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Kinds of Beneficiaries Terms modified by Beneficiaries Selected AbstractsRacial and Gender Trends in the Use of Implantable Cardioverter-Defibrillators Among Medicare Beneficiaries Between 1997 and 2003CONGESTIVE HEART FAILURE, Issue 2 2009Paul S. Chan MD Differences in the use of implantable cardioverter-defibrillators (ICDs) have been reported, but the extent to which they have widened after the publication of major clinical trials supporting their use is unclear. Using data on Medicare beneficiaries, the authors determined annual age-standardized population-based utilization rates of ICDs for white men, black men, white women, and black women from 1997 to 2003. During the study period, overall use of ICDs increased most for white men (81.7,254.7 procedures per 100,000 from 1997 to 2003) and black men (38.0,151.7 procedures per 100,000), with white women (28.9,98.4 procedures per 100,000) and black women (18.2,77.3 procedures per 100,000) showing smaller increases in comparison. After adjustment with multivariable regression models, differences in utilization rates between whites and men widened compared with blacks and women between 1997 and 2003, a period when indications for ICD therapy have expanded. [source] Trustees, Institutional Investors and Ultimate BeneficiariesCORPORATE GOVERNANCE, Issue 3 2004Chris Mallin No abstract is available for this article. [source] The Effect of Medicaid Payment Generosity on Access and Use among BeneficiariesHEALTH SERVICES RESEARCH, Issue 3 2005Yu-Chu Shen Objective. This study examines the effects of Medicaid payment generosity on access and care for adult and child Medicaid beneficiaries. Data Source. Three years of the National Surveys of America's Families (1997, 1999, 2002) are linked to the Urban Institute Medicaid capitation rate surveys, the Area Resource File, and the American Hospital Association survey files. Study Design. In order to identify the effect of payment generosity apart from unmeasured differences across areas, we compare the experiences of Medicaid beneficiaries with groups that should not be affected by Medicaid payment policies. To assure that these groups are comparable to Medicaid beneficiaries, we reweight the data using propensity score methods. We use a difference-in-differences model to assess the effects of Medicaid payment generosity on four categories of access and use measures (continuity of care, preventive care, visits, and perceptions of provider communication and quality of care). Principal Findings. Higher payments increase the probability of having a usual source of care and the probability of having at least one visit to a doctor and other health professional for Medicaid adults, and produce more positive assessments of the health care received by adults and children. However, payment generosity has no effect on the other measures that we examined, such as the probability of receiving preventive care or the probability of having unmet needs. Conclusions. Higher payment rates can improve some aspects of access and use for Medicaid beneficiaries, but the effects are not dramatic. [source] The Effect of Benefits, Premiums, and Health Risk on Health Plan Choice in the Medicare ProgramHEALTH SERVICES RESEARCH, Issue 4p1 2004Adam Atherly Objective. To estimate the effect of Medicare+Choice (M+C) plan premiums and benefits and individual beneficiary characteristics on the probability of enrollment in a Medicare+Choice plan. Data Source. Individual data from the Medicare Current Beneficiary Survey were combined with plan-level data from Medicare Compare. Study Design. Health plan choices, including the Medicare+Choice/Fee-for-Service decision and the choice of plan within the M+C sector, were modeled using limited information maximum likelihood nested logit. Principal Findings. Premiums have a significant effect on plan selection, with an estimated out-of-pocket premium elasticity of ,0.134 and an insurer-perspective elasticity of ,4.57. Beneficiaries are responsive to plan characteristics, with prescription drug benefits having the largest marginal effect. Sicker beneficiaries were more likely to choose plans with drug benefits and diabetics were more likely to pick plans with vision coverage. Conclusions. Plan characteristics significantly impact beneficiaries' decisions to enroll in Medicare M+C plans and individuals sort themselves systematically into plans based on individual characteristics. [source] Trends in Inpatient Treatment Intensity among Medicare Beneficiaries at the End of LifeHEALTH SERVICES RESEARCH, Issue 2 2004Amber E. Barnato Objective. Although an increasing fraction of Medicare beneficiaries die outside the hospital, the proportion of total Medicare expenditures attributable to care in the last year of life has not dropped. We sought to determine whether disproportionate increases in hospital treatment intensity over time among decedents are responsible for the persistent growth in end-of-life expenditures. Data Source. The 1985,1999 Medicare Medical Provider Analysis and Review (MedPAR) and Denominator files. Study Design. We sampled inpatient claims for 20 percent of all elderly fee-for-service Medicare decedents and 5 percent of all survivors between 1985 and 1999 and calculated age-, race-, and gender-adjusted per-capita inpatient expenditures and rates of intensive care unit (ICU) and intensive procedure use. We used the decedent-to-survivor expenditure ratio to determine whether growth rates among decedents outpaced growth relative to survivors, using the growth rate among survivors to control for secular trends in treatment intensity. Data Collection. The data were collected by the Centers for Medicare and Medicaid Services. Principal