Showing papers by "Urban Institute published in 2021"
TL;DR: In this article, the authors estimate changes in life expectancy in 2010-18 and during the covid-19 pandemic in 2020 across population groups in the United States and to compare outcomes with peer nations.
Abstract: Objective To estimate changes in life expectancy in 2010-18 and during the covid-19 pandemic in 2020 across population groups in the United States and to compare outcomes with peer nations. Design Simulations of provisional mortality data. Setting US and 16 other high income countries in 2010-18 and 2020, by sex, including an analysis of US outcomes by race and ethnicity. Population Data for the US and for 16 other high income countries from the National Center for Health Statistics and the Human Mortality Database, respectively. Main outcome measures Life expectancy at birth, and at ages 25 and 65, by sex, and, in the US only, by race and ethnicity. Analysis excluded 2019 because life table data were not available for many peer countries. Life expectancy in 2020 was estimated by simulating life tables from estimated age specific mortality rates in 2020 and allowing for 10% random error. Estimates for 2020 are reported as medians with fifth and 95th centiles. Results Between 2010 and 2018, the gap in life expectancy between the US and the peer country average increased from 1.88 years (78.66 v 80.54 years, respectively) to 3.05 years (78.74 v 81.78 years). Between 2018 and 2020, life expectancy in the US decreased by 1.87 years (to 76.87 years), 8.5 times the average decrease in peer countries (0.22 years), widening the gap to 4.69 years. Life expectancy in the US decreased disproportionately among racial and ethnic minority groups between 2018 and 2020, declining by 3.88, 3.25, and 1.36 years in Hispanic, non-Hispanic Black, and non-Hispanic White populations, respectively. In Hispanic and non-Hispanic Black populations, reductions in life expectancy were 18 and 15 times the average in peer countries, respectively. Progress since 2010 in reducing the gap in life expectancy in the US between Black and White people was erased in 2018-20; life expectancy in Black men reached its lowest level since 1998 (67.73 years), and the longstanding Hispanic life expectancy advantage almost disappeared. Conclusions The US had a much larger decrease in life expectancy between 2018 and 2020 than other high income nations, with pronounced losses among the Hispanic and non-Hispanic Black populations. A longstanding and widening US health disadvantage, high death rates in 2020, and continued inequitable effects on racial and ethnic minority groups are likely the products of longstanding policy choices and systemic racism.
94 citations
TL;DR: To build trust with patients, health providers should actively listen, provide detailed explanations, show caring for patients, and demonstrate their knowledge.
41 citations
TL;DR: In the four decades since 1980, US colleges and universities have seen the number of students from abroad quadruple, and the impacts are far from uniform, with significant differences evident by level of study and type of institution as discussed by the authors.
Abstract: In the four decades since 1980, US colleges and universities have seen the number of students from abroad quadruple. This rise in enrollment and degree attainment affects the global supply of highly educated workers, the flow of talent to the US labor market, and the financing of US higher education. Yet, the impacts are far from uniform, with significant differences evident by level of study and type of institution. The determinants of foreign flows to US colleges and universities reflect both changes in student demand from abroad and the variation in market circumstances of colleges and universities, with visa policies serving a mediating role. The consequences of these market mechanisms impact global talent development, the resources of colleges and universities, and labor markets in the United States and countries sending students.
32 citations
TL;DR: In 2019, as in prior years, Medicaid physician fees remained well below Medicare and private insurance fees despite growth in Medicaid enrollment as mentioned in this paper, which has important implications in terms of access to care for Medicaid enrollees and the effects of proposals to expand coverage through a Medicaid buy-in program or a Medicaid like public option.
Abstract: In 2019, as in prior years, Medicaid physician fees remained well below Medicare and private insurance fees despite growth in Medicaid enrollment. Low Medicaid physician fees have important implications in terms of access to care for Medicaid enrollees and the effects of proposals to expand coverage through a Medicaid buy-in program or a Medicaid-like public option.
