Social Policy

Financial Incentives and Fertility

Financial Incentives and Fertility
Review of Economics and Statistics, Volume 95 (Number 1), March 2013, pp. 1-20.

Dehejia, Rajeev and Alma Cohen.
03/01/2013

This paper investigates how fertility responds to financial incentives. We construct a large, individual-level panel data set of over 300,000 Israeli women during the period 1999–2005 with comprehensive information on their fertility histories, education, religious affiliation, ethnicity, and income. We exploit variation in Israel’s child subsidy program to identify the impact of changes in the price of a marginal child on fertility. We find a positive, statistically significant, and economically meaningful price effect on fertility. This positive effect is strongest for households in the lower range of the income distribution, weakens with income, and is present in all religious and ethnic subgroups. There is also a significant price effect on fertility among women who are close to the end of their lifetime fertility, suggesting that at least part of the effect that we estimate is due to a reduction in total fertility. Finally, we investigate how changes in household income affect fertility choices. Consistent with Becker (1960) and Becker and Tomes (1976), we find that the income effect is small in magnitude, and is negative at low income levels and positive at high income levels.

Growing Older in Hong Kong, New York and London

Growing Older in Hong Kong, New York and London
The Hong Kong Jockey Club Charities Trust. Hong Kong, 2012.

P. Chau, J. Woo, M. Gusmano, D. Weisz, and Rodwin, V.
05/08/2012

Declining birth rates, increasing longevity and urbanization have created a new challenge for cities: how to respond to an ageing population. Although population ageing and urbanization are not new concerns for national governments around the world, the consequences of these trends for quality of life in cities has only recently started to receive attention from policy makers and researchers. Few comparative studies of world cities examine their health or long-term care systems; nor have comparisons of national systems for the provision of long-term care focused on cities, let alone world cities.

By extending the work of the CADENZA and World Cities Projects , this report investigates how three world cities -- Hong Kong, New York and London -- are coping with this challenge. These world cities are centers of finance, information, media, arts, education, specialized legal services and advanced business services, and contribute disproportionate shares of GDP to their national economies. But are these influential centers prepared to meet the challenge posed by the “revolution of longevity?” How will these world cities accommodate this revolutionary demographic change? Are they prepared to implement the health and social policy innovations that may be required to serve their residents, both old and young? Will they be able to identify the new opportunities that increased longevity may offer? Can they learn from one another as they seek to develop creative solutions to the myriad issues that arise? Finally, can other cities learn from the experience of these three cities as they confront this challenge?

To address these questions, we examine comparable data on the economic and health status of older persons, as well as the availability and use of health, social and long-term care across and within these cities. In the report “How Well Are Seniors in Hong Kong Doing? An International Comparison”, a first attempt was made to compare the situation in Hong Kong with five economically developed countries. This report extends this study by comparing the situation in Hong Kong with two other world cities—New York City and London, which are more comparable in terms of population size and economic characteristics.

Valuing Improvement in Value Based Purchasing

Valuing Improvement in Value Based Purchasing
Circulation:  Cardiovascular Quality and Outcomes.  5:163-170  

Borden, William and Jan Blustein.
03/01/2012

Background

Medicare will soon implement hospital value-based purchasing (VBP), using a scoring system that rewards both achievement (absolute performance) and improvement (performance increase over time).  However, improvement is defined so as to give less credit to initial low performers than initial high performers.  Since initial low performers are disproportionately hospitals in socioeconomically disadvantaged areas, these institutions stand to lose under Medicare’s VBP proposal. 

 

Methods

We developed an alternative improvement scale, and applied it to hospital performance throughout the US.   Using 2005-2008 Medicare process measures for acute myocardial infarction (AMI) and heart failure (HF), we calculated hospital scores using Medicare’s proposal and our alternative.  Hospital performance scores were compared across 5 locational dimensions of socioeconomic disadvantage: poverty, unemployment, physician shortage, high school and college graduation rates.

 

Results

Medicare’s proposed scoring system yielded higher overall scores for the most locationally advantaged hospitals for 4 out of 5 dimensions in AMI and 2 out of 5 for HF.  Using our alternative, differences in overall scores between hospitals in the most and least advantaged areas were attenuated, with locationally advantaged hospitals having higher overall scores for 3 out of 5 dimensions in AMI and 1 out of 5 dimensions for HF. 

 

Conclusions

Using an alternative VBP formula that reflects the principle of “equal credit for equal improvement,” resulted in a more equitable distribution of overall payment scores, which could allow hospitals in both socioeconomically advantaged and disadvantaged areas to succeed under VBP.

 

 

The Greatest Grid: The Master Plan of Manhattan, 1811-2011

The Greatest Grid: The Master Plan of Manhattan, 1811-2011
January 2012

Ballon, Hilary
01/01/2012

Laying out Manhattan's street grid and providing a rationale for the growth of New York was the city's first great civic enterprise, not to mention a brazenly ambitious project and major milestone in the history of city planning. The grid created the physical conditions for business and society to flourish and embodied the drive and discipline for which the city would come to be known. Published to coincide with an exhibition at the Museum of the City of New York celebrating the bicentennial of the Commissioners' 1811 Plan of Manhattan, this volume does more than memorialize such a visionary effort, it serves as an enduring reference full of rare images and information.

The Greatest Grid shares the history of the Commissioners' plan, incorporating archival photos and illustrations, primary documents and testimony, and magnificent maps with essential analysis. The text, written by leading historians of New York City, follows the grid's initial design, implementation, and evolution, and then speaks to its enduring influence. A foldout map, accompanied by explanatory notes, reproduces the Commissioners' original plan, and additional maps and prints chart the city's pre-1811 irregular growth patterns and local precedent for the grid's design. Constituting the first sustained examination of this subject, this text describes the social, political, and intellectual figures who were instrumental in remaking early New York, not in the image of old Europe but as a reflection of other American cities and a distinct New World sensibility. The grid reaffirmed old hierarchies while creating new opportunities for power and advancement, giving rise to the multicultural, highly networked landscape New Yorkers thrive in today.

