Federal program expenditures for working-age people with disabilities: Research Report

Public assistance programs are important sources of support for working-age people with disabilities in the United States. Using a variety of information sources, the authors estimate that the federal government spent $226 billion in 2002 on working-age people with disabilities, including both cash and in-kind benefits. These expenditures account for about 2.2 percent of the nation’s gross domestic product (GDP) and 11.3 percent of all federal outlays. States contributed an additional$50 billion under federal-state programs. The bulk of these expenditures provided income support and health care to working-age people with disabilities who were not employed or had very low earnings. The authors provide a detailed accounting of the expenditures and question whether the distribution of expenditures is properly aligned with the evolving disability paradigm

Regional and Racial Variation in Health Care Among Medicare Beneficiaries

Focuses on variations in healthcare delivery and outcomes among and within hospital service areas, in addition to racial and geographic disparities, as measured by five indicators. Discusses variations in spending and considers implications for reform

Disparities in Health and Health Care Among Medicare Beneficiaries

Compares disparities in treatments and health outcomes -- diabetes-related leg amputations, mammograms, diabetes management, primary care, and hospitalization rates -- by race/ethnicity and state or region

Hospital and Physician Capacity Update

Offers an alternative view of healthcare costs by examining trends in hospital capacity and healthcare labor across regions. Outlines how effective management of healthcare capacity would enable affordable quality care that meets patient needs and wants

The Revolving Door: A Report on U.S. Hospital Readmissions

The U.S. health care system suffers from a chronic malady -- the revolving door syndrome at its hospitals. It is so bad that the federal government says one in five elderly patients is back in the hospital within 30 days of leaving.Some return trips are predictable elements of a treatment plan. Others are unplanned but difficult to prevent: patients go home, new and unexpected problems arise, and they require an immediate trip back to the hospital.But many of these readmissions can and should be prevented. They are the result of a fragmented system of care that too often leaves discharged patients to their own devices, unable to follow instructions they didn't understand, and not taking medications or getting the necessary follow-up care.The federal government has pegged the cost of readmissions for Medicare patients alone at $26 billion annually, and says more than$17 billion of it pays for return trips that need not happen if patients get the right care. This is one reason the Centers for Medicare & Medicaid Services has identified avoidable readmissions as one of the leading problems facing the U.S. health care system and now penalizes hospitals with high rates of readmissions for their heart failure, heart attack, and pneumonia patients. This report is being released in conjunction with the Robert Wood John Foundation's Care About Your Care initiative, which is devoted to improving care transitions when people leave the hospital. It looks at the issue of readmissions in two ways: by the numbers and through the eyes of the people who live them

The Health Care Financing Maze for Working-Age People with Disabilities

Much of the research on health care financing for people with disabilities has focused on the Medicaid and Medicare programs. The findings of this research often highlight the inadequacies of those programs in providing appropriate services to address the special needs of people with disabilities. A focus on these large programs, however, obscures the role of other public and private insurers, as well as the role of programs that provide many additional services to this population – all of which add complexity to the system. The purpose of this paper is to describe the health care financing system as a whole, including the large public programs, other public and private insurers, and the many other programs that provide additional services. The description of the system highlights structural problems that need to be addressed in order to substantially improve the delivery of health and related services to people with disabilities. In the next section, we describe each source of health care financing for working-age people with disabilities and highlight its implications for service delivery and quality of life. In the concluding section, we describe the key structural shortcomings of the current financing system, assess the extent to which current reform efforts are addressing these shortcomings, and discuss the implications for broader efforts to reform health care financing system

Trends and Regional Variation in Hip, Knee and Shoulder Replacement

Analyzes patterns in underuse or overuse of joint replacements among Medicare beneficiaries by geographic regions and race/ethnicity. Explores underlying factors and highlights the need for physician and patient education and shared decision making

Trends and Variation in End-of-Life Care for Medicare Beneficiaries With Severe Chronic Illness

Provides an updated analysis of regional and hospital variations in end-of-life care for Medicare beneficiaries with chronic illnesses, including percentage of hospital deaths, days in intensive care units, and physician labor per patient

The Effect of Projection on Derived Mass-Size and Linewidth-Size Relationships

Power law mass-size and linewidth-size correlations, two of "Larson's laws," are often studied to assess the dynamical state of clumps within molecular clouds. Using the result of a hydrodynamic simulation of a molecular cloud, we investigate how geometric projection may affect the derived Larson relationships. We find that large scale structures in the column density map have similar masses and sizes to those in the 3D simulation (PPP). Smaller scale clumps in the column density map are measured to be more massive than the PPP clumps, due to the projection of all emitting gas along lines of sight. Further, due to projection effects, structures in a synthetic spectral observation (PPV) may not necessarily correlate with physical structures in the simulation. In considering the turbulent velocities only, the linewidth-size relationship in the PPV cube is appreciably different from that measured from the simulation. Including thermal pressure in the simulated linewidths imposes a minimum linewidth, which results in a better agreement in the slopes of the linewidth-size relationships, though there are still discrepancies in the offsets, as well as considerable scatter. Employing commonly used assumptions in a virial analysis, we find similarities in the computed virial parameters of the structures in the PPV and PPP cubes. However, due to the discrepancies in the linewidth- and mass- size relationships in the PPP and PPV cubes, we caution that applying a virial analysis to observed clouds may be misleading due to geometric projection effects. We speculate that consideration of physical processes beyond kinetic and gravitational pressure would be required for accurately assessing whether complex clouds, such as those with highly filamentary structure, are bound.Comment: 25 pages, including 7 Figures; Accepted for publication in Ap