Abstracts

"Comments on Dr. Blustein's Paper, 'Toward a More Public Discussion of the Ethics of Federal Social Program Evaluation.'" Journal of Policy Analysis and Management, vol. 24, 2005, Peter Z. Schochet. Notes that the Job Corps evaluators adhered to the Belmont principles in accordance with the evaluation goals mandated by Congress and the realities of using random assignment to evaluate an ongoing program.

"Cost-Effectiveness of Targeted Reemployment Bonuses." Journal of Human Resources, 2005, Christopher J. O'Leary, Paul T. Decker, and Stephen A. Wandner. Targeting reemployment bonus offers to unemployment insurance recipients likely to exhaust benefits may reduce benefit payments, although earlier research has not generated overwhelming support for this technique. The authors show that targeting benefits with profiling models similar to those used in state Worker Profiling and Reemployment Services systems can improve targeting's cost-effectiveness. Because estimated average benefit payments do not steadily decline as the eligibility screen is tightened, narrow targeting is not optimal. The best model is a low bonus amount with a long qualification period, targeted to the half of profiled claimants most likely to exhaust their benefits.

"How Do Hired Workers Fare Under Consumer-Directed Personal Care?" The Gerontologist, vol. 45, no. 5, 2005, Stacy Dale, Randall Brown, Barbara Phillips, and Barbara Lepidus Carlson. A growing number of Medicaid beneficiaries receiving disability-related assistance in their homes hire workers and manage the services themselves under consumer-directed care. Although consumer direction clearly benefits beneficiaries, it is sustainable only if workers are satisfied with their experiences. Directly hired workers in this study were almost always the consumers' friends or relatives; compared with agency workers, these individuals provided comparable amounts of care and reported similar levels of physical injury, but they were more likely to report emotional strain and want more respect from the consumer's family. States may be able to reduce emotional strain and injury through educational materials and counseling.

"Prescription Drug Demand for Therapeutic Substitutes: The Influence of Copayments and Insurer Non-Price Rationing." Journal of Pharmaceutical Finance, Economics & Policy, vol. 14, 2005, Domenico Esposito. This study uses a retrospective medical claims data set to examine the influence of copayments and insurance type on the demand for therapeutically equivalent, cholesterol-lowering drugs in the statins class for a population of insured individuals. Multivariate regression results from a multinomial logit specification suggest that differences in copayments influence choice, shifting market share across drugs. Insurers also appear to affect patient drug choice through non-price rationing methods, as evidenced by differences in utilization across insurance type. These results imply that both health insurers and Medicare prescription drug plans could use differential copayments as a negotiating tool to obtain price discounts for higher volume from drug manufacturers, while manufacturers could use them to capture additional market share from competitors. Reprints available while supply lasts; call 609-275-2350.

"Watching the Clock Tick: Factors Associated with TANF Accumulation." Social Work Research, vol. 29, no. 4, 2005, Kristin S. Seefeldt and Sean M. Orzol. One of the most notable provisions of the 1996 welfare reform legislation was the 60-month lifetime limit on cash benefits under the Temporary Assistance to Needy Families (TANF) program. This study investigated the personal characteristics associated with accumulating more months on TANF. Using four waves of data from the Women's Employment Study, we examined factors surrounding receipt at varying levels: low (less than 20 months), medium (20 to 39 months), and high (40 to 60 months). Medium and high accumulation groups had many factors in common relative to the low group. However, demographic variables, such as the presence of a partner and number of children, mattered more in determining whether someone would accumulate a relatively low as opposed to medium amount of time on TANF. For the high accumulation group, the presence of human capital problems, as well as persistent personal and family challenges, such as child and maternal health problems and domestic violence, greatly increased the likelihood of a longer stay.

"Does Weighting for Nonresponse Increase the Variance of Survey Means?" Survey Methodology, vol. 31, no. 2, December 2005, Roderick J.A. Little and Sonya Vartivarian. Nonresponse weighting is a common method for handling unit nonresponse in surveys and is aimed at reducing nonresponse bias. Because the method can be accompanied by an increase in variance, the efficacy of weighting adjustments is often seen as a bias-variance trade-off. This view is an oversimplification, because weighting can reduce variance as well as bias. The authors provide a detailed analysis of bias and variance in setting weights to estimate a survey mean based on adjustment cells and suggest that the most important feature of variables for inclusion is that they are predictive of survey outcomes. Prediction of the propensity to respond is a secondary, though useful, goal. The authors also evaluate empirical estimates of root mean squared error for assessing when weighting is effective.

"Factors Influencing Patient Disposition After Ambulatory Herniorrhaphy." Journal of Ambulatory Surgery, November 2005, S. Memtsoudis, M. Besculides, and C. Swamidoss. This study examined factors associated with patients' discharge to a facility other than their home after elective, ambulatory inguinal hernia repair. These factors included anesthesia type, anesthesia provider, increasing age of the patient, and bi- versus unilaterality of the procedure. Differences were also found by facility type and region in which the procedure was performed. The increased cost associated with a discharge to a facility other than home requires identification of factors that independently contribute to such an outcome. This study identified a number of anesthesia-related and other factors that may affect patients' discharge options.

