Occupational Licensing: Ranking the States and Exploring Alternatives

Source: Adam B. Summers, Reason Foundation, Policy Study 361, August 2007

From press release:
Do you want to be a fortune teller in Maryland? Your future better include a license from the state. How about being a hair braider in Mississippi? You’ll need 300 to 1,500 hours of training and government permission. Want to sell flowers in Louisiana? Only licensed florists can do that. And almost every state requires certification if you want to move furniture and hang art while calling yourself an interior designer.

In California, there are a total of 177 different jobs that require a special license or credential, the most in the country, according to a new Reason Foundation study examining occupational licensing trends.

Northeastern states aren’t much better. Connecticut, Maine and New Hampshire all require job seekers to obtain a license before performing more than 130 jobs. In stark contrast, you can do most of those very same jobs – without a license – in Missouri, where just 41 careers require certification.

Press Release with Complete Rankings
Policy Summary
State-by-State Occupational Licensing List

University of Michigan Study Tracks Growing Income Gap Among American Families

Source: University of Michigan, Press release, August 7, 2007

The rich really are getting richer and the poor are getting poorer, a new University of Michigan study shows. The study–the most recent available analysis of long-term wealth trends among U.S. households is based on data from the Panel Study of Income Dynamics, conducted by the U-M Institute for Social Research (ISR) since 1968. Over the last 20 years, the net worth of the top two percentile of American families nearly doubled, from $1,071,000 in 1984 to $2,100,500 in 2005. But the poorest quarter of American families lost ground over the same period, with their 2005 net worth below their 1984 net worth, measured in constant 2005 dollars.
Data and Documentation

The Labor Market Effects of Rising Health Insurance Premiums

Source: Katherine Baicker and Amitabh Chandra, California Center for Population Research, On-Line Working Paper Series, Paper CCPR-038-06, January 1, 2006

From abstract:
We use variation in medical malpractice payments driven by the recent “medical malpractice crisis” to identify the causal effect of rising health insurance premiums on wages, employment and the distribution of part-time and full-time work. We estimate that a 10 percent increase in health insurance premiums reduces the aggregate probability of being employed by 1.2 percentage points, reduces hours worked by 2.4 percent, and increases the likelihood that a worker is employed only part-time by 1.9 percentage points. For workers covered by employer provided health insurance, a 10 percent increase in premiums results in an offsetting decrease in wages of 2.3 percent. Thus, rising health insurance premiums may both increase the ranks of the unemployed and place an increasing burden on workers through decreased wages for those with employer health insurance and decreased hours for those who may be moved from full time jobs with benefits to part time jobs without.

Emergency Response Planning in Hospitals, United States: 2003-2004

Source: Richard W. Niska, and Catharine W. Burt, Division of Health Care Statistics, Centers for Disease Control and Prevention, Advance Data From Vital and Health Statistics, Number 391, August 20, 2007

Objective–This study presents baseline data to determine which hospital characteristics are associated with preparedness for terrorism and natural disaster in the areas of emergency response planning and availability of equipment and specialized care units.

Methods–Information from the Bioterrorism and Mass Casualty Preparedness Supplements to the 2003 and 2004 National Hospital Ambulatory Medical Care Surveys was used to provide national estimates of variations in hospital emergency response plans and resources by residency and medical school affiliation, hospital size, ownership, metropolitan statistical area status, and Joint Commission accreditation. Of 874 sampled hospitals with emergency or outpatient departments, 739 responded for an 84.6 percent response rate. Estimates are presented with 95 percent confidence intervals.

Results–About 92 percent of hospitals had revised their emergency response plans since September 11, 2001, but only about 63 percent had addressed natural disasters and biological, chemical, radiological, and explosive terrorism in those plans. Only about 9 percent of hospitals had provided for all 10 of the response plan components studied. Hospitals had a mean of about 14 personal protective suits, 21 critical care beds, 12 mechanical ventilators, 7 negative pressure isolation rooms, and 2 decontamination showers each. Hospital bed capacity was the factor most consistently associated with emergency response planning and availability of resources.

What works: Healing the healthcare staffing shortage

Source: PricewaterhouseCoopers’ Health Research Institute, 2007

Many nurses and physicians are among the baby boomers who will start to retire in the next three to five years. The federal government is predicting that by 2020, nurse and physician retirements will contribute to a shortage of approximately 24,000 doctors and nearly 1 million nurses. While hospital leaders voice much of the concern over possible shortages, the implications extend throughout the labor-intensive, trillion-dollar United States health system. It’s expensive to educate new nurses and doctors. Taxpayer-funded Medicare spends $8 billion a year for residence training of physicians alone.

While the U.S. has more physicians and nurses today than ever before, they are not distributed or deployed efficiently. Shortage projections tend to be built around today’s often dysfunctional system, which makes them problematic. However, while future shortages are certainly worrisome, the bigger issue for health industry leaders today lies in orchestrating care in an increasingly complex and converging healthcare labor market.

