Does Hospitalization Make Elderly Households Poor? An Examination of the Case of Kerala,India

Physical and health risks are very high among aged persons. The precise implications of population ageing for future levels of health and healthcare utilization depend on whether the increases in life expectancy experienced in general are accompanied by an increase or a decrease in health problems in later life. The health risks of the presence of an aged person in a household can result in a catastrophic shock for the family and render such households more exposed to poverty. The increased cost of medical bills means that large numbers of the elderly in the developing world are deprived of access to health and to better health treatment. This article examines this question empirically, using the largest national survey in the Indian state of Kerala, comparing elderly with non‐elderly households. We also attempt to find the impact of unhealthy lifestyles on the financial status of these households, due to hospitalization as a result of an aged person's illness.     

Positive and negative impacts of job loss on family life: the perceptions of Australian car workers

This article contributes to research on the impact of job loss on families. It is based on survey responses from 371 workers and in‐depth interviews with 39 of them about the family impacts of their job loss from the Mitsubishi car factory in Adelaide in 2004–2005. A majority of workers said family life had been affected by their job loss. Quantitative analysis identified four variables significantly associated with family impacts: marital status, children living at home, employment status and financial management. Qualitative responses showed the predominantly negative impacts were financial strain, loss of relationship stability and general stress and worry, although few faced catastrophic impacts from their job loss. However, in contrast to most previous research, the in‐depth interviews also revealed positive impacts from job loss, such as having more time at home and to spend with their family. We conclude that the existence of ongoing income support and public health insurance in Australia were important in avoiding catastrophic financial impacts on these workers and their families.     

Forecasting the cost of U.S. Health Care in 2040

One of the most important debates among health economists in rich nations is whether advances in biotechnology will spare their health care systems from a financial crisis. We must consider that prevalence rates of chronic diseases declined during the twentieth century and that this rate of decline has accelerated. However, health care costs may continue to increase even as the age of onset of chronic diseases is delayed, because the proportion of a cohort living to late ages will increase. The accelerating decline in the prevalence of chronic diseases during the course of the twentieth century supports the proposition that increases in life expectancy during the twenty-first century will be fairly large, but the effect on health care in the U.S. will be modest. The income elasticity for health services is calculated at 1.6, meaning that income expenditures on health care in the U.S. are likely to rise from a current level of about 15 percent to about 29 percent of GDP in 2040.     

Short-term and long-term effects of an outpatient rehabilitation program for patients with musculoskeletal disorders

The objective of the study was to investigate whether intensified rehabilitation efforts in primary health care may produce any short-term or long-term reduction of sick leave. The resources at the health care center were fortified with a coordinator from the local insurance office and a specialist group from the hospital. In one primary health care district, a prospective study was performed among 100 patients with a musculoskeletal disorder, having caused at least 21 consecutive days of full-time sick leave (patients). Serving as a control group were individually matched patients from any other health care center in the surrounding municipality of Kristianstad (controls). The number of sick leave days was assessed during year one (short-term) and year three (long-term) after rehabilitation was initiated. The median number of days with sickness benefits for men in the short-term was lower for patients than for controls (34.5 vs 48.5). No difference was found among women. No differences were found in the long-term between patients and controls, either for men or women. We conclude that rehabilitation in primary health care was made more efficient through collaboration with the local insurance office and the specialists, but the effects were not maintained after the collaboration ended.     

Exploring how workplace and social policies relate to caregivers’ financial strain

Informal caregiving is a critical component of the US long-term care system, but can have significant negative impacts on caregiver employment, finances, and well-being. An online survey of Colorado caregivers was piloted in 2016–17 to explore whether workplace and social policies such as access to paid family leave and public health insurance can buffer the negative financial impacts of caregiving and help caregivers to remain in the workforce. Using standardized measures, the survey assessed caregivers’ employment and financial status, well-being (physical and mental health, caregiver strain, benefits of caregiving), access to workplace supports, and covariates (e.g., caregiver demographics, health, social support, and service utilization). Ninety-five caregivers, recruited through community agency partners, completed the survey. Respondents were predominately female (89%), middle-aged (M = 57), non-Hispanic White (64%) or Latino/a (22%), and caring for a parent (40%) or spouse (30%) for over one year. Half (51%) reported working full- or part-time jobs, while 16.4% had stopped working because of caregiving. In multivariate regression modeling, predictors of financial strain included the care recipients’ financial strain and the caregiver’s reduction or ceasing of work. Medicare may be protective to minimize caregivers’ need to reduce or cease work. Implications for caregivers’ ability to stay engaged in the workforce and prepare for their own retirement are explored.     

