Suchergebnisse

A discussion of the impact & effects of agri'al adjustments which will be made during the next 2 decades in the form of reducing the inputs of land & human resources & perhaps of material capital. Unmet consumer needs re goods & services, which could be expanded, are listed. The production of these goods & services could give employment to the unemployed & underemployed from the agri'al sector. Various alternative solutions are pointed out, including the establishment of higher levels of human & community capital formation, better defense posture, esthetic facilities & services, & minimum standards of living for the unemployables. The utilization of underutilized resources would reduce by nearly 50`Io the marginal soc cost of providing for the needs listed. Human & community capital formation could absorb any capital that is released. Productive uses for unneeded land can be found in the nonfarm sector, if present land valuations can be reduced sufficiently. Modified Author's Summary.

SURVEY OF STATE BUDGET OFFICES SHOWS THAT THE CONDUCT OF POLICY ANALYSIS HAS INCREASED CONSIDERABLY IN STATE BUDGETARY SYSTEMS SINCE 1970. A MAJORITY OF THE BUDGET OFFICES AND MANY MAJOR OPERATING AGENCIES AND LEGISLATURES NOW CONDUCT BOTH "EFFECTIVENESS ANALYSIS" AND "PRODUCTIVITYANALYSIS. THERE IS A MAJOR GAP, HOWEVER, BETWEEN THE EXISTENCE OF ANALYSIS AND ITS USE IN POLICY DELIBERATIONS.

The authors examine trends over 1997-2001 in racial or ethnic disparities in the utilization of three costly, referral-sensitive procedures among the elderly—coronary artery bypass grafting (CABG), percutaneous transluminal coronary angioplasty (PTCA), and hip/joint replacement. Using a multivariate framework, they undertake a simultaneous examination of the relationships between patient, local area context, and health systems on these admission types after comparing them to a control group. This period spans the implementation of the Balanced Budget Act and a major Department of Health and Human Services initiative to reduce disparities in cardiovascular and other diseases. Findings suggest increasing disparities for African Americans relative to Whites in their lower utilization of CABG and PTCA over time, and increasing disparities in the utilization of hip/joint replacement among other races' relative to Whites. The authors find that racial or ethnic disparities in use of referral-sensitive procedures did not narrow over 1997-2001.

This study assesses the association of HMO enrollment with preventable hospitalizations among the elderly in four states. Using 2001 hospital discharge abstracts for elderly Medicare enrollees (age 65 and above) residing in four states (New York, Pennsylvania, Florida, and California), from the Healthcare Cost and Utilization Project (HCUP-SID) database of the Agency for Healthcare Research and Quality, we use a multivariate cross-sectional design with patient-level data for each state. Holding other factors such as demographics and illness severity constant, we find that in three out of four states, Medicare HMO patients had lower odds of a preventable admission versus marker admission than Medicare fee-for-service (FFS) patients. Moreover, in the two states with longest tenure and greatest Medicare HMO penetration, California and Florida, the reduction in preventable admissions among Medicare HMO patients was mainly concentrated among more ill patients. These findings add to the evidence that managed care outperforms traditional care among the elderly, rather than simply skimming off the healthiest populations.