Health Expenditure Efficiency in the Commonwealth of Independent States: A Data Envelopment Analysis Approach

Efficiency of expenditure in health sector for the Commonwealth of Independent States is addressed in this paper. The efficiency frontier is built applying Data Envelopment Analysis methodology. Quantity inputs and expenditure measures are used to determine the efficiency outcomes and to detect some sources of inefficiency. The paper proves that the efficiency of expenditure on health varies significantly between these countries. Computing relative efficiency for each country the most efficient and inefficient cases are identified. The results derived herein may provide some insights into relative efficiencies among the Commonwealth of Independent States member countries in provision of health services.     

Do Nonprofits Treat Their Employees Differently? Incentive Pay and Health Benefits

We examine how nonprofit, public, and for‐profit establishments vary in the provision of health benefits and insurance and performance‐based incentives using the 2002 National Organization Survey of establishments in the United States. We found that in comparison to for‐profit firms, both nonprofit and public organizations are less likely to use performance‐based incentives, although they provide their employees with better health benefits and insurance. Sectoral differences in the provision of health benefits and insurance and use of performance‐based incentives persist after controlling for correlates of sector that predict these outcomes, including establishment size, independence of establishment, market competition, establishment age, and unionization. We also found trade‐offs between the provision of health benefits and insurance and use of performance‐based incentives. Our results are generally consistent with the prediction from agency theory and also consistent with a view that public and nonprofit organizations are more concerned with the well‐being of their employees.     

THE RISE OF SERVICES,DEINDUSTRIALIZATION, AND THE LENGTH OF ECONOMIC RECOVERY

Economic recovery is longer in service‐providing economies than in goods‐producing economies. Services cannot be produced and inventoried ahead of demand; goods can. We are the first to document this macroeconomic repercussion of the sectoral shift away from the secondary sector toward the tertiary sector, that is, of deindustrialization and the rise of services. We distinguish between nontradable services and all other sectors, using U.S. state‐level employment data for post‐1960 recessions. Concerns over the endogeneity of services are addressed in two ways: by using 3‐year pre‐recession averages of sector shares, and separately by invoking instrumental variables. Our results are robust to alternative specifications. The increase in service production and deindustrialization in the United States over the last half‐century lengthens the trough‐to‐peak employment recovery from recessions by about 40%. (JEL E24, E32, L80, N12)     

Occupational Channels for Mexican Migration: New Destination Formation in a Binational Context

In the 1990s, Mexican immigration dispersed spatially, leading to the emergence of many “new destinations,” in nonmetropolitan areas of the United States. Previous studies constrain the scope of the analysis to the United States, limiting our understanding of how new destinations are formed. We place new destination formation into a binational context and emphasize the role of supply‐side immigration dynamics. We argue that occupations in Mexico provide ready‐made paths, or “channels,” for economic incorporation into the United States and that these channels underlie the formation of many new destinations. Using a unique data set on Mexican migration, we estimate a multivariate model that tests for the presence of occupational channels linking analogous sectors of the U.S. and Mexican economies, focusing especially on the food‐processing sector. The results demonstrate that Mexican migration is strongly channeled along occupational lines. There are occupational channels linking each of the major economic sectors in Mexico and the United States, but the effect of channeling is particularly strong in the food‐processing sector. By empirically identifying the existence of occupational channels, this study uncovers a key explanation of new destination formation in many nonmetropolitan areas.     

Gendered,Invisible Work in Non‐profit Social Service Organizations: Implications for Worker Health and Safety

