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Biomedical subjects

S H Long

Publications and source records attributed to S H Long.

At least 19 recordsLinked to original sources
PubMed1997

Federalism and health system reform. Prospects for state action.

OBJECTIVE: To assess the prospect that the states, acting independently, would undertake health insurance coverage expansions that together would result in meaningful reductions in the extent of uninsurance nationally. DESIGN: We use microsimulation methods to contrast the federal income tax payments needed to finance a national program covering the uninsured with the state income tax payments needed to finance a state-specific program for the same purpose. The contrast reveals the effects on the tax burdens of differences among states in uninsured rates and tax capacity. SETTING: Continental United States. PATIENTS OR OTHER PARTICIPANTS: Observations from the 1990 through 1993 Current Population Survey (N =305 477 families), weighted to represent the population of each state. INTERVENTION: Illustrative public health insurance program for families with incomes below 250% of poverty, not covered by current public or employer-sponsored health insurance. MAIN OUTCOME MEASURES: Change in percent uninsured, change in per capita total tax payments. RESULTS: The per capita cost of a state-specific program is directly related to current uninsured rates, $130 in states with low uninsured rates (10%) to $230 in states with high uninsured rates (21%). This would represent increases in state total tax effort of 10% to 19%, respectively. In contrast, equal tax effort to finance a national program would imply per capita yields of about $200 in the low-uninsured states and about $150 in the high-uninsured states. CONCLUSIONS: Substantial state tax effort would be necessary to cover the low-income uninsured-especially in states with the highest uninsured rates, which also have the lowest tax capacity. Targeted federal financial assistance may be necessary, if policymakers wish to induce many states to provide health insurance coverage for their uninsured.

Health Care Reform↗
PubMed1997

Two models of grammar facilitation in children with language impairments: phase 2.

Fey, Cleave, Long and Hughes (1993) demonstrated the effectiveness of two 5-month interventions for preschoolers with problems in expressive grammar. This article reports the results of an additional 5-month intervention phase for 18 of the original participants. Results indicated that although participants improved during Phase 2, improvements generally were not as strong as those noted for Phase 1. Gains were larger and more consistent for children who received the relatively costly clinician-administered approach than for those who received a less expensive parent-administered intervention. The parent intervention was successful in helping parents to use sentence recasts, and especially so for parents of children at relatively early stages of grammatical development, Finally, children who were dismissed after a highly successful treatment Phase 1 generally exhibited no gains over the no-treatment Phase 2.

Child↗
PubMed1997

Verbs in the emergence of word combinations in young children with specific expressive language impairment.

Young children with specific expressive language impairment (SELI) are typically first identified by their delay in initial vocabulary learning. When their language difficulties persist they often have problems with verb constructions. The purpose of the present study was to examine the role of lexical development in children with SELI who were moving from the single-word to the multi-word stage of language production, with particular attention to verbs. The research examined the nature of the developing lexicon (lexicon size and composition) and realisation of lexical categories and their combinatorial properties transitivity of verbs) as the children began producing word combinations during a nine-week period of observation, three weeks of which involved treatment. Results indicated a moderate correlation between the developing lexicon, both in size and composition of vocabulary, and the emergence of word combinations as measured by mean length of utterance. Further, the data revealed the importance of intransitive and ditransitive verbs for children who demonstrated the greatest change in their language production. The findings are discussed in terms of their theoretical and clinical importance.

Child, Preschool↗
PubMed1996

Self-insured employer health plans: prevalence, profile, provisions, and premiums.

Data from three recent surveys indicate that about 40 percent of workers with employment-based health insurance are enrolled in plans that their employers self-insure. Despite the considerable differences between federal regulation of these self-insured plans and state regulation of employer plans purchased from an insurance company, we find striking similarities in the populations they serve, the benefits they offer, and their premium costs. Implications for health policy are discussed.

Adult↗
PubMed1996

Reconsidering the effect of Medicaid on health care services use.

OBJECTIVE: Our research compares health care use by Medicaid beneficiaries with that of the uninsured and the privately insured to measure the program's effect on access to care. DATA SOURCES/STUDY SETTING: Data include the 1987 National Medical Expenditure Survey and the Survey of Income and Program Participation for 1984-1988. STUDY DESIGN: We predict annual use of ambulatory care and inpatient hospital care for Medicaid beneficiaries receiving AFDC cash assistance and compare it to what their use would be if uninsured or if covered by private insurance. Comparisons are based on multivariate models of health care use that control for demographic and economic characteristics and for health status. Our model distinguishes among Medicaid beneficiaries on the basis of eligibility to account for the poor health of beneficiaries in some eligibility groups. PRINCIPAL FINDINGS: AFDC Medicaid beneficiaries use considerably more ambulatory care and inpatient care than they would if they remained uninsured. Use among the AFDC Medicaid population is about the same as use among otherwise similar, privately insured persons. Use rates differ substantially among different Medicaid beneficiary groups, supporting the expectation that some beneficiary groups are in poor health. CONCLUSIONS: Although Medicaid has increased access to health care services for beneficiaries to rates now comparable to those for the privately insured population, because of lower cost sharing in Medicaid we would expect higher service use than we are finding. This suggests possible barriers to Medicaid patients in receiving the care they demand. Enrollment of less healthy individuals into some Medicaid beneficiary groups suggests that pooled purchasing arrangements that include Medicaid populations must be designed to ensure adequate access for the at-risk populations and, at the same time, to ensure that private employers do not opt out because of high community-rated premiums.

