If attaining Medicare coverage improves health (Lichtenberg 2002), then the previous results may understate the impact of lack of insurance on health status at age 65. We also analyze data from the Health and Retirement Survey (HRS), but define our endpoint as health status at the last survey before turning 65. Second, Baker et al. (2001, 2002) did not adjust for possible bias in the estimation of the health insurance effect because of the selection of people into insurance states based on their unobserved health. This bias could occur through a combination of mechanisms. People who are uninsured at this age and in good health may forego insurance coverage, especially nongroup coverage, because of its very high cost for older people. At the other extreme, people in poor health who are unable to work may qualify for Medicaid and/or Medicare coverage because of a work-limiting disability. Similarly, people in less than perfect health with employer-sponsored insurance may be more likely to continue working to keep their insurance coverage, as opposed to taking early retirement without coverage. These behaviors raise the possibility that unobserved health, which affects future health, may be better among the uninsured and worse among the insured than if people were randomly assigned to alternative insurance states in an experiment. McWilliams et al. (2004) used a propensity score method based on health insurance status in 1992 to adjust for the effects of observable differences associated with insurance coverage. However, this adjustment may not fully account for the effects of unobserved factors. We use instrumental variable (IV) analysis (McClellan and Newhouse 2000) to adjust for possible biases because of unobserved factors, focusing on the percentage of time a person was insured over the entire observation period prior to turning 65. (McWilliams et al. [2004] adjust only for insurance status at baseline, 1992.) Third, Baker et al. (2001, 2002) measured the change in health by two categorical variables: a “major decline in health,” defined as a change in self-reported health status between baseline and endpoint either (1) from excellent, very good, or good health to fair or poor, or (2) from fair to poor, and a “new difficulty with mobility,” defined from specific questions asking whether the person had “no difficulty” with an activity at baseline, but was unable to perform the activity at the endpoint. Consequently, people already in poor health or unable to perform the mobility activities at baseline, as well as people who died, were excluded from the analysis. McWilliams et al. (2004) analyzed only mortality, ignoring changes in health status among survivors. We analyze a broader and more detailed measure of health prior to age 65, taking into account mortality, self-reported health status, and the presence of instrumental activities of daily living (IADL) or activities of daily living (ADL) limitations. Finally, we use the results from our analysis of the relationship between insurance coverage and health prior to age 65 to simulate whether medical spending by newly enrolled, aged Medicare beneficiaries might be affected by extending continuous insurance coverage to all people between the ages of 55 and 64. We use data on health and medical care spending from the Medicare Current Beneficiary Survey (MCBS) to simulate the effects of a change in the distribution of initial health states on both total and public (Medicare plus Medicaid) medical care spending by 66-70-year olds.1

The Determinants of the Incidence of Intergovernmenta l Grants: A Survey of the International Experience

Abstract: Although the presence of objective formula-based grants is an important component of a stable, equitable and efficient system of intergovernmental fiscal relations, the final incidence of grants is not always according to what is stated in the formula because there are other intervening institutional factors. Furthermore, the intergovernmental grant mechanism itself is often a function of the same interests or forces that ultimately drive the incidence of grant resources. This paper relates the horizontal allocation of intergovernmental grants directly to their potential underlying determinants, including normative policy issues, voter choice arguments and political considerations. An international comparison of empirical incidence studies reveals that besides local expenditure needs and local fiscal capacity, other factors including political influence and a jurisdiction’s size play important and consistent roles in determining the horizontal allocation of per capita intergovernmental grants

Massachusetts Health Care Reform: A Look At The Issues

Abstract: Massachusetts recently enacted a major health reform that could move the state to close to universal health insurance coverage. We describe some of the politics behind the legislation and...

The Uninsured And The Affordability Of Health Insurance Coverage

Abstract: The 2005 Current Population Survey (CPS) is used to estimate what share of uninsured Americans are eligible for coverage through Medicaid or the State Children's Health Insurance Program ...

