Showing papers by "Urban Institute published in 2020"
TL;DR: In this article, the authors analyzed changes of wind velocity, direction, and air pollutant flow caused by changes in building height, volume, form, and density using a simulated three-dimensional (3D) conceptual model.
109 citations
TL;DR: Given that unemployment rates may reach unprecedented heights during the COVID-19 crisis, steep increases in Medicaid coverage will strain state budgets, restricting already limited resources in the very communities hardest hit by the pandemic.
Abstract: The sharp reduction in US economic activity associated with public health efforts to slow the spread of the COVID-19 virus will likely result in millions of Americans losing their jobs, at least temporarily. Adding insult to injury, many Americans who lose their jobs could also lose their health insurance. In this paper, we examine the kinds of health insurance unemployed workers have and how coverage patterns have shifted under the Affordable Care Act (ACA). As the ACA’s coverage provisions took effect, the likelihood of unemployed adults being uninsured dropped by 35 percent, driven by a rise in Medicaid and Marketplace/other private coverage. The reduction in uninsurance rates among unemployed adults was greater in states that expanded Medicaid eligibility under the ACA than in states that did not expand Medicaid, and the difference owes to a larger increase in Medicaid coverage in expansion states. Joblessness will likely increase uninsurance rates throughout the country in the coming months, and states that did not expand Medicaid under the ACA will likely see larger increases. Given that unemployment rates may reach unprecedented heights during the COVID-19 crisis, steep increases in Medicaid coverage will strain state budgets, restricting already limited resources in the very communities hardest hit by the pandemic. Increasing the federal Medicaid matching rate, beyond the increase already mandated under the recently passed Families First Coronavirus Response Act, could help provide the critical resources needed to protect the states most in need.
57 citations
TL;DR: The main conclusions of this note are that the scale of such assistance is likely to be larger than has so far been proposed, that in countries with limited testing ability slums provide one of the most effective places to target assistance, and that philanthropy has a role to play in supporting innovation.
Abstract: A recent article by Corburn et al. lays out the policies that would help slum communities in the global south deal with COVID-19. That article notes the vulnerabilities of people in these informal settlements and argues that any assistance program must recognize these realities so that the policies do not further jeopardize the survival of large segments of the population of these communities. This note extends the arguments in that paper, focusing on some of the logistic issues involved in providing assistance to informal settlements. It argues that such assistance is essential not only for the help it would provide to people in these settlements but also because the residents of these communities should be key targets of assistance. Because of the location and occupation of most of the residents of these communities, targeting them simultaneously addresses health and economy-wide concerns generated by COVID-19. Their characteristics make them much more likely to be afflicted by the virus and spread it to others. The main conclusions of this note with respect to policy are that the scale of such assistance is likely to be larger than has so far been proposed, that in countries with limited testing ability slums provide one of the most effective places to target assistance, that the role of community groups in providing the assistance is difficult to exaggerate, and that philanthropy has a role to play in supporting innovation.
44 citations
TL;DR: The authors studied the relationship between changes in state funding and foreign enrollment in U.S. colleges and found that a significant set of public universities were able to take advantage of the expanding pool of potential students from abroad to provide a stream of tuition revenue that partially offsets declining state appropriations.
Abstract: The pool of students in the global economy prepared for higher education and able to pay tuition at U.S. colleges and universities has expanded markedly in the last two decades, with a particularly notable increase among potential undergraduate students from China. Given the concentration of high quality colleges and universities in the U.S., there has been a substantial increase in the demand for enrollment among students from abroad. At the same time, substantial declines in state support, driven by contractions in state budgets, have occurred at public sector universities. For such universities, declines in state appropriations force a choice between increasing tuition levels, cutting expenditures, or enrolling a greater proportion of students paying full out-of-state tuition. In this paper we present evidence showing that a significant set of public universities were able to take advantage of the expanding pool of potential students from abroad to provide a stream of tuition revenue that partially offsets declining state appropriations. Our analysis focuses on the interaction between the type of university experience demanded by students from abroad and the supply-side of the U.S. market. For the period between 1996 and 2012, we estimate that a 10% reduction in state appropriations is associated with an increase in foreign enrollment of 12% at public research universities and about 17% at the most resource-intensive public universities. Our results tell a compelling story about the link between changes in state funding and foreign enrollment in recent years. In the absence of the pool of foreign students, many universities would have faced larger cuts to expenditures and potentially greater increases in in-state tuition charges.