Findings. Real inpatient expenditures for the Medicare fee-for-service population increased by 60 percent, from $58 billion in 1985 to $90 billion in 1999, one-quarter of which were accrued by decedents. Between 1985 and 1999 the proportion of beneficiaries with one or more intensive care unit (ICU) admission increased from 30.5 percent to 35.0 percent among decedents and from 5.0 percent to 7.1 percent among survivors; those undergoing one or more intensive procedure increased from 20.9 percent to 31.0 percent among decedents and from 5.8 percent to 8.5 percent among survivors. The majority of intensive procedures in the United States were performed in the more numerous survivors, although in 1999 50 percent of feeding tube placements, 60 percent of intubations/tracheostomies, and 75 percent of cardiopulmonary resuscitations were in decedents. The proportion of beneficiaries dying in a hospital decreased from 44.4 percent to 39.3 percent, but the likelihood of being admitted to an ICU or undergoing an intensive procedure during the terminal hospitalization increased from 38.0 percent to 39.8 percent and from 17.8 percent to 30.3 percent, respectively. One in five Medicare beneficiaries who died in the hospital in 1999 received mechanical ventilation during their terminal admission. Conclusions. Inpatient treatment intensity for all fee-for-service beneficiaries increased between 1985 and 1999 regardless of survivorship status. Absolute changes in per-capita hospital expenditures, ICU admissions, and intensive inpatient procedure use were much higher among decedents. Relative changes were similar except for ICU admissions, which grew faster among survivors. The secular decline in in-hospital deaths has not resulted in decreased per capita utilization of expensive inpatient services in the last year of life. This could imply that net hospital expenditures for the dying might have been even higher over this time period if the shift toward hospice had not occurred. [source] Changing Patterns in Medication Use with Increasing Probability of Death for Older Medicare BeneficiariesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2010Thomas Shaffer MHS OBJECTIVES: To determine whether use of symptom relief drugs (e.g., antidepressants, anxiolytics, opioid analgesics, sleep aids) rises and use of two commonly prescribed classes of chronic medications (statins and osteoporosis drugs) falls with greater probability of death for older Medicare beneficiaries. DESIGN: Pooled cross-sectional study. SETTING: Noninstitutionalized older Medicare population in 2000 to 2005. PARTICIPANTS: Community-dwelling Medicare beneficiaries aged 65 and older (N=20,233). MEASUREMENTS: Use of medications measured according to dichotomous flags; intensity of use by annual medication fills. Annual probability of death modeled using logistic regression and stratified into seven groups with predicted probabilities of death that range from less than 5% to greater than 50%. Prevalence of use and intensity (mean prescription fills per month) were computed for each class of medication. RESULTS: For symptom relief medications, there is relatively constant use with increasing probability of death, along with greater intensity of use. For the two chronic medications, there was a monotonic decrease in use but at a relatively constant intensity. Decline in statin use ranged from 34.4% in the lowest mortality stratum to 17.6% for those in the highest (P<.001). Use of osteoporosis drugs fell from 10.4% to 6.6% over the same range (P<.001). CONCLUSION: Greater intensity of use of symptom relief medications with increasing probability of death is consistent with hypothesized use. The different profile for chronic medications suggests that the time to benefit is being considered regarding therapy initiation, which results in lower use. [source] Treatment of Dementia in Community-Dwelling and Institutionalized Medicare BeneficiariesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2007Ann L. Gruber-Baldini PhD OBJECTIVES: To establish nationally representative estimates of the use of agents to treat Alzheimer's disease and related dementias (ADRDs) and related behavioral symptoms in Medicare beneficiaries and to describe medication use according to residential status and other patient characteristics. DESIGN: Cross-sectional prevalence study. SETTING: Community and various long-term care (LTC) settings. PARTICIPANTS: Twelve thousand six hundred ninety-seven beneficiaries from the 2002 Medicare Current Beneficiary Survey (MCBS), of whom 11,593 were community dwelling and 1,104 resided in various LTC settings. MEASUREMENTS: ADRDs were identified according to International Classification of Diseases, Ninth Revision, codes in Medicare claims and self- and proxy reports. Medication use was derived from self-reports (community) and extracts of facility medication administration records (LTC). RESULTS: In 2002, an estimated 3.4 million Medicare beneficiaries were diagnosed with ADRDs (8.1%), of whom 58.9% resided in the community (prevalence rate=5.1%) and 41.1% resided in LTC facilities (prevalence rate=57.2%). Use of antidementia drugs was similar across settings, with 24.7% of subjects with dementia in the community and 26.3% of those in LTC receiving prescriptions for donepezil, galantamine, or rivastigmine. Use of haloperidol was comparable (and low) in both settings. Use of atypical antipsychotics, especially risperidone, olanzapine, and quetiapine, was much higher in LTC residents (21.0%, 11.9%, and 7.1%, respectively) than in the community (5.1%, 4.0%, and 2.3%). CONCLUSION: The prevalence of ADRDs in LTC settings is much larger than in the community, but there is little difference in the proportions receiving antidementia