The Revised CII-ESRI Survey - A Note. Quarterly Economic Commentary Special Article, July 1985

This note gives a brief description of the coverage and the results of the revised CII-ESRI Monthly Industrial Survey. As discussed in the previous article, by Conniffe, in this Commentary, up to the present the Survey could be improved on two grounds in particular, namely on the sample and on seasonality. The problem of seasonality can be partially dealt with by seasonally correcting the results along the lines suggested by Conniffe. The sample meanwhile has been enlarged and the weights used to aggregate the responses have been updated. The computer program used for the analysis has also been changed. Though not affecting the results, this affords greater flexibility in drafting the tables of responses

2018 Scorecard on State Health System Performance

Hawaii, Massachusetts, Minnesota, Vermont, and Utah are the top-ranked states according to the Commonwealth Fund's 2018 Scorecard on State Health System Performance, which assesses all 50 states and the District of Columbia on more than 40 measures of access to health care, quality of care, efficiency in care delivery, health outcomes, and income-based health care disparities.The 2018 Scorecard reveals that states are losing ground on key measures related to life expectancy. On most other measures, performance continues to vary widely across states; even within individual states, large disparities are common.Still, on balance, the Scorecard finds more improvement than decline between 2013 and 2016 in the functioning of state health care systems. This represents a reversal of sorts from the first decade of the century, when stagnating or worsening performance was the norm

Aiming Higher: Results from a Scorecard on State Health System Performance, 2015 Edition

The fourth Commonwealth Fund Scorecard on State Health System Performance tells a story that is both familiar and new. Echoing the past three State Scorecards, the 2015 edition finds extensive variation among states in people's ability to access care when they need it, the quality of care they receive, and their likelihood of living a long and healthy life. However, this Scorecard—the first to measure the effects of the Affordable Care Act's 2014 coverage expansions—also finds broad-based improvements. On most of the 42 indicators, more states improved than worsened. By tracking performance measures across states, this Scorecard can help policymakers, health system leaders, and the public identify opportunities and set goals for improvement. The 50 states and the District of Columbia are measured and ranked on 42 indicators grouped into five domains: access and affordability, prevention and treatment, avoidable hospital use and cost, healthy lives, and equity. Individual indicators measure things like rates of children or adults who are uninsured, hospital patients who get information about how to handle their recovery at home, hospital admissions for children with asthma, and breast and colorectal cancer deaths, among many others

Aiming Higher: Results from the Commonwealth Fund Scorecard on State Health System Performance, 2017 Edition

Issue: States are a locus of policy and leadership for health system performance.Goal: To compare and evaluate trends in health care access, quality, avoidable hospital use and costs, health outcomes, and health system equity across all 50 states and the District of Columbia.Methods: States are ranked on 44 performance measures using recently available data. Key findings: Nearly all states improved more than they worsened between 2013 and 2015. The biggest gains were in health insurance coverage and the ability to access care when needed, with states that had expanded their Medicaid programs under the Affordable Care Act experiencing the most improvement. There were also widespread state improvements on key indicators of treatment quality and patient safety; hospital patient readmissions also fell in many states. However, premature deaths crept up in almost two-thirds of states, reversing a long period of decline. Wide variations in performance across states persisted, as did disparities experienced by vulnerable populations within states.Conclusion: If every state achieved the performance of top-ranked states, their residents and the country as a whole would realize dramatic gains in health care access, quality, efficiency, and health outcomes

Findings from a Survey of Health Care Delivery Innovation Centers

Health care innovation centers around the country are working to discover, develop, test, and spread new models of care delivery--in hospitals, clinics, and patients' homes. Between November 2014 and January 2015, The Commonwealth Fund conducted an online survey of innovation centers affiliated with health care organizations to learn about their potential role in promoting health system transformation.Survey findings presented in this chartpack reveal how innovation centers define innovation, what factors into investment decisions, which technologies are most commonly used, and much more. While innovation centers have the potential to contribute to health system transformation, it appears that to succeed they will need sustainable funding and greater integration with clinical enterprises. The survey also reveals that innovation centers may benefit from collaboration to identify solutions to common problems and develop a mechanism for spreading their work

Health System Performance for the High-Need Patient: A Look at Access to Care and Patient Care Experiences

