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1
Laband, David N., and Bernard F. Lentz. "Higher Education Costs and the Production of Extension." Journal of Agricultural and Applied Economics 37, no. 1 (2005): 229–36. http://dx.doi.org/10.1017/s1074070800007215.
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Do cost considerations justify the current structure of production of extension services in which one or more providers exists in virtually all of the contiguous U.S. states? Provision of extension services has sizable cost implications for the host institutions. Yet, to our knowledge, there has been virtually no analysis of the impact of extension on higher education costs. Using academic year 1995–1996 data, we estimate a multiproduct cost function for 1,445 public institutions of higher education in the United States, including 65 that provide extension services. We find evidence of significant economies of scale with respect to the provision of extension services but no evidence of significant economies of scope between the provision of extension and the production of research, undergraduate education, or graduate education.
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Hill, Catharine B. "American Higher Education and Income Inequality." Education Finance and Policy 11, no. 3 (2016): 325–39. http://dx.doi.org/10.1162/edfp_a_00178.
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This paper demonstrates that increasing income inequality can contribute to the trends we see in American higher education, particularly in the selective, private nonprofit and public sectors. Given these institutions’ selective admissions and commitment to socioeconomic diversity, the paper demonstrates how increasing income inequality leads to higher tuition, costs, and financial aid. A numerical example is presented that estimates how much lower tuition, spending (costs), and financial aid would have been if household incomes in the United States had grown by the same aggregate amount between 1971 and 2009, but with no increase in income inequality. The policy implications include the government addressing rising income inequality directly or changing the incentives facing higher education and will be of interest to those concerned with the rising cost of higher education and issues of access and affordability.
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Vinnik, Alina Evgenievna. "Evaluation of higher education system management efficiency." Vestnik of Astrakhan State Technical University. Series: Economics 2020, no. 1 (2020): 101–7. http://dx.doi.org/10.24143/2073-5537-2020-1-101-107.
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The article presents the study results of the effectiveness of managing the higher education system using the experience of leading countries of the world. The higher education systems of the United States, the UK and Sweden were chosen as the objects of study representing the North American, European and Scandinavian models of education. The educational organizations of the above countries traditionally hold the leading positions in the world ratings, including the rating of the national education systems Universitas 21, rating of the world's academic universities and ranking of the best universities in the world according to the Times Higher Education version. The official data of the leading world ratings in the field of education were analyzed, as well as the distinctive features of the educational policy of the United States of America, the UK and Sweden were identified, on the basis of which factors ensuring the high efficiency and competitiveness of the higher education system in the global educational service market were stated. Among the main factors are the following: high government spending on the education system, increasing the accessibility of higher education for the population, ensuring high quality educational services, export orientation, etc. The system of indicators has been formed to assess the effectiveness of managing national educational systems. The dynamics of coefficient of higher education propagation in the period within 1970-2014 has been illustrated; the forecast of involving the population of the leading countries into the higher education up to 2050 has been presented. It has been stated that in the developing countries the problem of higher education can be solved due to its accessibility and in the economically developed countries it is solved due to increasing the quality of educational programs, rising the number of educational trajectories and costs.
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Martirosyan, Nara M. "American Community Colleges: The International Student’s Guide." Journal of International Students 8, no. 2 (2018): 1264–66. http://dx.doi.org/10.32674/jis.v8i2.146.
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As a former international student, I never thought of an American Community College as being a choice to start undergraduate education in the United States. This is also true for many prospective international students who explore study opportunities in the United States. American community colleges (also called 2-year colleges) offer diverse higher education opportunities with comparatively lower tuition costs. Moreover, unlike in many other foreign countries, American community colleges are often the best pathway to a bachelor’s degree through transfer agreements that exist between community colleges and 4-year institutions.
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Yue, John K., Pavan S. Upadhyayula, Lauro N. Avalos, and Tene A. Cage. "Pediatric Traumatic Brain Injury in the United States: Rural-Urban Disparities and Considerations." Brain Sciences 10, no. 3 (2020): 135. http://dx.doi.org/10.3390/brainsci10030135.
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Introduction: Traumatic brain injury (TBI) remains a primary cause of pediatric morbidity. The improved characterization of healthcare disparities for pediatric TBI in United States (U.S.) rural communities is needed to advance care. Methods: The PubMed database was queried using keywords ((“brain/head trauma” OR “brain/head injury”) AND “rural/underserved” AND “pediatric/child”). All qualifying articles focusing on rural pediatric TBI, including the subtopics epidemiology (N = 3), intervention/healthcare cost (N = 6), and prevention (N = 1), were reviewed. Results: Rural pediatric TBIs were more likely to have increased trauma and head injury severity, with higher-velocity mechanisms (e.g., motor vehicle collisions). Rural patients were at risk of delays in care due to protracted transport times, inclement weather, and mis-triage to non-trauma centers. They were also more likely than urban patients to be unnecessarily transferred to another hospital, incurring greater costs. In general, rural centers had decreased access to mental health and/or specialist care, while the average healthcare costs were greater. Prevention efforts, such as mandating bicycle helmet use through education by the police department, showed improved compliance in children aged 5–12 years. Conclusions: U.S. rural pediatric patients are at higher risk of dangerous injury mechanisms, trauma severity, and TBI severity compared to urban. The barriers to care include protracted transport times, transfer to less-resourced centers, increased healthcare costs, missing data, and decreased access to mental health and/or specialty care during hospitalization and follow-up. Preventative efforts can be successful and will require an improved multidisciplinary awareness and education.
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Conger, Dylan, and Colin C. Chellman. "Undocumented College Students in the United States: In-State Tuition Not Enough to Ensure Four-Year Degree Completion." Education Finance and Policy 8, no. 3 (2013): 364–77. http://dx.doi.org/10.1162/edfp_a_00101.
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Using restricted-access data from one of the largest urban public university systems in the United States—where many undocumented students are eligible for in-state tuition—we review the literature on undocumented college students in the United States and provide a comparison of the performance of undocumented students to that of U.S. citizens and other legal migrants. Overall, undocumented students perform well in the short-term, earning higher grades and higher rates of course and associate degree completion than their U.S. citizen counterparts. But undocumented students are less likely to earn their bachelor's degrees within four years. This finding suggests that, despite their earlier college successes and their access to in-state tuition rates, at some point after enrollment, undocumented students experience higher costs to completing their bachelor's degrees than they had anticipated upon enrollment. We offer a number of policy considerations for university officials and policy makers who aim to help undocumented college students succeed in postsecondary institutions.
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Welsh, Richard O. "School Hopscotch: A Comprehensive Review of K–12 Student Mobility in the United States." Review of Educational Research 87, no. 3 (2016): 475–511. http://dx.doi.org/10.3102/0034654316672068.
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This article provides an integrative review of the extant literature on K–12 student mobility in the United States. Student mobility is a widespread phenomenon with significant policy implications. Changing schools is most prevalent among minority and low-income students in urban school districts. There is an ongoing debate about whether student mobility is helpful or harmful. Earlier research compared movers with nonmovers using cross-sectional data and did not always include controls for the students’ prior achievement and demographic characteristics. Studies in the past decade compared movers with themselves over time using longitudinal data and provided more convincing estimates. Overall, switching schools is associated with a negative impact on students’ educational outcomes; however, transferring to higher quality schools may offset and outweigh the transition costs of moving. Strong causal claims are elusive due to considerable data and methodological challenges and the inability to account for the motivating reasons for changing schools.
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Vekeman, Francis, Marjolaine Gauthier-Loiselle, Elizabeth Faust, et al. "Patient and Caregiver Burden Associated With Fragile X Syndrome in the United States." American Journal on Intellectual and Developmental Disabilities 120, no. 5 (2015): 444–59. http://dx.doi.org/10.1352/1944-7558-120.5.444.
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Abstract This study evaluated the incremental healthcare costs associated with Fragile X syndrome (FXS) for patients and their caregivers. Using administrative healthcare claims data (1999-2012), subjects with ≥ 1 FXS diagnosis (ICD-9-CM: 759.83) were matched 1:5 with non-FXS controls using high-dimensional propensity scores. Costs and resource utilization were examined. Among employees, payment for disability leave and absenteeism were also examined. We identified 590 FXS and 2,950 non-FXS individuals along with 647 and 2,611 caregivers, respectively. FXS patients and their caregivers experienced higher all-cause direct costs compared to control cohorts (total[SD]: $14,677[46,752] vs. $6,103[26,081]; $5,259[19,360] vs. $2,120[6,425], respectively, p < 0.05). Employed FXS patients and caregivers had higher indirect costs compared to their controls (total[SD]: $4,477[5,161] vs. $1,751[2,556]; $2,641[4,238] vs. $1,211[1,936], respectively, p < 0.05).
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Fawver, Bradley, Garrett F. Beatty, John T. Roman, and Kevin Kurtz. "The Status of Youth Coach Training in the United States: Existing Programs and Room for Improvement." International Sport Coaching Journal 7, no. 2 (2020): 239–51. http://dx.doi.org/10.1123/iscj.2019-0017.
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The United States is one of the world’s perennial sports powers, yet the pathway to that success is littered with millions of youth athletes who either are not good enough to compete at a higher level or dropout from sport completely due to various personal, social, and organizational factors. These barriers are compounded by a win-at-all-costs mentality that pervades the U.S. sport culture and ultimately disenfranchises many youths from the opportunity to enjoy sport participation throughout their life. The authors argue that principle components in this flawed system are the lack of standardized coach education at the state and national level, weaknesses in the current curricula offered, and difficulties for aspiring coaches accessing existing training programs. In the current paper, the authors (a) briefly review the history of coach education in the United States as well as existing opportunities for coach education at the university, sport-specific, and private sectors; (b) provide a description of the strengths and weaknesses of the current coaching model; and (c) provide recommendations to improve coach education and training in the United States.
