Doing Good Work in a Crisis: Views of Pay and the COVID-19 Pandemic in the Public, Nonprofit, and For-Profit Sectors
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SUBMITTER: Miller S
PROVIDER: S-EPMC10225797 | biostudies-literature | 2023 May
REPOSITORIES: biostudies-literature
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Project description:ObjectiveTo determine whether profit status is associated with differences in hospital days per patient, an outcome that may also be influenced by provider financial goals.Data sourcesUnited States Renal Data System Standard Analysis Files and Centers for Medicare and Medicaid Services cost reports.DesignWe compared the number of hospital days per patient per year across for-profit and nonprofit dialysis facilities during 2003. To address possible referral bias in the assignment of patients to dialysis facilities, we used an instrumental variable regression method and adjusted for selected patient-specific factors, facility characteristics such as size and chain affiliation, as well as metrics of market competition.Data extraction methodsAll patients who received in-center hemodialysis at any time in 2003 and for whom Medicare was the primary payer were included (N=170,130; roughly two-thirds of the U.S. hemodialysis population). Patients dialyzed at hospital-based facilities and patients with no dialysis facilities within 30 miles of their residence were excluded.ResultsOverall, adjusted hospital days per patient were 17+/-5 percent lower in nonprofit facilities. The difference between nonprofit and for-profit facilities persisted with the correction for referral bias. There was no association between hospital days per patient per year and chain affiliation, but larger facilities had inferior outcomes (facilities with 73 or more patients had a 14+/-1.7 percent increase in hospital days relative to facilities with 35 or fewer patients). Differences in outcomes among for-profit and nonprofit facilities translated to 1,600 patient-years in hospital that could be averted each year if the hospital utilization rates in for-profit facilities were to decrease to the level of their nonprofit counterparts.ConclusionsHospital days per patient-year were statistically and clinically significantly lower among nonprofit dialysis providers. These findings suggest that the indirect incentives in Medicare's current payment system may provide insufficient incentive for for-profit providers to achieve optimal patient outcomes.
| S-EPMC2875752 | biostudies-literature
Project description:BackgroundOpioid use disorders are frequently associated with medical and psychiatric comorbidities (eg, HIV infection and depression), as well as social problems (eg, lack of health insurance). Comprehensive services addressing these conditions improve outcomes.ObjectiveTo compare the proportion of for-profit, nonprofit, and public opioid treatment programs offering comprehensive services, which are not mandated by government regulations.Design, setting, and participantsCross-sectional analysis of opioid treatment programs offering outpatient care in the United States (n=1036).Main outcome measureSelf-reported offering of communicable disease (HIV, sexually transmitted infections, and viral hepatitis) testing, psychiatric services (screening, assessment and diagnostic evaluation, and pharmacotherapy), and social services support (assistance in applying for programs such as Medicaid). Mixed-effects logistic regression models were developed to adjust for several county-level factors.ResultsOf opioid treatment programs, 58.0% were for profit, 33.5% were nonprofit, and 8.5% were public. Nonprofit programs were more likely than for-profit programs to offer testing for all communicable diseases [adjusted odds ratios (AOR), 1.7; 95% confidence interval (CI), 1.2, 2.5], all psychiatric services (AOR, 8.0; 95% CI, 4.9, 13.1), and social services support (AOR, 3.3; 95% CI, 2.3, 4.8). Public programs were also more likely than for-profit programs to offer communicable disease testing (AOR, 6.4; 95% CI, 3.5, 11.7), all psychiatric services (AOR, 25.8; 95% CI, 12.6, 52.5), and social services support (AOR, 2.4; 95% CI, 1.4, 4.3).ConclusionsFor-profit programs were significantly less likely than nonprofit and public programs to offer comprehensive services. Interventions to increase the offering of comprehensive services are needed, particularly among for-profit programs.
