"Quicker and sicker" under Medicare's prospective payment system for hospitals: new evidence on an old issue from a national longitudinal survey

Medicare's prospective payment system for hospitals (PPS), introduced in the USA in 1983, replaced cost reimbursement with a system of fixed rates which created incentives for hospitals to control costs. Previous studies found that elderly patients were discharged from hospital "quicker and sicker" under PPS and concluded that families were coping at home. We analyse a national longitudinal survey, the first National Health and Nutrition Examination Survey and its Epidemiologic Followup Study, which includes data on more outcomes over a longer period than earlier studies. We find that the rate of admission to nursing homes from the community in the first weeks after a hospital discharge more than tripled under PPS, suggesting that families were not always able to cope. As another response to sicker patients, discharges directly to nursing homes from hospitals, which jumped initially under PPS, may have risen further when payment rates were tightened in the early 1990s. Hospital readmissions fell after the first few years. Our findings are strengthened by the fact that we control for patients' health using health information collected independently of hospital admission.     

CHILD SUPPORT IN THE U.S.: CAN FATHERS AFFORD TO PAY MORE?

This paper presents up-to-date estimates of the ability of non-resident fathers to pay child support. While no nationally representative data exist on the incomes of fathers, this issue has become more pertinent in recent years, as child support has become an important national issue. We find that fathers on average are able to pay nearly five times more in child support than they currently pay, and also that low income fathers can afford to pay substantially more than they actually pay. We also find that changes in nonmarital childbearing and the returns to education have had only minimal effects on trends in fathers' incomes.     

an anti-trust regime for Britain

Britain needs a complete transformation of its policy towards monopoly. Robert Miller argues that freedom of entry is the vital ingredient of policy for regulating monopolies and public utilities.     

Coping with Stress in Outdoor Recreational Settings: An Application of Transactional Stress Theory

This study uses a transactional model of stress and coping as a way to understand how outdoor recreationists deal with negative setting elements during a recreation experience. Within the transactional model, coping behaviors can be viewed as the result of on-going transactions among personal and environmental factors, perceptions of threat or stress, and the perceived effectiveness of coping strategies. The current study focuses specifically on the relationship between reported levels of stress and the types of coping strategies used by recreationists in Glacier National Park. Findings suggest that certain behavioral and cognitive coping responses to stress are associated with different levels of reported stress. Specifically, respondents with lower levels of stress were more likely to engage in certain cognitive adjustments to cope with detracting situations. Respondents reporting higher levels of stress were more likely to engage in either direct action aimed at changing the environmental conditions or are displaced entirely from the recreational setting. In addition to these primary findings, the study discusses the range of coping behaviors employed.     

Applications of parks management information systems

The paper presents a conceptual model of an integrated management information system for municipal parks maintenance and operations. Research efforts in management information systems are presented in three categories: Business Research, Federally Sponsored Research, and Park and Recreation Systems Research. A case is made for further empirical research, the development of normative models, and evaluative criteria in an attempt to realize the full potential of electronic data processing in parks and recreation.