Showing papers by "Urban Institute published in 2011"

How Much Does the Supplemental Nutrition Assistance Program Reduce Food Insecurity

Abstract: Nearly 15% of all U.S. households and 40% of near-poor households were food insecure in 2009. The Supplemental Nutrition Assistance Program (SNAP) is the cornerstone of federal food assistance programs and serves as the first line of defense against food-related hardship. This paper measures the effectiveness of SNAP in reducing food insecurity using an instrumental variables approach to control for selection. Our results suggest that receipt of SNAP benefits reduces the likelihood of being food insecure by roughly 30% and reduces the likelihood of being very food insecure by 20%.

The protective effect of marriage for survival: a review and update.

Abstract: The theory that marriage has protective effects for survival has itself lived for more than 100 years since Durkheim’s groundbreaking study of suicide (Durkheim 1951 [1897]). Investigations of differences in this protective effect by gender, by age, and in contrast to different unmarried statuses, however, have yielded inconsistent conclusions. These investigations typically either use data in which marital status and other covariates are observed in cross-sectional surveys up to 10 years before mortality exposure, or use data from panel surveys with much smaller sample sizes. Their conclusions are usually not based on formal statistical tests of contrasts between men and women or between never-married, divorced/separated, and widowed statuses. Using large-scale pooled panel survey data linked to death registrations and earnings histories for U.S. men and women aged 25 and older, and with appropriate contrast tests, we find a consistent survival advantage for married over unmarried men and women, and an additional survival “premium” for married men. We find little evidence of mortality differences between never-married, divorced/separated, and widowed statuses.

Making a difference? The effects of Teach For America in high school

Abstract: Teach For America (TFA) selects and places graduates from the most competitive colleges as teachers in the lowest-performing schools in the country. This paper is the first study that examines TFA effects in high school. We use rich longitudinal data from North Carolina and estimate TFA effects through cross-subject student and school fixed effects models. We find that TFA teachers tend to have a positive effect on high school student test scores relative to non-TFA teachers, including those who are certified in field. Such effects offset or exceed the impact of additional years of experience and are particularly strong in science. © 2011 by the Association for Public Policy Analysis and Management.

Nonprofit Commercial Revenue: A Replacement for Declining Government Grants and Private Contributions?

Abstract: This article examines whether there has been an increase in nonprofit commercial revenue and if so whether declines in government grants and private contributions were behind the rise. A number of ...

Undocumented Immigrants, Left Out Of Health Reform, Likely To Continue To Grow As Share Of The Uninsured

Abstract: The increase in undocumented immigration between 1999 and 2007 contributed to an increase in the number of uninsured people in the United States. During this period, the number of undocumented immigrants increased from an estimated 8.5 million to 11.8 million, leading to an estimated additional 1.8 million uninsured. These uninsured and undocumented immigrants were estimated to represent 27 percent of the overall increase of 6.9 million uninsured people during this period. Undocumented immigrants accounted for one in seven of the uninsured in 2007, up from one in eight in 1999. These undocumented immigrants will not be eligible for public insurance or any type of private coverage obtained through exchanges under the Affordable Care Act of 2010. As a result, members of this group will eventually constitute a larger percentage of the uninsured population, unless other policy actions are taken to provide for their coverage, or their immigration status is changed.

Validation of New Measures of Disability and Functioning in the National Health and Aging Trends Study

Abstract: Background. Measurement gaps continue to hamper fuller understanding of late-life disability trends and dynamics. This article reports findings that validate the self-reported components of the disability protocol to be used in the new National Health and Aging Trends Study. The protocol was designed to redress existing measures by attending to environmental aspects of disability, capturing a broader range of capacity to perform tasks and including participation restriction items. Methods. We undertook an in-person validation study to determine the reliability, validity, and initial measurement properties of the National Health and Aging Trends Study self-reported disability protocol (n = 326). A random subset (n = 111) was readministered the protocol within 2–4 weeks. The interview and reinterview included new self-reported measures of physical capacity, activity limitations, and participation restrictions, as well as established performance and cognitive tests. We calculated percent agreement and kappa between interviews for all self-reported items and summary measures. We also assessed the construct validity of summary measures through correlations with demographic characteristics, frailty, memory, and performance-based mobility and confirmed whether activity limitations and participation restrictions were distinct domains. Results. New items and derived summary measures demonstrate robustness over a short time period, with kappas for retained/recommended items in the .60–.80 range. The summary measures correlate as expected with age, sex, residential status, and established performance-based constructs. Two factors, representing activity limitations and participation restrictions, were confirmed. Conclusions. The National Health and Aging Trends Study protocol preserves the ability to examine more traditional measures of functioning while offering new insights into how activities are performed and preserving key conceptual distinctions.

