Urban Institute

About: Urban Institute is a nonprofit organization based out in Washington D.C., District of Columbia, United States. It is known for research contribution in the topics: Medicaid & Population. The organization has 927 authors who have published 2330 publications receiving 86426 citations.

Disability and Medicare Costs of Elderly Persons

Abstract: Rapidly growing Medicare expenditures, which are already expected to exceed revenues by the year 2002, are likely to accelerate as a result of the increasing numbers of very old beneficiaries (85+ years), who are particularly at risk of being disabled. The concern for Medicare is that elderly persons with disabilities incur higher than average health care costs because of the underlying causes of their disability, which are usually chronic medical conditions (Manton and Stallard 1992). Such conditions often require long-term care, but they also tend to induce illnesses requiring acute care. This study analyzed data from the Medicare Current Beneficiary Survey to examine the relationship between disability and Medicare costs. It examined relations between levels of disability and costs, interactions between disability and other beneficiary characteristics, and changes in the level of disability and costs. (The Milbank Quarterly 1997 December; 75(4): 461-493).

Nonprofit conversion: theory, evidence, and state policy options.

Abstract: OBJECTIVE: To describe the contributions of nonprofit hospitals and health plans to healthcare markets and to analyze state policy options with regard to the conversion of nonprofits to for-profit status. DATA SOURCES/STUDY SETTING: Secondary national and state data from a variety of sources, 1980-present. STUDY DESIGN: Policy analysis. DATA COLLECTION/EXTRACTION METHODS: Development of a conceptual economic framework; analysis of empirical, legal, and theoretical literature; and review of statutes, rules, and court decisions. PRINCIPAL FINDINGS: Three main rationales support special status for nonprofits, especially hospitals: charity care, other community benefits, and consumer protection. The main social rationale for for-profits is their incentives for better efficiency. There are reasons to expect that nonprofit and for-profit goals differ; however, measured differences in community hospital cost, prices, and quality between nonprofit and for-profit hospitals are undetectable or inconclusive. Nonprofit hospitals do provide more uncompensated care than for-profit hospitals. Similarities between nonprofit and for-profit hospitals may exist because nonprofits may set norms that for-profits follow to some degree. States have substantial power and discretion in overseeing nonprofit conversions. Some have regularized oversight through new legislation that constrains, but does not eliminate, state officials' discretion. These statutes may be deferential to converting entities and their buyers or may be very restrictive of them. CONCLUSIONS: Overseeing the appropriate disposition of nonprofit assets in individual conversions is extremely important. States should also monitor local market conditions through community benefits assessments and other data collection, however, to accurately assess (and possibly redress) what is lost or gained from conversion. Local market conditions are likely more important in determining hospital behavior than ownership form. Potentially, a mix of for-profit and nonprofit hospitals in a given market may improve market performance due to constraints the two ownership types may exercise over one another. If nonprofits disappear, the states may need to maintain quality and access norms through regulation.

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

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

Sports in School: Source of Amity or Antipathy?

Abstract: Objectives. Previous research looks at the impact of school sports on participants’ delinquency, but not at the impact on delinquency in schools; further, it does not control for school size or for unobserved school-level variables. This research fills that gap. It uses social capital theory to frame the impact of sports programs on both participants and nonparticipants. Social capital theory predicts that group cohesion will increase cooperative, pro-social behavior among those in the group; however, it can also increase uncooperative, antisocial behavior among those not in the group—particularly when in-group membership is seen as desirable. Social capital theory also predicts that larger schools will have more disturbances, but subgroups in large schools will reduce these adverse effects. Methods. The hypotheses were tested by looking at the relation between disturbances and interscholastic sports programs in Montgomery County, Maryland high schools. Using three years of data on each high school in the county, the study regresses disturbances on sports participation, holding constant demographic variables, school size, and a dummy variable for each school. Results. Larger schools have more disturbances, but bigger interscholastic sports programs mitigate these effects. Conclusions. The policy implications suggest that to foster cooperative behavior in high schools, it might be wise to limit school size, or to foster participation in varsity sports as school size increases.