26 citations
23 citations
TL;DR: This article used data for new mothers with Medicaid-covering, and found that many women were not eligible for Medicaid before pregnancy or after sixty days postpartum, but they did qualify for Medicaid after pregnancy.
Abstract: Medicaid has a long history of serving pregnant women, but many women are not eligible for Medicaid before pregnancy or after sixty days postpartum. We used data for new mothers with Medicaid-cover...
23 citations
TL;DR: Nan et al. as discussed by the authors discuss the COVID-19 implications for housing and the socio-economic upheaval experienced so far is unlikely to end soon, and more complex and possibly much more severe socioeconomic impacts might follow as the CO VID-19 repercussions travel through the ramified world with layers of economic (national and local) and institutional structures Much will depend on how local and national governments attempt to intervene at various territorial scales over time
Abstract: Nan et al discuss the COVID-19 implications for housing The COVID-19 pandemic has made "home" an absolute focal point of people's lives The socio-economic upheaval experienced so far is unlikely to end soon, and more complex and possibly much more severe socio-economic impacts might follow as the COVID-19 repercussions travel through the ramified world with layers of economic (national and local) and institutional structures Much will depend on how local and national governments attempt to intervene at various territorial scales over time
20 citations
TL;DR: This analysis suggests that hardship would be even more prevalent in the United States without the existence of the current safety net programs, including TANF, SNAP, or Medicaid/SCHIP.
20 citations
TL;DR: Time-stamped EHR data offer researchers and health systems an opportunity to measure exam length and other objects of interest related to time.
Abstract: Background Physicians' time with patients is a critical input to care, but is typically measured retrospectively through survey instruments. Data collected through the use of electronic health records (EHRs) offer an alternative way to measure visit length. Objective To measure how much time primary care physicians spend with their patients, during each visit. Research design We used a national source of EHR data for primary care practices, from a large health information technology company. We calculated exam length and schedule deviations based on timestamps recorded by the EHR, after implementing sequential data refinements to account for non-real-time EHR use and clinical multitasking. Observational analyses calculated and plotted the mean, median, and interquartile range of exam length and exam length relative to scheduled visit length. Subjects A total of 21,010,780 primary care visits in 2017. Measures We identified primary care visits based on physician specialty. For these visits, we extracted timestamps for EHR activity during the exam. We also extracted scheduled visit length from the EHR's practice management functionality. Results After data refinements, the average primary care exam was 18.0 minutes long (SD=13.5 min). On average, exams ran later than their scheduled duration by 1.2 minutes (SD=13.5 min). Visits scheduled for 10 or 15 minutes were more likely to exceed their allotted time than visits scheduled for 20 or 30 minutes. Conclusions Time-stamped EHR data offer researchers and health systems an opportunity to measure exam length and other objects of interest related to time.
17 citations
TL;DR: In this article, the authors analyzed 488 respondents' perceptions of four visual attributes and their preferences of a set of simulated landscape scenes simultaneously to explore the relationships between visual attributes, and found that the depth of view only affected landscape preference significantly when the landscape had a moderate level of openness.
13 citations
TL;DR: In this article, the authors examined how time pressure, an important constraint faced by medical care providers, affects productivity in primary care and generated empirical predictions by incorporating time pressure into a model of physician behavior by Tai-Seale and McGuire.
01 Sep 2021
TL;DR: Challenges of environmental noise-related health impact assessment from a health equity perspective are summarised and residents’ control – both procedurally and environmentally – is focused on to illustrate how social and environmental determinants can cause vulnerability.