The 2007–09 Recession And Health Insurance Coverage

Abstract: Loss of employment and declining incomes meant that five million Americans lost employment-based health insurance during the recent economic recession (2007–09). All groups of Americans were affected, but the growth in the number of uninsured people was particularly noticeable for whites, native-born citizens, and residents of the Midwest and South. Adults did not benefit nearly as much as children from public programs designed to offset the decline in employer-sponsored insurance and thus bore all of the burden of rising uninsurance. Throughout the past decade, even in good economic times, the number of Americans with employer-sponsored insurance has fallen, and the number of uninsured Americans has increased. This finding underscores the importance of planned coverage expansions under the Affordable Care Act.

Effects of Individual Development Accounts on Asset Purchases and Saving Behavior: Evidence from a Controlled Experiment

Abstract: We evaluate the first controlled field experiment on Individual Development Accounts (IDAs). Including their own contributions and matching fund, treatment group members in the Tulsa, Oklahoma program could accumulate $6,750 for home purchase or $4,500 for other qualified uses. Almost all treatment group members opened accounts, but many withdrew all funds for unqualified purposes. Among renters at the beginning of the experiment, the IDA increased homeownership rates after 4 years by 7-11 percentage points and reduced non-retirement financial assets by $700-$1000. The IDA had almost no other discernable effect on other subsidized assets, overall wealth or poverty rates.

Electronic health records: an international perspective on "meaningful use".

Abstract: Research has shown that the United States lags many other countries in the adoption of electronic health records (EHRs). The U.S. has now embarked on a major effort to achieve "meaningful use" of health information technology by clinicians and hospitals. This issue brief describes the extent of meaningful use in three countries with very high levels of health information technology adoption—Denmark, New Zealand, and Sweden. While all three have achieved high levels of meaningful use, none has reached 100 percent in all categories. The brief find[sic] high levels of meaningful use for EHR items and substantial information-sharing with other organizations or health authorities, although less information is shared with patients. Insights that may prove useful to the United States include providing economic incentives to encourage adoption and designating an organization to take responsibility for standardization and interoperability.

The Impacts of State Health Reform Initiatives on Adults in New York and Massachusetts

Abstract: The 2010 national health reform legislation—The Patient Protection and Affordable Care Act (PPACA)—builds on state coverage initiatives, most notably on Massachusetts' 2006 landmark reform effort PPACA includes expansions of existing public programs, efforts to make private insurance more affordable, and individual and employer mandates This study looks at the impacts of state health reform initiatives in New York and Massachusetts on insurance coverage and health care access and use to expand our understanding of the likely impacts of national reform Understanding the impacts of coverage expansions on both insurance coverage and access to health care is critical to designing initiatives that lead to improvements in the health care available to the population and, thereby, population health—which is the ultimate goal of coverage expansion efforts (Hadley 2003; Institute of Medicine 2009; McWilliams 2009;) Prior studies of individual state health reform initiatives have seldom considered impacts on access to and use of health care, largely because of a lack of data This study takes advantage of the availability of state-level data in the National Health Interview Survey (NHIS) to examine the impacts of the health reform initiatives in New York and Massachusetts on coverage and access to and use of health care To our knowledge, this represents the first use of the NHIS, which is the nation's most comprehensive health survey, to study the effects of an individual state's health reform initiative on health care access and use

Job Demands and Work Ability at Older Ages

Abstract: Workers' ability to delay retirement depends partly on the demands of their jobs. Matching occupational characteristics from the Occupational Information Network to Current Population Survey respondents, this study finds that 7% of American workers held highly physically demanding jobs in 2006 and 35% held highly cognitively demanding jobs. The share of the workforce in physically demanding jobs fell by about one-sixth between 1971 and 2006, while the share in cognitively demanding jobs increased by more than one-third. The decline in physically demanding occupations will likely improve employment prospects for older adults, but the growth in cognitive demands may limit options for some older workers.

