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PubMed1992

Health policy and the distribution of lifetime income.

A number of health policies have implications for, and in turn can be influenced by, the distribution of income. However, current discussions define the distribution in current, not lifetime, income. This study describes a method of estimating gender and race differences in the distribution of lifetime incomes that account for mortality differences. When cohort lifetime incomes of living and deceased persons are compared, black men are found to be much worse off, whereas white women are found to be better off than existing estimates using annual income suggest. The mortality and lifetime income advantage of white women, however, is offset if, as some argue, white women have higher morbidity rates than white men of the same age. The authors use the concept of lifetime income to draw implications for health policy debates on cigarette and beer taxes, occupational safety and health, Medicaid versus Medicare spending, educational health promotion programs, and general investments in education.

Adult↗

PubMed1988

Income redistribution effect of the Swedish sickness allowance insurance in a comparison of two concepts of social class.

Social insurances effect income distributions between social strata. Here, insurance returns in relation to income are studied on the Swedish sickness allowance insurance, which is intended to redistribute from higher to lower social strata. Two measures of social class are used, the socio-economic classification, the official index of Sweden, and a structural class concept, which in earlier results discriminates better for material factors such as income and work conditions. The material consists of all sickness cases of 1983 for 3,161 persons, sampled from insurance registers and cross-classified with registers at taxation authorities. Data on insurance returns, incomes, and occupation are used. Results clearly confirm the intended redistribution effect, but considerably clearer with the structural class concept. The effect is even stronger than intended for some strata, where the system seems to lack in implementation. The consequences for choice of class measure are finally discussed.

Adolescent↗

PubMed1989

Young physicians and changes in medical practice characteristics between 1975 and 1987.

This article examines the proposition that an increasing representation in the total physician population has subjected young physicians to "baby boom" cohort effects seen in the general population. Analyzing comparative changes in income and other medical practice characteristics between 1975 and 1987, we find moderate evidence to support this proposition, particularly when specialty selection and changes in the income distribution are taken into account. Young male physicians experienced a significant income decline, as did certain specialties. Other characteristics also suggest that young physicians are working relatively harder now than a decade ago. However, the income decline for young physicians is smaller than for other baby boomers.

Adult↗

PubMed1989

When violence has a benevolent face: the paradox of hunger in the world's wealthiest democracy.

During the last two decades, Americans initially discovered that millions of fellow-citizens were going hungry, then acted to virtually eliminate the problem, and, in the 1980s, learned that hunger has reappeared in epidemic proportions. Hunger, particularly in a wealthy democracy, is most appropriately seen as a form of institutionalized violence, the product of ideologies that fail to distribute national abundance in a manner that achieves the possible goal of preventing hunger. The return of hunger to the United States is associated with economic and tax policies that have reallocated income distribution from poor and middle-income groups to the wealthy, and with a concomitant reluctance to utilize the federal government to protect needy citizens from undernutrition associated with growing economic deprivation.

Adolescent↗

PubMed1982

Distribution of family income: improved estimates.

This article describes the results of research to improve estimates of the distribution of family income. In this research, a microdata file was constructed for 1972 using several data sources. The data obtained from these sources were combined and adjusted to produce more precise estimates. Current Population Survey estimates were then evaluated using these improved estimates. Using the improved estimates increased 1972 mean income for all units by 11 percent. The income share of the top 5 percent of the distribution increased substantially. Property income increased and wage and salary income decreased in relative importance. The mean income of family units headed by persons aged 65 or older increased by about 40 percent, by far the largest rise for any group examined; the increase was far lower for low-income family units in that age group. A simple update of mean incomes to 1979 showed no substantial changes from the 1972 pattern of adjustments.

Adolescent↗

PubMed1992

Access to ambulatory care among noninstitutionalized, activity-limited persons 65 and over.

