Showing papers by "Urban Institute published in 2007"

Can Teacher Quality Be Effectively Assessed? National Board Certification as a Signal of Effective Teaching

Abstract: In this paper, we describe the results of a study assessing the relationship between the certification of teachers by the National Board for Professional Teaching Standards (NBPTS) and elementary-level student achievement. We examine whether NBPTS assesses the most effective applicants, whether certification by NBPTS serves as a signal of teacher quality, and whether completing the NBPTS assessment process serves as a catalyst for increasing teacher effectiveness. We find consistent evidence that NBPTS is identifying the more effective teacher applicants and that National Board Certified Teachers are generally more effective than teachers who never applied to the program. The statistical significance and magnitude of the “NBPTS effect,” however, differs significantly by grade level and student type. We do not find evidence that the NBPTS certification process itself does anything to increase teacher effectiveness.

Causal inference with observational data

Abstract: Problems with inferring causal relationships from nonexperimental data are briefly reviewed, and four broad classes of methods designed to allow estimation of and inference about causal parameters ...

Food Insecurity Works through Depression, Parenting, and Infant Feeding to Influence Overweight and Health in Toddlers

Abstract: We used the Early Childhood Longitudinal Study-Birth Cohort 9- and 24-mo surveys (n = 8693) and Structural Equation Modeling to examine direct and indirect associations between food insecurity and toddlers' overweight (weight for length), physical health, and length for age. There were significant effects of food insecurity on parental depression and parental depression in turn influenced physical health. There were also significant effects of food insecurity on parenting practices, which in turn were significantly associated with infant feeding and subsequently toddlers' overweight. There were no significant direct or indirect associations between food insecurity and toddlers' length for age. Our results show that food insecurity influences parenting, including both depression and parenting practices. Findings suggest parental depression is a stressor on parenting behavior that social policy should address to alleviate problematic child health outcomes. Findings underscore the importance of continuing and strengthening policy initiatives to ensure that families with infants and toddlers have sufficient, predictable, and reliable food supply.

Acting in the Public Interest? Another Look at Research on Nonprofit Governance

Abstract: This article begins to fill gaps that currently exist between research on the governance of nonprofit organizations and research on public governance and focuses on how nonprofit governance research can benefit from insights in the public governance literature. As boundaries between nonprofit governance and public governance are increasingly fluid, our theoretical understanding as well as our empirical work on governance must expand to encompass these new relationships. The article summarizes the extant empirical literature on nonprofit governance and compares this research to emerging work on public governance. Drawing on this literature, the article specifically calls for research on nonprofit governance that (a) gives greater attention to the links between organizational governance and the public interest, (b) incorporates a broader view of governance as a process engaging multiple actors and taking place at multiple levels, and (c) links governance to accountability for results.

Fundamental Reform of Payment for Adult Primary Care: Comprehensive Payment for Comprehensive Care

Abstract: Primary care is essential to the effective and efficient functioning of health care delivery systems, yet there is an impending crisis in the field due in part to a dysfunctional payment system. We present a fundamentally new model of payment for primary care, replacing encounter-based imbursement with comprehensive payment for comprehensive care. Unlike former iterations of primary care capitation (which simply bundled inadequate fee-for-service payments), our comprehensive payment model represents new investment in adult primary care, with substantial increases in payment over current levels. The comprehensive payment is directed to practices to include support for the modern systems and teams essential to the delivery of comprehensive, coordinated care. Income to primary physicians is increased commensurate with the high level of responsibility expected. To ensure optimal allocation of resources and the rewarding of desired outcomes, the comprehensive payment is needs/risk-adjusted and performance-based. Our model establishes a new social contract with the primary care community, substantially increasing payment in return for achieving important societal health system goals, including improved accessibility, quality, safety, and efficiency. Attainment of these goals should help offset and justify the costs of the investment. Field tests of this and other new models of payment for primary care are urgently needed.

