Higher income is associated with changes in long-term care utilization patterns among the elderly. Using a "benefits notch" in Social Security income as an instrumental variable, the study finds that a $1,000 increase in annual household income:
1) Decreases the likelihood of nursing home use by 2.9 percentage points;
2) Increases the likelihood of paid home care use by 2.3 percentage points; and
3) Has no significant effect on informal unpaid care.
The findings suggest higher income leads to substitution away from nursing home care towards paid home care utilization.
The document summarizes key data from the Bureau of Labor Statistics report on the August 2014 employment situation in the U.S. It notes that 142,000 nonfarm payroll jobs were added in August and the unemployment rate declined slightly to 6.1%. Several industries such as professional and business services and healthcare added jobs, while retail saw a decrease. The report also provides breakdowns of employment data by region.
April's welfare changes: the cumulative effects and the questions they raiseNewPolicyInstitute
The document summarizes the cumulative effects of four welfare changes introduced in April: the replacement of Council Tax Benefit with locally designed Council Tax Support schemes, the under-occupation penalty (bedroom tax), the household benefit cap, and the 1% uprating restriction on working-age benefits. It finds that over 2.4 million people will be negatively affected by changes to Council Tax Support alone, with average weekly losses of £2.60. Combined impacts are estimated to total £4.40 per week on average for those affected by multiple changes. The document raises questions about whether the goals of some reforms are primarily to cut spending rather than achieve social aims, and the risks of a centrally driven "localism" approach that
This document summarizes Senator Don Harmon's presentation to the Business and Civic Council of Oak Park on June 26, 2015. It discusses the state of Illinois' budget process and challenges, including Governor Rauner's proposed budget cuts and the resulting impacts. It also outlines Democratic proposals for alternative budget and reforms, including investing in education, human services, and a middle class agenda. Potential areas of compromise are identified. Background on pension reforms and Illinois' economic strengths are also provided.
Tom Stinson, MN State Economist and Tom Gillaspy, MN State Demographer, delivered a powerful presentation at a Minnesota High Tech Association CEO Briefing last summer.
This document summarizes Illinois' fiscal situation and recent budget debates. It notes that while the FY2013 budget was based on one-time revenues, the FY2014 budget maintains the same spending levels. It expresses concerns that this does not prepare for lower revenues in FY2015. The document also discusses Illinois' massive pension debt and underfunding, as well as the state's poor economic growth and job losses compared to other states. It advocates pension reform and policies to promote business growth and job creation in order to improve Illinois' fiscal health.
This document summarizes Illinois' fiscal situation and recent budget debates. It notes that while the FY2013 budget was based on one-time revenues, the FY2014 budget maintains the same spending levels. It expresses concerns that this does not prepare for lower revenues in FY2015. The document also discusses Illinois' massive pension debt and underfunding, as well as the state's poor economic growth and job losses compared to other states. It advocates pension reform and policies to promote business growth and job creation in order to address Illinois' fiscal challenges.
- The US economy added 288,000 new jobs in June 2014, with unemployment declining to 6.1%. This marks the fifth straight month of over 200,000 jobs added and over 1 million jobs added so far in 2014.
- Unemployment declined by 1.4% over the past year while the number of unemployed and long-term unemployed also declined.
- Major job gains occurred in professional and business services, healthcare, leisure and hospitality, and retail trade.
The document summarizes a town hall meeting held by State Senator Don Harmon and Representative Camille Lilly on June 9th. It discusses the state budget timeline and process, Governor Rauner's proposed budget cuts to areas like local governments, public transit, universities, and human services. It also outlines the budget gap due to cuts requiring legal changes, and compares funding levels under the current budget, Governor's proposal, and Democratic proposal. The document urges investing in areas like education, human services, and a higher minimum wage to help the middle class. Contact information is provided at the end.
The document summarizes key data from the Bureau of Labor Statistics report on the August 2014 employment situation in the U.S. It notes that 142,000 nonfarm payroll jobs were added in August and the unemployment rate declined slightly to 6.1%. Several industries such as professional and business services and healthcare added jobs, while retail saw a decrease. The report also provides breakdowns of employment data by region.
April's welfare changes: the cumulative effects and the questions they raiseNewPolicyInstitute
The document summarizes the cumulative effects of four welfare changes introduced in April: the replacement of Council Tax Benefit with locally designed Council Tax Support schemes, the under-occupation penalty (bedroom tax), the household benefit cap, and the 1% uprating restriction on working-age benefits. It finds that over 2.4 million people will be negatively affected by changes to Council Tax Support alone, with average weekly losses of £2.60. Combined impacts are estimated to total £4.40 per week on average for those affected by multiple changes. The document raises questions about whether the goals of some reforms are primarily to cut spending rather than achieve social aims, and the risks of a centrally driven "localism" approach that
This document summarizes Senator Don Harmon's presentation to the Business and Civic Council of Oak Park on June 26, 2015. It discusses the state of Illinois' budget process and challenges, including Governor Rauner's proposed budget cuts and the resulting impacts. It also outlines Democratic proposals for alternative budget and reforms, including investing in education, human services, and a middle class agenda. Potential areas of compromise are identified. Background on pension reforms and Illinois' economic strengths are also provided.
Tom Stinson, MN State Economist and Tom Gillaspy, MN State Demographer, delivered a powerful presentation at a Minnesota High Tech Association CEO Briefing last summer.
