This paper documents changes in infant mortality (IM) rates in São Paulo, Brazil, between 2003 an... more This paper documents changes in infant mortality (IM) rates in São Paulo, Brazil, between 2003 and 2013 and examines the association among neighborhood characteristics and IM. We investigate the extent to which increased use of health care services and improvements in economic and social conditions are associated with reductions in IM. Using data from the Brazilian Census and the São Paulo Secretaria Municipal da Saúde/SMS, we conducted a longitudinal analysis of panel data in all 96 districts of São Paulo for every year between 2003 and 2013. Our regression model includes district level measures that reflect economic, health care and social determinants of IM. We find that investments in health care have contributed to lower IM rates in the city, but the direct effect of increased spending is most evident for people living in São Paulo's middle- and high-income neighborhoods. Improvements in social conditions were more strongly associated with IM declines than increases in the ...
Partisan, fractious federalism has strongly shaped the Biden administration’s efforts to reverse ... more Partisan, fractious federalism has strongly shaped the Biden administration’s efforts to reverse Trump’s undermining of the Affordable Care Act (ACA). In June 2021, the U.S. Supreme Court sided with Democratic, rather than Republican, state attorneys general to uphold the ACA. This enabled Biden to proceed with legislative and executive initiatives to reinvigorate the program. Biden secured passage of the American Rescue Plan (ARP), which temporarily boosted ACA enrollments. He also successfully pursued several executive initiatives to bolster the program. The victories of Democratic state attorneys general and private litigants in the courts during the Trump presidency often provided the platform for Biden’s success. On balance, the ACA’s vital signs have improved under Biden. But the durability of these gains depends heavily on whether Congress approves Build Back Better legislation that extends ARP benefits, and whether Biden can overcome resistance by Republican states in the co...
ObjectiveSignificant inequalities in access to healthcare system exist between residents of world... more ObjectiveSignificant inequalities in access to healthcare system exist between residents of world megacities, even if they have different healthcare systems. The aim of this study was to estimate avoidable hospitalisations in the metropolitan area of Milan (Italy) and explore inequalities in access to healthcare between patients and across their areas of residence.DesignRetrospective observational study.SettingPublic and accredited private hospitals in the metropolitan area of Milan. Data obtained from the hospital discharge database of the Italian Health Ministry.Participants472 579 patients hospitalised for ambulatory care sensitive conditions and resident in the metropolitan area of Milan from 2005 to 2016.Outcome measureAge-adjusted rates of avoidable hospitalisations; OR for hospital admissions with ambulatory care sensitive conditions.MethodsAge-adjusted rates of avoidable hospitalisations in the metropolitan area of Milan were estimated from 2005 to 2016 using direct standard...
How Some Countries Control Spending: The Authors Reply We thank Pricivel Carrera for his response... more How Some Countries Control Spending: The Authors Reply We thank Pricivel Carrera for his response to our article (Nov 2020). Our investigation of how countries set physician fees was not intended as a comprehensive review of health care spending in these countries (France,Germany, and Japan).We recognize that the delivery of hospital care, for example, is not exclusively based on fee-for-service reimbursement. Nevertheless, our larger point about regular negotiations between health insurance funds and providers in the context of budget targets set by government applies to hospital and pharmaceutical spending as well as to physician fees. We agree that competition among health insurers in these countries is not based on price. A key point of our article is that feefor-service systems in countries with national health insurance usually involve centrally negotiated, standardized fee schedules.We also concur that it is crucial for each country to strengthen its existing institutions, bu...
