Race, Class, Gender & Diversity

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
04/01/2010

Objective

To examine racial disparities in health care service quality.

Design

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

Setting
Sixty communities across the United States.
Participants
A total of 41,537 insured adult patients making sick visits to primary care physicians in 1996–1997, 1998–1999, 2000–2001, and 2003.
Measurements
Lag between appointment and physician visit, waiting time in physician office, and satisfaction with care were analyzed.
Results
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.
Conclusion
There are substantial racial/ethnic disparities in satisfaction with care, and these are related to objective quality measures that can be improved.

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.

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.

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
01/01/2010

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.

 

Paradox and Collaboration in Network Management. Administration and Society

Paradox and Collaboration in Network Management. Administration and Society
Administration & Society July 2, 2010 vol. 42 no. 4 404-440

Ospina, S.
01/01/2010

Qualitative evidence from action networks is used to answer the research question, How do leaders of successful networks manage collaboration challenges to make things happen? This study of two urban immigration coalitions in the United States found that their leaders developed practices as a response to two paradoxical requirements of network collaboration: managing unity and diversity when doing inward work and confrontation and dialogue when doing outward work. By illuminating how leaders responded to these complex demands inherent in action networks, the authors open up the black box of managing whole networks of organizations and underscore the role of leadership in interorganizational collaboration.

The Behavioral Dimension of Governing Inter-Organizational Goal Directed Networks: Managing the Unity/Diversity Tension

The Behavioral Dimension of Governing Inter-Organizational Goal Directed Networks: Managing the Unity/Diversity Tension
Journal of Public Administration Research and Theory Second Author with A. Saz-Carranza

Ospina, S.
01/01/2010

Network management research documents how network members engage in activities to advance their own goals. However, this literature offers little insight into the nature of work that aims to advance the goals of the network as a “whole.” By examining the behavioral dimension of network governance, this article identifies a specific tension that network leaders address to effectively govern networks: although unity and diversity are essential to network performance, each makes contradictory demands which require attention. Findings from four case studies of immigrant networks in the United States point to three activities representing mechanisms that staff of network administrative organizations use to address this (network level) managerial tension. The study proposes that unity versus diversity represents a distinct challenge to the governance of networks that requires strategic action at the whole-network level and merits further study.

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.
01/01/2010

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
11/18/2009

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.

Stirring up the Mud: Using a Community-Based Participatory Approach to Address Health Disparities through a Faith-Based Initiative

Stirring up the Mud: Using a Community-Based Participatory Approach to Address Health Disparities through a Faith-Based Initiative
Journal of Health Care for the Poor and Underserved. Vol. 20.4

Kaplan, S.A.
11/01/2009

The paper provides a mid-course assessment of the Bronx Health REACH faith-based initiative four years into its implementation.

Pages

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