Wardens' Views on the Wisdom of Supermax Prisons

Abstract: Super-maximum security prisons have proliferated nationally, reflecting a belief among policy makers and corrections officials that such high-cost housing is effective. Yet little is known about the precise goals of “supermax” prisons, whether these goals are achieved, what unintended effects supermaxes may have, and, more generally, whether they represent a wise investment. State correctional data systems do not readily allow for assessment of these issues. The authors of this study therefore administered surveys to state prison wardens—a population uniquely situated to provide insight about supermaxes—to address existing gaps in knowledge and to inform research and policy debates. The authors discuss the study's findings and implications.

Collective Bargaining in Education: Negotiating Change in Today's Schools.

Abstract: This timely and comprehensive volume will spur and strengthen public debate over the role of teachers unions in education reform for years to come. Collective bargaining shapes the way public schools are organized, financed, staffed, and operated. Understanding collective bargaining in education and its impact on the day-to-day life of schools is critical to designing and implementing reforms that will successfully raise student achievement. But when it comes to public discussion of school reform, teachers unions are the proverbial elephant in the room. Despite the tremendous influence of teachers unions, there has not been a significant research-based book examining the role of collective bargaining in education in more than two decades. As a result, there is little basis for a constructive, empirically grounded dialogue about the role of teachers unions in education today.

Retention of New Teachers in California

Abstract: In California's continuing efforts to improve the quality of public schools, teacher retention is a potentially important strategy. Using a new longitudinal database on public school teachers, the authors examine teacher retention patterns in the state. They investigate the effects on retention of two policies intended to improve retention (teacher induction programs and teacher compensation), as well as the unintended consequences of class-size reduction programs. They also consider the relationship between teacher retention and the shortage of fully credentialed teachers, with a particular focus on high-poverty districts, where the shortage is most severe. (Public Policy Institute of California, February 2006.)

Out-of-pocket health spending between low-and higher-income populations: who is at risk of having high expenses and high burdens?

Abstract: Objective:We studied the effects of health insurance, health care needs, and demographic and area characteristics on out-of-pocket health care spending for low and higher income insured populations.Materials and Methods:We used the 2002 National Survey of America's Families to analyze out-of-pocket

Medicare fees and physicians' medicare service volume: beneficiaries treated and services per beneficiary.

Abstract: Using merged physician survey and Medicare claims data, this study analyzes how fee levels, market factors, and financial incentives affect physicians’ fee-for-service Medicare service volume. We find that Medicare fees are positively related to both the number of beneficiaries treated (η = 0.12 to 0.61) and service intensity (η = 1.04–1.71). Physicians with apparent incentives to induce demand appear to manipulate the mix of services provided in order to increase the effective Medicare fee. Finally, several market factors appear to influence the quantity of Medicare services physicians provide. Results highlight limitations of the present system for compensating physicians in Medicare’s fee-for-service program.

Access to Health Insurance, Barriers to Care, and Service Use among Adults with Disabilities:

Abstract: No studies to date have examined access to insurance coverage or medical care for a broadly defined population of uninsured nonelderly adults with disabilities. This analysis uses the 2002 National Survey of America's Families to examine access to coverage, access to care, and service use for a large sample of adults with disabilities, with a focus on the uninsured. All disabled groups reported unmet need and service use greater than their nondisabled counterparts with the same insured status. Access to coverage was most problematic for low-income adults with work limitations but no other indication of disability, with over one-third uninsured. This group deserves greater policy attention.

Stumbling Giants: The Emptiness, Fullness, and Recursiveness of Strategic Management

Abstract: A rational decision is inherently paradoxical because its necessity goes hand-in-hand with its impossibility. Not only is our rationality bounded, as Herbert Simon has so convincingly shown, but we also must make decisions under conditions in which there are no rules by which we can make a decision - even if it be just a satisficing decision. We have to decide when we don't really know and cannot know how to decide. This essential fact of decision making is ever the more true for strategic decisions which are, at their very core, about action under uncertainty and contingency. This paper discusses the recursive process through which corporate strategy, decision making, and restructuring occur.