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Hormel, Leontina, and Lynn M. McAlister. "“These Are the Choices We’ve Made”." Humanity & Society 41, no. 3 (2016): 313–32. http://dx.doi.org/10.1177/0160597616639623.
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This study uses surveys and in-depth interviews to explore professors’ student loan debt experiences at a university in the Northwest United States, focusing attention on their perceptions of fellow colleagues’ experiences. Having been long-term students in higher education themselves, professors’ student loan debt has increased with the trend toward privatization and corporatization of higher education over the last several decades. Interviews reveal professors’ tendency to disassociate their colleagues’ student loan debt experiences from the public issue of rising higher education costs. We find that a university culture imbued with market ethos shapes their explanations for professors’ student loan debt, rationalizing debt as a result of poor spending habits or career choices. These explanations detract from the public issue of rising education costs being shouldered increasingly by students and their families, which we contend will result in excluding minority groups’ access to the profession and limiting diversity in higher education and research.
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White, Elizabeth. "A Comparison of Nursing Education and Workforce Planning Initiatives in the United States and England." Policy, Politics, & Nursing Practice 18, no. 4 (2017): 173–85. http://dx.doi.org/10.1177/1527154418759666.
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Health care systems in England and the United States are under similar pressures to provide higher quality, more efficient care in the face of aging populations, increasing care complexity, and rising costs. In 2010 and 2011, major strategic reports were published in the two countries with recommendations for how to strengthen their respective nursing workforces to address these challenges. In England, it was the 2010 report of the Prime Minister’s Commission on the Future of Nursing and Midwifery, Front Line Care: The Future of Nursing and Midwifery in England. In the United States, it was the Institute of Medicine’s report The Future of Nursing: Leading Change, Advancing Health. The authors of both reports recommended shifting entry level nursing education to the baccalaureate degree and building capacity within their educational systems to prepare nurses as leaders, educators, and researchers. This article will explore how, with contrasting degrees of success, the nursing education systems in the United States and England have responded to these recommendations and examine how different regulatory and funding structures have hindered or enabled these efforts.
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Kimball, Bruce A., and Jeremy B. Luke. "Historical Dimensions of the “Cost Disease” in US Higher Education, 1870s–2010s." Social Science History 42, no. 1 (2017): 29–55. http://dx.doi.org/10.1017/ssh.2017.38.
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Among explanations for the escalating cost of higher education in the United States, two economic theories predominate: the revenue theory of cost and cost disease theory. Since its formulation in the 1960s, distinguished economists have concluded that cost disease theory has convincingly been proven to explain cost escalation in higher education. This article examines three historical dimensions of the cost disease in higher education from the 1870s to the 2010s. First, we explain how the scholarship on the cost disease in higher education has developed over the past 50 years. Second, we concurrently analyze the historical data and the reasoning presented by economists in support of the view that cost disease theory explains cost escalation in higher education. This analysis concludes that the scholarship over the last 50 years provides little validation for that explanation. Finally, we present historical research on cost trends in US higher education from 1875 to 1930. This formative period in US higher education witnessed enormous growth in the national economy. Due to the growth in productivity, cost disease theory would expect costs in higher education, a personal services industry, to rise sharply relative both to costs generally and to the national income. But this historical research reveals that the per capita cost of higher education grew very slowly over this period. These findings consist with our analysis of cost disease scholarship. We therefore conclude that there is little validation that cost disease theory explains cost escalation in US higher education from the 1870s to the 2010s, though it may explain some periods within that span.
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Sharma, Andy. "Wealth and the health of older Black women in the United States." Health Promotion International 34, no. 5 (2018): 1055–68. http://dx.doi.org/10.1093/heapro/day053.
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Summary Public health scholars and policy-makers are concerned that the United States continues to experience unmanageable health care costs while struggling with issues surrounding access and equity. To addresses these and other key issues, the National Academy of Medicine held a public symposium, Vital Directions for Health and Health Care: A National Conversation during September 2016, with the goal of identifying clear priorities for high-value health care and improved well-being. One important area was addressing social determinants of health. This article contributes to this objective by investigating the impact of wealth on older Black women’s health. Employing the 2008/2010 waves of the RAND Health and Retirement Study on a sample of 906 older Black women, this panel study examined self-assessed health ratings of very good/good/fair/poor within a relaxed random effects framework, thereby controlling for both (i) observed and (ii) unobserved individual-level heterogeneity. This analysis did not find a statistically significant association with wealth despite a difference of approximately $75 000 in its valuation from very good to poor health. This also occurred after wealth was (i) readjusted for outliers and (ii) reformulated as negative, no change or positive change from 2008. This finding suggests that wealth may not play as integral a role. However, the outcome was significant for earnings and education, particularly higher levels of education. Scholars should further this inquiry to better understand how earnings/education/wealth operate as social determinants of health for minority populations.
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Rickenbach, Elizabeth, Elizabeth H. Rickenbach, Chih-Chien Huang, Jessica Y. Allen, and Kelly E. Cichy. "LONG-TERM COSTS OF GRANDPARENT CAREGIVING: RESULTS FROM THREE WAVES OF THE MIDLIFE IN THE UNITED STATES STUDY (MIDUS)." Innovation in Aging 3, Supplement_1 (2019): S797—S798. http://dx.doi.org/10.1093/geroni/igz038.2936.
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Abstract Cross-sectional studies reveal the health burden of grandparent caregiving. Still, longitudinal, research is needed to understand how grandparent caregiving compromises grandparents’ long-term health. Using three waves of data from the Midlife in the United States Study (MIDUS), we examined sociodemographic factors, health and well-being outcomes between caregiving (CG) and non-caregiving (NCG) grandparents. By wave 3, 12.8% (n = 234) were CG. CG were younger, more likely female, and had lower income and education. MANCOVA adjusted for age, gender, education, and number of children revealed CG reported poorer physical and emotional well-being (e.g. higher depression, anxiety, lower life satisfaction, greater morbidity); CG were consistently less healthy than NCG across all three waves. Lower income and less healthy older adults are more likely to become grandparents, and they remain less healthy over time. Policies and resources to assist grandparents, particularly low-income and vulnerable older adults who are caring for grandchildren, are needed.
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Bryant, Gareth, and Ben Spies-Butcher. "Bringing finance inside the state: How income-contingent loans blur the boundaries between debt and tax." Environment and Planning A: Economy and Space 52, no. 1 (2018): 111–29. http://dx.doi.org/10.1177/0308518x18764119.
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Income-contingent loans are increasingly used by governments around the world to finance the costs of higher education. We use the case of income-contingent loans to explore how states are bringing the architecture of financial markets inside the state, disrupting conventional understandings of marketisation that are linked to concepts of commodification. We argue that income-contingent loans are hybrid policy instruments that combine elements of a state-instituted tax and a market-negotiated debt. We understand this hybrid construction in terms of the actors and mechanisms characteristic of what Polanyi identified in patterns of ‘redistribution’ and ‘exchange’. We then follow the contested mutations of income-contingent loans in Australia, England and the United States along three axes of hybridity that produce a variegated landscape of higher education finance: determining debt, charging interest and enforcing repayment. Our analysis reveals how, as processes of marketisation internalise financial ways of calculating and organising, states are blurring the boundaries between debts and taxes, redirecting political contestation over commodification.
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Lash, Rebecca Salisbury, Janice Bell, Robin L. Whitney, Sarah Reed, Andra Davis, and Jill G. Joseph. "Emergency department use and expenditures among cancer survivors in the United States, 2008-2011." Journal of Clinical Oncology 32, no. 30_suppl (2014): 3. http://dx.doi.org/10.1200/jco.2014.32.30_suppl.3.
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3 Background: The number of cancer survivors in the US surpassed 13 million in 2012. In response to rising costs or care and greater demand for services, recent national reports and policies promote cancer care coordination to reduce costly and potentially avoidable services such as Emergency Department (ED) visits. Such efforts must be informed by reliable estimates and improved understanding of ED use and costs among oncology patients. This study quantifies the extent to which cancer survivors use the ED compared to individuals with other chronic conditions and estimates related annual expenses. Methods: Data from the 2008-2011 Medical Expenditure Panel Survey (MEPS) and survey-weighted regression models were used to determine the odds of any ED use (logistic), counts of ED visits (negative binomial) and mean annual medical expenditures attributed to ED use (generalized linear models) in three groups of respondents: cancer survivors, those with chronic conditions other than cancer, and those with neither (reference group). All models were adjusted for important confounding variables (age, sex, race/ethnicity, education, health insurance and health status). Estimates are generalizable to US non-institutionalized populations. Results: Among individuals with cancer, other chronic conditions, and neither condition, 17%, 15% and 9% visited the ED, respectively. Mean annual expenditures attributed to ED use among those with visits were $1471 (95% CI: $1262-$1678), $1517 (95% CI:$1395-$1640) and $1106 (95% CI: $984-$1228). Cancer survivors and individuals with other chronic conditions consistently had significantly higher ED use and costs than did the reference group. The likelihood of having any ED visit was similar between cancer survivors and those with other conditions, however cancer survivors incurred more visits (IRR: 1.17; 95% CI: 1.01, 1.36). Conclusions: ED use and expenditures are substantial among cancer survivors and equal or exceed the same outcomes in individuals with other chronic conditions. Future research is recommended to explore specific areas of unmet health need that may be driving increased frequency of ED visits in the growing population of cancer survivors.
