Social and Behavioral Sciences Commons^™

Inter-Organizational Network Effects On The Implementation Of Public Health Services, Glen P. Mays

Health Management and Policy Presentations

Background: The Affordable Care Act created new incentives for hospitals, insurers, public health agencies, and others to contribute to disease prevention and health promotion activities, potentially changing inter-organizational relationships and expanding implementation of strategies that improve population health. This study uses data from the 1998-2014 National Longitudinal Survey of Public Health Systems to examine: (1) the extent and nature of change in inter-organizational contributions to public health activities; (2) whether network changes attenuate or exacerbate disparities in public health implementation across communities; and (3) how network changes affect preventable mortality and resource use.

Methods: We follow a longitudinal cohort of …

Estimating Health & Economic Gains From Public Health Delivery System Transformation, Glen P. Mays

Health Management and Policy Presentations

Objectives: The Affordable Care Act created new resources and incentives for hospitals, insurers, public health agencies, and others to contribute to disease prevention and health promotion activities, potentially changing the structure of public health delivery systems and expanding the implementation of strategies that improve population health. This study uses data from the 1998-2014 National Longitudinal Survey of Public Health Systems to examine: (1) the extent and nature of change in inter-organizational contributions to public health activities, which we use as indicators of public health system change; and (2) the effects of these changes on preventable mortality and resource use. Methods: …

Kentucky’S Public Health Strategic Plan: Strengthening Foundational Services & Improving Population Health, Glen P. Mays

Health Management and Policy Presentations

This session examines recent progress toward the 2012 Institute of Medicine recommendation to identify the components and costs of a "minimum package" of public health services and foundational capabilities to be available across the U.S. Research about the health and economic benefits of Foundational Public Health Services has begun to shape Kentucky's strategic plan for transforming the public health system.

Analytic Approaches For Causal Inference With Complex Multi-Component Interventions, Glen P. Mays, Arnold J. Stromberg, Jing Li, Mark V. Williams

Health Management and Policy Presentations

Estimating the causal effects of complex, multi-component health interventions is a task with many challenges in measurement and methodology. This presentation profiles the methods being used as part of the PCORI-funded Project Achieve, a national study to estimate the comparative effectiveness of heterogeneous care transition programs designed to help hospitalized patients and their caregivers navigate care delivery systems effectively and return back to the community with optimal health and wellbeing.

Want A Job? Get A College Degree, Christopher R. Bollinger

Issue Brief on Topics Affecting Kentucky’s Economy

While it is well known that a positive relationship exists between educational attainment and earnings for those who are in the labor market, an important part of how education impacts the well-being of families in Kentucky is the access to employment that it provides. In this brief, we examine the relationship between education and two measures of employment status: unemployment and labor force participation. What we find is quite striking: not only do those with higher education experience less unemployment, they are far more likely to be participating in the labor market. Education leads to better access to employment.

Education Pays Everywhere!, Christopher R. Bollinger

Issue Brief on Topics Affecting Kentucky’s Economy

Economists and other researchers have long demonstrated the relationship between education and earnings. In this brief, we focus on the relationship between educational attainment and earnings in the state of Kentucky. Our results, in many ways, are unsurprising, as the old ad campaign said, “Education Pays.” What may be surprising is that we demonstrate that education pays not only in the big cities of Lexington and Louisville, but also in the more rural parts of the state, such as eastern Kentucky and western Kentucky.

Moving People Off Public Assistance Programs Through Education, Christopher R. Bollinger

Issue Brief on Topics Affecting Kentucky’s Economy

Two of the largest federal transfer programs are the Supplemental Nutrition Assistance Program (SNAP) and Supplemental Security Income (SSI). Federal expenditures on SNAP exceeded $74 billion in 2014, and SSI exceeded $3 billion. While these programs provide families in distress with important support, ideally we desire that Kentucky families would not require this kind of assistance. In 2014, over 800,000 Kentuckians received SNAP assistance each month while over 190,000 received SSI. This brief examines the relationship between participation in these programs and educational attainment for Kentuckians. We find that education is highly related to participation and that those with higher …

Crime And Punishment And Education, Christopher R. Bollinger, Bethany L. Paris

Issue Brief on Topics Affecting Kentucky’s Economy

Crime impacts the lives of Kentuckians in myriad ways. It has direct costs to victims and indirect costs through property values and business activity. Citizens and policymakers alike desire to reduce and limit crime. In this brief, we investigate the link between crime rates in Kentucky’s counties and the aggregate level of education. Perhaps surprisingly, higher education, and specifically the percent of the population with a Bachelor’s degree, is associated with lower crime. We find that increasing educational attainment in Kentucky to the U.S. levels could reduce the costs of crime by over $3 million annually.

