Biomedical subjects

Richard M Scheffler

Publications and source records attributed to Richard M Scheffler.

12 recordsLinked to original sources

PubMed2007

How do we measure shortages of dental hygienists and dental assistants? Evidence from California: 1997-2005.

BACKGROUND: The authors examined the labor market for registered dental hygienists (RDHs) and dental assistants (DAs) in California from 1997 to 2005 to determine whether there was a shortage in either market. METHODS: This analysis used economic indicators interpreted within an economic framework to investigate trends in labor force numbers and market-determined wages for RDHs and DAs. Rising inflation-adjusted mean wages indicated a labor shortage, while declining inflation-adjusted mean wages indicated a labor surplus. RESULTS: From 1999 to 2002, the wages for RDHs increased 48 percent and then stabilized, indicating a shortage had occurred, after which the market achieved equilibrium. Wages for DAs increased 13.9 percent from 1997 to 2001, but then declined from 2001 to 2005, indicating a shortage that then became a surplus. The market for DAs may not have stabilized. CONCLUSIONS: Wages increased for RDHs and DAs, suggesting that labor shortages occurred in both markets. The large supply response in the market for DAs resulted in wages declining after their initial rise. PRACTICE IMPLICATIONS: Tracking the local labor markets for RDHs and DAs will enable dental professionals to respond more efficiently to market signals.

California↗

PubMed2006

The empirical relationship between community social capital and the demand for cigarettes.

We show that the proportion of community social capital attributable to religious groups is inversely and strongly related to the number of cigarettes that smokers consume. We do not find overall community social capital or the proportion of community social capital attributable to religious groups to be related to the overall prevalence of smoking. Using a new validated measure of community social capital, the Petris Social Capital Index and three years (1998-2000) of US data on 39 369 adults, we estimate a two-part demand model incorporating the following controls: community-level fixed effects, price (including excise taxes), family income, a smuggling indicator, nonsmoking regulations, education, marital status, sex, age, and race/ethnicity.

Adult↗

PubMed2006

Do physicians always flee from HMOs? New results using dynamic panel estimation methods.

OBJECTIVE: To assess the impact of changes in relative health maintenance organization (HMO) penetration on changes in the physician-to-population ratio in California counties when changes in the economic conditions in California counties relative to the U.S. average are taken into account. DATA SOURCES: Data on physicians who practiced in California at any time from 1988 to 1998 were obtained from the AMA Masterfile. The analysis was restricted to active, patient care physicians, excluding medical residents. Data on other covariates in the model were obtained from the Bureau of Economic Analysis, InterStudy, the Area Resource File, and the California state government. Data were merged using county FIPS codes. STUDY DESIGN: Changes in the physician-to-population ratio in California counties include the effects of both intrastate migration and interstate migration. A reduced-form model was estimated using the Arellano-Bond dynamic panel estimator. Economic conditions in California relative to the U.S. were measured as the ratio of county-level real per capita income to national-level real per capita income. Relative HMO penetration in California was measured as the ratio of county-level HMO penetration to HMO penetration in the U.S. relative HMO penetration was instrumented using five identifying variables to address potential endogeneity. Omitted-variable bias was controlled for by first differencing the model. The model also incorporated eight other covariates that may be associated with the demand for physicians: the percentage of the population enrolled in Medicaid, beds in short-term hospitals per 100,000 population, the percentage of the population that is black, the percentage of the population that is Hispanic, the percentage of the population that is Asian, the percentage of the population that is below age 18, the percentage of the population that is aged 65 and older, and the percentage of the population that are new legal immigrants in a given year. All of the above variables were lagged one period. The lagged physician-to-population ratio was also included to control for the supply of physicians. Separate equations were estimated for primary care physicians and specialist physicians. PRINCIPAL FINDINGS: Changes in lagged relative HMO penetration are negatively associated with changes in specialist physicians per 100,000 population. However, this effect of HMO penetration is attenuated and at times reversed in areas where the magnitude of the difference in relative economic conditions is sufficiently large. We did not find any statistically significant effects for primary care physicians. CONCLUSIONS: Consistent with prior studies, we find that changes in physician supply are associated with changes in relative HMO penetration. Relative economic conditions are an important moderator of the effect of changes in relative HMO penetration on physician migration.

California↗

PubMed2005

Medicines and vaccines for the world's poorest: is there any prospect for public-private cooperation?