This document summarizes Illinois' fiscal situation and recent budget debates. It notes that while the FY2013 budget was based on one-time revenues, the FY2014 budget maintains the same spending levels. It expresses concerns that this does not prepare for lower revenues in FY2015. The document also discusses Illinois' massive pension debt and underfunding, as well as the state's poor economic growth and job losses compared to other states. It advocates pension reform and policies to promote business growth and job creation in order to improve Illinois' fiscal health.
This document summarizes Illinois' fiscal situation and recent budget debates. It notes that while the FY2013 budget was based on one-time revenues, the FY2014 budget maintains the same spending levels. It expresses concerns that this does not prepare for lower revenues in FY2015. The document also discusses Illinois' massive pension debt and underfunding, as well as the state's poor economic growth and job losses compared to other states. It advocates pension reform and policies to promote business growth and job creation in order to address Illinois' fiscal challenges.
- The US economy added 288,000 new jobs in June 2014, with unemployment declining to 6.1%. This marks the fifth straight month of over 200,000 jobs added and over 1 million jobs added so far in 2014.
- Unemployment declined by 1.4% over the past year while the number of unemployed and long-term unemployed also declined.
- Major job gains occurred in professional and business services, healthcare, leisure and hospitality, and retail trade.
The document summarizes a town hall meeting held by State Senator Don Harmon and Representative Camille Lilly on June 9th. It discusses the state budget timeline and process, Governor Rauner's proposed budget cuts to areas like local governments, public transit, universities, and human services. It also outlines the budget gap due to cuts requiring legal changes, and compares funding levels under the current budget, Governor's proposal, and Democratic proposal. The document urges investing in areas like education, human services, and a higher minimum wage to help the middle class. Contact information is provided at the end.
This document outlines a research project on food access in Philadelphia. The project will use historical ethnography and qualitative methods to examine: (1) the historical transformation of Philadelphia's fresh produce markets; (2) the morality of food production and distribution; and (3) efforts to reconnect farms and cities through alternative markets. Specific research questions focus on the types of markets historically created for produce and changes in grocery stores over time. Newspaper archives will be analyzed to understand cultural representations of concepts like "farmer's markets" and "fresh food." Preliminary results found an increase in newspaper articles about farmer's markets over time and that their stories were part of narratives around industrialization and urbanization. The research aims to better understand "food
This study aimed to understand prostate cancer patients' attitudes toward out-of-pocket healthcare costs. Semi-structured interviews were conducted with 34 prostate cancer patients. The majority had health insurance and did not feel burdened by costs. However, 3 patients with less education and income reported financial difficulties. Most patients felt that health was more important than cost and their treatment choice was not affected by prices. However, patients without insurance may feel differently. The study provides insight into patients' perspectives on healthcare costs.
This document discusses health care reform and the 2008 election. It summarizes the health reform plans of Obama and McCain, noting their strengths and weaknesses. It outlines the political challenges to enacting reform and lessons that should be learned from past failures. While the problems are worse and some see signs of bipartisanship, major reforms have been proposed but not enacted before. Enacting comprehensive reform will be difficult despite Democratic congressional majorities.
This document summarizes a study on how endogenous cost-effectiveness analysis impacts health care technology adoption. It finds that when prices are set based on cost-effectiveness thresholds, rather than costs alone, it can lead technologies with higher costs but more demand to be adopted over those with lower costs. This is because demand allows prices and markups to exceed costs. The study uses data from the National Institute for Health and Clinical Excellence in the UK from 1999-2005 to show some evidence of reversals in adoption decisions compared to what cost-effectiveness alone would predict. It concludes more research is needed to fully understand the impact of endogenous cost-effectiveness on technology adoption decisions.
This document discusses how personalized medicine could help save the healthcare system by tailoring treatment to individuals based on their underlying risk profiles. It provides examples from studies showing how risk stratification can lead to more efficient and effective care by targeting high-risk groups and avoiding overtreatment of low-risk groups. The document argues current guidelines often define optimal care based on average results from clinical trials without considering individual risk factors and patient preferences.
- The document summarizes Brian Elbel's research on the influence of calorie labeling on fast food purchases in New York City and Newark.
- A field study found that calorie labeling in NYC did not significantly change the number of calories purchased by adults or children. About a quarter of adults noticed the labels but there was no difference in calories purchased.
- Knowledge of recommended daily calorie amounts was low both before and after labeling. The study suggests that calorie labeling may have limited influence if consumers are unaware of recommended calorie guidelines.
Workshop E Marta Szebehely Work Care Reconciliation in the Nordic CountriesCare Connect
Presentations by Prof Marta Szebehely, Professor of Social Work, Stockholm University, Sweden and
Dr Outi Jolanki, Postdoctoral Research Fellow, University of Jyväskylä, Finland
Carers and Work-Care Reconciliation International Conference
University of Leeds, 13th August 2013
Impact Evaluation of Savings and Internal Lending Communities: Data Collector...valentinejg
Data collector's training held in Lusaka Zambia for Savings and Internal Lending Communities (SILC) Evaluation conducted by Futures Group. The study is part of Implementation Science Investment study funded by USAID.
This document summarizes a presentation about strengthening systems to address social determinants of health in eastern Washington. It discusses how social and economic factors like housing, education and income influence health more than healthcare alone. Only 10% of health is due to access and quality of care, while 60% is influenced by social and environmental factors. The presentation outlines challenges in the region related to affordable housing, rural health disparities, and a growing Medicaid population. It proposes taking a systems approach to integrate housing, healthcare and other social services using community health workers and Medicaid reinvestment.