Abstract: Despite being an overall objective of European policies, health equity and environmental justice have not yet been systematically implemented in environmental policies. Taking control over one’s environment as an element of health equity, we consider intractable exposure to transportation noise as a highly relevant policy field. The European Environmental Noise Directive is designed as a sectoral policy dealing with one environmental health determinant (noise) and drawing on the Global Burden of Disease framework, whereas health equity demands an investigation of the manifold variations in the population by combining adverse noise exposure with salutogenetic (psycho-)social and environmental resources. Such resources or the lack thereof have been referred to as ‘non-acoustic factors’ in noise- and soundscape-related research and can presumably account for vulnerability to transportation noise exposure caused by social and environmental determinants. Thus, we aim to link the current discourse on ‘non-acoustic factors’ with health equity driven by the need to go beyond average exposure–response-relations. After summarising challenges of environmental noise-related health impact assessment from a health equity perspective, we focus on residents’ control – both procedurally and environmentally – to illustrate how social and environmental determinants can cause vulnerability. We advocate to consider ‘non-acoustic factors’ as leverage to promote health equity and environmental justice through three fields of potential action: (1) developing a theoretical and methodological groundwork and multi/interdisciplinary training of students and professionals, (2) introducing comprehensible information and inclusive participation methods, and (3) creating supportive institutional frames and governance modes. The contents of this paper were derived from a workshop held at the University of Bremen in September 2020.
TL;DR: The results suggest that younger and older occupants are different in thermal comfort, specifically older occupants prefer a warmer environment than younger occupants, and the neutral temperature produced by the predicted mean vote method is not warm enough for older occupants.
Abstract: Dry indoor air has been identified as the main cause of dry skin in winter which greatly affects older occupants' wellbeing, but HVAC design standards are based on average adults and do not specify...
TL;DR: Wang et al. as mentioned in this paper developed an urban ecosystem service model based on the social-ecological model framework, and used the PM2.5 removal service in Beijing, China as an example to simulate the impacts of different policy scenarios on the specified ecosystem service.
Abstract: To incorporate the concept of ecosystem services into the planning and management practices has been proposed as a way to improve the management of urban ecosystems. Nevertheless, the uptake of the idea is slow due to the many political and technical barriers. One of the technical barriers is the lack of tools for cities to predict the impacts of proposed policies and actions on urban ecosystem services. To address this gap, we have developed an urban ecosystem service model based on the social-ecological model framework. Using the PM2.5 removal service in Beijing, China as an example, we showed how this model could be used to simulate the impacts of different policy scenarios on the specified ecosystem service. Our simulation results show that he PM2.5 removal service contributed by the city’s ecosystem can help to lower PM2.5 emissions from its social system, which formed a positive feedback. The PM2.5 removal service provided by urban green spaces from 2016 to 2035 in Beijing vary significantly among the three policy scenarios, including business as usual, restricting urban growth, and adjusting the energy structure. Based on the projections of the PM2.5 removal service, we concluded that Beijing should give priority to the policy of restricting the urban growth through urban planning. Our study showed that the feedback effects of ecosystem services are significant in a long term. Also, the model developed in this study provides a useful tool to simulate the impact of urban planning and management on urban ecosystem services.
TL;DR: In this paper, the authors studied the effects of relaxing state-level scope of practice (SOP) restrictions on nurse practitioners' autonomy in their day-to-day jobs and the provision of low-value services at primary care practices.
Abstract: Nurse practitioners (NPs) are an increasingly integral part of the primary care workforce. NPs' authority to practice without physician oversight is regulated by state-level scope of practice (SOP) restrictions. To the extent that SOP restrictions prevent NPs from practicing to their full abilities and capacity, they could create inefficiencies and restrict access to health care. In this paper, I study what happens at primary care practices when states relax their SOP laws. Using a novel dataset of claims and electronic health records paired with a difference-in-differences research design, I quantify the effects of relaxing SOP laws on: (1) NPs' autonomy in their day-to-day jobs; (2) total workload and patient allocation between NPs and physicians; and (3) the provision of low-value services at primary care practices. I find some evidence that NPs practice more autonomously following SOP changes, but I find no evidence that relaxing SOP laws changes the volume nor allocation of patients to NPs, nor the provision of low-value services. Given the lower reimbursement that NPs typically receive, these findings suggest that allowing NPs to practice without physician oversight could reduce health care spending, without harming patients.