drugs, although LTC residents are more likely to be treated with atypical antipsychotics (risperidone, olanzapine, and quetiapine), presumably for behavioral symptoms. [source] The Effect of Dementia on Outcomes and Process of Care for Medicare Beneficiaries Admitted with Acute Myocardial InfarctionJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2004Frank A. Sloan PhD Objectives: To determine differences in mortality after admission for acute myocardial infarction (AMI) and in use of noninvasive and invasive treatments for AMI between patients with and without dementia. Design: Retrospective chart review. Setting: Cooperative Cardiovascular Project. Patients: Medicare patients admitted for AMI (N=129,092) in 1994 and 1995. Measurements: Dementia noted on medical chart as history of dementia, Alzheimer's disease, chronic confusion, or senility. Outcome measures included mortality at 30 days and 1-year postadmission; use of aspirin, beta-blocker, angiotensin-converting enzyme (ACE) inhibitor, thrombolytic therapy, cardiac catheterization, coronary angioplasty, and cardiac bypass surgery compared by dementia status. Results: Dementia was associated with higher mortality at 30 days (relative risk (RR)=1.16, 95% confidence interval (CI)=1.09,1.22) and at 1-year postadmission (RR=1.18, 95% CI=1.13,1.23). There were few to no differences in the use of aspirin and beta-blockers between patients with and without a history of dementia. Patients with a history of dementia were less likely to receive ACE inhibitors during the stay (RR=0.89, 95% CI=0.86,0.93) or at discharge (RR=0.90, 95% CI=0.86,0.95), thrombolytic therapy (RR=0.82, 95% CI=0.74,0.90), catheterization (RR=0.51, 95% CI=0.47,0.55), coronary angioplasty (RR=0.58, 95% CI=0.51,0.66), and cardiac bypass surgery (RR=0.41, 95% CI=0.33,0.50) than patients without a history of dementia. Conclusion: The results imply that the presence of dementia had a major effect on mortality and care patterns for this condition. [source] Predictors of Health Resource Use by Disabled Older Female Medicare Beneficiaries Living in the CommunityJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2003Michael Weiner MD OBJECTIVES: To identify specific clinical factors that could best predict resource use by disabled older women. DESIGN: Cross-sectional. SETTING: Urban community in Baltimore, Maryland. PARTICIPANTS: One thousand two community-dwelling, moderately to severely disabled, female Medicare beneficiaries aged 65 and older, from the Women's Health and Aging Study I (WHAS). MEASUREMENTS: WHAS data were merged with participants' 1992,1994 Medicare claims data for the year after baseline evaluation, reflecting inpatient, outpatient, home-based, and skilled-nursing services. The independent contributions of factors hypothesized to predict health expenditures were assessed, using chi-square and regression analyses, with the logarithm of Medicare expenditures as the primary outcome. RESULTS: Demographic factors were not associated with Medicare expenditures. Factors associated with expenditures in bivariate analyses included heart disease (1.4x), chronic obstructive pulmonary disease (1.3x), diabetes mellitus (1.1x), smoking, comorbidity, and severity of disability, as well as low creatinine clearance, serum albumin, caloric expenditure, or skinfold thickness. Heart disease, diabetes mellitus, and low skinfold thickness remained significant after adjustment for other factors. CONCLUSION: Heart disease, diabetes mellitus, and low skinfold thickness are important independent predictors of 1-year Medicare expenditures by disabled older women. Many other variables that reflect disease, disability, nutrition, or personal habits have less predictive ability. Most demographic factors are not predictors of expenditures in this population. Focusing on the best predictors may facilitate more-effective risk adjustment and creation of related health policies. [source] State Prescription Drug Policies, Cost Barriers, and the Use of Acute Care Services by Medicaid BeneficiariesJOURNAL OF CONSUMER AFFAIRS, Issue 1 2009SHARON TENNYSON This paper examines the relationship between Medicaid pharmacy benefit restrictions and reports of prescription cost barriers by beneficiaries, and the relationship between prescription cost barriers and hospitalizations. The analysis uses data for adult Medicaid beneficiaries from the 2000,2001 and 2003 Community Tracking Survey household surveys, combined with data on states' Medicaid pharmacy benefit restrictions and characteristics of local health-care markets. Estimation results show that state Medicaid restrictions are associated with a higher incidence of reported drug cost barriers and that Medicaid recipients who report prescription cost barriers experience a greater number of hospitalizations. [source] Choice of Personal Assistance Services Providers by Medicare Beneficiaries Using a Consumer-Directed Benefit: Rural-Urban DifferencesTHE JOURNAL OF RURAL HEALTH, Issue 4 2010Hongdao Meng PhD Abstract Purpose: To examine the impact of an experimental consumer-choice voucher benefit on the selection of independent and agency personal assistance services (PAS) providers among rural and urban Medicare beneficiaries with disabilities. Methods: The Medicare Primary and Consumer-Directed Care Demonstration enrolled 1,605 Medicare beneficiaries in 19 counties in New York State, West Virginia, and Ohio. A total of 839 participants were randomly assigned to receive a voucher benefit (up to $250 per month with a 20% copayment) that could be used toward PAS provided by either independent or agency workers. A bivariate probit model was used to estimate the probabilities of choosing either type of PAS provider while controlling for potential