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The degree to which disability benefit programs provide an adequate standard of living to those with work-limiting disabilities has long been overlooked in social policy research. This paper presents a framework for assessing disability-related decommodification and then applies that framework to an analysis of the Social Security Disability (SSD) programs in the United States. The paper draws on survey data from the Health and Retirement Study linked to administrative records from the Social Security Administration, and further compares the U.S. estimates to those from 27 other countries. The results indicate that more than 50 percent of older adults of working-age with work-disabilities in the U.S. do not receive SSD benefits, though rates of benefit receipt are higher than the average across other high-income countries. Those that receive SSD benefits, moreover, experience greater difficulty achieving an adequate standard of living, as measured by an index of financial security, than those with similar characteristics in the U.S. who do not receive disability benefits. The paper thus provides a framework for future policy research on benefit adequacy, while evaluating the availability and generosity of disability benefits in the U.S. [ABSTRACT FROM AUTHOR]

Goal: To document shifts in rural hospital service line offerings between 2010 and 2021 and to assess the resulting impacts on hospital profitability. Methods: We used annual Medicare cost report data for all rural hospitals that did not change payment classifications between 2010 and 2021. We documented changes in the percentages of hospitals offering each of the 37 inpatient or ancillary service lines included in the data. We then used panel event studies to assess effects on hospital operating margin for specific service lines that changed most prominently during this period. Principal Findings: Twelve service lines changed by more than 5% during our period of analysis. These are highlighted by hospitals adding rural health clinics (+32%) and CT scans (+20%) and removing delivery rooms (-21%) and skilled nursing facilities (-19%). Panel event studies demonstrated that the addition or subtraction of most services did not have statistically significant impacts on future hospital operating margins. Notable exceptions were the addition of rural health clinics and the removal of delivery services, both of which positively affected future operating margins. The addition of occupational therapy services had a positive effect on operating margin in the near term, but adding MRI services had a negative effect. Practical Applications: The finding that only a select few service line changes resulted in meaningful impacts to hospital operating margins suggests that hospital leaders should be wary of implementing such changes as a means of improving financial viability. [ABSTRACT FROM AUTHOR]

Poverty has long been indicated as a risk factor for child maltreatment. This review aims to synthesize the existing literature regarding the relationship between income-level poverty and child maltreatment in the United States. Of the 27 studies included, approximately 40% measured poverty using only income indicators, and 71% measured child maltreatment using administrative data. While the type of child maltreatment varied across studies, the associations generally revealed that higher income decreased the risk of child maltreatment, or families living in poverty had a higher risk of child maltreatment. The current study proposed several child welfare-related implications based on the findings. [ABSTRACT FROM AUTHOR]

The article offers information on medical students' feelings of unpreparedness regarding managing financial conflicts of interest. Topics discussed include the prevalence of industry gifts among students; the belief that medical schools should better educate on industry interactions; and the concern that current education does not sufficiently address potential biases in research.

Aim: The COVID-19 epidemic has caused risk and uncertainty. This study answers whether and how psychological distress and digital sports influence willingness to take the vaccine and precautionary savings. Subject and methods: We conducted a cross-sectional study with an online survey sample of 1016 Shanghai residents who live and work there and are aged between 16–60. All of them experienced the COVID-19 lockdown in Shanghai. We used logistic regressions to examine the relationships between the variables of interest. Results: Three findings were demonstrated. First, psychologically distressed individuals are less inclined to take the vaccine. Second, those engaged in fitness activities via digital media platforms are more willing to get vaccinated. Third, psychologically distressed individuals and digital video-based physical exercisers are more likely to precautionary save. Conclusions: This study contributes to the literature by documenting how people changed their life from the perspective of finance and health during the lockdown and providing practical implications. [ABSTRACT FROM AUTHOR]

The article discusses the importance of control for successful safety planning in healthcare. Topics covered include the needs for a robust control structure to maintain the gains after initial implementation, and a definition of clear measures of processes and outcomes to gauge success and sustain improvements. Also noted are such required competencies as systems thinking, stakeholder engagement and communication skills for project leadership.