36 citations
TL;DR: This article found that an additional $100, or a 3% increase in the average annual EITC exposure between birth and age 18 increases the likelihood of reporting very good or excellent health by 2.6% and decreases the likelihood being obese by 4.1% between ages 22 and 27.
34 citations
TL;DR: Findings lend support to the need for caregiver training on managing multiple task domains and--for dementia caregivers in particular--task-sharing skills.
Abstract: Objectives We provide national estimates of caregiving networks for older adults with and without dementia and examine how these networks develop over time. Most prior research has focused on primary caregivers and rarely on change over time. Method We identify a cohort of older adults continuously followed in the National Health and Aging Trends Study between 2011 and 2015 and receiving help from family members or unpaid caregivers in 2015 (n = 1,288). We examine differences by dementia status in network size, types of assistance and task sharing, and composition-differentiating between "specialist" and "generalist" caregivers helping in one versus multiple activity domains. Multinomial regression is used to estimate change over time in network task sharing and composition. Results In 2015, older adults with dementia had larger caregiving networks involving more task sharing than those without dementia and more often relied on generalist caregivers, especially the subset assisting with medical, household, and mobility or self-care activities. Uniformly greater reliance over time on these more intensely engaged generalist caregivers chiefly accounts for larger dementia networks. Discussion Findings lend support to the need for caregiver training on managing multiple task domains and-for dementia caregivers in particular-task-sharing skills. More generally, the design of new approaches to better support older adults and their caregivers should consider the complexity, heterogeneity, and change over time in caregiving networks.
32 citations
TL;DR: From the Document: Thirty million workers filed initial unemployment claims between March 15 and April 25 Near-term forecasts suggest the unemployment rate will likely be between 15 to 20 percent by June, and many will lose their employer-sponsored health insurance (ESI).
Abstract: Thirty million workers filed initial unemployment claims between March 15 and April 25. As workers lose their jobs, many will also lose their employer-sponsored health insurance (ESI), as will their dependents. Some of these workers and dependents will qualify for Medicaid coverage, particularly in states that expanded Medicaid eligibility under the Affordable Care Act (ACA). Others will purchase individual coverage on the health insurance Marketplaces, possibly with a subsidy to offset the premium cost. And many will be unable to replace their ESI coverage and become uninsured. In this brief, we estimate how health insurance coverage could change as millions of workers lose their jobs during the COVID-19 recession. We present national and state-level estimates of coverage changes if unemployment rates rise from precrisis levels (around 3.5 percent nationally) to 15 percent, 20 percent, or 25 percent. For each unemployment level, we provide a base case scenario of coverage changes and a high scenario, derived from two different estimation methods. In our base scenario, we estimate that at 20 percent unemployment, approximately 25 million people will lose ESI coverage, and of them, 12 million would gain Medicaid coverage, 6 million would gain Marketplace or other private coverage, and 7 million would become uninsured. In the high scenario, we estimate that 43 million people would lose ESI coverage. The increase in Medicaid coverage and uninsurance rates will be uneven across the country, with a greater share of those estimated to lose ESI gaining Medicaid coverage and a lower share becoming uninsured in states that expanded Medicaid under the ACA.
31 citations
TL;DR: It was found that women who received prenatal care in birth centers had lower rates of preterm and low-birthweight infants, lower rate of cesarean section, and higher rates of vaginal birth after cesAREan than did the women in the comparison groups.