confounders. Findings: The voucher was associated with a 32.4% (P < .01) increase in the probability of choosing agency providers and a 12.5% (P= .03) increase in the likelihood of choosing independent workers. When the analysis was stratified by rural/urban status, rural voucher recipients had 36.8% higher probability of using independent workers compared to rural controls. Urban voucher recipients had 37.1% higher probability of using agency providers compared to urban controls. Conclusions: This study provided evidence that rural and urban Medicare beneficiaries with disabilities may have very different responses to a consumer-choice PAS voucher program. Offering a consumer-choice voucher option to rural populations holds the potential to significantly improve their access to PAS. [source] The State of Diabetes Care Provided to Medicare Beneficiaries Living in Rural AmericaTHE JOURNAL OF RURAL HEALTH, Issue 4 2006Joseph P. Weingarten Jr PhD ABSTRACT:,Context: Diabetes poses a growing health burden in the United States, but much of the research to date has been at the state and local level. Purpose: To present a national profile of diabetes care provided to Medicare beneficiaries living in urban, semirural, and rural communities. Methods: Medicare beneficiaries with diabetes aged 18-75 were identified from Part A and Part B claims data from 1999 to 2001. A composite of 3 diabetes care indicators was assessed (annual hemoglobin A1c test, biennial lipid profile, and biennial eye examination). Findings: Over 77% had a hemoglobin A1c test, 74% a lipid profile, and 69% an eye examination. Patterns of care were considerably different across the urban-rural continuum at the state, Census division, and regional levels. States in the northern and eastern portions of the country had higher indicator rates for rural than for urban residents. States in the South had much lower rates for rural residents than their urban counterparts. Despite these within-state differences, across-state comparisons found that several states tended to have low indicator rates in every level of the urban-rural continuum. A common feature of these states was the relatively high concentration of nonwhite beneficiaries. For example, southern states had much higher concentrations of nonwhite beneficiaries relative to other areas in the country and demonstrated low rates in every level of the urban-rural continuum. Conclusions: Urban-rural quality of care differences may be a function not just of geography but also of the presence of a large nonwhite population. [source] Unmet Need Among Rural Medicaid Beneficiaries in MinnesotaTHE JOURNAL OF RURAL HEALTH, Issue 3 2002Sharon K. Long Ph.D. Given the vulnerabilities of rural residents and the health care issues faced by the Medicaid population generally, the combined effects of being on Medicaid and living in a rural area raise important questions about access to health care services. This study looks at a key dimension of health care access: unmet need for health care services. The study relies on data from a 1998 survey of rural Minnesota Medicaid beneficiaries. An overall response rate of 70% was obtained. For this study, the sample is limited to women who were on Medicaid for the full 12 months prior to the survey, resulting in 900 respondents. The study finds that the rural Medicaid beneficiaries face high levels of unmet need: more than 1 in 3 reported either delaying or not getting doctor, hospital, or specialist care that they felt they needed. Although the study lacks direct measures of the consequences of the high levels of unmet need, there is evidence that greater emergency room use is associated with unmet need. The survey data cannot necessarily be generalized to other rural areas, and like all surveys, this one is subject to nonresponse bias as well as potential biases because of respondent recall and self-assessment of medical needs. Nevertheless, these findings are suggestive of negative consequences of unmet need for both Medicaid beneficiaries and program costs. [source] Joint replacement surgeries among medicare beneficiaries in rural compared with urban areasARTHRITIS & RHEUMATISM, Issue 12 2009Mark L. Francis Objective People in rural areas live farther away from hospitals than do people in urban areas. Thus, there is concern that people living in rural areas may be less willing or able to undergo elective surgical procedures. This study was undertaken to determine whether Medicare beneficiaries in rural areas were less likely to have elective total knee or hip replacement surgeries compared with their urban counterparts. Methods We performed a cross-sectional study of Medicare beneficiaries, controlling for age, sex, race/ethnicity, and economic status. Beneficiaries were assigned to rural versus urban areas based on their zip code of residence and the 10-point Rural-Urban Commuting Area designation. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. Results Compared with urban beneficiaries, rural beneficiaries were 27% more likely to have total knee or hip replacement surgeries (OR 1.27 [95% CI 1.26,1.28]). After adjusting for age, sex, race/ethnicity, median household income, average house value, mean poverty ratio, and state of residence, rural beneficiaries were still 14% more likely to have total joint replacement surgeries (OR 1.14 [95% CI 1.13,1.16]). Differential use of surgery before and after receiving Medicare eligibility did not explain the findings. While significant sex, racial, and ethnic disparities were present in both rural and urban areas, for the most part these disparities were ameliorated rather than accentuated in rural areas. Conclusion Contrary to expectations, our findings indicate that Medicare beneficiaries living in rural areas are more likely to undergo total knee or hip replacement surgeries. [source] Effect of Managed Care Enrollment on Primary and Repeat Cesarean Rates Among U.S. Department of Defense Health Care Beneficiaries in Military and Civilian Hospitals Worldwide, 1999,2002BIRTH, Issue 4 2004Andrea Linton MS However, little conclusive evidence exists to support this solution. We undertook a study of the Department of Defense health care beneficiary population to assess the impact of enrollment in TRICARE Prime, the Department's managed care health plan, on cesarean delivery rates. Methods: Pooled hospital discharge records from 1999,2002 for live, singleton births were analyzed to calculate primary and repeat cesarean rates for TRICARE Prime and non-Prime beneficiaries in the military and civilian hospitals that comprise the Department of Defense health care network. Stepwise logistic regression was used to calculate adjusted odds ratios for clinical indicators for each combination of health plan and hospital setting using the,2difference(p < 0.05)to eliminate nonsignificant variables from the model. Total primary and repeat cesarean rates were compared with primary and repeat cesarean rates for women with no reported clinical complications to account for differences in case mix across subgroups. Statistical significance of the differences calculated for subgroups was assessed using,2. Results: Primary cesarean rates were significantly lower for TRICARE Prime enrollees relative to non-Prime beneficiaries for all race subgroups and three of five age subgroups in military hospitals and four of five age subgroups in civilian hospitals. No significant differences in repeat cesarean rates were observed between Prime and non-Prime beneficiaries within any race or age subgroup. Breech presentation followed by dystocia, fetal distress, and other complications were significant predictors for primary cesarean. Previous cesarean delivery was the leading predictor for repeat cesarean delivery. Primary and repeat cesarean rates observed for military hospitals were consistently lower than rates observed for civilian hospitals within each health plan type and age group. Conclusions: Enrollment in the managed care health plan was significantly associated with lower risk of primary cesarean delivery relative to membership in other health plans offered to Department of Defense health care beneficiaries. Repeat cesarean rates in this population varied independently of health plan type. Primary cesarean delivery was generally associated with clinical complications, whereas previous cesarean delivery was the strongest indictor for a repeat cesarean delivery. A clear explanation of reduced cesarean rates for Prime enrollees remains elusive, but it is likely that factors beyond individual practitioner decision-making were at work. [source] Effects of Maternal Characteristics on Cesarean Delivery Rates among U.S. Department of Defense Healthcare Beneficiaries, 1996,2002BIRTH, Issue 1 2004Andrea Linton MS Nonclinical factors associated with cesarean delivery include maternal age, race, socioeconomic status, and insurance coverage. This study compared cesarean delivery rates and trends for the U.S. Department of Defense healthcare beneficiary population from 1996 to 2002 with those observed nationally, and assessed the association of these nonclinical factors with cesarean rate variation in the U.S. Department of Defense healthcare beneficiary population. Methods: Hospital discharge and claims records for babies born in the military and civilian hospitals that comprise the Department of Defense healthcare network were used to calculate total and primary cesarean delivery rates and vaginal birth after cesarean (VBAC) rates from 1996 to 2002. Annual cesarean rates for subgroups defined by maternal age, race, and socioeconomic status were calculated to examine rate variations and rate trends within the study population. Pooled data from 1999 to 2002 were used to compare rates across socioeconomic status, stratified by age and race. Statistical significance of the differences calculated for subgroups was assessed using chi-square. Results: Total and primary cesarean delivery rates among the U.S. Department of Defense population were lower than those reported nationally for every year examined. Cesarean delivery and VBAC rate trends in the national and Department of Defense populations were similar. Within the Department of Defense population, total cesarean delivery increased with increasing maternal age and was more highly associated with racial minorities relative to white women. The higher socioeconomic subgroup (defined as active duty, retired, and warrant officers and their families in this study) was generally associated with reduced cesarean delivery rates. Conclusions: Cesarean deliveries are performed less frequently for the U.S. Department of Defense healthcare beneficiary population relative to the national population. Associations between socioeconomic factors and cesarean rates reported for the national population were not apparent in the study population. The consistent pattern of rate variation across racial subgroups in the Department of Defense population suggests that factors beyond those examined in this study are needed to explain the elevated cesarean rates for racial minorities. (BIRTH 31:1 March 2004) [source] Racial and Gender Trends in the Use of Implantable Cardioverter-Defibrillators Among Medicare Beneficiaries Between 1997 and 2003CONGESTIVE HEART FAILURE, Issue 2 2009Paul S. Chan MD Differences in the use of implantable cardioverter-defibrillators (ICDs) have been reported, but the extent to which they have widened after the publication of major clinical trials supporting their use is