Poverty,social disadvantage,and the black/white placement gap

In this paper, we examine whether county-level measures of poverty and social disadvantage are correlated with county-level variation in the black/white foster care placement gap. The black/white placement gap refers to the fact that when the rate of placement into foster care for black children is compared to the rate for white children living in the same area, the black placement rate is almost always higher than the rate for whites. Although differential exposure to poverty is often used to explain why the placement gap is so large, the problem has rarely been studied. Using Poisson event count models, we find that poverty, measured at the county ecological level, is associated with a narrower gap rather than a wider gap. The counterintuitive finding is due to the fact that the relationship between poverty and placement rates depends on race.     

Personalisation,social justice and social work: a reply to Simon Duffy

This paper begins by defining what is meant by adolescence and reviewing the literature which indicates concern for the high rates of suicidal behaviour in adolescence. Possible explanations as to why adolescents harm themselves are considered, as is the contagious aspect of some suicidal behaviours. Extracts from three interviews conducted with young women in residential care who have engaged in self-harming behaviours are then considered. Links are made between what they say and relevant theory. The paper goes on to discuss the impact of suicidal behaviour in residential care settings. It concludes that it is essential to create time and space to think carefully about this complex and multi-faceted difficulty both for the adolescents themselves and those in the caring professions charged with the responsibility of trying to help them.     

Ethnicity, Marginalisation and Mental Illness in Hawaii

This study examines the characteristics, treatment and care of severely and persistently mentally ill patients at Hawaii's largest public sector psychiatric facility, Hawaii State Hospital. The implications of this information are then discussed, in terms of treatment and care. Consistent with previous studies, the 88 patients included in this study were most often male, less than 40 years of age, with a high school education or less, and hospitalized under a penal code. More remarkable variations were revealed, however, when patients were grouped according to ethnicity and racial origin. For example, patients from marginalised groups had a significantly higher likelihood of violence than patients from more politically, economically and socially powerful groups in Hawaii. The findings of this research challenge health care providers in general, and nurses in particular, to combine social advocacy with clinical expertise to ensure that patients receive effective and complete treatment and care.     

Health Insurance and Risk of Divorce: Does Having Your Own Insurance Matter?

Most American adults under 65 obtain health insurance through their employers or their spouses' employers. The absence of a universal health care system in the United States puts Americans at considerable risk for losing their coverage when transitioning out of jobs or marriages. Scholars have found evidence of reduced job mobility among individuals who are dependent on their employers for health care coverage. In this study, the author found similar relationships between insurance and divorce. She applied the hazard model to married individuals in the longitudinal Survey of Income Program Participation (N = 17,388) and found lower divorce rates among people who were insured through their partners' plans without alternative sources of their own. Furthermore, she found gender differences in the relationship between health care coverage and divorce rates: Insurance‐dependent women had lower rates of divorce than men in similar situations. These findings draw attention to the importance of considering family processes when debating and evaluating health policies.     

Nativity,Duration of Residence,Citizenship, and Access to Health Care for Hispanic Children

This article examines differences in access to a regular source of health care for children of Hispanic subgroups within the United States. Particular attention is paid to the impact of the immigration status of the mother – including nativity, duration in the United States, and citizenship status – and its affect on access to health care for Hispanic children. Data are pooled from the National Health Interview Survey for 1999–2001 and logistic regression models are estimated to compare Mexican American, Puerto Rican, Cuban, and Other Hispanic children with non‐Hispanic whites and blacks. While initial disparities are recorded among the race/ethnic groups, in the final model, only Mexican American children display significantly less access to health care than non‐Hispanic whites. The combined influence of the mother's nativity, duration, and citizenship status explains much of the differentials in access to a regular source of care among children of Hispanic subgroups in comparison to non‐Hispanic whites.     

Alternative Practicum in Health Education

Abstract

Young African American men in the inner city have higher rates of mortality and morbidity from potentially preventable causes than other American men of the same age. They suffer disproportionately high rates of preventable illness from violence, sexually transmitted diseases, and HIV infection. These young men present with problems related to sexual concerns, mental health issues, substance abuse, and violence. They also report substantial risk-taking behaviors, including unprotected sex, substance use, and weapon carrying, as well as exposure to violence. Access to and use of preventive primary care services has been limited for these patients in the past because of financial barriers and competing social issues. Racism and historical oppression have created barriers of mistrust for young men of color. Factors that contribute to their adverse health status, as well as ways to address these problems, are discussed.     

