Showing papers by "Urban Institute published in 2008"
TL;DR: As the medical home concept is further developed, it will be important to not overemphasize redesign of practices at the expense of patient-centered care, which is the hallmark of excellent primary care.
Abstract: The “patient-centered medical home” has been promoted as an enhanced model of primary care. Based on a literature review and interviews with practicing physicians, we find that medical home advocates and physicians have somewhat different, although not necessarily inconsistent, expectations of what the medical home should accomplish—from greater responsiveness to the needs of all patients to increased focus on care management for patients with chronic conditions. As the medical home concept is further developed, it will be important to not overemphasize redesign of practices at the expense of patient-centered care, which is the hallmark of excellent primary care.
285 citations
TL;DR: Results of cross-level interactions showed that at the neighborhood level, women were more fearful than men in neighborhoods without violence, but that the difference in fear between men and women shrinks as neighborhood violence increases.
194 citations
TL;DR: The authors examined the life experiences of a sample of high-risk women to assess whether their offending pathways into jail are consistent with those predicted by earlier research, finding substantial overlaps with feminist pathways, but notable differences as well.
Abstract: Some researchers suggest that crime pathways are gendered and that different paths may be revealed depending on the point of contact with the criminal justice system. Drawing from the feminist and age-of-onset literatures, we examine the life experiences of a sample of ‘high-risk’ women to assess whether their offending pathways into jail are consistent with those predicted by earlier research.We find substantial overlaps with feminist pathways, but notable differences as well — differences that may lie with which populations are under study (jailed and awaiting trial/disposition versus convicted felons; by racial composition). Sorting the women by onset age (early, adolescent, and adult), we discover a sizeable group of adult onset offenders (54%). Compared with those who begin offending earlier, these late onset women appear to have distinct risk factors. Empirical questions raised by the age–crime curve, feminist and criminal career/developmental research have challenged the notion that a single causal mechanism or general theory of crime can explain involvement in criminal activity (see, e.g., Blumstein, Cohen, Roth, & Visher, 1986; Blumstein, Cohen, & Farrington, 1988; Daly, 1994; Heimer, 1995; Moffitt, 1993; Patterson & Yoerger, 1993). Feminist scholars, in particular, question whether theories developed by males about males and based on males can account for female experiences (i.e., the generalisability problem, Daly & Chesney-Lind, 1988). But, even scholars who reject arguments that crime aetiology is gendered assert that there are multiple pathways to crime. Developmental and criminal career approaches suggest that there are different kinds of offenders whose paths into crime and subsequent offending patterns follow different routes and trajectories (Nagin, Farrington, & Moffitt, 1995). Considering that there is still considerable debate around these issues, we believe there is merit in further exploration of women’s pathways to crime and the justice system. 1
173 citations
TL;DR: Morbidly obese Medicare patients who underwent bariatric surgery had increased survival rates over the 2 years of this study when compared with a similar morbidly obese nonsurgical group, and the diagnosed prevalence of weight-related comorbid conditions declined afterbariatric surgery relative to a control cohort of morbidly obesity patients who did not undergo surgery.
Abstract: Objective:To evaluate survival rates and changes in weight-related comorbid conditions after bariatric surgery in a high-risk patient population as compared with a similar cohort of morbidly obese patients who did not undergo surgery.Summary Background Data:Morbid obesity is increasingly becoming a
132 citations
TL;DR: In roughly the first year under reform, uninsurance among working-age adults was reduced by almost half among those surveyed, and access to care improved, and the share of adults with high out-of-pocket costs and problems paying medical bills dropped.
Abstract: In April 2006, Massachusetts passed legislation intended to move the state to near-universal coverage within three years and, in conjunction with that expansion, to improve access to affordable, high-quality health care. In roughly the first year under reform, uninsurance among working-age adults was reduced by almost half among those surveyed, dropping from 13 percent in fall 2006 to 7 percent in fall 2007. At the same time, access to care improved, and the share of adults with high out-of-pocket costs and problems paying medical bills dropped. Despite higher-than-anticipated costs, most residents of the state continued to support reform.