Policy Points Medicaid policymakers have a growing interest in addressing homelessness as a socia... more Policy Points Medicaid policymakers have a growing interest in addressing homelessness as a social determinant of health and driver of the potentially avoidable use of expensive medical services. Drawing on extensive document reviews and in‐depth interviews in four early‐adopter states, we examined the implementation of Medicaid's Section 1115 demonstration waivers to test strategies to finance tenancy support services for persons experiencing or at risk of homelessness. ContextThe Affordable Care Act extended Medicaid eligibility to large numbers of individuals experiencing or at risk of homelessness. This legislative development and the growing recognition of homelessness as a significant social determinant of health have encouraged advocates and policymakers to seek new ways to use Medicaid to provide housing supports.MethodsWe conducted 28 semistructured interviews with 36 stakeholders in four states. The stakeholders were government administrators, health care providers, no...
Background The largest cities on the world face the unprecedented challenge of meeting the needs ... more Background The largest cities on the world face the unprecedented challenge of meeting the needs of a population that lives longer, has declining birthrates, and is altering the demographic profile on which social welfare programs have long been premised. This work is part of an international project aimed at comparing health and social care systems in megacities worldwide. We study access to healthcare in the metropolitan area of Milan to quantify avoidable hospital care and social inequalities within this world city, and compare Milan with other OECD megacities. Methods Two sources of data are combined: individual-level hospital discharge data to measure hospitalization for ambulatory-care sensitive conditions (ACSC), and municipality-level data collected from the national office for statistics. First, we performed an ecological analysis using a linear model for ACSC hospitalization rates to detect the risk factors in the municipality where the patient resides. Then, to identify b...
Medicaid waivers for Delivery System Reform Incentive Payment (DSRIP) seek to hold hospitals and ... more Medicaid waivers for Delivery System Reform Incentive Payment (DSRIP) seek to hold hospitals and other providers accountable for measureable improvements in health care delivery. We explore the policy context giving rise to these waivers in six states, with particular attention to the interplay among the financial needs of hospitals; the rise of managed care; and federal interest in replacing an "unconditional" Medicaid funding stream, the upper payment limit, with one rooted in pay-for-performance. Key characteristics of these main DSRIP waivers are compared with a particular focus on the establishment of project menus, performance metrics, and pay-for-performance processes. Concluding sections discuss the potential and limits of the waivers as vehicles for health care reform. The long-term durability and impact of DSRIP remains unclear. But federal and state officials have made considerable headway in planning and otherwise laying the groundwork for it.
In the United States most adults have a preference to die at home and is an indicator of good end... more In the United States most adults have a preference to die at home and is an indicator of good end-of-life care. In the context of dementia, family members and caregivers are decision makers and part of good and equitable care involves understanding cultural variation in attitudes and social norms related to dementia, death and dying, and the meaning of a good death. This symposium explores racial and ethnic variation in lifetime dementia diagnosis and end-of-life care quality indicators. The first presentation examines racial, ethnic, and geographic variation in the rarely discussed lifetime prevalence of dementia and survival time from dementia diagnosis to death using national Medicare data. The second presentation describes the relationship between end-of-life care planning and satisfaction with end-of-life care using data from the Health and Retirement Study. The third presentation describes variation in place of death, a key indicator of end-of-life care quality, by dementia di...
... ein gesundes Altern sein [2] und für die Europäische Kommission sowie für die Entscheidungstr... more ... ein gesundes Altern sein [2] und für die Europäische Kommission sowie für die Entscheidungsträger in ganz Europa ei-ne Priorität ... Patienten dar Impfkosten für die Patienten senken oder komplett übernehmen Informationstechnologie kann den Arzt-Patienten-Dialog ...
The World Cities Project (WCP) originated as a joint research project between the International L... more The World Cities Project (WCP) originated as a joint research project between the International Longevity Center-USA and New York University's Robert F. Wagner Graduate School of Public Service. It has since grown to include the active involvement of the ILC-France, ILC-Japan, and ILC-UK. Also the City of Paris Department of Health and Social Affairs, the London Regional Office of the British National Health Service, the Tokyo Metropolitan Government Bureau of Health and Social Welfare, and the New York City Department of Aging and Department of Health have provided important support to the project. The project compares health, social services, and quality of life for persons aged 65 and over in the four largest urban agglomerations in the countries belonging to the Organization for Economic Cooperation and Development (OECD): New York, Paris, Tokyo and London.Although these four cities have been the subject of numerous studies in the fields of architecture and urban planning, t...