View the slides from our webinar: 2018: A policy review of the year. We were joined by guest speakers Deven Ghelani and Paul Howarth, Policy in Practice.
We reviewed the social policy analysis we delivered for clients in 2018 and recapped on key findings we uncovered. We also discussed what this means for local organisations in 2019.
Find out what we learnt about:
Homelessness and housing
Changing living standards of low income households
Universal Credit's impact on people
Universal Credit's impact on frontline organisations
For more information please visit www.policyinpractice.co.uk, call 0330 088 9242 or email hello@policyinpractice.co.uk.
Plenary session 3 3 tim smeeding stik iariwIARIW 2014
The document summarizes two papers presented at a conference on measuring inequality accounting for social transfers in kind. The first paper from Italy develops a new method for valuing national health services and incorporates adjustments for demographics and regional differences. This raises the estimated value of health subsidies for the poor. The second paper applies the US Supplemental Poverty Measure methodology to compare poverty in the US and Australia, finding that medical out-of-pocket expenses significantly impact poverty rates when accounted for as a resource. The paragraph asks whether thresholds used to measure poverty should also account for in-kind benefits included as resources to have a fully consistent measure of resources versus needs.
Public service and demographic change: an ILC-UK/Actuarial Profession joint d...ILC- UK
Full details of the event are available here: http://www.ilcuk.org.uk/index.php/events/ilc_uk_and_the_actuarial_profession_debate_public_service_and_demographic_c
The live blog for this event is available here: http://blog.ilcuk.org.uk/2013/04/23/live-blog-public-service-and-demographic-change/
Long term care provides support services for those who need assistance with daily living over an extended period of time, often older adults. Services include skilled nursing facilities, assisted living, home care, hospice, respite care, and adult day care. As the population ages, demand for long term care is increasing while availability of informal family caregivers is decreasing. The future will require diversifying and expanding long term care services to meet a wide range of needs within the community-based settings preferred by most.
The 2008 Chilean pension reform aimed to increase coverage of the pension system. Key measures included creating a new solidarity pillar with a basic pension and supplement, mandating contributions from self-employed workers, and providing subsidies for young workers' early contributions and voluntary savings. Initial results showed positive trends in contributory coverage and uptake of the new solidarity benefits. Fiscal costs of 0.4-0.5% of GDP were in line with estimates, and projected to reach 1% of GDP by 2025 primarily due to the new solidarity pillar. The reform took an integrated approach to address high mobility in and out of formal employment and gender inequities in the defined contribution system.
Providing Support To Employers And Working Caregivers 6 14 2010 2Elderplanner
Our “Elder Life Planning for Organizations” program allows non-profit and small eldercare enterprises
to offer a comprehensive eldercare program to employers, banks, membership organizations and faith based communities without the significant capital outlay that would otherwise be required.
This document provides an overview of 11 grant programs that received funding from the Potomac Health Foundation's Large Grant Program in 2017-2018. Each grant summary includes the target population, planned activities, expected outcomes, and opportunities for partnership or questions for the foundation. The grants focus on issues like comprehensive case management, childhood obesity treatment, mental health services for families, electronic health records, and medication access.
The document discusses health financing issues in post-conflict settings based on a research program called ReBuild. It finds that most post-conflict countries rely more on informal payments and donor funding for health care. A Sierra Leone study found the Free Health Care Initiative increased some maternal health services, especially in rural areas, but the impact was disappointing due to continued costs and medicine shortages. A Uganda study found no significant changes in self-reported health or health care use after displaced people returned home, but saw increased food expenditures. Overall the literature on post-conflict health financing is limited due to varied contexts and data availability.
This document defines different categories of older adulthood and discusses issues pertaining to aging populations. It notes that the percentage of Canadians over age 65 has been increasing and is projected to reach 18.9% by 2021 due to longer life expectancies and lower birth rates. The document also discusses health problems that are more common in older adults such as mobility issues, vision problems, and memory loss. Additionally, it examines the needs of older adults for care at home or in long-term care facilities, caregiver stress, and rights of older adults in institutional settings. Income sources for older Canadians such as Old Age Security, Canada Pension Plan and Guaranteed Income Supplement are also outlined. Vulnerable groups facing higher risks of poverty
De Pere Area Chamber Affordable Care Act Presentation, Daren Allen, Common Gr...Cheryl Detrick
Presentation on the Affordable Care Act given by Daren Allen, Vice President of Sales & Business Development for the Common Ground Healthcare Cooperative to De Pere Area Chamber of Commerce on 9/11/13.
This document outlines a research project on food access in Philadelphia. The project will use historical ethnography and qualitative methods to examine: (1) the historical transformation of Philadelphia's fresh produce markets; (2) the morality of food production and distribution; and (3) efforts to reconnect farms and cities through alternative markets. Specific research questions focus on the types of markets historically created for produce and changes in grocery stores over time. Newspaper archives will be analyzed to understand cultural representations of concepts like "farmer's markets" and "fresh food." Preliminary results found an increase in newspaper articles about farmer's markets over time and that their stories were part of narratives around industrialization and urbanization. The research aims to better understand "food
This study aimed to understand prostate cancer patients' attitudes toward out-of-pocket healthcare costs. Semi-structured interviews were conducted with 34 prostate cancer patients. The majority had health insurance and did not feel burdened by costs. However, 3 patients with less education and income reported financial difficulties. Most patients felt that health was more important than cost and their treatment choice was not affected by prices. However, patients without insurance may feel differently. The study provides insight into patients' perspectives on healthcare costs.
