Insights into the black box of child care supply: Predictors of provider participation in the Massachusetts child care subsidy system

The United States child care subsidy system relies on the voluntary participation of private providers in the market in order for low-income families to access otherwise unaffordable care. However, with few states able to pay child care providers subsidy payment rates at market value (National Women's Law Center, 2015) and increasing pressure for providers to improve their quality of care (Child Care and Development Fund [CCDF] Program, 2016), there is concern at the federal level regarding the supply of providers willing to participate in the subsidy system (CCDF Program, 2016; Schumacher, 2015). Using administrative data from Massachusetts, this study examines the factors associated with provider participation in the child care subsidy system. Findings from logistic regression analyses indicate that lower administrative capacity, higher private pay prices (in comparison to the subsidy payment rate), and higher local market household income may limit or reduce opportunities for participation in the subsidy system. Results also suggest that for-profit providers are not avoiding participating in the subsidy system, but may find participation challenging if subsidy payment rates are too low (compared to private pay prices). Additionally, although the total pool of accredited providers is small, accredited providers have greater odds of participation compared to non-accredited providers, indicating that families may have some access to quality care. These findings suggest that states should focus on identifying 1) ways to ease administrative impediments to entry into the subsidy system, 2) effective provider recruitment tactics, and 3) monetary/non-monetary incentive structures that can build a large and diverse supply of high quality subsidized care.     

Sources,Providers and Self-Reported Complications among Indian Women Seeking Induced Abortion: Evidence from the National Family Health Survey (2015–16)

Abstract

This article attempts to find types of sources and providers, and likelihood of self-reported complication among Indian women. Fifty-three percent of abortions are done at private health facilities. Only one in every 5 women went to public health facilities, and the rest did not go anywhere (27.5%). Doctors are the major abortion service providers (52.3%) in India. Eighteen percent of women who sought abortion reported some complication. Logit regression shows that complications were 1.8 times higher in the second-trimester than the first-trimester abortion. This study suggests for addressing the demand of abortion by accessing and improving services in public health system.     

The Centers for Medicare and Medicaid Services' Nursing Home Case-Mix and Quality Demonstration: a descriptive overview

This paper presents the first comprehensive account of a major national demonstration designed to integrate skilled nursing facilities (SNF) prospective case-mix payment and quality of care. It describes the Centers for Medicare and Medicaid Services' Nursing Home Case-Mix and Quality (NHCMQ) Demonstration-the template for Medicare's SNF Prospective Payment System (PPS) implemented July 1998. The NHCMQ Demonstration provided the basis for one of the most significant changes in SNF reimbursement and quality monitoring policies to date. Prospective reimbursement policies created positive incentive for providers to admit Medicare residents under more equitable payment rates. However, controversy regarding unanticipated perverse provider incentives remains. The quality management system designed under the NHCMQDemonstration is currently used in over 17,000 nursing homes. Furthermore, under the NHCMQ Demonstration, one standardized assessment tool-the MDS-was used to assess a resident's clinical condition, to monitor quality, and to calculate provider reimbursement. Experiences from the NHCMQ Demonstration and continued evaluation of the current national PPS, along with state systems, provide a rich information source regarding prospective, case-mix reimbursement, and provider incentives.     

The interplay of public and private spaces in internet access

The creation of public internet access facilities is one of the principal policy instruments adopted by governments in addressing 'digital divide' issues. The lack of plans for ongoing funding, in North America at least, suggests that this mode is regarded mainly as transitional, with private, home-based access being perceived as superior. The assumption apparently is that as domestic internet penetration rates rise, public access facilities will no longer be needed. Central to this issue are the varied characteristics of publicly provided and privately owned access sites and their implications for non-employment internet activities. What are the relative advantages and disadvantages of these two access modes? More fundamentally, how do people conceptualize public and private spaces and how does this perception influence their online activities? Finally, why do people choose one over the other, and how do they navigate between the two? This article attempts to answer these questions by drawing on data generated within the Everyday Internet Project, a 'neighborhood ethnography' of internet usage. It argues that the conventional view of private and public access facilities as immiscible, fixed alternatives is inadequate. Rather than 'pure' types, they are better understood as offering hybrid spaces whose identity and character are fluid, perceived differently by individuals in light of the activities being performed, life experiences, infrastructure and architecture. The picture emerging from our study is one where public and private access modes intertwine with each other in a variety of ways, their combination offering significant additional value for many users. From a public policy perspective, these findings suggest that if universal access is to be achieved, there is a continuing need for publicly supported broad-spectrum facilities with integrated technical support and learning opportunities, even if domestic penetration rates approach that of the telephone.     