130 citations
TL;DR: A review of the literature on poverty dynamics in the U.S. can be found in this paper, which surveys the most prevalent data, theories, and methods used to answer three key questions: How likely are people to enter, exit, and reenter poverty? How long do people remain in poverty? And what events are associated with entering and exiting poverty?
Abstract: This paper reviews the literature on poverty dynamics in the U.S. It surveys the most prevalent data, theories, and methods used to answer three key questions: How likely are people to enter, exit, and reenter poverty? How long do people remain in poverty? And what events are associated with entering and exiting poverty? The paper then analyzes the combined findings of the literature, discussing overarching patterns of poverty dynamics, differences among demographic groups, and how poverty probabilities, duration, and events have changed over time. We conclude with a discussion of the policy implications of these findings and avenues for future research. © 2008 by the Association for Public Policy Analysis and Management.
122 citations
TL;DR: There is no significant difference between racial/ethnic groups in the prevalence of child mental health problems in either urban or rural areas, but there are disparities in the use of mental health services.
Abstract: This study examines racial/ethnic disparities in children's mental health and the receipt of mental health services, and whether those disparities differ between urban and rural areas. We find no significant difference between racial/ethnic groups in the prevalence of child mental health problems in either urban or rural areas. However, there are disparities in the use of mental health services. Hispanic children and Black children in urban areas receive less mental health care than their White counterparts, and the disparity persists for Hispanic children in rural areas, even after controlling for other relevant factors. Initiatives to improve access to mental health care for racial/ethnic minorities should recognize these disparities, and address the lack of culturally appropriate services in both urban and rural areas. In addition, outreach should raise awareness among parents, teachers, and other community members concerning the need for mental health services for minority children.
110 citations
TL;DR: This paper examined whether subject-specific teacher certification and academic degrees are related to teacher quality and found that subject-certified teachers are not more effective at promoting the intellectual engagement of their students but are more likely to have negative opinions of a given student's performance.
Abstract: This study examines whether subject-specific teacher certification and academic degrees are related to teacher quality. The research design exploits contemporaneous, within-student comparisons made possible by a unique feature of the National Education Longitudinal Study of 1988 (NELS:88). Specifically, NELS:88 contains subject-specific outcomes for eighth-grade students in two subjects as well as data on their teachers for those subjects. The analysis of these data indicates that assignment to a subject-certified teacher is associated with higher test scores. However, these gains appear to be concentrated in social studies and mathematics. Furthermore, the authors also find that subject-certified teachers are not more effective at promoting the intellectual engagement of their students but are more likely to have negative opinions of a given student's performance.
83 citations
TL;DR: Legislation mandating paid sick leave could dramatically increase access to this benefit among low-income families and diminish gaps in parents’ leave taking to care for others between families with and without the benefit.
Abstract: OBJECTIVE. The ability of employed parents to meet the health needs of their children may depend on their access to sick leave, especially for low-income workers, who may be afforded less flexibility in their work schedules to accommodate these needs yet also more likely to have children in poor health. Our goal was to provide rates of access to paid sick leave and paid vacation leave among low-income families with children and to assess whether access to these benefits is associated with parents’ leave taking to care for themselves or others. METHODS. We used a sample of low-income families ( RESULTS. Access to paid leave was lower among children in low-income families than among those in families with higher income. Within low-income families, children without ≥1 full-time worker in the household were especially likely to lack access to this benefit, as were children whose parents work for small employers. Among children whose parents had access to paid sick leave, parents were more likely to take time away from work to care for themselves or others. This relationship is even more pronounced among families with the highest need, such as children in fair or poor health and children with all parents in full-time employment. CONCLUSIONS. Legislation mandating paid sick leave could dramatically increase access to this benefit among low-income families. It would likely diminish gaps in parents’ leave taking to care for others between families with and without the benefit. However, until the health-related consequences are better understood, the full impact of such legislation remains unknown.
77 citations
TL;DR: Tax expenditures measure the cost of spend? ing programs run through the tax system as discussed by the authors, and tax expenditures are "static," meaning that they assume no change in economic behavior if they are eliminated.