unclear. Using data on Medicare beneficiaries, the authors determined annual age-standardized population-based utilization rates of ICDs for white men, black men, white women, and black women from 1997 to 2003. During the study period, overall use of ICDs increased most for white men (81.7,254.7 procedures per 100,000 from 1997 to 2003) and black men (38.0,151.7 procedures per 100,000), with white women (28.9,98.4 procedures per 100,000) and black women (18.2,77.3 procedures per 100,000) showing smaller increases in comparison. After adjustment with multivariable regression models, differences in utilization rates between whites and men widened compared with blacks and women between 1997 and 2003, a period when indications for ICD therapy have expanded. [source] Heart Failure Drug Utilization Patterns for Medicaid Patients Before and After a Heart Failure-Related HospitalizationCONGESTIVE HEART FAILURE, Issue 3 2005Patricia A. Howard PharmD The authors examined heart failure (HF) drug utilization patterns in Medicaid patients before and after a HF-related hospitalization. This was a retrospective claims analysis of Kansas Medicaid beneficiaries hospitalized for HF between July 1, 2000, and March 31, 2001. HF drugs were tracked 6 months prior and 6 months following the admission. Angiotensin-converting enzyme (ACE) inhibitor doses were compared with target ranges. The cohort of 135 patients had a mean age of 53.6 years and was predominantly female (66.7%) and Caucasian (70.4%) with a high prevalence of cardiovascular comorbidities. Before hospitalization, less than one third of patients were receiving ACE inhibitors, angiotensin receptor blockers, , blockers, digoxin, or vasodilators. Following hospitalization, increased utilization was observed for , blockers, digoxin, and angiotensin receptor blockers, but overall usage remained low. ACE inhibitors and vasodilator use remained constant. ACE-inhibitor doses were below target ranges before and after hospitalization. In this Medicaid cohort, HF-related hospitalizations did not lead to improved HF therapy. [source] The Regulatory State and Turkish Banking Reforms in the Age of Post-Washington ConsensusDEVELOPMENT AND CHANGE, Issue 1 2010Caner Bakir ABSTRACT The new era of the Post-Washington Consensus (PWC), promoted under the auspices of International Financial Institutions such as the International Monetary Fund and the World Bank, centres on the need to develop sound financial regulation and strong regulatory institutions, especially in the realm of banking and finance in post-financial crisis developing countries. This article uses an examination of the Turkish banking sector experience with the PWC in the aftermath of the 2001 financial crisis to show its considerable strengths and weaknesses. The authors argue that the emergent regulatory state in the bank-based financial system has a narrow focus on strengthening prudential regulation, whilst ignoring the increased ,financialization' of the Turkish economy. They identify the positive features of the new era of the PWC in terms of prudential regulation, which has become much more robust in its ability to withstand external shocks. At the same time, however, the article highlights some of the limitations of the new era which resemble the limitations of the PWC. These include the distributional impact of the regulatory reforms within the banking sector, and notably the emergence of foreign banks as the major beneficiaries of this process; weaknesses in promoting productive bank intermediation that finance the real economy and economic growth, leading to poverty reduction via growth of employment whilst stimulating financialization within the economy; and finally, the exclusive focus on prudential regulation, whilst ignoring regulatory costs, consumer protection and competition regulation. [source] ,Who is the Developed Woman?': Women as a Category of Development Discourse, Kumaon, IndiaDEVELOPMENT AND CHANGE, Issue 1 2004Rebecca M. Klenk This article analyses gendered discourses of development in rural North India, and addresses the usefulness of recent scholarship on development as ,discourse' for understanding connections between development and subjectivity. This scholarship is an excellent point of departure for exploring the contradictions inherent in the institutionalization of economic development and the global reach of its discourses, but it has focused primarily upon development as discourse at official sites of deployment, while paying less attention to how specific discourses and processes of development are appropriated by those constituted as beneficiaries of development. The under-theorization of this aspect has meant that the range of processes through which development projects may encourage new subject positions are poorly understood. By investigating what some women in rural Kumaon have made of their own development, this article contributes to emerging scholarship on development and subjectivity with an ethnographic analysis of the polysemic enthusiasm for development expressed by some of its ,beneficiaries'. [source] Agro-Food Preferences in the EU's GSP Scheme: An Analysis of Changes Between 2004 and 2006DEVELOPMENT POLICY REVIEW, Issue 6 2008Federica DeMaria This article examines the extent to which the 2006 revisions to the EU's Generalised System of Preferences improved market-access opportunities for developing-country agro-food exports. It shows that they resulted in only a slight increase in the percentage preferential margin, but that there has been a significant increase in the value of preferential trade and of the preferential margin enjoyed by exporters. This was accompanied by changes in the ranking of beneficiaries. Countries such as China, Brazil, Argentina, India