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.

Do Teachers' Race, Gender, and Ethnicity Matter?: Evidence from Nels88

Abstract: Our study uses a unique national longitudinal survey, the National Educational Longitudinal Study of 1988 (NELS), which permits researchers to match individual students and teachers, to analyze issues relating to how a teacher's race, gender, and ethnicity, per se, influence students from both the same and different race, gender, and ethnic groups. In contrast to much of the previous literature, we focus both on how teachers subjectively relate to and evaluate their students and on objectively how much their students learn. On balance, we find that teachers' race, gender, and ethnicity, per se, are much more likely to influence teachers' subjective evaluations of their students than they are to influence how much the students objectively learn. For example, while white female teachers do not appear to be associated with larger increases in test scores for white female students in mathematics and science than white male teachers 'produce', white female teachers do have higher subjective evaluations than their white male counterparts of their white female students. We relate our findings to the more general literature on gender, race, and ethnic bias in subjective performance evaluations in the world of work and trace their implications for educational and labor markets.

Which children are still uninsured and why.

Abstract: Summary A strong economy and increased enrollment in employer-sponsored health insurance coverage, together with expansions in Medicaid and State Children's Health Insurance Program (SCHIP) led to reductions in uninsurance among low-income American children between 1998 and 2000 (from 15.6% to 13.3%). Nonetheless, 12% (about 9 million) of children remained uninsured. Identifying these children and understanding the factors that contribute to their continued lack of health coverage is key to providing them access to health care. Using 1994, 1998, and 2000 census data, this article analyzes recent trends in children's health coverage, as well as the groups that make up the population of uninsured children. The picture that emerges from these analyses is one of tremendous variation in coverage for different groups of children, with some groups having a higher risk for lacking health insurance. For example, poor children, Hispanics, adolescents, and children with foreign-born parents (particularly those whose parents are not U.S. citizens) are overrepresented among the uninsured. The authors conclude that the strong economy and concomitant increase in employer-based coverage played a bigger part in reducing uninsurance rates than did expansions in public programs. They also argue that lack of participation by eligible children rather than inadequate eligibility levels is the key policy issue, and conclude with several recommendations to increase program participation. The late 1990s saw an unprecedented federal and state commitment to reducing uninsurance among children, which culminated in 1997 with the enactment of the State Children's Health Insurance Program (SCHIP). The period also wimessed an unparalleled economic boom. Even so, 9.2 million children--12% of all children nationwide--were uninsured in 2000. (1) Given the adverse consequences of going without insurance (2-4)--such as a lower likelihood of having a usual source of care, greater unmet health and dental needs, lower receipt of preventive services, and higher rates of avoidable hospitalizations (see the article by Hughes and Ng in this journal issue)--the lack of insurance coverage for children is a serious problem in this country. This article sheds light on why so many children remain uninsured in spite of Medicaid and SCHIP programs, which could cover 65% to 75% of all uninsured children, and a period of great economic prosperity. (5) It begins with an analysis of recent trends in children's health insurance coverage, (6) and an analysis of the population of uninsured children. These analyses suggest that specific groups of children will need to be targeted if major inroads are to be made in reducing uninsurance among children. The article closes by discussing the major policy changes needed to increase the participation of currently unenrolled children. Recent Trends in Children's Health Insurance Coverage Children's insurance coverage is influenced by a host of factors, including access to public and private coverage, and the sociodemographic characteristics of children and their families. (7-9) The 1990s were characterized by a number of shifts in these underlying factors that combined to produce a decline in the rate of uninsurance among children, from 14.5% in 1994 to 13.3% in 2000. (10) The primary factor in this decfine, however, was the large increase in employer-sponsored insurance (ESI) coverage of children, not expanded access to public insurance programs. Moreover, the decline would have been even greater if not for two important demographic changes: growth in the share of children who are Hispanic or "other" race/ethnicity, and growth in the percentage of children age six and older. Because these groups have higher rates of uninsurance, as the number of children in them increased, more children were at risk of not being covered. Shifts in Reliance on Public and Private Coverage Between 1994 and 2000, ESI coverage of children expanded from 60. …

Beyond Measurement and Reward: Methods of Motivating Quality Improvement and Accountability

Abstract: Objective The article examines public policies designed to improve quality and accountability that do not rely on financial incentives and public reporting of provider performance. Principal Findings Payment policy should help temper the current “more is better” attitude of physicians and provider organizations. Incentive neutrality would better support health professionals’ intrinsic motivation to act in their patients’ best interests to improve overall quality than would pay-for-performance plans targeted to specific areas of clinical care. Public policy can support clinicians’ intrinsic motivation through approaches that support systematic feedback to clinicians and provide concrete opportunities to collaborate to improve care. Some programs administered by the Centers for Medicare & Medicaid Services, including Partnership for Patients and Conditions of Participation, deserve more attention; they represent available, but largely ignored, approaches to support providers to improve quality and protect beneficiaries against substandard care. Conclusions Public policies related to quality improvement should focus more on methods of enhancing professional intrinsic motivation, while recognizing the potential role of organizations to actively promote and facilitate that motivation. Actually achieving improvement, however, will require a reexamination of the role played by financial incentives embedded in payments and the unrealistic expectations placed on marginal incentives in pay-for-performance schemes.

Variations in Medicaid Mental Health Service Use and Cost for Children

Abstract: Mental health care is a critical component of Medicaid for children. This study used summary tables drawn from the 1999 Medicaid Analytic Extract (MAX) files, the first available Medicaid data for the entire US, to examine fee-for-service Medicaid in 23 selected states. Data show that 9% of children and youth (ages 0–21) had a mental health-related diagnosis on a claim, varying from 5% to 17% across the states. The proportion increased with age, and was higher for boys. Over half of those diagnosed received psychotropic medication, and approximately 7% had an inpatient psychiatric admission during the year. Mental health costs accounted for 26.5% of total fee-for-service Medicaid expenditures, varying from 14% to 61% depending on the state.

Understanding The Recent Growth In Medicaid Spending, 2000–2003

Abstract: Growth in Medicaid spending averaged 10.2 percent per year between 2000 and 2003, resulting in a one-third increase in program spending. Spending growth was lower from 2002 to 2003 becaus...