Nonprofit organizations (NPOs) play an important role in the provision of health and social services. In Canada the nonprofit sector includes 7.5 million volunteers and employs over 1.6 million paid workers. The sector is overwhelmingly female‐dominated — women make up over 80 per cent of workers in these nonprofit services. Work performed by women has traditionally been undervalued and invisible. It has often been considered safe by researchers, employers, policymakers and sometimes even workers themselves. Although there is some indication that jobs in the restructuring social services sector can be characterized by constant demand, high stress and violence, research into the working conditions and health hazards of these types of jobs has not been a priority. Using data from a qualitative study examining work in NPOs, we trace the ways that work performed in these workplaces is both gendered and invisible. We identify three types of invisible labour. ‘Background work’ facilitates and supports more visible and recognized organizational activities. Certain organizational language obscures the full spectrum of work that takes place in the organizations and the risks it may involve. ‘Empathy work’ includes the relationship building, counselling and crisis intervention that comprise key components of social service delivery. ‘Emotional labour’ involves the management of client emotions and workers' own emotions in the process of working with clients and delivering care under conditions of scarcity and contraction. The invisibility of these activities means that much of the day‐to‐day work done in the organizations, while particularly important in the context of social service restructuring, is taken‐for‐granted and undervalued by organizational outsiders. As a result, many of the hazards present in the jobs are hidden from view and workers' health may be compromised. We argue that the invisibility and taken‐for‐grantedness of certain types of work in NPOs is reflected in, and constitutive of, particular exclusions and shortcomings of current occupational health and safety systems designed to protect the health of workers.     

Evidence from the field: Findings on issues related to planning,implementing and evaluating gender-based programs

An Initiative of the United States Department of Health and Human Services’ Office on Women's Health (OWH), Coalition for a Healthier Community (CHC), supports ten grantees across the U.S. in the implementation of gender-based health interventions targeting women and girls. A national evaluation is assessing whether gender-focused public health systems approaches are sustainable and cost effective in addressing health disparities in women and girls. To inform the evaluation, a systematic examination was conducted of literature in both the public and private sector designed to track, assess, understand, and improve women's health, public health systems approaches, and the cost-effectiveness and sustainability of gender-based programs. A two-person team assured the quality of the results following the review of abstracts and full-text articles. Of 123 articles meeting eligibility criteria (See inclusion criteria described in Section 2.2 below), only 18 met inclusion criteria specific to a focus on a systems approach, cost-effectiveness and/or sustainability. Studies assessing systems approaches suggested their effectiveness in changing perceptions and increasing knowledge within a community; increasing involvement of local decision-makers and other community leaders in women's health issues; and increasing community capacity to address women and girls’ health. Further evaluation of the cost-effectiveness and sustainability of gender-based approaches is needed.     

The role of evidence in nutrition policy‐making in Ethiopia: Institutional structures and issue framing

Malnutrition is the single greatest contributor to the global burden of morbidity and mortality, with most cases arising in low‐ and middle‐income countries. However, the multi‐sectoral nature of nutrition policy‐making adds considerable complexity to the implementation of effective programmes. This raises questions about why or how relevant policy change can come about within different country settings. This article examines multi‐sectoral nutrition policy‐making from the health sector perspective, specifically focusing on different sectoral perspectives and the role and use of evidence within this. Ethiopia provides a unique example of the challenging nature of multi‐sectoral nutrition policy‐making, even with a strong co‐ordinating infrastructure. In December 2014 we undertook 23 in‐depth semi‐structured interviews with stakeholders from key health sector organizations, along with a related documentary analysis. Participants represented a diverse range of perspectives, including government representatives, policy stakeholders, aid providers from multi‐lateral organizations and academic researchers. Our respondents described how nutrition framing in Ethiopia is changing, with greater consideration of overweight, obesity and non‐communicable diseases, as well as undernutrition and micronutrient deficiencies. However, overweight‐ and obesity‐related concerns are still less evident in key documents. Some health actors described the challenge of enacting structural policy changes when doing so requires engagement from the agriculture sector. While multi‐sectoral plans and infrastructure to address malnutrition are in place, respondents suggested that the mandate for addressing nutrition resting with the health sector was reinforced by the nature of evidence collected. This study of nutrition policy‐making in Ethiopia highlights the complex interaction of evidence within different conceptualisations of policy problems and responses. Despite Ethiopia's strategic framework and its progress in achieving terms of nutrition targets, it shares the challenge of countries elsewhere in addressing nutrition as a multi‐sectoral issue.     