Abstract: The federal Strong Start for Mothers and Newborns initiative supported alternative approaches to prenatal care, enhancing service delivery through the use of birth centers, group prenatal care, and maternity care homes. Using propensity score reweighting to control for medical and social risks, we evaluated the impacts of Strong Start's models on birth outcomes and costs by comparing the experiences of Strong Start enrollees to those of Medicaid-covered women who received typical prenatal care. We found that women who received prenatal care in birth centers had lower rates of preterm and low-birthweight infants, lower rates of cesarean section, and higher rates of vaginal birth after cesarean than did the women in the comparison groups. Improved outcomes were achieved at lower costs. There were few improvements in outcomes for participants who received group prenatal care, although their costs were lower in the prenatal period, and no improvements in outcomes for participants in maternity care homes.
30 citations
TL;DR: ACA Medicaid expansions are associated with increased Medicaid coverage and reduced uninsurance among poor new mothers, and opportunities remain for expansion and nonexpansion states to increase insurance coverage among new mothers living in poverty.
Abstract: BACKGROUND: Medicaid plays a critical role during the perinatal period, but pregnancy-related Medicaid eligibility only extends for 60 days post partum. In 2014, the Affordable Care Act’s (ACA’s) Medicaid expansions increased adult Medicaid eligibility to 138% of the federal poverty level in participating states, allowing eligible new mothers to remain covered after pregnancy-related coverage expires. We investigate the impact of ACA Medicaid expansions on insurance coverage among new mothers living in poverty. METHODS: We define new mothers living in poverty as women ages 19 to 44 with incomes below the federal poverty level who report giving birth in the past 12 months. We use 2010–2017 American Community Survey data and a difference-in-differences approach using parental Medicaid-eligibility thresholds to estimate the effect of ACA Medicaid expansions on insurance coverage among poor new mothers. RESULTS: A 100-percentage-point increase in parental Medicaid-eligibility is associated with an 8.8-percentage-point decrease (P CONCLUSIONS: ACA Medicaid expansions are associated with increased Medicaid coverage and reduced uninsurance among poor new mothers. Opportunities remain for expansion and nonexpansion states to increase insurance coverage among new mothers living in poverty.
27 citations
TL;DR: A four‐stage regionally oriented approach to achieving optimal systemwide resource allocation across a region's post‐acute service settings and providers over time is offered.
Abstract: Coronavirus disease 2019 (COVID-19) has led to a surge of patients requiring post-acute care. In order to support federal, state and corporate planning, we offer a four-stage regionally oriented approach to achieving optimal systemwide resource allocation across a region's post-acute service settings and providers over time. In the first stage, the post-acute care system must, to the extent possible, help relieve acute hospitals of non-COVID-19 patients to create as much inpatient capacity as possible over the surge period. In the second stage after the initial surge as subsided, post-acute providers must protect vulnerable populations from COVID-19, prepare treat-in-place protocols for non-COVID-19 admissions, and create and formalize COVID-19 specific settings. In the third stage after a vaccine has been developed or an effective prophylactic option is available, post-acute care providers must assist with distribution and administration of vaccinations and prophylaxis, develop strategies to deliver non-COVID-19 related medical care, and begin to transition to the post-COVID-19 landscape. In the final stage, we must create health advisory bodies to review post-acute sector's response, identify opportunities to improve performance going forward, and develop a pandemic response plan for post-acute care providers. J Am Geriatr Soc 68:1150-1154, 2020.
27 citations
TL;DR: This essay provides a brief overview of public support and the financial and health benefits for older individuals who remain in the community during the pandemic and reports the case example of Austin, Texas, a city with a rapidly aging and diverse population of almost a million residents.
