The Global Welfare Economics of Immigration

We study the effect of immigration on global welfare. The world is modeled as consisting of two regions, South and North, the former populated by low-skill workers, and the latter by both low- and high-skill workers. Production in the North uses both labor inputs in a complementary way. A trade union in the North keeps the wage of low-skill workers above the Walrasian wage, generating unemployment of low-skill workers. Northern citizens fund unemployment benefits for workers through taxation. Immigration from South to North has two effects in the North: a mixed native-foreign working-class lowers union power, because of reduced solidarity among low-skill workers, and hence it lowers the mark-up on the Walrasian wage that the union is able to negotiate. It also lowers the solidarity between employed citizens and the unemployed (as the latter, now, consist in part of non-natives) and thus the unemployment benefit, set by a democratic process, falls. We calculate the optimal levels of immigration, from the viewpoint of an observer who maximizes global welfare, according to an egalitarian and a utilitarian social welfare function. We compare these levels to the open-borders-equilibrium level. We find that the optimal level of immigration for the cosmopolitan egalitarian is significantly less than the open-borders equilibrium level, while the optimal level for a global utilitiarian is significantly greater than the open-borders level.     

Welfare Reform and Elderly Immigrants' Naturalization: Access to Public Benefits as an Incentive for Naturalization in the United States

Welfare reform in the United States restricted non‐citizens' eligibility for public assistance programs and strengthened economic benefits from naturalization. We examine the impact of these policy changes on elderly immigrants' naturalization, considering their level of need for public benefits. Using individual data from the Current Population Survey as well as state‐level data, we employ a differences‐in‐differences approach to consider variations in time, state policy, and probability of Medicaid participation. Results show that naturalization significantly increased among elderly immigrants who were likely to participate in Medicaid, suggesting that elderly immigrants in need of Medicaid became naturalized to maintain their eligibility for public benefits after welfare reform.     

Health Care of American Indian Elderly: Determinants of the Perceived Difficulty Obtaining Access to Health Care

This study examines the perceived areas of difficulty in obtaining access to health care and the factors influencing that difficulty among elderly American Indians in a rural environment. One hundred thirty-seven elderly Indians in the Ponca and Pawnee tribes of Oklahoma were interviewed. Four major difficulties are reported: a long waiting period at Indian health centers, difficulty in making appointments to see physicians, language and cultural barriers to communication with the health care providers, and lack of available transportation. The long waiting period is the most serious problem, and lack of transportation is the least serious. The results of probit analysis show that physical health, automobile ownership, education, employment, and the presence of an informal caregiver are related to difficulty obtaining access to health care. Ways to minimize this difficulty are discussed.     

Young African American Males: Barriers to Access to Health Care

African American males continue to experience an unacceptable and disproportionate number of health disparities when compared with other racial and ethnic groups. Young African American males can expect to live the least amount of time when compared to any other ethnic minority or racial sub-group. Understanding the obstacles and barriers that impede access to health care and wellness services among young African American males is essential to begin the process of decreasing health disparities. The goal of this qualitative study was to explore and identify the barriers experienced by young African American males in accessing health care services while also creating a rare opportunity to give voice to young African American males. The study results indicate that young African American males have multiple perceptions of barriers to health care services. Their perceptions fell into three categories: the negative impact of environment or community, lack of finances or no insurance, and distrust of medical practices associated with race history resulting in accessing healthcare as a last resort. Additional research is needed to craft community-based programs to: a) educate young African American males on the importance of preventative strategies to maintain wellness; and b) ensure that the appropriate medical and wellness services are available and reaching young African American males in need.     

Resource Effects on Access to Long-Term Care for Frail Older People

Abstract

Access to long-term care depends primarily on personal resources, including family members and income, and on external resources, including Medicaid and Medicare. This study investigates how resources affect frail older individuals' access to long-term care, with a focus on Black and White widows. Data from the 1989 National Long-Term Care Survey is used, in conjunction with state-level Medicaid and Medicare reimbursement rates for nursing home and home health care, to estimate the likelihood of five types of care arrangements. Results show that children are a primary resource for unmarried individuals in maintaining access to informal care. Income effects are nonlinear in relation to nursing home care: increasing incomes below the mean income are associated with decreasing probabilities of nursing home care, while increasing incomes above the mean are associated with increasing probabilities of nursing home care. Income and Medicaid effects are interrelated, with nonlinearities associated with income having the potential to adversely affect some older persons' ability to access nursing home care.     