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Ruthberg, Jeremy S., Hammad A. Khan, Konrad D. Knusel, Nicholas M. Rabah, and Todd D. Otteson. "Health Disparities in the Access and Cost of Health Care for Otolaryngologic Conditions." Otolaryngology–Head and Neck Surgery 162, no. 4 (2020): 479–88. http://dx.doi.org/10.1177/0194599820904369.
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Objective To demonstrate whether race, education, income, or insurance status influences where patients seek medical care and the cost of care for a broad range of otolaryngologic diseases in the United States. Study Design Retrospective cohort study using data from the Medical Expenditure Panel Survey, from 2007 to 2015. Setting Nationally representative database. Subjects and Methods Patients with 14 common otolaryngologic conditions were identified using self-reported data and International Classification of Diseases, 9th Revision Clinical Modification diagnosis codes. To analyze disparities in the utilization and cost of otolaryngologic care, a multivariate logistic regression model was used to compare outpatient and emergency department visit rates and costs for African American, Hispanic, and Caucasian patients, controlling for sociodemographic characteristics. Results Of 78,864 respondents with self-reported otolaryngologic conditions, African American and Hispanic patients were significantly less likely to visit outpatient otolaryngologists than Caucasians (African American: adjusted odds ratio [aOR], 0.57; 95% CI, 0.5-0.65; Hispanic: aOR, 0.64; 95% CI, 0.56-0.73) and reported lower average costs per emergency department visit than Caucasians (African American: $4013.67; Hispanic: $3906.21; Caucasian: $7606.46; P < .001). In addition, uninsured, low-income patients without higher education were significantly less likely to receive outpatient otolaryngologic care than privately insured, higher-income, and more educated individuals (uninsured: aOR, 0.38; 95% CI, 0.29-0.51; poor: aOR, 0.75; 95% CI, 0.64-0.87; no degree: aOR, 0.67; 95% CI, 0.54-0.82). Conclusion In this study, significant racial and socioeconomic discrepancies exist in the utilization and cost of health care for otolaryngologic conditions in the United States.
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Beck, Angela J., Jonathon P. Leider, Heather Krasna, and Beth A. Resnick. "Monetary and Nonmonetary Costs and Benefits of a Public Health Master’s Degree in the 21st Century." American Journal of Public Health 110, no. 7 (2020): 978–85. http://dx.doi.org/10.2105/ajph.2020.305648.
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As postsecondary tuition and debt levels continue to rise, the value proposition of higher education has been increasingly called into question by the popular media and the general public. Recent data from the National Center for Education Statistics now show early career earnings and debt, by program, for thousands of institutions across the United States. This comes at an inflection point for public health education—master’s degrees have seen 20 years of growth, but forecasts now call for, at best, stagnation. Forces inside and outside the field of public health are shifting supply and demand for public health master’s degrees. We discuss these forces and identify potential monetary and nonmonetary costs and benefits of these degrees. Overall, we found a net benefit in career outcomes associated with a public health master’s degree, although it is clear that some other master’s degrees likely offer greater lifetime earning potentials or lower lifetime debt associated with degree attainment. We outline the issues academic public health must engage in to successfully attract and train the next generation of public health graduates.
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Balmuth, Alexa, Julie Miller, Samantha Brady, Lisa D’Ambrosio, and Joseph Coughlin. "Mothers, Fathers, and Student Loans: Contributing Factors of Familial Conflict Among Parents Repaying Student Loan Debt for Children." Journal of Family and Economic Issues 42, no. 2 (2021): 335–50. http://dx.doi.org/10.1007/s10834-021-09761-9.
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AbstractAs college costs rise in the United States, many parents are forced to make difficult decisions about how to pay for their children’s higher education. Stress and conflict accompany financial issues and play a role in the financial picture for many families. Using Hill’s (Hill, Social casework 39:139–150, 1958) ABC-X model of family stress as a framework, this study describes results of a national survey of parents contributing to student loan payments for their child’s education and explores how this experience may play a role in familial conflict. Findings suggest marked gender differences in the relationship between contribution reason and the experience of conflict. Results also carry implications for financial professionals, suggesting a need for family-focused and gender-conscious financial education both before and during the student loan repayment process.
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Driver, Vickie R., Matteo Fabbi, Lawrence A. Lavery, and Gary Gibbons. "The Costs of Diabetic Foot." Journal of the American Podiatric Medical Association 100, no. 5 (2010): 335–41. http://dx.doi.org/10.7547/1000335.
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In 2007, the treatment of diabetes and its complications in the United States generated at least $116 billion in direct costs; at least 33% of these costs were linked to the treatment of foot ulcers. Although the team approach to diabetic foot problems is effective in preventing lower-extremity amputations, the costs associated with implementing a diabetic-foot–care team are not well understood. An analysis of these costs provides the basis for this report. Diabetic foot problems impose a major economic burden, and costs increase disproportionately to the severity of the condition. Compared with diabetic patients without foot ulcers, the cost of care for those with foot ulcers is 5.4 times higher in the year after the first ulcer episode and 2.8 times higher in the second year. Costs for treating the highest-grade ulcers are 8 times higher than are those for treating low-grade ulcers. Patients with diabetic foot ulcers require more frequent emergency department visits and are more commonly admitted to the hospital, requiring longer lengths of stay. Implementation of the team approach to manage diabetic foot ulcers in a given region or health-care system has been reported to reduce long-term amputation rates 62% to 82%. Limb salvage efforts may include aggressive therapy such as revascularization procedures and advanced wound-healing modalities. Although these procedures are costly, the team approach gradually leads to improved screening and prevention programs and earlier interventions and, thus, seems to reduce long-term costs. To date, aggressive limb preservation management for patients with diabetic foot ulcers has not usually been paired with adequate reimbursement. It is essential to direct efforts in patient-caregiver education to allow early recognition and management of all diabetic foot problems and to build integrated pathways of care that facilitate timely access to limb salvage procedures. Increasing evidence suggests that the costs of implementing diabetic foot teams can be offset in the long term by improved access to care and reductions in foot complications and amputation rates. (J Am Podiatr Med Assoc 100(5): 335–341, 2010)
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Mulligan, Karen, Seema Choksy, Catherine Ishitani, and John A. Romley. "New Evidence on the Compensation of Chief Executive Officers at Nonprofit U.S. Hospitals." Medical Care Research and Review 77, no. 5 (2019): 498–506. http://dx.doi.org/10.1177/1077558719849356.
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Chief executive officer (CEO) compensation is highly scrutinized, with nonprofit organizations often receiving additional attention due to their tax-exempt status. Understanding hospital CEO compensation is of increasing importance as health care costs remain high and strong leadership is required to implement new health policies. This study documents CEO compensation at nonprofit hospitals in the United States for 2010 and 2015. We compare hospital CEO compensation with CEO compensation in other institution types, including nonhospital health care. We also explore changes in hospital CEO compensation over time and differences across states. We find CEOs at hospitals earn substantially less than CEOs of publicly traded companies though more than presidents of nonprofit institutions of higher education. Additionally, we find that the relationship between CEO compensation and hospital size was weaker in 2015 than in 2010, and substantial variation in CEO compensation exists across states.
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Go, Sun, and Peter Lindert. "The Uneven Rise of American Public Schools to 1850." Journal of Economic History 70, no. 1 (2010): 1–26. http://dx.doi.org/10.1017/s0022050710000033.
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Three factors help to explain why school enrollments in the Northern United States were higher than those in the South and in most of Europe by 1850. One was affordability: the northern schools had lower direct costs relative to income. The second was the greater autonomy of local governments. The third was the greater diffusion of voting power among the citizenry in much of the North, especially in rural communities. The distribution of local political voice appears to be a robust predictor of tax support and enrollments, both within and between regions. Extra local voice raised tax support without crowding out private support for education.
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Tamura, Robert, and Curtis Simon. "SECULAR FERTILITY DECLINES, BABY BOOMS, AND ECONOMIC GROWTH: INTERNATIONAL EVIDENCE." Macroeconomic Dynamics 21, no. 7 (2017): 1601–72. http://dx.doi.org/10.1017/s1365100515001017.
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We present a model capable of explaining 200 years of declining fertility, 200 years of rising educational achievement, and a significant baby boom for the United States and twenty other industrialized market countries. We highlight the importance of secularly declining young adult mortality risk for producing secularly declining fertility and a sudden decline in housing costs after the end of the Second World War, but ending by 1970. In addition, we introduce a new puzzle for the profession: Given the magnitude of the Baby Boom, roughly equal to fertility in 1900 for many of these countries, why did schooling of the Baby Boom cohorts not fall to the 1900 level of their predecessors? In fact, not only did it not fall, but the schooling levels of these cohorts are higher than for previous cohorts. Using a quantitative model, we are able to identify the magnitude of the reduction in costs of education necessary to explain this paradoxical increase in schooling. We produce a novel data set on historical education expenditures with over 1,500 observations. We find empirical support for these cost reductions.
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Manchikanti, Laxmaiah. "Health Care Reform in the United States: Radical Surgery Needed Now More Than Ever." Pain Physician 1;11, no. 1;1 (2008): 13–42. http://dx.doi.org/10.36076/ppj.2008/11/13.