Settlement has many faces: physicians, attorneys and medical malpractice

We conduct an analysis of the jurisdictional dispute over the management of medical malpractice lawsuits, focusing on the process through which liability is defined. We utilize a North Carolina sample of physicians who have been sued, their defense counsel, and counsel for the plaintiff in the case. A comparison of the perspectives of these three parties reveals that over half of the physicians who settle perceive themselves as not liable. Defense counsel are more adept at predicting both negotiated resolutions and whether or not money will be paid than either plaintiffs' counsel or physicians. Almost two-thirds of physicians who thought they were not liable expressed a desire for vindication. Almost half the time when the physicians denied liability money was nonetheless paid to resolve the claim. Physician responses to the outcome of their cases focus on the need for reform, especially in terms of a call for peer or expert review. We identify and discuss culture conflict between law and medicine. For lawyers "settlement" is not a negative thing, but for physicians it implies fault. We challenge existing literature which analyzes the settlement of medical malpractice claims solely in terms of rational economic models, and we argue that social psychological variables are equally important.     

Primary care for young African American men

Young African American men in the inner city have higher rates of mortality and morbidity from potentially preventable causes than other American men of the same age. They suffer disproportionately high rates of preventable illness from violence, sexually transmitted diseases, and HIV infection. These young men present with problems related to sexual concerns, mental health issues, substance abuse, and violence. They also report substantial risk-taking behaviors, including unprotected sex, substance use, and weapon carrying, as well as exposure to violence. Access to and use of preventive primary care services has been limited for these patients in the past because of financial barriers and competing social issues. Racism and historical oppression have created barriers of mistrust for young men of color. Factors that contribute to their adverse health status, as well as ways to address these problems, are discussed.     

"Macho men" and preventive health care: implications for older men in different social classes

The gender paradox in mortality--where men die earlier than women despite having more socioeconomic resources--may be partly explained by men's lower levels of preventive health care. Stereotypical notions of masculinity reduce preventive health care; however, the relationship between masculinity, socioeconomic status (SES), and preventive health care is unknown. Using the Wisconsin Longitudinal Study, the authors conduct a population-based assessment of masculinity beliefs and preventive health care, including whether these relationships vary by SES. The results show that men with strong masculinity beliefs are half as likely as men with more moderate masculinity beliefs to receive preventive care. Furthermore, in contrast to the well-established SES gradient in health, men with strong masculinity beliefs do not benefit from higher education and their probability of obtaining preventive health care decreases as their occupational status, wealth, and/or income increases. Masculinity may be a partial explanation for the paradox of men's lower life expectancy, despite their higher SES.     

Lessons on social and health disparities from older lesbians with alcoholism and the role of interventions to promote culturally competent services

ABSTRACT

Older adults who are lesbian, gay, bisexual, or transgender (LGBT) face greater health risks and possibly more costly care because of their reluctance to seek out health and long-term care services because of limited cultural sensitivity of service providers. This is particularly evident in older lesbians who face substantial risk of health problems associated with alcoholism and are less likely to be open with health care providers because of stigma combined with feelings of alienation, stress, and depression. An estimated 4.4 million older adults are predicted to have problems with alcohol by 2020, and the rates of alcohol-related hospitalizations are similar to those for heart attacks, creating exorbitant medical costs. More culturally competent health and long-term care may reduce health care costs by effectively addressing the dynamics of alcoholism, aging, and lesbian culture. Training initiatives such as those developed by the National Resource Center on LGBT Aging have begun to address the need of a more culturally competent aging services network. This article provides exemplars from empirical data on older lesbians with alcoholism to highlight some of the health, economic, and social disparities experienced in the aging LGBT community. Current interventions in the form of cultural competence training for service providers are presented as a potential step toward addressing health disparities among LGBT older adults.     