| S-EPMC4277871 | biostudies-literature
Project description:Background and objectivesThe vast majority of US dialysis facilities are for-profit and profit status has been associated with processes of care and outcomes in patients on dialysis. This study examined whether dialysis facility profit status was associated with the rate of hospitalization in patients starting dialysis.Design, setting, participants, & methodsThis was a retrospective cohort study of Medicare beneficiaries starting dialysis between 2005 and 2008 using data from the US Renal Data System. All-cause hospitalization was examined and compared between for-profit and nonprofit dialysis facilities through 2009 using Poisson regression. Companion analyses of cause-specific hospitalization that are likely to be influenced by dialysis facility practices including hospitalizations for heart failure and volume overload, access complications, or hyperkalemia were conducted.ResultsThe cohort included 150,642 patients. Of these, 12,985 (9%) were receiving care in nonprofit dialysis facilities. In adjusted models, patients receiving hemodialysis in for-profit facilities had a 15% (95% confidence interval [95% CI], 13% to 18%) higher relative rate of hospitalization compared with those in nonprofit facilities. Among patients receiving peritoneal dialysis, the rate of hospitalization in for-profit versus nonprofit facilities was not significantly different (relative rate, 1.07; 95% CI, 0.97 to 1.17). Patients on hemodialysis receiving care in for-profit dialysis facilities had a 37% (95% CI, 31% to 44%) higher rate of hospitalization for heart failure or volume overload and a 15% (95% CI, 11% to 20%) higher rate of hospitalization for vascular access complications.ConclusionsHospitalization rates were significantly higher for patients receiving hemodialysis in for-profit compared with nonprofit dialysis facilities.
| S-EPMC3878699 | biostudies-literature
Project description:ImportanceFederal and state policymakers continue to pursue work requirements and premiums as conditions of Medicaid participation. Opinion polling should distinguish between general policy preferences and specific views on quotas, penalties, and other elements.ObjectiveTo identify views of adults in Kentucky regarding the design of Medicaid work requirements and premiums.Design, setting, and participantA cross-sectional survey was conducted via telephone and the internet from June 27 through July 11, 2019, of 1203 Kentucky residents 9 months before the state intended to implement Medicaid work requirements and mandatory premiums. Statistical analysis was performed from October 2019 to August 2023.Main outcomes and measuresAgreement, disagreement, or neutral views on policy components were the main outcomes. Recruitment for the survey used statewide random-digit dialing and an internet panel to recruit residents aged 18 years or older. Findings were weighted to reflect state demographics. Of 39 110 landlines called, 209 reached an eligible person (of whom 150 participated), 8654 were of unknown eligibility, and 30 247 were ineligible. Of 55 305 cell phone lines called, 617 reached an eligible person (of whom 451 participated), 29 951 were of unknown eligibility, and 24 737 were ineligible. Internet recruitment (602 participants) used a panel of adult Kentucky residents maintained by an external data collector.ResultsPercentages were weighted to resemble the adult population of Kentucky residents. Of the participants in the study, 52% (95% CI, 48%-55%) were women, 80% (95% CI, 77%-82%) were younger than 65 years, 41% (95% CI, 38%-45%) were enrolled in Medicaid, 36% (95% CI, 32%-39%) were Republican voters, 32% (95% CI, 29%-36%) were Democratic voters, 14% (95% CI, 11%-16%) were members of racial and ethnic minority groups (including but not limited to American Indian or Alaska Native, Asian, Black, Hispanic or Latinx, and Native Hawaiian or Pacific Islander), and 48% (95% CI, 44%-52%) were employed. Most participants supported work requirements generally (69% [95% CI, 66%-72%]) but did not support terminating benefits due to noncompliance (43% [95% CI, 39%-46%]) or requiring quotas of 20 or more hours per week (34% [95% CI, 31%-38%]). Support for monthly premiums (34% [95% CI, 31%-38%]) and exclusion penalties for premium nonpayment (22% [95% CI, 19%-25%]) was limited. Medicaid enrollees were significantly less supportive of these policies than nonenrollees. For instance, regarding work requirements, agreement was lower (64% [95% CI, 59%-69%] vs 72% [95% CI, 68%-77%]) and disagreement higher (26% [95% CI, 21%-31%] vs 20% [95% CI, 16%-24%]) among current Medicaid enrollees compared with nonenrollees (P = .04). Among Medicaid enrollees, some beliefs about work requirements varied significantly by employment status but not by political affiliation. Among nonenrollees, beliefs about work requirements, premiums, and Medicaid varied significantly by political affiliation but not by employment.Conclusions and relevanceThis study suggests that even when public constituencies express general support for Medicaid work requirements or premiums, they may oppose central design features, such as quotas and termination of benefits. Program participants may also hold significantly different beliefs than nonparticipants, which should be understood before policies are changed.