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It is often claimed that American health care provides good medical care, but the system through which that care is financed is falling apart. In 1994, Joseph A. Califano, Jr., former Secretary of Health, Education and Welfare reported that the American health care system was in such turmoil, that it needed radical surgery. Health care in the United States is different from other countries. Health care costs in America have skyrocketed and in 2006 occupied 16% of the Gross Domestic Product (GDP) with a budget of over $2 trillion. Health care expenditures per capita in the United States are higher than 13 other countries utilized in a sample by the Organisation for Economic Co-operation and Development. Estimated spending according to wealth was utilized to measure each country’s health care spending in comparison to each other. This measure, including various parameters (undoubtedly some have been missed), largely showed that after adjusting to its higher per capita income levels, the United States spends $477 billion - $1,645 per capita more on health care than any other peer country. Many health care proposals have been forwarded since 1965, when Lyndon Johnson succeeded in enacting Medicare. These come from Republicans, Democrats, Independents, physicians, insurers, non-partisan and partisan groups. However, none has been able to provide a guaranteed proposal to fix the health care ills and also provide reasonable coverage. This manuscript will review escalating national health care expenditures, factors contributing to health care increases, health care systems in many other countries, and various proposals. Key words: Health care reform, Organisation for Economic Co-Operation and Development, Estimated Spending According to Wealth (ESAW), Centers for Medicare and Medicaid (CMS), universal health care, managed health care reform
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Xie, Weizhen, Stephen Campbell, and Weiwei Zhang. "Working memory capacity predicts individual differences in social-distancing compliance during the COVID-19 pandemic in the United States." Proceedings of the National Academy of Sciences 117, no. 30 (2020): 17667–74. http://dx.doi.org/10.1073/pnas.2008868117.
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Noncompliance with social distancing during the early stage of the coronavirus disease 2019 (COVID-19) pandemic poses a great challenge to the public health system. These noncompliance behaviors partly reflect people’s concerns for the inherent costs of social distancing while discounting its public health benefits. We propose that this oversight may be associated with the limitation in one’s mental capacity to simultaneously retain multiple pieces of information in working memory (WM) for rational decision making that leads to social-distancing compliance. We tested this hypothesis in 850 United States residents during the first 2 wk following the presidential declaration of national emergency because of the COVID-19 pandemic. We found that participants’ social-distancing compliance at this initial stage could be predicted by individual differences in WM capacity, partly due to increased awareness of benefits over costs of social distancing among higher WM capacity individuals. Critically, the unique contribution of WM capacity to the individual differences in social-distancing compliance could not be explained by other psychological and socioeconomic factors (e.g., moods, personality, education, and income levels). Furthermore, the critical role of WM capacity in social-distancing compliance can be generalized to the compliance with another set of rules for social interactions, namely the fairness norm, in Western cultures. Collectively, our data reveal contributions of a core cognitive process underlying social-distancing compliance during the early stage of the COVID-19 pandemic, highlighting a potential cognitive venue for developing strategies to mitigate a public health crisis.
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Krahn, Murray, and Kenneth R. Chapman. "Economic Issues in the Use of Office Spirometry for Lung Health Assessment." Canadian Respiratory Journal 10, no. 6 (2003): 320–26. http://dx.doi.org/10.1155/2003/158736.
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The National Lung Health Education Program (United States) has recently recommended using office spirometry to screen for subclinical lung disease in adult smokers. No published studies evaluate the economic consequences of this recommendation. This review article outlines the issues that must be considered when evaluating the costs and health benefits of office spirometry. Much of the available data on the effectiveness of screening is from studies that included smoking cessation interventions, making it difficult to determine the effects of screening alone. The sensitivity and specificity of screening spirometry are not known, but may not be important in the economic model, because even false positive test results are beneficial if they lead to smoking cessation. Costs to be considered include those of spirometry itself, of implementing and maintaining screening and smoking cessation programs, and of their consequences, ie, reduced morbidity (lower short term health care costs) and mortality (perhaps higher long term health care costs). Despite these unique challenges, data are available to perform economic analyses regarding screening spirometry. Such analyses should play a role in future clinical policy making. Even modest quit rates attributable to screening spirometry may result in highly favourable cost effectiveness ratios.
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Burkholder, Gary J., Jim Lenio, Nicole Holland, et al. "An Institutional Approach to Developing a Culture of Student Persistence." Higher Learning Research Communications 3, no. 3 (2013): 16. http://dx.doi.org/10.18870/hlrc.v3i3.120.
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<p>There continues to be increasing focus on college student retention and persistence. This focus is coming from the United States federal government, accrediting organizations, and from students, parents and the public. Given the spiraling costs of education and the fact that retention rates have not improved over time, various stakeholders are concerned about the value of a higher education credential. The purpose of this manuscript is to describe the efforts of a for-profit, distance education institution to focus its resources, in an evidence-based manner, on retention and to develop a culture of retention and persistence throughout the institution. The literature review and analysis of internal initiatives demonstrates that (a) institutions must make a commitment to retention, include retention efforts as part of its strategic plan, and provide resources to support retention efforts; (b) mastery of knowledge of the research on retention and persistence is critical for designing evidence-based interventions; and (c) institutions should identify, develop, and implement pilot projects aimed at improving student progress and share results to help stimulate development of best practices throughout higher education.</p>
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Abbas, Kaja M., Gloria J. Kang, Daniel Chen, Stephen R. Werre, and Achla Marathe. "Demographics, perceptions, and socioeconomic factors affecting influenza vaccination among adults in the United States." PeerJ 6 (July 13, 2018): e5171. http://dx.doi.org/10.7717/peerj.5171.
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Objective The study objective is to analyze influenza vaccination status by demographic factors, perceived vaccine efficacy, social influence, herd immunity, vaccine cost, health insurance status, and barriers to influenza vaccination among adults 18 years and older in the United States. Background Influenza vaccination coverage among adults 18 years and older was 41% during 2010–2011 and has increased and plateaued at 43% during 2016–2017. This is below the target of 70% influenza vaccination coverage among adults, which is an objective of the Healthy People 2020 initiative. Methods We conducted a survey of a nationally representative sample of adults 18 years and older in the United States on factors affecting influenza vaccination. We conducted bivariate analysis using Rao-Scott chi-square test and multivariate analysis using weighted multinomial logistic regression of this survey data to determine the effect of demographics, perceived vaccine efficacy, social influence, herd immunity, vaccine cost, health insurance, and barriers associated with influenza vaccination uptake among adults in the United States. Results Influenza vaccination rates are relatively high among adults in older age groups (73.3% among 75 + year old), adults with education levels of bachelor’s degree or higher (45.1%), non-Hispanic Whites (41.8%), adults with higher incomes (52.8% among adults with income of over $150,000), partnered adults (43.2%), non-working adults (46.2%), and adults with internet access (39.9%). Influenza vaccine is taken every year by 76% of adults who perceive that the vaccine is very effective, 64.2% of adults who are socially influenced by others, and 41.8% of adults with health insurance, while 72.3% of adults without health insurance never get vaccinated. Facilitators for adults getting vaccinated every year in comparison to only some years include older age, perception of high vaccine effectiveness, higher income and no out-of-pocket payments. Barriers for adults never getting vaccinated in comparison to only some years include lack of health insurance, disliking of shots, perception of low vaccine effectiveness, low perception of risk for influenza infection, and perception of risky side effects. Conclusion Influenza vaccination rates among adults in the United States can be improved towards the Healthy People 2020 target of 70% by increasing awareness of the safety, efficacy and need for influenza vaccination, leveraging the practices and principles of commercial and social marketing to improve vaccine trust, confidence and acceptance, and lowering out-of-pocket expenses and covering influenza vaccination costs through health insurance.
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Fellmeth, Robert C., Bridget Fogarty Gramme, and C. Christopher Hayes. "Cartel Control of Attorney Licensure and the Public Interest*." British Journal of American Legal Studies 8, no. 2 (2019): 193–233. http://dx.doi.org/10.2478/bjals-2019-0006.
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Abstract The purpose of regulating any profession is to assure competent practitioners, particularly where its absence can cause irreparable harm. Regulatory “licensing” ideally achieves such assurance, while at the same time avoiding unnecessary supply constriction. The latter can mean much higher prices and an inadequate number of practitioners. Regrettably, the universal delegation to attorneys of the power to regulate themselves has led to a lose/lose system lacking protection from incompetent practice while also diminishing needed supply. The problem is manifest in four regulatory flaws: First, state bars—in combination with the American Bar Association—require four years of largely irrelevant higher education for law school entry. Most of this coursework commonly has nothing to do with law. Second, and related, these seven-years of mandatory higher education (that only the United States requires for attorney licensure) impose extraordinary costs. Those costs now reach from $190,000 to $380,000 in tuition and room and board per student—driven by shocking tuition levels lacking competitive check. Third, attorney training focuses almost entirely on a few traditional subjects, with little attention paid to the development of useful skills in most of the 24 disparate areas of actual practice (e.g., administrative, bankruptcy, corporate, criminal, family, taxation, et al.). And schools often pay scant attention to legislation, administrative proceedings, or the distinct areas of law that will be relevant to a student’s future practice. Fourth, state bars rely on supply-constricting bar examinations of questionable connection to competence assurance. In the largest state of California, the bar examination fails about 2/3 of its examinees. This system has fostered an opportunistic cottage industry of increasingly expensive preparatory courses that further raise the cost of becoming an attorney—even after 7 years of higher education. Meanwhile, the bars regulating attorneys in the respective states: a) Do not treat negligent acts as a normal basis for discipline (outside of extreme incapacity); b) Do not require malpractice insurance—effectively denying consumer remedies for negligence; c) Do not allow clients injured by malpractice to recover from “client security funds”; d) Do not require post-licensure “legal education” in the area of an attorney’s practice; e) Do not test attorneys in the area of practice relied upon by consumers—ever; and f) Respond to cost-effective, technology-centric solutions to legal problems not by regulation to assure consumer benefit, but by attempts to categorically foreclose them in favor of total reliance on often unavailable/expensive counsel. No area of state regulation has more openly violated federal antitrust law than has the legal profession. The United States Supreme Court held in 2015 that any state body controlled by “active market participants” in a profession regulated is not a sovereign entity for antitrust purposes without “active state supervision.” Yet four years later, attorneys continue to regulate themselves without such supervision, overlooking the threat of criminal felony and civil treble damage liability.
