Healthcare Markets, the Safety Net and Access to Care Among the Uninsured

We use nationally representative Medical Expenditure Panel Survey (MEPS) data linked with data from multiple secondary sources to study the relationship between access to care among the uninsured and the local healthcare market and safety net. We find that distances between the rural uninsured and safety net providers such as hospital emergency rooms, public hospitals, migrant health centers, public housing primary care programs, and community health centers are significantly associated with utilization of a variety of healthcare services. In urban areas, we find that the capacity of the safety net and the pervasiveness and competitiveness of managed care have a significant relationship with healthcare utilization. Our findings suggest that facilitating transport to safety net providers and increasing the number of such providers are likely to improve access to care among the rural uninsured. By contrast, policies oriented toward enhancing funding for the safety net and increasing the capacity of safety net providers are likely to be important to ensuring access among the urban uninsured.

Evaluating an Integrated Science, Technology, Engineering, and Math/Computational Thinking Professional Development Program for Elementary Level Paraprofessional Educators

For my dissertation, I looked at a training program one Utah school district used to teach paraprofessional educators science, technology, engineering, math, and computational thinking. Specifically, the program taught them about what computational thinking is and how they could use it when teaching science, technology, engineering, and math to students from kindergarten to sixth grade. While reviewing this program, I evaluated 1) The experiences the paraprofessionals had with the program, 2) Whether the paraprofessionals understood computational thinking, and 3) Whether the program prepared them to teach computational thinking to K-6 students. I worked with eight paraprofessionals who participated in this program. Each participant was given a survey before and after the training program, and I interviewed each of them to gather their thoughts, feelings, and experiences at the end of the program. This evaluation showed that the program provided a positive experience for participants and opportunities for them to understand computational thinking and how they can teach elementary school children those concepts. My evaluation also highlighted several ways the school district can support paraprofessionals to make them more effective when teaching computational thinking

Overweight in Adolescents: Implications for Health Expenditures

We consider two compelling research questions raised by the increased prevalence of overweight among adolescents. First, what factors explain variation in adolescent bodyweight and the likelihood of being overweight? Next, do overweight adolescents incur greater health care expenditures compared to those of normal weight? We address the former question by examining the contribution of individual characteristics, economic factors, parental and family attributes, and neighborhood characteristics to variation in these bodyweight outcomes. For the second question, we estimate a two-part, generalized linear model of health spending. Using data from the Medical Expenditure Panel Survey, our econometric analyses indicate that adolescent bodyweight and the likelihood of being overweight are strongly associated with parental bodyweight, parental education, parental smoking behavior, and neighborhood attributes such as the availability of fresh food markets and convenience/snack food outlets, and neighborhood safety and material deprivation. Our expenditure model indicates that overweight females have annual expenditures that exceed those of normal weight by nearly $800 with part of the disparity explained by differences in mental health expenditures. We use both sets of empirical results to draw implications for policies to address adolescent overweight.

Socioeconomic Status and Medical Care Expenditures in Medicare Managed Care

This study examined the effects of education, income, and wealth on medical care expenditures in two Medicare managed care plans. The study also sought to elucidate the pathways through which socioeconomic status (SES) affects expenditures, including preferences for health and medical care and ability to navigate the managed care system. We modeled the effect of SES on medical care expenditures using Generalized Linear Models, estimating separate models for each component of medical expenditures: inpatient, outpatient, physician, and other expenditures. We found that education, income, and wealth all affected medical care expenditures, although the effects of these variables differed across expenditure categories. Moreover, the effects of these SES variables were much smaller than the effects found in earlier studies of fee-for-service Medicare. The pathway variables also were associated with expenditures. Accounting for the pathways through which SES affects expenditures narrowed the effect of SES on expenditures; however, the change in the estimates was very small. Thus, although our measures of preferences and ability to navigate the system were associated with expenditures, they did not account for an appreciable share of the impact of SES on expenditures.

The Health Effects of Medicare for the Near-Elderly Uninsured

We study how the trajectory of health for the near-elderly uninsured changes upon enrolling into Medicare at the age of 65. We find that Medicare increases the probability of the previously uninsured having excellent or very good health, decreases their probability of being in good health, and has no discernable effects at lower health levels. Surprisingly, we found Medicare had a similar effect on health for the previously insured. This suggests that Medicare helps the relatively healthy 65 year olds, but does little for those who are already in declining health once they reach the age of 65. The improvement in health between the uninsured and insured were not statistically different from each other. The stability of insurance coverage afforded by Medicare may be the source of the health benefit suggesting that universal coverage at other ages may have similar health effects.

Carbon-catalyzed oxidation of SO2 by NO2 and air

A series of experiments was performed using carbon particles (commercial furnace black) as a surrogate for soot particles. Carbon particles were suspended in water, and gas mixtures were bubbled into the suspensions to observe the effect of carbon particles on the oxidation of SO2 by air and NO2. Identical gas mixtures were bubbled into a blank containing only pure water. After exposure each solution was analyzed for pH and sulfate. It was found that NO2 greatly enhances the oxidation of SO2 to sulfate in the presence of carbon particles. The amount of sulfate found in the blanks was significantly less. Under the conditions of these experiments no saturation of the reaction was observed and SO2 was converted to sulfate even in a highly acid medium (pH or = 1.5)

Points to consider for prioritizing clinical genetic testing services: a European consensus process oriented at accountability for reasonableness.

Given the cost constraints of the European health-care systems, criteria are needed to decide which genetic services to fund from the public budgets, if not all can be covered. To ensure that high-priority services are available equitably within and across the European countries, a shared set of prioritization criteria would be desirable. A decision process following the accountability for reasonableness framework was undertaken, including a multidisciplinary EuroGentest/PPPC-ESHG workshop to develop shared prioritization criteria. Resources are currently too limited to fund all the beneficial genetic testing services available in the next decade. Ethically and economically reflected prioritization criteria are needed. Prioritization should be based on considerations of medical benefit, health need and costs. Medical benefit includes evidence of benefit in terms of clinical benefit, benefit of information for important life decisions, benefit for other people apart from the person tested and the patient-specific likelihood of being affected by the condition tested for. It may be subject to a finite time window. Health need includes the severity of the condition tested for and its progression at the time of testing. Further discussion and better evidence is needed before clearly defined recommendations can be made or a prioritization algorithm proposed. To our knowledge, this is the first time a clinical society has initiated a decision process about health-care prioritization on a European level, following the principles of accountability for reasonableness. We provide points to consider to stimulate this debate across the EU and to serve as a reference for improving patient management