Shock, but no Shift: Hospitals\u27 Responses to Changes in Patient Insurance Mix

Medicaid reimburses healthcare providers for services at a lower rate than any other type of insurance coverage. To account for the burden of treating Medicaid patients, providers claim that they must cost-shift by raising the rates of individuals covered by private insurance. Previous investigations of cost-shifting has produced mixed results. In this paper, I exploit a disabled Medicaid expansion where crowd-out was complete to investigate cost-shifting. I find that hospitals reduce the charge rates of the privately insured. Given that Medicaid is expanding in several states under the Affordable Care Act, these results may alleviate cost-shifting concerns of the reform

Medicaid Expansions for the Working Age Disabled: Revisiting the Crowd-out of Private Health Insurance

Disabled individuals under 65 years old account for 15% of Medicaid recipients but half of all Medicaid spending. Despite their large cost, few studies have investigated the effects of Medicaid expansions for disabled individuals on insurance coverage and crowd-out of private insurance. Using an eligibility expansion that allowed states to provide Medicaid to disabled individuals with incomes less than 100% of the federal poverty level, I address these issues. Crowd-out estimates range from 49% using an ordinary least squares procedure to 100% using two-stage least-squares analysis. This potentially large degree of crowd-out could have fiscal implications for the Affordable Care Act which has greatly expanded Medicaid eligibility in 2014

Electronic Consultations Between Primary and Specialty Care Clinicians: Early Insights

Outlines how e-consultation enables clinicians and specialists to communicate more easily and reduce the need for in-person referrals; experiences for patients, clinicians, and health systems; benefits such as continuity of care; and barriers to adoption

Gestational Weight Gain, Offspring Asthma and Wheeze Phenotypes in Project Viva

In the US, 8.4% of children are diagnosed with asthma by age 18, making asthma one of the most common chronic conditions among children. Additionally, 25% of children experience persistent wheezing by age 6, an indicator of childhood asthma. Both childhood asthma and persistent wheezing may be linked to inflammatory and immune mechanisms, which are associated with inadequate and excessive gestational weight gain. Studies investigating the relationship between gestational weight gain and offspring asthma and wheeze phenotypes are limited by self-reported gestational weight gain, early age at asthma and wheeze assessments, limited adjustment for potential confounders and no trimester-specific evaluations. Therefore, we investigated the association between total and trimester-specific gestational weight gain, offspring asthma and wheeze phenotypes among 2128 mother-child pairs in Project Viva, a prospective cohort study in eastern Massachusetts. Gestational weight gain was abstracted from medical records and self-reported prepregnancy weight, and defined both continuously and using Institute of Medicine guidelines. Offspring asthma was obtained via maternal report at approximately 7 years, while wheeze trajectories were derived via latent class mixed models based on presence of wheeze between 1 and 9 years, inclusively, via maternal report. We investigated the relationship between gestational weight gain, offspring asthma and wheeze phenotypes using multivariable regressions and predicted probabilities, adjusting for important covariates. Most women had excessive gestational weight gain (56%), while 31% had adequate gestational weight gain and 13% had inadequate gestational weight gain. Approximately 18% of children had current mid-childhood asthma, 13% had early transient wheeze and 13% had persistent wheeze. We found a non-linear association between total gestational weight gain and offspring current mid-childhood asthma. Additionally, there was a 36% decreased odds of early transient wheeze among children of mothers with excessive third trimester gestational weight gain (aOR= 0.64; 95% CI: 0.42-0.98). This study adds to the body of literature by incorporating adequate inclusion of confounders and risk factors for adjustment, as well as being the first study to evaluate the association between trimester-specific gestational weight gain, offspring asthma and wheeze phenotypes

(WP 2017-02) The Great Recession and Public Education

We examine the impact of the Great Recession on K-12 education finance and employment and generate five key results. First, nearly 300,000 school employees lost their jobs. Second, schools that were heavily dependent financially on state governments were particularly vulnerable to the recession. Third local revenues from the property tax actually increased during the recession, primarily because millage rates rose in response to declining property values. Fourth, inequality in school spending rose sharply during the Great Recession. Fifth, the federal government’s efforts to shield education from some of the worst effects of the recession achieved their major goal

Disabling Psychology: A Crip Analysis of Deaf and Blind Psychotherapists in Practice

This dissertation explores the phenomenological experience of d/Deaf or blind psychotherapists who work with nondisabled clients, seeking to understand the perceived impact of disability on the therapeutic relationship. There is an abundance of research on nondisabled therapists treating disabled clients but only a handful of studies qualitatively considering the disabled therapist’s understanding of practicing in a largely ableist world. Six deaf and eight blind therapists were interviewed for this dissertation. Results were qualitatively analyzed using interpretive phenomenological analysis (IPA). Results were also interpreted through a critical disability studies framework with an eye toward challenging the ableism embedded within traditional research practices (cripping them, in the language of disability studies). An autoethnographic analysis was incorporated with respect to the researcher’s own experience practicing as a deaf therapist, and a member check was utilized with select participants to get feedback on the results. The range of explicit and implicit themes that emerge from the researcher’s analyses include the systemic challenges that deaf and blind therapists face in the work setting; the impact of self-disclosure on patient reactions to disability; the nuanced ways the therapist’s disability influenced the alliance, transference, and countertransference; and the therapists’ own complicated relationships to their disabilities. Participant stories about working with well-meaning but ill-informed supervisors also highlighted the lack of instruction in disability studies and larger systems of oppression in graduate training programs and continuing education courses. Interpreted through a critical disability studies framework, these results crip normative beliefs about disability (as something one must “overcome”) and problematize traditional qualitative research practices. Conversations occurring at the intersections of psychology and gender and psychology and race have shed much insight into marginalizations occurring within the therapy space. Though disability issues are coming to the forefront, psychology has yet to take on board the critical insights of disability studies. If psychology wants to contribute to disability studies, the field as a whole needs to move away from the medical and even sociopolitical models of disability in order to take seriously the lived experiences of disabled people on their own diverse terms. In arguing that ableism must be removed as the norm, this project offers some suggestive glimmers of what it might mean to challenge normative beliefs about disability within psychology and qualitative research practices