"Evaluation of School Absenteeism Data for Early Outbreak Detection, New York City." BMC Public Health, October 2005, Melanie Besculides, Richard Heffernan, Farzad Mostashari, and Don Weiss. School absenteeism data may provide an early indicator of disease outbreaks. This paper describes an evaluation of the utility of these data for early detection of outbreaks in New York City. Moderate increases in absenteeism were observed among children during peak influenza season. Although monitoring school absenteeism may be moderately useful for detecting large citywide epidemics, school-level data were noisy, and cluster analysis did not seem useful in identifying localized outbreaks. The authors are evaluating the utility of more specific school-based data for outbreak detection.

"Donated Care Programs: A Stopgap Measure or a Long-Run Alternative to Health Insurance?" Journal of Health Care for the Poor and Underserved, August 2005, Jeffrey Kullgren, Erin Fries Taylor, and Catherine McLaughlin. In the absence of broad federal health care reform, interest has grown in local solutions to the problem of providing health care to the uninsured. Community-based donated medical care models have emerged as one alternative. The authors examine the early experience of a donated care program in southern Maine called CarePartners. Although such programs are often viewed as a short-term solution for those temporarily without health insurance, CarePartners served a different role for many individuals. While clearly a short-term stopgap measure for some, CarePartners appears to be a longer-term means for getting access to care for most enrollees.

"Easing the Burden of Caregiving: The Impact of Consumer Direction of Primary Informal Caregivers in Arkansas." The Gerontologist, vol. 45, no.4, August 2005, Leslie Foster, Randall Brown, Barbara Phillips, and Barbara Lepidus Carlson. Although providing personal care to a family member with disabilities often is rewarding, it can also be emotionally, physically, and financially burdensome. Caregiver burden may be exacerbated if paid personal care services (PCS), such as those provided by Medicaid-certified personal care agencies, are unsatisfactory. Consumer-directed Cash and Counseling programs provide eligible Medicaid beneficiaries with a monthly allowance to direct their PCS as they see fit. This article assesses the effect of consumer-directed PCS on the primary informal caregivers of Arkansas beneficiaries who voluntarily participated in the Cash and Counseling Demonstration and Evaluation. The demonstration randomly assigned beneficiaries to a program in which they could direct their own PCS (the treatment group) or rely on traditional agency services (the control group). At followup, the caregivers of treatment group members provided fewer hours of assistance than did their control group counterparts and reported better emotional, physical, and financial well-being.

"Individual Training Accounts, Eligible Training Provider Lists, and Consumer Reporting Systems." In Job Training Policy in the United States, July 2004, edited by Christopher J. O'Leary, Robert A. Straits, and Stephen A. Wandner. Paul Decker and Irma Perez-Johnson. This book reviews the effectiveness of major federal job training programs, examines features of current programs, and speculates about directions for future programs. The contributors discuss the implementation of training programs under WIA, assess methods for delivering training, examine performance management of U.S. training programs, and compare public training programs to private programs and to programs offered in other industrialized nations.

"Parent's Language of Interview and Access to Care for Children with Special Health Care Needs." Ambulatory Pediatrics, March/April 2004, Stella M. Yu, Rebecca M. Nyman, Michael Kogan, Zhihuan J. Huang, and Renee H. Schwalberg. Examines the association between a parent's language of interview and access to care for children with special health care needs. These children with non-English-speaking parents were more likely to be from disadvantaged families, to have inadequate insurance and unmet needs, and to lack a usual source of care and family-centered care. Recommends that systems of care for children with special health care needs should consider the needs and challenges of families whose primary language is not English.

"Earnings of Black and White Youth and Their Relation to Poverty." In Race, Poverty, and Domestic Policy, edited by C. Michael Henry, 2004, Philip M. Gleason and Glen G. Cain. The paper examines how unemployment among African American teenage males influences rates of family poverty. The authors suggest that, if the employment and earnings of young black males were similar to those of young white males, the poverty rate among black families would be substantially reduced.

"How Much More Can They Work? Setting Realistic Expectations for Welfare Mothers." In Race, Poverty, and Domestic Policy, edited by C. Michael Henry, 2004, LaDonna Pavetti. This paper uses data from the National Longitudinal Survey of Youth to examine young women's work experiences over a fixed period to gauge how much additional work can be realistically expected from young welfare recipients. The analysis suggests that, even if states succeed in getting the most disadvantaged young welfare recipients into the labor market, the women are likely to continue to experience substantial periods of joblessness and may continue to need access to a safety net for an extended period.

"Community Responses to National Healthcare Firms." Journal of Health and Social Behavior, 2004, Douglas R. Wholey, Jon B. Christianson, Debra A. Draper, Cara S. Lesser, and Lawton R. Burns. Over the past 25 years, national HMOs and hospital firms have attempted to enter local health care markets. This paper explores the reasons that national HMOs have been relatively successful, while national hospital firms have had much less success, using data from the Community Tracking Study.

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