Nursing Faculty Member Explores Factors Effecting Frequency of Non-Intercepted Medication Errors in 17 NJ Hospitals

Source: Rutgers College of Nursing, Press Release, August 15, 2007

From press release:
(NEWARK, N.J., Aug. 14, 2007) – Rutgers College of Nursing faculty member Linda Flynn is conducting a study to explore the effects of nurse staffing, work environment and safety technology on the frequency of non-intercepted medication errors in 17 New Jersey hospitals.

Funded by a two-year $308,254 grant from the Robert Wood Johnson Foundation, the study’s focus is to determine the best practices for reducing non-intercepted medication errors.

Keeping Score: A comparison of pay-for-performance programs among commercial insurers

Source: PricewaterhouseCoopers’ Health Research Institute, 2007

It is impossible to improve what cannot be measured or to measure what hasn’t been defined. Take, for example, the topic of healthcare quality. Everyone wants quality, but everyone’s keeping score differently. This conundrum was described in some detail in The Quality Conundrum, a book developed and distributed in 2007 by PricewaterhouseCoopers’ Health Research Institute (HRI). It explores practical approaches to improving the quality of patient care from the perspective of patients, physicians, payers, and employers.

One of these approaches is pay-for-performance (P4P), which attempts to define, measure, and reward quality. This represents a radical departure from traditional payment methods, which pay providers the same regardless of differences in quality. P4P has gained traction, largely because the Centers for Medicare and Medicaid Services (CMS) has told hospitals and physicians that future increases in payment will be linked to improvements in clinical performance. Commercial health plans are also responding to employers’ demands for quality improvement by developing “scorecards” that use quality metrics to grade care provided by hospitals and physicians. By tying providers’ scores to financial payments, non-financial rewards, and public reporting, both private and public payers intend to incent improvements in quality of care and outcomes.

The most mature P4P programs are more than 10 years old. However, among payers interviewed for this report, P4P programs are still evolving. As they’ve blossomed, providers have faced a host of new and varied reporting requirements-what some call a “virtual soup of different metrics.” This has caused some to question the value of P4P and whether the results are worth the administrative burden.
See also:
Pay-for-Performance: Will the Latest Payment Trend Improve Care?
Source: Meredith B. Rosenthal, R. Adams Dudley, JAMA: Journal of the American Medical Association, Vol. 297 No. 7, February 21, 2007 (subscription required)

Push For Merit-Based Teacher Pay Heats Up

Source: Hays Daily News, 8/26/2007

OKLAHOMA CITY (AP) — A merit-based teacher salary plan proposed by Republican state lawmakers could cause teachers’ paychecks to vary dramatically depending on how well their students perform in the classroom.

Supporters say tying teacher pay to performance will lead to increased accountability and more innovation and effort in the classroom. But opponents say teachers would be forced to compete instead of collaborate. And tying raises or bonuses to student test scores is not the best measure of what constitutes a good teacher, many say.

Recent/Updated CRS Reports: Health Insurance, Medicare and Social Security

Source: Congressional Research Service (via OpenCRS)

American taxpayers spend nearly $100 million a year to fund the Congressional Research Service, a “think tank” that provides reports to members of Congress on a variety of topics relevant to current political events. Yet, these reports are not made available to the public in a way that they can be easily obtained. A project of the Center for Democracy & Technology, Open CRS provides citizens access to CRS Reports that are already in the public domain and encourages Congress to provide public access to all CRS Reports.
Integrating Medicare and Medicaid Services Through Managed Care
Medicare Prescription Drug Benefit: Low-Income Provisions
Primer on Disability Benefits: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI)
Social Security Administration: Administrative Budget Issues
Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI): Proposed Changes to the Disability Determination and Appeals Processes
Supplemental Security Income (SSI): Accounts Not Counted As Resources
Tax Benefits for Health Insurance and Expenses: Overview of Current Law and Legislation

Post-Election Audits: Restoring Trust In Elections

Source: Lawrence Norden, Aaron Burstein, Joseph Lorenzo Hall
and Margaret Chen, Samuelson Law, Technology, & Public Policy Clinic/Brennan Center for Justice, NYU School of Law, 2007

From press release:
The Samuelson Clinic has co-authored with the Brennan Center for Justice at NYU School of Law the first comprehensive review of state laws and academic research on audits designed to check the integrity of electronic voting systems.

The report, “Post Elections Audits: Restoring Trust in Elections,” finds that most states are not doing enough to use post-election audits of paper trails to ensure that electronic voting is secure and accurate. Taking account of the wide variations in the organization of election jurisdictions around the country, “Restoring Trust in Elections” outlines goals and methods for conducting cost-effective, rigorous audits that will help guard against programming errors as well as malicious attacks against electronic voting systems.

See also:
Clinic’s Electronic Voting Research Helps To Advance Election Integrity
Legal Issues Facing Election Officials in an Electronic-Voting World