| S-EPMC10589806 | biostudies-literature
Project description:The climate crisis challenges farmer livelihoods as increasingly frequent extreme weather events impact the quantum and consistency of crop production. Here, we develop a novel paradigm to raise whole farm profit by optimising manifold variables that drive the profitability of irrigated grain farms. We build then invoke a new decision support tool-WaterCan Profit-to optimise crop type and areas that collectively maximise farm profit. We showcase four regions across a climate gradient in the Australian cropping zone. The principles developed can be applied to cropping regions or production systems anywhere in the world. We show that the number of profitable crop types fell from 35 to 10 under future climates, reflecting the interplay between commodity price, yield, crop water requirements and variable costs. Effects of climate change on profit were not related to long-term rainfall, with future climates depressing profit by 11-23% relative to historical climates. Impacts of future climates were closely related to crop type and maturity duration; indeed, many crop types that were traditionally profitable under historical climates were no longer profitable in future. We demonstrate that strategic whole farm planning of crop types and areas can yield significant economic benefits. We suggest that future work on drought adaptation consider genetic selection criteria more diverse than phenology and yield alone. Crop types with (1) higher value per unit grain weight, (2) lower water requirements and (3) higher water-use efficiency are more likely to ensure the sustainability and prosperity of irrigated grain production systems under future climates.
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Project description:Human milk (HM) is a highly evolutionary selected, complex biofluid, which provides tailored nutrition, immune system support and developmental cues that are unique to each maternal-infant dyad. In the absence of maternal milk, the World Health Organisation recommends vulnerable infants should be fed with screened donor HM (DHM) from a HM bank (HMB) ideally embedded in local or regional lactation support services. However, demand for HM products has arisen from an increasing awareness of the developmental and health impacts of the early introduction of formula and a lack of prioritisation into government-funded and nonprofit milk banking and innovation. This survey of global nonprofit milk bank leaders aimed to outline the trends, commonalities and differences between nonprofit and for-profit HM banking, examine strategies regarding the marketing and placement of products to hospital and public customers and outline the key social, ethical and human rights concerns. The survey captured information from 59 milk bank leaders in 30 countries from every populated continent. In total, five companies are currently trading HM products with several early-stage private milk companies (PMCs). Products tended to be more expensive from PMC than HMB, milk providers were financially remunerated and lactation support for milk providers and recipients was not a core function of PMCs. Current regulatory frameworks for HM vary widely, with the majority of countries lacking any framework, and most others placing HM within food legislation, which does not include the support and care of milk donors and recipient prioritisation. Regulation as a Medical Product of Human Origin was only in place to prevent the sale of HM in four countries; export and import of HM was banned in two countries. This paper discusses the safety and ethical concerns raised by the commodification of HM and the opportunities policymakers have globally and country-level to limit the potential for exploitation and the undermining of breastfeeding.
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Project description:For more than a century, advocates have promoted minimum wage laws to protect workers and their families from poverty. Opponents counter that the policy has, at best, small poverty-reducing effects. We summarize the evidence and describe three factors that might dampen the policy's effects on poverty: imperfect targeting, heterogeneous labor market effects, and interactions with income support programs. To boost the poverty-reducing effects of the minimum wage, we propose increasing the federal minimum wage to $12 per hour and temporarily expanding an existing employer tax credit. This is a cost-saving proposal because it relies on regulation and creates no new administrative functions. We recommend using those savings to "make work pay" and improve upward mobility for low-income workers through lower marginal tax rates.
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Project description:Abstract Nonprofit organizations have somewhat different foci, contexts, and resources than typical for‐profit organizations, so may have experienced and responded to COVID‐19 in ways not covered in traditional corporate research. We investigate the influence of nonprofit organizations' communication support and use, crisis experience and preparation, and extent and impacts of COVID‐19 on their strategic responses to the crisis (from retrenchment to perseverance to innovation). Our study is a longitudinal panel survey conducted with 578 U.S. public charities, once before the pandemic and the other 6 months into it. Data were analyzed using descriptive statistics to characterize the sample, and hierarchical regressions to assess the influences on strategic responses to the COVID‐19 pandemic. A major finding is that communication with external stakeholders predicted organizations' abilities to maintain core activities (perseverance) during a crisis and to pivot (innovating) on mission delivery. Practical applications for nonprofit organizations are addressed, with particular attention to COVID‐19.
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Project description:The climate crisis poses the greatest threat to human health this century. Mental health services will be called on to address the psychological consequences of its effects on peoples' lives, particularly the socially disadvantaged and those on low incomes. However, healthcare systems are also contributors to the climate crisis. This editorial discusses how services can continue to provide care while contributing less to climate change. Specifically, it suggests what services such as forensic mental healthcare, which is constrained by legal, political and resourcing concerns, can do differently.
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Project description:In a cohort of patients with diabetic foot osteomyelitis who were recommended to undergo below-knee amputation, those who deferred amputation and chose medical therapy were more likely to die during the follow-up time compared with those who proceeded with amputation.
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