Adolescent↗
PubMed1996

Some pitfalls in making cost estimates of state health insurance coverage expansions.

This paper cautions state policy analysts who estimate expected costs of state health reforms using state-specific data from general purpose, national surveys. It compares cost estimates of subsidized insurance programs for low-income uninsured persons in 10 states using the Current Population Survey (CPS) and the Robert Wood Johnson Foundation state surveys. Depending on the measure of insurance and concept of the family that are used, costs of state programs could exceed the estimates by more than 50%. State policy analysts need to be aware of such pitfalls and make appropriate adjustments when using CPS data to estimate program costs.

Bias↗
PubMed1995

Private employment-based health insurance in ten states.

This Data Watch reports key findings from the 1993 Robert Wood Johnson Foundation Employer Health Insurance Survey, through which more than 20,000 employers in ten states were interviewed. Our report contrasts the behavior of four size classes of small businesses (fewer than fifty workers) with that of all other businesses. We examine offer rates by business size; characteristics of employers and workers in business offering and not offering insurance; premiums, benefits, and medical underwriting; the extent of choice among plans; and self-insurance. We discuss the implications of our findings for health policy.

Data Collection↗
PubMed1995

Do shifts toward service industries, part-time work, and self-employment explain the rising uninsured rate?

It is conventional wisdom that the increase in the number of uninsured people during the 1980s was due, in part, to systematic trends in employment, specifically: 1) shifts from full-time to part-time jobs and to self-employment; and 2) changes in the industrial mix of employment, especially toward the service industries. This paper uses the March Current Population Survey data from 1980 through 1987 to measure the contribution of these factors to the rise in the uninsured. In the first case, we find the premise of rising part-time work and self-employment to be untrue. In the second case, less than 15% of the decline in health insurance over this period was due to employment shifting from higher-coverage to lower-coverage industries. Instead, the decline resulted from falling coverage rates across all industries. This is not to dismiss the possible importance of such employment trends over decades, but to emphasize the need to investigate other causes of the change during recent years.

Data Collection↗
PubMed1994

Effects of grammar facilitation on the phonological performance of children with speech and language impairments.

Although there is a great deal of evidence for a significant developmental relationship between grammar and phonology, the nature of this relationship and its implications for the intervention of children with impairments in both grammar and phonology are unclear. The purpose of this investigation was to determine whether two approaches to grammar facilitation that placed no emphasis on phonology would have indirect effects on the phonological output of preschoolers with speech and language impairments. All 26 subjects, ages 44-70 months, had impairments both in grammar and in phonology. Ten subjects took part in a clinician-administered intervention program, eight subjects received a similar intervention program implemented by their parents, and eight children served as delayed intervention controls (Fey, Cleave, Long, & Hughes, 1993). The results indicated that despite a strong effect for the intervention on the children's grammatical output, there were no indirect effects on the subjects' phonological production. It is concluded that despite a close relationship between the development of grammar and phonology, language intervention approaches for children approximately 4 to 6 years of age should address phonological problems directly if significant effects on phonology are to be expected.

Child↗
PubMed1994

The costs and financing of perinatal care in the United States.

OBJECTIVES: The purpose of this study was to estimate the aggregate annual costs of maternal and infant health care and to describe the flow of funds that finance that care. METHODS: Estimates of costs and financing based on household and provider surveys, third-party claims data, and hospital discharge data were combined into a single, best estimate. RESULTS: The total cost of perinatal care in 1989 was $27.8 billion, or $6850 per mother-infant pair. Payments made directly by patients or third parties for this care totaled $25.4 billion, or about 7% of personal health care spending by the nonaged population. Payments were less than costs because they did not include a value for direct delivery care or for bad debt and charity care, which accounted for $2.4 billion. Private insurance accounted for about 63% of total payments, and Medicaid accounted for 17% of the total. CONCLUSIONS: National health reform would provide windfall receipts to hospitals, which would receive payment for the considerable bad debt and charity care they provide. Reform might also provide short-term gains to providers as private payment rates are substituted for those of Medicaid.