This study aimed to examine self-report of financial leverage, conflict, and satisfaction pertaining to representative payeeship for persons with mental illness, which research has not examined in the past decade. Sixty representative payee recipients with mental illness residing across the U.S. completed an online survey, with most (n = 50) receiving representative payeeship by family members/friends. Wilcoxon-Mann-Whitney tests and Spearman correlations were computed. One-third of participants reported experiencing financial leverage and conflict "sometimes" or more often and were dissatisfied with their representative payee arrangement. With the exception of use of alcohol and/or drugs, no participant characteristic was associated with financial leverage, conflict, or satisfaction. Financial leverage was reported to be greater when representative payees were family members/friends. Financial leverage and conflict were positively associated with each other and negatively associated with satisfaction. It is advisable that satisfaction with representative payeeship be increased and conflict resulting from representative payeeship be minimized. [ABSTRACT FROM AUTHOR]

The exit from active substance use presents barriers to achieving and maintaining health, especially as individuals lack the economic resources to afford healthcare access. Treatment settings that strengthen resources may support stability in recovery and influence health. Analyzing a sample of recovery home residents over two years (N = 494), the current study assessed individually held resources (e.g., wages, employment) and the average economic conditions of a resident's house (e.g., house employment rate) to understand their association with self-reported health status. Employment status, but not wages or transportation access, was associated with reported health scores. The average employment rate of a recovery home was also positively correlated with the health of its residents. Results indicate the need to address employment and other economic issues which plague recovering individuals. Community aftercare settings may offer such a pathway through affordable housing, employment opportunities, and supportive relationships. [ABSTRACT FROM AUTHOR]

Objectives Contextually driven decision making is multidimensional, as individuals need to contend with prioritizing both competing and complementary demands. However, data is limited as to whether temporal discounting rates vary as a function of framing (gains vs loss) and domain (monetary vs social) in middle-to-older aged adults. It is also unclear whether socioaffective characteristics like social isolation and loneliness are associated with temporal discounting. Methods Temporal discounting rates were examined across monetary gain, monetary loss, social gain, and social loss conditions in 140 adults aged 50–90 during the Omicron stage of the pandemic. Self-report measures assessed loneliness and social isolation levels. Results Results found evidence of steeper temporal discounting rates for gains as compared to losses in both domains. Social outcomes were also more steeply discounted than monetary outcomes, without evidence of an interaction with the framing condition. Socioeconomic and socioaffective factors were unexpectedly not associated with temporal discounting rates. Discussion Community-dwelling middle-to-older aged adults showed a preference for immediate rewards and devalued social outcomes more than monetary outcomes. These findings have implications for tailoring social and financial incentive programs for middle to later adulthood. [ABSTRACT FROM AUTHOR]

Background: Rural hospitals are increasingly at risk of closure. Closure reduces the availability of hospital care in rural areas, resulting in a disparity in health between rural and urban citizens, and it has broader economic impacts on rural communities as rural hospitals are often large employers and are vital to recruiting new businesses to a community. To combat the risk of closure, rural hospitals have sought partnerships to bolster financial performance, which often results in a closure of services valuable to the community, such as obstetrics and certain diagnostic services, which are viewed as unprofitable. This can lead to poor health outcomes as community members are unable to access care in these areas. Purpose: In this article, we explore rural hospital service offerings and financial performance, with an aim to illuminate if specific service offerings are associated with positive financial performance in a rural setting. Methods: Our study used hospital organization data, as well as county-level demographics with periods of analysis from 2015 and 2019. We employed a pooled cross-sectional regression analysis with robust standard errors examining the association between total margin and service lines among rural hospitals in the United States. Results: The findings suggest that some services deemed unprofitable in urban and suburban hospital settings--such as obstetrics and drug/alcohol rehabilitation--are associated with higher margins in rural hospitals. Other unprofitable service lines--such as psychiatry and long-term care--are associated with lower margins in rural hospitals. Conclusion: Our results suggest the need of rural hospitals to choose services that align with environmental circumstances to maximize financial performance. Practice Implication: Hospital administrators in rural settings need to take a nuanced look at their environmental and organizational specifics when deciding upon the service mix. Generalizations regarding profitability should be avoided to maximize financial performance. [ABSTRACT FROM AUTHOR]