This document discusses health care reform and the 2008 election. It summarizes the health reform plans of Obama and McCain, noting their strengths and weaknesses. It outlines the political challenges to enacting reform and lessons that should be learned from past failures. While the problems are worse and some see signs of bipartisanship, major reforms have been proposed but not enacted before. Enacting comprehensive reform will be difficult despite Democratic congressional majorities.
This document summarizes a study on how endogenous cost-effectiveness analysis impacts health care technology adoption. It finds that when prices are set based on cost-effectiveness thresholds, rather than costs alone, it can lead technologies with higher costs but more demand to be adopted over those with lower costs. This is because demand allows prices and markups to exceed costs. The study uses data from the National Institute for Health and Clinical Excellence in the UK from 1999-2005 to show some evidence of reversals in adoption decisions compared to what cost-effectiveness alone would predict. It concludes more research is needed to fully understand the impact of endogenous cost-effectiveness on technology adoption decisions.
This document discusses how personalized medicine could help save the healthcare system by tailoring treatment to individuals based on their underlying risk profiles. It provides examples from studies showing how risk stratification can lead to more efficient and effective care by targeting high-risk groups and avoiding overtreatment of low-risk groups. The document argues current guidelines often define optimal care based on average results from clinical trials without considering individual risk factors and patient preferences.
- The document summarizes Brian Elbel's research on the influence of calorie labeling on fast food purchases in New York City and Newark.
- A field study found that calorie labeling in NYC did not significantly change the number of calories purchased by adults or children. About a quarter of adults noticed the labels but there was no difference in calories purchased.
- Knowledge of recommended daily calorie amounts was low both before and after labeling. The study suggests that calorie labeling may have limited influence if consumers are unaware of recommended calorie guidelines.
Workshop E Marta Szebehely Work Care Reconciliation in the Nordic CountriesCare Connect
Presentations by Prof Marta Szebehely, Professor of Social Work, Stockholm University, Sweden and
Dr Outi Jolanki, Postdoctoral Research Fellow, University of Jyväskylä, Finland
Carers and Work-Care Reconciliation International Conference
University of Leeds, 13th August 2013
Impact Evaluation of Savings and Internal Lending Communities: Data Collector...valentinejg
Data collector's training held in Lusaka Zambia for Savings and Internal Lending Communities (SILC) Evaluation conducted by Futures Group. The study is part of Implementation Science Investment study funded by USAID.
This document summarizes a presentation about strengthening systems to address social determinants of health in eastern Washington. It discusses how social and economic factors like housing, education and income influence health more than healthcare alone. Only 10% of health is due to access and quality of care, while 60% is influenced by social and environmental factors. The presentation outlines challenges in the region related to affordable housing, rural health disparities, and a growing Medicaid population. It proposes taking a systems approach to integrate housing, healthcare and other social services using community health workers and Medicaid reinvestment.
View the slides from our webinar: 2018: A policy review of the year. We were joined by guest speakers Deven Ghelani and Paul Howarth, Policy in Practice.
We reviewed the social policy analysis we delivered for clients in 2018 and recapped on key findings we uncovered. We also discussed what this means for local organisations in 2019.
Find out what we learnt about:
Homelessness and housing
Changing living standards of low income households
Universal Credit's impact on people
Universal Credit's impact on frontline organisations
For more information please visit www.policyinpractice.co.uk, call 0330 088 9242 or email hello@policyinpractice.co.uk.
Plenary session 3 3 tim smeeding stik iariwIARIW 2014
The document summarizes two papers presented at a conference on measuring inequality accounting for social transfers in kind. The first paper from Italy develops a new method for valuing national health services and incorporates adjustments for demographics and regional differences. This raises the estimated value of health subsidies for the poor. The second paper applies the US Supplemental Poverty Measure methodology to compare poverty in the US and Australia, finding that medical out-of-pocket expenses significantly impact poverty rates when accounted for as a resource. The paragraph asks whether thresholds used to measure poverty should also account for in-kind benefits included as resources to have a fully consistent measure of resources versus needs.
Public service and demographic change: an ILC-UK/Actuarial Profession joint d...ILC- UK
Full details of the event are available here: http://www.ilcuk.org.uk/index.php/events/ilc_uk_and_the_actuarial_profession_debate_public_service_and_demographic_c
The live blog for this event is available here: http://blog.ilcuk.org.uk/2013/04/23/live-blog-public-service-and-demographic-change/
Long term care provides support services for those who need assistance with daily living over an extended period of time, often older adults. Services include skilled nursing facilities, assisted living, home care, hospice, respite care, and adult day care. As the population ages, demand for long term care is increasing while availability of informal family caregivers is decreasing. The future will require diversifying and expanding long term care services to meet a wide range of needs within the community-based settings preferred by most.
The 2008 Chilean pension reform aimed to increase coverage of the pension system. Key measures included creating a new solidarity pillar with a basic pension and supplement, mandating contributions from self-employed workers, and providing subsidies for young workers' early contributions and voluntary savings. Initial results showed positive trends in contributory coverage and uptake of the new solidarity benefits. Fiscal costs of 0.4-0.5% of GDP were in line with estimates, and projected to reach 1% of GDP by 2025 primarily due to the new solidarity pillar. The reform took an integrated approach to address high mobility in and out of formal employment and gender inequities in the defined contribution system.
Providing Support To Employers And Working Caregivers 6 14 2010 2Elderplanner
Our “Elder Life Planning for Organizations” program allows non-profit and small eldercare enterprises
to offer a comprehensive eldercare program to employers, banks, membership organizations and faith based communities without the significant capital outlay that would otherwise be required.