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Zadorozhna, Olha. "DISTANCE EDUCATION IN UKRAINE: REALITIES OF TODAY." Educational Discourse: collection of scientific papers, no. 24(6) (July 15, 2020): 56–67. http://dx.doi.org/10.33930/ed.2019.5007.24(6)-4.
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The first attempts to introduce distance education technologies in the education sector were made in the 60s of the twentieth century in Western Europe and the United States. The rapid development of information technology and computerization of the population have led to an increase in demand for new, specific technologies in education, which allows applicants to study at considerable distances from educational institutions. It is the criteria to which the distance learning conforms, and which has been and remains the subject of active scientific discussion both abroad and in our country. Such a system of acquiring knowledge can significantly reduce the cost of education, as distance education is cheaper than traditional forms of higher education, and also reduces transport costs for travel to the place of study and back. Moreover, distance education can be obtained in any rhythm convenient for the applicant, distributing the workload at will. With the correct organization of classes and control of knowledge high efficiency of this method of professional education can be achieved through the use of new software and hardware platforms and electronic courses. On the other hand, critics of distance education say that its quality cannot be compared even with extramural education, and such educational technologies allow only to obtain a diploma with minimal investment of effort and resources without acquiring factual knowledge. The low quality of distance education, according to some experts, can be explained by the lack of quality methods of distance teaching, the average quality of e-courses, as well as the e-learning environments themselves.
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Liu, Xiangmin, and Liang Zhang. "Flexibility at the Core: What Determines Employment of Part-Time Faculty in Academia." Articles 68, no. 2 (2013): 312–39. http://dx.doi.org/10.7202/1016321ar.
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Summary In this study, we examine institutional predictors of part-time faculty employment in the higher education sector in the United States. We draw upon institutional and individual-level data to examine the variation in the intensity of part-time employment in faculty positions among a representative sample of higher education institutions. Institutional-level data are from Integrated Postsecondary Education Data System (IPEDS) and individual-level data are from National Study of Postsecondary Faculty (NSOPF). These data allow us to examine the impact of both economic factors and social environment on employment practices of colleges and universities. This analysis adds to the emerging literature on non-standard work arrangements in core organizational functions. Our results suggest that the employment of part-time faculty is significantly associated with a set of organizational attributes and characteristics such as institutional type, sources of revenue, and part-time student enrolment. Private institutions, on average, have higher levels of part-time faculty than their public counterparts. The proportion of part-time students and the share of institutional revenues derived from tuition and fees are positively associated with part-time faculty employment. Faculty unions are positively related to the employment of part-time faculty. Finally, institutions that have limited resource slack and pay high salaries to their full-time faculty members tend to employ a high proportion of part-time faculty. These results support the arguments that higher educational institutions actively design and adopt contingent work arrangements to manage their resource dependence with constituencies and to reduce labour costs.
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Hays, Laura H. "Infective endocarditis: call for education of adults with CHD: review of the evidence." Cardiology in the Young 26, no. 3 (2015): 426–30. http://dx.doi.org/10.1017/s1047951115002395.
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AbstractAdvanced surgical repair procedures have resulted in the increased survival rate to adulthood of patients with CHD. The resulting new chronic conditions population is greater than one million in the United States of America and >1.2 million in Europe. This review describes the risks and effects of infective endocarditis – a systemic infectious process with high morbidity and mortality – on this population and examines the evidence to determine whether greater patient education on recognition of symptoms and preventative measures is warranted. The literature search included the terms “infective endocarditis” and “adult congenital heart disease”. Search refinement, the addition of articles cited by included articles, as well as addition of supporting articles, resulted in utilisation of 24 articles. Infective endocarditis, defined by the modified Duke Criteria, occurs at a significantly higher rate in the CHD population due to congenitally or surgically altered cardiac anatomies and placement of prosthetic valves. This literature review returned no studies in the past five years assessing knowledge of the definition, recognition of symptoms, and preventative measures of infective endocarditis in the adult CHD population. Existing data are more than 15 years old and show significant knowledge deficits. Studies have consistently shown the need for improved CHD patient knowledge with regard to infective endocarditis, and there is no recent evidence that these knowledge deficits have decreased. It is important to address and decrease knowledge deficits in order to improve patient outcomes and decrease healthcare utilisation and costs.
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Carpenter, Christopher, and Carlos Dobkin. "The Minimum Legal Drinking Age and Public Health." Journal of Economic Perspectives 25, no. 2 (2011): 133–56. http://dx.doi.org/10.1257/jep.25.2.133.
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The Amethyst Initiative, signed by more than 100 college presidents and other higher education officials calls for a reexamination of the minimum legal drinking age in the United States. A central argument of the initiative is that the U.S. minimum legal drinking age policy results in more dangerous drinking than would occur if the legal drinking age were lower. A companion organization called Choose Responsibility explicitly proposes “a series of changes that will allow 18–20 year-olds to purchase, possess and consume alcoholic beverages.” Does the age-21 drinking limit in the United States reduce alcohol consumption by young adults and its harms, or as the signatories of the Amethyst Initiative contend, is it “not working”? In this paper, we summarize a large and compelling body of empirical evidence which shows that one of the central claims of the signatories of the Amethyst Initiative is incorrect: setting the minimum legal drinking age at 21 clearly reduces alcohol consumption and its major harms. We use a panel fixed effects approach and a regression discontinuity approach to estimate the effects of the minimum legal drinking age on mortality, and we also discuss what is known about the relationship between the minimum legal drinking age and other adverse outcomes such as nonfatal injury and crime. We document the effect of the minimum legal drinking age on alcohol consumption and estimate the costs of adverse alcohol-related events on a per-drink basis. Finally we consider implications for the correct choice of a minimum legal drinking age.
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WEINSTEIN, MAXINE, NOREEN GOLDMAN, ALLISON HEDLEY, LIN YU-HSUAN, and TERESA SEEMAN. "SOCIAL LINKAGES TO BIOLOGICAL MARKERS OF HEALTH AMONG THE ELDERLY." Journal of Biosocial Science 35, no. 3 (2003): 433–53. http://dx.doi.org/10.1017/s0021932003004334.
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The social environment and exposure to life challenge affect a person's physical and emotional well-being. The present research uses a population-based study of the elderly in Taiwan to elaborate the cumulative physiological costs – as reflected in biological markers of risk factors known to have adverse consequences for health – of challenge and unfavourable position in social hierarchies and networks. Overall, biological markers of risk among the elderly are similar in Taiwan and the United States. However, male and female Taiwanese elderly are at lower risk for illness associated with indicators of DHEA-S, while women are at higher risk for illness associated with elevated blood pressure, and men at lower risk for illness associated with total/HDL cholesterol, and glycosylated haemoglobin. There are strong and statistically significant effects of position in social hierarchy (education) and challenge (recent widowhood and a perception of high demands) on an index of cumulative risk (allostatic load). Membership in social networks and participation in social activities have expected, but not statistically discernible, effects.
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Rocque, Gabrielle B., Courtney P. Williams, Bradford E. Jackson, et al. "Choosing Wisely: Opportunities for Improving Value in Cancer Care Delivery?" Journal of Oncology Practice 13, no. 1 (2017): e11-e21. http://dx.doi.org/10.1200/jop.2016.015396.
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Introduction: Patients, providers, and payers are striving to identify where value in cancer care can be increased. As part of the Choosing Wisely (CW) campaign, ASCO and the American Society for Therapeutic Radiology and Oncology have recommended against specific, yet commonly performed, treatments and procedures. Methods: We conducted a retrospective analysis of Medicare claims data to examine concordance with CW recommendations across 12 cancer centers in the southeastern United States. Variability for each measure was evaluated on the basis of patient characteristics and site of care. Hierarchical linear modeling was used to examine differences in average costs per patient by concordance status. Potential cost savings were estimated on the basis of a potential 95% adherence rate and average cost difference. Results: The analysis included 37,686 patients with cancer with Fee-for-Service Medicare insurance. Concordance varied by CW recommendation from 39% to 94%. Patient characteristics were similar for patients receiving concordant and nonconcordant care. Significant variability was noted across centers for all recommendations, with as much as an 89% difference. Nonconcordance was associated with higher costs for every measure. If concordance were to increase to 95% for all measures, we would estimate a $19 million difference in total cost of care per quarter. Conclusion: These results demonstrate ample room for reduction of low-value care and corresponding costs associated with the CW recommendations. Because variability in concordance was driven primarily by site of care, rather than by patient factors, continued education about these low-value services is needed to improve the value of cancer care.
