Comparison of health care utilization: United States versus Canada.

Objective: To compare health care utilization between Canadian and U.S. residents.

The role of local food availability in explaining obesity risk among young school-aged children.

In recent years, research and public policy attention has increasingly focused on understanding whether modifiable aspects of the local food environment - the types and composition of food outlets families have proximate access to - are drivers of and potential solutions to the problem of childhood obesity in the United States. Given that much of the earlier published research has documented greater concentrations of fast-food outlets alongside limited access to large grocery stores in neighborhoods with higher shares of racial/ethnic minority groups and residents living in poverty, differences in retail food contexts may indeed exacerbate notable child obesity disparities along socioeconomic and racial/ethnic lines. This paper examines whether the lack of access to more healthy food retailers and/or the greater availability of "unhealthy" food purveyors in residential neighborhoods explains children's risk of excessive weight gain, and whether differential food availability explains obesity disparities.

Social-emotional effects of early childhood education programs in Tulsa.

This article assesses the effects of Tulsa, Oklahoma's early childhood education programs on social-emotional outcomes, examining teacher ratings of children's behavior from the Adjustment Scales for Preschool Intervention and a measure of attentiveness using fixed effects regressions with propensity score matching. The sample includes 2,832 kindergarten students in 2006, of whom 1,318 participated in the Tulsa Public Schools (TPS) pre-K program and 363 participated in the CAP of Tulsa County Head Start program the previous year. Program participation was associated with lower timidity and higher attentiveness for TPS pre-K alumni and a marginally significant reduction in timidity for Head Start alumni.

From science to policy in early childhood education.

This paper examines the relationship between scientific research and public policy. After explaining why the simple conversion of research into public law is unlikely, several factors are identified that can promote the use of research by public officials. Examples of use and non-use are cited from early childhood education, where empirical evidence on program effects is relatively strong.

Comparing and decomposing differences in preventive and hospital care: USA versus Taiwan.

As the USA expands health insurance coverage, comparing utilization of healthcare services with countries like Taiwan that already have universal coverage can highlight problematic areas of each system. The universal coverage plan of Taiwan is the newest among developed countries, and it is known for readily providing access to care at low costs. However, Taiwan experiences problems on the supply side, such as inadequate compensation for providers, especially in the area of preventive care.

How the Affordable Care Act can help move States toward a high-performing system of long-term services and supports.

The United States may advance toward a high-performing health care system that offers long-term services and supports for people with disabilities and chronic conditions, or it may retreat from gains achieved in recent years. Since the 1980s, policy makers and advocates for the disabled have sought to move from a system that emphasizes nursing homes and institutional care to one that includes a broader range of care options. The Affordable Care Act of 2010 gives this movement a considerable boost by offering states timely new options and enhanced federal funding to create a care system that meets the diverse needs and preferences of people with disabilities and that also recognizes the role of family caregivers.

The effects of the National School Lunch Program on education and health.

This paper estimates the effects of participating in the National School Lunch Program in the middle of the 20th century on adult health outcomes and educational attainment. I utilize an instrumental variables strategy that exploits a change in the formula used by the federal government to allocate funding to the states. Identification is achieved by the fact that different birth cohorts were exposed to different degrees to the original formula and the new formula, along with the fact that the change of the formula affected states differentially by per capita income.

Effect of physician ownership of specialty hospitals and ambulatory surgery centers on frequency of use of outpatient orthopedic surgery.

Background: Physician-owned specialty hospitals and ambulatory surgery centers have become commonplace in many markets throughout the United States. Little is known about whether the financial incentives linked to ownership affect frequency of outpatient surgery.

Objective: To evaluate if financial incentives linked to physician ownership influence frequency of outpatient orthopedic surgical procedures.

Racial/Ethnic Differences in Breastfeeding Initiation and Duration Among Low-income, Inner-city Mothers.

OBJECTIVES: Despite the promotion of breastfeeding as the "ideal" infant feeding method by health experts, breastfeeding continues to be less common among low-income and minority mothers than among other women. This paper investigates how maternal socio-demographic and infant characteristics, household environment, and health behaviors are related to breastfeeding initiation and duration among low-income, inner-city mothers, with a specific focus on differences in breastfeeding behavior by race/ethnicity and nativity status. METHODS: Using data from a community-based, longitudinal study of women in Philadelphia, PA (N=1,140), we estimate logistic regression and Cox proportional hazard models to predict breastfeeding initiation and duration.

Diversion, transition programs target nursing homes' status quo.

As millions of Americans age and exercise their preference for long-term care in the least restrictive environment, policymakers search for ways to increase community-based services. A new federal program--Money Follows the Person--is off to a slow but promising start. The program's "downstream" approach moves residents out of nursing homes and into community care settings.

Partners in solutions to the nurse faculty shortage.

The looming shortage of nurses and the faculty to educate them threatens Americans' access to quality health care across all settings. The Robert Wood Johnson Foundation (RWJF), the American Association of Retired Persons (AARP) Foundation, and AARP are joining together to raise the level of awareness of this crisis and solutions to resolve it in a sustained way. These leaders in health and social change created the Center to Champion Nursing in America (the Center) to ensure Americans have the highly skilled nurses we need to provide affordable, quality health care now and in a reformed health care system.