How To Raise State Revenue Without Raising Taxes, Christopher R. Bollinger

Issue Brief on Topics Affecting Kentucky’s Economy

A positive relationship exists between educational attainment and earnings, which has been well established in the literature through multiple studies. This, in turn, influences the revenues generated for the state of Kentucky through the personal income tax. We predict even the modest change of increasing Associate’s and Bachelor’s degree holders by 1% would increase revenue by $37 million. Kentucky loses between $300 million and $500 million in state tax revenues every year because our educational attainment is lower than the national average.

Impact Of Education On Medicaid Eligibility, Christopher R. Bollinger

Issue Brief on Topics Affecting Kentucky’s Economy

The individual mandate of the Affordable Care Act (ACA) coupled with the Medicaid expansion in Kentucky makes reducing Medicaid eligibility rates of crucial importance. This brief examines the link between education and eligibility for Medicaid for the citizens of Kentucky. In general, the relationship is nearly mechanical in that higher education leads to higher incomes. Since income is the key determining factor of Medicaid eligibility, and because of the individual mandate eligibility is mostly equivalent to participation, our estimates show that higher education reduces the likelihood that an adult will be on Medicaid or have children and family members on …

Education For Your Health!, Christopher R. Bollinger

Issue Brief on Topics Affecting Kentucky’s Economy

The health of the people of Kentucky is of high concern for policymakers and citizens alike. Individuals want to live healthy, productive lives, while policymakers recognize that chronic illnesses cost the state in myriad ways. In this brief, we examine the link between educational attainment and health outcomes. We focus on two groups of health outcomes. The first are behavioral and include choices: tobacco use, alcohol use, obesity, and exercise. The second group are outcomes highly associated with these behaviors: heart attack, angina, stroke, and diabetes. The Center for Disease Control (CDC) estimates that these four diseases may cost Kentuckians …

The Effects Of Education Across The Kentucky Economy, Christopher R. Bollinger

Issue Brief on Topics Affecting Kentucky’s Economy

The Center for Business and Economic Research (CBER) (Gatton College, University of Kentucky) was commissioned by Kentucky’s Council for Postsecondary Education to examine the implications of education across the Kentucky economy. This study used data on Kentuckians from the American Community Survey (ACS), the Behavioral Risk Factor Surveillance System (BRFSS), the Uniform Crime Reports (UCR), the Bureau of Labor Statistics (BLS), and the Bureau of Economic Analysis (BEA). The focus on Kentucky is unique, as most studies of this kind have used only national data. The results have allowed us to examine how education is related to important outcomes related …

Trends In Health Care Delivery Systems: Implications For Cancer Prevention And Control, Glen P. Mays

Health Management and Policy Presentations

The Affordable Care Act and larger economic forces are leading both health care providers and public health agencies to renegotiate their roles and responsibilities within the U.S. health system. This session reviews major changes occurring in both health care and public health delivery systems, with a focus on the implications for cancer prevention and control. The information infrastructure created by cancer registries and other health information systems are increasingly important for enabling greater coordination, alignment and accountability within the nation's changing delivery systems.

Temporary Assistance For Needy Families, James P. Ziliak

University of Kentucky Center for Poverty Research Discussion Paper Series

The provision of public assistance to families with children in America faced a watershed moment with the passage of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA). PRWORA replaced the Aid to Families with Dependent Children (AFDC) program, which was an entitlement funded via a federal-state matching grant, with Temporary Assistance for Needy Families (TANF), which is no longer an entitlement and is financed with a fixed federal block-grant to the states. The impetus for reform had been building for at least the two decades prior to passage, but took on greater currency with the dramatic growth …

Trouble In The Tails? What We Know About Earnings Nonresponse Thirty Years After Lillard, Smith, And Welch, Christopher R. Bollinger, Barry T. Hirsch, Charles M. Hokayem, James P. Ziliak

