Assuntos
Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Serviços de Saúde Mental/legislação & jurisprudência , Patient Protection and Affordable Care Act , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Implementação de Plano de Saúde/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/economia , Humanos , Medicaid/economia , Medicaid/legislação & jurisprudência , Serviços de Saúde Mental/economia , Transtornos Relacionados ao Uso de Substâncias/economia , Estados UnidosRESUMO
When all of the insurance and health care reforms of the ACA are fully implemented, some public financing needs for behavioral health services will remain. This commentary outlines a number of the residual functions of the public mental health system in an ACA world, and it identifies opportunities for expansions of service areas not covered by traditional insurance or the health delivery reforms for behavioral health services within the scope of the ACA.
Assuntos
Emigrantes e Imigrantes/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Medicaid/legislação & jurisprudência , Indigência Médica/legislação & jurisprudência , Serviços de Saúde Mental/legislação & jurisprudência , Pessoas Mentalmente Doentes/legislação & jurisprudência , Patient Protection and Affordable Care Act/economia , Emigrantes e Imigrantes/classificação , Financiamento Governamental , Psiquiatria Legal/economia , Psiquiatria Legal/legislação & jurisprudência , Implementação de Plano de Saúde , Acessibilidade aos Serviços de Saúde/economia , Humanos , Cobertura do Seguro/economia , Cobertura do Seguro/legislação & jurisprudência , Medicaid/economia , Indigência Médica/tendências , Pessoas sem Cobertura de Seguro de Saúde , Transtornos Mentais/economia , Transtornos Mentais/prevenção & controle , Transtornos Mentais/terapia , Serviços de Saúde Mental/economia , Avaliação das Necessidades , Patient Protection and Affordable Care Act/normas , Prisioneiros/legislação & jurisprudência , Estados UnidosRESUMO
The potentially serious adverse impacts of behavior problems during adolescence on employment outcomes in adulthood provide a key economic rationale for early intervention programs. However, the extent to which lower educational attainment accounts for the total impact of adolescent behavior problems on later employment remains unclear As an initial step in exploring this issue, we specify and estimate a recursive bivariate probit model that 1) relates middle school behavior problems to high school graduation and 2) models later employment in young adulthood as a function of these behavior problems and of high school graduation. Our model thus allows for both a direct effect of behavior problems on later employment as well as an indirect effect that operates via graduation from high school. Our empirical results, based on analysis of data from the NELS, suggest that the direct effects of externalizing behavior problems on later employment are not significant but that these problems have important indirect effects operating through high school graduation.
RESUMO
The relationship between depression and development of chronic illness among older adults is not well understood. This study uses data from the Health and Retirement Study to evaluate the relationship between depression at baseline and new onset of chronic illnesses including cancer, heart problems, arthritis, and diabetes. Analysis controlling for demographics (age, gender, race, education), health risk indicators (BMI and smoking), functional limitations (gross motor index, health limitations for work), and income show that working-age older people (ages 50-62) with depression at baseline are at significantly higher risk to develop diabetes, heart problems, and arthritis during the 12-year follow-up. No significant association was found between depression and cancer. Prevention efforts aimed at chronic illnesses among the elderly should recognize the mind-body interaction and focus on preventing or alleviating depression.
Assuntos
Atividades Cotidianas/psicologia , Doença Crônica/psicologia , Depressão/psicologia , Distribuição por Idade , Idoso , Doença Crônica/epidemiologia , Depressão/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Estados Unidos/epidemiologiaRESUMO
We consider the implementation, in a non-research setting, of a new prevention program that has previously been evaluated in a randomized trial. When the target population for the implementation is heterogeneous, the overall net benefits of the implementation may differ substantially from those reported in the economic evaluation of the randomized trial, and from those that would be realized if the program were implemented within a selected subgroup of the target population. This note illustrates a simple and practical approach to targeting that can combine risk-factor results from the literature with the overall cost-benefit results from the program's randomized trial to maximize the expected net benefit of implementing the program in a heterogeneous population.