This paper reviews the current status of the global pharmaceutical industry and its research and development focus in the context of the health care needs of the developing world. It will consider the attempts to improve access to critical drugs and vaccines, and increase the research effort directed at key public health priorities in the developing world. In particular, it will consider prospects for public-private collaboration. The challenges and opportunities in such public-private partnerships will be discussed briefly along with a look at factors that may be key to success. Much of the focus is on HIV/AIDS where the debate on the optimal balance between intellectual property rights (IPR) and human rights to life and health has been very public and emotive.

Journal Article↗

PubMed2005

An analysis of the significant variation in psychostimulant use across the U.S.

OBJECTIVE: To provide a national profile of the area variation in per-capita psychostimulant consumption in the U.S. METHODS: We separated 3030 U.S. counties into two categories of 'low' and 'high' per-capita use of attention deficit hyperactivity disorder (ADHD) drugs (based on data from the Drug Enforcement Administration), and then analyzed them on the basis of their socio-demographic, economic, educational and medical characteristics. RESULTS: We found significant differences and similarities in the profile of counties in the U.S. that are above and below the national median rate of per-capita psychostimulant use (defined as g/per 100K population). Compared to counties below the median level, counties above the median level have: significantly greater population, higher per-capita income, lower unemployment rates, greater HMO penetration, more physicians per capita, a higher ratio of young-to-old physicians and a slightly higher students-to-teacher ratio. CONCLUSIONS: Our analysis of the DEA's ARCOS data shows that most of the significant variables correlated with 'higher' per-capita use of ADHD drugs serve as a proxy for county affluence. To provide a more complex, multivariate analysis of the area variation in psychostimulant use across the U.S.-which is the logical next step-requires obtaining price data to match the DEA's quantity data.

Adolescent↗

PubMed2002

Variation in routine psychiatric workload: the role of financing source, managed care participation, and mental health workforce competition.

This study was conducted to examine the association between psychiatrists' demographic characteristics, payment source, and managed care participation and psychiatrists' practice workload, and between the supply of other mental health providers in a psychiatrist's county of practice and psychiatrists' practice workload. Data from the 1996 American Psychiatric Association National Survey of Psychiatric Practice were merged with national countywide measures of mental health workforce and environmental data from the 1996 Area Resource File. In comparison to male psychiatrists, female psychiatrists treat fewer patients per week, provide less total hours of weekly patient care, and obtain fewer new monthly referrals. An increase in psychiatrists' managed care participation was associated with only minor increases in the number of patients per week, weekly time spent in clinical care, and number of new monthly referrals. The supply of other mental health providers was not associated with variation in practice workload. Once psychiatrists participate in managed care plans, an increase in their participation rate does not significantly expand clinical practice workload. The supply of other mental health providers was not significantly associated with variation in psychiatrists' workload, which suggests that substitution effects may not be evident with this aspect of psychiatric practice.

Adult↗

PubMed2002

Comparison of psychiatrists and psychologists in clinical practice.

OBJECTIVE: The authors compared data from psychiatrists and psychologists in California to determine whether long-standing differences in clinical practice remain after the introduction of managed care and other changes in mental service delivery. METHODS: Responses from practicing clinicians in California who participated in the 1998 National Survey of Psychiatric Practice and the 2000 California Survey of Psychological Practice were compared on items related to patient caseload, practice profile, and insurance or reimbursement arrangements. RESULTS: Data from 97 psychiatrists and 395 psychologists were available for the study. Psychiatrists reported spending more hours on most aspects of practice and working more total hours per week than psychologists. The weekly caseloads reported by psychiatrists included a greater percentage of persons treated for psychotic conditions than did the caseloads of psychologists. Psychologists reported that their weekly caseloads included a greater percentage of persons treated for anxiety disorders, personality disorders, and other disorders. Psychiatrists reported receiving a greater average payment for services from public insurance, and psychologists reported treating a greater average percentage of patients who did not have insurance coverage. Significant differences in income sources and fee arrangements were observed, and the net reported income of psychiatrists was nearly 80 percent greater than that of psychologists. CONCLUSIONS: Long-standing differences in clinical practice patterns remain between psychiatrists and psychologists despite managed care staffing arrangements and treatment strategies that streamline the practices of both provider groups. The significant income and wage differences between psychiatrists and psychologists may be partly due to supply dynamics of the mental health workforce that adversely affect psychologists.

