Disparities in Service Quality Among Insured Adult Patients Seen in Physicians’ Offices

Disparities in Service Quality Among Insured Adult Patients Seen in Physicians’ Offices
Journal of General Internal Medicine, 2010. Volume 25 / Issue 04 / April 2010, pp 357-362, Published online

Dan Ly, Sherry Glied


To examine racial disparities in health care service quality.


Secondary data analyses of visits by primary care service users in the Community Tracking Study household sample.

Sixty communities across the United States.
A total of 41,537 insured adult patients making sick visits to primary care physicians in 1996–1997, 1998–1999, 2000–2001, and 2003.
Lag between appointment and physician visit, waiting time in physician office, and satisfaction with care were analyzed.
Blacks but not other minorities were more likely to have an appointment lag of more than 1 week (13% white vs. 21% black, p < 0.001). Blacks, Hispanics, and other minorities were more likely to wait more than 30 min before being seen by the physician (16% white vs. 26% black, p < 0.001; vs. 27% Hispanic and 22% other minority, p < 0.001 and p = 0.02, respectively) and were less likely to report that they were very satisfied with their care (65% white vs. 60% black, p = 0.02; vs. 57% Hispanic and 48% other minority, p = 0.004 and p < 0.001, respectively). The differences in appointment lag and wait time remain large and statistically significant after the inclusion of multiple covariates, including geographic controls for CTS site. For all groups, satisfaction with care was affected by objective measures of service quality. Differences in objective measures of service quality explained much of the black-white difference in satisfaction, though not differences for other minority groups.
There are substantial racial/ethnic disparities in satisfaction with care, and these are related to objective quality measures that can be improved.

A qualitative analysis of environmental policy and children's health in Mexico

A qualitative analysis of environmental policy and children's health in Mexico
Environ Health. 2010 Mar 23;9:14

Cifuentes E, Trasande L, Ramirez M, Landrigan PJ.


Since Mexico's joining the North American Free Trade Agreement (NAFTA) and the Organization for Economic Cooperation and Development (OECD) in 1994, it has witnessed rapid industrialization. A byproduct of this industrialization is increasing population exposure to environmental pollutants, of which some have been associated with childhood disease. We therefore identified and assessed the adequacy of existing international and Mexican governance instruments and policy tools to protect children from environmental hazards.


We first systematically reviewed PubMed, the Mexican legal code and the websites of the United Nations, World Health Organization, NAFTA and OECD as of July 2007 to identify the relevant governance instruments, and analyzed the approach these instruments took to preventing childhood diseases of environmental origin. Secondly, we interviewed a purposive sample of high-level government officials, researchers and non-governmental organization representatives, to identify their opinions and attitudes towards children's environmental health and potential barriers to child-specific protective legislation and implementation.


We identified only one policy tool describing specific measures to reduce developmental neurotoxicity and other children's health effects from lead. Other governance instruments mention children's unique vulnerability to ozone, particulate matter and carbon monoxide, but do not provide further details. Most interviewees were aware of Mexican environmental policy tools addressing children's health needs, but agreed that, with few exceptions, environmental policies do not address the specific health needs of children and pregnant women. Interviewees also cited state centralization of power, communication barriers and political resistance as reasons for the absence of a strong regulatory platform.


The Mexican government has not sufficiently accounted for children's unique vulnerability to environmental contaminants. If regulation and legislation are not updated and implemented to protect children, increases in preventable exposures to toxic chemicals in the environment may ensue.

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.

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.

Age of Entry and the High School Performance of Immigrant Youth

Age of Entry and the High School Performance of Immigrant Youth
Journal of Urban Economics 67: 303-314

Stiefel, Leanna, Amy Ellen Schwartz, and Dylan Conger

In 2005, immigrants exceeded 12% of the US population, with the highest concentrations in large metropolitan areas. While considerable research has focused on how immigrants affect local wages and housing prices, less research has asked how immigrants fare in US urban public schools. Previous studies find that foreign-born students outperform native-born students in their elementary and middle school years, but urban policymakers and practitioners continue to raise concerns about educational outcomes of immigrants arriving in their high school years.

The authors use data on a large cohort of New York City (NYC) public high school students to examine how the performance of students who immigrate during high school (teen immigrants) differs from that of students who immigrate during middle school (tween immigrants) or elementary school (child immigrants), relative to otherwise similar native-born students. Contrary to prior studies, their difference-in-difference estimates suggest that, ceteris paribus, teen immigrants do well compared to native-born migrants, and that the foreign-born advantage is relatively large among the teen (im)migrants. That said, their findings provide cause for concern about the performance of limited English proficient students, blacks and Hispanics and, importantly, teen migrants. In particular, switching school districts in the high school years - that is, student mobility across school districts - may be more detrimental than immigration per se. Results are robust to alternative specifications and cohorts, including a cohort of Miami students.