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Zuniga, Ruth, and Jerome M. Fischer. "Emotional Intelligence and Attitudes toward People with Disabilities: A Comparison between Two Cultures." Journal of Applied Rehabilitation Counseling 41, no. 1 (2010): 12–18. http://dx.doi.org/10.1891/0047-2220.41.1.12.
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The purpose of the study was to provide a framework for understanding the relationships among culture, emotional intelligence as measured by the Affective Response to Literature Survey (ARLS) and the Schutte Self-Report Inventory (SSRI), and attitude towards people with disabilities as measured by the Attitudes Toward Disabled Person Scale-Form A (ATDP-A). Results indicated significant (p < .01) differences among students' educational levels and their attitudes toward people with disabilities: Students with higher education levels reported higher ATDP-A scores. Costa Rican students scored significantly (p < .01) higher on the SSRI than students in the United States. In addition, significant (p < .01) differences were found between females from both groups and their male counterparts on the ARLS. Implications include the possibility of enhancing clients' emotional intelligence to assist in their coping and to increase individual's positive attitudes toward people with disabilities.
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Hu, Ming. "ASSESSMENT OF EFFECTIVE ENERGY RETROFIT STRATEGIES AND RELATED IMPACT ON INDOOR ENVIRONMENTAL QUALITY." Journal of Green Building 12, no. 2 (2017): 38–55. http://dx.doi.org/10.3992/1943-4618.12.2.38.
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1.0. INTRODUCTION In the United States, K–12 school buildings spend more than $8 billion each year on energy—more than they spend on computers and textbooks combined [1]. Most occupied older buildings demonstrate poor operational performance—for instance, more than 30 percent of schools were built before 1960, and 53 percent of public schools need to spend money on repairs, renovations, and modernization to ensure that the schools' onsite buildings are in good overall condition. And among public schools with permanent buildings, the environmental factors in the permanent buildings have been rated as unsatisfactory or very unsatisfactory in 5 to 17 percent of them [2]. Indoor environment quality (IEQ) is one of the core issues addressed in the majority of sustainable building certification and design guidelines. Children spend a significant amount of time indoors in a school environment. And poor IEA can lead to sickness and absenteeism from school and eventually cause a decrease in student performance [3]. Different building types and their IEQ characteristics can be partly attributed to building age and construction materials. [4] Improving the energy performance of school buildings could result in the direct benefit of reduced utility costs and improving the indoor quality could improve the students' learning environment. Research also suggests that aging school facilities and inefficient equipment have a detrimental effect on academic performance that can be reversed when schools are upgraded. [5] Several studies have linked better lighting, thermal comfort, and air quality to higher test scores. [6, 7, 8] Another benefit of improving the energy efficiency of education buildings is the potential increase in market value through recognition of green building practice and labeling, such as that of a LEED or net zero energy building. In addition, because of their educational function, high-performance or energy-efficient buildings are particularly valuable for institution clients and local government. More and more high-performance buildings, net zero energy buildings, and positive energy buildings serve as living laboratories for educational purposes. Currently, educational/institutional buildings represent the largest portion of NZE (net zero energy) projects. Educational buildings comprise 36 percent of net zero buildings according to a 2014 National New Building Institute report. Of the 58 net zero energy educational buildings, 32 are used for kindergarten through grade 12 (K–12), 21 for higher education, and 5 for general education. [9] Finally, because educational buildings account for the third largest amount of building floor space in the United States, super energy-efficient educational buildings could provide other societal and economic benefits beyond the direct energy cost savings for three reasons: 1) educational buildings offer high visibility that can influence community members and the next generation of citizens, 2) success stories of the use of public funds that returns lower operating costs and healthier student learning environments provide documentation that can be used by others, and 3) this sector offers national and regional forums and associations to facilitate the transfer of best design and operational practices.
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ALEXANDER, MARCUS. "Determinants of Social Capital: New Evidence on Religion, Diversity and Structural Change." British Journal of Political Science 37, no. 2 (2007): 368–77. http://dx.doi.org/10.1017/s000712340700018x.
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Americans not only bowl less today than they did fifty years ago, but also some bowl more than others. This is one of the major and simple messages of Robert Putnam's influential study of social capital in America. Using a variety of data sources, Putnam documents a significant variation in the states' levels of social capital, while arguing for specific general causes of the decline of social capital across the United States. Here, we evaluate the power of Putnam's theory in explaining state-level variation of stocks of social capital. We find that the strongest determinants of social capital levels are basic social and economic differences between states, such as education, church membership, farming and unemployment. Controlling for these determinants, we also find no evidence for a much-debated link between diversity and social capital.Since the publication of Putnam's book, a growing quantitative literature on social capital has contributed to a much more nuanced and theoretically precise understanding of the link between social capital and the quality of American democracy. Pamela Paxton, as well as Dora Costa and Matthew Kahn, have re-examined Putnam's finding of the aggregate decline in social capital in the United States since the 1960s. Putnam's claim that higher levels of social capital improve the functioning of democracy on the state level has been examined systematically by, among others, Stephen Knack and Tom W. Rice. On a methodological level, Eric M. Uslaner has argued for a need to disaggregate different concepts of trust, and focus on generalized social trust and its effect on making democracy more effective.
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Edward, Jean, Nageen Mir, Denise Monti, Enbal Shacham, and Mary C. Politi. "Exploring Characteristics and Health Care Utilization Trends Among Individuals Who Fall in the Health Insurance Assistance Gap in a Medicaid Nonexpansion State." Policy, Politics, & Nursing Practice 18, no. 4 (2017): 206–14. http://dx.doi.org/10.1177/1527154418759312.
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States that did not expand Medicaid under the Affordable Care Act (ACA) in the United States have seen a growth in the number of individuals who fall in the assistance gap, defined as having incomes above the Medicaid eligibility limit (≥44% of the federal poverty level) but below the lower limit (<100%) to be eligible for tax credits for premium subsidies or cost-sharing reductions in the marketplace. The purpose of this article is to present findings from a secondary data analysis examining the characteristics of those who fell in the assistance gap ( n = 166) in Missouri, a Medicaid nonexpansion state, by comparing them with those who did not fall in the assistance gap ( n = 157). Participants completed online demographic questionnaires and self-reported measures of health and insurance status, health literacy, numeracy, and health insurance literacy. A select group completed a 1-year follow-up survey about health insurance enrollment and health care utilization. Compared with the nonassistance gap group, individuals in the assistance gap were more likely to have lower levels of education, have at least one chronic condition, be uninsured at baseline, and be seeking health care coverage for additional dependents. Individuals in the assistance gap had significantly lower annual incomes and higher annual premiums when compared with the nonassistance gap group and were less likely to be insured through the marketplace or other private insurance at the 1-year follow-up. Findings provide several practice and policy implications for expanding health insurance coverage, reducing costs, and improving access to care for underserved populations.
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Hicks, Lisa, and Dan Schmidt. "The Healthy DiplomaTM and Healthy Titans: Two Innovative Campus Programs for Progressive Student, Profession, and Community Outcomes." Kinesiology Review 5, no. 4 (2016): 269–75. http://dx.doi.org/10.1123/kr.2016-0026.
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There is a tremendous need for wellness programming at all university levels as well as the United States as a whole. Healthy lifestyles benefit the workplace through lower healthcare costs, lower rates of injury and absenteeism, higher productivity, and improved morale and retention. This paper describes two innovative programs in higher education, the Healthy DiplomaTM and Healthy Titans, which are designed to improve the health and well-being of both students and employees. Two universities addressed the health and wellness of students (Healthy DiplomaTM) and employees (Healthy Titans) by utilizing the strengths of their respective kinesiology department students and faculty members. The Healthy DiplomaTM program was designed to lead university students to a healthy lifestyle while enhancing their postgraduation contributions as healthy entry-level employees. The Healthy Titans program was designed to provide University of Wisconsin Oshkosh employees and their families an affordable fitness program with an onsite clinical setting for kinesiology students to gain practical experience with fitness programming. Students were provided the opportunity to gain personal health and wellness skills and competencies, and practice their future profession in an applied, yet highly-supervised setting. Practitioners were provided current research and best profession practices. These two programs at two different universities further illustrate both the practicality and advantages of faculty and student collaborations for campus-wide wellness. Programs addressing wellness at the university level have demonstrated appropriateness as well as benefits for students, employees, and community members, and suggest expansion of similar programs to other university settings.
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White, Rebecca M. B., Katharine H. Zeiders, and M. Dalal Safa. "Neighborhood structural characteristics and Mexican-origin adolescents’ development." Development and Psychopathology 30, no. 5 (2018): 1679–98. http://dx.doi.org/10.1017/s0954579418001177.
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AbstractEthnic–racial and socioeconomic residential segregation are endemic in the United States, representing societal-level sociocultural processes that likely shape development. Considered alongside communities’ abilities to respond to external forces, like stratification, in ways that promote youth adaptive functioning and mitigate maladaptive functioning, it is likely that residence in segregated neighborhoods during adolescence has both costs and benefits. We examined the influences that early adolescents’ neighborhood structural characteristics, including Latino concentration and concentrated poverty, had on a range of developmentally salient downstream outcomes (i.e., internalizing, externalizing, prosocial behaviors, and ethnic–racial identity resolution) via implications for intermediate aspects of adolescents’ community participation and engagement (i.e., ethnic–racial identity exploration, ethnic–racial discrimination from peers, and school attachment). These mediational mechanisms were tested prospectively across three waves (Mage w1-w3 = 12.79, 15.83, 17.37 years, respectively) in a sample of 733 Mexican-origin adolescents (48.8% female). We found higher neighborhood Latino concentration during early adolescence predicted greater school attachment and ethnic–racial identity exploration and lower discrimination from peers in middle adolescence. These benefits, in turn, were associated with lower externalizing and internalizing and higher ethnic–racial identity resolution and prosocial behaviors in late adolescence. Findings are discussed relative to major guidelines for integrating culture into development and psychopathology.
