Occupational status and mobility among undocumented immigrants by gender

Immigration has long been a national and state concern. The 1989 Legalized Population Survey (LPS-1) collected data on illegal immigrants to the US who subsequently became legalized aliens under the provisions of the 1986 Immigration Reform and Control Act. These data are used in a study assessing whether undocumented male and female immigrants improve their earnings and occupational status over time and the extent of variation in occupational status and mobility by gender and region. The data indicate that both undocumented men and women, on average, improved their earnings and occupational status between their first jobs in the US and their jobs just before applying for legalization under the 1986 Immigration Reform and Control Act. However, the earnings, occupational status, and occupational mobility of men were greater than for women.     

Implications of ERISA for health benefits and the number of self-funded ERISA plans

This Issue Brief provides an overview of the issues relating to the Employee Retirement Income Security Act of 1974 (ERISA) and health benefit plans, the major case law relating to ERISA and health plans, and the implications of the preemption of state regulations for health plan sponsors and participants. It also presents the latest data on the number of health plan participants in self-funded ERISA plans. Finally, it presents a summary of current legislative proposals that would attempt to amend ERISA. Under the framework ERISA established for employee benefit plans, the regulation of employment-based health benefit plans has evolved into a two-tiered system in which both federal and state laws play important roles. The Supreme Court has interpreted ERISA's "savings" and "deemer" clauses to mean that insured plans are subject to regulations directly at the federal level and indirectly at the state level, while self-funded plans are regulated exclusively at the federal level. The ERISA statute and the courts' interpretations of the Act have created a sharp controversy over how employee health benefit plans are provided and administered, with state regulators and consumer advocates on one side of the debate and plan sponsors (e.g., employers and unions) on the other. State regulators and consumer advocates tend to favor more regulation, and in many instances greater regulation at the state level, which they argue would provide more protections for consumers. However, employers and unions (or any plan sponsors) think ERISA preemption is very important to their ability to provide innovative and cost-effective health benefits for their employees, and assert that ERISA's present structure should be preserved. The U.S. General Accounting Office (GAO) found that 44 million individuals (39 percent of those in ERISA plans) were enrolled in self-funded ERISA plans in 1993, up from 39 million (33 percent of those in ERISA plans) in 1989. The Employee Benefit Research Institute (EBRI), using the same methodology as GAO with 1995 data, estimated that 48 million individuals (39 percent of those in ERISA plans) were enrolled in self-funded ERISA plans in 1995. When policymakers look to amend ERISA, they should consider whether the change to ERISA will produce a higher level of quality for consumers than is being provided under the present system and will continue to do so in the future. Policymakers must also decide whether quality of care is better enhanced by health plans' greater exposure to liability or by market forces. If policymakers decide that increased exposure to liability is the route to go, will consumers be able to enjoy any potential improvement in quality or will more individuals end up uninsured because of increased costs and not be able to get any care regardless of the quality?     

A tobacco and alcohol use profile of San Francisco's Chinese community

Relatively little is known about Asian American tobacco and alcohol use patterns. This is particularly true of Chinese living in the United States--either U.S.-born or non-U.S.-born Chinese. This article presents data from a research project studying tobacco and alcohol use patterns in San Francisco's Chinese community. Data were secured both from focus groups and a self-report telephone survey of a random sample of 1,808 Chinese residents in San Francisco. This results indicate that the prevalence of both tobacco and alcohol use is lower for San Francisco's Chinese population than for the general population. Moreover, those persons who report smoking tend to be different from those who report consuming alcohol. The study concludes that specific, culturally relevant tobacco and alcohol prevention programs should be designed to better reach this target population.     

Quality. A tightrope for the '90s

How accurately can you measure quality of care in health care? Recently, HMOs and other types of managed care organizations have been in the process of defining quality in quantitative terms. Physicians who utilize fewer resources and who care for more patients per-unit-of-time are valued as providing better care than colleagues who may work at a slower (more expensive?) pace. The pressure to evaluate or treat greater numbers of patients in shorter periods of time can produce adverse consequences. And numbers do not necessarily take into account the quality of the care delivered. There is clearly a middle road. Physicians must take care of a sufficient number of patients with a given problem to gain and maintain expertise and mastery. But they must also guard against the insidious pressure for the procedure to become the end in itself.     