Improving coverage for children under health reform will require maintaining current eligibility standards for Medicaid and CHIP.

Abstract: When the Affordable Care Act of 2010 is fully implemented, it will extend health insurance coverage to many adult Americans who currently lack it. It is not known, however, how the health reform legislation will affect children and parents who would otherwise be uninsured. Based on our analysis, the Affordable Care Act has the potential to cut the number of uninsured children by about 40 percent, from 7.4 million to 4.2 million, and the number of uninsured parents by almost 50 percent, from 12.7 million to 6.6 million. However, the actual impact will depend on increasing the share of children and parents who are enrolled in public coverage and on other implementation outcomes. Most strikingly, if the requirement that states continue their Medicaid and Children’s Health Insurance Program (CHIP) coverage is rescinded and if Congress does not continue funding CHIP, the uninsurance rate of children could more than double, increasing from 4.2 million to 7.9–9.1 million children. In that case, the uninsurance r...

Performance-Based Payment Incentives Increase Burden And Blame For Hospital Nurses

Abstract: We interviewed hospital leaders and unit nurses in twenty-five hospitals between June and October 2008 to explore the effect of performance-based incentives. Interviewees expressed favorable impressions of the impact that incentive policies have on quality and safety. However, they raised concerns about the policies’ effects on the nurse workforce. Their concerns included the belief that performance-based incentives would increase both the burden and the blame for nurses without corresponding improvements in staffing levels, work environment, salaries, or turnover. To maximize the intended policy impact without jeopardizing the workforce that holds the key to their adoption, we recommend that policy makers invest in implementation support, redesign hospital incentives to reward teamwork, and involve nursing leaders in the design of future incentive policies.

The potential impact of the Great Recession on future retirement incomes

Abstract: This study uses DYNASIM3, the Urban Institute’s dynamic microsimulation model, to examine the long-run effects of the Great Recession on the future retirement incomes of working-age individuals in 2008. It compares a baseline scenario that incorporates the historic and projected effects of high unemployment and lower wages from the recession with a no-recession scenario that assumes the recession had not occurred. The results show that the recession will reduce average annual incomes at age 70 by 4.3 percent, or $2,300 per person. This drop results almost entirely from the anemic wage growth that occurred during the recession, which the model assumes will permanently reduce future wages. Employment declines will have little effect on future aggregate retirement incomes because most workers remained employed during the recession and the losses that occurred are generally inconsequential when averaged over an entire career. Retirement incomes will fall most for high-socioeconomic-status groups, who have the most to lose, but relative income losses will not vary much across groups. Those workers who were youngest when the recession began will be hit hard. They are most likely to have lost their jobs and the impact of lower wages will accumulate over much of their working lives. But retirement incomes will also fall substantially for those in their late fifties in 2008, because the drop in the economy-wide average wage will lower the index factor in the Social Security benefit formula, permanently reducing their annual benefits. Also, many workers who lost jobs late in life will never become reemployed.

Pathways after Default: What Happens to Distressed Mortgage Borrowers and Their Homes?

Abstract: We use a detailed dataset of seriously delinquent mortgages to examine the dynamic process of mortgage default – from initial delinquency and default to final resolution of the loan and disposition of the property. We estimate a two-stage competing risk hazard model to assess the factors associated with whether a borrower behind on mortgage payments receives a legal notice of foreclosure, and with what ultimately happens to the borrower and property. In particular, we focus on a borrower’s ability to avoid a foreclosure auction by getting a modification, by refinancing the loan, or by selling the property. We find that the outcomes of the foreclosure process are significantly related to: the terms of the loan; the borrower’s credit history; current loan-to-value and the presence of a junior lien; the borrower’s post-default payment behavior; the borrower’s participation in foreclosure counseling; neighborhood characteristics such as foreclosure rates, recent house price depreciation and median income; and the borrower’s race and ethnicity.

