Gender and geographic differences in Medicare service utilization during the last six months of life

ABSTRACT

End-of-life issues are important for senior women, particularly rural women, who are more likely than their urban counterparts to live alone. The role of residence as a factor for health-care utilization among Medicare beneficiaries during the last six months of life has yet to be investigated. The purpose of this study is to examine whether service utilization in the last six months of life differs across gender and rurality. The sample was restricted to fee-for-service Medicare beneficiaries who died between July 1, 2013, and December 31, 2013 (n = 39,508). The odds of rural beneficiaries using home health (aOR 0.87; 95% CI 0.81–0.93) and/or hospice (aOR 0.82; 95% CI 0.77–0.87) in the last six months of life were lower than urban beneficiaries. Female beneficiaries were more likely to use support services such as hospice (aOR 1.24; 95% CI 1.18–1.29) and/or home health services (aOR 1.07; 95% CI 1.02–1.13) than male beneficiaries. The odds of female beneficiaries using inpatient (aOR 1.14; 95% CI 1.08–1.20) and/or outpatient (aOR 1.06; 95% CI 1.01–1.12) were higher than male beneficiaries. This research is important as we examine the range of health services used during the last six months of life, by gender and rurality. Future research is needed to understand how access to health services, residential isolation, and age- and disease-related factors relate to women’s observed greater use of inpatient, outpatient, hospice, and home health services in the last six months of life.     

Female entrepreneurship: business,marriage and motherhood in England and Wales, 1851–1911

ABSTRACT

This article offers a new perspective on what it meant to be a business proprietor in Victorian Britain. Based on individual census records, it provides an overview of the full population of female business proprietors in England and Wales between 1851 and 1911. These census data show that around 30% of the total business population was female, a considerably higher estimate than the current literature suggests. Female entrepreneurship was not a uniform experience. Certain demographics clustered in specific trades and within those sectors employers and own-account proprietors had strikingly different age, marital status and household profiles. A woman’s life cycle event such as marriage, motherhood and widowhood played an important role in her decision whether to work, the work available to her and the entrepreneurial choices she could make. While marriage and motherhood removed women from the labour force, they had less of an effect on their levels of entrepreneurship. Women who had young children were more entrepreneurial than those who had none, and entrepreneurship rates rose with the arrival of one child and continued to rise the more children were added to the family.     

Marketing of Voluntary Organizations as Contract Providers of National and Local Government Welfare Services in the UK

Voluntary organisations have become major providers of numerous social welfare services that previously were supplied by the state. In Britain, between 35 and 40% of the average human services charity’s annual income now derives from government (predominantly local government) sources, meaning that the acquisition of fresh contracts to undertake government funded work, in conjunction with the maintenance of good relations with government funders vis-à-vis current assignments, is increasingly important for ensuring a human service charity’s financial survival. An organization that wishes to obtain new contracts and to keep government bodies satisfied with its present activities will need to market itself effectively. This empirical study examined two aspects of charity marketing relevant to this requirement: the extent to which voluntary organizations applied the principles of strategic account management (otherwise known as key account management) to their relations with government funders, and the organizational characteristics (passion and commitment, low wage costs, etc.) that they emphasized to government bodies when making bids. A number of organizational variables (e.g., mission rigidity, strategic intent, short term operational focus) were employed in regression analyses as possible determinants of: (i) the degree to which a charity used strategic account management; and (ii) the genres of the organizational characteristics that it accentuated when tendering for government funded work.

Welfare reform and changes in the economic well-being of children*

Since the implementation of the Temporary Assistance for Needy Families (TANF) program in late-1996, welfare rolls have declined by more than half. This paper explores whether improvements in the economic well-being of children have accompanied this dramatic reduction in welfare participation. Further, we examine the degree to which the success or failure of welfare reform has been shared equally among families of varying educational background. We analyze data from the March Current Population Surveys (CPS) over the years 1988 through 2001. Specifically, we link data for families with children who are interviewed in adjacent years and determine whether their economic circumstances either improved or deteriorated. We use two alternative approaches to address this general issue: a variety of regression models and a difference-in-differences methodology. These approaches provide consistent answers. In a bivariate framework TANF is associated with higher incomes; but this association becomes insignificant in the presence of business cycle controls. We also determine that children who were poor at an initial time period benefit differently, depending on their parents' educational attainment level. Poor children with parents who do not have a high school degree are significantly worse off in the TANF era, relative to the era prior to welfare reform, than are poor children of more educated parents.     