The Effects of Unemployment on Prenatal Care Use and Infant Health

Do recessions improve birth outcomes? This study investigated the relationship between unemployment fluctuations, prenatal care utilization and infant health. Analyzing the US Natality Detail Files for the period 1989–1999 aggregated by county, year, and race, I found the overall effects of unemployment to be beneficial but concluded that at least some of the apparent benefits are attributable to the Medicaid “safety net.” In supplementary analyses stratified by socioeconomic status, Medicaid played the largest role among economically disadvantaged (single and less educated) women. Thus, unemployment seems to be good for at least some pregnancies—provided Medicaid steps in.     

Disparities in Access to Health Care Among Middle-Aged and Older Adults with Disabilities

Disability is increasing among middle-aged adults and, reversing earlier trends, increasing among older adults as well. Disability is experienced disproportionately by Black and lower socioeconomic status (SES) individuals. We used Medical Expenditure Panel Survey data to examine health care disparities in access to health care for middle-aged (31 to 64 years of age) and older (65+ years of age) adults with disabilities by race and ethnicity, education, and income (n = 13,174). Using logistic regression, we examined three measures of potential (e.g., usual source of care), and three measures of realized (e.g., counseling related to smoking) access. Middle-aged and older minority individuals with disabilities had lower relative risks of having usual sources of care and higher relative risks of having suboptimal usual sources of care (e.g., a place rather than a person) than White adults with disabilities. There were SES effects observed for middle-aged adults with disabilities across most measures that were, for certain measures, more pronounced than SES effects among older adults with disabilities. These findings are important, since health resources (e.g., a usual source of care) may mediate relations among disability, morbidity, and mortality. Policy actions that may mitigate the disparities we observed include financial incentives to support access to an optimal usual source of care and mechanisms to foster behavioral interventions related to smoking and exercise. Ensuring that these actions address the specific concerns of individuals with disabilities, such as physical accessibility and provider cultural competency, is essential.     

The U.S. Health System and Immigration: An Institutional Interpretation1

We examine the institutions that comprise the U.S. health system and their relationship to a surging immigrant population. The clash between the system and this human flow originates in the large number of immigrants who are unauthorized, poor, and uninsured and, hence, unable to access a system largely based on ability to pay. Basic concepts from sociological theory are brought to bear on the analysis of this clash and its consequences. Data from a recently completed study of health institutions in three areas of the United States are used as an empirical basis to illustrate various aspects of this complex relation. Implications of our results for theory and future health policy are discussed.     

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.     

Welfare Reform in Indiana: The Political Economy of Restricting Access to Education and Training

This article interrogates welfare reform policies that restrict welfare reliant mothers' access to education and training. It focuses on how these policies have been implemented through the Indiana Manpower Placement and Comprehensive Training Program (IMPACT), Indiana's work first response to women's growing experience of poverty. Using methods of inquiry inspired by Dorothy E. Smith's articulation of institutional ethnography, a case study is developed to investigate the critical disjuncture that arises when welfare reliant mothers attempt to navigate these policies in the context of Indiana's extended political economy. It is argued that through these restrictive policies, welfare reliant mothers are forced into Indiana's unrelenting low-wage labor market, increasing the pervasiveness of poverty and further perpetuating the reproduction of inequality.     

A Contradiction in the Health Care Delivery System: Problems of Access*

State-wide sample survey data regarding issues and problems frequently incurred in gaining access to health care delivery systems, as well as reports of illness, are utilized in an analysis covariance. The results indicate that the black population reports receiving more preventive health care services than the white population when controlling for all relevant independent variables. This surprising reversal of the most frequently found relationship between black and white populations, coupled with the reporting by the black population of experiencing more difficulty in gaining access to the system for needed help, presents evidence of a contradiction in the delivery of care.     

The Development and Challenges in Health Care Policy and Health Care Financing in Contemporary China

China’s market-oriented reform has had great success in the past few decades. Along with the rapid economic growth of the country, the economic development also influenced various aspects of China’s social, economical, and political life. Recent debate has criticized the overheated market reform in social provision, thus arguing for the return of government interventions. However, in the health care sector, it is inappropriate to attribute all distortions to market imperfection. It is rather the design of the health care system and the lack of government interventions in regulating the health care market that obstruct the functions of health care provision. To examine the proposed hypotheses, the paper focuses on China’s medical care provision, evaluating the actual performance of China’s medical care provision in the environment of economic transition from a multidimensional analysis, hence providing forward-looking suggestions for the design of China’s health care provision. Findings from this study indicate that government interventions are indispensable in regulating the health care market as well as ensuring health care delivery.      