Purpose: Healthcare-associated infections (HAIs) place a significant financial burden on United States hospitals. HAI treatments extend hospital lengths of stay and increase hospital operational costs while significantly reducing hospital profit margins. Given these challenges, the research aim of this study was to explore the association between HAIs and hospital financial performance. A better understanding of this relationship can assist hospital leaders in optimizing the use of scarce financial resources to reduce HAI prevalence. Methods: Data for calendar year 2022 for active short-term acute care hospitals (n = 1454) in the US were analyzed using multiple linear regression analysis. We explored two derived dependent variables, operating expense per staffed bed and operating expense per discharge. The independent variables included four healthcare-associated infection rates: methicillin-resistant Staphylococcus aureus (MRSA) infection rate, Clostridium difficile (C. diff) infection rate, Catheter-Associated Urinary Tract Infection (CAUTI) rate, and Central Line Associated Blood Stream Infections (CLABSI). Appropriate organizational and market-level variables that may independently influence hospital financial performance were included as control variables. Results: The results revealed that C. diff (β: 0.037, p < 0.05) and CAUTI (β: 0.031, p < 0.05) rates were positively associated with an increase in operating expense per staffed bed, while increases in MRSA (β: 0.042, p < 0.001), C. diff (β: 0.062, p < 0.001), and CAUTI rates (β: 0.039, p < 0.001) were correlated with increased operating expenses per discharge. Conclusions: This study demonstrates that specific HAIs may be associated with increased hospital expenses. Proactively targeting these infections through tailored interventions may lead to reduced hospital costs, improved financial performance, and economic stability. [ABSTRACT FROM AUTHOR]

This article examines the transformation of public employee pension investment in the United States, from investing public funds in public infrastructure before the 1950s, to investing public funds in private securities in the years after. Three factors drove this change. First, motivated financial professionals convinced states to adopt the "prudent man rule," a legal investment standard that emphasized professional management and maximum financial returns. Second, declining bond yields during World War II led public pension managers to reconceptualize the political goals of pension investment, from balancing retiree returns against low-cost public infrastructure, to maximizing employee benefits by achieving maximum returns in financial markets. Third, public officials hired private asset managers to undertake new investment strategies. These professionals then used their influence to pursue further pension liberalization. Ultimately, US financialization was not a break, but a continuous process through which government officials intentionally used financial markets to enhance public social provision. [ABSTRACT FROM AUTHOR]

Given varied insurance acceptances and differing pay between insurances, our objective was to examine the number of California physicians enrolled in Medicare and Medicaid (Medi-Cal), stratified by specialty and graduation year. Medi-Cal and Medicare providers were extracted from publicly available databases (Centers for Medicare & Medicaid Services and California Health and Human Services) and were subsequently merged into one dataset using National Provider Identifier. From there, we stratified physicians by specialty and graduation year. We found that emergency medicine, radiology, pathology, anesthesiology, general surgery, and internal medicine had the highest percent of Medi-Cal-accepting physicians, whereas dermatology, psychiatry, physical medicine & rehabilitation, and plastic & reconstructive surgery physicians had the lowest. There also appears to be an inverse relationship between acceptance of Medi-Cal and earlier year of graduation (P < 0.05). This study demonstrated striking variability in Medi-Cal acceptance based upon physician years in practice and specialty. Older, experienced physicians, as well as physicians of certain specialties, are less likely to accept Medi-Cal. [ABSTRACT FROM AUTHOR]

Background and Purpose. Financial management (FM) knowledge, skills, and attitudes (KSAs) are essential components of contemporary physical therapist (PT) practice. The Commission on Accreditation in Physical Therapy Education requires that FM content is included in professional PT education program (PTEP) curriculums but provides freedom in how the content is delivered. The purpose of this systematic review is to identify learning experiences PTEPs used to educate students regarding FM KSAs that are necessary for entry-level PT practice in the United States. Methods. Articles were eligible for inclusion if they were 1) published in a peerreviewed scholarly journal, 2) written in English, and 3) described a learning experience used to deliver FM content. Articles describing didactic education, clinical education, or service-learning activities that were a required or voluntary component of professional PTEPs in the United States were included if they reported on objectives or outcomes related to FM. Electronic databases and relevant journals were searched. Search results were subjected to title, abstract, and fulltext review. Selected articles were evaluated for methodological rigor. Pertinent data were extracted, analyzed, and synthesized. Results. Eighteen articles were included. Four categories were identified: 1) classroom learning 2) clinical education 3) pro bono clinics, and 4) service learning. Discussion and Conclusion. Student PTs were exposed to FM content in several ways. There was variability in whether participation was required or voluntary, the time commitment required by the student, and the concepts to which students were exposed. There are many opportunities for future research in this area from operationally defining FM, determining necessary FM KSAs for entrylevel PTs, and to identifying the most effective learning experiences to ensure that new clinicians are prepared to effectively engage in this aspect of clinical practice. [ABSTRACT FROM AUTHOR]