This study examined the impact of income and insurance type on ambulatory care contact use by persons 65 and over who expressed a limitation in their activity. This large group (39% of noninstitutionalized older persons in 1984) had significantly more health problems and ambulatory care contacts than persons not activity-limited. The only previous study on equity in use of physician services among elderly in poorer than average health found relatively little inequality of use due to income and insurance. This study came to the opposite conclusion. Activity-limited persons without Medicare private supplementary insurance, as well as those with supplementary insurance in the bottom and middle of the income distribution, had 15-32% fewer ambulatory care contacts than activity-limited persons with higher income and private supplementary insurance. Particularly striking were the declines in consumption among middle income persons relative to the reference group, indicating that the issue of equity in consumption of health services among older disabled persons affects a much broader group than only the poor and near-poor.

Activities of Daily Living↗

PubMed1979

Effects of jet noise on mortality rates.

Two areas, containing a total of over 160,000 people, were examined for mortality rates; one area was directly under incoming flights, near Los Angeles International Airport (LAX). The other was removed from the LAX flight patterns so that jet noise was not dominant. The two areas were chosen so that they were as nearly alike as possible in age, racial distribution, income and in other relevant factors with the sole major difference of jet noise in one of them. It was found that there was a substantial increase in mortality rates in the area under the jets where there was large noise radiation. In particular, by a most conservative statistical treatment there was in the jet noise area: a 15% increase in deaths due to strokes (cerebro-vascular disease) which accounted for 39 deaths in the two-year period of the study--presumably attributable to the excessive jet noise. Further, in the noise-radiated area there was a 100% increase in deaths due to cirrhosis of the liver (primarily attributed to alcoholism)--amounting to 24 extra deaths in the two years, due to jet noise. One of the disturbing side results of this study was that in these relatively poor regions it appears that there should be about 50% more deaths than were reported and recorded by Los Angeles County. These losses were perhaps due to a concentration of bad, given addresses in the areas in question; this serious loss casts grave doubt on previous studies of eath rates for minority peoples (e.g. blacks), suggesting that the rates may be considerably higher than those previously reported.

Aircraft↗

PubMed1995

Mortality and income inequality among economically developed countries.

The absence of a correlation between age-adjusted death rates and the average income levels of economically developed countries has led researchers to conclude that income does not affect the mortality levels of economically developed countries. The mortality experiences of the former Soviet Union and some of the eastern European countries have further brought into question the importance of income's distribution in determining mortality among economically developed countries; prior to its breakup, the income distribution of the Soviet Union was as equal as that of Sweden, yet the life expectancy of the Soviets has been dramatically shorter than that of the Swedes. Using insights from a longitudinal microanalysis of U.S. mortality, this study presents evidence that, even for economically developed countries, the income distribution of a nation is an important determinant of its mortality. The results of this study also suggest that the relatively unequal income distribution of the United States is an important contributing factor to its low life expectancy relative to other high-income countries.

Adult↗

PubMed1987

State-level public policy as a predictor of individual and family well-being.

This exploratory study examines the relationship between state-level public policy and individual and family well-being and factors that affect it. The inquiry, based on exchange and choice theories, assumes that state-level public policy reflects states' awareness of the needs of individuals and families, their ability to predict the future in failing to meet them, and the extent to which the norm of reciprocity prevails in the 50 states. Measures of states' collective choices were states' per capita expenditures for public welfare, education, and health, and per capita taxes in 1980; measures of states' individual and well- or ill-being, or social malaise, were states' teenage birthrates, infant death rates, and suicide rates. Taken into account as antecedent and intervening variables were age, gender, and racial composition, income distribution, marital, socioeconomic, and employment status of states' populations, and attitudes toward public spending. The findings show that higher state expenditures for public welfare and for education indeed contribute to individual and family well-being as measured by lower state rates of suicide and teenage births. States per capita spending for education, which together with state per capita spending for public welfare was a positive predictor of school completion rates and positively associated with states' income level, accounted for almost all of the variance in states' per capita taxes. State spending for public welfare was not a predictor of state per capita taxes. These findings are cause for considerable concern given the reduced role of the federal government in human affairs, particularly in states whose choices violate the assumptions underlying exchange and choice theories and the norm of reciprocity which says that people should help, not hurt, others.