Female↗

PubMed2002

An analysis of the definitions of mental illness used in state parity laws.

OBJECTIVE: Thirty-four states have enacte mental health parity laws that require a health plan, insurer, or employer to provide coverage for mental illness equal to that for physical illness. This study analyzed definitions of mental illness used in state parity laws, identified factors influencing the development of these definitions, and examined the effects of different definitions on access to care for persons with mental illness. METHODS: Specific language in each state's parity legislation was analyzed. Interviews were conducted with policy makers, mental health providers, advocates, and insurers to determine factors influencing a state's definition. Current definitions of mental illness used in the clinical literature and in federal policy were reviewed and compared with definitions used in state parity laws. RESULTS: The definitions of mental illness used in state parity legislation vary significantly and fall into one of three major categories: "broad-based mental illness," "serious mental illness," or "biologically based mental illness." To define each of these categories, state legislatures do not rely on clinically accepted definitions or federal mental health policy. Rather, influenced by political and economic factors, they are developing their own definitions. CONCLUSIONS: Definitions of mental illness in state parity laws have important implications for access, cost, and reimbursement; they determine which populations receive a higher level of mental health services. Future research must qualitatively examine how state definitions affect the use and cost of mental health services.

Brain Diseases↗

PubMedDate not supplied

The occupational transformation of the mental health system.

The mental health workforce has changed dramatically since the mid-1970s. Nonphysician providers, particularly psychologists and clinical social workers, have become a much larger share of the workforce. While the supply of psychiatrists has been relatively stable, there has been a dramatic increase in the supply of psychologists and social workers. Changes in clinical practice, combined with the continued expansion of managed care into mental health, will largely determine the future composition and supply of the mental health workforce.

Forecasting↗

PubMedDate not supplied

Private health insurance in developing countries.

A joint Wharton School-World Bank conference called attention to the high proportions of medical care spending paid out of pocket in most developing countries. One of the reasons for this, attendees said, is the problem in such economies of generating high tax revenues in a nondistortive way. Since people are paying out of pocket, they should be able to afford some private insurance that can spread the risk of above-average out-of-pocket payments. The potential efficiency gains from greater use of voluntary private insurance seem large, but there are a number of possible impediments to the emergence of such insurance.

Developing Countries↗

PubMedDate not supplied

Millionaires and mental health: Proposition 63 in California.

In November 2004 California passed Proposition 63, a landmark piece of mental health and fiscal legislation. This initiative places a 1 percent tax on adjusted gross income over dollar 1 million, affecting about 30,000 taxpayers and raising dollar 1.8 billion (a 31 percent increase) in new revenues over the first three years to support county-operated mental health systems. Our analysis suggests that Proposition 63 passed with strong support from Democrats, urban dwellers, and social workers and in counties with high rates of homelessness. Proposition 63 faces challenges in implementation and provides unprecedented opportunities for transformation and change.

California↗

PubMedDate not supplied

Changes in service availability in california hospitals, 1995 to 2002.

Hospitals face serious financial challenges in the current healthcare marketplace. In response to these challenges, they may alter their service offerings, eliminating services that are perceived as money-losing or adding new services in areas where profitability is expected to be greater. Although research has examined hospital closures, the more subtle phenomenon of hospital service changes has not been systematically studied. This issue is important because different types of hospital service changes could have different effects on hospital financial viability: extensive service closures could contribute to a downward spiral leading to hospital closure, whereas adding new services might help improve a hospital's finances. This article' examines changes in hospital service availability in California general acute care hospitals between 1995 and 2002. Our major findings indicate that many California hospitals made changes in their service offerings during the study period, although few made extensive changes. Altogether, about half of the hospitals in our study population either closed or opened at least one service. Nearly one-fourth of the hospitals in our study population closed one or more services, whereas just under one-third opened one or more new services. However, the vast majority of the hospitals that closed or added a service made only one or two such changes. In addition, few hospitals both closed and opened services. The service closed most frequently was normal newborn labor and delivery (obstetrics), whereas inpatient rehabilitation was the most frequently opened service. Hospitals that made the most service changes tended to be small, rural, and financially troubled at the start of the study period. Among this group of hospitals, service closures were associated with continued financial deterioration, whereas new service openings were associated with improvements in key financial ratios.

California↗