University of Kentucky Center for Poverty Research Discussion Paper Series

Earnings nonresponse in household surveys is widespread, yet there is limited evidence on whether and how nonresponse bias affects measured earnings. This paper examines the patterns and consequences of nonresponse using internal Current Population Survey individual records linked to administrative Social Security Administrative data on earnings for calendar years 2005-2010. Our findings confirm the conjecture by Lillard, Smith, and Welch (1986) that nonresponse across the earnings distribution is U-shaped. Left-tail “strugglers” and right-tail “stars” are least likely to report earnings. Household surveys understate earnings dispersion, reporting too few low and too few extremely high earners. Throughout much of the earnings …

Using Research And Roi To Drive Partnerships In Public Health Delivery Systems, Glen P. Mays

Health Management and Policy Presentations

Stimulating public-private partnerships (PPP) for health and economic development initiatives requires research that can answer key questions: (1) what are the health and economic returns likely to be realized; (2) over what time frames and with what certainty; (3) what investments are required to achieve results; and (4) what are the implementation strategies most likely to succeed. This presentation reviews ongoing research on the PPPs used to deliver public health services in the U.S., and explores the lessons this research offers PPPs in low and middle income countries. We examine how scientific evidence on public health delivery systems and their …

Estimating Patient-Centered And Community-Centered Treatment Effects: Examples From Medical Care And Public Health, Glen P. Mays

Health Management and Policy Presentations

Health services researchers face growing clinical and policy imperatives for estimating how the effectiveness of medical and public health interventions vary across patients, population groups, and community settings. Recent advances in local instrumental variables estimation techniques allow for the estimation of person-specific and community-specific treatment effects in the presence of unobserved heterogeneity. This presentation explores examples from both medicine and public health following the local IV methods developed by Basu et al. (2013).

Foundational Public Health Services And Health System Reform, Glen P. Mays

Health Management and Policy Presentations

The Institute of Medicine's 2012 report on public health financing recommended a national initiative to identify the components and costs of a "minimum package" of public health programs and infrastructure that should be available in every U.S. community. In response, efforts are now underway to reach consensus on a set of "Foundational Public Health Services" for the nation, and to identify resource requirements for implementing these services. This presentation reviews existing research on the current availability of Foundational Public Health Services across the U.S. and the health and economic effects attributable to these services. We also review progress on ongoing …

Fundamentals Of Economic Evaluation For Public Health, Glen P. Mays, Cezar Mamaril

Health Management and Policy Presentations

This workshop provides an overview of the design and implementation of economic evaluation studies of public health programs and policies. Strategies for integrating economic evaluation principles, measurement strategies, analytic approaches, and results into the routine operations of public health agencies are examined.

Student Loan Debt: The Devil Is In The Details, Christopher R. Bollinger

Issue Brief on Topics Affecting Kentucky’s Economy

Student loan debt has received a great deal of attention on in the popular press recently. However, the statistics and data that are frequently presented fail to fully capture the complexity of student loans and student debt. This brief presents a more complete picture of student loan debt, examining not only average debt of student borrowers, but presenting a full assessment of the distribution of debt and the types of schools.

Medicaid Crowd-Out Of Other Public Health Spending: Modeling Economic & Health Effects, Glen P. Mays

Health Management and Policy Presentations

MOTIVATION: Thirty states are expanding Medicaid eligibility under the Affordable Care Act (ACA) as of 2015, and while federal funds cover most costs for newly eligible recipients, states must share the additional costs of covering previously-eligible state residents who enroll in Medicaid. States, together with their local government counterparts, also provide the vast majority (87%) of public sector funds for public health programs designed to promote health and prevent disease and injury on a population-wide basis. Fiscal constraints and generous federal matching funds create strong budgetary incentives for states to channel their health-related spending to Medicaid rather than to other …

Using Network Analysis To Understand Public Health Delivery Systems & Community Health Initiatives, Glen P. Mays

Health Management and Policy Presentations

The increasingly connected world of health care delivery relies on an expanding frontier of multi-stakeholder structures and processes, from interdisciplinary patient-centered care teams, to virtual accountable care organizations (ACOs), to complex community-level interventions. This session highlights recent advances in applying social network analysis (SNA) methods to study the implementation and impact of these types of innovations. This methods workshop examines the benefits and limits of novel SNA applications based on the expanding availability of large, linkable electronic clinical and administrative data sources with dependent data structures. This paper profiles examples of using SNA principles and methods to study the implementation …

Learning From Network Analysis: Care Transitions, Market Competition, & Community Interventions, Glen P. Mays

Health Management and Policy Presentations

The increasingly connected world of health care delivery relies on an expanding frontier of multi-stakeholder structures and processes, from interdisciplinary patient-centered care teams, to virtual accountable care organizations (ACOs), to complex community-level interventions. This methods workshop highlights recent advances in applying social network analysis (SNA) methods to study the implementation and impact of these types of innovations. This session will examine the benefits and limits of novel SNA applications based on the expanding availability of large, linkable electronic clinical and administrative data sources with dependent data structures.

