Impact of gentrification on adult mental health.

OBJECTIVE: To estimate the net effect of living in a gentrified neighborhood on probability of having serious psychological distress. DATA SOURCES: We pooled 5 years of secondary data from the California Health Interview Survey (2011-2015) and focused on southern California residents. STUDY DESIGN: We compared adults (n = 43 815) living in low-income and gentrified, low-income and not gentrified, middle- to high-income and upscaled, and middle- to high-income and not upscaled neighborhoods. We performed a probit regression to test whether living in a gentrified neighborhood increased residents' probabilities of having serious psychological distress in the past year and stratified analyses by neighborhood tenure, homeownership status, and low-income status. Instrumental variables estimation and propensity scores were applied to reduce bias arising from residential selection and simultaneity. An endogenous treatment effects model was also applied in sensitivity analyses. DATA COLLECTION/EXTRACTION METHODS: Adults who completed the survey on their own and lived in urban neighborhoods with 500 or more residents were selected for analyses. Survey respondents who scored 13 and above on the Kessler 6 were categorized as having serious psychological distress in the past year. We used eight neighborhood change measures to classify respondents' neighborhoods. PRINCIPAL FINDINGS: Living in a gentrified and upscaled neighborhood was associated with increased likelihood of serious psychological distress relative to living in a low-income and not gentrified neighborhood. The average treatment effect was 0.0141 (standard error = 0.007), which indicates that the prevalence of serious psychological distress would have been 1.4 percentage points less if none of the respondents lived in gentrified neighborhoods. Gentrification appears to have a negative impact on the mental health of renters, low-income residents, and long-term residents. This effect was not observed among homeowners, higher-income residents, and recent residents. CONCLUSIONS: Gentrification levies mental health costs on financially vulnerable community members and can worsen mental health inequities.

Do Medicare Beneficiaries Living With HIV/AIDS Choose Prescription Drug Plans That Minimize Their Total Spending?

This article examines whether California Medicare beneficiaries with HIV/AIDS choose Part D prescription drug plans that minimize their expenses. Among beneficiaries without low-income supplementation, we estimate the excess cost, and the insurance policy and beneficiary characteristics responsible, when the lowest cost plan is not chosen. We use a cost calculator developed for this study, and 2010 drug use data on 1453 California Medicare beneficiaries with HIV who were taking antiretroviral medications. Excess spending is defined as the difference between projected total spending (premium and cost sharing) for the beneficiary's current drug regimen in own plan vs spending for the lowest cost alternative plan. Regression analyses related this excess spending to individual and plan characteristics. We find that beneficiaries pay more for Medicare Part D plans with gap coverage and no deductible. Higher premiums for more extensive coverage exceeded savings in deductible and copayment/coinsurance costs. We conclude that many beneficiaries pay for plan features whose costs exceed their benefits.

How much 'skin in the game' do medicare beneficiaries have? The increasing financial burden of health care spending, 1997-2003.

Rising health costs and an aging population present critical policy challenges. This paper examines the financial burden of out-of-pocket health spending among Medicare beneficiaries between 1997 and 2003. Over this period, median out-of-pocket spending as a share of income increased from 11.9 percent to 15.5 percent. In 2003, the 25 percent of beneficiaries with the largest burden spent at least 29.9 percent of their income on health care, while 39.9 percent spent more than a fifth of their income on health care. Results suggest that sustained increases in out-of-pocket spending could make health care less affordable for all but the highest-income beneficiaries.