TL;DR: In this article, the authors use the results of a longitudinal survey of local governments to infer that zoning explains housing price inflation in fast-growth metro areas, which is not supported by empirical evidence.
Abstract: Pundits and economists have recently inferred that zoning explains housing price inflation in fast-growth metro areas. In this article, we use the results of a longitudinal survey of local governme...
TL;DR: In this paper, the authors extend prior body-worn camera research by using a panel analysis design with a measure of treatability, which can help improve transparency, accountability, and policing behaviors.
Abstract: Police body-worn cameras (BWCs) can help improve transparency, accountability, and policing behaviors. This study extends prior BWC research by using a panel analysis design with a measure of treat...
TL;DR: Buchanan developed an urban fiscal club framework for thinking about urban problems that he used to analyze cities' tax policy and the negative externalities of congestion, crime, and pollution.
Abstract: This paper explores James Buchanan’s contributions to urban economics and urban public finance. Buchanan never self-identified as an “urban economist,” so his contributions to the field tend to blend into his broader body of work on public finance and externalities. However, in a series of papers in the 1960s and 1970s Buchanan developed an urban fiscal club framework for thinking about urban problems that he used to analyze cities’ tax policy and the negative externalities of congestion, crime, and pollution. By drawing out those contributions and their relation to each other we can reconstruct James Buchanan as an urban economist. This reconstruction casts new light on Buchanan’s service with several academic and federal urban policy commissions, including Richard Nixon’s 1968-1969 Task Force on Urban Affairs and his 1969-1970 Task Force on Model Cities, the Committee on Urban Public Expenditures, and the Southern Regional Congress on City Planning. Buchanan’s interest in urban economics has deep roots in an often-ignored member of his dissertation committee, Harvey Perloff. Perloff’s joint appointment with the Chicago Planning Program brought Buchanan into contact with several renowned urban planners and urban economists that would continue to engage him in urban policy work throughout his career, including Julius Margolis and Edward Banfield.
TL;DR: The early positive financial impact of Medicaid expansion was sustained in fiscal years 2016 and 2017 as hospitals in expansion states continued to experience decreased uncompensated care costs and increased Medicaid revenue and financial margins as discussed by the authors.
Abstract: States' decisions to expand Medicaid may have important implications for their hospitals' financial ability to weather the coronavirus disease 2019 (COVID-19) pandemic. This study estimated the effects of the Affordable Care Act (ACA) Medicaid expansion on hospital finances in 2017 to update earlier findings. The analysis also explored how the ACA Medicaid expansion affects different types of hospitals by size, ownership, rurality, and safety-net status. We found that the early positive financial impact of Medicaid expansion was sustained in fiscal years 2016 and 2017 as hospitals in expansion states continued to experience decreased uncompensated care costs and increased Medicaid revenue and financial margins. The magnitude of these impacts varied by hospital type. As COVID-19 has brought hospitals to a time of great need, findings from this study provide important information on what hospitals in states that have yet to expand Medicaid could gain through expansion and what is at risk should any reversal of Medicaid expansions occur.
TL;DR: This article used quasi-experimental analyses to estimate the effectiveness of police-operated CCTV cameras in Milwaukee, Wisconsin, and found that the cameras can deter crime by detecting and identifying suspicious behaviour.
Abstract: This study uses quasi-experimental analyses to estimate the effectiveness of police-operated CCTV cameras in Milwaukee, Wisconsin. Most studies have focused on how cameras can deter crime. But, lik...
TL;DR: In this article, two types of community-based approaches to addressing sexual assault that survivors may encounter, nurse examiners and victim advocates from nonprofit community organizations, are reviewed and compared.
Abstract: This article reviews two types of community-based approaches to addressing sexual assault that survivors may encounter—sexual assault nurse examiners and victim advocates from nonprofit community a...