Foundation Approaches to Effectiveness: A Typology:

Abstract: The heterogeneity of foundations is usually captured in terms of classifications based on size or type (community, corporate, independent). This article argues that to capture broader elements of foundation approaches to philanthropy, we also need ways of categorizing foundations that reflect differences in how they approach their work and the underlying philosophies that inform their philanthropy. The article develops one such typology, drawing on research on 1,192 foundations. The typology is proposed as useful for understanding variations among foundations, and for its practical value in helping foundations clarify their own guiding frameworks.

Would safety-net expansions offset reduced access resulting from lost insurance coverage? Race/ethnicity differences.

Abstract: This study simulated whether increased community health center (CHC) funding under the Bush administration narrowed racial/ethnic gaps in access to care among low-income people. Expanded CHC funding resulted in small increases in access to care, more so for minorities than for whites. Spanish-speaking Hispanics had the largest improvements in access in the simulation. However, minorities experienced bigger drops in insurance coverage. The net result was no improvements in the access measures for Spanish-speaking Hispanics and slight decreases in access for whites, English-speaking Hispanics, and African Americans. Access gaps either remained the same or worsened slightly for English-speaking Hispanics and African Americans relative to whites.

What Do Individual Development Accounts Do? Evidence from a Controlled Experiment

Abstract: This paper evaluates the first controlled field experiment on Individual Development Accounts (IDAs). Including their own contributions and matching funds, treatment group members could accumulate up to $6,750 for home purchase or $4,500 for other qualified uses. Almost all treatment group members opened accounts, but many withdrew the balances for unqualified purposes. For black renters at baseline, the IDA raised home ownership rates by almost 10 percentage points over 4 years, but reduced financial assets and business ownership. White renters experienced no home ownership effects, but business equity rose. Home owners used the IDA in different ways than renters.

Trends In Retiree Health Insurance, 1997–2003

Abstract: Although millions of older Americans rely on employer-sponsored retiree health benefits to help pay their medical expenses, declines in this coverage have been documented. Using data from the Medical Expenditure Panel Survey, our findings reveal steady erosion in retiree health benefits since the mid-1990s. Based on this much larger survey of private establishments than previous studies have used, we conclude that in 2003 only about one-quarter of private-sector employees worked at establishments that offered health benefits to retirees, down from 32 percent in 1997. Private firms have also been passing higher shares of health insurance costs to retirees.

Promoting Declines in the Prevalence of Late‐Life Disability: Comparisons of Three Potentially High‐Impact Interventions

Abstract: Although the prevalence of late-life disability has been declining, how best to promote further reductions remains unclear. This article develops and then demonstrates an approach for comparing the effects of interventions on the prevalence of late-life disability. We review evidence for three potentially high-impact strategies: physical activity, depression screening and treatment, and fall prevention. Because of the large population at risk for falling, the demonstrated efficacy of multi-component interventions in preventing falls, and the strong links between falls and disability, we conclude that, in the short run, multi-component fall-prevention efforts would likely have a higher impact than either physical activity or depression screening and treatment. However, longer-term comparisons cannot be made based on the current literature and may differ from short-run conclusions, since increases in longevity may temper the influences of these interventions on prevalence. Additional research is needed to evaluate longer-term outcomes of interventions, including effects on length and quality of life.

Effects of Premium Increases on Enrollment in SCHIP: Findings from Three States

Abstract: This study examines the effects of new and higher premiums on SCHIP enrollment in Kansas, Kentucky, and New Hampshire—three states that implemented premium changes in 2003. We used state administra...