This document provides an overview of 11 grant programs that received funding from the Potomac Health Foundation's Large Grant Program in 2017-2018. Each grant summary includes the target population, planned activities, expected outcomes, and opportunities for partnership or questions for the foundation. The grants focus on issues like comprehensive case management, childhood obesity treatment, mental health services for families, electronic health records, and medication access.
The document discusses health financing issues in post-conflict settings based on a research program called ReBuild. It finds that most post-conflict countries rely more on informal payments and donor funding for health care. A Sierra Leone study found the Free Health Care Initiative increased some maternal health services, especially in rural areas, but the impact was disappointing due to continued costs and medicine shortages. A Uganda study found no significant changes in self-reported health or health care use after displaced people returned home, but saw increased food expenditures. Overall the literature on post-conflict health financing is limited due to varied contexts and data availability.
This document defines different categories of older adulthood and discusses issues pertaining to aging populations. It notes that the percentage of Canadians over age 65 has been increasing and is projected to reach 18.9% by 2021 due to longer life expectancies and lower birth rates. The document also discusses health problems that are more common in older adults such as mobility issues, vision problems, and memory loss. Additionally, it examines the needs of older adults for care at home or in long-term care facilities, caregiver stress, and rights of older adults in institutional settings. Income sources for older Canadians such as Old Age Security, Canada Pension Plan and Guaranteed Income Supplement are also outlined. Vulnerable groups facing higher risks of poverty
De Pere Area Chamber Affordable Care Act Presentation, Daren Allen, Common Gr...Cheryl Detrick
Presentation on the Affordable Care Act given by Daren Allen, Vice President of Sales & Business Development for the Common Ground Healthcare Cooperative to De Pere Area Chamber of Commerce on 9/11/13.
Elderly care conference 2017 - The state of social care: the commissioning la...Browne Jacobson LLP
Joy looks at 'what is social care in the 21st Century and why it is important?' including the current state of the social care market and taking a look at the future.
This document summarizes an audit of the Crisis Assessment and Home Treatment (CAHT) service in Sheffield, England. Some key findings include:
- CAHT provides 24/7 crisis assessment and home-based treatment as an alternative to hospitalization. The majority of referrals come from A&E departments.
- Over half of episodes (56.4%) were for patients receiving repeated treatment. No significant differences were found in repeat episodes based on ethnicity.
- The population served by CAHT has a higher proportion of individuals who are single, unemployed, and from Black and Ethnic Minority groups compared to Sheffield's general population.
- Significant differences were found in the ethnic distributions of patients across different
Developing Networks of Care through Long Term Conditions Year of Care Commissioning & Long Term Conditions Improvement Programmes
Bev Matthews
Programme Lead for Long Term Conditions @Bev_J_Matthews
Presentation from the Tackling Long Term Conditions conference on 29 October 2014
LTC Year of Care Commissioning Model
Lesley A Callow, Delivery Support Manager - Long Term Conditions Year of Care Commissioning Model
NHSIQ
Fionuala Bonnar, Year of Care Programme Manager
LTC Year of Care benefits:
Improved outcomes and wellbeing:
Patients receive care that is better managed, more seamless across different care services and more needs focused.
Reduction in acute admissions to hospital; and shorter lengths of stay when these are required.
Clinical professionals contribute to a more holistic service for patients by working within an integrated patient-centred care plan
Local health and Social Care economies:
Provide care that delivers value for money and is better managed by integrated teams.
Incentive to improve services for patients
Improved joint working and shared responsibility for outcomes
The document summarizes a study conducted in Dauphin, Manitoba, Canada in the 1970s that provided a guaranteed annual income to residents. Key findings included reductions in hospitalization rates and mental health visits compared to similar communities without the program. Interviews with participants suggest the income improved quality of life by allowing for basics and education. While more research is needed, proponents argue a guaranteed income empowers individuals and could reduce costs of other social programs.
This study analyzed insurance claims data from before and after the implementation of the Federal Mental Health Parity and Addiction Equity Act to examine the effects of parity on substance use disorder treatment. The results showed:
1) There was no change in the use of substance use disorder services or the total annual spending per enrollee on these services (which increased by only $10 per enrollee).
2) There was also no change in out-of-pocket spending for substance use disorder treatment users or several HEDIS quality measures related to identification and initiation of treatment.
3) This suggests that concerns about parity greatly increasing health care costs related to substance use disorder treatment were unfounded.
This study analyzed insurance claims data from before and after the implementation of the Federal Mental Health Parity and Addiction Equity Act to examine the effects of parity on substance use disorder treatment. The results showed:
1) There was no change in the use of substance use disorder services or the total annual spending per enrollee on these services (which increased by only $10 per enrollee).
2) There was also no change in out-of-pocket spending for substance use disorder treatment users or several HEDIS quality measures related to identification and initiation of treatment.
3) This suggests that concerns about parity greatly increasing health care costs related to substance use disorder treatment were unfounded.
This study compared retention rates, satisfaction, and safety between intimate partner violence (IPV) research participants paid via wireless gift cards versus cash. Participants receiving gift cards completed significantly more of the 12 weekly phone surveys (average 8.3 vs 6 calls). Over 90% of gift card recipients expressed satisfaction, and 60% preferred this method. While safety did not differ, wireless incentives may improve retention in repetitive IPV research that can involve remote data collection.