Insurance Coverage, Medical Care Use, and Short-term Health Changes Following an Unintentional Injury or the Onset of a Chronic Condition

Abstract: ContextGiven the large and increasing number of uninsured US individuals, identifying the health consequences of being uninsured has assumed increased importance.ObjectiveTo compare medical care use and short-term health changes among US uninsured individuals and insured nonelderly individuals following a health shock caused by either an unintentional injury or the onset of a chronic condition.Design, Setting, and ParticipantsMultivariate logistic regression analysis of longitudinal data from Medical Expenditure Panel Surveys (1997-2004) limited to nonelderly individuals whose insurance status was established for 2 months prior to 1 or more unintentional injuries (20 783 cases among 15 866 individuals) and onset of 1 or more chronic conditions (10 485 cases among 7954 individuals).Main Outcome MeasuresSelf-reported medical care use and change in short-term general health status following the health shock.ResultsAfter experiencing a health shock, uninsured individuals were less likely to obtain any medical care (unintentional injury [UI] group: 78.8% uninsured vs 88.7% insured [adjusted odds ratio {AOR}, 0.47; 95% confidence interval {CI}, 0.43-0.51]; new chronic condition [NCC] group: 81.7% uninsured vs 91.5% insured [AOR, 0.45; 95% CI, 0.40-0.50]) and more likely not to have received any recommended follow-up care (UI group: 19.3% uninsured vs 9.2% insured [AOR, 2.59; 95% CI, 2.15-3.11]; NCC group: 9.4% uninsured vs 4.4% insured [AOR, 1.65; 95% CI, 1.32-2.06]). Based on the AORs, uninsured individuals with UIs had fewer outpatient visits (6.1% uninsured vs 9.0% insured; AOR, 0.71 [95% CI, 0.63-0.80]), office-based visits (41.8% uninsured vs 57.3% insured; AOR, 0.59 [95% CI, 0.56-0.62]), and prescription medicines (35.5% uninsured vs 35.6% insured; AOR, 0.71 [95% CI, 0.67-0.75]). Uninsured individuals with an NCC had fewer office-based visits (58.9% uninsured vs 68.3% insured; AOR, 0.77 [95% CI, 0.72-0.82]) and prescription medicines (52.7% uninsured vs 61.7% insured; AOR, 0.66 [95% CI, 0.57-0.76]). Higher proportions of uninsured individuals reported a decrease in health status (classified as much worse) approximately 3.5 months after the health shock (UI group: 9.8% uninsured vs 6.7% insured; AOR, 0.86 [95% CI, 0.75-0.98]; NCC group: 12.3% uninsured vs 10.1% insured; AOR, 0.74 [95% CI, 0.68-0.80]). Uninsured individuals with UIs were more likely to report not being fully recovered and no longer receiving treatment. At approximately 7 months after the health shock, uninsured individuals with NCCs still reported worse health status.ConclusionsAmong individuals who experienced a health shock caused by an unintentional injury or a new chronic condition, uninsured individuals reported receiving less medical care and poorer short-term changes in health than those with insurance.

Using Geographically Weighted Regression to Explore Local Crime Patterns

Abstract: The present research examines a structural model of violent crime in Portland, Oregon, exploring spatial patterns of both crime and its covariates. Using standard structural measures drawn from an opportunity framework, the study provides results from a global ordinary least squares model, assumed to fit for all locations within the study area. Geographically weighted regression (GWR) is then introduced as an alternative to such traditional approaches to modeling crime. The GWR procedure estimates a local model, producing a set of mappable parameter estimates and t-values of significance that vary over space. Several structural measures are found to have relationships with crime that vary significantly with location. Results indicate that a mixed model— with both spatially varying and fixed parameters—may provide the most accurate model of crime. The present study demonstrates the utility of GWR for exploring local processes that drive crime levels and examining misspecification of a global model of urban violence.

Into the Eye of the Storm: Assessing the Evidence on Science and Engineering Education, Quality, and Workforce Demand

Abstract: Recent policy reports claim the United States is falling behind other nations in science and math education and graduating insufficient numbers of scientists and engineers. Review of the evidence and analysis of actual graduation rates and workforce needs does not find support for these claims. U.S. student performance rankings are comparable to other leading nations and colleges graduate far more scientists and engineers than are hired each year. Instead, the evidence suggests targeted education improvements are needed for the lowest performers and demand-side factors may be insufficient to attract qualified college graduates.