The effects of Medicaid and CHIP policy changes on receipt of preventive care among children.

Abstract: Timely receipt of preventive medical and dental care for children is important for screening and early diagnosis of health problems, including developmental and behavioral problems that may require early intervention, and it has been shown to be associated with reductions in avoidable hospital admissions, reductions in dental costs later in life, and improved child health (Hakim and Bye 2001; Savage et al 2004;) The American Academy of Pediatrics guidelines recommend that children ages 3–21 receive annual well-child visits and more frequent visits under age 3 (Hagan, Shaw, and Duncan 2008), while the American Academy of Pediatric Dentistry recommends semi-annual clinical oral examinations beginning at age 6–12 months (American Academy of Pediatric Dentistry 2009) National data indicate that the receipt of preventive care for children falls below recommended levels, particularly for children in low-income families (Selden 2006; Edelstein and Chinn 2009;) This study examines Medicaid and Children's Health Insurance Program (CHIP) policy changes in Kentucky and Idaho aimed at increasing use of preventive care among children National surveys vary widely in their estimates of the share of Medicaid/CHIP children who received a well-child visit (40–91 percent) and a preventive dental visit (24–76 percent) over a 12-month period (Kenney, McFeeters, and Yee 2005; National Survey of Children's Health 2007; Perry and Kenney 2007;) Medicaid covers well-child and preventive dental care under its Early and Periodic Screening, Diagnostic, and Treatment benefit In CHIP, well-child care is mandatory; dental benefits have been included in almost all CHIP programs, though it was an optional benefit until CHIP was reauthorized in 2009 (Kaye, Pernice, and Cullen 2006) Preventive care receipt likely falls below recommended levels because of both supply and demand barriers Public programs often reimburse physicians and dentists at lower rates than commercial insurers (Berman et al 2002; Zuckerman et al 2004;), and other payment issues (such as delays in reimbursement) may make providers less willing to provide services to children covered under these programs (Cunningham and O'Malley 2009) The literature suggests that higher Medicaid reimbursement rates can increase receipt of preventive care but that such an effect is not assured (Mayer et al 2000; Hughes et al 2005; McInerny, Cull, and Yudkowsky 2005; Shen and Zuckerman 2005;) In terms of demand barriers, some families may not place a high value on preventive services, particularly if their children appear to be healthy (Blumberg, O'Connor, and Kenney 2005), or they may face difficulty obtaining preventive medical and dental services due to language and transportation barriers, low quality of care, or discrimination (Cohen and Christakis 2006; Kelly et al 2005;) Evidence on past attempts to use incentives to raise the use of preventive services is mixed (Redmond, Solomon, and Lin 2007; Sutherland, Christianson, and Leatherman 2008;) This paper examines whether reimbursement increases, incentives, and the adoption of managed care in two state Medicaid/CHIP programs led to greater preventive care receipt among publicly insured children

Capital Income Taxation and Progressivity in a Global Economy

Abstract: The increase in international capital mobility over the past two decades has put pressure on the tax treatment of corporate equity income. Corporate-level taxes distort investment flows across locations and create opportunities for tax avoidance by shifting income across jurisdictions. Outward flows of capital shift part of the burden of the corporate-level tax on equity income from capital to labor, thereby making its incidence less progressive. Individual-level taxes on corporate equity income lower the after-tax return to savings but have less distorting effects on investment location and are more likely to fall on owners of capital than workers. This logic suggests there may be both efficiency gains and increases in progressivity from shifting taxes on corporate equity income from the corporate to the shareholder level. We estimate the distributional effects of a tax reform that raises shareholder-level taxes on corporate equity income and uses the revenue to cut the corporate tax rate. We find that taxing capital gains and dividends as ordinary income (subject to a maximum 28% rate on long-term capital gains) would finance a cut in the corporate tax rate from 35% to about 26%, assuming no behavioral response. While the distributional effect depends on what one assumes about the incidence of the corporate income tax, our results suggest that even if the corporate income tax were paid entirely by capital income, the reform would make the tax system more progressive.

