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Too often individuals with long-term-care needs are placed in nursing homes when they might well be better served at a lower level of care. The uneven distribution of residents across settings stems from interacting factors of supply and demand: clinical need; lack of consensus among physicians about what constitutes the best setting for their patients; regulations restricting services in personal care homes. Three sets of clinical criteria identify nursing-home residents according to their appropriateness for lower levels of care. Factors like cost and ability of the patient's family to make informed decisions affect placement as well. Policies for shifting patients to lower levels of care must be carefully designed in order to save costs and ensure that quality of care is retained.

The feasibility of the Section 8 certificate program for individuals with chronic mental illness (CMI) and the outcomes associated with independent housing are examined. The analysis is based on data from a longitudinal survey of Section 8 certificate users in Baltimore and Hamilton County (Cincinnati) and on information from Section 8 application forms in each site. A pre-post research design was used to examine changes in hospitalization, residential stability, and mental health service outcomes. Four key dimensions of the CMI certificate program are examined: affordability, housing conditions, neighborhood conditions, and service gaps. Results suggest that the certificate program has a positive effect on independent living, that certificate use is associated with positive mental health outcomes, and that there is no evidence of "creaming" among program applicants.

This article investigates the use of market incentives to encourage household waste recycling by pricing waste-disposal services according to the quantity of waste generated. We use a natural experiment from an upstate New York county to examine how quantity-based pricing of waste disposal affects reported household recycling behavior, when used by itself or in conjunction with curbside pickup of recyclables or mandatory recycling laws. Curbside pickup was found to have the greatest effect on reported recycling behavior, although higher waste-disposal prices might alter these conclusions. Other concerns about quantity-based pricing of solid waste—distributional effects, public acceptance, and adverse incentives—are also examined.