and South Africa maintained their significant shares of GSP agro-food exports, but other countries such as Thailand and Vietnam have now emerged as major GSP beneficiaries. [source] Cash-based interventions: lessons from southern SomaliaDISASTERS, Issue 3 2006Hanna Mattinen Abstract Commodity distributions, the predominant relief response, are subject to growing criticism, while donors and humanitarian actors are increasingly viewing cash-based interventions as a viable alternative. This paper aims to contribute to the current debate on cash-based interventions by drawing on the experience of Action Contre la Faim in southern Somalia, where it has implemented cash for work programmes since 2004. The authors conclude that cash-based interventions are a feasible option in complex emergencies as well as in highly insecure environments as long as appropriate modalities are employed and objectives are clearly set in accordance with the needs and the context. Cash as a relief response offers wide-reaching possibilities for the future from both the perspective of the donor/agency and the standpoint of the beneficiary. It enables the beneficiaries to take control of the relief themselves and to adapt it to their individual requirements in a timely manner. [source] Restoring sanitation services after an earthquake: field experience in Bam, IranDISASTERS, Issue 3 2005Jean-François Pinera Abstract A powerful earthquake hit the city of Bam in southeast Iran on 26 December 2003. In its aftermath, a number of international relief agencies, including Oxfam, assisted in providing emergency sanitation services. Oxfam's programme consisted of constructing and repairing toilets and showers in villages located outside of the city. In contrast with other organisations, Oxfam opted for brickwork structures, using local materials and human resources rather than prefabricated cubicles. The choice illustrates the dilemmas faced by agencies involved in emergency sanitation: responding to needs in a manner consistent with international standards and offering assistance in a timely fashion while involving beneficiaries. Following a preliminary survey, Oxfam concluded that the provision of showers and latrines, in addition to utilisation of local materials and human resources, was essential for ensuring well-being, empowerment and dignity among members of the affected population, thereby maximising the benefits. [source] Food Security in Protracted Crises: Building More Effective Policy FrameworksDISASTERS, Issue 2005Margarita Flores This paper considers the principal elements that underpin policy frameworks for supporting food security in protracted crisis contexts. It argues that maintaining the food entitlements of crisis-affected populations must extend beyond interventions to ensure immediate human survival. A ,policy gap' exists in that capacities for formulating policy responses to tackle the different dimensions of food insecurity in complex, fluid crisis situations tend to be weak. As a result, standardised, short-term intervention designs are created that fall short of meeting the priority needs of affected populations in the short and long term and only partially exploit the range of policy options available. The paper discusses key attributes of agency frameworks that could support more effective policy processes to address longer term as well as immediate food security needs. Additionally, it points to some main challenges likely to be encountered in developing such frameworks and, with the participation of beneficiaries, translating them into effective action. [source] Matching Response to Context in Complex Political Emergencies: ,Relief', ,Development', ,Peace-building' or Something In-between?DISASTERS, Issue 4 2000Philip White There is an ongoing debate over the value and pitfalls of the policy and practice of ,linking relief and development' or ,developmental relief' in aid responses to complex political emergencies (CPEs). Driven by concerns about relief creating dependence, sometimes doing harm and failing to address root causes of emergencies despite its high cost, pursuit of both relief and development has become a dominant paradigm among international aid agencies in CPEs as in ,natural' disasters. In CPEs a third objective of ,peace-building' has emerged, along with the logic that development can itself help prevent or resolve conflict and sustain peace. However, this broadening of relief objectives in ongoing CPEs has recently been criticised on a number of counts, central concerns being that it leads to a dilution of commitment to core humanitarian principles and is overly optimistic. This paper addresses these issues in the light of two of the CPEs studied by the COPE project: Eritrea and Somalia/Somaliland. It is argued that the debate has so far suffered from lack of clarity about what we mean by ,relief', ,development' and, for that matter, ,rehabilitation' and ,peace-building'. The wide spectrum of possible aid outcomes does not divide neatly into these categories. The relief,development divide is not always as clear-cut, technically or politically, as the critics claim. Moreover such distinctions, constructed from the point of view of aid programmers, are often of little relevance to the concerns of intended beneficiaries. Second, there has been insufficient attention to context: rather than attempting to generalise within and across CPE cases, a more productive approach would be to examine more closely the conditions under which forms of aid other than basic life support can fruitfully be pursued. This leads to consideration of collective agency capacity to respond effectively to diverse needs in different and changing circumstances. [source] Uncovering Local