Economics

Socioeconomic Status and Dissatisfaction Among HMO Enrollees

Socioeconomic Status and Dissatisfaction Among HMO Enrollees
Medical Care. 2000, Volume 38, pages 506-516.

Carlson, M., Blustein, J., Fiorentino, N.& Prestianni, F.
05/01/2000

Objectives. Member satisfaction is commonly used as an indicator of the quality of care delivered by health plans. Yet few contemporary studies have explored the extent to which individual patient characteristics influence dissatisfaction in HMOs. We sought to determine whether socioeconomic status is associated with enrollee dissatisfaction.

Methods. Data are from a cross-sectional, telephone survey of a probability sample of adults enrolled in New Jersey HMOs in 1998 (n = 7,983). Health plan ratings were elicited as part of the Consumer Assessment of Health Plans Study (CAHPS) survey, along with income, education, and race/ethnicity. Other factors known to influence satisfaction (age, gender, health status, extent of plan choice, and payment for plan) were also ascertained.

Results. Socioeconomically advantaged enrollees were more likely to give low ratings to their health plans. In a multivariate logistic regression model, those with incomes exceeding $100,000 had 1.65 times the odds of being dissatisfied compared with those with family incomes less than $25,000 (P <0.001); those with a college education had 2.53 times the odds of being dissatisfied than those who had not completed high school (P <0.001). However, among enrollees in their plans for >=5 years, those in the lowest income group were significantly more dissatisfied than higher-income enrollees.

Conclusions. Among New Jersey HMO enrollees, higher socioeconomic status (SES) is associated with greater dissatisfaction. Although based on cross-sectional data and thus preliminary, the evidence presented here also suggests that the SES-dissatisfaction relationship varies as a function of duration of enrollment. Further research using longitudinal data could shed additional light on the SES-dissatisfaction link.

A New White Flight? The Dynamics of Neighborhood Change in the 1980s

A New White Flight? The Dynamics of Neighborhood Change in the 1980s
in Nancy Foner, Ruben G. Rumbaut, and Steven J. Gold, eds., Immigration Research for a New Century: Multidisciplinary Perspectives. New York City: Russell Sage Foundation, pp. 423-441.

Ellen, I.G.
01/01/2000

The rapid rise in immigration over the past few decades has transformed the American social landscape, while the need to understand its impact on society has led to a burgeoning research literature. Predominantly non-European and of varied cultural, social, and economic backgrounds, the new immigrants present analytic challenges that cannot be wholly met by traditional immigration studies. Immigration Research for a New Century demonstrate show sociology, anthropology, history, political science, economics, and other disciplines intersect to answer questions about today's immigrants. In Part I, leading scholars examine the emergence of an interdisciplinary body of work that incorporates such topics as the social construction of race, the importance of ethnic self-help and economic niches, the influence of migrant-homeland ties, and the types of solidarity and conflict found among migrant populations. The authors also explore the social and national origins of immigration scholars themselves, many of whom came of age in an era of civil rights and ethnic reaffirmation, and may also be immigrants or children of immigrants. Together these essays demonstrate how social change, new patterns of immigration, and the scholars' personal backgrounds have altered the scope and emphases of the research literature,allowing scholars to ask new questions and to see old problems in new ways. Part II contains the work of a new generation of immigrant scholars, reflecting the scope of a field bolstered by different disciplinary styles. These essays explore the complex variety of the immigrant experience, ranging from itinerant farmworkers to Silicon Valley engineers. The demands of the American labor force, ethnic, racial, and gender stereotyping, and state regulation are all shown to play important roles in the economic adaptation of immigrants. The ways in which immigrants participate politically, their relationships among themselves, their attitudes toward naturalization and citizenship, and their own sense of cultural identity are also addressed. Immigration Research for a New Century examines the complex effects that immigration has had not only on American society but on scholarship itself, and offers the fresh insights of a new generation of immigration researchers.

Is Biology Destiny: Birth Weight and Life Chances

Is Biology Destiny: Birth Weight and Life Chances
American Sociological Review. 65:458-467,

Conley, D. & Bennett, N.
01/01/2000

Two key questions are addressed regarding the intersection of socioeconomic status, biology, and low birth weight over the life course. First, do the income and other socioeconomic conditions of a mother during her pregnancy affect her chances of having a low-birth-weight infant net of her own birth weight, that of the father, and other family-related, unobserved factors? Second, does an individual's birth weight status affect his or her adult life chances net of socioeconomic status? These questions have implications for the way we conceive of the relationship between socio- economic status and health over the life course, specifically in sorting out causal directionality. We use intergenerational data from the Panel Study of Income Dynamics, for the years 1968 through 1992. Results of sibling comparisons (family- fixed-effects models) demonstrate that maternal income does not appear to have a significant impact on birth weight. However, low birth weight results in lower educational attainment net of other factors. These findings suggest that, when considered across generations, causality may not be as straightforward as implied by cross-sectional or unigenerational longitudinal studies.

