Abstracts from Spring 2003 Conference

Health Care Economics and the Economics of the Commons
(click here for full paper)
Dr. Art Warmoth, Professor and Chair of Psychology, Sonoma State University

Finding solutions to the health care crisis requires considering health care as a complex economic system. Recently, several analysts have pointed out the importance of "the economics of the commons," which includes all resources, goods, services, and assets that must be produced and/or consumed (used), at least in part, collectively. The economics of the commons functions according systems dynamics that are different from those of price auction markets, and in many ways, health care is a common good.

This paper will present a schematic overview of the systems components of health care economics, with a particular focus on the character of the political negotiations required to deal with those aspects of the system that represent collective, rather than individual, wealth and well-being.

Do Food Stamps Cause an Over-Consumption of Food?
Dr. Steven Cuellar, Asst. Professor of Economics, Sonoma State University

This paper analyzes the effects of the federal food stamp program on the consumption of food and the potential effects the incidence of obesity among food stamp recipients. Obviously, an effective food stamp program will lead to an increase in the consumption of food. However, if the food stamp program, because of the fixed quantity nature of its implementation, has led to an “over-consumption” of food and increased incidence of obesity, then switching from a fixed quantity subsidy to a cash grant would reduce the incidence of obesity among the poor. To examine these issues, this paper starts with a theoretical analysis using a standard microeconomic model of consumer optimization to analyze the effects of a food stamp program on the consumption of food and the effect that switching from a food stamp program to a program that provides a cash grant has on food consumption. The paper then proceeds to examine data on the food stamp program and the incidence of obesity among various groups.

Changes in cesarean rates and infant mortality: A longitudinal analysis
Dr. Vincent Richman, Associate Professor of Accounting, Sonoma State University

National cesarean rates in Canada more than tripled from the mid-1960’s, reaching almost 20% in the late 1980’s. It is generally believed that this cesarean rate is not medically justified. A major justification for performing cesarean sections is improving infant outcomes. This paper analyzes the relationship between changes in cesarean rates and changes in infant mortality. Changes in the numbers of cesarean sections and changes in the numbers of infant deaths are calculated for each of the 240 largest Canadian maternity units. Annual, aggregate data on births, cesarean sections and infant deaths were obtained from Statistics Canada for Canadian maternity units for 1983 through 1992. Increased cesarean rates were not associated with decreased infant mortality rates. These results do not support a major justification for the increased cesarean rate.

Comparison of Organizational Forms in the Calif. Nursing Home Industry
Mr. Timothy A. Aust, Graduating MBA Student, Sonoma State University

Purpose of the Study: The purpose of this paper is to perform an investigation and analysis of various organizational forms in the current California nursing home industry in order to determine if differences exist in the provision of quality of care between ownership types, and in access to care by Medi-Cal residents.

Procedure: A random sample of all California nursing homes was gathered. An analysis of publicly available data pertaining to each sampled nursing home was performed, and included federal and state deficiencies and citations received for the years 1999 through 2002, percentage of Medi-Cal residents, staff turnover, prevalence of weight loss, prevalence of bed bound residents, prevalence of restraint usage, prevalence of pressure sores, prevalence of incontinence, late loss functioning of activities of daily living, prevalence of depression, and levels of nursing staff. SPSS was used to compute means of all variables, and a 1-way analysis of variance was used to test for significant differences.

Findings: Deficiencies were found to be significantly higher in all for-profit ownership types than in all nonprofit ownership types. No significant differences in deficiencies were found between for-profit ownership types or between nonprofit ownership types. Serious deficiencies were significantly higher in for-profit independents than in nonprofit independents. All nonprofit ownership types had significantly lower percentages of Medi-Cal residents than all for-profit ownership types. Publicly traded chains had significantly lower percentages of Medi-Cal residents than for-profit independents and for-profit chains. Nursing staffing was found to be significantly higher in all nonprofit ownership types than in all for-profit ownership types. For-profit independents had significantly higher nursing staffing than publicly traded chains. Both for-profit chains and publicly traded chains staffed below the legal state requirement of 3.2 nursing hours per patient day. No significant differences were found in staff turnover rates among any of the ownership types. Weight loss was found to be significantly less prevalent in for-profit independents than in publicly traded chains. Prevalence of bed bound residents was significantly lower in for-profit independents and for-profit chains than publicly traded chains. Prevalence of residents in restraints was significantly lower in publicly traded chains than for-profit independents and for-profit chains. Prevalence of residents with pressure sores was significantly lower in nonprofit chains than in publicly traded chains. There were no significant differences in prevalence of incontinence between any of the ownership types. Late loss functioning in activities of daily living was significantly less prevalent in for-profit independents and for-profit chains than in publicly traded chains and non-profit chains. Depression was found to be significantly less prevalent in for-profit independents and for-profit chains than in nonprofit independents. No significant differences were found in any variables between nonprofit independents and nonprofit chains.

Conclusions: While the findings show that nonprofit ownership types have significantly fewer deficiencies than for-profits, they should not be construed as conclusive evidence that nonprofit nursing homes provide significantly better quality of care. Many factors need to be considered when evaluating quality differences, such as the positive impact of chain acquisition on quality outcomes, significant surveyor subjectivity and bias, significant inconsistencies in the resident assessment process (MDS 2.0) by resident assessment nurses, asymmetry, and efficiency. In addition, while prevalence of Quality Indicators might be an indication of quality deficiencies, they are also indicative of the resident population being served and areas of specialty care that the nursing home provides.
Nonprofit nursing homes have significantly less Medi-Cal patients than for-profit nursing homes, strongly suggesting that medically indigent residents face significant barriers to access of nonprofit nursing homes. The significant differences in percentages of Medi-Cal residents found between for-profit ownership types is most likely a result of for-profit public chains providing higher numbers of rehabilitation services to Medicare and managed care residents.
The significantly higher nursing staffing found in for-profit independents, with no resulting significant decrease in deficiencies, suggests that incremental staffing level increases do not result in a significant decrease in deficiencies among for-profit ownership types, even though they substantially add to nursing home labor costs and increase the state’s Medi-Cal expenditures. Although nonprofit nursing homes have significantly higher nursing staffing than for-profit nursing homes, they have a significantly higher base of private pay revenues in which to fund the additional labor.

Health Issues Facing Teachers
Professor Barbara Russell, Lecturer, Department of Educational Leadership and Special Education, SSU

Safeguards and concerns pertaining to health issues on the school campus are varied and broad across the education environment. School personnel in both general education and special education
are involved with students who present health concerns. School Districts provide inservice trainings and workshops to address these issues and provide training to school personnel and teaching staff.
This information is also carried to families, transportation departments along with district and county support.

We will be discussing health concerns that appear within the education setting. These issues will include specific information regarding students with special needs and those who have a 504 Accommodation
Plan. We will also be discussing general safety strategies for teachers and staff concerning conditions such as allergies, communicable diseases and epilepsy. . School and classroom plans will be reviewed and discussed throughout the session. Concerns and questions are welcome.