Controlling Access to Sick Leave Programmes: Practices of Physicians in the Netherlands

Policymakers in industrialized countries attempt to contain the costs of sick leave and disability schemes by limiting access to include medically proven cases only. However, a person's incapacity to work cannot be fully deduced by referring to his or her medical condition. It is the question whether using more restrictive eligibility criteria that focus on medical evidence actually reduces the number of benefit recipients and makes access to employee benefit arrangements fairer. This ethnographic study shows that physicians working in Dutch illness certification practices use alternative methods to restrict access to sick leave programmes. Doctors do not control their clients in a restrictive sense of the word. Rather, they exercise control over their clients by inciting them to internalize norms about being active and responsible. While we do not claim that this is good per se, we do contend that this control style may have some advantages over and above more restrictive control mechanisms. Elaborating on policy that supports this alternative notion of control, therefore, seems worthwhile.     

Previous sickness presence among long‐term sick‐listed in Norway and Sweden: A retrospective study of prevalence and self‐reported reasons

The aim of the present study was to analyse previous sickness presence among long‐term sick‐listed individuals in Norway and Sweden and the reasons given for sickness presence. The study was based on survey data for 3,312 persons in Norway and Sweden who had been sick‐listed for at least 30 days. Two questions were used. One measured prevalence: During the last 12 months prior to your current sick leave, did you go to work even when feeling so ill that you should have taken sick leave? The second question concerned reasons for sickness presence. Large differences were found between Norway and Sweden in the prevalence of sickness presence. More long‐term sick‐listed Norwegians than Swedes reported sickness presence [adjusted odds ratio (OR) for Sweden 0.65 (0.53–0.80)]. The Swedes more often reported financial reasons for sickness presence [adjusted OR 2.77 (2.1 to ?3.54)], while the Norwegians more often gave positive reasons related to work. The national differences may be related to differences in sickness insurance strategies.     

浅析奥巴马政府的医疗改革政策及其对中国的启示

针对美国医疗领域长期存在的医疗费用快速上涨、医疗保险制度性障碍和医疗服务质量等问题,奥巴马政府提出了以控制医疗费用、扩大医疗保险覆盖面、提高医疗服务质量为主要内容的医疗改革方案,意在实现"向全美国民众提供可承受的、可进入性的医疗保健"之目标。相关法案虽然几经修改,但最终在美国国会众、参两院获得微弱通过,并在日前由奥巴马总统签署。尽管其效果目前还无法判断,但方案本身在一定程度上已经能够为我国的医疗改革提供一些启示。     

美印核协议中的印裔美国人游说

随着冷战结束和文化多元主义的发展，族裔游说在美国政治中的影响力日益上升。印裔美国人的积极游说在美印核协议的达成过程中发挥了相当重要的作用，保证了美国国会在《海德法案》和美印核协议的审议过程中的高票支持，从而大大提升了印度在美国的战略地位。今后。印裔美国人的游说影响可能继续上升。     

Biology,Social Environment,and Health: How Family History and Social Conditions Affect Adult Asthma*

Objective. We examine how multiple measures of both biological (family history of asthma) and social risk factors (home environment quality, socioeconomic status, and demographic characteristics) influence asthma risk among U.S. adults. Method. Using logistic regression models, we analyze data from a sample of 6,337 adults from the 2003–2004 National Asthma Survey. Results. Prevalence rates of current asthma are four times higher among adults with a family history of asthma, and the odds of having asthma are influenced most strongly by having asthmatic parents or grandparents (and, to a lesser extent, asthmatic siblings). We also find that social factors, especially characteristics of the home environment, significantly increase the odds of suffering from asthma as an adult. Conclusion. Our results show that all measures of family history are strongly linked to adult asthma prevalence, even when social factors are controlled. Social factors are also important, but very little of this is as a mediating influence that links family history and adult asthma; rather, family and social conditions have mostly independent effects.     

