Economic Forecasting for Large Russian Cities

The Budget Code of the Russian Federation requires that local self-governments prepare their budgets for the next year taking into account the likely economic situation in that year. To date these governments have had little guidance to use in preparing their budgets. This paper reports the results of initial steps to develop a procedure for forecasting key economic parameters at the local level. “Local level” is defined as cities that are capitals of Subjects of the Federation (similar to U.S. states); generally these are cities of over 100,000 population. Econometric models are reported for employment, manufacturing production, retail sales, average wage rates, volume of newly constructed housing, and fixed capital formation. The choice of estimation procedures was significantly constrained by data availability. The current document is an interim report, prepared after the basic econometric work has been completed but before the model is tested in actual forecasting. The paper consists of six further sections. The first lists the economic variables to be projected. The second describes the economic logic underlying the models specified for each variable. The third section then outlines the econometric strategy. This is followed in the fourth section with an overview of the data employed in the estimates. The fifth section presents the final models. The paper closes with a short discussion of the plans for future work in this direction. In the next phase of the work the forecasting qualities of these models will be evaluated.

Primary Care Appointment Availability for Medicaid Patients: Comparing Traditional and Premium Assistance Plans

Key Findings: In 2014, Arkansas and Iowa expanded their Medicaid programs and enrolled many of their adult beneficiaries in commercial Marketplace plans. This study suggests that this “private option” may make it easier for new Medicaid patients to get primary care appointments

Declining Medicaid Fees and Primary Care Availability for New Medicaid Patients

Primary care appointment availability for new Medicaid patients declined when Medicaid fees for providers decreased after the ACA-mandated “fee bump” expired

Primary Care Access for new Patients on the eve of Health Care Reform

Importance: Current measures of access to care have intrinsic limitations and may not accurately reflect the capacity of the primary care system to absorb new patients. Objective: To assess primary care appointment availability by state and insurance status. Design, Setting, and Particpants: We conducted a simulated patient study. Trained field staff, randomly assigned to private insurance, Medicaid, or uninsured, called primary care offices requesting the first available appointment for either routine care or an urgent health concern. The study included a stratified random sample of primary care practices treating nonelderly adults within each of 10 states (Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas), selected for diversity along numerous dimensions. Collectively, these states comprise almost one-third of the US nonelderly, Medicaid, and currently uninsured populations. Sampling was based on enrollment by insurance type by county. Analyses were weighted to obtain population-based estimates for each state. Main Outcomes and Measures: The ability to schedule an appointment and number of days to the appointment. We also examined cost and payment required at the visit for the uninsured. Results: Between November 13, 2012, and April 4, 2013, we made 12,907 calls to 7788 primary care practices requesting new patient appointments. Across the 10 states, 84.7% (95% CI, 82.6%-86.8%) of privately insured and 57.9% (95% CI, 54.8%-61.0%) of Medicaid callers received an appointment. Appointment rates were 78.8% (95% CI, 75.6%-82.0%) for uninsured patients with full cash payment but only 15.4% (95% CI, 13.2%-17.6%) if payment required at the time of the visit was restricted to $75 or less. Conditional on getting an appointment, median wait times were typically less than 1 week (2 weeks in Massachusetts), with no differences by insurance status or urgency of health concern. Conclusions and Relevance: Although most primary care physicians are accepting new patients, access varies widely across states and insurance status. Navigator programs are needed, not only to help patients enroll but also to identify practices accepting new patients within each plan\u27s network. Tracking new patient appointment availability over time can inform policies designed to strengthen primary care capacity and enhance the effectiveness of the coverage expansions with the Patient Protection and Affordable Care Act

Nursing Home Use by Dual-Eligible Beneficiaries in the Last Year of Life

Research on health care at the end of life has focused on Medicare-financed acute care services. Much less information has been available on nursing home use in the last year of life, particularly for individuals who are dually eligible for Medicare and Medicaid. We used Medicare and Medicaid enrollment and claims data to examine nursing home admissions, odds of dying in nursing homes versus hospitals or the community, and variations in Medicare and Medicaid service use and costs by place of death. We found that, in the last year of life, 75% of dual-eligible people use nursing home care, increasing age is associated with greater likelihood of dying in nursing homes, and dual-eligible people who die in hospitals have notably higher costs than other beneficiaries

Price, Quality, and Income in Child Care Choice

Recent legislation may substantially expand federal assistance in paying for child care. This paper examines the potential effects of three aspects of federal assistance-reducing child care price (through vouchers or grants to providers), improving its quality (through incentives or regulation), and increasing family income (through tax credits)-on the child care choices employed mothers make. The data come from the 1985 wave of the National Longitudinal Survey of Youth, Ohio State University. Both multinomial and universal logit models are used. The results suggest that price is a critical variable in child care choice. The higher the price, the lower the probability a mode of care will be chosen. Parents do not consistently select high quality care, although overall quality improvements may increase the use of family day care. Mothers who earn more per hour and families who have higher incomes (other than the mother's earnings) are more likely to select center care over other modes. Consequently, subsidizing child care expenditures directly through vouchers and reduced fees or increasing other family income through tax credits consistently increases the use of center-based programs, all else equal.

Correction: Price and Quality in Child Care Choice: A Revision

In Hofferth and Wissoker (1992) we estimated the effects of price and quality on mode of child care chosen. We found large negative effects of price and quality on choice. This paper presents a revised version of our original model. The new results suggest negative price effects which are smaller than those in the original paper. The estimated effects of child/ staff ratios also become less negative and one becomes positive.