National income inequality and ineffective health insurance in 35 low- and middle-income countries

Source: Francisco N. Alvarez and Abdulrahman M. El-Sayed, Health Policy and Planning, Advance Access, First published online: December 26, 2016
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From the abstract:
Global health policy efforts to improve health and reduce financial burden of disease in low- and middle-income countries (LMIC) has fuelled interest in expanding access to health insurance coverage to all, a movement known as Universal Health Coverage (UHC). Ineffective insurance is a measure of failure to achieve the intended outcomes of health insurance among those who nominally have insurance. This study aimed to evaluate the relation between national-level income inequality and the prevalence of ineffective insurance. We used Standardized World Income Inequality Database (SWIID) Gini coefficients for 35 LMICs and World Health Survey (WHS) data about insurance from 2002 to 2004 to fit multivariable regression models of the prevalence of ineffective insurance on national Gini coefficients, adjusting for GDP per capita. Greater inequality predicted higher prevalence of ineffective insurance. When stratifying by individual-level covariates, higher inequality was associated with greater ineffective insurance among sub-groups traditionally considered more privileged: youth, men, higher education, urban residence and the wealthiest quintile. Stratifying by World Bank country income classification, higher inequality was associated with ineffective insurance among upper-middle income countries but not low- or lower-middle income countries. We hypothesize that these associations may be due to the imprint of underlying social inequalities as countries approach decreasing marginal returns on improved health insurance by income. Our findings suggest that beyond national income, income inequality may predict differences in the quality of insurance, with implications for efforts to achieve UHC.

Can a Flexibility/Support Initiative Reduce Turnover Intentions and Exits? Results from the Work, Family, and Health Network

Source: Phyllis Moen, Erin L. Kelly, Shi-Rong Lee, J. Michael Oakes, Wen Fan, Jeremy Bray, David Almeida, Leslie Hammer, David Hurtado, Orfeu Buxton, Social Problems, Advance Access, First published online: 29 December 2016
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From the abstract:
We draw on panel data from a randomized field experiment to assess the effects of a flexibility/supervisor support initiative called STAR on turnover intentions and voluntary turnover among professional technical workers in a large firm. An unanticipated exogenous shock—the announcement of an impending merger—occurred in the middle of data collection. Both organizational changes reflect an emerging employment contract characterized by increasing employee temporal flexibility even as employers wield greater flexibility in reorganizing their workforces. We theorized STAR would reduce turnover intentions and actual turnover by making it more attractive to stay with the current employer. We found being in a STAR team (versus a usual practice team) lowered turnover intentions 12 months later and reduced the risk of voluntary turnover over almost three years. We also examined potential mechanisms accounting for the effects of these two organizational changes; STAR effects on reducing turnover intentions are partially mediated by reducing work-to-family conflict, family-to-work conflict, burnout, psychological distress, perceived stress, and increasing job satisfaction. The effect of learning about the merger on increasing turnover intentions is fully mediated by increased job insecurity. STAR also moderates the negative effects of learning about the merger on turnover intentions for different subgroups. Findings provide insights into the effectiveness of an organizational intervention, the dynamics of organizations, and how competing logics of two organizational changes affect employees’ labor market expectations and behavior.

As Republicans ready to dismantle ACA, insurers likely to bolt

Source: J.B. Silvers, The Conversation, December 29, 2016

….To entice insurers into the market, the ACA also offered well-established methods to reduce risk. For example, it built in protections for insurers who enrolled especially sick people. It also provided back-up payments for very high-cost cases and protected against big losses and limited big gains in the first three years.

These steps worked well in establishing a stable market for Medicare drug plans when this program started under President Bush in 2006. Competition there is vigorous, rates are lower than estimated and enrollees are satisfied. In other words, the market works well…..

…..But when the time came to pay up for risk reduction in the Obamacare exchanges, Congress reneged and paid only 12 percent of what was owed to the insurers. So, on top of the fact that the companies had to bear the risk of unknown costs and utilization in the start-up years, which turned out to be higher than they expected, insurers had to absorb legislative uncertainty of whether the rules would be rewritten.