Building Bridges from Margins: The Work of Leadership in Social Change Organizations

Building Bridges from Margins: The Work of Leadership in Social Change Organizations
The Leadership Quarterly  

Ospina, S. and E. G. Foldy

Attention to the relational dimensions of leadership represents a new frontier of leadership research and is an expression of the growing scholarly interest in the conditions that foster collective action within and across boundaries. This article explores the antecedents of collaboration from the perspective of social change organizations engaged in processes of collaborative governance. Using a constructionist lens, the study illuminates the question how do social change leaders secure the connectedness needed for collaborative work to advance their organization's mission? The article draws on data from a national, multi-year, multi-modal qualitative study of social change organizations and their leaders. These organizations represent disenfranchised communities which aspire to influence policy makers and other social actors to change the conditions that affect their members' lives. Narrative analysis of transcripts from in-depth interviews in 38 organizations yielded five leadership practices that foster strong relational bonds either within organizations or across boundaries with others. The article describes how these practices nurture interdependence either by forging new connections, strengthening existing ones, or capitalizing on strong ones.

Do Public Schools Disadvantage Students Living in Public Housing?

Do Public Schools Disadvantage Students Living in Public Housing?
Urban Affairs Review, 46 (1):68-89.

Ellen, I.G., Schwartz, A.E., McCabe, B. & Chellman, C.

In the United States, public housing developments are predominantly located in neighborhoods with low median incomes, high rates of poverty and disproportionately high concentrations of minorities. While research consistently shows that public housing developments are located in economically and socially disadvantaged neighborhoods, we know little about the characteristics of the schools serving students in these neighborhoods.

In this paper, the authors examine the characteristics of elementary and middle schools attended by students living in public housing developments in New York City. Using the proportion of public housing students attending each elementary and middle school as their weight, they calculate the weighted average of school characteristics to describe the typical school attended by students living in public housing. They then compare these characteristics to those of the typical school attended by other students throughout the city in an effort to assess whether public schools systematically disadvantage students in public housing in New York City. 

Their  results are decidedly mixed. On one hand, they find no large differences between the resources of the schools attended by students living in public housing and the schools attended by their peers living elsewhere in the city; on the other hand, they find significant differences in student characteristics and outcomes. The typical school attended by public housing students has higher poverty rates and lower average performance on standardized exams than the schools attended by others. These school differences, however, fail to fully explain the performance disparities: they find that students living in public housing score lower, on average, on standardized tests than their schoolmates living elsewhere -- even though they attend the same school. These results point to a need for more nuanced analyses of policies and practices in schools, as well as the outside-of-school factors that shape educational success, to identify and address the needs of students in public housing.

Professed impressions: What people say about others affects onlookers' perceptions of speakers' power and warmth

Professed impressions: What people say about others affects onlookers' perceptions of speakers' power and warmth
Journal of Experimental Social Psychology, 46, 152-158

Ames, Daniel R., Emily C. Bianchi, Joe C. Magee.

During a conversation, it is common for a speaker to describe a third-party that the listener does not know. These professed impressions not only shape the listener's view of the third-party but also affect judgments of the speaker herself. We propose a previously unstudied consequence of professed impressions: judgments of the speaker's power. In two studies, we find that listeners ascribe more power to speakers who profess impressions focusing on a third-party's conscientiousness, compared to those focusing on agreeableness. We also replicate previous research showing that speakers saying positive things about third parties are seen as more agreeable than speakers saying negative things. In the second study, we demonstrate that conscientiousness-power effects are mediated by inferences about speakers' task concerns and positivity-agreeableness effects are mediated by inferences about speakers' other-enhancing concerns. Finally, we show that judgments of speaker status parallel judgments of agreeableness rather than of power, suggesting that perceivers use different processes to make inferences about status and power. These findings have implications for the literatures on person perception, power, and status.

Transportation to Clinic: Findings from a Pilot Clinic-Based Survey of Low-Income Suburbanites

Transportation to Clinic: Findings from a Pilot Clinic-Based Survey of Low-Income Suburbanites
Journal of Immigrant and Minority Health 2010.  DOI: 10.1007/s10903-010-9410-0

Silver D, J Blustein, BC Weitzman.

Health care policymakers have cited transportation barriers as key obstacles to providing health care to low-income suburbanites, particularly because suburbs have become home to a growing number of recent immigrants who are less likely to own cars than their neighbors. In a suburb of New York City, we conducted a pilot survey of low income, largely immigrant clients in four public clinics, to find out how much transportation difficulties limit their access to primary care. Clients were receptive to the opportunity to participate in the survey (response rate = 94%). Nearly one-quarter reported having transportation problems that had caused them to miss or reschedule a clinic appointment in the past. Difficulties included limited and unreliable local bus service, and a tenuous connection to a car. Our pilot work suggests that this population is willing to participate in a survey on this topic. Further, since even among those attending clinic there was significant evidence of past transportation problems, it suggests that a population based survey would yield information about substantial transportation barriers to health care.

The High Cost of Segregation: The Relationship Between Racial Segregation and Subprime Lending

The High Cost of Segregation: The Relationship Between Racial Segregation and Subprime Lending
November 2009

Furman Center for Real Estate & Urban Policy

This study examines whether the likelihood that borrowers of different races received a subprime loan varied depending on the level of racial segregation where they live. It looks both at the role of racial segregation in metropolitan areas across the country and at the role that neighborhood demographics within communities in New York City played.


Subscribe to Inequality