Perspectives on Humanitarian Assistance and Its OutcomesDISASTERS, Issue 2 2000Oliver Bakewell This paper draws on a study of Angolan refugees in Zambia to suggest ways that the perspectives and interests of the local population can be included in the assessment of relief interventions. Taking an actor-oriented approach, the paper suggests stepping back from the categorisation of the situation as an emergency and particular groups of people as the beneficiaries. Such categories are imposed from outside and may not reflect local people's outlook on the situation. In the case of Angolans in Zambia, the category of refugees had dissolved in the border villages to the extent that it was practically impossible to distinguish between refugees and hosts. This was in contrast to the official settlements where people were marked out as refugees and the label was maintained and reproduced over many years. Investigating outcomes in the border villagers in terms of refugees and the refugee problem would have been futile. The paper calls for evaluations of humanitarian assistance in complex emergencies to look beyond the ,beneficiaries' and to investigate the wider context of ,normality'. Neglecting the life and world of local people will make it impossible to understand the process by which external interventions are mediated at the local level to give particular outcomes, and valuable lessons which could help alleviate suffering will be lost. [source] A fine balancing act: Freedom and accountabilityECONOMIC AFFAIRS, Issue 3 2001Baroness Warwick of Undercliffe The recent Funding Options Review identified a minimum additional funding requirement of £900 million per annum for higher education by 2004/05 and also considered more specific needs, such as correcting for past under-investment in infrastructure. At the same time, it contributed to the debate about the ,key choice' of funding by government or by the ,beneficiaries of higher education.' Government will need to match its aspirations for higher education with adequate funding and the universities will have to be ,even more sensitive and responsive to the needs of students.' [source] China and the UK EconomyECONOMIC OUTLOOK, Issue 5 2004Article first published online: 29 OCT 200 China's boom has been a major pillar of the global economic recovery from early 2002 onwards. However, earlier this year fears that the economic boom was threatening to run out of control prompted the Chinese authorities to implement a number of targeted measures to try to restrain activity in the most overheated sectors. This article by Simon Knapp discusses both how much the UK has benefited from the China boom and how much it might be affected if the Chinese slowdown now becomes a hard landing. It argues that emerging Asia, Japan and raw materials producers have been the principal beneficiaries of the China boom, while the UK's gains have been small, because exports to the whole of Asia only account for 9% of the total. Equally, looking forward, the UK, and the UK's two major trading partners, the US and Eurozone, would only be relatively lightly affected if Chinese growth decelerated rapidly, as they would be helped by offsets such as lower oil prices and a lower interest rate profile. However, the current evidence suggests that the Chinese economy is slowing down in broadly the way the government wants, with the greatest deceleration in the previously overheated sectors but relatively little impact on the export and consumer sectors. An abrupt halt in bank lending could, however, still pose a significant downside risk. [source] IS EQUALITY OF OPPORTUNITY POLITICALLY FEASIBLE?ECONOMICS & POLITICS, Issue 1 2005Stefan Zink We develop a political-economy model where the amount of education subsidies is determined in a majority vote and spending is financed by revenues from taxation. Our analysis demonstrates that limiting the extent of subsidization and thus excluding the poor from gaining enough education can be a political equilibrium. Despite being the main beneficiaries of subsidies, the politically decisive middle class hesitates to extend monetary benefits, since improved access to higher education diminishes the return to education. Moreover, a non-monotone relation between inequality and the extent of redistribution through tax-financed educational subsidies obtains. [source] Who inhabits the European public sphere?EUROPEAN JOURNAL OF POLITICAL RESEARCH, Issue 2 2007Winners, losers, opponents in Europeanised political debates, supporters This article investigates which actors profit from and which actors stand to lose from the Europeanisation of political communication in mass-mediated public spheres. Furthermore, it asks to what extent these effects of Europeanisation can help one to understand collective actors' evaluation of European institutions and the integration process. Data is analysed on some 20,000 political claims by a variety of collective actors, drawn from 28 newspapers in seven European countries in the period 1990,2002, across seven different issue fields with varying degrees of EU policy-making power. The results show that government and executive actors are by far the most important beneficiaries of the Europeanisation of public debates compared to legislative and party actors, and even more so compared to civil society actors, who are extremely weakly represented in Europeanised public debates. The stronger is the type of Europeanisation that is considered, the stronger are these biases. For most actors, a close correspondence is found between how Europeanisation affects their influence in the public debate, on the one hand, and their public support for, or opposition to, European institutions and the integration process, on the other. [source] |