It is no wonder that this year they have dramatically increased premiums, averaging 20 percent, to compensate for the extra risk they didn’t factor into the original lower rates. In contrast, underlying health costs are rising at about 5 percent…..

Who Hires Social Workers? Structural and Contextual Determinants of Social Service Staffing in Nursing Homes

Source: Amy Restorick Roberts and John R. Bowblis, Health & Social Work, Advance Access, First published online: December 7, 2016
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From the abstract:
Although nurse staffing has been extensively studied within nursing homes (NHs), social services has received less attention. The study describes how social service departments are organized in NHs and examines the structural characteristics of NHs and other macro-focused contextual factors that explain differences in social service staffing patterns using longitudinal national data (Certification and Survey Provider Enhanced Reports, 2009–2012). NHs have three patterns of staffing for social services, using qualified social workers (QSWs); paraprofessional social service staff; and interprofessional teams, consisting of both QSWs and paraprofessionals. Although most NHs employ a QSW (89 percent), nearly half provide social services through interprofessional teams, and 11 percent rely exclusively on paraprofessionals. Along with state and federal regulations that depend on facility size, other contextual and structural factors within NHs also influence staffing. NHs most likely to hire QSWs are large facilities in urban areas within a health care complex, owned by nonprofit organizations, with more payer mixes associated with more profitable reimbursement. QSWs are least likely to be hired in small facilities in rural areas. The influence of policy in supporting the professionalization of social service staff and the need for QSWs with expertise in gerontology, especially in rural NHs, are discussed.

Certified Nursing Assistants Balancing Family Caregiving Roles: Health Care Utilization Among Double- and Triple-Duty Caregivers

Source: Nicole DePasquale, Lauren R. Bangerter, Jessica Williams, and David M. Almeida, The Gerontologist, Volume 56, Issue 6, December 2016
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From the abstract:
Purpose of the Study: This study examines how certified nursing assistants (CNAs) balancing family caregiving roles—child care (double-duty child caregivers), elder care (double-duty elder caregivers), and both child and elder care (triple-duty caregivers)—utilize health care services relative to nonfamily caregiving counterparts (formal-only caregivers).

Design and Methods: A sample of 884 CNAs from the Work, Family and Health Study was drawn on to assess the number of acute care (i.e., emergency room or urgent care facility) and other health care (i.e., outpatient treatment or counseling) visits made during the past 6 months.

Results: Double-duty elder and triple-duty caregivers had higher acute care utilization rates than formal-only caregivers. CNAs with and without family caregiving roles had similar rates of other health care visits.

Implications: CNAs providing informal care for older adults have higher acute care visit rates. Given the increasing need for family caregivers and the vital importance of the health of the nursing workforce for the health of others, future research on how double- and triple-duty caregivers maintain their health amidst constant caregiving should be a priority.

The Effect of Police Slowdowns on Crime

Source: Andrea Cann Chandrasekher, American Law and Economics Review, Volume 18, Issue 2, Fall 2016
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From the abstract:
Though police strikes have been well studied, there are almost no articles written on the public safety consequences of police work slowdowns—labor actions where police officers reduce their ticket-writing and/or arrest productivity for a temporary period. This article fills the current void by presenting evidence on the 1997 New York City Police Department work slowdown, to my knowledge the longest documented police slowdown in U.S. history. Drawing on several, originally collected data sources from the NYPD and other city agencies, the article assesses the impact of the slowdown on ticket enforcement, arrest enforcement, and crime. The findings indicate that, at least in the context of contract-motivated slowdowns where the union may be motivated to garner public support for pay increases, the effects on public safety may be limited. Specifically, in the case of the 1997 slowdown, ticket-writing for all categories of tickets fell dramatically but arrest enforcement for all types of serious crime stayed the same or increased. Accordingly, the crime effects were mostly concentrated in the area of minor criminal disorder (misdemeanors and violations). Only two categories of serious crime (larcenies and assaults) were affected and those crime increases were minimal.

