Cities

Hospital Performance, the Local Economy, and the Local Workforce: Findings from a US National Longitudinal Study

Hospital Performance, the Local Economy, and the Local Workforce: Findings from a US National Longitudinal Study
PLoS Med 7(6): e1000297. doi:10.1371/journal.pmed.1000297

Blustein, J., Borden, W.B., Valentine, M.
06/29/2010

Abstract

Background: Pay-for-performance is an increasingly popular approach to improving health care quality, and the US government will soon implement pay-for-performance in hospitals nationwide. Yet hospital capacity to perform (and

improve performance) likely depends on local resources. In this study, we quantify the association between hospital performance and local economic and human resources, and describe possible implications of pay-for-performance for socioeconomic equity.

Methods and Findings: We applied county-level measures of local economic and workforce resources to a national sample of US hospitals (n = 2,705), during the period 2004–2007. We analyzed performance for two common cardiac conditions (acute myocardial infarction [AMI] and heart failure [HF]), using process-of-care measures from the Hospital Quality Alliance [HQA], and isolated temporal trends and the contributions of individual resource dimensions on performance, using multivariable mixed models. Performance scores were translated into net scores for hospitals using the Performance Assessment Model, which has been suggested as a basis for reimbursement under Medicare’s ‘‘Value-Based Purchasing’’ program. Our analyses showed that hospital performance is substantially associated with local economic and workforce resources. For example, for HF in 2004, hospitals located in counties with longstanding poverty had mean HQA composite scores of 73.0, compared with a mean of 84.1 for hospitals in counties without longstanding poverty (p,0.001). Hospitals located in counties in the lowest quartile with respect to college graduates in the workforce had mean HQA composite scores of 76.7, compared with a mean of 86.2 for hospitals in the highest quartile (p,0.001). Performance on AMI measures showed similar patterns. Performance improved generally over the study period. Nevertheless, by 2007—4 years after public reporting began—hospitals in locationally disadvantaged areas still lagged behind their locationally advantaged counterparts. This lag translated into substantially lower net scores under the Performance Assessment Model for hospital reimbursement.

Conclusions: Hospital performance on clinical process measures is associated with the quantity and quality of local economic and human resources. Medicare’s hospital pay-for-performance program may exacerbate inequalities across regions, if implemented as currently proposed. Policymakers in the US and beyond may need to take into consideration the balance between greater efficiency through pay-for-performance and socioeconomic equity.

Please see later in the article for the Editors’ Summary.

Economic Development Impacts of High-speed Rail

Economic Development Impacts of High-speed Rail
RCWP 10-007 June, 2010

Levinson, David
06/01/2010

High-speed rail lines have been built and proposed in numerous countries throughout the world. The advantages of such lines are a higher quality of service than competing modes (air, bus, auto, conventional rail), potentially faster point-to-point times depending on specific locations, faster
loading and unloading times, higher safety than some modes, and lower labor costs. The disadvantage primarily lies in higher fixed costs, potentially higher energy costs than some competing modes, and higher noise externalities. Whether the net benefits outweigh the net costs is an empirical question that awaits determination based on location specific factors, project costs, local demand, and network effects (depending on what else in the network exists). The optimal network design problem is hard (in the mathematical sense of hard, meaning optimal solutions are hard to find because of the combinatorics of the possible different network configurations), so heuristics and human judgment are used to design networks.

 

How to House the Homeless

How to House the Homeless
Russell Sage Foundation Press

Ellen, I.G. & O'Flaherty, B. (eds.).
06/01/2010

How to House the Homeless, editors Ingrid Gould Ellen and Brendan O’Flaherty propose that the answers entail rethinking how housing markets operate and developing more efficient interventions in existing service programs. The book critically reassesses where we are now, analyzes the most promising policies and programs going forward, and offers a new agenda for future research. How to House the Homeless makes clear the inextricable link between homelessness and housing policy. Contributor Jill Khadduri reviews the current residential services system and housing subsidy programs. For the chronically homeless, she argues, a combination of assisted housing approaches can reach the greatest number of people and, specifically, an expanded Housing Choice Voucher system structured by location, income, and housing type can more efficiently reach people at-risk of becoming homeless and reduce time spent homeless. Robert Rosenheck examines the options available to homeless people with mental health problems and reviews the cost-effectiveness of five service models: system integration, supported housing, clinical case management, benefits outreach, and supported employment. He finds that only programs that subsidize housing make a noticeable dent in homelessness, and that no one program shows significant benefits in multiple domains of life. Contributor Sam Tsemberis assesses the development and cost-effectiveness of the Housing First program, which serves mentally ill homeless people in more than four hundred cities. He asserts that the program’s high housing retention rate and general effectiveness make it a viable candidate for replication across the country. Steven Raphael makes the case for a strong link between homelessness and local housing market regulations—which affect housing affordability—and shows that the problem is more prevalent in markets with stricter zoning laws. Finally, Brendan O’Flaherty bridges the theoretical gap between the worlds of public health and housing research, evaluating the pros and cons of subsidized housing programs and the economics at work in the rental housing market and home ownership. Ultimately, he suggests, the most viable strategies will serve as safety nets—“social insurance”—to reach people who are homeless now and to prevent homelessness in the future. It is crucial that the links between effective policy and the whole cycle of homelessness—life conditions, service systems, and housing markets—be made clear now. With a keen eye on the big picture of housing policy, How to House the Homeless shows what works and what doesn’t in reducing the numbers of homeless and reaching those most at risk.

