Linking Process Quality and Resource Usage: An Empirical Analysis

Motivated by an increasing adoption of evidence‐based medical guidelines in the delivery of medical care, we examine whether increased adherence to such guidelines (typically referred to as higher process quality) is associated with reduced resource usage in the course of patient treatment. In this study, we develop a sample of US hospitals and use cardiac care as our context to empirically examine our questions. To measure a patient's resource usage, we use the total length of stay, which includes any additional inpatient stay necessitated by unplanned readmissions within thirty days after initial hospitalization. We find evidence that higher process quality, and more specifically its clinical (as opposed to its administrative) dimensions, are associated with a reduction in resource usage. Moreover, the standardization of care that is achieved via the implementation of medical guidelines, makes this effect more pronounced in less focused environments: higher process quality is more beneficial when the cardiac department's patient population is distributed across a wider range of medical conditions. We explore the implications of these findings for process‐oriented pay‐for‐performance programs, which tie the reimbursement of hospitals to their adherence to evidence‐based medical guidelines.     

An empirical analysis of the matching patterns of same-sex and opposite-sex couples

We used 1990 Census data to compare the matching behaviors of four types of cohabiting couples: same-sex male couples, same-sex female couples, opposite-sex unmarried couples, and married couples. In general, we found evidence of positive assortative mating for all traits and across all types of couples. The positive assortative mating, however, is stronger for non-labor-market traits (e.g., age, education) than for labor-market traits (e.g., hourly earnings). Further, members of married couples are more alike with respect to most characteristics than are members of opposite-sex cohabiting couples, and members of opposite-sex cohabiting couples are more alike than are members of same-sex couples.     

The health expectancies of older Australians

Health expectancies of the states ‘Disability-free’ and ‘Disabled’ are estimated for Australian females and males aged 60 and over, both by cohort from 1980 and current for survey years 1981, 1988, 1993 and 1998. Modifications of recently developed logistic regression techniques are used rather than the standard 1971 method due to Sullivan. Results from the three later surveys are broadly similar and differ in important respects from those of the 1981 survey. Based on the last three surveys our estimates support the view that, depending on age, two-thirds or more of the increase in female life expectancy over the decade 1988–1998 is spent in the Disabled state. The situation is worse for elderly men, for whom all of the increased years of expected life are estimated to be spent in the Disabled state. The findings do not support rectangularization of the survival curve or Disability-free survival curve.     

Abortion demand

Abortion may be characterized as fertility control. Costs and benefits of an additional child are weighed over time. If costs exceed benefits, fertility control is employed. An economic model of abortion demand is developed that incorporates price, income, demographic factors (tastes), and public policy issues such as abortion funding. A key finding is that state abortion funding, substituted for federal funding under Medicaid as a result of the Hyde Amendments, may be important to abortion demand but it is difficult to differentiate its effect from other effects at the state level with an econometric model.     

Risk-taking behavior in the presence of nonconvex asset dynamics

The growing literature on poverty traps emphasizes the links between multiple equilibria and risk avoidance. However, multiple equilibria may also foster risk-taking behavior by some poor people. We illustrate this idea with a simple analytical model in which people with different wealth and ability endowments make investment and risky activity choices in the presence of known nonconvex asset dynamics. This model underscores a crucial distinction between familiar static concepts of risk aversion and forward-looking dynamic risk responses to nonconvex asset dynamics. Even when unobservable preferences exhibit decreasing absolute risk aversion, observed behavior may suggest that risk aversion actually increases with wealth near perceived dynamic asset thresholds. Although high ability individuals are not immune from poverty traps, they can leverage their capital endowments more effectively than lower ability types and are therefore less likely to take seemingly excessive risks. In general, linkages between behavioral responses and wealth dynamics often seem to run in both directions. Both theoretical and empirical poverty trap research could benefit from making this two-way linkage more explicit.     

Alcohol prevention strategies on college campuses and student alcohol abuse and related problems

This study examined the relationship between colleges' alcohol abuse prevention strategies and students' alcohol abuse and related problems. Alcohol prevention coordinators and first year students in 22 colleges reported whether their schools were implementing 48 strategies in six domains, and students (N = 2041) completed another survey concerning their use of alcohol and related consequences. Colleges were most likely to prevent alcohol use in public places on campus and the delivery and use of kegs. Four alcohol prevention domains were inversely associated with at least one of five outcomes related to student alcohol abuse or related consequences, and the alcohol policy and enforcement domain was inversely associated with all outcomes. Colleges should pay particular attention to strategies related to policy and enforcement.     

Developmental outcomes after five years for foster children returned home, remaining in care, or adopted

A substantial proportion of children who enter foster care in the US are infants or toddlers and will exit from foster care before they have been in care for long, either returning home or to adoption. These first years of involvement may predict a significant amount about children's longer term development so understanding developmental outcomes after five years is valuable to understanding if child welfare services (CWS) are serving the intention of promoting the well-being of children. A subsample of 353 infants (less than 13 months of age when investigated by CWS) and subsequently placed into foster care were selected from the National Survey of Child and Adolescent Well-Being. After 66 months, these infants had been reunified, adopted, or were still in foster care. Bivariate comparisons were completed. Statistical controls for maltreatment type and severity, demographic traits, and current caregiver education were implemented to help clarify the role of terminal child welfare placement, current caregiver behaviors, and household income, on eight linear regression models of developmental outcomes. Results support the longstanding tenet of child welfare services policy that remaining in foster care is less developmentally advantageous than having a more permanent arrangement of return home or adoption.     

Interviewing parents of children in care: Perspectives, discourses and accountability

The ‘parental perspective’ in child care work is a matter of concern and is actively solicited by practitioners, managers, policymakers and researchers for differing reasons. This paper argues that the search for such a stable “parental perspective” should be abandoned and suggest that research should embrace a social constructionist turn by concentrating on how parents' views are negotiated conversationally in discourse. Using data drawn from research interviews with parents of children in care and employing conversation and discourse analytic methods, the paper demonstrates how there are critical issues of accountability, blame, and testing at stake in the interview encounter, as interviewer and interviewee jointly produce a moral version of the client, the institution, the case and its attributes. The implications of this argument are delineated.     

Affective and Cognitive Correlates of Gambling Behavior in University Students

The purpose of the following study was to explore certain affective and cognitive components and their relationships to gambling behavior in an undergraduate population. Specifically, the aim was to predict gambling severity using depression scores on the BDI-II, the dependency and self-criticism subscales on the DEQ, emotional awareness scores on the LEAS, cognitive flexibility scores from the STROOP, and a creativity subtests from the TTCT. Participants were 200 undergraduate students and 3.5–7.5% of individuals reported some level of problematic gambling behavior. Multiple regression analysis indicated that self-criticism and creative originality were significant predictors of gambling behavior, explaining 7.6% of the variance. Further analyses reveal a non-linear trend in the creative originality of those who gamble; only the at-risk gamblers were high in creativity whereas abstainers and problematic gamblers display similarly lower levels of creativity. Results are discussed in regards to Blaszczynski and Nower’s Addiction 97:487–499 (2002) subtypes of gambling vulnerability.