HAS WAL‐MART BURIED MOM AND POP?: THE IMPACT OF WAL‐MART ON SELF‐EMPLOYMENT AND SMALL ESTABLISHMENTS IN THE UNITED STATES

This paper explores the widely accepted view that Wal‐Mart causes significant harm to the traditional, small “mom and pop” business sector of the U.S. economy. We present the first rigorous econometric investigation of this issue by examining the rate of self‐employment and the number of small employer establishments using both time series and cross‐sectional data. We also examine alternative measures and empirical techniques for robustness. Contrary to popular belief, our results suggest that the process of creative destruction unleashed by Wal‐Mart has had no statistically significant long‐run impact on the overall size and profitability of the small business sector in the United States. (JEL L81, D59, C21)     

Explaining the Mexican‐American Health Paradox Using Selectivity Effects

While typically socioeconomically disadvantaged, Mexican migrants in the United States tend to have better health outcomes than non‐Hispanic whites. This phenomenon is known as the “Hispanic health paradox.” Using data from Mexico and the United States, we examine several health outcomes for non‐Hispanic whites and Mexicans in the United States and in Mexico and employ Blinder–Oaxaca decompositions to help explain the paradox. We find evidence that selectivity is playing a significant role in the relatively healthy status of Mexican migrants in the United States. More importantly, there is evidence that health selectivity is a complex process and its effects typically do not work the same way for different health conditions and across genders. We also find evidence that some of migrants' health advantages are lost as they spend more time in the United States.     

Millennium Development Goal Achievements and Policies in Education and Health: What Has Been Learnt?

This article reviews the effectiveness and efficiency of key policy instruments for MDG (Millennium Development Goals) achievement, focusing on the role of demand‐ and supply‐side factors in education and health‐service utilisation. It comes to the following conclusions. First, specific policy interventions can have a considerable impact on social‐service utilisation. Second, demand‐side policies have proved extremely effective in the education sector, but may need more consideration in the health sector. Third, policy effectiveness and efficiency are highly dependent on initial conditions and the specificities of the respective policy. Fourth, complementarities between MDG targets are likely to be very important.     

Diaspora and Health? Traditional Medicine and Culture in a Mexican Migrant Community

As members of the Mexican diaspora acculturate/assimilate to life in the United States they gain skills that help them improve their socioeconomic status and overcome barriers to the mainstream American healthcare system. Thus, we might expect better health among more acculturated Mexicans. However, most of the research conducted during the past 20 years shows that the health of Mexicans living in the United States deteriorates as acculturation increases. This suggests that certain health promoting aspects of Mexican culture are lost as migrants adapt to and adopt American ways of life. This paper is the first step in testing the hypothesis that declining health among acculturated people of Mexican descent is related to a loss of traditional medical knowledge. During an ethnographic study of women’s medical knowledge in an unacculturated Mexican migrant community in Athens, Georgia, I observed many ways low‐income, undocumented migrants maintain good health. Migrant women encourage health‐promoting behaviors and treat sick family members with a variety of home remedies that appear to be effective according to chemical and pharmacological analyses. Additionally, migrant women in Athens learn how to navigate the American medical and social service systems and overcome barriers to professional healthcare services using information provided through social networks. Nevertheless, migrant women often prefer to treat sick family at home and indicated a preference for Mexican folk medicines over professional medical care in most situations. This case study suggests that migration and diaspora need not always lead to disease. The maintenance of a Mexican culture that is distinct from the rest of American society helps ensure that traditional medical knowledge is not lost, while the social networks that link Mexicans to each other and to their homeland help minimize threats to health, which are usually associated with migration. Thus, increased access to professional medical care may not improve the health of migrants if it comes with the loss of traditional medical knowledge.     