Using Object Knowledge in Visual Tracking and Reaching

Nine‐month‐old infants were presented with an engaging and challenging task of visually tracking and reaching for a rolling ball that disappeared and reappeared from behind an occluder. On some trials, the infant observed the experimenter place a barrier on the ball's track; the barrier remained partially visible above the occluder throughout the remainder of the trial. When the task involved only predictive tracking, infants' anticipatory gaze shifts were faster when no barrier was present. When the task involved both tracking and reaching, there were more reaches when no barrier was present. If the infant reached, the timing and extension of the reach and the accompanying gaze shift did not differ with regard to the barrier. Because catching the ball was quite difficult for these infants, task demands interfered with the integration of visual information and visuospatial reasoning about the barrier with the reaching action.     

The cluster that never was: germ warfare experiments and health authority reality in Dorset

In 1997 intense media coverage raised public concerns about germ warfare simulation experiments conducted by the Ministry of Defence during the 1960s, which included the release of bacteria over Dorset. Families in East Lulworth, Dorset, have linked this with allegedly high rates of miscarriages, still-births, congenital malformations, learning and other neurodevelopmental disabilities in their village. The response of the Dorset Health Authority (DHA) included the examination of background information from the Ministry of Defence, national data on congenital malformations in Dorset, health information collected by campaigners and a systematic health survey conducted by the DHA among former and current residents of East Lulworth. The investigation did not confirm the presence of a cluster. It is debatable whether the DHA should have proceeded with their survey when none of the other more immediately available results indicated the presence of a cluster.     

The Changing Experience of Australian Female Entrepreneurs

The study of female entrepreneurship is a dynamic field, with more women than men engaging in self‐employment in Australia, the United Kingdom and the United States. Prior research in this field has identified a series of factors which characterize entrepreneurs. This paper examines the extent to which the experiences of Australian women entrepreneurs are reflected in the prior research. In particular, emphasis is placed on whether the personal characteristics, educational levels, motivations for starting business and resource acquisition behaviour of contemporary Australian women entrepreneurs are reflected in the prior research. While many of the key findings of prior research were found to describe accurately the experience of Australian women entrepreneurs, three new factors have been identified. First, Australian women entrepreneurs have increasingly come from business education backgrounds compared to the predominantly liberal arts backgrounds reported elsewhere. Second, the reasons for establishing small business differ insofar as they represent a greater proportion of general business needs as well as personal internal needs. Third, Australian women entrepreneurs are moving away from traditional ’female industries‘ into sectors identified as ’male industries‘ such as manufacturing. Overall, Australian women entrepreneurs demonstrate similarities in their identifying characteristics; however, significant shifts are occurring in their behaviours.     

Effects of a Stimulus-Stimulus Pairing Procedure on Conditioning Vocal Sounds as Reinforcers

The Analysis of Verbal Behavior - Two experiments were conducted to investigate the effects of stimulus-stimulus pairing on conditioning vocal sounds as reinforcers. Four preschoolers with severe...     

Unions and coal mine safety: Comment

In a recent article in this journal, Appleton and Baker tried to account for the variability in mine injury rates by using several variables, one of which we claim to be an inadequate measure of the climate for safety brought about by unionization. In this paper, we criticize their empirical work for lack of documentation, misinterpretation of analyses, and poor model specification; and their generalizations to global union effects and to specific union practices. We also offer several suggestions that could improve the applicability of future research to decisions about whether coal miners’ unions beneficially influence their members’ safety. The authors would like to thank C. Bise, J. Kiusalaas, T. Long, and E. Ray from The Pennsylvania State University for their suggestions during the review of this article.