Based on a comparison of discharges for avoidable hospital conditions (AHCs), we find that Paris ... more Based on a comparison of discharges for avoidable hospital conditions (AHCs), we find that Paris provides greater access to primary care than Manhattan. Ageadjusted AHC rates are more than 2.5 times as high in Manhattan as in Paris. In contrast, the difference in rates of hospital discharge for “marker conditions” are only about 20 percent higher in Manhattan. Rates of discharges for AHCs are higher among residents of low-income neighborhoods in both cities, but the disparity among highand low-income neighborhoods is more than twice as great in Manhattan. Our analysis highlights the consequences of access barriers to care in Manhattan, particularly among vulnerable residents. [Health Affairs 25, no. 2 (2006): 510–520; 10.1377/hlthaff.25.2.510] A n i m m e n s e l i t e r at u r e c o m pa r e s national health care systems and attempts to assess their performance and derive “lessons” from countries’ experiences. Although there are major differences between countries, the focus on na...
With population aging and increasing urbanization, it is important to examine the quality of life... more With population aging and increasing urbanization, it is important to examine the quality of life of older people living in cities, in particular world cities. However, few comparative studies of world cities examine their health, long-term care systems, or the characteristics of their older populations. To assess how well world cities are addressing the challenges associated with aging populations, it is helpful to review comparable data on the economic and health status of older persons, as well as the availability and use of health, social, and long-term care services. By extending the work of the " CADENZA: A Jockey Club Initiative for Seniors " Project and the World Cities Project, this chapter compares three world cities—Hong Kong, New York City, and London. The three world cities are similar in the size and proportion of their older populations, but the characteristics of older people and the health and long-term care systems available to them differ in signi fi can...
This paper documents changes in infant mortality (IM) rates in São Paulo, Brazil, between 2003 an... more This paper documents changes in infant mortality (IM) rates in São Paulo, Brazil, between 2003 and 2013 and examines the association among neighborhood characteristics and IM. We investigate the extent to which increased use of health care services and improvements in economic and social conditions are associated with reductions in IM. Using data from the Brazilian Census and the São Paulo Secretaria Municipal da Saúde/SMS, we conducted a longitudinal analysis of panel data in all 96 districts of São Paulo for every year between 2003 and 2013. Our regression model includes district level measures that reflect economic, health care and social determinants of IM. We find that investments in health care have contributed to lower IM rates in the city, but the direct effect of increased spending is most evident for people living in São Paulo's middle- and high-income neighborhoods. Improvements in social conditions were more strongly associated with IM declines than increases in the ...
Partisan, fractious federalism has strongly shaped the Biden administration’s efforts to reverse ... more Partisan, fractious federalism has strongly shaped the Biden administration’s efforts to reverse Trump’s undermining of the Affordable Care Act (ACA). In June 2021, the U.S. Supreme Court sided with Democratic, rather than Republican, state attorneys general to uphold the ACA. This enabled Biden to proceed with legislative and executive initiatives to reinvigorate the program. Biden secured passage of the American Rescue Plan (ARP), which temporarily boosted ACA enrollments. He also successfully pursued several executive initiatives to bolster the program. The victories of Democratic state attorneys general and private litigants in the courts during the Trump presidency often provided the platform for Biden’s success. On balance, the ACA’s vital signs have improved under Biden. But the durability of these gains depends heavily on whether Congress approves Build Back Better legislation that extends ARP benefits, and whether Biden can overcome resistance by Republican states in the co...