Abstract: As the coronavirus crisis spreads swiftly through the population, it takes a particularly heavy toll on minority individuals and older adults, with older minority adults at especially high risk. Given the shockingly high rates of infections and deaths in nursing homes, staying in the community appears to be a good option for older adults in this crisis, but in order for some older adults to do so much assistance is required. This situation draws attention to the need for benevolent intervention on the part of the state should older adults become ill or lose their sources of income and support during the crisis. This essay provides a brief overview of public support and the financial and health benefits for older individuals who remain in the community during the pandemic. It reports the case example of Austin, Texas, a city with a rapidly aging and diverse population of almost a million residents, to ask how we can assess the success of municipalities in responding to the changing needs of older adults in the community due to COVID-19. It concludes with a discussion of what governmental and non-governmental leadership can accomplish in situations such as that brought about by the current crisis.
TL;DR: It is found that federal EITC expansions are associated with improved self-reported mental health for all mothers and large positive effects on employment for unmarried mothers, and for married mothers, improved mental health is driven through the direct credit alone.
Abstract: While earned income tax credit (EITC) expansions are typically associated with improvements in maternal mental health, little is known about the mechanisms through which the program affects this outcome The EITC could primarily affect mental health through changes in family financial resources, changes in labor supply or changes in health insurance coverage of participants We attempt to disentangle these mechanisms by assessing the effects of state and federal EITC expansion on mental health, employment, and health insurance by maternal marital status We find that federal EITC expansions are associated with improved self-reported mental health for all mothers and large positive effects on employment for unmarried mothers State EITC expansions are associated with improvements in mental health for married mothers only and have no effect on employment for married or unmarried mothers Overall and for most subgroups of mothers, we find little association between EITC expansions and changes in health insurance coverage These findings suggest that while EITC expansions improved mental health for unmarried mothers through a combination of the credit and employment effects, for married mothers, improved mental health is driven through the direct credit alone
TL;DR: The findings reveal that the physical environment features are foundational for the emergence of social and personal meanings associated with a sense of home, and highlight the impact of care practices on thesense of home when the workplace becomes a home.
Abstract: Although moving from institutional to home-like long-term care (LTC) settings can promote and sustain the health and wellbeing of older adults, there has been little research examining how home is perceived by older adults when moving between care settings. A qualitative study was conducted over a two-year period during the relocation of residents and staff from an institutional LTC home to a purpose-built LTC home in Western Canada. The study explored perceptions of home amongst residents, family members and staff. Accordingly, 210 semi-structured interviews were conducted at five time-points with 35 residents, 23 family members and 81 staff. Thematic analyses generated four superordinate themes that are suggestive of how to create and enhance a sense of home in LTC settings: (a) physical environment features; (b) privacy and personalisation; (c) autonomy, choice and flexibility; and (d) connectedness and togetherness. The findings reveal that the physical environment features are foundational for the emergence of social and personal meanings associated with a sense of home, and highlight the impact of care practices on the sense of home when the workplace becomes a home. In addition, tension that arises between providing care and creating a home-like environment in LTC settings is discussed.
TL;DR: The authors examined how the amount and makeup of police-initiated activities changed after the introduction of body-worn cameras (BWCs) and found that BWC-wearing officers may be less likely to engage in proactive activities that are highly discretionary and that could potentially lead to confrontations with community members.
Abstract: Examine how the amount and makeup of police-initiated activities changed after the introduction of body-worn cameras (BWCs). From May 21 to November 22, 2016, patrol officers and sergeants from the Milwaukee Police Department were involved in a randomized controlled trial. Through a stratified random sampling procedure, half the officers (n = 252) were assigned BWCs, while officers from the control group (n = 252) continued business as usual. The counts of proactive activities, which included a total count of self-initiated events, as well as traffic stops, business checks, subject stops, and park and walks, were examined using random-effects negative binominal panel regression analyses. The models included a unique measure of contamination to assess its impact on officers’ proactivity. BWCs had no impact on the total amount of officer-initiated activities, traffic stops, or business checks. Officers with BWCs conducted approximately 8% fewer subject stops and 23% more park and walks than those in the control group. In all models, contamination levels were significantly, positively associated with the number of proactive activities that were conducted; however, the size of this effect was very small. Results suggest that BWC-wearing officers may be less likely to engage in proactive activities that are highly discretionary and that could potentially lead to confrontations with community members. As departments continue to develop BWC programs or fine-tune their existing BWC policies, more research is needed to understand the degree to which BWCs affect officers’ behaviors and interactions with the public.