Abstract: Tax expenditures measure the cost of spend? ing programs run through the tax system. In preparing their annual lists, the Office of Management and Budget (OMB) and Congress's Joint Committee on Taxation (JCT) define tax expenditures as deviations from the "normal" individual and corporate income tax bases. OMB has recently also listed tax expenditures measured against consumption tax and compre? hensive income tax bases. Tax expenditures are "static," meaning that they assume no change in economic behavior if they are eliminated. Tax expenditure estimates may thus be much larger than revenue estimates for eliminating a par? ticular provision. The measurement of tax expenditures is controversial, mainly because there is no com? monly agreed tax baseline against which to measure departures. In spite of this and other measurement issues, most public finance econo? mists believe that measuring tax expenditures is an important part of good budget management because tax benefits can have the same effect on beneficiaries as direct spending programs, and impose similar opportunity costs in terms of higher taxes, reduced federal spending, and higher deficits. We should assess their effects on the federal budget and on achieving program objectives the same way we assess direct spend? ing programs. Non-business tax expenditures?the focus of this paper?are large relative to the size of the economy and to total tax revenues.1 They rose sharply between 1976 and 1985, from 4.2 to 6.4 percent of GDP. They dropped between 1985 and 1990 as a result of the Tax Reform Act of
74 citations
TL;DR: In this article, Nichols et al. described the probability an observation receives a binary treatment as a function of observable variables X (using e.g. logit or probit), and using the estimated probabilities of treatment or "propensity scores" λ to reweight the data (as an alternative to matching).
Abstract: Nichols (2007) described estimating the probability an observation receives a binary “treatment” as a function of observable variables X (using e.g. logit or probit), and using the estimated probabilities of treatment or “propensity scores” λ to reweight the data (as an alternative to matching). Section 3.4 neglects to mention that the weights λ/ ( 1− λ ) should only be applied to the control group in order to make the mean of each variable in the matrix X (i.e. those variables included in the propensity score model) approximately equal across the treatment and control groups. The examples in Section 3.5 also neglect this restriction on propensity-based weights. That is, the line
TL;DR: In 2000, the Urban Institute paired African-American and Hispanic testers with whites and sent the pairs to visit lenders in Chicago and Los Angeles, in order to inquire about information on obtaining a home mortgage as discussed by the authors.
TL;DR: This study used summary tables drawn from the 1999 Medicaid Analytic Extract (MAX) files, the first available Medicaid data for the entire US, to examine fee-for-service Medicaid in 23 selected states.
Abstract: Mental health care is a critical component of Medicaid for children. This study used summary tables drawn from the 1999 Medicaid Analytic Extract (MAX) files, the first available Medicaid data for the entire US, to examine fee-for-service Medicaid in 23 selected states. Data show that 9% of children and youth (ages 0–21) had a mental health-related diagnosis on a claim, varying from 5% to 17% across the states. The proportion increased with age, and was higher for boys. Over half of those diagnosed received psychotropic medication, and approximately 7% had an inpatient psychiatric admission during the year. Mental health costs accounted for 26.5% of total fee-for-service Medicaid expenditures, varying from 14% to 61% depending on the state.
TL;DR: This paper explored whether housing assistance that helps low-income families move to better neighborhoods can also improve access to good schools, and found that most MTO families did not relocate to communities with substantially better schools and those who did often moved again after a few years.
Abstract: Educational failure is one of the costliest and most visible problems associated with ghetto poverty. We explore whether housing assistance that helps low-income families move to better neighborhoods can also improve access to good schools. Research on the Gautreaux housing desegregation program indicated significant, long-term educational benefits, yet results from the Moving to Opportunity (MTO) experiment showed no measurable impacts on school outcomes for the experimental group. We use interviews and ethnographic fieldwork to explore this puzzle. Most MTO families did not relocate to communities with substantially better schools, and those who did often moved again after a few years. Where parents had meaningful school choices, these were typically driven by poor information obtained from insular social networks or by cultural logic centered on avoiding ghetto-type school insecurity and disorder, not garnering academic opportunity. Those factors may not shift if poor families with less educated parents are served by a relocation-only strategy.
TL;DR: The prominence of low-risk behaviors over time suggests that most young men avoid sexual risk-taking, and effective strategies to reduce HIV and STD risk in young men must simultaneously address multiple dimensions of sexual behavior.
