Policy Analysis

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.


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).


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.


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.

Preserving History or Restricting Development: The Heterogenous Effects of Historic Districts on Local Housing Markets in New York City

Preserving History or Restricting Development: The Heterogenous Effects of Historic Districts on Local Housing Markets in New York City
2016. Journal of Urban Economics, 92(2016): 16-30.

Vicki Been, Ingrid Gould Ellen, Michael Gedal, Edward Glaeser, and Brian McCabe

Since Brooklyn Heights was designated as New York City's first landmarked neighborhood in 1965, the Landmarks Preservation Commission has designated 120 historic neighborhoods in the city. This paper develops a theory in which landmarking has heterogeneous impacts across neighborhoods and exploits variation in the timing of historic district designations in New York City to identify the effects of preservation policies on residential property markets. We combine data on residential transactions during the 35-year period between 1974 and 2009 with data from the Landmarks Preservation Commission on the location of the city's historic districts and the timing of the designations. Consistent with theory, properties just outside the boundaries of districts increase in value after designation. Further, designation raises property values within historic districts, but only outside of Manhattan. As predicted, impacts are more positive in areas where the value of the option to build unrestricted is lower. Impacts also appear to be more positive in districts that are more aesthetically appealing.

The CBO’s Crystal Ball: How Well Did It Forecast the Effects of the Affordable Care Act?

The CBO’s Crystal Ball: How Well Did It Forecast the Effects of the Affordable Care Act?
S. Glied, A. Arora, and C. Solís-Román, The CBO’s Crystal Ball: How Well Did It Forecast the Effects of the Affordable Care Act? The Commonwealth Fund, December 2015.

Sherry A. Glied, Anupama Arora, Claudia Solis-Roman

The Congressional Budget Office (CBO), a nonpartisan agency of Congress, made official projections of the Affordable Care Act’s impact on insurance coverage rates and the costs of providing subsidies to consumers purchasing health plans in the insurance marketplaces. This analysis finds that the CBO overestimated marketplace enrollment by 30 percent and marketplace costs by 28 percent, while it underestimated Medicaid enrollment by about 14 percent. Nonetheless, the CBO’s projections were closer to realized experience than were those of many other prominent forecasters. Moreover, had the CBO correctly anticipated income levels and health care prices in 2014, its estimate of marketplace enrollment would have been within 18 percent of actual experience. Given the likelihood of additional reforms to national health policy in future years, it is reassuring that, despite the many unforeseen factors surrounding the law’s rollout and participation in its reforms, the CBO’s forecast was reasonably accurate.

Wholesale Prices, Retail Prices and the Lumpy Pass-Through of Alcohol Taxes

Wholesale Prices, Retail Prices and the Lumpy Pass-Through of Alcohol Taxes

Rao, Nirupama S. (with Chris Conlon)

This paper examines the pass-through of taxation in the market for distilled spirits. By using detailed UPC level data from Nielsen Homescan, as well as state specific wholesale prices from the regulator in Connecticut we are able to measure the pass-through rate of taxation at both the wholesale and the retail level. We find that pass-through of taxes to wholesale prices is incomplete and approximately 70% while pass-through of taxation to retail prices is often excess of 100 and as high as 160%, consistent with other results on the pass-through of excise taxes for spirits. This over-shifting of the tax burden onto consumers is difficult to rationalize with profit maximizing firm behavior and log-concave demand (such as Linear Demand, Logit, or Probit). We offer an alternative explanation which incorporates dynamics in price adjustment, and shows that large pass-through rates are an artifact of small tax increases and lumpy price adjustment via $1.00 increments. When firms follow an (s, S) rule, this has implications for a policy where tax-increases minimize over-shifting behavior that generates additional deadweight loss per unit of government revenue.

Participation in the Wake of Adversity: Blame Attribution and Policy-Oriented Evaluations

Participation in the Wake of Adversity: Blame Attribution and Policy-Oriented Evaluations
Levin, I., Sinclair, J. A., & Alvarez, R. M. (2015). Participation in the Wake of Adversity: Blame Attribution and Policy-Oriented Evaluations. Political Behavior, 1-26.