Understanding the Challenges of Regional Ferry Service in New York City

Understanding the Challenges of Regional Ferry Service in New York City
RCWP 10-006 June, 2010

McCandless, Patrick
06/01/2010

On February 12th, 2008, Christine Quinn, Speaker of the New York City Council, took to the dais at the City Council Chambers to deliver the State of the City Address.  Towards the 17th page of an 18 page address, the Speaker’s remarks turned to public transit and the Mayor’s recently released PlaNYC initiatives.  While transit is generally a hot topic in New York, Mayor Bloomberg had made transportation a centerpiece of his second term and was spending the winter in a campaign to convince the State Legislature to approve a congestion pricing scheme in Manhattan to finance transportation capital projects. 

“It’s only natural to look at our natural highways, our water ways... to move New Yorkers efficiently and sustainably.” Said Speaker Quinn,  “That’s why we are proposing and the Mayor has agreed to begin developing a comprehensive five borough, year-round New York City Ferry System.”   The Speaker explained that the idea for ferry service originated through a series of public hearings she held with her colleagues in the Council:

 “Soon after, we began exploring the concept of a pilot ferry service for the Rockaways…got a commitment from the Mayor to fund it…and that service should be up and running by this summer.


Two years and twelve days later, the rhetoric of the State of the City speech came crashing to an anti-climactic end, as a report in the Daily News announced the cancellation of the Rockaways service.  The ferry would cease operations at the end of March.  

Plans for a five borough Ferry System have not materialized, except for an East River ferry serving developments along the Queens/Brooklyn waterfront, currently with two sailings during the AM and PM peak hours is expected to offer more frequent service next year  The Rockaway route had not met ridership projections and was recovering only 15-30% of its operational costs from revenues collected at the farebox.   The failure of the Rockaway ferry service, combined with the cancellation of another newly opened ferry service between Yonkers and Lower Manhattan in 2009 has dashed the hopes of some who wished to exploit New York’s water resources to improve commuting options via ferries.  This has led to questions about the feasibility of expanding ferry service in New York City more broadly. 

As large sections of the New York City waterfront are reclaimed from decades of industrial land use, idyllic waterfront parks have been developed next to gleaming residential towers.  It seems only natural that ferries will soon serve a role in transporting residents and visitors to these new neighborhoods throughout the City.  However, recent experiences illustrate the many obstacles facing expanded ferry services in New York City 

Health Care in World Cities: New York, London and Paris

Health Care in World Cities: New York, London and Paris
Johns Hopkins University Press, April

Gusmano, M.K., Rodwin, V.G. & Weisz, D.
04/01/2010

New York. London. Paris. Although these cities have similar sociodemographic characteristics, including income inequalities and ethic diversity, they have vastly different health systems and services. This book compares the three and considers lessons that can be applied to current and future debates about urban health care.

Highlighting the importance of a national policy for city health systems, the authors use well-established indicators and comparable data sources to shed light on urban health policy and practice. Their detailed comparison of the three city health systems and the national policy regimes in which they function provides information about access to health care in the developed world's largest cities.

The authors first review the current literature on comparative analysis of health systems and offer a brief overview of the public health infrastructure in each city. Later chapters illustrate how timely and appropriate disease prevention, primary care, and specialty health care services can help cities control such problems as premature mortality and heart disease.

In providing empirical comparisons of access to care in these three health systems, the authors refute inaccurate claims about health care outside of the United States.

Click here for a brief excerpt of the content.