The Power of Virginity: The Political Position and Symbolism of Ancient Rome’s Vestal Virgin

The Vestal virgin has forever been an image of a woman draped in white priestly garments, carrying herself with an air of purity and near divinity. The Vestal\u27s image is one that has captured the imagination of writers, painters, sculptures and scholars for centuries. However this near divine woman is more than what she appears. The Vestal was more than a virgin; she was the daughter, mother and priestess of Rome herself. Behind this glamorous image is a strong, influential, pious and powerful woman who has sacrificed her sexuality and familial ties for not just the service of the Goddess Vesta but also to reap the rewards that such devotion sowed. It is the purpose of this paper to examine the many faces behind the Vestal virgin, and how she achieved not only political power and honor but ritually forged the sacred familial protections on a grand scale -the protection of The Empire at large

The Impact of a Lifestyle Intervention on Risk Factors of Cardiovascular Disease and Type II Diabetes among At-Risk Hispanic Women

Cardiovascular disease and type 2 diabetes are global epidemics affecting approximately 127 and 21 million people in the U.S., respectively. Women who are overweight, obese or who develop glucose intolerance during pregnancy represent high-risk groups for the development of cardiovascular disease and type 2 diabetes. Hispanic women are both more likely to begin their pregnancies as overweight or obese and have a higher prevalence of type 2 diabetes, compared to non-Hispanic whites. However, prior lifestyle interventions have largely been limited to non-Hispanic whites. Therefore, this research assessed how culturally tailored lifestyle modification may affect cardiovascular disease and type 2 diabetes risk factors among at-risk Hispanic women using data from Estudió PARTO and Proyecto Mamá, two randomized controlled trials of pregnant Hispanic women in western Massachusetts. Chapter 1 examined the impact of a lifestyle intervention on postpartum cardiovascular disease risk and insulin resistance biomarkers among Hispanic women with abnormal glucose tolerance. The Lifestyle Intervention (LI) arm experienced clinically significant lower levels of insulin than the comparison Health and Wellness arm (HW), statistically lower levels of HDL cholesterol and TNF-a, and no differences in all other cardiovascular disease risk and insulin resistance biomarkers. Chapter 2 examined the impact of a lifestyle intervention on pregnancy and postpartum cardiovascular disease risk and insulin resistance biomarkers among overweight and obese Hispanic women. The lifestyle intervention did not lead to a significant difference in change over the pregnancy and postpartum follow-up time in most cardiovascular disease risk and insulin resistance biomarkers, with the exception of higher LDL cholesterol concentrations among the LI arm compared to the HW arm. Lastly, Chapter 3 examined the impact of a lifestyle intervention on postpartum weight retention among overweight and obese Hispanic women. The LI arm had a clinically significant 5.5-fold higher odds of meeting postpartum weight reduction goals, at 12 months postpartum and a 5 kg smaller increase in weight at 6 months postpartum, compared to the HW arm. In conclusion, a lifestyle intervention had beneficial impacts on numerous cardiovascular disease risk and insulin resistance biomarkers, including insulin, and postpartum weight retention in this high-risk Hispanic population

The Mindfully Embedded Classroom: An Investigation of the Mindfulness Traits, Philosophies, and Practices of High School Teachers

The underlying impact of high school teachers’ mindfulness practices and philosophies in a classroom environment is investigated through a conceptual framework of self-identity, neuro-semantic language learning, attachment, interpersonal neurobiology, and social cognitive theories. The purpose of this study is to determine if trait mindfulness is related to teacher demographics and to triangulate trait data with classroom observations and teacher interviews. 48 high school teachers in an urban comprehensive high school completed the Five Facet Mindfulness Questionnaire (FFMQ) with demographics. Six ‘highly mindful’ teachers participated in a semi-structured interview investigating their educational philosophy and conceptualizations of mindfulness, identity, teacher-student relationships, analyzed with a phenomenological approach. Classroom observations were conducted in these six classrooms using an observation protocol for effective communicative thoughtfulness and triangulated with interview responses. Findings show that underrepresented minority teachers reported lower scores in the FFMQ facet Non-judgment of Inner Experience than white teachers. STEAM (Science, Technology, Engineering, Arts and Mathematics) teachers reported lower scores than humanities teacher in the Describing facet of the FFMQ. The age of the teacher and number of years of teaching experience was only correlated with the Observing facet of the FFMQ. The ‘highly mindful’ teacher participants fostered respectful authoritative classrooms with the teachers viewing themselves as mentors who are not solely focused on academic outcomes, viewed intelligence as functional, identified that language frames ones’ thoughts and names perceptions, and defined mindfulness as a shift in perspective not necessitating formal training. This study adds to the burgeoning literature of mindfulness research, provides insight to the experience and philosophies of teachers who self-report higher levels of mindfulness, and suggests strategies to improve teacher mindfulness with positive social and emotional outcomes for teachers and students alike