TL;DR: Wang et al. as mentioned in this paper surveyed the woody plant species in 240 sample plots in 54 remnant forest patches in Guiyang City, China, and analyzed the taxonomic diversity of woody plants and the effects of influencing factors using multi-level taxonom diversity indicators and the generalized dissimilarity modeling.
Abstract: Remnant forests in urban areas are hotspots of urban biodiversity. However, the survival and integrity of many remnant forests are currently at risk. Better knowledge of the interactions between remnant forests and urban environments is urgently needed for guiding the conservation effort. In this study, we intend to answer the question: how do patch attributes and landscape patterns of surrounding environments affect the taxonomic diversity of woody plants in urban forest remnants? We surveyed the woody plant species in 240 sample plots in 54 remnant forest patches in Guiyang City, China. We analyzed the taxonomic diversity of woody plants and the effects of influencing factors using multi-level taxonomic diversity indicators and the generalized dissimilarity modeling. The results showed that shrubs had higher within-patch α-diversity than that of trees. However, adult trees had higher among-group β-diversity than those of shrubs and saplings/seedlings. The vegetation type of the patch had more influence than other factors on the compositional dissimilarity of adult trees and sapling/seedling among patches. The patch size had the highest impact on the compositional dissimilarity of shrubs. Besides, small patches had a higher rate of compositional turnover in all woody plants. The percentage of impervious surfaces in surrounding areas and the spatial distance from each other were the main influencing factors for adult trees and saplings/seedlings, respectively. Based on our results, we recommend that more attention should be paid to preserve the small remnant forest patches and protect sampling/seedlings to maintain the taxonomic diversity of urban remnant forests.
TL;DR: In the context of worsening housing affordability for low and moderate-income households, the authors assemble data from metropolitan areas in the United States, France, and the United Kingdom to analyze r...
Abstract: In the context of worsening housing affordability for low- and moderate-income households, we assemble data from metropolitan areas in the United States, France, and the United Kingdom to analyze r...
TL;DR: Findings indicate that more men than women reported forced marriage experiences, and that service provision needs are notably acute for this population of Internet users over 18 years of age.
Abstract: In Western European countries and Canada, an emerging scholarly literature has helped inform awareness and prevention efforts and justice system responses to address forced marriages. But, little i...
03 Feb 2021
TL;DR: An in-depth evaluation of several differentially private synthetic data algorithms used in the recent NIST PSCR Division's "Differential Privacy Synthetic Data Challenge" based on both the accuracy of the data they create and their usability by potential data providers is offered.
Abstract: Differentially private synthetic data generation offers a recent solution to release analytically useful data while preserving the privacy of individuals in the data. In order to utilize these algorithms for public policy decisions, policymakers need an accurate understanding of these algorithms' comparative performance. Correspondingly, data practitioners also require standard metrics for evaluating the analytic qualities of the synthetic data. In this paper, we present an in-depth evaluation of several differentially private synthetic data algorithms using actual differentially private synthetic data sets created by contestants in the recent National Institute of Standards and Technology Public Safety Communications Research (NIST PSCR) Division's ``"Differential Privacy Synthetic Data Challenge." We offer analyses of these algorithms based on both the accuracy of the data they create and their usability by potential data providers. We frame the methods used in the NIST PSCR data challenge within the broader differentially private synthetic data literature. We implement additional utility metrics, including two of our own, on the differentially private synthetic data and compare mechanism utility on three categories. Our comparative assessment of the differentially private data synthesis methods and the quality metrics shows the relative usefulness, general strengths and weaknesses, preferred choices of algorithms and metrics. Finally we describe the implications of our evaluation for policymakers seeking to implement differentially private synthetic data algorithms on future data products.
TL;DR: Scholars in the field of public administration are operating in an increasingly globalising world in which people and polities enjoy an unprecedented degree of connectivity irrespective of their geographies.
Abstract: Scholars in the field of public administration are operating in an increasingly globalising world in which people and polities enjoy an unprecedented degree of connectivity irrespective of their ge...