Faith-Based Programs and the Role of Empirical Research

Abstract

After some decades of being subject to neglect or contempt, faith-based social care programs are receiving increased attention and resources enabling them to undertake a greater role in the national network of human services. Faith-based programs receiving public support can expect to be rightly scrutinized by the public, in terms of their ability to attain professed program goals. The tools of conventional empirically-oriented program evaluation research have tremendous potential to help demonstrate the effectiveness of faith-based programs, which will justify their receipt of ongoing support from public funds. Negative research findings can be properly scrutinized by the faith-based community of service providers to help make tough, data-based, decisions on funding priorities. Several examples are described, illustrating how various types of faith-based programs have profitably participated in program evaluation studies.     

The Centers for Medicare and Medicaid Services' Nursing Home Case-Mix and Quality Demonstration

Abstract

This paper presents the first comprehensive account of a major national demonstration designed to integrate skilled nursing facilities (SNF) prospective case-mix payment and quality of care. It describes the Centers for Medicare and Medicaid Services' Nursing Home Case-Mix and Quality (NHCMQ) Demonstration—the template for Medicare's SNF Prospective Payment System (PPS) implemented July 1998. The NHCMQ Demonstration provided the basis for one of the most significant changes in SNF reimbursement and quality monitoring policies to date. Prospective reimbursement policies created positive incentive for providers to admit Medicare residents under more equitable payment rates. However, controversy regarding unanticipated perverse provider incentives remains. The quality management system designed under the NHCMQ Demonstration is currently used in over 17,000 nursing homes. Furthermore, under the NHCMQ Demonstration, one standardized assessment tool—the MDS—was used to assess a resident's clinical condition, to monitor quality, and to calculate provider reimbursement. Experiences from the NHCMQ Demonstration and continued evaluation of the current national PPS, along with state systems, provide a rich information source regarding prospective, case-mix reimbursement, and provider incentives.     

AIDS education and prevention programs for intravenous drug users: the California experience

The state of California, pursuant to 1985 legislation, established the California AIDS Program (CAP) within the state Office of AIDS. As part of this program, the Office of AIDS contracts with public and private agencies to provide AIDS education to specific target groups throughout the state. Intravenous drug users (IVDUs) constitute one of the target populations singled out for special attention by the state. This article, based on a statewide evaluation, describes the AIDS education programs for IVDUs funded by the Office of AIDS. The types of educational interventions used are presented, both for IVDUs in treatment and those not in treatment. The unique problems in reaching this target population are also discussed. The article concludes that the state is making a good effort to reach IVDUs, but that further educational and evaluative efforts are needed. Specifically, the individual educational programs must move beyond the transmission and evaluation of cognitive knowledge about AIDS to an assessment of the attitudes that impede behavior change.     

Four criteria to evaluate providers' service-delivery response to new contraceptive introduction

This article presents an evaluation framework developed to assess the first-level effects of introducing the Standard Days Method (SDM) in Peru Ministry of Health clinics. Four questions are asked: 1) To what extent do providers routinely achieve SDM service delivery standards? 2) Is the time invested in SDM delivery consistent with program norms? 3) How does SDM delivery compare with delivery of established methods? and 4) How does SDM introduction affect delivery of established methods? A study at 62 clinics demonstrated the framework's usefulness. The Standard Days Method introduction had positive overall effects on the quality of care but provider training needed adjustments.     

Breastfeeding interventions in Kansas: A qualitative process evaluation of program goals and objectives

Across the state of Kansas, eighteen public health departments received funding through the 2011 Breastfeeding Grant Initiative to start a breastfeeding intervention. The main objective of this study was to evaluate the progress toward program goals and objectives. This study was a process evaluation. Qualitative data were collected from recipient health departments at two time-points during the program year. Structured, open-ended questions were asked through telephone interviews. This study examined: (1) progress toward program goals and objectives, (2) problems encountered during implementation, and (3) evaluation measures employed to assess program impact. All health departments reported making significant progress toward program goals and objectives and reported successful collaboration with other healthcare providers. The use of breast pumps, educational classes, and professional training of staff were reported as providing the best outcome in the promotion of breastfeeding. The majority of respondents did not measure program impact. From a public health perspective, it is important that infants receive breast milk for the first six months of life. It appears that goals and objectives set a priori guided health departments with the administration of their breastfeeding program. Results may be used to enhance and sustain delivery of breastfeeding support programs in Kansas communities.     