Levin, Ines and J. Andrew Sinclair and R. Michael Alvarez

In this paper we investigate to what extent perceptions of economic conditions, policy-oriented evaluations, and blame attribution affected Californians’ involvement in political activities in 2010. We use a statistical methodology that allows us to study not only the behavior of the average citizen, but also the behavior of “types” of citizens with latent predispositions that incline them toward participation or abstention. The 2010 election is an excellent case study, because it was a period when citizens were still suffering the consequences of the 2008 financial crisis and many were concerned about the state’s budgetary crisis. We find that individuals who blamed one of the parties for the problems with the budget process, and who held a position on the 2010 Affordable Care Act, were often considerably more likely to participate. We also find, however, that the impact of economic evaluations, positions on the health care reform, and blame attributions was contingent on citizens’ latent participation propensities and depended on the class of political activity.

The Role of Design-Build Procurement

The Role of Design-Build Procurement
Rudin Center for Transportation, sponsored by RBC Capital Markets and the Association for a Better New York


In 2011, the New York State Legislature approved and Governor Andrew Cuomo signed into law the New York State Infrastructure Investment Act. The new law authorized five state agencies – the Department of Transportation, the Department of Environmental Conservation, the Office of Parks, Recreation and Historic Preservation, the New York State Thruway Authority, and the New York State Bridge Authority – to manage the delivery of construction projects using a method known in the industry as “Design-Build.”

Design-Build is a form of project delivery in which a public agency or private sector owner enters into a single contract with a single entity (usually a construction firm) that takes full responsibility for both design and construction of the project. The 2011 law also authorized the five agencies to hire firms based on qualifications and innovation, not just the lowest bid.

When used appropriately, Design-Build can effectively reduce the time required to complete a project, reduce the cost of a project, provide clearer accountability for a project, and encourage more innovation in design and construction.

Using Comparative Analysis to Address Health System Caricatures

Using Comparative Analysis to Address Health System Caricatures
International Journal of Health Services; 44(3): 547–559. doi: http://dx.doi.org/10.2190/HS.44.3.g

Gusmano, MK. Rodwin, VG. and Weisz, D.

To learn from health care systems abroad, we must move beyond simplistic characterizations and compare different systems with respect to salient performance measures. Despite findings from recent cross-national studies suggesting that many health care systems outperform the United States, claims by U.S. public officials often fail to acknowledge the actual accomplishments of health care systems abroad. We document significant variation among the United States and France, Germany, and England, which provide universal coverage, albeit in different ways. As previously documented, the United States has the highest rate of mortality amenable to health care. We extend this work by adding two indicators: (a) access to timely and effective primary care as measured by hospital discharges for avoidable hospital conditions; and (b) use of specialty services as indicated by coronary revascularization (bypass surgery and angioplasty), adjusted for the burden of coronary artery disease. Our findings indicate that: (a) the United States suffers the gravest consequences of financial barriers to primary care; (b) in all four countries, older people (65+) receive fewer revascularizations than their younger counterparts once we account for disease burden; and (c) in France, patients receive the most revascularizations, after adjusting for the burden of disease.

Decentralization in Uganda: Reforms, Reversals, and an Uncertain Future

Decentralization in Uganda: Reforms, Reversals, and an Uncertain Future
In Tyler Dickovich and James Wunsch, eds., Decentralization in Africa: A Comparative Perspective. (Boulder, CO: Lynne Rienner Publishers, 2014).

Smoke, P., W. Muhumuza and E. Ssewankambo

Uganda was long considered one of the most successful cases of public sector devolution in the developing world. The post-conflict national government began robust empowerment of local governments in the early 1990s. The drive for reform emerged largely from domestic political forces with little involvement of the external donor agencies that have often promoted decentralization in countries with similar development profiles. Two decades after this highly touted reform began, the system has severely deteriorated on almost every aspect by which decentralization is usually judged. This chapter documents the economic, political and social dynamics that led to the rise of decentralization and also laid the foundation for its decline. The chapter concludes by suggesting possible future scenarios for the intergovernmental system in Uganda and drawing potential lessons for other countries considering such bold reforms.


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