TL;DR: In this article, the authors present the findings from a pilot research project in Medellín, Colombia, which aimed to explore the scope for, and acceptability of, landslide risk-reducing strategies for informal settlements from the community and state perspectives, and identify politically and practically viable approaches to such strategies within a wider and more complex context of social and physical risk in the area.
Abstract: Urbanization continues to drive informal settlement growth on land exposed to hazards such as landslides, increasing risk among low-income populations. Though technical and social ways of managing landslide risk are known, in developing countries these measures are often difficult to implement because of complex social, economic, political, and institutional reasons. We present the findings from a pilot research project in Medellín, Colombia, which aimed to explore the scope for, and acceptability of, landslide risk-reducing strategies for informal settlements from the community and state perspectives; understand the barriers to landslide riskreducing strategies; and identify politically and practically viable approaches to such strategies within a wider and more complex context of social and physical risk in the area. Focusing on the latter objective, we compare two forms of community-local government spaces for negotiation that were used during the project (a Cabildo Abierto and a joint local government-community Working Group), applying Fung’s “democratic cube” to their analysis. This helps understand their different nature, but also raises questions about the ability of Fung’s model to address governance arrangements related to so-called informal settlements in the Global South, and the need to revisit this model drawing on context-sensitive approaches and insights on informal governance arrangements from the growing literature on service coproduction. The key conclusions highlight the importance of overcoming the state-community stand-off over land occupation rights in Medellín, which is also found in self-built neighborhoods worldwide, by reorienting the problem away from conventional longterm land use planning issues toward issues of safety in the short and medium term, together with an incremental approach, in opening up opportunities to develop wider negotiated mitigation of landslide risk at a more strategic level involving both community and local government.
TL;DR: In this paper, the authors proposed to use big data to understand the interactions between the social system and the natural system in the city across time and space, and to provide theories and solutions to sustainable urban development.
Abstract: Urban ecology is experiencing the third paradigm shift. To understand the interactions between the social system and the natural system in the city across time and space, and to provide theories and solutions to sustainable urban development are essential tasks for urban ecology in the next decade. Big data can play a crucial role in future urban ecology studies due to the interdisciplinary nature of urban ecology, the fact that cities are factories of big data, and the new insights gained by using big data in studies. Nevertheless, to translate big data from a concept to research results that can guide planning, policymaking, and management of cities, we need to overcome multiple challenges existing in the theoretical framework, data acquisition, and analytic methods. Urban ecologists should enhance the collaboration with the data scientists to increase the application of big data in studies of urban biodiversity, urban ecosystem services and human wellbeing, and processes of urban ecosystems.
TL;DR: In this article, a collection of original empirical contributions and interventions by experts from across social geography and sociology is presented to consolidate and advance feminist, women's empowerment, and women's rights.
Abstract: Our key aim with this collection, a combination of original empirical contributions and interventions by experts from across social geography and sociology, is to consolidate and advance feminist, ...
TL;DR: In this article, the authors argue that cities have been experiencing neoliberal urbanization processes since the 1970s, while also contributing to the production of the neoliberal condition per se, and that the neoliberal state plays a role in these processes.
Abstract: Globally, cities have been experiencing neoliberal urbanization processes since the 1970s, while also contributing to the production of the neoliberal condition per se. The neoliberal state plays a...
TL;DR: It is found that the likelihood of living alone is higher in generous welfare states, with social support and spending both positively associated with living alone.
Abstract: While we know that living alone is often associated with greater risk of financial hardship, we have limited knowledge on the possible link between the availability of public support and independent living. We use data from the 2014 Health and Retirement Study and the 2011-2015 Survey of Health, Ageing and Retirement in Europe to compare income and wealth profiles of the population aged 60 and above who are living alone in the United States and 19 European countries. We find that the likelihood of living alone is higher in generous welfare states, with social support and spending both positively associated with living alone. The relationship between personal resources and living alone has a smaller positive gradient in countries with robust welfare systems. The lack of adequate public support in less generous welfare states may constrain the ability of many low-income older adults without a partner to continue living independently.