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Noback, Peter C., Tess Dougherty, Christina Freibott, Eric F. Swart, Melvin P. Rosenwasser, and J. Turner Vosseller. "Measuring the Total Cost of Ankle Fractures: A Prospective Analysis." Foot & Ankle Orthopaedics 5, no. 4 (2020): 2473011420S0006. http://dx.doi.org/10.1177/2473011420s00065.
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Category: Trauma; Ankle Introduction/Purpose: Ankle fractures (AFx) are the most common foot and ankle fracture seen at hospitals in the United States, and are undoubtedly costly to patients. Quantification of the costs of fractures and their associated treatments has garnered increased attention in orthopedics in recent years through cost-effectiveness analysis. However, literature pertaining to AFx’s almost never reports on the indirect costs of AFx’s, and thus fails to accurately assess the true value of treatments. The purpose of this study was to prospectively assess the direct and indirect costs of AFx’s in operatively and nonoperatively treated patients. Secondary analysis included evaluation of the composition of indirect cost, the duration these costs are endured, and the factors that influence their magnitude. Methods: A prospective observational single-center study was performed. Adult patients presenting for initial consult for an AFx that could speak English or Spanish were enrolled. Polytrauma patients and those unable to provide complete indirect cost data were excluded. Patients completed a cost form that asked the money they had spent in the last week on transportation, household chores, and self-care due to their AFx. Patients were considered to have complete indirect cost data if they returned for follow-up visits until they reported no recurring indirect costs and had returned to work. Direct cost data was obtained directly from the hospital billing department. Amount collected was utilized. Direct costs included any costs incurred from staff treating the patient, supplies required for treatment, and the use of healthcare facilities. A descriptive analysis of the entire cohort and stratification by operative status was performed for the primary comparative analysis. Results: 60 patients were ultimately analyzed. Average age was 46.5 years. 55% were female. 10% of patients were diabetic. 17% smoked cigarettes actively. Weber A, B, and C fractures composed 12%, 72%, and 18% of fractures, respectively. Operatively treated patients (n=37) had a significantly higher total and direct cost than non-operative patients (P<0.01). Average salary of the 39 employed patients was $61,416 and return to work period was 11.2 weeks. In all patients, lost income accounted for the largest portion of total and indirect cost, averaging 38% of total cost. Longer periods of return to work were significantly associated with undergoing surgery and having less than a college-level education (P<0.05). Average number of weeks for indirect costs to amount to zero was 19.1. Conclusion: In patients treated operatively and nonoperatively, the largest cost component was an indirect cost: missed wages at 28.6% and 63.3%, respectively. While the majority of the direct costs of AFx’s are accrued in the period immediately following the injury, indirect cost components will regularly be incurred for nearly 5 months and often longer. The degree and duration to which these indirect costs accumulate are novel findings. Future research should no longer neglect reporting on an intervention’s impact on the indirect costs of AFx’s. [Table: see text]
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Wu, Janet, Kaitlyn R. Rivard, Elizabeth A. Neuner, et al. "1958. Assessment of Guideline-Concordant Antimicrobial Prescribing in Urgent Care Centers." Open Forum Infectious Diseases 6, Supplement_2 (2019): S62. http://dx.doi.org/10.1093/ofid/ofz359.135.
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Abstract Background In the United States in 2014, 266 million outpatient antibiotic prescriptions were dispensed. The Center for Disease Control and Prevention estimates that 30% of outpatient antibiotic prescriptions are inappropriate. These inappropriate prescriptions contribute to increased resistance, adverse events, and healthcare costs. Methods This was a retrospective study of patients presenting to 22 urgent care centers within a large healthcare system between September 1, 2018 and February 28, 2019. Data were collected from a dashboard designed to track antimicrobial prescribing data by indication, location, and provider. ICD-9 and -10 codes associated with otitis media, pharyngitis, sinusitis, cystitis, and upper respiratory infections (URI) were included. Guideline-concordant antimicrobial prescribing was determined based on compliance with national guideline recommendations, after taking patient allergies into account. The URI category includes disease states in which antimicrobials are rarely appropriate (e.g., acute rhinitis, nasopharyngitis, and acute bronchitis). Results A total of 57,799 encounters were included in this analysis (19,242 pediatric and 38,557 adult) and 60% of patients received an antibiotic prescription. Overall antimicrobial guideline concordance was higher in pediatrics (84%) than adults (62%). Rates of guideline-concordant antimicrobial selection are shown in Table 1. The most common guideline-discordant prescriptions were tetracyclines (39%), amoxicillin/clavulanate (26%), and macrolides (17%) in adult patients with sinusitis, pharyngitis, or otitis media. In pediatric patients, the most common discordant prescriptions were macrolides (32%), third-generation cephalosporins (30%), and amoxicillin/clavulanate (19%). Unnecessary antimicrobial prescribing for URI occurred in 23% of pediatric patients and 36% of adult patients. Conclusion Guideline-discordant antimicrobial prescribing is common in urgent care centers, particularly in adult patients. In addition to encouraging utilization of order sets, emphasis on education and feedback may be important to improve and sustain guideline-concordant prescribing rates and reduce prescribing for URI. Disclosures All Authors: No reported Disclosures.
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De Souza, Jonas A., Raymon Grogan, and Brisa Aschebrook-Kilfoy. "Financial toxicity in thyroid cancer: An analysis from the North American Thyroid Cancer Survivorship study." Journal of Clinical Oncology 34, no. 3_suppl (2016): 17. http://dx.doi.org/10.1200/jco.2016.34.3_suppl.17.
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17 Background: Financial toxicity (FTox) has been associated with worse health-related quality-of-life (HRQoL), compliance, and even survival in cancer patients (pts). Measuring FTox and understanding its predictors are of paramount importance when planning intervention strategies, the value of care, and healthcare policies. We report FTox and its predictors in a large cohort of thyroid cancer pts and survivors. Methods: Pts with thyroid cancer were surveyed in the North American Thyroid Cancer Survivorship Study. FTox was assessed by the previously validated COmprehensive Score for financial Toxicity (COST), as well as by questions related to financial distress (out-of-pocket costs, loss of income and bankruptcy). Data on sociodemographics, income, type of disease, length of diagnosis (LOD), and prior therapies were collected. Predictors of FTox were assessed in multivariate analyses, controlling for potential confounders, such as HRQoL (as measured by the thyroid cancer-specific City of Hope instrument), type of treatment received, and LOD. Results: 591 pts with thyroid cancer within the past 6 years were surveyed in 2 countries: 553 (93.5%) in the United States (U.S.), and 38 (6.5%) in Canada. Most were women (n = 518 pts, 88%). The median LOD was 857 days (range 105-2176 days), and 430 pts (72.8%) had papillary thyroid cancer. There were 61 pts (10.3%) with Stage IV, and 11 (1.9%) were on tyrosine kinase inhibitors. Overall, 234 pts (39.5%) stated that their out-of-pocket costs were higher than previously thought; 207 pts (35%) felt their disease resulted in loss of income; 44 pts (7.4%) were unable to meet their monthly expenses; and 7 pts (1.2%) declared bankruptcy after diagnosis. The median COST value was 24 (range 0-44). In multivariate analyses, the independent predictors of worse FTox were lower income (p < 0.001), female gender (p = 0.01), lower educational level (p = 0.002), healthcare delivery in the U.S., (p = 0.002), and worse HRQoL (p < 0.001). Conclusions: A significant proportion of thyroid cancer pts experience FTox. We identified pts characteristics (gender, education, income), as well as geographical differences (healthcare delivery in the U.S.) as predictors of FTox.
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Meh, Catherine, Jasmeet Gill, and Danny H. Kim. "Comparison of Skin Cancer Knowledge, Attitude, and Protective Behavior in African American Students in East and West Coasts." Californian Journal of Health Promotion 11, no. 3 (2013): 25–35. http://dx.doi.org/10.32398/cjhp.v11i3.1539.
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Purpose and Background: African Americans, in comparison to other ethnic groups, are often diagnosed with melanoma at advanced stages, resulting in low survival rates. One of the strongest risk factors for all types of skin cancer is exposure to UV radiation from the sun. UV ray intensity is associated with latitude; lower latitudes have stronger UV rays than higher latitudes. This study examines and compares the knowledge, attitude, and protective behavior toward skin cancer among United States African American college students who live in two different latitudes, Maryland and southern California. Methods: We surveyed 360 African American students from two major universities in southern California and Maryland. Students were asked to fill out questionnaires that assessed their knowledge, attitude, and protective behavior regarding sun exposure. Results: More African American students from Maryland knew the direct link between UV/sun radiation exposure and the occurrence of skin cancer (p = 0.02), while those from California were significantly more knowledgeable about skin cancer risk factors such as sunbathing without sunscreen (p ? 0.001). Although students from Maryland were more concerned that exposure to the sun may give them skin cancer (p = 0.003) and more worried about the possibility of skin cancer (p < 0.001), they were less likely to engage in sun protection behaviors such as using sunscreen (p = 0.001). Conclusion: Based on this study, efforts to increase sun protective behaviors through education regarding skin cancer risk factors in Maryland are warranted.