Provider and care workforce influences on quality of home-care services in England

A key trend in home care in recent years in England has been movement away from "in-house" service provision by local government authorities (e.g., counties) towards models of service commissioning from independent providers. A national survey in 2003 identified that there were lower levels of satisfaction and perceptions of quality of care among older users of independent providers compared with in-house providers. This paper reports the results of a study that related service users' views of 121 providers with the characteristics of these providers. For the most part, characteristics associated with positive perceptions of quality were more prevalent among in-house providers. Multivariate analyses of independent providers suggested that aspects of the workforce itself, in terms of age and experience, provider perceptions of staff turnover, and allowance of travel time, were the most critical influences on service user experiences of service quality.     

Replacing revolving door: a collaborative approach to treating individuals in crisis

The Crisis Assessment and Psychiatric Emergency Services (CAPES) unit was designed to improve the quality of psychiatric treatment, contain costs, and provide relief to overburdened psychiatric inpatient and emergency services in Delaware. This innovative program is the result of collaboration between public and private agencies to treat individuals in crisis. The myriad factors that contributed to a broken system and instigated Delaware's search for a solution are discussed in this article. The CAPES unit has resulted in improved communication among providers, decreased committal rates, better linkage to appropriate levels of care, increased safety, and improved coordination of services. Clinical implications for nursing practice include providing more holistic care in a safer environment.     

The operations and effectiveness of public and private provision of solid waste collection services in Kampala

This paper compares the operations and discusses the effectiveness of public and private sector provision of solid waste collection in Kampala, Uganda. Household data suggest that the private sector is more effective than the public sector. Private sector companies provide services like container provision and providing timely and fixed collection time tables. Contrary to popular perception, fees charged by private companies are moderate. Public sector clients are charged fees even when the service is supposed to be free. Clients of private sector providers are more satisfied than those of public sector providers. It is however, revealed that while public sector serve mainly the low incomes, the private sector serves mainly the rich. In spite of these notable differences, clients of both public and private sector perceive the problem of solid waste management (SWM) in Kampala to be very serious. The effectiveness of public and private sector operations in solid waste collection in Kampala is hampered by corruption and lack of transparency. Given the situation of open competition for clients involving both public and private sector in Kampala, it is possible the public sector can operate effectively if they start commercial services officially like their private sector counterparts. This calls for a formal public-private partnership where the public and private sector can work together with the public sector dominating poor and marginalized areas while the private sector concentrates on rich neighborhoods.     

Social distance and patients' rating of healthcare providers

Racial inequity in the provision of healthcare is widely recognized. In this paper, I assess the role of social distance from healthcare providers in accounting for whites' higher rating of healthcare providers. Using data from the Detroit Area Study, I test whether having higher socioeconomic status, like most healthcare providers, and racial concordance with healthcare provider account for the gap in satisfaction between whites and African Americans. I find that socioeconomic status and racial concordance variables account for a portion of whites' higher rating of the respect shown by their healthcare provider. Racial differences in evaluation of time spent with healthcare provider are accounted for by socioeconomic status, but not racial concordance. As researchers explore the causes of and remedies for the racial disparity in use and evaluation of healthcare, the subtle and indirect effects of race on the patient-healthcare provider relationship must be considered.     

Provider and Care Workforce Influences on Quality of Home-Care Services in England

Abstract

A key trend in home care in recent years in England has been movement away from “in-house” service provision by local government authorities (e.g., counties) towards models of service commissioning from independent providers. A national survey in 2003 identified that there were lower levels of satisfaction and perceptions of quality of care among older users of independent providers compared with in-house providers. This paper reports the results of a study that related service users views of 121 providers with the characteristics of these providers. For the most part, characteristics associated with positive perceptions of quality were more prevalent among in-house providers. Multivariate analyses of independent providers suggested that aspects of the workforce itself, in terms of age and experience, provider perceptions of staff turnover, and allowance of travel time, were the most critical influences on service user experiences of service quality.     

Evaluation of a cross-sector community initiative partnership: Delivering a local sport program

Corporate community initiatives (CCI) are often established via cross-sector partnerships with nonprofit agencies to address critical social problems. While there is a growing body of literature exploring the effectiveness and social impact of these partnerships, there is a limited evaluative research on the implementation and execution processes of CCIs. In this paper, we examined the implementation and operational processes in the delivery of a professional sport organization's CCI initiative using program theory evaluation. The findings showed discrepancies between the associate organization and the implementers regarding understanding and fulfilling responsibilities with performing certain aspects (maintaining accurate records and program marketing) of the service delivery protocol. Despite program stakeholders being satisfied overall with the program delivery, contradictions between program stakeholders’ satisfaction in the quality of program delivery was found in critical components (marketing and communications) of the service delivery. We conclude that ongoing evaluations are necessary to pinpoint the catalyst of the discrepancies along with all partners valuing process evaluation in addition to outcome evaluation.     