TL;DR: Zhenghu Village as discussed by the authors has been found to have limitations related to the assessment process, method, and indicators, meaning that it cannot be used to perform a balanced evaluation of the social, economic, and environmental aspects of an eco-village.
Abstract: Eco-village development has been considered by the Chinese central government as part of its rural revitalisation campaign and it is seen as a crucial/main solution to the increasingly serious rural issues caused by urban–rural inequality. A significant number of eco-villages are being or will be developed with government leadership and support under the guidance of a corresponding assessment. However, the latest Chinese eco-village assessment, the Evaluation for the Construction of Beautiful Villages (ECBV), has been found to have limitations related to the assessment process, method, and indicators, meaning that it cannot be used to perform a balanced evaluation of the social, economic, and environmental aspects of an eco-village. As assessing an eco-village is as essential as building it, it has become necessary to balance the criteria and improve the ECBV assessment so that it can review existing achievements, guide further development, and ensure better outcomes. Thus, this paper aims to: (1) identify the limitations of ECBV through a case study of a carefully selected Chinese eco-village, Zhenghu Village, by repeating the assessment process and analysing the assessment results, and (2) propose three possible solutions to improve the assessment by applying a revised ECBV assessment, the components of which are adopted and revised from an internationally recognised sustainability assessment, the Sustainable Development Indicators (SDIs). The results of the case study confirm the limitations of the ECBV assessment. Besides, the research outcomes of these three possible solutions can improve ECBV assessment and also provide ideas for the improvement of other existing assessment methods. Moreover, other developing countries may apply the research process and method introduced in this paper to formulate or improve their own eco-village assessments.
01 Apr 2021
TL;DR: A new DIPS approach, STatistical Election to Partition Sequentially (STEPS), is proposed that partitions data by attributes according to their importance ranks per either a practical importance or statistical importance measure and develops a general-utility metric to assess the similarity of the synthetic data to the actual data.
Abstract: Differential Privacy (DP) formalizes privacy in mathematical terms and provides a robust concept for privacy protection. DIfferentially Private Data Synthesis (DIPS) techniques produce and release synthetic individual-level data in the DP framework. One key challenge to develop DIPS methods is the preservation of the statistical utility of synthetic data, especially in high-dimensional settings. We propose a new DIPS approach, STatistical Election to Partition Sequentially (STEPS) that partitions data by attributes according to their importance ranks according to either a practical or statistical importance measure. STEPS aims to achieve better original information preservation for the attributes with higher importance ranks and produce thus more useful synthetic data overall. We present an algorithm to implement the STEPS procedure and employ the privacy budget composability to ensure the overall privacy cost is controlled at the pre-specified value. We apply the STEPS procedure to both simulated data and the 2000–2012 Current Population Survey youth voter data. The results suggest STEPS can better preserve the population-level information and the original information for some analyses compared to PrivBayes, a modified Uniform histogram approach, and the flat Laplace sanitizer.
TL;DR: In this paper, the authors explored the distributional effects of the Affordable Care Act's (ACA's) expansion of health benefits and the resulting income inequality, using alternative income measures that incorporate the value of the ACA's health insurance changes under the law.
Abstract: Income inequality estimates based on traditional poverty measures do not capture the effects of health care spending and health insurance. To explore the distributional effects of the Affordable Care Act's (ACA's) expansion of health benefits and the resulting income inequality, this study used alternative income measures that incorporate the value of the ACA's health insurance changes under the law. The study simulated the impact of the ACA on income inequality in 2019 compared with a scenario without the ACA. We found that the ACA reduced income inequality and that the decrease was much larger in states that expanded Medicaid than in states that did not. We also decomposed the effect of the ACA on inequality by race/ethnicity, age, and family educational attainment. The ACA reduced inequality both across groups and within these groups. With efforts to repeal the ACA-specifically, California v. Texas-having shifted from Congress to the courts, it remains important to consider the consequences of fully repealing the ACA, which would likely reverse reduced inequality observed under the law.