Evaluation of the Senate Standing Committee on Health and Welfare

In their books The Assessment of Social Research and Exemplars of Social Research, Fellin, Tripodi and Meyer develop, describe and discuss a method for classifying and assessing social research. They state that “this classification system is intended for use with empirical research reports, and is not applicable for categorising non-empirical studies such as historical and bibliographical research. Furthermore, only reports of single research investigations can be usefully classified in this scheme.”     

Recent Immigration to Canada and the United States: A Mixed Tale of Relative Selection

Using large‐scale census data and adjusting for sending‐country fixed effect to account for changing composition of immigrants, we study relative immigrant selection to Canada and the U.S. during 1990–2006, a period characterized by diverging immigration policies in the two countries. Results show a gradual change in selection patterns in educational attainment and host‐country language proficiency in favor of Canada as its post‐1990 immigration policy allocated more points to the human capital of new entrants. Specifically, in 1990, new immigrants in Canada were less likely to have a B.A. degree than those in the U.S.; they were also less likely to have a highschool or lower education. By 2006, Canada surpassed the U.S. in drawing highly educated immigrants, while continuing to attract fewer low‐educated immigrants. Canada also improved its edge over the U.S. in terms of host‐country language proficiency of new immigrants. Entry‐level earnings, however, do not reflect the same trend: Recent immigrants to Canada have experienced a wage disadvantage compared to recent immigrants to the U.S., as well as Canadian natives. One plausible explanation is that while the Canadian points system has successfully attracted more educated immigrants, it may not be effective in capturing productivity‐related traits that are not easily measurable.     

Effects of Welfare Participation on Marriage

We investigate the widely held premise that welfare participation causes women to refrain from marriage. Using data from the Fragile Families and Child Wellbeing study (N = 3,219), we employ an event history approach to study transitions to marriage among mothers who have had a non-marital birth. We find that welfare participation reduces the likelihood of transitioning to marriage (hazard ratio is .67, p < .01), but only while the mother is receiving benefits. Once the mother leaves welfare, past receipt has little effect on marriage. We infer that the negative association between welfare participation and subsequent marriage reflects temporary economic disincentives rather than an erosion of values.     

Assessing the Effect of Welfare Reforms on Public Assistance Caseloads in Four Ohio Counties

Abstract

The implementation of welfare reform at the local level is critical to assessing the effects of structural reforms initiated since the passage of the Personal Responsibility and Work Opportunities Reconciliation Act of 1996. Wide variations in the activities undertaken in response to national welfare reform have hindered efforts to understand the factors that have contributed to the success of welfare reform apparent in caseload reductions. This paper reviews Community Human Service Plans in four Ohio counties and examines their trends in caseloads. Two strategies emerge: “job attachment” and “human capital development.” These differences in local implementation can be related to caseload trends.     

Closing the Loophole: A Case Study of Organizing for More Equitable and Affordable Access to Health Care in San Francisco

This paper presents in-depth case study of a successful hybrid political and community organizing campaign to ensure equitable access to health care through the perspective of a grassroots San Francisco community-based organization, the Chinese Progressive Association (CPA), which has been organizing low-income Chinese immigrants for over four decades. First, it outlines the Health Care Security Ordinance (HCSO), which, since its passage in 2006, has established a near-universal health care access program, helping to make health care accessible and affordable to individuals living and working in San Francisco. Then it presents the campaign to save the HCSO, focusing on CPA’s participation in the HCSO coalition. Finally, it discusses health care as it relates to the San Francisco’s affordability crisis and the political economic context in which it is taking place. Despite the limitations inherent in small case studies like this one, it nevertheless provides a valuable opportunity to better understand how one politically progressive city attempted to address the problem of grossly inequitable health care access through the lens of community organizing, advocacy, and coalition building. San Francisco, like many major American cities today, is being confronted with rapid gentrification and growing economic inequality—the backdrop to the HCSO. Through innovative experiments in social responsibility like the HCSO, however, the city has made leaps in health care access. It concludes with lessons learned from local organizing and advocacy to save the HCSO as these may inform other local efforts to promote health care for all.