For whom does a transitional jobs program work

Abstract: Each year, more than 700,000 individuals are released from prisons nationwide (Sabol, West, and Cooper, 2009). Many former prisoners have lengthy criminal backgrounds and struggle to avoid recidivating while reintegrating into the communities to which they return. A person’s criminal history, age, and gender all contribute to the likelihood of future crime (Gendreau, Little, and Goggin 2006; Levinson, 2002). Among released prisoners, younger males with extensive criminal histories are often at greatest risk of future recidivism (Langan and Levin, 2002).1

Potential national and state medical care savings from primary disease prevention.

Abstract: The authors present national and state-level estimates of effects on medical spending over time of reductions in the prevalence of conditions amenable to primary prevention. Reducing diabetes and hypertension prevalence by 5% nationally would save approximately $8.2 billion annually in the near term. The resulting reductions in comorbidities could bring medium-term savings to approximately $26.8 billion annually. Returns are greatest in absolute terms for private payors, but greatest in percentage terms for public payors. State savings vary with demographic makeup and prevailing morbidity. We conclude that well-designed interventions that achieve improvements in lifestyle-related risk factors could result in sufficient savings to substantially offset intervention costs.

Revisiting E&M visit guidelines--a missing piece of payment reform.

Abstract: The Current Procedural Terminology codes covering evaluation and management ( E&M) services and their interpretive documentation guidelines create serious problems that should be addressed now, lest they be replicated in new approaches to provider payment.

Rural Hospital Ownership: Medical Service Provision, Market Mix, and Spillover Effects

Abstract: The organizational landscape of hospital care in the United States is shifting once again. The Patient Protection and Affordable Care Act (PPACA) includes new regulation of nonprofit hospitals, including community benefit obligations and billing practice reform (PPACA 2010). Moreover, hospital conversions from nonprofit to for-profit ownership are on the rise again (Gold 2010). Since the last spate of conversions in the early 1990s, we have learned a great deal about the effects of hospital ownership in urban settings. However, despite claims that hospitals are the heart of rural health systems (Holmes et al. 2006) and for-profit ownership may harm rural health services (Moscovice and Stensland 2002), researchers have largely studied ownership in the urban context. The marked divergence between rural and urban health care makes it inappropriate to apply findings from one context to the other, and highlights the need for research into the particular effects of ownership on rural hospitals. Differences in urban and rural health care can be seen in insurance status (Lenardson et al. 2009), provider demographics (Reschovsky and Staiti 2005), case mix and government payment structures (Moscovice and Stensland 2002), and the relatively high government hospital market penetration in rural markets (Table 1). For these reasons, as well as the fact that roughly half of all U.S. hospitals are located outside of metropolitan statistical areas (MSAs), we examine the direct and spillover effects of hospital ownership on the availability of medical services in rural areas. Table 1 Hospital Ownership (1988–2005) by Year and Rural Status First, we provide new descriptive information on for-profit and nonprofit market share in rural markets. We also identify systematic differences in the characteristics of geographic areas in which for-profits and nonprofits locate, patterns that are particularly important to consider when analyzing the effects of rural hospital ownership on hospital behavior. Previous studies concluding that rural for-profit hospitals have better controlled labor and other operating costs (McCue 2007) or are otherwise more efficient (Ferrier and Valdmanis 1996) than either nonprofit or government hospitals acknowledge the importance of location. But these studies address neither the variation in population density within nonurban areas nor related selection effects. Second, using regression analysis, we identify two distinct types of ownership effects: (1) the direct effects of a rural hospital's own ownership on medical service offerings and (2) the spillover effects of the market mix of hospital types on a hospital's service offering. Our strongest findings suggest that nonprofit hospitals are more likely than rural for-profit hospitals to offer unprofitable services, many of which are in short supply in rural areas. Nonprofits are also less responsive than for-profits to changes in medical service profitability. Moreover, nonprofit hospitals located in areas with more for-profit competitors act more like for-profit hospitals in terms of service offerings than do nonprofits located in areas with fewer for-profit competitors. It is unclear, however, whether these similarities are because nonprofits must make up for lost revenue due to cream skimming by for-profit hospitals or because the characteristics of those markets favor that type of behavior. Given both the recent increase in hospital conversions and debate at all levels of government regarding whether nonprofit hospitals merit their tax exemptions, these results are both timely and important for understanding the potential effects of nonprofit and tax policy for health policy.