Psychotherapy dropouts: differences by modality, license, and DSM-IV diagnosis

Dropouts are frequent in mental health care. Several client factors have been identified as dropout predictors, including ethnic minority status, race, low SES, and more severe symptoms. Research on therapist and process variables is less common, and findings are inconsistent. This study used administrative data for 434,317 patients from CIGNA Behavioral Health (CIGNA) to examine dropout rates by profession of provider, therapy modality, and DSM-IV diagnosis. Results indicate that among the providers, MFTs have the lowest dropout rates in the CIGNA network. Of the therapy modalities, individual therapy is associated with lower dropout rates than family therapy. Mood and anxiety disorders have lower dropout rates than other diagnosis categories, while schizophrenia, psychotic, and substance use disorders have the highest dropout rates.     

Racial Disparities in Hospital Length of Stay for Asthma: Implications for Economic Policies

Asthma is one of the most common health burdens on American families. An understanding of how the costs of asthma are distributed across communities is essential to realizing cost savings from preventative care. We model the household’s utilization of hospital services using Grossman’s health production framework. We then test for differences in asthma-related hospitalizations by race using inpatient records from the Massachusetts Division of Health Care Finance. On average black and nonwhite-Hispanic patients stayed between one-third and one-fourth of a day less than similar white patients which translates into a difference in expenditures of $8 million over 1994–2002. The difference in expenditures raises questions for market-based methodologies to value health and for policies directed at reducing inequalities in health outcomes.     

Community,Family, and Race/Ethnic Differences in Health Status in Rural Areas1

Abstract Many race-specific differences in health outcomes that have been observed in previous research have been attributed to class and racebased group differences which either facilitate or constrain health opportunities and behaviors. These include such variables as different rates of poverty, health insurance coverage, and access to medical care. However, these relationships have been inadequately examined in rural communities where minority status may be even more detrimental to health than in urban areas, due to various constraints on access to health care. We present an analysis that assesses the effects of community, family structure, sociodemographic, and medical care variables on self-reported health status among Hispanics, Mrican Americans, and non-Hispanic whites in six rural communities in Florida. Community structural characteristics had a significant effect on self-reported health, as did some of the measures of how respondents “experience” community. These relationships held even when other sets of variables were added to the models. Family/household characteristics and sociodemographic and medical care variables were less important in explaining self-reported health status. These findings suggest that community continues to be important in explaining differences in health status in rural areas.     

Evidence-based practice in family group decision-making for Anglo, African American and Hispanic families

This study addresses the need and gap in the literature on evidence-based practice in family group decision-making services by reporting on the Texas Department of Family and Protective Services' Family Group Decision-Making study, conducted between December 2003 and July 2005 with Anglo, African American and Hispanic families throughout Texas. These services are compared to standard practice by assessing satisfaction, child well-being and exits from care. Findings indicate that both parents and relatives are more satisfied with family group decision-making conferences than standard practice on a number of dimensions, with relatives reporting feeling more empowered than parents. Children are reported to be less anxious if their families participate in a conference, and they may be more adjusted when they are placed with relatives following a conference. Finally, exits from care are faster if families participate in family group decision-making conferences, and exits to reunification are increased; this may be especially true of African American and Hispanic children.     

Extended Family Integration Among Euro and Mexican Americans: Ethnicity,Gender, and Class

This article compares the extended family integration of Euro and Mexican American women and men and assesses the importance of class and culture in explaining ethnic differences. Using National Survey of Families and Households II data (N = 7,929), we find that ethnic differences depend on the dimension of integration. Mexican Americans exhibit higher rates of kin coresidence and proximity, but lower rates of financial support than Euro Americans. Two additional differences exist only among women: Mexican American women are more likely than Euro American women to give household or child care help. As to the explanation for these differences, social class is the key factor; cultural variables have little effect. Our findings support a theoretical framework attending to intersections among ethnicity, gender, and class.     

Parity getting worse,not better: Milliman report

Medical and behavioral (addiction and mental health) care are further apart now than they were two years ago, according to a study published by Milliman Inc. last week. The report, commissioned by the Bowman Family Foundation, shows that the gap for employees and their families between mental/addiction care and medical/surgical care is widening. The report, Addiction and Mental Health vs. Physical Health: Widening Disparities in Network Use and Provider Reimbursement, is based on actual claim data in 50 states for 37 million employees and their dependents.     

