Inequality

Paths to improving engagement among racial and ethnic minorities in addiction health services

Paths to improving engagement among racial and ethnic minorities in addiction health services
Substance Abuse Treatment, Prevention, & Policy (2015) 10:40.

Guerrero, E., Fenwick, K., Kong, Y., Grella, C., & D'Aunno, T.
05/26/2016

BACKGROUND

Members of racial and ethnic minority groups are most likely to experience limited access and poor engagement in addiction treatment. Research has been limited on the role of program capacity and delivery of comprehensive care in improving access and retention among minorities with drug abuse issues. The goal of this study was to examine the extent to which access and retention are enhanced when racial and ethnic minorities receive care from high-capacity addiction health services (AHS) programs and via coordination with mental health and receipt of HIV testing services. Methods: This multilevel cross-sectional analysis involved data from 108 programs merged with client data from 2011 for 13,478 adults entering AHS. Multilevel negative binomial regression models were used to test interactions and indirect relationships between program capacity and days to enter treatment (wait time) and days in treatment (retention).

RESULTS

Compared to low-capacity programs and non-Latino and non-African American clients, Latinos and African Americans served in high-capacity programs reported shorter wait times to admission, as hypothesized. African Americans also had longer treatment retention in high-capacity programs. Receipt of HIV testing and program coordination of mental health services played an indirect role in the relationship between program capacity and wait time.

CONCLUSIONS

Program capacity and coordinated services in AHS may reduce disparities in access to care. Implications for supporting low-capacity programs to eliminate the disparity gap in access to care are discussed.

Portfolios of the Poor: How the World's Poor Live on $2 a Day

Portfolios of the Poor: How the World's Poor Live on $2 a Day
Arabic translation.

Jonathan Morduch, Daryl Collins, Stuart Rutherford, & Orlanda Ruthven
05/24/2016

Portfolios of the Poor: How the World's Poor Live on $2 a Day (Princeton University Press, 2009) tackles the fundamental question of how the poor make ends meet. Over 250 families in Bangladesh, India, and South Africa participated in this unprecedented study of the financial practices of the world's poor.

These households were interviewed every two weeks over the course of a year, reporting on their most minute financial transactions. This book shows that many poor people have surprisingly sophisticated financial lives, saving and borrowing with an eye to the future and creating complex "financial portfolios" of formal and informal tools.

Indispensable for those in development studies, economics, and microfinance, Portfolios of the Poor will appeal to anyone interested in knowing more about poverty and what can be done about it.

Failure vs. Displacement: Why an Innovative Anti-Poverty Program Showed no Net Impact in South India

Failure vs. Displacement: Why an Innovative Anti-Poverty Program Showed no Net Impact in South India
September 2015. Journal of Development Economics 116: 1-16.

Jonathan Morduch, Jonathan Bauchet, & Shamika Ravi
05/24/2016

We analyze a randomized trial of an innovative anti-poverty program in South India, part of a series of pilot programs that provide “ultra-poor” households with inputs to create new, sustainable livelihoods (often tending livestock). In contrast with results from other pilots, we find no lasting net impact on income or asset accumulation in South India. We explore concerns with program implementation, data errors, and the existence of compelling employment alternatives. The baseline consumption data contain systematic errors, and income and consumption contain large outliers. Steps to address the problems leave the central findings largely intact: Wages for unskilled labor rose sharply in the area while the study was implemented, blunting the net impact of the intervention and highlighting one way that treatment effects depend on factors external to the intervention itself, such as broader employment opportunities.

Child diarrhea and nutritional status in rural Rwanda: a cross-sectional study to explore contributing environmental and demographic factors

Child diarrhea and nutritional status in rural Rwanda: a cross-sectional study to explore contributing environmental and demographic factors
DOI: 10.1111/tmi.12725

Sheela S. Sinharoy, Wolf-Peter Schmidt, Kris Cox, Zachary Clemence, Leodomir Mfura, Ronald Wendt, Sophie Boisson, Erin Crossett, Karen A. Grépin, William Jack, Jeannine Condo, James Habyarimana and Thomas Clasen
05/23/2016

Objective

To explore associations of environmental and demographic factors with diarrhoea and nutritional status among children in Rusizi district, Rwanda.