TL;DR: Addressing policy barriers identified in this study would promote birth centers' participation in Medicaid, leading to better outcomes for Medicaid-covered mothers and newborns and significant savings for the Medicaid program.
Abstract: Policy Points Birth center services must be covered under Medicaid per federal mandate, but reimbursement and other policy barriers prevent birth centers from serving more Medicaid patients. Midwifery care provided through birth centers improves maternal and infant outcomes and lowers costs for Medicaid beneficiaries. Birth centers offer an array of birth options and have resources to care for patients with medical and psychosocial risks. Addressing the barriers identified in this study would promote birth centers' participation in Medicaid, leading to better outcomes for Medicaid-covered mothers and newborns and significant savings for the Medicaid program. Context Midwifery care, particularly when offered through birth centers, has shown promise in both improving pregnancy outcomes and containing costs. The national evaluation of Strong Start for Mothers and Newborns II, an initiative that tested enhanced prenatal care models for Medicaid beneficiaries, found that women receiving prenatal care at Strong Start birth centers experienced superior birth outcomes compared to matched and adjusted counterparts in typical Medicaid care. We use qualitative evaluation data to investigate birth centers' experiences participating in Medicaid, and identify policies that influence Medicaid beneficiaries' access to midwives and birth centers. Methods We analyzed data from more than 200 key informant interviews and 40 focus groups conducted during four case study rounds; a phone-based survey of Medicaid officials in Strong Start states; and an Internet-based survey of birth center sites. We identified themes related to access to midwives and birth centers, focusing on influential Medicaid policies. Findings Medicaid beneficiaries chose birth center care because they preferred midwife providers, wanted a more natural birth experience, or in some cases sought certain pain relief methods or birth procedures not available at hospitals. However, Medicaid enrollees currently have less access to birth centers than privately insured women. Many birth centers have difficulty contracting with managed care organizations and participating in Medicaid value-based delivery system reforms, and birth center reimbursement rates are sometimes too low to cover the actual cost of care. Some birth centers significantly limit Medicaid business because of low reimbursement rates and threats to facility sustainability. Conclusions Medicaid beneficiaries do not have the same access to maternity care providers and birth settings as their privately insured counterparts. Medicaid policy barriers prevent some birth centers from serving more Medicaid patients, or threaten the financial sustainability of centers. By addressing these barriers, more Medicaid beneficiaries could access care that is associated with positive birth outcomes for mothers and newborns, and the Medicaid program could reap significant savings.
TL;DR: In this article, an internet-based survey of 37 questions to medical directors or nurse managers at 145 birth hospitals in California was conducted to assess management of Neonatal abstinence syndrome (NAS) in California hospitals to identify potential opportunities to expand the use of best practices.
Abstract: Assess management of neonatal abstinence syndrome (NAS) in California hospitals to identify potential opportunities to expand the use of best practices. We fielded an internet-based survey of 37 questions to medical directors or nurse managers at 145 birth hospitals in California. Seventy-five participants (52%) responded. Most respondents reported having at least one written protocol for managing NAS, but gaps included protocols for pharmacologic management. Newer tools for assessing NAS severity were not commonly used. About half reported usually or always using nonpharmacologic strategies; there is scope for increasing breastfeeding when recommended, skin-to-skin care, and rooming-in. We found systematic gaps in care for infants with NAS in a sample of California birth hospitals, as well as opportunities to spread best practices. Adoption of new approaches will vary across hospitals. A concerted statewide effort to facilitate such implementation has strong potential to increase access to evidence-based treatment for infants and mothers.
TL;DR: In this paper, the authors investigate whether employers use university prestige as a signal of workers' unobservable productivity and find that college prestige becomes less important for employers as workers reveal their quality throughout their careers.