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Parikh, Divya Ahuja, Meera Vimala Ragavan, Sana Khateeb, and Manali I. Patel. "Financial toxicity among veterans with cancer." Journal of Clinical Oncology 37, no. 27_suppl (2019): 103. http://dx.doi.org/10.1200/jco.2019.37.27_suppl.103.
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103 Background: Financial toxicity of cancer care has not previously been studied within the Veterans Health Administration (VHA). The VHA provides health care for veterans in VA hospitals across the United States (US). It is a single-payer system and the largest integrated health system in the US and in this study we sought to assess financial toxicity experienced by veterans at a VA hospital. Methods: We asked veterans with oncology clinic visits at the VA Palo Alto to complete a survey that included an 11-item validated questionnaire called the COST tool. The COST tool calculates a score 0-44 with higher scores suggestive of higher financial toxicity. We also assessed demographic factors including gender, education, race, income, and insurance status as well as monthly out of pocket costs (OOPC) and suggested resources to reduce burden. We coded responses and calculated descriptive statistics with proportions. Results: A total of 84 veterans completed the survey and demographic factors are depicted in Table. Veterans were predominantly male (96%), high school or less educated (46%), white (61%), with annual income less than $50,000 (81%), and VA insurance (95%). The mean COST score was 21. The majority of veterans (63%) reported less than $100 of monthly OOPC and many (56%) reported transportation as a major expense and requested transportation resources. Conclusions: Financial toxicity is an unmet concern among veterans. Despite low monthly OOPC in the VHA single-payer system, financial toxicity as measured by the COST score at a VA hospital was as high as a nearby academic center. Transportation was the most significant expense and future studies should evaluate interventions to reduce the financial burden of transportation for veterans. [Table: see text]
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Bjarnadottir, Ragnhildur, and Robert Lucero. "AN INNOVATIVE DATA-DRIVEN FALL PREVENTION COMMUNICATION TOOL FOR ADMINISTRATORS, NURSE MANAGERS, AND STAFF NURSES." Innovation in Aging 3, Supplement_1 (2019): S332. http://dx.doi.org/10.1093/geroni/igz038.1208.
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Abstract Falls are the leading cause of injury among older adults, resulting in 3 million emergency department visits and 800,000 hospitalizations each year in the United States alone. In the hospital setting, falls are among the most common adverse events, causing longer stays and higher costs of care. Substantial efforts have been made to reduce falls in the past decade but with limited sustained effect. This may in part be due to limitations of existing tools for fall-risk assessment and evidence-based fall prevention. Therefore, there is a need to strengthen the evidence on risk factors for hospital-acquired falls and address barriers to translating the best available evidence into practice. To this end, we undertook the development of an innovative dissemination tool to implement fall-related evidence generated through state-of-the-art data science and information visualization approaches. Through a multidisciplinary academic-clinical partnership, we have developed an infographic to disseminate empirical evidence to nurses and administrators in the hospital setting. The infographic was developed based on principles of user-centered design and persuasive communication, and focuses on providing clear and accessible information about factors contributing to a patients’ risk of falling in the hospital. This innovative dissemination approach is intended to foster dialogue between administrators, mid-level nursing management and staff nurses as well as evidence-based practice at the bedside. Future use and evaluation of this fall prevention tool will focus on adapting the infographic as an interactive digital tool for education and engagement of patients and families in the hospital setting.
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Assari, Shervin. "Parental Educational Attainment and Mental Well-Being of College Students: Diminished Returns of Blacks." Brain Sciences 8, no. 11 (2018): 193. http://dx.doi.org/10.3390/brainsci8110193.
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Background. According to the Minorities’ Diminished Returns (MDR) theory, the health returns of socioeconomic status (SES) are systemically smaller for Blacks compared to Whites. Less is known, however, about trans-generational aspects of such diminished gains. For example, the differential impact of parental educational attainment on differences in mental well-being between White versus Black college students remains unknown. Aims. With a national scope, this study explored racial differences in the effect of parental educational attainment on the mental well-being of college students in the United States. Methods. The Healthy Mind Study (HMS), 2016–2017, is a national telephone survey that included 41,898 college students. The sample was composed of Whites (n = 38,544; 92.0%) and Blacks (n = 3354; 8.0%). The independent variable was highest parental educational attainment. The dependent variable was mental well-being (mentally healthy days in the past month) which was measured using a single item. Age and gender were covariates. Race was the moderator. Logistic regression was used for data analysis. Results. In the pooled sample, high parental educational attainment was associated with better mental wellbeing, independent of race, age, and gender. Race, however, showed a significant interaction with parental educational attainment on students’ mental wellbeing, indicating a smaller effect of parent education on the mental wellbeing of Black compared to White college students. Conclusions. The returns of parental educational attainment in terms of mental well-being is smaller for Black college students compared to their White counterparts. To minimize the diminished returns of parental education in Black families, policies should go beyond equalizing SES and reduce the structural barriers that are common in the lives of Black families. Policies should also aim to reduce extra costs of upward social mobility, prevent discrimination, and enhance the quality of education for Blacks. As the mechanisms that are involved in MDR are multi-level, multi-level solutions are needed to minimize the racial gaps in gaining mental health benefits from higher socioeconomic levels.
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Barker, A., K. Verhoeven, M. Ahsan, et al. "ID: 25: SOCIAL DETERMINANTS OF PATIENT ANTIBIOTIC MISUSE IN HARYANA, INDIA." Journal of Investigative Medicine 64, no. 4 (2016): 935.1–935. http://dx.doi.org/10.1136/jim-2016-000120.49.
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BackgroundAntibiotic resistance is recognized globally as an urgent health crisis. Multidrug resistant organisms lead to deadly hospital and community acquired infections and complicate patients' underlying health issues. In the United States, antibiotic resistance causes 23,000 deaths and direct healthcare costs of $20 billion a year. In the developing world, the costs are estimated to be even higher. In India alone, antibiotic resistance is responsible for an estimated 58,000 infant deaths annually. While its severity is agreed upon, the causes and solutions to antibiotic misuse are complex. Antibiotic dispensing laws are poorly enforced in many developing nations, including India. Patient and provider contributions are intertwined, thus confronting the problem requires a better understanding of the motivations of several populations.MethodsWe conducted a mixed methods study in the northern state of Haryana, India, between June and August 2015. We qualitatively assessed the antibiotic knowledge and use practices of 20 local community members using semi-structured interviews. We also completed 64 surveys of community members and healthcare workers. Both populations were given the same survey, which focused on the participant's experience obtaining antibiotics as a patient. The interviews and surveys were conducted in English and Hindi, as applicable, by bilingual members of the research team. Interview data was coded for themes using NVivo software, and quantitative survey responses were analyzed in SAS. We used DAGitty software to construct a directed acyclic graph to determine the minimally sufficient adjustment sets needed to block confounders of the relationship between antibiotic knowledge and antibiotic misuse.ResultsOver a third of survey participants reported antibiotic misuse, defined as purchasing medication from a pharmacy without a doctor's prescription (36.5%). Furthermore, none of the 20 community member interviewees were able to correctly define antibiotics without prompting. The interviews also revealed that limited health education, inadequate access to a doctor, and poverty all influence patients' antibiotic decision making. Participants with these characteristics were more likely to bypass doctors and seek medical care directly from a pharmacist.The effect of antibiotic knowledge on antibiotic misuse was significant in our pilot survey data, even after adjusting for the variables in the minimally sufficient adjustment set: first vs. fourth quartile of knowledge, OR=72.09, p=0.014; second vs. fourth quartile, OR=44.09, p=0.006. The covariates in the model include age, income, healthcare occupation, education, having a doctor in the family, and having access to a doctor in your local community.DiscussionThis study highlights the need for public health education regarding antibiotics and the extensive health implications of their misuse. Local and national governments should consider social factors when enacting future antibiotic policies.
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Manjila, Sunil, Gagandeep Singh, Ayham M. Alkhachroum, and Ciro Ramos-Estebanez. "Understanding Edward Muybridge: historical review of behavioral alterations after a 19th-century head injury and their multifactorial influence on human life and culture." Neurosurgical Focus 39, no. 1 (2015): E4. http://dx.doi.org/10.3171/2015.4.focus15121.
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Edward Muybridge was an Anglo-American photographer, well known for his pioneering contributions in photography and his invention of the “zoopraxiscope,” a forerunner of motion pictures. However, this 19th-century genius, with two original patents in photographic technology, made outstanding contributions in art and neurology alike, the latter being seldom acknowledged. A head injury that he sustained changed his behavior and artistic expression. The shift of his interests from animal motion photography to human locomotion and gait remains a pivotal milestone in our understanding of patterns in biomechanics and clinical neurology, while his own behavioral patterns, owing to an injury to the orbitofrontal cortex, remain a mystery even for cognitive neurologists. The behavioral changes he exhibited and the legal conundrum that followed, including a murder of which he was acquitted, all depict the complexities of his personality and impact of frontal lobe injuries. This article highlights the life journey of Muybridge, drawing parallels with Phineas Gage, whose penetrating head injury has been studied widely. The wide sojourn of Muybridge also illustrates the strong connections that he maintained with Stanford and Pennsylvania universities, which were later considered pinnacles of higher education on the two coasts of the United States.