Systematic Review of Non-Custodial Employment Programs: Impact on Recidivism Rates of Ex-Offenders

Abstract: The objective of this Campbell systematic review was to assess the effects of programs designed to increase employment through job training and/or job placement among formerly incarcerated persons (i.e., those recently released), aimed at improving employment and reducing recidivism. Searches of literature reviews by the first author were augmented by structured searches of nine electronic data bases, including the Campbell SPECTR database of trials to identify random assignment studies conducted after 1970. Experts in the field were consulted and relevant citations were followed up. We report narratively on the eight eligible studies. More than 6,000 older youth (aged 16‐17) and adults with prior contact with the criminal justice system participated in these studies. The analyses show that employment‐focused interventions for ex‐offenders in these studies did not reduce recidivism, although this group of random assignment studies is highly heterogeneous both in the type of employment program delivered and the individuals enrolled in the program. Thus, the results should not be generalized to former prisoners who are enrolled in employment programs after release. The studies are also mostly out of date and the average subject was not typical of persons released from prison in the US in the early 2000s. Employment‐focused interventions for former prisoners have not been adequately evaluated for their effectiveness using random assignment designs. A new generation of rigorous evaluations is needed to provide direction to policymakers as to the most effective combination of employment‐related services for specific types of ex‐offenders. ABSTRACT Background Over the last 25 years, many programs that were designed to increase employment for persons with a criminal history have been implemented and evaluated. The implicit, and often explicit, intent of these programs has been to reduce recidivism. Wilson et al. (1999, 2000) conducted a quantitative synthesis of 33 evaluations of educational, vocational, and work programs for persons in correctional facilities. To date, however, the evaluation literature on employment services programs for those with a recent criminal record who are not in custody has not been systematically reviewed. Objectives To assess the effects of programs designed to increase employment through job training and/or job placement among formerly incarcerated persons (i.e., those recently released), aimed at improving employment and reducing recidivism. Search Strategy Searches of literature reviews by the first author were augmented by structured searches of nine electronic data bases, including the Campbell SPECTR database of trials to identify random assignment studies conducted after 1970. Experts in the field were consulted and relevant citations were followed up. Selection Criteria Selecting studies based on the original objective – to examine employment services interventions for recently released prisoners – did not produce a sufficient number of studies for analysis. Thus, the selection criteria were expanded to include studies that tested the effects of job training or job placement programs or both for persons who had been arrested, convicted or incarcerated in connection with a criminal charge. Only random assignment studies of adults or studies that combined older youth (ages 16‐17) and adults were included. If the treatment or comparison groups included subjects who were not ex‐offenders, the results must have been reported separately for the ex‐offenders. Data Collection and Analysis We report narratively on the eight eligible studies. More than 6,000 older youth (aged 16‐17) and adults with prior contact with the criminal justice system participated in these studies. Two studies contributed two independent effect sizes for a total of ten effect sizes for the eight studies. We used arrests during the follow‐up period (typically, 12 months) as the outcome measure. We ran three analyses: one with a mixture of dichotomized and continuous arrest measures, a second with logged odds ratio effect sizes, and a third splitting the sample into those with a conviction and those without a conviction. Main Results The analyses show that employment‐focused interventions for ex‐offenders in these studies did not reduce recidivism, although this group of random assignment studies is highly heterogeneous both in the type of employment program delivered and the individuals enrolled in the program. Thus, the results should not be generalized to former prisoners who are enrolled in employment programs after release. The studies are also mostly out of date and the average subject was not typical of persons released from prison in the U.S. in the early 2000s. Reviewers' Conclusions We conclude that employment‐focused interventions for former prisoners have not been adequately evaluated for their effectiveness using random assignment designs. After broadening the selection criteria to include individuals with criminal records, only eight studies, the majority of which are more than 10 years old, could be identified. Nonetheless, overall, the eight interventions had no significant effect on the likelihood that participants would be rearrested. Many employment‐focused interventions for ex‐offenders are being implemented. A new generation of rigorous evaluations is needed to provide direction to policymakers as to the most effective combination of employment‐related services for specific types of ex‐offenders.