Does Life in the United States Take a Toll on Health? Duration of Residence and Birthweight among Six Decades of Immigrants

We used data from the 1998–2009 waves of the National Health Interview Survey to investigate cohort differences in low birthweight among US‐born children of mothers arriving in the United States between 1955 and 2009, cohort‐adjusted patterns in low birthweight by maternal duration of residence in the United States, and cohort‐adjusted patterns in low birthweight by maternal duration of US residence stratified by age at arrival and region of origin. We found a consistent deterioration in infant health with successive immigrant cohorts and heterogeneous effects of cohort‐adjusted duration in the United States by age at arrival and region. Most notably, we found evidence that maternal health (as proxied by low birthweight) deteriorates with duration in the United States only for immigrant mothers who came to the United States as children. For mothers who arrived as adults, we found no evidence of deterioration. The findings underscore the importance of considering age at arrival and place of origin when studying post‐migration health trajectories and provide indirect evidence that early life exposures are a key to understanding why the United States lags other developed nations in health.     

Are We at the Cutting Edge or the Blunt Edge?: Improving NGO Organizational Performance with Private and Public Sector Strategic Management Frameworks

Bankruptcy or irrelevance are likely paths for not‐for‐profit organizations (NGOs) that do not reshape themselves to achieve greater impact, efficiency, and accountability in an increasingly global, competitive environment. But how relevant are public and private sector management frameworks for NGO repositioning? This article provides initial answers through a case study of CARE, one of the largest international relief and development nonprofit organizations in the United States. It explores the transformation frameworks employed at CARE between 1992 and 1997, assesses what worked and what did not, and identifies initial lessons learned for the broader sector.     

Like Oil and Water in the American West: Water Market Access amid Unconventional Oil Production in Colorado

Characterized as a “wicked” problem, water shortage in the American West will soon become a reality—due to increasing population, climate change, and decreased flows. Concurrently, water‐centered technologies such as hydraulic fracturing and directional drilling have facilitated the rapid and widespread growth of unconventional oil and gas (UOG) production in the United States. Water markets are increasingly touted as the best, most efficient, and fairest mechanisms for allocating vital and scarce resources. Yet this contention is largely unexplored at the food‐energy‐water nexus, particularly from an environmental justice perspective—where equitable water access for all users is a central concern. We utilize a case study in Colorado's South Platte basin based on 41 in‐depth interviews to show: (1) distortions created in regional water markets as wealthy UOG operators participate in them and (2) ways in which access to water markets becomes blocked for smaller, newer, or water‐poor water users. We also highlight how UOG producers’ presence may inhibit the formation of alternative systems for water exchange. Thus, the participation of UOG operators in Colorado's water markets appears to drive environmental injustice and increased inequity at the food‐energy‐water nexus, rather than facilitating fair or efficient access to water for all users.     

The World Bank,Organized Hypocrisy,and Women's Health: A Cross‐National Analysis of Maternal Mortality in Sub‐Saharan Africa

The theory of organized hypocrisy asserts that an organization depends upon its external environment for both financial support and conferred legitimacy, which can lead to conflicting policy agendas. We apply the theory of organized hypocrisy to World Bank structural adjustment and investment lending for reproductive health, hypothesizing these two lending policies should have differential effects on maternal mortality. We estimate a two‐way fixed effects regression model with robust standard errors clustered by country to examine the effect of World Bank reproductive health lending on maternal mortality within sub‐Saharan African nations over the period 1990–2010. We find that in every model the coefficients for World Bank structural adjustment lending in the health sector are positive and significant while the coefficients for World Bank investment lending in the reproductive health sector are negative and significant. The findings lend support to the theory that the World Bank is pursuing contradictory agendas, embodied by its lending policies, which can have differential effects on maternal mortality.     

The Role of Job Insecurity in Explanations of Racial Health Inequalities

The literature documenting substantial health differences for racial minorities in the United States is well developed and has considered a multitude of explanations for such disparities. However, the literature seldom addresses the health effects for racial minorities produced in the workplace. This study bridges these two literatures in order to understand the mediating role of job insecurity in explanations of racial health disparities. Our central argument is that racial differences in job insecurity resulting from the marginalized labor market positions of racial minorities are partially responsible for racial disparities in health. This study utilizes adjacent category and partial adjacent category logit models of general health using data from the 2000 to 2010 General Social Survey in order to test this claim. Overall, the results from this study indicate that there are substantial racial differences in job insecurity, and both race and job insecurity are important predictors of general self‐rated health. Additionally, racial differences in job insecurity help explain a portion of the racial disparities in health. We conclude with a discussion of the implications for the study of health disparities in the United States.     