Assuntos
Disseminação de Informação , Serviços Preventivos de Saúde/organização & administração , Análise Custo-Benefício , Humanos , Modelos Psicológicos , Avaliação de Resultados em Cuidados de Saúde , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVE: Data from a national study of persons with schizophrenia-related disorders were examined to determine clinical factors and labor-market conditions related to employment outcomes. METHODS: Data were obtained from the U.S. Schizophrenia Care and Assessment Program, a naturalistic study of more than 2,300 persons from organized care systems in six U.S. regions. Data were collected via surveys and from medical records and clinical assessments at baseline and for three years. Outcome measures included any community-based (nonsheltered) employment, 40 or more hours of work in the past month, employment at or above the federal minimum wage, days and hours of work, and earnings. Bivariate and multiple regression analyses of data from more than 7,000 assessments tested relationships between outcomes and sociodemographic, clinical, and local labor market characteristics. RESULTS: The employment rate was 17.2%; only 57.1% of participants who worked reported 40 or more hours of past-month employment. The mean hourly wage was $7.05, and mean monthly earnings were $494.20. Employment rates and number of hours worked were substantially below those found in household surveys or in baseline data from trials of employment programs but substantially higher than those found in a recent large clinical trial. Strong positive relationships were found between clinical factors and work outcomes, but evidence of a relationship between local unemployment rates and outcomes was weak. CONCLUSIONS: Work attachment and earnings were substantially lower than in previous survey data, not very sensitive to labor market conditions, and strongly related to clinical status.
Assuntos
Relações Comunidade-Instituição , Readaptação ao Emprego/economia , Readaptação ao Emprego/estatística & dados numéricos , Salários e Benefícios/economia , Esquizofrenia/epidemiologia , Adulto , Coleta de Dados , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Maryland/epidemiologia , Estudos Prospectivos , Esquizofrenia/diagnóstico , Fatores SocioeconômicosRESUMO
Due to the lack of internal consistency across unit root and cointegration test methods for short time-series data, past research findings conflict on whether the OECD health expenditure data are stationary. Stationarity reasonably guarantees that the estimated OLS relationship is nonspurious. This paper departs from past investigations that applied asymptotic statistical tests of unit root to insufficient time-series lengths. Instead, data were calibrated in annual growth rates, in 5-year (1968-72, ..., 1993-97) partitions, for maximum likelihood estimation using flexible Box-Cox transformations model and bias-reducing jackknife resampling plan for data expansion. The drivers of OECD health care spending growth are economic and institutional. Findings from the growth convergence theory affirm that health care expenditure growth accords with conditional beta convergence. Statistical significance and optimal functional form models are not unique across the growth period models. Our findings exemplify the benefits of jackknife resampling plan for short data series, and caution researchers against imposing faulty functional forms and applying asymptotic statistical methods to short time-series regressions. Policy implications are discussed.
Assuntos
Países Desenvolvidos/economia , Países Desenvolvidos/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Projetos de Pesquisa/estatística & dados numéricos , Análise de Variância , Comparação Transcultural , Política de Saúde/economia , Modelos Econométricos , Análise de RegressãoRESUMO
Despite rapid advances in medicine and beneficial lifestyle changes, the incidence and mortality rate of gynecologic carcinoma remains high worldwide. This paper presents the econometric model findings of the major drivers of breast cancer mortality among US women. The results have implications for public health policy formulation on disease incidence and the drivers of mortality risks. The research methodology is a fixed-effects GLS regression model of breast cancer mortality in US females age 25 and above, using 1990-1997 time-series data pooled across 50 US states and DC. The covariates are age, years schooled, family income, 'screening' mammography, insurance coverage types, race, and US census region. The regressions have strong explanatory powers. Finding education and income to be significantly and positively correlated with mortality supports the 'life in the fast lanes' hypothesis of Phelps. The policy of raising a woman's education at a given income appears more beneficial than raising her income at a given education level. The relatively higher mortality rate for Blacks suggests implementing culturally appropriate set of disease prevention and health promotion programs and policies. Mortality differs across insurance types with Medicaid the worst suggesting need for program reform. Mortality is greater for women ages 25-44 years, females 40-49 years who have had screening mammography, smokers, and residents of some US states. These findings suggest imposing more effective tobacco use control policies (e.g., imposing a special tobacco tax on adult smokers), creating a more tractable screening mammography surveillance system, and designing region-specific programs to cut breast cancer mortality risks.