Demand for health risk reductions: A cross-national comparison between the U.S. and Canada

Using a large stated preference survey conducted across the U.S. and Canada, we assess differences in individual willingness to pay (WTP) for health risk reductions between the two countries. Our utility-theoretic choice model allows for systematically varying marginal utilities for avoided future time in different adverse health states (illness-years, recovered/remission years, and lost life-years). We find significant differences between Canadian and U.S. preferences. WTP also differs systematically with age, gender, education, and marital status, as well as a number of attitudinal and subjective health-perception variables. Age profiles for WTP are markedly different across the two countries. Canadians tend to display flatter age profiles, with peak WTP realized at older ages.     

Work/Family Policies,The Changing Role of Fathers and The Presumption of Shared Responsibility for Parenting

Recent approaches to work/family policies which emphasise options for women have the potential to reinforce gender divisions of labour and to increase conflicts between paid work and family. It is argued here that more account needs to be taken of the interaction between male and female commitments to work and family, and of the possible increased involvement by men in family life. The movement away from the traditional role as the autocratic head of the household towards a more nurturant and available father role, while still small, appears to be gathering momentum. This is reflected in recent research findings, in newspaper articles and other media reports, and in proposals for changes in employment policies (e.g., the ACTU “family leave” test case). While research and everyday accounts provide some hope for future changes in gender divisions of labour, more caution needs to be taken in interpreting research findings and in making statements about the extent to which change has already occurred. A radical new direction in approaches to policy development is needed if the existing status quo of father as the major breadwinner and more distant family member, and mother as the housewife, nurturer and supplementary income earner, is to be altered. Suggestions are made for the development of policies that would both respond to the needs of fathers who are primary caregivers, and help promote a greater sharing of parenting responsibilities by fathers. The basis of these proposals is an argument for the adoption of a presumption of shared parenting to parallel the current presumption of gender equality in the paid workforce.     

A Comparison of the Lifetime Economic Prospects of Women Informal Carers and Non‐carers,Australia, 2007

Informal care provided at home to family members with a disability is a major part of the disability and aged care system in Australia. Using data from the 2007 Household Income and Labour Dynamics in Australia survey, this study provides an updated comparison of the financial wellbeing, or lack thereof, over the working life of women primary carers and non‐carers. This study focuses on selected groups of primary carers and non‐carers disaggregated by partnership status, level of education and self‐assessed health status. While women primary carers tend to be more financially disadvantaged than non‐carers, having a post‐school education and being in good health contribute positively to bridge the gaps.     

Using the Internet and Email for Health Purposes: The Impact of Health Status*

Objective. Increasingly, people use the Internet and email for health purposes; however, we know little about whether this varies by health status. This study examines whether sick or healthy people are more likely to access the Internet, conduct online health searches, and exchange emails regarding health issues. Methods. We conduct multivariate analysis on a random sample of 2,038 adults. Results. Despite greater Internet access, respondents in excellent/good health are less likely to say they conduct online health searches because they have no health concerns or are satisfied with other health sources. In contrast, sick and disabled respondents are more likely to seek medical information online, and do so more frequently. They are also more likely to exchange health emails with friends and physicians. Conclusions. Practitioners especially need to educate their sicker patients about the uneven quality of online health information since they are more likely than healthier patients to conduct online health searches.     

Costs and distortion of U.S. regulation policy in intercoastal lumber shipping

This article quantitatively analyzes the various impacts of current U.S. coastal restrictions on the Northwest lumber industry. The history of U.S. maritime regulation is briefly reviewed and a simulation model is developed to measure its affect on lumber shipments and transport costs. The results of the model indicate that aggregate cost redutions obtained through deregulation are likely to be small. The pattern of intercoastal shipments could change a great deal, however, with U.S. producers picking up a large share of the Northeast market.     