Achieving a high-performing health system will require improving outcomes and reducing costs for high-need, high-cost patients—those who use the most health care services and account for a disproportionately large share of health care spending. Goal: To compare the health care experiences of adults with high needs—those with three or more chronic diseases and a functional limitation in the ability to care for themselves or perform routine daily tasks—to all adults and to those with multiple chronic diseases but no functional limitations. Methods: Analysis of data from the 2009–2011 Medical Expenditure Panel Survey. Key findings: High-need adults were more likely to report having an unmet medical need and less likely to report having good patient–provider communication. High-need adults reported roughly similar ease of obtaining specialist referrals as other adults and greater likelihood of having a medical home. While adults with private health insurance reported the fewest unmet needs overall, privately insured highneed adults reported the greatest difficulties having their needs met. Conclusion: The health care system needs to work better for the highest-need, most-complex patients. This study's findings highlight the importance of tailoring interventions to address their need

Closing the Gap: Past Performance of Health Insurance in Reducing Racial and Ethnic Disparities in Access to Care Could Be an Indication of Future Results

This historical analysis shows that in the years just prior to the Affordable Care Act's expansion of health insurance coverage, black and Hispanic working-age adults were far more likely than whites to be uninsured, to lack a usual care provider, and to go without needed care because of cost. Among insured adults across all racial and ethnic groups, however, rates of access to a usual provider were much higher, and the proportion of adults going without needed care because of cost was much lower. Disparities between groups were narrower among the insured than the uninsured, even after adjusting for income, age, sex, and health status. With surveys pointing to a decline in uninsured rates among black and Hispanic adults in the past year, particularly in states extending Medicaid eligibility, the ACA's coverage expansions have the potential to reduce, though not eliminate, racial and ethnic disparities in access to care

Reducing Racial and Ethnic Disparities in Access to Care: Has the Affordable Care Act Made a Difference?

Issue: Prior to the Affordable Care Act (ACA), blacks and Hispanics were more likely than whites to face barriers in access to health care.Goal: Assess the effect of the ACA's major coverage expansions on disparities in access to care among adults.Methods: Analysis of nationally representative data from the American Community Survey and the Behavioral Risk Factor Surveillance System.Findings and Conclusions: Between 2013 and 2015, disparities with whites narrowed for blacks and Hispanics on three key access indicators: the percentage of uninsured working-age adults, the percentage who skipped care because of costs, and the percentage who lacked a usual care provider. Disparities were narrower, and the average rate on each of the three indicators for whites, blacks, and Hispanics was lower in both 2013 and 2015 in states that expanded Medicaid under the ACA than in states that did not expand. Among Hispanics, disparities tended to narrow more between 2013 and 2015 in expansion states than nonexpansion states. The ACA's coverage expansions were associated with increased access to care and reduced racial and ethnic disparities in access to care, with generally greater improvements in Medicaid expansion states

Effect of calcination method and clay purity on the performance of metakaolin-based geopolymers

The calcination of kaolinite clay to produce metakaolin can be achieved using a range of processes, including rotary, fluidised bed and flash calcination. Rotary calcination was the most popular of these processes for many years as it takes place in a rotary kiln, which is readily available, at easily attainable temperatures of 650 – 800 °C. However, in recent years’ flash calcination processes have become more widely used, and the technology has advanced to a point where commercial flash metakaolin-based geopolymers are now available. Flash calcination involves the rapid heating of clay at temperatures of around 1000 °C for less than a few seconds. The differences in these calcination methods can have a notable effect on the structural ordering of the metakaolin itself, as well as playing an important role in defining the chemical and physical properties of metakaolin-based geopolymers. The purity of the clay also plays a key role in the chemistry of the geopolymers produced. Calcined clay-based geopolymers can be used as construction materials or for the immobilisation of problematic wastes, among other applications, as they can offer desirable performance characteristics. The chemical and physical properties of these geopolymers, and thus the influence of the clay source on key performance parameters, will need to be fully understood when deciding how they can be used for many different applications. This study demonstrates the effect of the calcination method on the properties of calcined metakaolin geopolymer systems for waste immobilisation applications. A main focus of this study is the rheological properties, as the flow properties of these systems are one of the most important parameters for many geopolymer applications. The porosity, heat evolution and mineralogical development of these systems is also presented, with a view towards assessing performance in targeted applications for the immobilisation of nuclear waste