I mmigrant diversity and social security: recent patterns and future prospects

Abstract: Immigration is transforming the U.S. labor force with important consequences for Social Security’s adequacy and finances. Using longitudinal data from the Survey of Income and Program Participation matched to rich administrative data on lifetime earnings and benefit receipt, we measure the extent to which non-natives’ lifetime earning patterns, payroll taxes paid, benefits received, and total incomes differ from those for the U.S.- born population. We consider other outcomes important to retirement security, like health status, marital status, and financial wealth. We also compare various immigrant groups with one another. Our findings stress heterogeneity in labor force and Social Security experiences among immigrants.

Medical Spending and the Health of the Elderly

Abstract: A significant body of recent research reports wide variations in Medicare spending per beneficiary across geographic areas, but with little apparent variation in the quality of care or health outcomes (Skinner, Fisher, and Wennberg 2005; Wennberg et al. 2008; Fisher et al. 2009). Based on this research, policy makers have considered proposals that would limit Medicare payments in high-cost areas or pay bonuses in low-cost areas (Congressional Budget Office [CBO] 2008; U.S. Senate Committee on Finance 2009; Abelson and Harris 2010). Although prior research has studied people who age into Medicare and found that greater medical care use following Medicare coverage improved health (Lichtenberg 2002; McWilliams et al. 2007a, b, 2003; Card, Dobkin, and Maestas 2009), none of these studies is directly relevant to the question of whether variations in medical spending for people already covered by Medicare affect their health. Earlier studies that found a positive relationship between medical spending and health at the geographic level may be out of date (Hadley 1982; Hadley 1988). More recently, studies by Doyle (2008) and Martin, Rice, and Smith (2008) used instrumental variable (IV) analysis and found that people treated in higher spending areas had better health outcomes, but neither focused only on the Medicare population. Kaestner and Silber (2010) estimated a positive relationship between Medicare spending and health outcomes, but only for hospitalized patients with particular medical conditions. Like these recent studies, we use IV analysis to investigate the relationship between medical spending and health using data on individual Medicare beneficiaries. If a person-level analysis also finds no relationship between medical spending and health of the elderly, it will reinforce the finding of Medicare inefficiencies drawn from geographic analyses (Fisher et al. 2009).

Negotiating motherhood and work: a typology of role identity associations among low-income, urban women

Abstract: Increasing international migration and an expanding low-wage economy call for continuous research into the work–family experiences of low-income and ethnic minority women. Most research highlights that these women are disproportionately exposed to challenging employment conditions while lacking the supports working and middle-class women rely on. To better capture variation in work–family decisions and well-being under significant structural and social constraints, researchers need to consider women's understanding of themselves as mothers and workers, and their perceptions of the interplay between these roles. Building on role identity theory and the concept of gendered moral rationalities, this paper proposes a five-fold typology of mother–worker role identity associations that captures complexity in work–family identification processes among low-income, ethnically diverse women. The analysis is based on ethnographic data from 25 mothers in New York City who were visited 12 times over a period of 9 mont...

Age differences in job displacement, job search, and reemployment

Abstract: Working longer is often hailed as the best way to increase retirement incomes, yet this strategy depends crucially on seniors' ability to find work and hold on to their jobs. This study examines how the incidence and consequences of job displacement vary by age. Data come primarily from the 1996, 2001, and 2004 panels of the Survey of Income and Program Participation (SIPP), which follow respondents for up to 48 months. The data span the years 1996 to 2007, covering the 2001 recession but not the 2007-2009 recession. Results show that older workers are less likely than younger workers to lose their jobs, but only because they generally have spent more time with their employers. When older workers lose their jobs, they appear to have more trouble than their younger counterparts finding work. Compared with their counterparts ages 25 to 34, displaced men ages 50 to 61 are 39 percent less likely to become reemployed each month and displaced women ages 50 to 61 are 18 percent less likely. When older displaced workers find jobs, they typically experience sharp wage declines. Among displaced men who become reemployed, for example, the median hourly wage on the new job falls 20 percent below the median wage on the old job at ages 50 to 61, compared with only 2 percent at ages 25 to 34. These findings suggest that some employers are reluctant to hire older workers, and raise questions about the employability of older adults.

