Robert J. Carney, Dianne R. Morrison, Lise Graham and Ryan Morrison
Reports that under a third of the increasing numbers of US citizens needing long‐term care (LTC) in a nursing home pay their own fees; and that Medicaid (health programme for the…
Abstract
Reports that under a third of the increasing numbers of US citizens needing long‐term care (LTC) in a nursing home pay their own fees; and that Medicaid (health programme for the poor) meets over half of LTC costs. Describes the rules applied to qualify for Medicaid LTC payments, the growth of “Medicaid estate planning” to shield the income/assets of the middle classes so that they can qualify and the actions taken by the government to restrict misuse of Medicaid and reduce its costs. Explains methods which are still being used to protect middle class income/assets without losing Medicaid eligibility; and the alternative of private LTC insurance, including its tax implications. Discusses efforts to develop a partnership between Medicaid and the insurance companies in some states; and the pros and cons of the plans available for both individuals and the government.
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Robert J. Carney and Lise Graham
Notes increasing US support for the BTID insurance strategy, i.e. buy low cost term life insurance and invest the difference between the cost of this and of whole life insurance…
Abstract
Notes increasing US support for the BTID insurance strategy, i.e. buy low cost term life insurance and invest the difference between the cost of this and of whole life insurance. Points out some other investment possibilities and compares the terminal and interim wealth accumulation potential of five different insurance/saving combinations for both sexes at five ages, taking tax into account. Discusses ease of access to savings, taxation of death proceeds and restrictions on creditor rights to distribution for various types of insurance/savings and considers the implications. Draws some conclusions about the best investment performance but stresses that investment choice also depends on individual factors, e.g. tax bracket, risk, tolerance and investment knowledge.
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Communications regarding this column should be addressed to Mrs. Cheney, Peabody Library School, Nashville, Term. 37203. Mrs. Cheney does not sell the books listed here. They are…
Abstract
Communications regarding this column should be addressed to Mrs. Cheney, Peabody Library School, Nashville, Term. 37203. Mrs. Cheney does not sell the books listed here. They are available through normal trade sources. Mrs. Cheney, being a member of the editorial board of Pierian Press, will not review Pierian Press reference books in this column. Descriptions of Pierian Press reference books will be included elsewhere in this publication.
Emily Walton and Denise L. Anthony
Racial and ethnic minorities utilize less healthcare than their similarly situated white counterparts in the United States, resulting in speculation that these actions may stem in…
Abstract
Racial and ethnic minorities utilize less healthcare than their similarly situated white counterparts in the United States, resulting in speculation that these actions may stem in part from less desire for care. In order to adequately understand the role of care-seeking for racial and ethnic disparities in healthcare, we must fully and systematically consider the complex set of social factors that influence healthcare seeking and use.
Data for this study come from a 2005 national survey of community-dwelling Medicare beneficiaries (N = 2,138). We examine racial and ethnic variation in intentions to seek care, grounding our analyses in the behavioral model of healthcare utilization. Our analysis consists of a series of nested multivariate logistic regression models that follow the sequencing of the behavioral model while including additional social factors.
We find that Latino, Black, and Native American older adults express greater preferences for seeking healthcare compared to whites. Worrying about one’s health, having skepticism toward doctors in general, and living in a small city rather than a Metropolitan Area, but not health need, socioeconomic status, or healthcare system characteristics, explain some of the racial and ethnic variation in care-seeking preferences. Overall, we show that even after comprehensively accounting for factors known to influence disparities in utilization, elderly racial and ethnic minorities express greater desire to seek care than whites.
We suggest that future research examine social factors such as unmeasured wealth differences, cultural frameworks, and role identities in healthcare interactions in order to understand differences in care-seeking and, importantly, the relationship between care-seeking and disparities in utilization.
This study represents a systematic analysis of the ways individual, social, and structural context may account for racial and ethnic differences in seeking medical care. We build on healthcare seeking literature by including more comprehensive measures of social relationships, healthcare and system-level characteristics, and exploring a wide variety of health beliefs and expectations. Further, our study investigates care seeking among multiple understudied racial and ethnic groups. We find that racial and ethnic minorities are more likely to say they would seek healthcare than whites, suggesting that guidelines promoting the elicitation and understanding of patient preferences in the context of the clinical interaction is an important step toward reducing utilization disparities. These findings also underscore the notion that health policy should go further to address the broader social factors relating to care-seeking in the first place.
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Until the 2008 Crash, the prevailing economic orthodoxy, accepted across the broad political spectrum, was that inequality was a necessary condition for economic health. The…
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Until the 2008 Crash, the prevailing economic orthodoxy, accepted across the broad political spectrum, was that inequality was a necessary condition for economic health. The evidence of the last four decades is that this trade-off theory – that you can have more equal or more efficient economies but not both – is incorrect. Not only do excessive concentrations of income and wealth bring social dislocation and breed public discontent with democratic institutions, but a number of studies have shown that inequality on today’s scale brings slower growth and greater economic turbulence. Although there is now a broad acceptance amongst global leaders that inequality poses significant risks for social cohesion and economic stability, there has been little or no action to match the high level verbal war against inequality. As a result, inequality has carried on rising within nations since 2008. In the United Kingdom, the gap between the top and bottom has continued to widen, in part because post-2010 governments have weakened the pro-equality role of the state. Tackling inequality is now one of the most pressing issues of the day – an economic as well as a social imperative – while reversing this four decade long trend will require a major restructuring of the pro-market economic models in place across most of the rich world.
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Lawton Robert Burns, Jeff C. Goldsmith and Aditi Sen
Researchers recommend a reorganization of the medical profession into larger groups with a multispecialty mix. We analyze whether there is evidence for the superiority of these…
Abstract
Purpose
Researchers recommend a reorganization of the medical profession into larger groups with a multispecialty mix. We analyze whether there is evidence for the superiority of these models and if this organizational transformation is underway.
Design/Methodology Approach
We summarize the evidence on scale and scope economies in physician group practice, and then review the trends in physician group size and specialty mix to conduct survivorship tests of the most efficient models.
Findings
The distribution of physician groups exhibits two interesting tails. In the lower tail, a large percentage of physicians continue to practice in small, physician-owned practices. In the upper tail, there is a small but rapidly growing percentage of large groups that have been organized primarily by non-physician owners.
Research Limitations
While our analysis includes no original data, it does collate all known surveys of physician practice characteristics and group practice formation to provide a consistent picture of physician organization.
Research Implications
Our review suggests that scale and scope economies in physician practice are limited. This may explain why most physicians have retained their small practices.
Practical Implications
Larger, multispecialty groups have been primarily organized by non-physician owners in vertically integrated arrangements. There is little evidence supporting the efficiencies of such models and some concern they may pose anticompetitive threats.
Originality/Value
This is the first comprehensive review of the scale and scope economies of physician practice in nearly two decades. The research results do not appear to have changed much; nor has much changed in physician practice organization.
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Robert J. Ceglie, Ginger Black and Somer Saunders
COVID-19’s influence on the teaching profession will be felt for many years as teachers faced experiences that they have never encountered. The pandemic forced already taxed…
Abstract
COVID-19’s influence on the teaching profession will be felt for many years as teachers faced experiences that they have never encountered. The pandemic forced already taxed teachers to assume additional responsibilities, many of which they were not prepared to deal with. The result was an exodus of teachers from the profession, and those who remained reported challenges that impacted their personal and professional lives. The authors describe the effects on teachers and the impact that this had on them, including reasons why many departed from teaching. In closing, the authors offer recommendations to teacher preparation programs, districts, and schools.