Motivated Reasoning about Public Performance: An Experimental Study of How Citizens Judge the Affordable Care Act

Source: Oliver James and Gregg G. Van Ryzin, Journal of Public Administration Research and Theory, Vol. 27 no. 1, January 2017
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From the abstract:
Public performance reporting is often promoted as a means to better inform citizens’ judgments of public services. However, political psychology has found evidence of motivated reasoning, with citizens’ accuracy motives often supplanted by biased searching for and evaluation of information to defend prior political attitudes, beliefs or identities. We conducted a survey experiment to evaluate motivated reasoning about the performance of the US Affordable Care Act (also known as Obamacare), which has been politically contentious. In the experiment, we randomly assigned a sample of US adults to either a politics prime, to encourage partisan motivated reasoning, or a health care needs prime, to encourage accuracy motived reasoning stemming from their own perceived need for health care. We then asked them to rate the strength of real performance information in the form of evidence statements about the Affordable Care Act and to choose real performance indicators from a graphical array. The findings show that the political prime strengthened partisan differences in both the ratings of evidence statements and the selection of performance indicators. Thus, for contentious public programs where partisan identities are activated, partisan motivated reasoning influences how citizens process performance information and thus may limit its potential for enhancing democratic accountability.

Preemption conflicts between state and local governments

Source: Ballotpedia, Last updated on January 2, 2017

Out of 15 resolved preemption cases tracked by Ballotpedia, states were able to preempt local ordinances or initiatives in 14 cases.

A tug-of-war between cities and state governments has developed behind the scenes of the 21st century’s biggest policy debates. Interest groups advancing policy reforms ranging from bans on fracking to higher minimum wages have led local and state officials to tussle over appropriate responses. Mayors, city councils, and community activists are passing ordinances and initiatives on wages, gun control, and LGBT issues in order to fill gaps perceived in existing law. Governors and state legislators have pushed back against these local responses, citing their interests in creating uniform policies across all local governments in their states.

This struggle continues the decades-long evolution of preemption, a legal concept that allows a state law to supersede a conflicting local law due to the state’s power to create cities as granted by state constitutions….

Restrictions on Lobbying the Government: Current Policy and Proposed Changes

Source: Jacob R. Straus, Congressional Research Service, CRS Insight, IN10625, December 15, 2016

During the 2016 presidential campaign, President-elect Donald Trump proposed a series of ethics measures, including several lobbying-related provisions. They are:
• extending “cooling off” periods on lobbying the government for five years after government service; “instituting a five-year ban on lobbying by former Members of Congress and their staffs”;
• expanding the definition of a lobbyist to cover former government officials who engage in strategic consulting; and
• issuing a “lifetime ban against senior executive branch officials lobbying on behalf of a foreign government.”

President-elect Trump’s ethics plan shares some features with past efforts to restrict Administration officials’ future lobbying activities (the “revolving door”) by adjusting “cooling off” periods—a period of time a former government official is restricted from contacting their former employer on particular matters they might have worked on in government. These previous efforts include a 1993 executive order issued by President Bill Clinton (E.O. 12834) and a 2009 executive order issued by President Barack Obama (E.O. 13490), and the Honest Leadership and Open Government Act (HLOGA) of 2007. The executive orders supplemented existing statutory revolving door and “cooling off” period requirements…

How Safety and Health Issues Can Drive Organizing Campaigns – A Case Study on Airports

Source: LRAN Training, December 12, 2016
(registration required)

At LaGuardia Airport in October 2014, more than 200 contracted cabin cleaners launched a strike over occupational hazards and unhealthy and unsafe working conditions, including lack of protection from possible exposure to Ebola and other infectious diseases, and to protest unfair labor practices, including illegal threats to workers who planned to strike. Learn how these workers won the union through a campaign to expose safety and health conditions on the job and applications for other organizing campaigns.