Strategy, structure, and patient quality outcomes in ambulatory surgery centers (1997-2004).

Abstract: The purpose of this study was to examine potential associations among ambulatory surgery centers' (ASCs) organizational strategy, structure, and quality performance. The authors obtained several large-scale, all-payer claims data sets for the 1997 to 2004 period. The authors operationalized quality performance as unplanned hospitalizations at 30 days after outpatient arthroscopy and colonoscopy procedures. The authors draw on related organizational theory, behavior, and health services research literatures to develop their conceptual framework and hypotheses and fitted fixed and random effects Poisson regression models with the count of unplanned hospitalizations. Consistent with the key hypotheses formulated, the findings suggest that higher levels of specialization and the volume of procedures may be associated with a decrease in unplanned hospitalizations at ASCs.

Lifetime risk and duration of chronic disease and disability.

Abstract: Objective: To estimate risk and duration of chronic conditions and disability for all older Americans and demographic subgroups. Method: Analysis of National Mortality Followback Survey data for survivors to age 65 to project lifetime risk and duration of selected conditions and examine their relationship with life expectancy and disability. Results: For women, Blacks, and non-Blacks, arthritis is most common and has the longest average duration, followed by diabetes and COPD. Among men, diabetes duration is longest, followed by COPD. Disability risk is elevated for all conditions studied, except heart attack. Those very overweight most of life and persons with dementia have the greatest disability risk and relatively long disability durations. Among women, those very overweight most of life can expect to die 3.1 years sooner and have above average disability duration. Discussion: Findings provide new information about the relative burden of common chronic diseases among all older Americans and major subg...

Qualitative Methods in Health Services and Management Research: Pockets of Excellence and Progress, but Still a Long Way to Go:

Abstract: The 10-year systematic review of published health services and management research by Weiner et al. (2011) chronicles the contributions of qualitative methods, highlights areas of substantial progress, and identifies areas in need of more progress. This article (Devers, 2011) discusses possible reasons for lack of progress in some areas— related to the under-supply of well-trained qualitative researchers and more tangible demand for their research—and mechanisms for future improvement. To ensure a robust health services research toolbox, the field must take additional steps to provide stronger education and training in qualitative methods and more funding and publication opportunities. Given the rapidly changing health care system post the passage of national health reform and the chalresearch issues associated with it, the health services research and management field will not meet its future challenges with quantitative methods alone or with a half-empty toolbox.

Clarifying the relationship between nonradiologists' financial interest in imaging and their utilization of imaging

Abstract: OBJECTIVE. Several limitations and deficiencies have been identified in existing studies of physician financial interest in imaging that show financial interest is associated with more imaging. We conducted extensive quantitative analysis of seven deficiencies that have been identified. MATERIALS AND METHODS. Using Symmetry’s Episode Grouper, we created episodes of care from all the 2004–2007 health care claims for a random 5% sample of Medicare fee-for-service beneficiaries. We compared utilization of imaging in nonhospital episodes having a nonradiologist physician who had a financial interest in imaging with utilization in episodes with no such physician. We studied 23 combinations of medical conditions with imaging modalities commonly used for these conditions. RESULTS. Across four different definitions of financial interest and the 23 combinations, the relative probability (risk ratio) of imaging was uniformly higher for episodes of physicians with a financial interest, predominantly at p < 0.001. Th...

Employer-Sponsored Insurance Under Health Reform: Reports of Its Demise Are Premature

Abstract: Some have argued that the Patient Protection and Affordable Care Act would erode employer-sponsored insurance (ESI) by providing incentives for employers to stop offering coverage. Others have claimed that most businesses would face increased costs as a result of reform. A new study finds that overall ESI coverage under the ACA would not differ significantly from what coverage would be without reform. The average employer contribution per person covered by ESI would decrease by nearly 8 percent for small firms and would decrease slightly for larger firms. Total employer health care spending would be 0.6 percent lower under the ACA.