TL;DR: Two possible reform pathways that can take place within the current multipayer system are offered, aimed at ensuring coverage, access, continuity, and comprehensiveness to move the nation closer to the goal of providing the health care that children need to reach their full potential and to reduce racial and economic inequalities.
Abstract: Expansion of Medicaid and establishment of the Children’s Health Insurance Program (CHIP) represent a significant success story in the national effort to guarantee health insurance for children. Th...
TL;DR: The authors compared the financial outcomes of residents in areas hit by natural disasters and found that natural disasters can throw even better-situated families into financial turmoil, compared to those living on the financial edge.
Abstract: Many families live on the financial edge, but a natural disaster can throw even better-situated families into financial turmoil. Comparing the financial outcomes of residents in areas hit by natura...
TL;DR: Six activities of the patient-centered medical home model of care are associated with lower spending and utilization among Medicare beneficiaries and practices seeking to deliver more efficient care may benefit from implementing these 6 activities.
Abstract: PURPOSE To identify components of the patient-centered medical home (PCMH) model of care that are associated with lower spending and utilization among Medicare beneficiaries. METHODS Regression analyses of changes in outcomes for Medicare beneficiaries in practices that engaged in particular PCMH activities compared with beneficiaries in practices that did not. We analyzed claims for 302,719 Medicare fee-for-service beneficiaries linked to PCMH surveys completed by 394 practices in the Centers for Medicare & Medicaid Services’ 8-state Multi-Payer Advanced Primary Care Practice demonstration. RESULTS Six activities were associated with lower spending or utilization. Use of a registry to identify and remind patients due for preventive services was associated with all 4 of our outcome measures: total spending was $69.77 less per beneficiary per month (PBPM) (P = 0.00); acute-care hospital spending was $36.62 less PBPM (P = 0.00); there were 6.78 fewer hospital admissions per 1,000 beneficiaries per quarter (P1KBPQ) (P = 0.003); and 11.05 fewer emergency department (ED) visits P1KBPQ (P = 0.05). Using a patient registry for pre-visit planning and clinician reminders was associated with $29.31 lower total spending PBPM (P = 0.05). Engaging patients with chronic conditions in goal setting and action planning was associated with 4.62 fewer hospital admissions P1KBPQ (P = 0.01) and 11.53 fewer ED visits P1KBPQ (P = 0.00). Monitoring patients during hospital stays was associated with $22.06 lower hospital spending PBPM (P = 0.03). Developing referral protocols with commonly referred-to clinicians was associated with 11.62 fewer ED visits P1KBPQ (P = 0.00). Using quality improvement approaches was associated with 13.47 fewer ED visits P1KBPQ (P =0.00). CONCLUSIONS Practices seeking to deliver more efficient care may benefit from implementing these 6 activities.
TL;DR: This article explored Friedman's views on conditional lending by the International Monetary Fund (IMF) and found that Friedman opposed conditional lending both in public fora and privately with other neoliberals at Mont Pelerin Society meetings.
Abstract: This paper explores Milton Friedman’s views on conditional lending by the International Monetary Fund (IMF). Conditional lending by international financial institutions, which began with a few IMF stand-by arrangements in the 1950s and grew to include extensive World Bank structural adjustment programs, is considered a quintessential neoliberal policy tool. This paper shows that despite his reputation as a neoliberal, Friedman was a vocal opponent of conditional lending by the IMF. He saw conditionality as unacceptably undemocratic, even though in several cases he approved of the policy prescriptions embedded in IMF conditional lending agreements. Friedman opposed conditional lending both in public fora and privately with other neoliberals at Mont Pelerin Society meetings. This paper focuses on Friedman’s views on conditionality in the 1960s and 1970s, during the IMF’s initial turn away from unconditional lending. It also shows how Friedman’s rhetoric changed after the collapse of the Bretton Woods system of fixed exchange rates. By the 1980s Friedman moved past criticizing the undemocratic nature of IMF conditionality and instead argued that without a system of fixed exchange rates to manage the IMF should be abolished.