ObjectiveSignificant inequalities in access to healthcare system exist between residents of world... more ObjectiveSignificant inequalities in access to healthcare system exist between residents of world megacities, even if they have different healthcare systems. The aim of this study was to estimate avoidable hospitalisations in the metropolitan area of Milan (Italy) and explore inequalities in access to healthcare between patients and across their areas of residence.DesignRetrospective observational study.SettingPublic and accredited private hospitals in the metropolitan area of Milan. Data obtained from the hospital discharge database of the Italian Health Ministry.Participants472 579 patients hospitalised for ambulatory care sensitive conditions and resident in the metropolitan area of Milan from 2005 to 2016.Outcome measureAge-adjusted rates of avoidable hospitalisations; OR for hospital admissions with ambulatory care sensitive conditions.MethodsAge-adjusted rates of avoidable hospitalisations in the metropolitan area of Milan were estimated from 2005 to 2016 using direct standard...
How Some Countries Control Spending: The Authors Reply We thank Pricivel Carrera for his response... more How Some Countries Control Spending: The Authors Reply We thank Pricivel Carrera for his response to our article (Nov 2020). Our investigation of how countries set physician fees was not intended as a comprehensive review of health care spending in these countries (France,Germany, and Japan).We recognize that the delivery of hospital care, for example, is not exclusively based on fee-for-service reimbursement. Nevertheless, our larger point about regular negotiations between health insurance funds and providers in the context of budget targets set by government applies to hospital and pharmaceutical spending as well as to physician fees. We agree that competition among health insurers in these countries is not based on price. A key point of our article is that feefor-service systems in countries with national health insurance usually involve centrally negotiated, standardized fee schedules.We also concur that it is crucial for each country to strengthen its existing institutions, bu...
Policy Points Medicaid policymakers have a growing interest in addressing homelessness as a socia... more Policy Points Medicaid policymakers have a growing interest in addressing homelessness as a social determinant of health and driver of the potentially avoidable use of expensive medical services. Drawing on extensive document reviews and in‐depth interviews in four early‐adopter states, we examined the implementation of Medicaid's Section 1115 demonstration waivers to test strategies to finance tenancy support services for persons experiencing or at risk of homelessness. ContextThe Affordable Care Act extended Medicaid eligibility to large numbers of individuals experiencing or at risk of homelessness. This legislative development and the growing recognition of homelessness as a significant social determinant of health have encouraged advocates and policymakers to seek new ways to use Medicaid to provide housing supports.MethodsWe conducted 28 semistructured interviews with 36 stakeholders in four states. The stakeholders were government administrators, health care providers, no...
Background The largest cities on the world face the unprecedented challenge of meeting the needs ... more Background The largest cities on the world face the unprecedented challenge of meeting the needs of a population that lives longer, has declining birthrates, and is altering the demographic profile on which social welfare programs have long been premised. This work is part of an international project aimed at comparing health and social care systems in megacities worldwide. We study access to healthcare in the metropolitan area of Milan to quantify avoidable hospital care and social inequalities within this world city, and compare Milan with other OECD megacities. Methods Two sources of data are combined: individual-level hospital discharge data to measure hospitalization for ambulatory-care sensitive conditions (ACSC), and municipality-level data collected from the national office for statistics. First, we performed an ecological analysis using a linear model for ACSC hospitalization rates to detect the risk factors in the municipality where the patient resides. Then, to identify b...
Medicaid waivers for Delivery System Reform Incentive Payment (DSRIP) seek to hold hospitals and ... more Medicaid waivers for Delivery System Reform Incentive Payment (DSRIP) seek to hold hospitals and other providers accountable for measureable improvements in health care delivery. We explore the policy context giving rise to these waivers in six states, with particular attention to the interplay among the financial needs of hospitals; the rise of managed care; and federal interest in replacing an "unconditional" Medicaid funding stream, the upper payment limit, with one rooted in pay-for-performance. Key characteristics of these main DSRIP waivers are compared with a particular focus on the establishment of project menus, performance metrics, and pay-for-performance processes. Concluding sections discuss the potential and limits of the waivers as vehicles for health care reform. The long-term durability and impact of DSRIP remains unclear. But federal and state officials have made considerable headway in planning and otherwise laying the groundwork for it.