Importation,SES-selective acculturation,and the weaker SES-health gradients of Mexican immigrants in the United States

Previous studies find U.S. immigrants have weaker socioeconomic gradients in health relative to non-Hispanic Whites and their U.S.-born co-ethnics. Several explanations have been advanced but few have been tested empirically. We use data from the Mexican Family Life Survey and the U.S. National Health Interview Survey, including longitudinal data in the former measuring socioeconomic status (SES) and health previous to emigration, to test if (1) immigrants “import” their gradients from the sending country, or if (2) they may be changing as a result of SES-graded acculturation among Mexican migrant men in two health indicators: obesity and current smoking. We find evidence consistent with the first hypothesis: the gradients of migrants measured prior to coming to the U.S. are not statistically different from those of nonmigrants, as the gradients of each are relatively weak. Although the gradients for obesity and smoking appear to weaken with time spent in the U.S., the differences are not significant, suggesting little support for the selective acculturation hypothesis.     

Governing universal health insurance in Korea and Taiwan

This article examines policy responses to the rising costs of healthcare in the Republic of Korea and Taiwan from a governance perspective. It tries to answer why the two countries responded differently to a similar set of challenges facing their National Health Insurance (NHI). While Taiwan – in an attempt to contain costs – introduced a global budgeting system, Korea failed to do so. Governments in both countries attempted to establish a new mode of governance, bringing multiple stakeholders to health policy making in order to build social consensus. But the Korean government, as this article shows, could not resolve its policy deadlock because of a loss of trust between the government and the medical profession, caused by the separation reform of 2001. Even though Taiwan was better able than Korea to address the financial challenges of its NHI, the new mode of health governance is still on shaky ground. This article argues that because neither government now enjoys the exclusive power over health policy that they once did under the developmental state, it is essential to find a way in which different stakeholders can make the necessary compromises that will enable the NHI to run on a sustainable path for the future.     

Benefits and incentives for lone parents: A comparative analysis

One of the most striking trends over the past 20 years is the growth in the number of lone parent families in developed countries. This article provides an analysis of the structure of incentives in benefit systems for lone parents in a cross-national perspective, using data from a recent comparative study of the systems of support for families with children in 17 countries (the members of the European Union, Australia, Japan, Norway, Sweden and the United States). The article compares the level of benefits for lone parents and takes into account the impact of housing costs, health costs, and education and preschool provision. It assesses the possible incentive effects of different systems through a comparison of the financial positions of lone parents not in paid employment, lone parents in the labour market and other family types.     

Family leave policy and child mortality: Evidence from 19 OECD countries from 1969 to 2010

This study examined the effects of family leave policy on five age‐specific child mortality rates across 19 Organization for Economic Co‐operation and Development countries from 1969 to 2010. I used the dataset developed by Ruhm and Tanaka and extended it with data from various institutions, including the Max Planck Institute for Demographic Research. I controlled for six relevant variables including GDP per capita and health expenditures, three child health indicators, as well as three social expenditure measures for families. I included in all models country and year fixed effects as well as country‐time trend interactions. Throughout all model specifications, the results indicated that job‐protected paid leave significantly reduces infant mortality (death at less than 1 year of age) and postneonatal mortality (death between 1 month and 1 year of age). Other leave (unpaid or nonjob protected) had no significant effects on any of the outcome indicators.     

Election Day Registration's Effect on U.S. Voter Turnout

Objective . Early voter registration deadlines make voting more difficult for many American citizens. In an attempt to facilitate voting, several U.S. states now permit registration on election day, at the height of the campaign. This article examines the turnout effects of adopting election day registration (EDR) and other smaller reductions in closing dates. Methods . Primarily using the Current Population Study (1972-1996), we estimate the turnout advantage of EDR for citizens having low, middle, and high socioeconomic status. Results . The elimination of closing dates, through EDR, is predicted to produce about a 7-percentage-point turnout boost in the average state. Those having a high school education and middle incomes are expected to see the largest turnout gains, with the less educated and poorer citizens doing almost as well. No evidence is found to link the implementation of EDR to subsequent changes in the electorate's partisan balance. Conclusions . Even the most dramatic easing of voter registration costs has a modest effect on the total number of voters and little impact on the long-standing skew toward greater representation of those having higher status in the voting electorate of the United States.