23 Sep 2020
TL;DR: This project develops an alternative privacy protection method: a fully synthetic representation of the income tax data that is statistically representative of the original data that protects the underlying data from disclosure and evaluates the quality of the data.
Abstract: US government agencies possess data that could be invaluable for evaluating public policy, but often may not be released publicly due to disclosure concerns. For instance, the Statistics of Income division (SOI) of the Internal Revenue Service releases an annual public use file of individual income tax returns that is invaluable to tax analysts in government agencies, nonprofit research organizations, and the private sector. However, SOI has taken increasingly aggressive measures to protect the data in the face of growing disclosure risks, such as a data intruder matching the anonymized public data with other public information available in nontax databases. In this paper, we describe our approach to generating a fully synthetic representation of the income tax data by using sequential Classification and Regression Trees and kernel density smoothing. This synthetic data file represents previously unreleased information useful for tax policy modeling. We also tested and evaluated the tradeoffs between data utility and disclosure risks of different parameterizations using a variety of validation metrics. The resulting synthetic data set has high utility, particularly for summary statistics and microsimulation, and low disclosure risk.
TL;DR: There is considerable overlap between the clinical activities of colocated NPs and physicians, with some differentiation based on intensity of services provided.
Abstract: Background Primary care practices increasingly include nurse practitioners (NPs), in addition to physicians. Little is known about how the patient mix and clinical activities of colocated physicians and NPs compare. Objectives To describe the clinical activities of NPs, compared with physicians. Research design We used claims and electronic health record data from athenahealth Inc., on primary care practices in 2017 and a cross-sectional analysis with practice fixed effects. Subjects Patients receiving treatment from physicians and NPs within primary care practices. Measures First, we measured patient characteristics (payer, age, sex, race, chronic condition count) and visit characteristics (new patient, scheduled duration, same-day visit, after-hours visit). Second, we measured procedures performed and diagnoses recorded during each visit. Finally, we measured daily quantity (visit volume, minutes scheduled for patient care, total work relative value units billed) of care. Results Relative to physicians, NPs treated younger and healthier patients. NPs also had a larger share of patients who were female, non-White, and covered by Medicaid, commercial insurance, or no insurance. NPs scheduled longer appointments and treated more patients on a same-day or after-hours basis. On average, "overlapping" services-those performed by NPs and physicians within the same practice-represented 92% of all service volume. The small share of services performed exclusively by physicians reflected greater clinical intensity. On a daily basis, NPs provided fewer and less intense visits than physicians within the same practice. Conclusions Our findings suggest considerable overlap between the clinical activities of colocated NPs and physicians, with some differentiation based on intensity of services provided.
TL;DR: It is shown that a strong association in 2013 between living close to a conflict zone and acute malnutrition in Nigerian children, with larger effects for rural children than urban children, is related to the severity of the conflict.
Abstract: The new millennium brought renewed attention to improving the health of women and children. In this same period, direct deaths from conflicts have declined worldwide, but civilian deaths associated with conflicts have increased. Nigeria is among the most conflict-prone countries in Sub-Saharan Africa, especially recently with the Boko Haram insurgency in the north. This paper uses two data sources, the 2013 Demographic and Health Survey for Nigeria and the Social Conflict Analysis Database, linked by geocode, to study the effect of these conflicts on infant and young child acute malnutrition (or wasting). We show a strong association in 2013 between living close to a conflict zone and acute malnutrition in Nigerian children, with larger effects for rural children than urban children. This is related to the severity of the conflict, measured both in terms of the number of conflict deaths and the length of time the child was exposed to conflict. Undoubtedly, civil conflict is limiting the future prospects of Nigerian children and the country's economic growth. In Nigeria, conflicts in the north are expected to continue with sporadic attacks and continued damaged infrastructure. Thus, Nigerian children, innocent victims of the conflict, will continue to suffer the consequences documented in this study.
31 Dec 2020