Nativity,Duration of Residence,and the Health of Hispanic Adults in the United States1

This article examines subgroup differences in the health status of Hispanic adults in comparison to non‐Hispanic whites and non‐Hispanic blacks. We pay particular attention to the influences of nativity and duration of residence in the United States. Data are pooled from the National Health Interview Survey (NHIS) for 1989–94. Puerto Ricans exhibited the worst health outcomes of any group (including whites and blacks) for each of the three health measures. Persons of Central/South American origin exhibited the most favorable outcomes for activity limitations and bed sick days, advantages that were eliminated when controlled for nativity/duration. For two of the three health status variables, Mexican Americans were very similar to non‐Hispanic whites in baseline models and were more favorable than non‐Hispanic whites once socio‐economic factors were controlled; this was not the case, however, for self‐reported overall health. Immigration also helped to explain the relatively positive outcomes among Central/South American origin individuals, Cubans, and Mexican Americans. For most Hispanic groups (as well as non‐Hispanic whites and non‐Hispanic blacks), immigrants reported better health than the U.S. born, which is consistent with a selectivity hypothesis of immigrant health. In addition, this advantage tended to be significantly smaller among immigrants with ten or more years' duration in the United States. Although the latter finding is consistent with the negative acculturation hypothesis, alternative interpretations, including the generally more limited access of immigrants to the formal health care system, are suggested.     

What to Do with the Informal Sector?

Almost all informal firms in the Kenyan manufacturing sector are managed by Kenyans of African origin. Formal enterprises are run by Kenyans of both African and Asian origin. These three groups are distinct in terms of experience, productivity and access to finance. Asian formal firms are the most efficient, while there is no significant productivity difference between informal and formal African firms. There are thus weak incentives for African informal firms to become formal. At the same time, Kenya needs higher investments and larger exports to achieve economic take‐off, and this can only be achieved through an efficient formal sector. Therefore policy should aim to integrate the sectors by improving infrastructure, capacity‐building, credit delivery, and supporting networks.     

The Rapid Rise of Supermarkets in Central and Eastern Europe: Implications for the Agrifood Sector and Rural Development

During the 1990s transition period in Central and Eastern Europe, the retail sector was privatised and some domestic‐capital supermarket chains gradually emerged. Massive inflows of foreign direct investment followed and competitive domestic investments drove a rapid take‐off of large‐format modern retail sector development from a tiny ‘luxury’ niche of around 5% of food retail in the mid‐1990s to 40–50% by 2003 in ‘firstwave’ and 20–40% in ‘second‐wave’ countries. In ‘third‐wave’ countries like Russia, it is still only 10% but growing very fast. In most countries there is rapid multi‐nationalisation and consolidation of the supermarket sector, with profound changes in procurement systems affecting the conditions facing farmers, and creating important opportunities and challenges.     

Marital Quality,Gender, and Markers of Inflammation in the MIDUS Cohort

Marital quality is an important factor for understanding the relationship between marriage and health. Low‐quality relationships may not have the same health benefits as high‐quality relationships. To understand the association between marital quality and health, we examined associations between two indicators of marital quality (marital support and marital strain) and two biomarkers of inflammation (interleukin‐6 and C‐reactive protein) among men and women in long‐term marriages using data from the Survey of Midlife in the United States (N = 542). Lower levels of spousal support were associated with higher levels of inflammation among women but not men. Higher levels of spousal strain were weakly and inconsistently associated with higher levels of inflammation among women and men; the effects were diminished with the addition of psychosocial and behavioral covariates. These findings suggest marital quality is an important predictor of inflammation, especially among women.