In the United States most adults have a preference to die at home and is an indicator of good end... more In the United States most adults have a preference to die at home and is an indicator of good end-of-life care. In the context of dementia, family members and caregivers are decision makers and part of good and equitable care involves understanding cultural variation in attitudes and social norms related to dementia, death and dying, and the meaning of a good death. This symposium explores racial and ethnic variation in lifetime dementia diagnosis and end-of-life care quality indicators. The first presentation examines racial, ethnic, and geographic variation in the rarely discussed lifetime prevalence of dementia and survival time from dementia diagnosis to death using national Medicare data. The second presentation describes the relationship between end-of-life care planning and satisfaction with end-of-life care using data from the Health and Retirement Study. The third presentation describes variation in place of death, a key indicator of end-of-life care quality, by dementia di...
... ein gesundes Altern sein [2] und für die Europäische Kommission sowie für die Entscheidungstr... more ... ein gesundes Altern sein [2] und für die Europäische Kommission sowie für die Entscheidungsträger in ganz Europa ei-ne Priorität ... Patienten dar Impfkosten für die Patienten senken oder komplett übernehmen Informationstechnologie kann den Arzt-Patienten-Dialog ...
The World Cities Project (WCP) originated as a joint research project between the International L... more The World Cities Project (WCP) originated as a joint research project between the International Longevity Center-USA and New York University's Robert F. Wagner Graduate School of Public Service. It has since grown to include the active involvement of the ILC-France, ILC-Japan, and ILC-UK. Also the City of Paris Department of Health and Social Affairs, the London Regional Office of the British National Health Service, the Tokyo Metropolitan Government Bureau of Health and Social Welfare, and the New York City Department of Aging and Department of Health have provided important support to the project. The project compares health, social services, and quality of life for persons aged 65 and over in the four largest urban agglomerations in the countries belonging to the Organization for Economic Cooperation and Development (OECD): New York, Paris, Tokyo and London.Although these four cities have been the subject of numerous studies in the fields of architecture and urban planning, t...
Based on a comparison of discharges for avoidable hospital conditions (AHCs), we find that Paris ... more Based on a comparison of discharges for avoidable hospital conditions (AHCs), we find that Paris provides greater access to primary care than Manhattan. Ageadjusted AHC rates are more than 2.5 times as high in Manhattan as in Paris. In contrast, the difference in rates of hospital discharge for “marker conditions” are only about 20 percent higher in Manhattan. Rates of discharges for AHCs are higher among residents of low-income neighborhoods in both cities, but the disparity among highand low-income neighborhoods is more than twice as great in Manhattan. Our analysis highlights the consequences of access barriers to care in Manhattan, particularly among vulnerable residents. [Health Affairs 25, no. 2 (2006): 510–520; 10.1377/hlthaff.25.2.510] A n i m m e n s e l i t e r at u r e c o m pa r e s national health care systems and attempts to assess their performance and derive “lessons” from countries’ experiences. Although there are major differences between countries, the focus on na...
With population aging and increasing urbanization, it is important to examine the quality of life... more With population aging and increasing urbanization, it is important to examine the quality of life of older people living in cities, in particular world cities. However, few comparative studies of world cities examine their health, long-term care systems, or the characteristics of their older populations. To assess how well world cities are addressing the challenges associated with aging populations, it is helpful to review comparable data on the economic and health status of older persons, as well as the availability and use of health, social, and long-term care services. By extending the work of the " CADENZA: A Jockey Club Initiative for Seniors " Project and the World Cities Project, this chapter compares three world cities—Hong Kong, New York City, and London. The three world cities are similar in the size and proportion of their older populations, but the characteristics of older people and the health and long-term care systems available to them differ in signi fi can...
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