Adolescent↗

PubMed1978

The 1973 CPS-IRS-SSA exact match study.

The 1973 CPS-IRS-SSA Exact Match Study--a joint undertaking of the Social Security Administration and the Bureau of the Census--links survey records for persons in the March 1973 Current Population Survey to their respective earnings and benefit information in SSA administrative records and to selected items from their 1972 Internal Revenue Service individual income tax returns. The resulting set of files provides a very broad base for cross-section and longitudinal analyses of income-distribution questions. This article attempts to provide an overview of the techniques employed in the study. Among the topics discussed are the confidentiality requirements in force during the project. The original study goals are also described and a list of some of the completed research is provided.

Confidentiality↗

PubMed1982

Political constraints to nutritional improvement: the case of Guyana.

The processes generating malnutrition are examined with particular reference to Guyana. The theoretical framework includes the concept of limiting factors, which in this case means that the failure to alter a critical variable will prevent nutritional improvement, despite intervention in other variables. Among important factors found to cause malnutrition age low national production, inequitable income distribution, and maladaptive cultural practices. These are located in the economy of the country and in the institutions and ideas which support that economy. Power and politics therefore fundamentally affect nutritional outcome; and imperialist control of underdeveloped economies makes international relations an indispensible consideration. It is concluded that for Guyana the political process is the limiting factor which must be altered before significant nutritional improvement can occur.

Child, Preschool↗

PubMed1986

Health care usage by Hispanic outpatients as function of primary language.

Three groups of Hispanic patients at five outpatient clinics in San Diego County, California, participated in a survey questionnaire concerning health care usage according to whether they were Spanish-speaking only, bilingual with Spanish as a primary language or primarily English speaking. Although the three groups were similar in age and income distribution, the use of health services (regular source of health care, health insurance, admission to hospital and frequency of general physical, eye and dental examinations) was positively correlated with increased use of English. Likewise, respondents whose primary language was English were more likely to describe their health care as more than adequate and their own health as excellent than were those whose primary language was Spanish.

California↗

PubMed1983

Structural characteristics of the macroeconomy and mental health: implications for primary prevention research.

Recent research on the impact of economics on mental and physical health has raised fundamental questions about structural elements in the macro-economy. Specifically, five characteristics of our current economic system: instability in the business cycle, unemployment, inequality in income distribution, capital mobility, and fragmentation of the work process, appear to play some pathogenic role in the incidence of behavioral and physical disorders. These macroeconomic elements require intervention at the social policy level since they seem to be more powerful than the individual coping mechanisms of some demographic subgroups. Psychologists can play an important role in policy decisions by providing data on the relative impact of structural economic variables on human functioning. Examples of structural research are presented and the implications for primary prevention are discussed.

Community Mental Health Services↗

PubMed1985

The impact of cost sharing on emergency department use.

We studied the effect of insurance coverage on the use of emergency department services, using data from a national trial of cost sharing in health insurance. A total of 3973 persons below the age of 62 years were randomly assigned to fee-for-service health insurance plans with coinsurance rates of 0, 25, 50, or 95 per cent, subject to an income-related upper limit on out-of-pocket expenses. Persons with no cost sharing had emergency department expenses that were 42 per cent higher than those for persons on the 95 per cent plan (P less than 0.01) and about 16 per cent higher than those for persons with smaller amounts of cost sharing. Without cost sharing, emergency department visits for less serious diagnoses (e.g., abrasions) increased three times as much as did visits for more serious diagnoses (e.g., lacerations). After control for insurance, persons in the lower third of the income distribution had emergency department expenses that were 64 per cent higher than those in the upper third (P less than 0.001) and received a greater proportion of their ambulatory care in the emergency department. We conclude that the absence of cost sharing results in significantly greater emergency department use than does insurance with cost sharing. A disproportionate amount of the increased use involves less serious conditions.