Abstract: CONTEXT: Understanding how young men’s sexual risk behaviors change during the transition from adolescence to early adulthood is important for the design and evaluation of effective strategies to reduce the transmission of HIV and other STDs.
METHODS: Data from three waves of the National Survey of Adolescent Males (1988, 1991 and 1995) were used to categorize 1,880 respondents into clusters according to sexual risk behaviors. Univariate and bivariate analyses were conducted to assess associations between clusters and rates of self-reported STD diagnoses and positive chlamydia tests.
RESULTS: Two dimensions of sexual risk-taking defined the clusters: partner characteristics and condom use. More than 50% of men remained in low-risk groups over time. In the first two waves, 24–32% of men reported engaging in high-risk behaviors (risky partners, condom nonuse); these behaviors were associated with elevated levels of STD outcomes. Nearly 40% of men who entered a high-risk group in the first two waves transitioned to a lower risk group by the third wave. Nine percent of men either engaged in increasingly risky behaviors or maintained membership in high-risk groups; elevated STD rates characterized both trajectories. Low condom use combined with having multiple partners during adolescence was associated with elevated STD rates in the year preceding the third wave; high condom use coupled with having risky partners was not.
CONCLUSIONS: The prominence of low-risk behaviors over time suggests that most young men avoid sexual risk-taking. Effective strategies to reduce HIV and STD risk in young men must simultaneously address multiple dimensions of sexual behavior.
TL;DR: It is shown that treatment of mother's depression improves management of child's asthma, resulting in a reduction in asthma costs in the 6-month period following diagnosis of $798 per asthmatic child whose mother is treated for depression.
TL;DR: The Judicial Oversight Demonstration (JOD) as mentioned in this paper was designed to increase victim safety, hold offenders accountable, and reduce repeat offending using coordinated community services and integrated justice system policies in intimate partner violence court cases.
Abstract: Research Summary
In 1999, three communities were selected to participate in a research demonstration designed to test the feasibility and impact of a coordinated response to intimate partner violence that involved the courts and justice agencies in a central role. The primary goals of the Judicial Oversight Demonstration (JOD) were to increase victim safety, hold offenders accountable, and reduce repeat offending using coordinated community services and integrated justice system policies in intimate partner violence court cases. The partnerships differed from earlier coordinated community responses to domestic violence by placing special focus on the role of the court, specifically the judge, to facilitate offender accountability in collaboration with both nonprofit service providers and other criminal justice agencies. This article presents the results of an impact evaluation of this demonstration in all sites. The demonstration received mostly positive responses from justice system agencies, service providers, offenders, and victims. Improvements were made in offender monitoring, consistent sanctioning, and increased supervision. However, these changes did not translate into gains in victim perceptions of their safety or into reductions in repeat violence in all sites.
Policy Implications
The demonstration had minimal impact on changing offender attitudes and behavior. The mixed results of the evaluation indicate that the most effective justice system responses to intimate partner violence must include a focus on protecting victims, close monitoring of offenders, and rapid responses with penalties when violations of court-ordered conditions are detected. Indications were found that JOD strategies were effective for some subgroups, including younger offenders with fewer ties to the victim and offenders with extensive arrest histories. The observed reductions in intimate partner violence in selected subgroups in the JOD sites may suggest a fruitful way to begin designing new intervention strategies, including prevention programs for men and women.
TL;DR: In this article, the effects of specific food stamp and welfare policies, as well as the minimum wage and EITC, on the food stamp receipt of the low-income population were investigated.
Abstract: This paper uses monthly SIPP data from 1996 through 2003 and state-level policy data to measure the effects of specific food stamp and welfare policies, as well as the minimum wage and EITC, on the food stamp receipt of the low-income population. We find strong evidence that more lenient vehicle exemption policies, longer recertification periods, and expanded categorical eligibility increase food stamp receipt and that the use of biometric technology reduces food stamp receipt. We also find some evidence that more lenient immigrant eligibility rules, simplified reporting, implementation of the EBT program, and outreach spending increase food stamp receipt.
TL;DR: This article studied inbound call centers in fourteen businesses, using interview-based case studies and found that despite the notion that U.S. businesses are eliminating job security and internal career tracks, these firms still incorporate these features in their job structures and in many cases businesses that initially dismantled job and career structures ended up rebuilding them.