Pulmonary rehabilitation (PR) is a highly effective intervention for persons with chronic respiratory diseases, resulting in improvement in exercise capacity, dyspnea, health-related quality of life, mood, reduced hospitalization, and improved survival and cost savings post-COPD hospitalization. Despite demonstrated effectiveness, PR is underutilized in part due to lack of awareness, limited access, and inadequate PR reimbursement. Poor payment is a long-standing barrier to PR's financial stability and access. Addressing PR payment, access, and utilization is a complex challenge and requires strategic, collaborative long-term approaches to meaningful solutions. Strategies to overcome payment disparities begin with legislative approaches to address limitations of Centers for Medicare and Medicaid Services coverage. Additional priorities include permanent approval for remote physician and advanced practice provider (APP) PR supervision, PR referrals by APPs, telerehabilitation using two-way audio/video technology, and elimination of the PR lifetime maximum limit of 72 h or units/patient. Methods are needed to effectively link appropriate PR prescribing and encouragement with primary care providers, hospitalists, case managers, and hospital navigators to optimize PR referrals. There is an important need to address inadequate PR access in rural settings. Potential opportunities to improve PR referrals and access include exploration of PR synergies with value-based care models that emphasize high-quality care and cost savings. Development and use of effective PR provider tools and resources may help address the above challenges as well as financially benefit PR programs. [ABSTRACT FROM AUTHOR]

Older adults are thought to be more susceptible to scams, yet understanding the relationship between chronological age and victimization is limited by underreporting. This study avoids underreporting bias by merging four longitudinal databases of Americans (N = 1.33 million) who paid money in response to mail scams over 20 years. We investigate the risk of repeat victimization and victimization by multiple scam types over the life course. Victims in their 70s and 80s are 9% more likely to experience another victimization incident than those in their 50s. Those age 18 to 29 are 24% less likely to experience another victimization incident. Relative to adults in their 50s, the odds of victimization by multiple scams are greater for those in their 60s and 70s, but lower for those 80 +. This study demonstrates the research potential in using scammers' data to understand patterns of victimization. Fraud prevention efforts should target older individuals who are at higher risk of repeat victimization and suffer greater losses as a result. [ABSTRACT FROM AUTHOR]

Financial exploitation (FE) is one of the most common reports to Adult Protective Services (APS) and the cases are often complex. Consequently, APS caseworkers report FE investigations to be among the most difficult while simultaneously reporting low confidence in productive outcomes for these investigations. This necessitates finding ways to support APS FE investigations. This paper describes the structure, process, and formative findings of a collaboration between forensic accounting examiners and APS workers to investigate complex cases of FE. Among the 77 FE cases completed, forensic examiners reviewed multiple years of financial records which included over 101,000 transactions, totaling over $213,000,000.00 in finances, and identified over $8,000,000 in questionable activity. Scores on the 8-item Client Satisfaction Questionnaire were high indicating high program satisfaction by APS workers, subject matter experts, and forensic examiners. These findings support the feasibility and acceptability of forensic accounting and APS collaborations to investigate complex cases of FE. [ABSTRACT FROM AUTHOR]

The article discusses the growing influence of the financial sector, particularly private equity, in the home health and hospice industries in the U.S. Topics discussed include the shift from nonprofit to for-profit ownership, the potential conflict between profit motives and patient care quality, and the implications for care outcomes and Medicare costs.