Adult↗
PubMed1993

Two approaches to the facilitation of grammar in children with language impairment: an experimental evaluation.

Two approaches to grammar facilitation in preschool-age children with language impairment were evaluated. One approach was administered by a speech-language pathologist and the other was presented by the subjects' parents, who were trained by the speech-language pathologist. Both treatment packages ran for 4 1/2 months and made use of focused stimulation procedures and a cyclical goal-attack strategy. Subjects were 30 children between the ages of 3:8 and 5:10 (years:months) who had marked delays in grammatical development. Children who served in a delayed-treatment control group averaged no gains over their no-treatment period. In contrast, large treatment effects were observed for both treatment groups on three of four measures of grammatical expression. However, closer inspection of the data revealed that the effects for the clinician treatment were more consistent across treatment administrations than were those for the parent treatment. Although the specific contributions of the focused stimulation procedures and the cyclical goal attack strategy were not evaluated, the results support the viability of these components as parts of larger treatment packages. The results also support the participation of parents as primary intervention agents in grammar facilitation programs. When parents take such a large role in the intervention process, however, it is imperative that the children's progress be monitored carefully and that program adjustments be made whenever gains are smaller than expected.

Child↗
PubMed1993

Gaps in employer coverage: lack of supply or lack of demand?

According to data from the May 1988 Current Population Survey, 18 percent of workers are in firms that do not offer health insurance. The question explored here is whether the absence of insurance in these firms is related to lack of supply (that is, a failure of the firm to offer the benefit because the price it faces is too high or the benefit too low) or lack of demand (that is, employees in these firms would not purchase the insurance even if it were offered). Characteristics hypothesized to affect the supply of insurance by firms (size, rate of turnover, and union status) are found to distinguish whether or not firms offer insurance. The data show near-universal acceptance of group insurance among employees offered the opportunity to participate. Both of these factors suggest a failure of supply. However, employees in firms that do not offer insurance are young, low-wage earners who work part time. These are also characteristics of workers who do not purchase group insurance even when it is offered, suggesting that many of the workers who are not offered group insurance would not participate in a plan even if the supply failure were corrected. These findings have implications for the effectiveness of voluntary strategies to improve access, but they also raise concern over the fairness to workers of mandates requiring that they purchase coverage.

Adolescent↗
PubMed1988

Patterns of language comprehension deficit in abused and neglected children.

The similarity between factors associated with child abuse/neglect and those associated with language disability suggests that maltreated children are a population at risk for language problems. This study investigated the performance of three groups of abused/neglected children and a matched group of nonmaltreated subjects on three tests of language comprehension. Results revealed significant differences among groups for all measures. Severely neglected children obtained the lowest scores on all tests; the abused children consistently obtained lower scores than the controls; and generally neglected children showed the smallest difference in performance from the control group. These findings suggest a model for understanding relationships between abuse/neglect and language disability.

Child↗
PubMed1988

Employee premiums, availability of alternative plans, and HMO disenrollment.

The notion that greater competition among health plans helps contain health-care costs presumes that consumers respond to economic incentives. This article tests that proposition through an examination of the factors that cause individuals to disenroll from health maintenance organizations (HMOs). The study relies upon a multivariate probit model of disenrollment behavior, estimated with data on 1,553 subscribers in three Minneapolis-St. Paul HMOs in 1984. The results indicate that disenrollments are a function largely of economic factors; disenrollments rise significantly with increases both in relative premiums and in the number of plan choices available to consumers. To illustrate, a +5.00 increase in the employee's monthly premium for one HMO, relative to the average change in the employees' premiums for all other available plans, would lead to a two thirds increase in that HMO's disenrollment rate.

Economic Competition↗
PubMed1988

An evaluation of Utah's primary care case management program for Medicaid recipients.

One of the first case management (CM) programs for limiting Medicaid enrollees' freedom of choice of provider was established by Utah. By assigning enrollees to specific providers responsible for arranging all nonemergency care, Utah intended both to improve access and to reduce program costs. State officials expected the program to increase recipients' use of primary-care providers, while reducing their use of specialists, prescription drugs, and hospital outpatient services. Savings from reductions in unnecessary use were expected to more than offset increases in outlays arising from access enhancements, resulting in lower program expenditures. This study investigated the extent to which the state Medicaid program achieved these goals. The analysis was based on a two-part multivariate model of usage, estimated from data created from claims-level information provided by Utah. The findings revealed that the use of primary-care physician services increased significantly. However, the program also raised the use of specialists' services and prescription drugs. In contrast, the use of hospital outpatient services was lowered. Overall, CM apparently achieved the objective of increased access, but failed to attain the cost-containment goal. The findings indicated that expected costs for ambulatory care rose by 25% in the early years as a result of case management.

Cost Control↗