The nursing workforce in long-term care.

Nurses play an essential role in long-term care (LTC). They can and should do more to create the kind of services and supports that people seek for themselves and for their families. To provide this crucial leadership, nurses must understand and advocate the array of services and programs that fall within the term "LTC," including, but not limited to, "nursing home care.

Preparing for climate change: a perspective from local public health officers in California.

Background: The most recent scientific findings show that even with significant emission reductions, some amount of climate change is likely inevitable. The magnitude of the climate changes will depend on future emissions and climate sensitivity. These changes will have local impacts, and a significant share of coping with these changes will fall on local governmental agencies.

Controlling the escalating use of advanced imaging: the role of radiology benefit management programs.

Since the late 1990s, the use of advanced diagnostic imaging modalities has increased by double-digit rates, outpacing the rate of increase of medical spending overall. In an attempt to assure the appropriate use of advanced imaging procedures, private insurers are increasingly contracting with radiology benefit management programs (RBMs) to reduce overall use and expenditures for radiology services. This article describes the services offered by RBMs and then presents trends in utilization of advanced imaging procedures from three health plans that adopted RBM prior authorization protocols.

The international migration of nurses in long-term care.

This article describes five major factors that are affecting patterns of international migration among nurses who work in long-term care settings: DEMOGRAPHIC DRIVERS: The aging of the populations in developed countries and the low to negative growth in the working-age population will increase the demand for international workers to provide long-term care services. GENDER AND RACE: A dual labor market of long-term care workers, increasingly made up of women of color, is becoming internationalized by the employment of migrating nurses from developing countries. CREDENTIALING: The process of credentialing skilled workers creates barriers to entry for migrating nurses and leads to "decredentialing" where registered nurses work as licensed practical nurses or aides.

Do financial incentives linked to ownership of specialty hospitals affect physicians' practice patterns?

Background: Although physician-owned specialty hospitals have become increasingly prevalent in recent years, little research has examined whether the financial incentives linked to ownership influence physicians' referral rates for services performed at the specialty hospital.

Objective: We compared the practice patterns of physician owners of specialty hospitals in Oklahoma, before and after ownership, to the practice patterns of physician nonowners who treated similar cases over the same time period in Oklahoma markets without physician-owned specialty hospitals.

Research Design: We constructed episodes of care for injured workers with a primary diagnosis of back/spine disorders.

Accidents, claiming, and regional subcultures: are medical errors and malpractice lawsuits related to social capital?

Method: This study examined states' performance on Patient Safety Indicators (PSIs), statistics on malpractice lawsuits, and analogous data on automobile accidents to identify state-level patterns in safety and claiming.

Results: Hospital safety varied in a pattern similar to highway safety on the state level, suggesting that cultural traits may play a greater role than differences in legal or other environmental factors. States performing well or poorly in hospital and driver safety tended to correspond with states grouped together in regional culture typologies developed by Elazar and Lieske.

Role of state policies in the adoption of naltrexone for substance abuse treatment.

Objective: To examine state policies associated with adoption of a pharmaceutical agent-naltrexone-by substance abuse treatment facilities to treat alcohol-dependent clients.

Data Sources: Facility-level data from the 2003 National Survey of Substance Abuse Treatment Services, and state-level data on policy and environmental factors from publicly available sources.

Study Design: We use facility- and state-level data in a cross-sectional, multilevel model to analyze state-level policies that are associated with treatment facilities' naltrexone adoption.

Utilization trends for advanced imaging procedures: evidence from individuals with private insurance coverage in California.

Background: Recent reports by the Medicare Payment Advisory Commission have highlighted sharp increases in the use of advanced diagnostic imaging procedures among the Medicare fee-for-service population. Little research has examined whether such trends also exist among persons with generous private insurance coverage. Moreover, research documenting changes in the share of utilization linked to self-referral is nonexistent.

The Healthy People 2010 outcomes for the care of children with special health care needs: an effective national policy for meeting mental health care needs?

Objectives: To assess the effectiveness of the Maternal and Child Health Bureau's (MCHB) Six Core Outcomes for children with special health care needs (CSHCN) as indicators in measuring the degree to which mental health care needs are met.

Methods: This study analyzes data from the 2001 National Survey of Children with Special Health Care Needs for 9,748 CSHCN who needed mental health care. Bivariate and logistic analyses were employed to investigate the impact of the MCHB's Six Core Outcomes on the probability of having an unmet need for mental health services.

Does the private sector care about AIDS? Evidence from firm surveys in East Africa.

Objective: Our objective was to identify the determinants of HIV/AIDS prevention activity and pre-employment health checks by private firms in Kenya, Uganda and Tanzania.

Design: We used data from the World Bank Enterprise Surveys for Uganda, Kenya and Tanzania, encompassing 860 formally registered firms in the manufacturing sector.

Methods: Econometric analysis of firm survey data was used to identify the determinants of HIV/AIDS prevention including condom distribution and voluntary counselling and testing (VCT).