429,999 research outputs found

    Out of Control: Patients Are Unwittingly Subjected to Enormous, Unfair, Out-of-Network "Balance Bills"

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    Excessive medical debt resulting from the provision of health care can cause families and individuals to spend down their savings, forego medical treatment, and even go without paying for food and heat. In the United States, medical bills are the leading cause of individual and family bankruptcy. In 1981, only 8 percent of families filing for bankruptcy protection did so in the aftermath of receiving medical care.However, by 2007, more than 62 percent of all bankruptcies were linked to a medical event, according to a study published in the American Journal of Medicine. And bankruptcy was not limited to the uninsured. To the contrary, the study reported that more than 75 percent of filers had health insurance.One driver of excessive health care bills is a practice known as "balance billing," which refers to bills for the difference between the amount that an insurance company is willing to pay for treatment and a provider's total charges. Providers who are not members of a patient's insurance network have charged patients as much as 9,000 percent of what Medicare would have paid for the same procedure.In contrast, payment for in-network medical services is on average 123 percent of Medicare.Patients can be subjected to balance bills despite making their best efforts to avoid them. For instance, they might receive care at an in-network facility, only to find out later that an out-of-network doctor also provided medical services. This is because many doctors work at hospitals rather than for hospitals, and are not members of the same insurance network as the hospital.Solutions are possible at both the federal and state levels that would protect consumers from balance bills without unduly burdening providers or insurers, or upsetting the existing system of insurance networks. This paper outlines policies that have been implemented at each of these levels and proposes additional protections at the federal level

    Great East Japan Earthquake, JR East Mitigation Successes, and Lessons for California High-Speed Rail, MTI Report 12-37

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    California and Japan both experience frequent seismic activity, which is often damaging to infrastructure. Seismologists have developed systems for detecting and analyzing earthquakes in real-time. JR East has developed systems to mitigate the damage to their facilities and personnel, including an early earthquake detection system, retrofitting of existing facilities for seismic safety, development of more seismically resistant designs for new facilities, and earthquake response training and exercises for staff members. These systems demonstrated their value in the Great East Japan Earthquake of 2011 and have been further developed based on that experience. Researchers in California are developing an earthquake early warning system for the state, and the private sector has seismic sensors in place. These technologies could contribute to the safety of the California High-Speed Rail Authority’s developing system, which could emulate the best practices demonstrated in Japan in the construction of the Los Angeles-to-San Jose segment

    Next Stop: California: The Benefits of High-Speed Rail Around the World and What's in Store for California

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    Outlines the advantages of high-speed rail systems replacing short-haul air and inter-city car travel, including energy, environmental, and economic benefits. Makes recommendations for land use, planning, and design to maximize benefits for California

    Looking Beyond “Mow, Blow and Go”: A Case Study of Mexican Immigrant Gardeners in Los Angeles

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    Abstract: Recent research on Mexican immigrants focuses on the working conditions of farm workers, garment workers, janitors and day laborers. This coincides with successful efforts by organized labor and immigrant advocacy groups to organize these marginalized workforces. Little attention, however, has been given to Mexican paid gardeners. As part of the household service economy, paid gardeners represent a difficult labor sector to organize and research because they typically operate as independent contractors in the informal economy. This paper seeks to provide a more holistic picture of this dynamic, informal workforce. Drawing primarily upon ethnographic techniques, the paper documents how this informal sector operates and its social organization. Based on research conducted in Los Angeles, the paper also demonstrates how a select group of self-employed, Mexican gardeners function as petty-entrepreneurs, benefiting financially and socially in the informal economy by successfully utilizing their social capital and social networks

    Issues Related to the Emergence of the Information Superhighway and California Societal Changes, IISTPS Report 96-4

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    The Norman Y. Mineta International Institute for Surface Transportation Policy Studies (IISTPS) at San José State University (SJSU) conducted this project to review the continuing development of the Internet and the Information Superhighway. Emphasis was placed on an examination of the impact on commuting and working patterns in California, and an analysis of how public transportation agencies, including Caltrans, might take advantage of the new communications technologies. The document reviews the technology underlying the current Internet “structure” and examines anticipated developments. It is important to note that much of the research for this limited-scope project was conducted during 1995, and the topic is so rapidly evolving that some information is almost automatically “dated.” The report also examines how transportation agencies are basically similar in structure and function to other business entities, and how they can continue to utilize the emerging technologies to improve internal and external communications. As part of a detailed discussion of specific transportation agency functions, it is noted that the concept of a “Roundtable Forum,” growing out of developments in Concurrent Engineering, can provide an opportunity for representatives from multiple jurisdictions to utilize the Internet for more coordinated decision-making. The report also included an extensive analysis of demographic trends in California in recent years, such as commute and recreational activities, and identifies how the emerging technologies may impact future changes
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