Sustainability of family planning and health projects

USAID has assisted the Ghanian Ministry of Health since 1991 to boost family planning services under the Ghana Family Planning and Health Project by providing supplies and information and increasing the effectiveness of HIV/AIDS prevention and control. The sustainability of the health system is endangered by favoring capital expenditures in lieu of continuous expenditures; the lack of linkage between project activities and regular activities; the centralization of resource flow; and too ambitious targeting. Capital outlays provided by USAID featured in the construction of four public health laboratories, but their operation also requires continuous financing amounting to about 10% of the whole investment. The latter is the responsibility of the government, although the details of these recurrent costs were not detailed at the outset and providing these funds for continuous operation may impair the operation of other systems. The resource constraints could be alleviated by an effective cost-recovery system or by the general improvement of the economy. The lack of linkage between project and regular activities is serious at regional and district levels. The centralization of resource flow means that most resources are kept for headquarter level activities, thus other activities suffer and the health sector becomes excessively reliant on donor support. Too ambitious planning stems from pressure on donors and hastily implemented projects result in duplication and waste. Closer consultation with the parties involved would improve the situation. The rivalry of technical and policy groups has contributed to past deficiencies. Double funding for the same activity has also occurred further increasing the dependence on donor funding. By concentration on people and systems sustainability would be enhanced, while cost recovery would help the operation of the laboratories. The Health Education Unit (HEU) recognized the importance of IEC and obtained financing for such activities.     

The health status of elderly people and the new direction of health services

The projected increase of people in Japan aged 75 years and older in the years to come implies the increase of the disabled elderly. Thus, the core of societal preparation for the aging of the population is generally considered to be the expansion of services for the disabled elderly. However, gerontological studies on the health status of the elderly conducted in Japan show that the prevalence of disability is quite low and even decreasing. Relative to the services for the disabled elderly, preventive services for the healthy elderly have long been overlooked. In 1994, the Metropolitan Tokyo Government organized a task force to develop a new health education program as the preventive health service for the healthy urban elderly. A preliminary plan outlining the health education program--consisting of propagation with a booklet, on-the-job training of practitioners, and development of new curricula and teaching materials--was proposed by the authors for discussion within the task force. Although the inquiry has just begun and the plan is still nascent, it seems adequate to fit the needs for preventive health services in the near future.     

Health care futures. Part 2: The future of physician executives? Panel discussion

What is the future of health care in America? This is Part 2 of The Physician Executive panel discussion that explores the future of health care in America. To narrow this ambitious focus somewhat, the future is defined as five to 10 years hence. In Part 1, which was published in the May/June issue, Russell C. Coile, Jr., Barbara LeTourneau, MD, MBA, FACPE, James Reinertsen, MD, Uwe Reinhardt, PhD, Marshall Ruffin, MD, MPH, MBA, FACPE, and David Vogel, MS, shared their opinions about what the future holds in managed care, information technology, and biotechnology. In Part 2, Susan Cejka, Barbara LeTourneau, MD, MBA, FACPE, John Henry Pfifferling, PhD, Uwe Reinhardt, PhD, and James Todd, MD, share their views on the future of medical education and physician executives.     

Retirement patterns in Hong Kong: a censored regression analysis

This paper provides an overview of retirement patterns in Hong Kong on the basis of limited data. A censored regression model is used to infer the retirement age from people‘s current retirement status and their current age. This model is equivalent to a restricted probit model, and the interpretation of parameters is straightforward. The results clearly show a negative income effect on the retirement decision. The retirement age seems to be positively related to lifetime earnings but negatively related to the rate of decline of earnings with age. JEL classification: C24, J14, J26 Received May 6, 1996 / Accepted February 5, 1997     

Modeling household fertility decisions with generalized Poisson regression

This paper models household fertility decisions by using a generalized Poisson regression model. Since the fertility data used in the paper exhibit under-dispersion, the generalized Poisson regression model has statistical advantages over both standard Poisson and negative binomial regression models, and is suitable for analysis of count data that exhibit either over-dispersion or under-dispersion. The model is estimated by the method of maximum likelihood. Approximate tests for the dispersion and goodness-of-fit measures for comparing alternative models are discussed. Based on observations from the Panel Study of Income Dynamics of 1989 interviewing year, the empirical results support the fertility hypothesis of Becker and Lewis (1973). Received January 7, 1997 /Accepted April 3, 1997