Estimating the Health Effects of Retirement

Abstract: We estimate the magnitude of any direct effect of retirement on health. Since retirement is endogenous to heath, it is not possible to estimate this effect by comparing the health of individuals before and after they retire. As an alternative we use institutional features of the pension system in the United Kingdom that are exogenous to the individual to isolate exogenous variation in retirement behavior. Data used will include both vital statistics and survey data that include both "objective" physical measurements and respondent self-reports. We find no evidence of negative health effects of retirement and some evidence that there may be a positive effect, at least for men.

Why Do Boomers Plan to Work Longer

Abstract: Objectives. Recent changes in retirement trends and patterns have raised questions about the likely retirement behavior of baby boomers, the large cohort born between 1946 and 1964. This study examined recent changes in retirement expectations and the factors that drove them. Methods. Using data from the Health and Retirement Study, the analysis compared self-reported probabilities of working full time past ages 62 and 65 among workers aged 51 to 56 in 1992 and 2004. The study modeled retirement expectations for both generations and used the estimated regression coefficients to identify the forces that accounted for generational differences. Results. Between 1992 and 2004, the mean self-reported probability of working full time past age 65 among workers aged 51 to 56 increased from 27% to 33%. Lower rates of retiree health insurance offers from employers, higher levels of educational attainment, and lower rates of defined benefit pension coverage accounted for most of the growth. Discussion. Given the continued erosion in employer-sponsored retiree health benefits and defined benefit pension plans, boomers will likely remain at work longer than members of the previous generation. Lengthier careers will likely promote economic growth, increase government revenue, and improve individual financial security at older ages.

How Do Marital Status, Work Effort, and Wage Rates Interact?

Abstract: How marital status interacts with men’s earnings is an important analytic and policy issue, especially in the context of debates in the United States over programs that encourage healthy marriage. This paper generates new findings about the earnings-marriage relationship by estimating the linkages among flows into and out of marriage, work effort, and wage rates. The estimates are based on National Longitudinal Survey of Youth panel data, covering 23 years of marital and labor market outcomes, and control for unobserved heterogeneity. We estimate marriage effects on hours worked (our proxy for work effort) and on wage rates for all men and for black and low-skilled men separately. The estimates reveal that entering marriage raises hours worked quickly and substantially but that marriage’s effect on wage rates takes place more slowly while men continue in marriage. Together, the stimulus to hours worked and wage rates generates an 18%–19% increase in earnings, with about one-third to one-half of the marriage earnings premium attributable to higher work effort. At the same time, higher wage rates and hours worked encourage men to marry and to stay married. Thus, being married and having high earnings reinforce each other over time.

Hospitals in Hurricane Katrina: challenges facing custodial institutions in a disaster.

Abstract: In the days after Hurricane Katrina struck and New Orleans's infrastructure failed, hospitals and other organizations that have custodial responsibility for human beings (such as nursing homes and jails) faced special difficulties. In some two dozen hospitals, patients had to be evacuated because of the loss of power, water, and sewage service, and many of these hospitals required external assistance, which was slow to arrive. Meanwhile, patients' needs for care continued unabated. Some hospitals evacuated all patients successfully, but by the end of that long week, some had become places of death. This paper explores what happened in New Orleans-area hospitals during and after Hurricane Katrina and why hospitals had such varied experiences. We conclude with lessons based on the Katrina experience.

Predicting Women's Perceptions of Domestic Violence and Sexual Assault Agency Helpfulness: What Matters to Program Clients?

Abstract: Study goals were to assess if community agency interactions, the characteristics of services provided by staff, and the combinations of services received can predict women's perceptions of victim service helpfulness around domestic violence and sexual assault. Data were collected from agency representatives in 26 communities, and both women who used services and others living in the community (n = 1,509 women). Women found nonprofit victim services more helpful based on staff behavior in those agencies and the extent to which women felt control when working with staff; helpfulness of services was enhanced when agencies interacted with the legal system and other community agencies.

Working for a Good Retirement

Abstract: One way of relieving the economic pressures created by an aging population is to encourage workers to delay retirement. When people leave the workforce, they forgo earnings. To replace these earnings, many retirees begin collecting pensions and/or drawing down their assets. Most retirees also begin collecting Social Security benefits. At the same time, retirees pay fewer taxes — not just payroll taxes that support Social Security, but also federal, state, and local income taxes that support other government programs. Thus, the retirement of the boomer generation, some 76 million people, is expected to have a large impact on individuals, the retirement system, and the economy.

