December 2, 2015
Composite measures are a relatively new arrival on the performance measure scene. Many federal, state and private organizations are adopting them for quality monitoring, provider profiling, and pay-for-performance programs. But not all approaches to composite measures are alike. In a new study in the December issue of The Milbank Quarterly, Michael Shwartz from the Boston University Questrom School of Business, and colleagues, highlight the advantages and disadvantages of different approaches to creating composite measures and summarize key issues related to the use of the various measures. They point out that because of the sensitivity of results to the methods used to create composite measures, careful analysis is warranted before deciding to implement a particular method.
Are Caregivers of Older Adults Expected to “Gift” Hours of Care Above and Beyond their Compensation?
December 2, 2015
Caregiving has traditionally been viewed as part of family life, and as a personal obligation rather than a form of paid work. Even within programs that pay family members and non-family members to provide care to low-income older adults, caregivers have to negotiate the care they provide as paid caregivers with uncompensated “gift” assistance motivated by emotional attachment.
A new study in the December issue of The Milbank Quarterly looks at the blurred line between market and gift economies of care—and finds that policies that cut or restrict formal long-term services and supports for older adults can either push caregivers to provide more uncompensated care or leave older adults with unmet needs for care. Written by Jacqueline Torres from the University of California, San Francisco, and colleagues, the study also found that policies that assume that family caregivers can readily fill in gaps in care should be reassessed.
December 2, 2015
Government policies and laws against weight discrimination have broad public support in four nations where this form of bias is prevalent, according to a new multinational study by the Rudd Center for Food Policy & Obesity at the University of Connecticut. The findings of the study, published in The Milbank Quarterly, suggest that a key condition needed to foster policy change—strong public support—is present in the United States and three other countries surveyed.
September 9, 2015
The consequences of incarceration on former inmates and their families are well known. But how does incarceration affect the health care system as a whole? A new study in the September issue of The Milbank Quarterly finds that along with the steady increase in incarceration in the United States comes a negative effect on the quality and functioning of the health care system.
The study, by Jason Schnittker of the University of Pennsylvania and colleagues, addresses the ties between the prison system and other social systems—and brings to light the broader social costs of incarceration. In particular, the researchers found that those states that incarcerate the largest number of people have experienced significant declines in overall access to and quality of care.
Legal Protections in Public Settings: A Critical Public Health Issue for Transgender and Gender-Nonconforming People
July 29, 2015
Gender minority people who are transgender or gender nonconforming experience widespread discrimination and health inequities. Since 2012, Massachusetts law has provided legal protections against discrimination on the basis of gender identity in employment, housing, public education, and business. However, the law does not protect against discrimination based on gender identity in places open to the public, such as transportation, retail stores, restaurants, health care facilities, and bathrooms.
A new Early View study in The Milbank Quarterly that surveyed transgender and gender nonconforming adults in Massachusetts has found that discrimination in public settings is not only common, but is associated with adverse health outcomes. The study, by lead author Dr. Sari Reisner of Harvard T.H. Chan School of Public Health and Fenway Health, and colleagues, examines the relationship between social stressors, including discrimination, and the health and well-being of gender minority adults in Massachusetts since the 2012 implementation of the state’s gender identity nondiscrimination law. It also looks at the frequency and health correlates of public-setting discrimination among gender minority adults in Massachusetts, with particular attention to discrimination in health care settings, such as health centers, hospitals, and nursing homes.