INDIVIDUAL WELFARE WHEN CONSUMERS CAN SHOP FOR HEALTH INSURANCE

The statewide system of health insurance exchanges established by the Affordable Care Act (ACA) of 2010 will allow millions of U.S. citizens to change their health care policies more easily than they can switch automobile or homeowner insurance coverages, because deniability based on prior claim history is illegal. Focusing on this consumer endogeneity of health insurance policy choice, we examine the individual moral hazard welfare implications of a reduction in the price of medical care, which is a potential consequence of the ACA. We show that endogenous policy choice plays a key role in determining the welfare outcome. While moral hazard welfare improvement is not precluded, a distinctly possible outcome is that the consumer revises his/her choice of insurance policy so as to retain some portion of the reduction in expenditure risk caused by the medical care price decrease. In this event, moral hazard welfare loss is higher than it was before the price decrease, although the increased loss is tempered by the endogenous contract choice effect. This result resuscitates an old conventional wisdom. (JEL I11, I13, I30)     

The effect of social anxiety,generalized anxiety,depression and substance abuse on child support payment compliance among non-custodial parents

Millions of children live with custodial parents (CPs) who have child support court orders for the non-custodial parent (NCP) to provide payments to the CP for care of the children. Unfortunately, less than half of CPs receives full child support. A key issue influencing the failure to pay child support is NCP unemployment. Despite a clear association between unemployment and several mental disorders, the nature and prevalence of mental disorders has not been investigated in the NCP population. The purpose of this study was to explore the association between mental health and substance use problems among non-custodial parents and their payment of child support. The study also investigated whether unemployment mediated the relationship between these variables.Surveys that included validated screening instruments to assess for generalized anxiety, social anxiety, depression, and substance use disorders were administered to a convenience sample of 633 NCPs. Survey respondents were matched with state support payment information.The results indicated that depression, generalized anxiety, social anxiety and substance use problems were present at a much higher rate than 12-month rates of these conditions found in the general population. This study also confirmed the strong association between child support payments and employment. Employment mediated the relationship between mental health problems and child support payments. The findings suggest that non-compliant NCPs, particularly those who are also unemployed, may experience clinically significant mental health conditions that contribute to unemployment and potentially, payment non-compliance. Future studies could explore if providing mental health assessment and employment-focused treatment for mental health-related barriers to employment may increase employment and child support compliance for NCPs, thereby improving children's economic stability and well-being.     

Health care consolidation and the changing health care marketplace. A review of the literature and issues

This Issue Brief examines the academic literature and issues in consolidation of the hospital sector in the context of responses to changes in the competitive environment. It analyzes the motivations for consolidation as well as its effects. Hospital merger activity has increased dramatically in recent years. The current wave of mergers is primarily a reaction to a competitive environment that is placing a greater emphasis on controlling costs and forcing high-cost providers out of the market. The growth of managed care has placed considerable pressure on providers of health care and, in particular, on hospitals. The evolution of insurance companies' behavior helps explain the recent hospital consolidation movement. As managed care has become the dominant type of coverage in the last decade, insurance companies have become more active in trying to control costs--a reversion to their previous practices before the advent of managed care. Insurance companies have placed cost constraints on providers, both in the early years of health insurance and currently, when there are strong competitive forces. Hospitals claim that their primary merger motives are improving efficiency and the quality of care. The empirical evidence on this claim is mixed. Vertical integration (between suppliers and buyers of health care services, such as between hospitals and physicians) has appealed to hospitals because of their need to obtain more patients. More research is needed to explore the effects of vertical integration in the health care sector. In one of the more significant recent legal rulings, the U.S. Justice Department lost a 1997 case challenging the merger of two hospitals in the New York City metropolitan area. This, along with other recent losses by the antitrust authorities, does not bode well for the government's ability to prevent hospital mergers in metropolitan areas. It is difficult to generalize on an appropriate antitrust policy for hospital mergers. Hospital consolidation is likely to continue at a rapid pace. Since some developments may reduce the cost of employee benefits while others may increase the cost of these benefits, the final effect on the provision of health care benefits by employers is uncertain. Employers must pay close attention to the hospital consolidation movement because it will lead to important changes in the provision of health care benefits.