Community-wide strategies for preventing homelessness: recent evidence.

Abstract: This article summarizes the findings of a study of community-wide strategies for preventing homelessness among families and single adults with serious mental illness, conducted for the US Department of Housing and Urban Development. The study involved six communities, of which this article focuses on five. A major finding of this study was that it was difficult to identify sites with community-wide strategies, and even harder to find any that maintained data capable of documenting prevention success. However, the five communities selected for this study presented key elements of successful strategies including mechanisms for accurate targeting, a high level of jurisdictional commitment, significant mainstream agency involvement, and mechanisms for continuous system improvement.

Use of physicians' services under Medicare's resource-based payments

Abstract: BACKGROUND In 1992, Medicare implemented the resource-based relative-value scale, which established payments for physicians' services based on relative costs. We conducted a study to determine how the use of physicians' services changed during the first decade after the implementation of this scale. METHODS With the resource-based relative-value scale, Medicare payments are based on the number of relative-value units (RVUs) assigned to physicians' services. The total number of RVUs reflects the volume of physicians' work (the time, skill, and training required for a physician to provide the service), practice expenses, and professional-liability insurance. Using national data from Medicare on physicians' services and American Medical Association files on RVUs, we analyzed the growth in RVUs per Medicare beneficiary from 1992 to 2002 according to the type of service and specialty. We also examined this growth with respect to the quantity and mix of services, revisions in the valuation of RVUs, and new service codes. RESULTS Between 1992 and 2002, the volume of physicians' work per Medicare beneficiary grew by 50%, and the total RVUs per Medicare beneficiary grew by 45%. The quantity and mix of services were the largest sources of growth, increasing by 19% for RVUs for physicians' work and by 22% for total RVUs. Our findings varied among services and specialties. Revised valuation of RVUs was a key source of the growth in RVUs for physicians' work and total RVUs for evaluation and management and for tests. New service codes were the largest drivers of growth for major procedures (accounting for 36% of the growth in RVUs for physicians' work and 35% of the growth in total RVUs), and the quantity and mix of existing services were the largest drivers of growth for imaging. The growth in RVUs for physicians' work was greatest in cardiology (114%) and gastroenterology (72%). The total growth in RVUs was greatest in cardiology (99%) and dermatology (105%). CONCLUSIONS In the first 10 years after the implementation of the resource-based relative-value scale, RVUs per Medicare beneficiary grew substantially. The leading sources of growth varied among service types and specialties. An understanding of these sources of growth can inform policies to control Medicare spending.

Can We Promote Child Well‐Being by Promoting Marriage?

Abstract: This article uses data from the National Longitudinal Survey of Youth 1979 Cohort Mother-Child files to explore the idea that child well-being can be improved by encouraging and enhancing parental marriage. I consider how children's living arrangements, the stability of parental marriages, and changes in living arrangements are related to children's behavior and cognitive test scores. Although there is some evidence that children living with their married parents, even parents in unstable marriages, have better outcomes than children living in certain nonmarital arrangements, the findings vary across domains and specifications, and the effect sizes are generally small. Thus, any benefits of policies aimed improving child well-being by encouraging and enhancing parental marriage are likely to be modest at best. Key Words: children, family policy, family structure, living arrangements, marriage, well-being. Conventional wisdom and considerable social science research hold that children who live with their married biological or adoptive parents fare better on a host of indicators and outcomes man children in any other living arrangement (e.g., McLanahan & Sandefur, 1994). In public policy circles, this convergence of ideology and research has given momentum to the marriage movement, policymakers, and advocates who believe that government should actively support "healthy" marriages. Indeed, under the Bush Administration's Healthy Marriage Initiative, the federal government will spend $150 million a year on research, policies, and programs aimed at promoting healthy marriages. The ultimate success of this translation of research findings to policy prescriptions depends on the answers to two key questions. First, if marriage promotion efforts are successful, children who otherwise would live in an alternative arrangement will live with married parents. Can one reasonably expect that children living in families formed as a result of marriage promotion will fare as well as their counterparts living with married parents today? second, for some children, moving into a married family represents a disruption in their living arrangement and perhaps a change in residence or the introduction of a stepparent, or both. Do such transitions have negative consequences for children that may offset some of the benefits of marriage? This article examines how the relationships between children's well-being and their living arrangements are affected by the stability of their parents' marriages and changes in their living arrangements using data from the National Longitudinal Survey of Youth 1979 (NLSY-79) Cohort Mother-Child files. These data are ideal for this investigation because they contain detailed measures of child well-being, living arrangements, and other socioeconomic information, and these factors are measured at several points in time. The key innovation introduced here is using the future marital status of a child's mother to measure the stability of the relationship between married parents, and stability can be considered a proxy for marital quality. The home environment for children whose parents ultimately separate and divorce is likely to be of lower quality than that of children whose parents remain married. Including this measure of adult relationship stability helps to account for the possibility that children in marriage-promoted families may be in lower quality home environments than the average child with married parents today. Background A substantial amount of research exists on the relationship between living arrangements and children's well-being. The research considers a wide variety of outcomes for children across several different domains and explores different mechanisms by which living arrangements can affect these outcomes. Children's outcomes can be broadly grouped into three domains: cognitive, school based, and behavioral. Cognitive outcomes are usually measured by test scores (e. …