Methods

We obtained cross-sectional data from 8,847 households in May–August 2013 from a baseline survey conducted for an evaluation of an integrated health intervention. We collected data on diarrhoea, water quality, and environmental and demographic factors from households with children <5, and anthropometry from children <2. We conducted log-binomial regression using diarrhoea, stunting and wasting as dependent variables.

Results

Among children <5, 8.7% reported diarrhoea in the previous 7 days. Among children <2, stunting prevalence was 34.9% and wasting prevalence was 2.1%. Drinking water treatment (any method) was inversely associated with caregiver-reported diarrhoea in the previous seven days (PR=0.79, 95% CI: 0.68-0.91). Improved source of drinking water (PR=0.80, 95% CI:0.73-0.87), appropriate treatment of drinking water (PR=0.88, 95% CI:0.80-0.96), improved sanitation facility (PR=0.90, 95% CI:0.82-0.97), and complete structure (having walls, floor, and roof) of the sanitation facility (PR=0.65, 95% CI:0.50-0.84) were inversely associated with stunting. None of the exposure variables were associated with wasting. A microbiological indicator of water quality was not associated with diarrhoea or stunting.

Conclusions

Our findings suggest that in Rusizi district, appropriate treatment of drinking water may be an important factor in diarrhoea in children <5, while improved source and appropriate treatment of drinking water as well as improved type and structure of sanitation facility may be important for linear growth in children <2. We did not detect an association with water quality.

Does Preservation Accelerate Neighborhood Change? Examining the Impact of Historic Preservation in New York City

Does Preservation Accelerate Neighborhood Change? Examining the Impact of Historic Preservation in New York City

Brian J. McCabe and Ingrid Gould Ellen
04/05/2016

Problem, research strategy, and findings: A number of studies have examined the property value impacts of historic preservation, but few have considered how preservation shapes neighborhood composition. In this study, we ask whether the designation of historic districts contributes to changes in the racial composition and socioeconomic status of New York City neighborhoods. Bringing together data on historic districts with a panel of census tracts, we study how neighborhoods change after the designation of a historic district. We find little evidence of changes in the racial composition of a neighborhood, but report a significant increase in socioeconomic status following historic designation.
Takeaway for practice: Our research offers empirical evidence on changes in the racial composition and socioeconomic status of neighborhoods following the designation of a historic district. It suggests that historic preservation can contribute to economic revitalization in urban neighborhoods, but that these changes risk making neighborhoods less accessible to lower-income residents. Planners should consider ways that the city government can work to preserve the highly valued amenities of historic neighborhoods while mitigating the potential for residential displacement.

Variation in Payment Rates under Medicare’s Inpatient Prospective Payment System

Variation in Payment Rates under Medicare’s Inpatient Prospective Payment System
HSR [Health Services Research]. Published online: DOI: 10.1111/1475-6773.12490

Krinsky S, Ryan AM, Mijanovich T, Blustein J
02/04/2016

Objective

To measure variation in payment rates under Medicare's Inpatient Prospective Payment System (IPPS) and identify the main payment adjustments that drive variation.

Data Sources/Study Setting

Medicare cost reports for all Medicare-certified hospitals, 1987–2013, and Dartmouth Atlas geographic files.

Study Design

We measure the Medicare payment rate as a hospital's total acute inpatient Medicare Part A payment, divided by the standard IPPS payment for its geographic area. We assess variation using several measures, both within local markets and nationally. We perform a factor decomposition to identify the share of variation attributable to specific adjustments. We also describe the characteristics of hospitals receiving different payment rates and evaluate changes in the magnitude of the main adjustments over time.

Data Collection/Extraction Methods

Data downloaded from the Centers for Medicare and Medicaid Services, the National Bureau of Economic Research, and the Dartmouth Atlas.

Principal Findings

In 2013, Medicare paid for acute inpatient discharges at a rate 31 percent above the IPPS base. For the top 10 percent of discharges, the mean rate was double the IPPS base. Variations were driven by adjustments for medical education and care to low-income populations. The magnitude of variation has increased over time.

Conclusions

Adjustments are a large and growing share of Medicare hospital payments, and they create significant variation in payment rates.

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