Abstract: We study inbound call centers in fourteen businesses, using interview-based case studies. Contrary to the notion that U.S. businesses are eliminating job security and internal career tracks, these firms still incorporate these features in their job structures, and in many cases businesses that initially dismantled job and career structures ended up rebuilding them. The paper suggests a more nuanced account of changing job structures that incorporates market, institutional, and agency factors.
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TL;DR: A strong inverse relationship emerges between their initial earnings and their subsequent U.S. earnings growth, which has important implications for the projection of immigrant earnings and emigration in microsimulation models.
Abstract: As the first in a trio of pieces devoted to incorporating immigration into policy models, this article traces the history of research on immigrant earnings. It covers how the earnings trajectories of immigrants differ from those of U.S. natives, how they vary across immigrant groups, and how they have changed over time. The highlighted findings underscore key lessons for modeling immigrant earnings and pave the way for representing the earnings trajectories of immigrants in policy models.
TL;DR: Although the recent decline was less than that experienced from 2000 to 2004, growth in public coverage was small, and the number of uninsured people increased by 1.0 million children and 2.4 million adults.
Abstract: The number of uninsured Americans increased by 3.4 million between 2004 and 2006, despite improving economic conditions. In the first four years of the decade, during a period of economic recession, the number increased by 6.0 million. The dominant factor in both periods was a decline in employer-sponsored insurance coverage. Although the recent decline was less than that experienced from 2000 to 2004, growth in public coverage was small, and the number of uninsured people increased by 1.0 million children and 2.4 million adults. Employer coverage declined most for self-employed or small-firm workers, in the South, and among noncitizens.
TL;DR: In this article, the authors examined the effects of asset-holding and asset accumulation on individuals and families from theoretical and empirical perspectives, and paid special attention to the way assets affect low-income families.
Abstract: This report examines the effects of asset-holding and asset accumulation on individuals and families from theoretical and empirical perspectives. The report pays special attention to the way assets affect low-income families, while recognizing that research on this topic is limited. The goal of the report is to distill the main findings from the vast theoretical and empirical literature on how assets influence economic and social well-being. The first step is to present a conceptual framework based largely on our classification of existing literature in economics, psychology, and sociology. The second step is to bring together the empirical findings relevant to the categories specified in the conceptual framework. The report concludes with suggestions for future research, especially related to the role of assets in the lives of low-income families.
TL;DR: There is some evidence of improved access to care under MMC; however, the gains appear to be largely limited to beneficiaries in urban areas with fully capitated managed care.
Abstract: States increasingly are shifting Medicaid beneficiaries with disabilities from the fee-for-service (FFS) delivery system to managed care in an effort to control program costs and address long-stand...
TL;DR: In this article, a literature review identified 106 evaluations of criminal justice interventions that reported both an effect size and measures of net benefit, and they found that effect size is only weakly related to net benefits.
Abstract: This paper asks whether undertaking a cost-benefit analysis provides additional information to policy makers as compared to an analysis solely of the effect of an intervention. A literature review identified 106 evaluations of criminal justice interventions that reported both an effect size and measures of net benefit. Data on net benefit and effect size were extracted from these studies. We found that effect size is only weakly related to net benefits. The rank order of net benefits and effect size are minimally correlated. Furthermore, we found that the two analytic methods would yield opposing policy recommendations for more than one in four interventions. These bi-variate findings are supported by the results of multivariate models. However, further research is needed to verify the accuracy of the standard errors on net benefit estimates, so these models must be interpreted with caution.
TL;DR: It was found that women who had experienced sexual assault in addition to physical abuse used more help, but were also more likely to say that they did not seek help when they needed it, and fear was the greatest obstacle to reaching out for help.
Abstract: SUMMARY Within intimate partner violence (IPV), sexual assault is often subsumed under the heading of physical abuse, but evidence suggests qualitative differences in outcomes when both types of abuse occur. This study explores the cumulative effect of sexual assault and physical abuse by a current or former intimate partner on helpseeking. Using a dataset of 1,072 IPV victims from 8 states, we found that women who had experienced sexual assault in addition to physical abuse (44%) used more help, but were also more likely to say that they did not seek help when they needed it. Among those who were aware of services, fear was the greatest obstacle to reaching out for help. Implications include the need for information on best practices in addressing the sequelae of both physical and sexual assault in victim service agencies.