Ambulatory Care↗

PubMed1991

Social policy and economic change in Chile, 1974-1985: the case of children.

Taking the case of Chile in the period 1974-85, this article examines the impact of economic conditions and social policies on poor households, and especially on children. The study starts with an analysis of the nature of the economic policies implemented in Chile during 1974-85 and their effects on income distribution and on the material living conditions of poor households. It then looks into the social policies, government expenditure, and the main programs directed toward poor households and children, as well as at the changes in child welfare that followed. From this macrosocial level the study diverts to the household level and describes, based on several in-depth studies of small samples of households in the Santiago metropolitan area during the years 1982-85, the daily experiences of poor households--their deteriorating economic conditions and the behaviors adopted to stretch scarce resources to satisfy basic needs. The final part draws some lessons from the Chilean case.

Child↗

PubMed1980

[Environmental and sociocultural parameters affecting nutrition in Third World countries].

The thrust of this paper is an analysis of the environmental and sociocultural parameters affecting dietary patterns in Third World countries. The author utilizes data from several studies to emphasize her thesis that malnutrition in developing societies is not an entity caused simply by income constraints, or food availability, but rather that malnutrition constitutes a critical entity resulting from a constellation of problems, ranging from environmental stresses, to social inequities to cultural factors. Special discussion is given to the variables of income distribution, social stratification and food beliefs as major contributing influences of malnutrition in Third World countries. The problems facing newly migrating urban squatters--or what is known as "societies in transition" in the context of high unemployment and new demands for food--are also dealt with in the Latin American setting. The author discusses the importance to recognize that since the etiology of malnutrition is ecologically-based; therefore, the approaches to solve this problem should--also by definition--be of an ecological nature. The need to further develop meaningful conceptual models--in contrast to utilizing "imported" ones--in order to study and understand the nature and magnitude of malnutrition problems in Third World countries is also stressed.

Developing Countries↗

PubMed1985

Health care in Costa Rica: boom and crisis.

In 1960-1980 Costa Rica experienced a health boom, achieving significant improvements which moved that country into the number two position in Latin America for indicators such as population coverage, infant mortality, life expectancy and health services. In addition, there was a gradual process of integration of health services. But in the same period, the cost of health care as a percentage of GNP increased almost 5-fold and in 1980 was the fourth highest in the region. The economic crisis of the 1980s aggravated the financial difficulties; to cope with them, the government introduced an austere program to reduce costs and plans to transform the current model of health care into a more efficient one capable of maintaining Costa Rica's high health standards in the future. The paper is divided into five sections: summary of the historical development of health care, and description of its current organization and of its gradual process of integration; estimation of population coverage and its trends, evaluation of inequalities in coverage, and identification of the non-covered group; analysis of health-care financing and its sources, as well of the recent financial desequilibrium, its causes and measures to restore the equilibrium; description of health care benefits and their differences among groups and regions, analysis of the country's advances in health-care facilities and standards, and measurement of the impact of the health care system in income distribution; and description of the rising cost of health care and the current crisis, analysis of the causes of both phenomena, and review of the measures that have been and should be implemented to solve these problems.

Cost Control↗

PubMed1986

Changes in health financing: the Chilean experience.

This paper examines the organizational and financial changes experienced by the Chilean Health System in the last 20 years. The succession of widely different political and philosophical views sponsored by the governments of Frei, Allende and Pinochet and the marked economic fluctuations experienced in the last decade have affected the organization of health care financing and the allocation of resources among the population. The trend towards a completely state financed health care system was reversed in 1973. Pinochet's government explicitely included the private sector in the provision of public health services and assigned the State a subsidiary role. Several financing mechanisms created to coopt private capital into the health system are described as well as the evolution of private and public health care expenditures. The political and economic context that shapes the allocation of limited health care resources among a population with a highly unequal income distribution may endanger the access and the quality of health care services in the country.

Chile↗