Does government oversight improve access to nursing home care? Longitudinal evidence from US counties.

Gains in life expectancy around the world have increasingly placed pressure on governments to ensure that the elderly receive assistance with activities of daily living. This research examines the impact of government oversight of Medicaid payment policies on access to nursing home care services in the United States. Variation in price levels induced by a federal policy shift in 1997 is used to identify the effect of Medicaid reimbursements on the number of nursing homes and beds available. Court rulings prior to the policy change are used to categorically define a range of oversight treatments at the state level. Difference-in-differences estimates indicate a significant decline in access to nursing home care services for individuals living in states in which courts consistently ruled that Medicaid reimbursements did not meet the minimum standard implied by federal law. The findings suggest that nursing home care services were made more accessible through a combination of legislative and judicial oversight of Medicaid payment policies.

Do the Medicaid and Medicare programs compete for access to health care services? A longitudinal analysis of physician fees, 1998-2004.

As the demand for publicly funded health care continues to rise in the U.S., there is increasing pressure on state governments to ensure patient access through adjustments in provider compensation policies. This paper longitudinally examines the fees that states paid physicians for services covered by the Medicaid program over the period 1998-2004. Controlling for an extensive set of economic and health care industry characteristics, the elasticity of states' Medicaid fees, with respect to Medicare fees, is estimated to be in the range of 0.2-0.7 depending on the type of physician service examined. The findings indicate a significant degree of price competition between the Medicaid and Medicare programs for physician services that is more pronounced for cardiology and critical care, but not hospital care. The results also suggest several policy levers that work to either increase patient access or reduce total program costs through changes in fees.

Modeling the effects of immunizations timing on child health outcomes in India.

Timely vaccinations of children in developing countries are important for reducing morbidity and mortality, which are Millennium Development Goals. However, a majority of children do not possess vaccination cards compiling information on timing. We investigated the benefits of vaccination cards for the uptake of immunizations against diphtheria, pertussis and tetanus (DPT), polio, tuberculosis (BCG), and measles using data on over 200,000 Indian children from the District Level Health and Facility Survey 3. Methodological issues such as whether parents of children with higher morbidity levels may have them vaccinated were investigated. The results from the models for DPT, polio, measles, and BCG vaccinations showed significant beneficial effects of maternal education, household possessions, and access to health care facilities. Moreover, models for children's ages at the time of vaccination showed significant interactions between maternal education and access to and availability of health care facilities. Finally, models for child morbidity due to diarrhea, cough, and fever showed that timely vaccinations against DPT, access to piped water, and cooking with electricity or natural gas were associated with lower morbidity. Overall, issuing paper or electronic vaccination cards to children is likely to enhance timely uptake of various immunizations thereby reducing child morbidity.

Food Insecurity Experiences Predict Children's Fruit and Vegetable Consumption in the USA.

This research analyses the longitudinal relationships between household food insecurity (very low and low food security) experiences and children's consumption (servings/week) of fruit, green salad, carrots, potatoes, and other types of vegetables. Using a panel of 5,670 children aged 10-13 years who were first observed in spring 2004 and then again in spring 2007 at age 13-16 years, the main findings are as follows: first, children experiencing low food security consume significantly (P < 0.05) more fruit per week. In contrast, children experiencing very low food security consume significantly more carrots and potatoes per week, and estimates based on gender-stratified models indicate that the association is strongest among girls. Second, activity patterns are significantly related to children's dietary patterns; physical exercise is positively associated with fruit, green salad, carrot, and other vegetables consumption, while television watching is positively associated with potato consumption. Overall, the findings suggest that children living in food insecure home environments consume a greater number of servings of fruits and vegetables per week, relative to children living in food secure home environments.

Transitions between food insecurity and food security predict children's social skill development during elementary school.

Recent findings indicate that household food insecurity affects children's social skill development in the early years of elementary school. It is important to assess the persistency of developmental consequences and investigate whether all categories of social skills are equally affected by food insecurity experiences. The present paper estimates population-averaged and subject-specific models for children's social skill scores reported by school teachers using longitudinal data on 2310 boys and 2400 girls in the USA enrolled in the 1st (aged 6-9 years), 3rd (aged 8-11 years) and 5th (aged 10-13 years) grades (1999-2003) from the Early Childhood Longitudinal Study-Kindergarten. The main findings are, first, significantly (P < 0·05) negative, contemporaneous and transitional relationships between food insecurity experiences and children's social skill scores are evident. Estimates based on sex-stratified samples indicate that the contemporaneous association is strongest among girls, while the association of an early transition from food insecurity in the 1st grade to food security in the 3rd grade is strongest among boys. Second, food insecurity experiences predict children's social skill scores emphasising self-control, attentiveness and task persistence, rather than interpersonal relationships or externalising behaviour. Overall, the findings underscore the multifaceted effect that household food insecurity has on children's social skills and provide the strongest empirical evidence to date that the experiences are linked with non-nutritional developmental consequences for children over a time horizon spanning several years.

Socio-economic, behavioural and environmental factors predicted body weights and household food insecurity scores in the Early Childhood Longitudinal Study-Kindergarten.

Recent increases in obesity prevalence among children in developed countries are of policy concern. While significant positive associations between households' food insecurity status and body weights have been reported for adults, it is known from the energy physiology literature that energy requirements depend on BMR, anthropometric measures and physical activity. It is therefore important to model the bi-directional relationships between body weights and households' food insecurity scores especially for children that have evolving nutrient and energy requirements. The present paper estimated dynamic random effects models for children's body weights and BMI, and households' food insecurity scores using longitudinal data on 7635 children in the USA enrolled in 1st, 3rd and 5th grades (1999-2003) of the Early Childhood Longitudinal Study-Kindergarten. The main findings were, first, physical exercise and numbers of siblings were significantly (P < 0.05) negatively associated with body weights, while households' food insecurity score was not a significant predictor. Moreover, children's body weights were significantly lower in households with higher parental education and incomes; time spent watching television and in non-parental care were positively associated with weights. Second, models for households' food insecurity scores showed that poverty and respondents' poor emotional and physical health significantly increased food insecurity. Moreover, households with children who were taller and heavier for their ages faced significantly higher food insecurity levels. Overall, the results showed that household food insecurity was unlikely to exacerbate child obesity in the USA and it is important that children receive balanced school meals and perform higher physical activity.