 

Resetting our priorities in environmental health: An example from the south-north partnership in Lake Chapala, Mexico

Resetting our priorities in environmental health: An example from the south-north partnership in Lake Chapala, Mexico
Environ Res. 2011 Aug;111(6):877-80.

Cifuentes E, Lozano Kasten F, Trasande L, Goldman RH.
08/01/2011

Lake Chapala is a major source of water for crop irrigation and subsistence fishing for a population of 300,000 people in central Mexico. Economic activities have created increasing pollution and pressure on the whole watershed resources. Previous reports of mercury concentrations detected in fish caught in Lake Chapala have raised concerns about health risks to local families who rely on fish for both their livelihood and traditional diet. Our own data has indicated that 27% of women of childbearing age have elevated hair mercury levels, and multivariable analysis indicated that frequent consumption of carp (i.e., once a week or more) was associated with significantly higher hair mercury concentrations. In this paper we describe a range of environmental health research projects. Our main priorities are to build the necessary capacities to identify sources of water pollution, enhance early detection of environmental hazardous exposures, and deliver feasible health protection measures targeting children and pregnant women. Our projects are led by the Children's Environmental Health Specialty Unit nested in the University of Guadalajara, in collaboration with the Department of Environmental Health of Harvard School of Public Health and Department of Pediatrics of the New York School of Medicine. Our partnership focuses on translation of knowledge, building capacity, advocacy and accountability. Communication will be enhanced among women's advocacy coalitions and the Ministries of Environment and Health. We see this initiative as an important pilot program with potential to be strengthened and replicated regionally and internationally.

Are Land Use Planning and Congestion Pricing Mutually Supportive? Evidence From a Pilot Mileage Fee Program in Portland, OR

Are Land Use Planning and Congestion Pricing Mutually Supportive? Evidence From a Pilot Mileage Fee Program in Portland, OR
Journal of American Planning Association, Vol. 77, 3, 232-250

Guo, Zhan, Asha W. Agrawal & Jennifer Dill
05/09/2011

Congestion pricing and land use planning have been proposed as two promising strategies to reduce the externalities associated with driving, including traffic congestion, air pollution, and greenhouse gas emissions. However, they are often viewed by their proponents as substitutive instead of complementary to each other. Using data from a pilot mileage fee program run in Portland, OR, we explored whether congestion pricing and land use planning were mutually supportive in terms of vehicle miles traveled (VMT) reduction. We examined whether effective land use planning could reinforce the benefit of congestion pricing, and whether congestion pricing could strengthen the role of land use planning in encouraging travelers to reduce driving.

VMT data were collected over 10 months from 130 households, which were divided into two groups: those who paid a mileage charge with rates that varied by congestion level (i.e., congestion pricing) and those who paid a mileage charge with a flat structure. Using regression models to compare the two groups, we tested the effect of congestion pricing on VMT reduction across different land use patterns, and the effect of land use on VMT reduction with and without congestion pricing. With congestion pricing, the VMT reduction is greater in traditional (dense and mixed-use) neighborhoods than in suburban (single use, low-density) neighborhoods, probably because of the availability of travel alternatives in the former. Under the same land use pattern, land use attributes explain more variance of household VMT when congestion pricing is implemented, suggesting that this form of mileage fee could make land use planning a more effective mechanism to reduce VMT. In summary, land use planning and congestion pricing appear to be mutually supportive.

For policymakers considering mileage pricing, land use planning affects not only the economic viability but also the political feasibility of a pricing scheme. For urban planners, congestion pricing provides both opportunities and challenges to crafting land use policies that will reduce VMT. For example, a pricing zone that overlaps with dense, mixed-use and transit-accessible development, can reinforce the benefits of these development patterns and encourage greater behavioral changes.

 

Climate Change and Urban Transportation Systems

Climate Change and Urban Transportation Systems
in Urban Climate Change Research Network (UCCRN), First UCCRN Assessment Report on Climate Change in Cities (ARC3), edited by C. Rosenzweig, W. D. Solecki, S. A. Hammer, and S. Mehrotra. New York, NY: Cambridge University Press, 2011, forthcoming, pp. 143- 182.

S. Mehrotra (Nairobi, Mexico City), B. Lefevre (Paris), R. Zimmerman (New York City, Coordinating Lead Authors and H. Gercek, K. Jacob, and S. Srinivasan.
05/01/2011

Fine particulate matter pollution linked to respiratory illness in infants and increased hospital costs

Fine particulate matter pollution linked to respiratory illness in infants and increased hospital costs
Health Aff (Millwood). 2011 May;30(5):871-8.

Sheffield P, Roy A, Wong K, Trasande L.
05/01/2011

There has been little research to date on the linkages between air pollution and infectious respiratory illness in children, and the resulting health care costs. In this study we used data on air pollutants and national hospitalizations to study the relationship between fine particulate air pollution and health care charges and costs for the treatment of bronchiolitis, an acute viral infection of the lungs. We found that as the average exposure to fine particulate matter over the lifetime of an infant increased, so did costs for the child's health care. If the United States were to reduce levels of fine particulate matter to 7 percent below the current annual standard, the nation could save $15 million annually in reduced health care costs from hospitalizations of children with bronchiolitis living in urban areas. These findings reinforce the need for ongoing efforts to reduce levels of air pollutants. They should trigger additional investigation to determine if the current standards for fine-particulate matter are sufficiently protective of children's health.

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