The impacts of the State Children's Health Insurance Program on children who enroll: findings from ten states.

Abstract: The State Children's Health Insurance Program (SCHIP) was created in 1997 primarily to expand insurance coverage to more low-income children States had latitude over numerous aspects of their program design and ultimately all states expanded eligibility for public coverage under the new program (Kenney and Chang 2004) One of the yardsticks by which SCHIP is measured is the extent to which the program improves children's access to and receipt of care over and above what they would have experienced otherwise SCHIP is expected to lower the costs and other barriers associated with obtaining care for the children who enroll, particularly relative to being uninsured, which should in turn, increase their access to care Prior research has demonstrated that uninsured children experience more access problems and receive fewer services than children with public health insurance coverage (Rosenbach 1989; Monheit and Cunningham 1992; Stoddard, St Peter, and Newacheck 1994; Currie and Thomas 1995; Newacheck, Hughes, and Stoddard 1996; Moreno and Hoag 2001; Dubay and Kenney 2001) However, the access and use gaps found between the uninsured and the insured may derive not only from differential access to health care, but may also reflect unmeasured differences between the two groups in health seeking behavior and attitudes toward health care A number of studies have attempted to address the potential bias introduced when comparing the uninsured and insured, by examining changes in access and use following enrollment in a public health insurance program (Lave et al 1998; Szilagyi et al 2000, 2004, 2006; Slifkin et al 2001; Damiano et al 2002; Dick et al 2004; Kempe et al 2005; McBroome, Damiano, and Willard 2005; Shone et al 2005) These studies have found improvements in access and use for children who enrolled in the program based on a longitudinal analysis of children's experiences before and after they have coverage Two of these studies examined the impacts of non-Medicaid programs that predated the enactment of the SCHIP program: Szilagyi et al (2000) reported on Child Health Plus in New York and Lave et al (1998) reported on the Children's Health Insurance Program in Pennsylvania while the other studies focused on SCHIP programs All of these studies found improvements in a number of different measures of health care access and use for children who enrolled in these programs These findings suggest that differences in service use found between the uninsured and the insured are not all driven by unmeasured differences in characteristics of the two groups, but instead reflect greater access to care afforded to children with health insurance coverage In this paper, the impacts of SCHIP on the children who are served by the program are examined using an approach that is a variant on that used by Lave et al (1998), Szilagyi et al (2000), Damiano and Williard (2002), and Dick et al (2004) The 10 states examined—California, Colorado, Florida, Illinois, Louisiana, Missouri, New Jersey, New York, North Carolina, and Texas—include a large proportion of all low-income uninsured children in the United States, wide geographic representation, and diverse approaches to program design These states account for over 60 percent of all SCHIP enrollees nationwide and represent all four census regions (Smith and Rousseau 2005) They reflect the three different SCHIP program structures (California, Colorado, Florida, New York, North Carolina, and Texas have separate non-Medicaid expansions,1 Louisiana and Missouri have Medicaid expansions, and Illinois and New Jersey have a combination program with Medicaid and non-Medicaid components) They also vary in terms of their reliance on managed care, their cost sharing structures, and benefit packages (Hill et al 2005) To estimate impacts, the experience of a sample of enrollees who have been on the program for at least 5 months is contrasted with the pre-SCHIP experience of a separate sample of recent enrollees, using data from 2002 The following section describes the data and methodological approach Subsequent sections present results and discuss the implications