This study analyzed data from 658 insured pregnant women in a Midwestern county to compare risks and outcomes between those who did and did not utilize the emergency department (ED) during their peripartum period. The study found that 218 women (33%) visited the ED at least once during this time. ED users were more likely to experience psychosocial risks like postpartum depression and smoking, have poorer birth outcomes like prematurity, and have inadequate prenatal care. After adjusting for demographic factors, ED use was associated with a higher likelihood of postpartum depression, smoking during pregnancy, unstable housing, delayed prenatal care initiation, and missing a postpartum visit.
This study conducted a telephone survey of labor and delivery units at U.S. hospitals to determine the prevalence of hospital policies addressing non-medically indicated deliveries prior to 39 weeks gestation. They found that 66.5% of responding hospitals reported having such a policy. Hospitals in states with initiatives to reduce early deliveries were more likely to have a policy, with 67.8% of hospitals in initiative states reporting a policy compared to 62.1% in non-initiative states. The majority (68.8%) of policies were coded as having a "hard stop" against early deliveries. The study concludes that state initiatives can effectively encourage more hospitals to adopt restrictive policies on non-medically indicated early deliver
This study explored a broader range of adverse childhood experiences reported by low-income adults from Philadelphia compared to those measured in previous research. The researchers conducted focus groups with 119 participants who generated a list of childhood stressors across 10 domains. The most commonly reported experiences were issues within family relationships, community safety threats, personal victimization, and economic hardship. The study concludes that considering a wider range of adversities is important for understanding health impacts on low-income urban populations.
This document summarizes a mixed-methods study examining the relationship between mental health therapists' attitudes towards evidence-based practices (EBPs), perceptions of organizational factors, and degree status. The study found that doctoral-level therapists with positive attitudes reported more autonomy, while those with less positive attitudes reported requirements to use CBT and lack of time. Non-doctoral therapists reported lack of resources, space, funding, and regular client access as barriers. Managerial support was a facilitator for all therapists. The study provides insight into implementation challenges faced in community clinics from front-line perspectives.
This document proposes a model where doulas receive training in cognitive behavioral therapy (CBT) principles from staff at an integrated maternal wellness clinic. The objectives are to incorporate doulas into standard practice while providing training, and to utilize doulas to increase implementation of evidence-based CBT for common mental health issues in the perinatal period like anxiety and depression. Limitations include challenges of implementing a novel intervention and ensuring standardized training, protected staff time, and adherence to practice guidelines.
This study piloted a modified social skills intervention for children with ASD implemented by school personnel in public school settings. The intervention focused on facilitating peer engagement during lunch and recess. Results showed improvements in social network centrality and joint engagement for children who received the immediate treatment compared to those in the waitlist control. However, barriers like unclear staff roles, lack of support, and loss of recess time prevented long-term sustainability. Future work is needed to address school-level barriers to implementation and adapt interventions to fit individual school contexts.
This study examined the healthcare system supports for internists caring for young adult patients with chronic illnesses that began in pediatric care. Semi-structured interviews were conducted with 21 internists across 4 states. The interviews identified 5 major themes of healthcare system burdens experienced by internists, including difficulty identifying patients' medical teams, inadequate time for complex patients, significant administrative burden, lack of social/case management support, and financial constraints. The interviews also identified 3 potential strategies to improve supports, such as formalizing transfer processes, maximizing electronic records/communication, and leveraging patient-centered medical homes and bundled payments.
Most internists found more similarities than differences in caring for young adults with intellectual and developmental disabilities (I/DD) and elderly adults with dementia. Both populations require longer office visits and more staffing resources due to complex health histories. Obtaining records and coordinating care can be difficult for both. Reliance on advocates, community services for transportation and supervision, and vulnerability to insurance changes are also similarities. While specific diseases differ, models for geriatric care could potentially address supervision and caretaking needs for adults with I/DD. Strengthening safety net services would help low-income families and elderly patients with dementia or I/DD.
This study examines the association between patient perceptions of case manager performance and satisfaction with care, as well as the relationship between perceptions of case managers and primary care providers (PCPs) and subsequent healthcare utilization. The study analyzed survey and claims data from over 2,000 patients receiving primary care from a medical home model with embedded case managers. The results found that higher ratings of both case manager and PCP performance were independently associated with greater patient satisfaction. The study concludes by noting that perceptions of case management may impact health outcomes and behaviors, warranting further analysis of utilization patterns.
This document analyzes survey data from 2002-2010 on HIV testing rates and chronic disease screening in Southeastern Pennsylvania. It finds that HIV testing rates are lower than screening for other chronic diseases. Populations receiving care at community health clinics, emergency rooms, or with no primary care are more likely to get HIV testing than those at private clinics. While community health clinics perform similar to private clinics on chronic disease screening, those using emergency rooms or with no primary care are less likely to receive routine chronic disease screening. Primary care physicians adhere to guidelines for screening of conditions like blood pressure and cancer but may neglect appropriately screening for HIV.
This study analyzed survey data from 50,698 individuals in Southeastern Pennsylvania between 2002-2010 to compare HIV testing rates to other routine health screenings. It found that HIV testing rates were lower than for other conditions. Those receiving care at community health clinics, emergency rooms, or with no primary care had higher odds of receiving an HIV test compared to private clinics. While community health clinics performed similarly to private clinics on other screenings, emergency rooms and no primary care had lower rates. The study suggests primary care physicians may neglect appropriate HIV screening of patients despite adhering to other screening guidelines.