Medicare and Drug Coverage: A Women's Health Issue

Medicare and Drug Coverage: A Women's Health Issue
Women's Health Issues. 2000, Volume 10, pages 47-53.

Blustein, J.
01/01/2000

The lack of prescription drug coverage under the Medicare program translates into high out-of-pocket drug costs for seniors. This nationwide study of older Americans with hypertension (''high blood pressure'') demonstrates that women bear the disproportionate burden of this gap in Medicare coverage. Women form the majority of older people with hypertension, and are less likely to have supplemental policies to cover the cost of the prescription drugs that are needed to treat the disease. Moreover, women have substantially lower incomes. Despite their economic vulnerability, older women with hypertension spend substantially more on prescription drugs than men.

No Easy Answers

No Easy Answers
Brookings Review, Summer 2000, Vol. 18 Issue 3, p44, 4p.

Ellen, I.G. & Schwartz, A.E.
01/01/2000

Discusses the strategies applied to foster economic growth among cities in the United States. Measurement of the impact of economic development programs; Effectiveness of infrastructure investments to boost economic growth; Impact of tax cuts on economy; Development of sports stadiums and arenas.

Politics, Growth, and Inequality in Rural China: Does it Pay to Join the Party?

Politics, Growth, and Inequality in Rural China: Does it Pay to Join the Party?
Journal of Public Economics 77 (3), September 2000, 331 - 346.

Morduch, J. & Sicular, T.
01/01/2000

Presents survey data of the household incomes of local officials in northern China and their relation to market liberalization, increases in consumer demand and the provision of local public goods. Description of the rank-and-file bureaucrats; Political status in rural China; Survey data and economic setting; Effects of political variables on income levels; Analyses; Economic reform.

Race and the Inheritance of Low Birth Weight

Race and the Inheritance of Low Birth Weight
Social Biology. 47:77-93,

Conley, D. & Bennett, N.
01/01/2000

This paper uses intergenerational data from the Panel Study of Income Dynamics (PSID) to address the black-white difference in propensities toward low birth weight (LBW). We determine that socioeconomic conditions account for some variation in low birth weight across race. Further, while race differences in the risk of low birth weight cannot be explained entirely, we find that the inheritance of parental birth weight status dramatically reduces the black-white gap in low birth weight. Intergenerational legacies of poor infant health explain the largest share of racial disparities in filial birth weight. We then try to assess whether this intergenerational transmission of low birth weight is indeed genetic by using grandparent-fixed effects models to factor out, to a great extent, family socioeconomic circumstances. We find that even within this framework, both father's and mother's birth weight status have an important impact on filial outcomes. However, the degree of inheritance is weaker for African Americans than for other races. Finally, we theorize that the importance of paternal birth weight status implies a genetic association that does not work through the uterine environment but rather through the fetus itself.

The Microfinance Schism

The Microfinance Schism
World Development, 28 (4), April 2000, 617 - 629.

Morduch, J.
01/01/2000

Presents a study on win-win proposition, a principle of good banking, by leading microfinance advocates which can alleviate poverty through microfinance institution. Logic of the win-win proposition; Advantages of financial sustainability; Limits of the proposition.

The Microfinance Promise

The Microfinance Promise
Journal of Economic Literature, Dec 1999, Vol. 37 Issue 4, p1569, 46p.

Morduch, J.
12/01/1999

The article presents information about a set of financial institutions in underdeveloped countries which are striving to alleviate poverty by providing financial services to low-income households. These institutions, united under the banner of microfinance, share a commitment to serving clients that have been exclude from the formal banking sector. Almost all of the borrowers do so to finance self-employment activities, and many start by taking loans as small as $75, repaid over several months or a year. Only a few programs require borrowers to put up collateral, enabling would-be entrepreneurs with few assets to escape positions as poorly paid wage laborers or farmers. The programs point to innovations like "group-lending" contracts and new attitudes about subsidies as keys to their success. Group-lending contracts effectively make a borrower's neighbors co-signers to loans, mitigating problems created by informational asymmetries between lender and borrower. Neighbours now have incentives to monitor each other and to exclude risky borrowers from participation, promoting repayment even in the absence of collateral requirements.

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