Minimum Parking Requirements, Transit Proximity and Development in New York City

Minimum Parking Requirements, Transit Proximity and Development in New York City
RCWP 10-004 Furman Center for Real Estate and Urban Policy

McDonnell, Simon, Josiah Madar and Vicki Been
04/01/2010

New York City policymakers are planning for a city of over 9 million residents by 2030, a large increase from today. A central goal of City officials is to accommodate this increase while simultaneously improving the City’s overall environmental performance, addressing externalities arising from traffic congestion and providing increased access to affordable housing. The requirement in the City’s zoning code that new residential construction be accompanied by a minimum number of off-street parking spaces, however, may conflict with this goal. This paper combines a theoretical discussion of parking requirements in New York City with a quantitative analysis of how they relate to transit and development opportunity. It draws direct relations between minimum parking requirements with the rise in housing prices and the reduction of density.

Causality vs. Correlation: Rethinking Research Design in the Case of Pedestrian Environments and Walking

Causality vs. Correlation: Rethinking Research Design in the Case of Pedestrian Environments and Walking
RCWP 10-001  

Guo, Zhan
03/01/2010

This paper investigates the causal effect of pedestrian environments on walking behavior and focuses on the issue of research design. The paper differentiates between two types of research designs:treatment-based and traveler-based. The first approach emphasizes the variation of the treatment (pedestrian environments), and generally compares distinct neighborhoods, such as urban vs. suburban or transit-oriented vs. auto-dependent. The second approach emphasizes the homogeneity of subject (pedestrians), and aims at the same pedestrian under different environments normally due to home relocation, or the improvement of pedestrian environments.

This paper presents a third method, following a traveler-based research design while providing the pedestrian multiple walking paths with different pedestrian environments.

 

Welcome to the Neighborhood: What Can Regional Science Contribute to the Study of Neighborhoods?

Welcome to the Neighborhood: What Can Regional Science Contribute to the Study of Neighborhoods?
JOURNAL OF REGIONAL SCIENCE, VOL. 50, NO. 1, 2010, pp. 363-379

Ellen, I.G. & O'Regan, K.
01/13/2010

We argue in this paper that neighborhoods are highly relevant for the types of issues at the heart of regional science. First, residential and economic activity takes place in particular locations, and particular neighborhoods. Many attributes of those neighborhood environments matter for this activity, from the physical amenities, to the quality of the public and private services received. Second, those neighborhoods vary in their placement in the larger region and this broader arrangement of neighborhoods is particularly important for location choices, commuting behavior and travel patterns. Third, sorting across these neighborhoods by race and income may well matter for educational and labor market outcomes, important components of a region's overall economic activity. For each of these areas we suggest a series of unanswered questions that would benefit from more attention. Focused on neighborhood characteristics themselves, there are important gaps in our understanding of how neighborhoods change - the causes and the consequences. In terms of the overall pattern of neighborhoods and resulting commuting patterns, this connects directly to current concerns about environmental sustainability and there is much need for research relevant to policy makers. And in terms of segregation and sorting across neighborhoods, work is needed on better spatial measures. In addition, housing market causes and consequences for local economic activity are under researched. We expand on each of these, finishing with some suggestions on how newly available data, with improved spatial identifiers, may enable regional scientists to answer some of these research questions.

Welcome to the Neighborhood: What can Regional Science Contribute to the Study of Neighborhoods?

Welcome to the Neighborhood: What can Regional Science Contribute to the Study of Neighborhoods?
Journal of Regional Science

O'Regan, K. & Ellen, I.G.
01/13/2010

We argue in this paper that neighborhoods are highly relevant for the types of issues at the heart of regional science. First, residential and economic activity takes place in particular locations, and particular neighborhoods. Many attributes of those neighborhood environments matter for this activity, from the physical amenities, to the quality of the public and private services received. Second, those neighborhoods vary in their placement in the larger region and this broader arrangement of neighborhoods is particularly important for location choices, commuting behavior and travel patterns. Third, sorting across these neighborhoods by race and income may well matter for educational and labor market outcomes, important components of a region's overall economic activity. For each of these areas we suggest a series of unanswered questions that would benefit from more attention. Focused on neighborhood characteristics themselves, there are important gaps in our understanding of how neighborhoods change - the causes and the consequences. In terms of the overall pattern of neighborhoods and resulting commuting patterns, this connects directly to current concerns about environmental sustainability and there is much need for research relevant to policy makers. And in terms of segregation and sorting across neighborhoods, work is needed on better spatial measures. In addition, housing market causes and consequences for local economic activity are under researched. We expand on each of these, finishing with some suggestions on how newly available data, with improved spatial identifiers, may enable regional scientists to answer some of these research questions.

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