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1. Income and the Utilization of Long-Term Care
Services: Evidence from the Social Security
Benefit Notch
Gopi Shah Goda
Stanford University
Ezra Golberstein
Harvard Medical School
David C. Grabowski
Harvard Medical School
2. Talk Overview
Research Objective: Income → LTC Utilization
Overview
• Why this relationship is important
• Potential endogeneity issue
• Benefit “notch” as an instrument
• Data/Methods
• Results
• Implications
3. Projected Lifetime Need and Spending for
Long-Term Care, at Age 65
Source: Kemper P, Komisar HL, and Alecxih L. Dollar values present discounted values for individuals turning 65 in 2005.
None
None
1 year
or
less
Under
$10K
1-2
years
$10-
25K
2-5
years
$25-
100K
More
than
5
years
$100K+
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Duration of LTC Need Total LTC Spending
Bottom line: most people will need some LTC during their lives,
but there is wide variation in how extensive these needs will be.
4. Coverage for LTC
• No universal coverage for LTC
– Means-tested Medicaid
– Medicare covers post-acute rehabilitative care but not long-term
supportive services
• Few people purchase private insurance
– fewer than 10% of individuals 55+ have LTC insurance
Implications of coverage gap:
• Substantial role of care from family and friends
– at least equal in value to ALL formal spending
• Prominent role for out-of-pocket payments
• Medicaid as primary public payer (safety net) when private
resources are exhausted
5. LTC Settings/Providers
• Potential LTC providers include family and
friends, paid home care, assisted living and
nursing homes
• Individuals generally prefer services in least
restrictive setting possible, suggesting large
welfare effects as individuals transition across
settings
– Mattimore et al. (1997) found 30% of elderly survey
respondents would rather die than enter a nursing
home and an additional 26% indicated they were very
unwilling to move to an institutional setting
6. Role of Income
1) Many elderly individuals require some LTC assistance
and some elderly individuals require many services
2) However, due to incomplete coverage, LTC represents
the largest source of out-of-pocket health care costs for
the elderly
- Medicaid is a safety net
1) Strong preference for care in less restrictive settings
• Income may be an important determinant of LTC
utilization patterns among elderly recipients
7. Conceptual Framework
• Higher income is expected to lead to:
– More paid home care
– More nursing home care
– Less informal care
• However, alternate hypothesis that NH
care is an inferior good. Thus, higher
income would lead to:
– Less nursing home care
8. Prior Research
• Using baseline Channeling data, higher income
associated with greater probability of formal home care
use and a lower probability of informal care (Kemper
1992)
• Using NLTCS data, income statistically unrelated to NH
entry, but positively related to paid home care use and
negatively related to informal care (Ettner 1994)
• Using the CPS, greater (instrumented) income was
found to increase the likelihood of living alone, implying
that privacy is a valued good among elderly individuals
(Engelhardt et al. 2005)
9. Potential Endodeneity of Income
• Income and LTC use may be jointly
determined
– E.g., an individual in poorer health may have
both lower income and higher LTC use
• We rely on a natural experiment that
generated plausibly exogenous variation
in income
– The Social Security benefits “notch”…
10. Social Security Benefits Notch
• Social Security payments are based on lifetime earnings
• Pre-1972: neither lifetime earnings nor post-retirement
payments were indexed for inflation, but rather
periodically adjusted by the Congress
• 1972: Congress provided automatic indexation of
credited earnings for workers not yet retired
– However, due to an error, earnings were doubly indexed for
inflation, leading to a huge windfall for retirees from certain birth
cohorts due to high rate of inflation over next several years
• 1977: Congress passed another law to eliminate double
indexation for future retirees, but those cohorts born
before 1917 (near retirement in 1977) retained doubly
indexed benefits under a grandfather provision
11. SS Benefits Notch (cont.)
Note: Each cohort’s benefits computed with identical real earnings history using the
SSA’s ANYPIA program
12. SS Benefits Notch (cont.)
• The 1977 law raised the covered earnings
maximum such the fraction of earnings used to
calculate Average Indexed Monthly Earnings
(AIME) was greater for high-income workers
(with no change for low-income workers)
• This law introduced earnings-level-by-year-of-
birth variation in SS benefits
– Notch more powerful for low-wage workers
13. SS Benefits Notch as an
Instrument?
• Benefits changes under the Notch were:
– Large and permanent
– Unanticipated
– Otherwise outside the control of the beneficiaries
• Well-utilized by other economists to study the effect of
income on labor supply (Krueger & Pishcke 1992),
prescription drug use (Moran & Simon 2006), mortality
(Snyder & Evans 2006), obesity (Cawley, Moran &
Simon in press), and elderly living arrangements
(Engelhardt, Gruber & Perry 2005)
14. Our Contribution
• Using the notch to instrument for Social
Security income, examine the effect of
income on:
– Paid home care use
– Informal care use
– Nursing home use
15. Data
• AHEAD is a longitudinal survey of community-dwelling
elderly born in 1923 or earlier and their spouses
regardless of age
• Baseline data were collected between October 1993 and
July 1994
– 8,222 individuals from 6,047 households
– Due to variable concordance issues, we only use the first
AHEAD wave to examine paid home care and informal care use
• Follow-up AHEAD survey in 1995
– Exit interviews conducted with family members for AHEAD
respondents who died before follow-up
16. Estimation Sample
• Unit of analysis is person but we have multiple
obs for certain households
• SS income measured at the household level
– We assigned household SS income based on primary
beneficiary using a series of rules (Krueger & Pischke
1992; Moran & Simon 2006)
• Sample restricted to individuals born between
1901 and 1930
• Excluded individuals with SS income less than
$100/month
• Ultimately, our sample had 5,592 individuals
from 4,146 households
17. Outcomes
• Nursing home care
– Any use between 1993 and 1995 AHEAD waves
• Paid home care
– Any help related to ADL/IADL limitation over previous
4 weeks prior to 1993 AHEAD
– Any medically-trained assistance over past 12 months
prior to 1993 AHEAD survey
• Informal care
– Any unpaid care related to ADL/IADL limitation over 4
weeks prior to 1993 AHEAD survey
18. Base Specification
Where:
U = LTC utilization for individual i in household h
I = annual household Social Security income
X = intercept and a set of exogenous controls
ε = residual.