TL;DR: The Urban Institute (UI) worked with cities in post-Soviet Kyrgyzstan to apply better management practices through the development of Strategic Land Management Plans as mentioned in this paper, which led to several improvements including proper registration of parcels and proactive policies to lease and sell land through open competition, and established a model for determining public policy that countered corruption and public deliberation of costs and benefi ts in the use of local assets.
Abstract: The Urban Institute (UI) worked with fi ve cities in post-Soviet Kyrgyzstan to apply better management practices through the development of Strategic Land Management Plans. Kyrgyzstan transferred property to local governments, but municipal land management had remained poor owing to a proliferation of responsible agencies, lack of rule of law, cor- ruption, and passiveness on the part of local governments. UI worked with local governments to make an inventory of municipal land, publicize the results, and develop a strategy that articulated principles for land management and an implementation plan. This led to several improvements including proper registration of parcels and proactive policies to lease and sell land through open competition. It also established a model for determining public policy that countered corruption and public deliberation of costs and benefi ts in the use of local assets. Donor involvement to promote good land legislation, the property registration system, and decentralization was also critical to success.
TL;DR: A four-year evaluation of the Los Angeles Healthy Kids program finds that the program has improved access for more than 40,000, most of whom are immigrant Latino children, who have almost no access to employer coverage.
Abstract: A large number of California counties have recently taken bold steps to extend health insurance to all poor and near-poor children through county-based Children’s Health Initiatives. One initiative...
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TL;DR: The authors found that years of service are not likely to provide an effective way to protect the lowest-wage workers, and that men and women with the least education also work the least.
Abstract: While growing fiscal pressures and increasing life expectancy have prompted calls to raise retirement ages so that lifetime benefits would be concentrated in older ages, some fear that this change - without other adjustments - might harm long-career, lower-wage workers. Tying retirement benefit eligibility to years of service might protect lower-wage workers if they tend to start their careers relatively early and work more years prior to retirement than higher-wage workers. But higher disability rates and greater employment volatility could offset lower-wage workers’ early labor force starts, and lead to fewer total years of service completed. Using survey data matched to administrative earnings records, we describe variation in work histories for current and near retirees by gender, education, and other important characteristics. We find that years of service are not likely to provide an effective way to protect the lowest-wage workers. Among other reasons, men and women with the least education also work the least.
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01 Dec 2008TL;DR: Using Taxes to Reform Health Insurance, a joint product of the Urban-Brookings Tax Policy Center and the American Tax Policy Institute, examines the role taxes currently play, the likely effects of recently introduced health savings accounts, and options for using the tax system to expand health insurance coverage.
Abstract: Few people realize that one of the nation's largest health programs runs through the tax system. Reformers of all stripes propose to modify current tax rules as part of larger programs to increase coverage and control costs. Is the current system working? Will tax-based reforms achieve their goals? Several of the nation's foremost experts on taxation and health policy address these questions in Using Taxes to Reform Health Insurance, a joint product of the Urban-Brookings Tax Policy Center and the American Tax Policy Institute. Led by respected economists Henry Aaron of the Brookings Institution and Leonard Burman of the Urban Institute, contributors examine the role taxes currently play, the likely effects of recently introduced health savings accounts, the challenges of administering major subsidies for health insurance through the tax system, and options for using the tax system to expand health insurance coverage. No taxpayer or consumer of health care services can afford to ignore these issues.
TL;DR: Trends in states' Medicaid flexibility are explored and policies implemented during the Bush administration could lead to profound changes in Medicaid and could be carried out relatively easily.
Abstract: Since 2001, more than half the states have changed their Medicaid programs, through either Medicaid waivers or provisions included in the Deficit Reduction Act of 2005. These changes are in benefit flexibility, cost sharing, enrollment expansions and caps, privatization, and structure of program financing. With a few important exceptions, the changes have been fairly circumscribed. However, states may exercise this new flexibility if, for example, national health care reforms do not occur or an economic downturn creates state fiscal pressures. If that happens, new policies could lead to profound changes in Medicaid and could be carried out relatively easily.