The differential effects of repeating kindergarten

Abstract: We use the Early Childhood Longitudinal Study to investigate national patterns addressing (a) who repeats kindergarten, and (b) the subsequent cognitive effects of this event. Using OLS regression techniques, we investigate 1st-time kindergartners who are promoted, 1st-time kindergartners who are retained, and children who are already repeating kindergarten. Boys, children from low socioeconomic backgrounds, and children who enter kindergarten younger than typical age standards are consistently at risk for repeating kindergarten, but racial/ethnic patterns differ across the 2 cohorts of kindergarten repeaters. Evidence suggests that repeating kindergarten rarely leads to cognitive benefits in literacy or mathematics performance. On average, kindergarten repeaters continue to perform below their peers in terms of literacy skills both at the end of kindergarten and at the end of first grade (effect size [ES] = −0.20 and −0.24, respectively). In mathematics, the performance differentials are smaller but rema...

Preventive Care for Children in Low-Income Families: How Well Do Medicaid and State Children's Health Insurance Programs Do?

Abstract: OBJECTIVE: Child health problems that are caused or exacerbated by health behaviors remain a leading cause of medical spending for children. We examined receipt of clinician advice by low-income children, comparing children who had public insurance with those who had private insurance, as well as with children who were uninsured for part or all of the year. METHODS: We used children who were aged 3 to 17 and living in families with incomes of<250% of the federal poverty level in the Medical Expenditure Panel Survey data from 2001 to 2003 to estimate linear probability models on receipt of preventive advice. The main outcome measures were receipt of clinician's advice about healthy eating, physical activity, the harmful effects of smoking in the home, proper safety restraints in a car, and use of a bicycle helmet. We also examined 2 related barriers to receiving clinician advice: whether the child had any preventive care visits in the past year and whether the child had a usual source of care other than a hospital emergency department. RESULTS: Publicly insured children were more likely than privately insured, full-year-uninsured children, and part-year-uninsured children to have had a preventive care visit in the past year, but regardless of health insurance group, many children went without preventive care. Even conditional on having had a preventive care visit, 48% did not receive clinician advice in any of the areas measured, and 41% of the overweight children were advised about neither healthy eating nor exercise in the past year. CONCLUSIONS: Enrolling more uninsured children in Medicaid and State Children's Health Insurance Programs could improve the chances that families receive advice about health behaviors and injury prevention; however, nearly half of the children who were insured for the entire year did not receive important advice from their clinicians. Language: en

Low income parents' reports of communication problems with health care providers: effects of language and insurance.

Abstract: Objectives.This study examines how parental reports of communication problems with health providers vary over a wider range of characteristics of low income children than considered in previous studies.Methods.Data were drawn from the 1999 and 2002 National Survey of America's Families. Communication problems, insurance type, socioeconomic characteristics, health factors, and provider type were examined. Data were analyzed using bivariate and multivariate techniques.Results.Bivariate analysis identified that the parents of 24.4% of low income children and 36.4% of publicly covered low income children with a Spanish interview reported poor communication with health providers. Coefficients from regression analysis suggest that, controlling for covariates, foreign-born parents with a Spanish interview were 11.8 percentage points (p<0.01) more likely to report communication problems than U.S.-born parents with an English interview. Among low income publicly covered children with a Spanish interview, regressio...

SCHIP At A Crossroads: Experiences To Date And Challenges Ahead

Abstract: As reauthorization of the State Children’s Health Insurance Program (SCHIP) looms, we examine the program’s first decade and identify changes needed so that SCHIP can better serve its target population. We conclude that by many objective standards, SCHIP has been a success, but the challenge will be to maintain and build upon that success. Critical issues include the level and structure of federal funding; the continued problem of uninsurance among low-income children; the lack of information on quality, access, and costs; and whether SCHIP can serve as the foundation for addressing broader health care needs among low-income families.