hi h hU I Xβ δ ε= + +
19. Independent Variables
Xh encompasses:
• Type of household
– Male head, married or cohabiting
– Male head, single
– Female head, never married
– Female head, widowed
– Female head, divorced
• Age of head
– Due to collinearity with presence in notch, we enter age as a
polynomial function ranging from one (linear) to three (cubic)
• Race of the head
– White
– African American
– Other race
• Hispanic ethnicity of the head
• Whether household located in an MSA
• Household location based on 9 census regions
20. Methods: IV Model
Assume SS income has the following reduced
form:
Identifying assumption is that the Notch
variable N is correlated with SS income, but
not ε, the error term in the LTC utilization
equation
Instrument:
• Presence in the benefits notch is defined by
birth during the years 1915-1917
h h h hI N Xλ γ µ= + +
21. Methods: IV Model (cont.)
• Previous research has suggested notch
instrument much stronger for low-income
beneficiaries
– The 1977 law raised the covered earnings maximum
such that greater fraction of earnings entered into
AIME calculation for high-wage workers (low-wage
workers unaffected)
• Can show this by splitting sample based on
education of household head…
23. Analyses
• We estimate probit and ivprobit models for
low education group (N=2,429)
– IV probit results robust to two-stage residual
inclusion (2SRI) models
• All analyses are weighted using the
AHEAD person-level weights
• Standard errors are adjusted for clustering
based on year of birth of household head
28. Results: Any Nursing Home Use (past 2 yrs)
$1,000 increase in SS income decreases likelihood
of NH care by 3 percentage pts (or 33.6%)
29. Intensive Margin
• We also examined the amount of LTC use
– “NH days” outcome is unavailable for AHEAD
respondents who died before follow-up (not
asked in the interviews with family members)
• Results generally consistent with results
from previous slides in sign and
magnitude but lack statistical precision
30. Robustness Checks
• Results generally robust to a number of
alternate specifications:
– Exclude widowed and divorced household
heads with imputed birth years
– Exclude cohorts born during the flu pandemic
in 1918 and 1919
– Limit the range of cohorts included in the
study (1910-1920)
31. Substitution between Types of Care
• We found higher income decreases NH use but
increases home care use
• It is possible that individuals substitute one for
the other in the context of an income shock
• Using first two AHEAD waves, we categorize
individuals into one of four categories: no LTC
use, only home care use, only NH use, and both
NH & home care use
• We estimate a multinomial logit regression using
the 2SRI method
33. Summary of Results
• Probit and IV probit models suggest dramatically
different results
• After accounting for endogenous income, we
find that an increase in income:
– Decreases nursing home use
– Increases the utilization of paid home care
– Has no consistent statistically significant effect on
informal care
– Leads to some substitution away from NH care and
towards paid home care
34. Summary (cont.)
• Intuition underlying the direction of bias across probit
and IV probit?
– Probit findings of negative correlation between (endogenous)
income and LTC use consistent with the idea that poorer health
correlated with lower income/SS benefits AND greater LTC
utilization
• What is the mechanism for shift between home health
and nursing home care?
– More income → better health → less need for institutional LTC
– More income → less Medicaid → greater access to HCBS
– More income → sub away from NH care and towards home care
b/c NH care is an inferior good and home care is a normal good
35. Implications
• A $1,000 increase in annual household
SS income (in 2009$) leads to a 2.3
percentage point increase in the use of
home care and a 2.9 percentage point
decrease in the use of NH care
– Caveat: the world has changed (PAC; ALFs,
etc.), but these are meaningful estimates
36. Implications (cont.)
• The annuity value for a 65 year old male born in 1916 is 10.91, and
for females is 13.33. This value assumes a 2.9% interest rate and
"Alternative 2" mortality probabilities (the middle scenario) that
Social Security used in their 2007 Trustees Report
• So a $1,200 annual increase amounts to a $13,092 lump sum for
men and $15,996 for women
• Because Social Security pays 100% of the primary earner's benefit
to the surviving spouse, the correct annuity value is a joint, second-
to-die annuity that pays until the second death
• $16,000 is not a bad estimate
– As a potential benchmark, average PDV of projected lifetime out-of-
pocket LTC expenditures for individuals turning 65 in 2005 was $21,100
(Kemper et al., 2005)
37. Implications (cont.)
• Direct implications for potential Soc Sec reform…
• Indirect implications
– Pensions and asset income
– Many households lost substantial dollars in the recent stock
market crash
• E.g., assisted living sector has been somewhat stagnant since crash
• Given our piecemeal coverage of LTC and large reliance
on private resources, any income shock will have major
implications for long-term care utilization
– Also may have implications for elderly health, Medicaid eligibility,
LTC private insurance purchase