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.

Assessing Potential Enrollment and Budgetary Effects of SCHIP Premiums: Findings from Arizona and Kentucky

Abstract: Objective. To assess whether new premiums in SCHIP affect rates of disenrollment and reenrollment in SCHIP and whether they have spillover enrollment effects on Medicaid. Data Source. We used SCHIP administrative enrollment data from Arizona and Kentucky. The enrollment data covered July 2001 to December 2005 in Arizona and November 2001 to August 2004 in Kentucky. Study Design. We used administrative data from two states, Arizona and Kentucky, which introduced new premiums for certain income categories in their SCHIP programs in 2004 and 2003, respectively. We used multivariate hazard models to study rates of disenrollment and re-enrollment for the recipients who had been enrolled in the categories of SCHIP in which the new premiums were implemented. Competing hazard models were used to determine if recipients leaving SCHIP following the introduction of the premium were obtaining other public coverage or exiting public insurance entirely at higher rates. We also used time-series models to measure the effect of premiums on changes in caseloads in premium-paying SCHIP and other categories of public coverage and we assessed the budgetary implications of imposing premiums. Principal Findings. In both states, the new premiums increased the rate of disenrollment and decreased the rate of re-enrollment in premium-paying SCHIP among the children who were enrolled in those categories before the premiums were implemented. The competing hazard models indicated that almost all of the increased disenrollment is caused by recipients leaving public insurance entirely. The time-series models indicated that the new premium reduced caseloads in premium-paying SCHIP, but that it might have increased caseloads for other types of public coverage. The amount of premiums collected net of the costs associated with administering premiums is small in both states. Estimating the full budgetary effects with certainty was not possible given the imprecision of the key time-series estimates. Conclusion. These results suggest that the new premium reduced enrollment in the premium-paying group by 18 percent (over 3,000 children) in Kentucky and by 5 percent (over 1,000 children) in Arizona, with some of these children apparently leaving public coverage altogether. While most children enrolled in these categories did not appear to be directly affected by the imposition of $10–$20 monthly premiums, the premiums may have caused some children to go without health insurance coverage, which in turn could have adverse effects on their access to care. Imposing nominal premiums may reduce state spending, but projected savings appear to be small relative to total state SCHIP spending and resulting increases in enrollment in other public programs and in uninsurance rates could offset those savings.

The 'New' Globalization of Engineering: How the Offshoring of Advanced Engineering Affects Competitiveness and Development

Abstract: Changes in the strategies of multinationals and in the global distribution and movement of technologists have accelerated a “new” globalization of engineering. Field studies with our colleagues in China, Germany, India, Japan, Mexico, South Korea, the UK, and the U.S., lead us to consider in this paper aspects of the recent offshoring of advanced engineering to emerging economies. We examine the potential consequences for multinationals and their home countries of the new globalization of engineering, many of which are unintended, suggesting the need for greater attention by managers, government policymakers and scholars. A generation ago the typical multinational (MNE) was vertically integrated and hierarchically organized. Key functions were headquartered in one of the triad economies of the U.S., Japan or Europe. In the case of technology development, for example, more basic R&D work might be conducted by central research laboratories, with more applied work done at triad production facilities. Some engineering activities were conducted in emerging economies, but these had little to do with the core engineering programs of the firm. At a Whirlpool facility in India, for example, washing machines were redesigned to keep out rats, to survive shipment on bad roads, and to cope with power ebbs and surges in electrical current (WSJ, June 12, 2004). At an automobile plant in an emerging economy, we found, as part of

An Assessment of Evaluation Designs Case Studies of 12 Large Federal Evaluations

Abstract: This article provides a critical review of the quality of 12 recent large federal program evaluations. The review focused on elements of the evaluation design, inclusion of evaluation expertise amo...

The relationship between automatic enrollment and DC plan contributions: evidence from a national survey of older workers

Abstract: Automatic enrollment has been widely embraced for raising employee participation in 401(k) plans. However, the empirical evidence is based on data with limitations that, up until now, have prevented researchers from extrapolating the effects of automatic enrollment to the broader population of workers. This paper reexamines the determinants of 401(k) participation and contributions in the presence of automatic enrollment using nationally representative data from the Health and Retirement Study (HRS) for 2006 through 2012. The results confirm previous findings that automatic enrollment is associated with a higher proportion of workers included in DC plans; however, automatically enrolled workers are less likely to contribute to their DC plans than voluntarily enrolled workers. Auto enrollment is also associated with lower employee contribution amounts and rates. However, the employers of auto-enrolled workers are more likely to contribute to their employees’ accounts than are the employers of voluntarily enrolled workers. Additionally, employer contribution amounts and rates are higher among workers who are automatically enrolled. Even so, the combined effect is that the retirement accounts of automatically enrolled older workers receive, on average, $900 less in combined annual contributions and have contribution rates that are 1.6 percentage points lower than those of voluntarily enrolled workers.The paper found that: Automatic enrollment is associated with a higher probability of being included in a DC plan. On average, workers who are automatically enrolled in a DC plan tend to be less likely to contribute positive amounts than those who opt in. However, the employers of automatically enrolled workers are more likely to make contributions and to contribute, on average, higher amounts and a higher percentage of their employees’ earnings. The correlation between automatic enrollment and combined (employer and employee) contribution amounts and contribution rates, however, is still negative, despite controlling for a range of factors. The policy implications of the findings are: Auto enrollment could do a better job of boosting overall contribution levels among participants. Possible ways to achieve this might be by offering a more generous employer match and by using auto escalation. More research and better data are needed to assess the potential impact on retirement plan contributions of implementing automatic enrollment features in DC plans on a national scale.

Men at family planning clinics: the new patients?

Abstract: Using a survey of family planning clinics in the continental United States that received Title X funding conducted by The Urban Institute in 1993 those clinics were identified that had made substantial efforts to serve male clients The final sample size was 567 clinics 10% of their clients were men and 31% reported that their male clientele had increased in the previous 5 years During January through March 1995 follow-up telephone interviews were conducted with 25 selected clinics that reported a 10% male share of clients The clinics were classified into 5 types: 1) 7 clinics with a family planning focus beginning to provide primary care to attract more men; 2) 7 clinics with a family planning focus using community outreach and the partners of female clients to recruit men for clinic services; 3) 6 primary health care clinics beginning to place more emphasis on male reproductive health; 4) 3 hospital-based clinics providing comprehensive and reproductive health care for young men; and 5) 2 school-based clinics providing sports physicals primary health care and reproductive health services In Type 1 clinics males made up 10-40% of clients They also screened for testicular cancer and provided infertility mental health and nutrition counseling services Type 2 clinics had an average of 10% male clients and offered male infertility services nutrition counseling and specific STD and HIV services for males in the Hispanic and immigrant communities Type 3 clinics promoted the male role in family planning decision making and STD prevention A substantial proportion of the clientele was low-income males but men who came for vasectomies tended to have higher incomes Type 4 clinics catered to 20-40% male clients with outreach programs for gay minority men and sessions on stopping domestic violence male role in family planning and responsible parenthood Type 5 clinics had 40-45% males and provided mental health counseling HIV risk assessment and screening for testicular cancer