Vertical axes on the long-term care continuum: a comparison of board and care and assisted living

As the continuum of long-term care has expanded, public funding has not accompanied new care options. I detail access, provider profits and resources, and care quality in two types of residential care that fall in the center of the continuum, assisted living and board and care. These two options provide examples of how limited public funding leads to vertical axes, which represent access to services, the resources providers draw on to give care, and the quality of long-term care services, at each service point on the long-term care continuum.     

Factors influencing the success of PPP at feasibility stage – A tripartite comparison study in Hong Kong

Public Private Partnerships (PPP) have been used extensively in both developing and developed countries in delivering various types of projects, ranging from road construction, railway transport systems to health care facilities and schools. Critical success factors of PPP schemes at the implementation stage were identified. It is however more important for decision-makers to identify the factors for feasibility evaluation of adopting the PPP at the outset. This study aims to explore the key successful ingredients to be assessed at the initial stage of PPP projects as perceived public sector, private consortium and general community so as to attain a “triple win” scenario, via a questionnaire survey and a series of expert interviews conducted in Hong Kong. Survey results indicate that the most critical factor for evaluating the feasibility of PPP projects, especially to the general community, is an acceptable level of tariff. Cost effectiveness and financial attractiveness are the most important evaluation factors as ranked by the public sector and private consortium respectively. In addition, the existence of a long-term demand for the proposed services, availability of strong private consortium, alignment with government’s strategic objectives, as well as reliable service delivery are also rated as highly important to the success of PPP schemes. Addressing the tripartite expectations is indispensable to ensure the feasibility and successful delivery of public services and infrastructure projects via PPP schemes.     

Assessment of workplace product accessibility: a human factors perspective

This paper illustrates the advantages of using human factors evaluation techniques as a method of informing rehabilitation service provider decisions about client care and assistive technology selection. Successful integration of accessibility evaluation techniques can strengthen an evidence based service program and offer service providers another tool for providing efficient, effective, and rapid services to individuals in need. With accessibility evaluation data showing the functional abilities required to operate a given product or set of products, it is possible to empirically demonstrate that an individual has the potential to successfully utilize the provided workplace equipment. Conversely, if the accessibility evaluation data reveal that the functional capabilities required to use a product exceed the capabilities of a given user, it would be possible to demonstrate the need for particular interventions or accommodations. With accessibility evaluation data, service providers can make better informed decisions about client care.     

Patterns of child care subsidy use and stability of subsidized care arrangements: Evidence from Illinois and New York

Given the prevalence of short child care subsidy spells and program churning documented in prior studies, researchers and policymakers have been concerned about the implications of discontinuity in subsidy receipt for the stability of children's care arrangements. Yet little research has studied the stability of subsidized arrangements or how subsidy discontinuity relates to changes in subsidized providers. Using child care subsidy program administrative records from a cohort of children in four diverse sites across Illinois and New York states, this study examines patterns of subsidy use and stability of subsidized care arrangements, as well as the relationship between the two. Results suggest that the length of states' eligibility periods is related to the duration of subsidy spells; however, significant variation in patterns of subsidy use within states suggests that local level factors are also important. Results show that subsidy discontinuity is related to children experiencing more total changes in subsidized providers. Focusing on provider changes across spells, we also find that the timing of subsidy exits, the length of gaps in subsidy receipt, and within spell provider instability are each related to whether or not children re-enter the program with a different subsidized provider after a break in subsidy receipt. We discuss these findings' implications for understanding how new program requirements established in the 2014 reauthorization of the Child Care and Development Block Grant may matter for subsidy continuity and care stability.     

Public education provision,private schooling and income redistribution

Availability of free public education induces a transfer in kind among households with school age children. We provide evidence of the redistributive character of public education provision. We estimate structural quantile treatment effects of household income on the distribution of expected educational transfers in kind. Under the assumption that education quality is a normal good, better services (ancillary to the core education mission) supplied by private schools increase quality therein and reduce the incentives for wealthy households to enroll in public education. Because of these incentives, rich families benefit less from educational transfers in kind and the public education system is redistributive. Using household survey data from Italy, we find that an increase in net income reduces the value of the expected educational in kind transfers for compulsory education.