Learning From Delivery System Behavior, Dynamics & Interactions To Advance A Culture Of Health, Glen P. Mays

Health Management and Policy Presentations

A new "Systems for Action" national research program flows directly from the Robert Wood Johnson Foundation's Culture of Health action framework. This program will build evidence on how best to align the delivery and financing systems for medical care, public health, and community services & supports so as to promote wellbeing and resiliency, realize efficiencies in resource use, and reduce inequities in health.

Changes In Public Health System Capital And Long-Run Health And Economic Outcomes: 1998 To 2014, Glen P. Mays, Cezar B. Mamaril

Health Management and Policy Presentations

Research Objective: The Affordable Care Act created new resources and incentives for hospitals, insurers, public health agencies, and others to contribute to disease prevention and health promotion activities, potentially changing the structure of public health delivery systems and expanding the implementation of strategies that improve population health. This study uses data from the 1998-2014 National Longitudinal Survey of Public Health Systems to examine: (1) the extent and nature of change in inter-organizational contributions to public health activities, which we use as indicators of public health “system capital”; and (2) the effects of these changes on preventable mortality and resource use. …

Cost Estimation In Public Health Services & Systems Research, Glen P. Mays

Health Management and Policy Presentations

Considerable uncertainty persists about the resources required to implement public health programs and policies, and about the factors that drive variation in resource needs and utilization across community and institutional settings. This paper reviews several alternative approaches to cost estimation that we have used in the field of public health services & systems research (PHSSR). This review was prepared for an expert panel meeting convened as part of a study commissioned by the U.S. Assistant Secretary for Planning and Evaluation (ASPE) to estimate the costs associated with public health emergency preparedness capabilities.

A Measure Of The Economic Impact Of Keeneland Racing And Sales On Lexington-Fayette County, Christopher R. Bollinger

CBER Research Report

Keeneland is an important Lexington Institution. This report shows that Keeneland draws individuals into Fayette County who spend money not only at Keeneland but in the city itself. We measure the economic impact of this spending on the local economy. For our initial study, we considered spending by patrons at the 2014 Fall Meet, the September Yearling Sale and the November Breeding Stock Sale. Based upon these findings, we were also able to assess the impact of the Spring Race Meeting, January Horses of All Ages Sale and the April Two-Year-Olds in Training Sale.

Geographic Variation In The Delivery Of Public Health Services: Understanding Causes And Consequences, Glen P. Mays

Health Management and Policy Presentations

The implementation and reach of evidence-based prevention and public health programs varies widely across the U.S., as does the availability of cross-cutting infrastructure and foundational capabilities required to support these interventions. This talk profiles ongoing research to uncover the causes and consequences of variation in public health delivery. This research points to policy and administrative strategies that can reduce inequities and inefficiencies in public health protections.

Aca Implementation In The South: The Political Economy Of Full Participation In Kentucky, Glen P. Mays

Health Management and Policy Presentations

This analysis, conducted as part of the ACA Implementation Research Network, examines economic and political forces shaping Kentucky's early experience with implementation of the Patient Protection and Affordable Care Act.

The Impact Of Education Cascading Through The Economy, Center For Business And Economic Research, Gatton College Of Business And Economics, University Of Kentucky

CBER Infographic Posters

Research confirms what common sense suggests, higher levels of education are associated with better economic outcomes like higher wages and lower unemployment. And by improving health, increasing technology use, expanding volunteerism, and reducing public assistance, higher education levels have long-lasting effects on the economy. Eighty years ago, Kentucky's per capita personal income was just over 50% of the U.S. average; today it is just over 80%. Kentucky's educational position has improved significantly over the last twenty-five years, but the state still lags the U.S. in college attainment (23% compared to 30%) and academic achievement gaps continue to mute overall educational …