Social Security Spouse and Survivor Benefits for the Modern Family

Abstract: Our project uses DYNASIM3, the Urban Institute's dynamic microsimulation model of the U.S. population, to simulate several alternative systems of Social Security auxiliary benefits. We specifically consider earnings sharing, a system in which a husband's and a wife's earnings records are combined and averaged over the duration of their marriage when computing Social Security benefits. We also consider whether other changes to Social Security's benefit computations - like caregiver credits, minimum benefits, and more modest changes to spouse/survivor benefits - could improve program adequacy and horizontal equity with less complexity and fewer transition difficulties relative to earnings sharing. Each proposal we examine substitutes existing spouse (and, sometimes, all or parts of survivor) benefits with mechanisms that explicitly acknowledge marital partnerships, are more neutral with respect to marriage, and/or better target economically vulnerable people. All proposals are roughly cost-equivalent in 2050. We find that all three packages - earnings sharing, replacement of most of the spouse benefit with a minimum, and full spouse replacement with caregiver credits - reduced poverty modestly and made lifetime benefits more similar for couples paying the same amount in taxes relative to current law scheduled. The earnings-sharing proposal, however, only achieved the poverty reduction with significant adjustments to the treatment of surviving spouses through a self-financed survivor benefit. The packages reveal important tradeoffs among beneficiary groups, with particular tensions between workers and non-workers, and married, never married, divorced, and widowed persons.

Job changes at older ages: Effects on wages, benefits, and other job attributes

Abstract: Despite the benefits of work at older ages, questions persist about the availability and quality of jobs for older Americans. This study examines older adults' employment opportunities by studying job changes at ages 45 to 75. Many older workers move to new occupations and industries when they switch jobs, often assuming positions that involve less stress and physical effort. Although most older job changers enjoy their new jobs, they generally experience sharp hourly wage reductions and often lose pension coverage and health benefits. The findings highlight the special labor market challenges faced by older displaced workers.

Early Transition Experiences of Transition-Age Child SSI Recipients New Evidence From the National Survey of Children and Families

Abstract: This article describes the challenges faced by pretransition-age (14 to 17 years) young people with disabilities receiving Supplemental Security Income (SSI) and outlines potential policy options t...

The Relativity of Foundation Effectiveness: The Case of Community Foundations:

Abstract: This article proposes that efforts to understand and achieve greater foundation effectiveness would be advanced by expanding the discussion to be more attuned to the relative and context-dependent ...

Low-Income Uninsured Children With Special Health Care Needs: Why Aren't They Enrolled in Public Health Insurance Programs?

Abstract: OBJECTIVE. We examined potential barriers to enrollment in public programs among low-income children with special health care needs who are uninsured. Barriers considered include parents not knowing about the Medicaid and State Children9s Health Insurance programs, not believing that their child is eligible for public coverage, not perceiving the enrollment processes as easy, and not wanting to enroll their child in a public program. METHODOLOGY. The source of data is the 2001 National Survey of Children With Special Health Care Needs. A series of 5 questions about the child9s health needs, known as the Children With Special Health Care Needs Screener, was used to identify children with special health care needs. Uninsurance is defined as having no insurance coverage at the time of the survey. Low-income families are defined as those with household incomes below 200% of the federal poverty level. The analytic sample consists of 968 low-income uninsured children with special health care needs. We examined the socioeconomic and demographic characteristics of the sample, the reasons the children lack coverage, and the awareness and perception measures, both individually and combined as a summary measure. RESULTS. Many low-income parents with uninsured children with special health care needs do not have full information about Medicaid and State Children9s Health Insurance programs or do not have positive perceptions of the application processes. Although 93.5% had heard of at least 1 of the 2 programs, only 54.6% believed that their child was eligible for public coverage, and just 48.1% believed that the application processes were easy. Almost all said that they would enroll their child if told he or she was eligible for public coverage. CONCLUSIONS. Understanding why uninsured children with special health care needs do not participate in public programs is important, because these programs have the potential to cover almost all of this population. Initiatives to increase enrollment should yield real dividends given that the vast majority of low-income uninsured children with special health care needs have parents who say they would enroll their children in public coverage.

Measuring Emergent Organizational Properties A Structural Equation Modeling Test of Self- Versus Group-Referent Perceptions

Abstract: This article presents a theoretical rationale and empirical evidence regarding the validity of scores obtained from two competing approaches to operationalizing scale items to measure emergent orga...