Objectives Low-cost debt can potentially enhance wealth and indirectly benefit health, yet Black Americans disproportionately lack this type of debt, which may constrain their ability to accumulate wealth throughout their lives and across generations. Our objectives are to develop a novel debt–asset measure, use it to quantify the Black–White differential in debt–asset profiles, and estimate its contribution to the racial gap in cognition. Methods Using the Health and Retirement Study (1998–2020), we grouped individuals based on debt and asset information during the preretirement period of ages 55–61, including the absence of debt and the relative amount of debt compared to assets. Linear mixed models were used to examine the extent to which cognition in later life (ages 62–80) differs across these debt–asset profiles and its role in explaining the racial disparity in cognition. Results Compared with Whites, Blacks were more likely to fall into categories characterized by high debt-to-asset ratio (DAR) or limited asset ownership. Low-asset nonborrowers displayed the poorest cognition, followed closely by high-DAR borrowers. The Black–White differential in debt–asset profiles contributed to the racial gap in cognition. Discussion There were 2 unfavorable debt–asset profiles: high debt relative to assets and little or no debt due to a lack of assets, which was more prevalent among Blacks than Whites. We discuss how institutional and structural racism shapes Black–White disparities in debt–asset profiles, such as limited access to borrowing opportunities, thereby contributing to health inequalities, including cognition. [ABSTRACT FROM AUTHOR]

Background and Objectives: To understand the relationship between Lean implementation in information technology (IT) departments and hospital performance, particularly with respect to operational and financial outcomes. Methods: Primary data were sourced from 1222 hospitals that responded to the National Survey of Lean (NSL)/Transformational Performance Improvement, which was fielded to 4500 general medical-surgical hospitals across the United States. Secondary sources included hospital performance data from the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS). We performed 2 sets of multivariable regressions using data gathered from US hospitals, linked to AHRQ and CMS performance outcomes. We examined 10 different outcomes measuring financial performance, quality of care, and patient experience, and their associations with Lean adoption within hospital IT departments. We then focused only on those hospitals that adopted Lean in IT to identify specific practices associated with performance. Results: Controlling for other factors, adoption of Lean IT management was associated with lower length of stay (b= -0.098, P= .018) and inpatient expense per discharge (b= -0.112, P= .090). Specifically, use of visual management tools (eg, A3 storyboards, status sheets) was associated with lower adjusted inpatient expense per discharge (b= -0.176, P= .034) and higher earnings before interest, taxes, depreciation, and amortization margin (b= 0.124, P= .042). Such tools were also associated with hospital participation in bundled payment programs (odds ratio = 2.326; P= .046; 95% confidence interval, 0.979-5.527) and percentage of net revenue paid on a shared risk basis (b= 0.188, P= .031). Conclusions: Lean IT management was associated with positive financial performance, particularly with hospital participation in value-based payment. More detailed study is needed to understand other influential factors and types of work processes, activities, or mechanisms by which high-functioning IT can contribute to financial outcomes. [ABSTRACT FROM AUTHOR]

Outcomes Based Commissioning (OBC) – for example, Pay for Success (in the US) or Payment by Results (in the UK) – has been suggested as a way to provide 'more' social services for 'less' public resources. Such commissioning is often linked with an innovative financing tool called a Social Impact Bond (SIB). Using data from the Social Finance UK Database and focusing on SIBs in the US and UK, we evaluate whether the SIB approach aligns with the theoretical predictions of social innovation. The results provide limited evidence that SIBs facilitate capital injections from the private sector into the production of social goods as well as facilitate parts of the process of social innovation – namely, piloting and scaling. We conclude that there is significant variation, both between the US and UK and within the US, in social innovation ecosystems and the role played by SIBs. [ABSTRACT FROM AUTHOR]

Objectives Access to local banking represents an understudied dimension of neighborhood-based inequalities that could significantly influence older adults' perceptions of their neighborhood spaces in ways that matter for disparities in well-being. We evaluate disparities in banking access and then examine how local banking access informs older adults' perceptions of neighborhood collective efficacy and danger, above and beyond other neighborhood socioeconomic characteristics. Methods We use nationally representative data from older adults in the United States who were interviewed at Round 3 of the National Social Life, Health, and Aging Project, linked with data on banks in respondents' residential and surrounding census tracts from the National Establishment Time-Series database, in a series of bivariate and multivariable regression analyses. Results White older adults and those with higher levels of education have significantly greater local banking access than Black and Hispanic older adults and those with lower levels of education. Higher rates of local banking institutions are associated with significantly lower perceptions of neighborhood danger, but not with perceived collective efficacy. This finding emerges when accounting for neighborhood concentrated disadvantage and physical disorder. Discussion Local banks may represent neighborhood investment and the broader economic vitality of a community, as well as the ability of communities to meet older adults' everyday needs in ways that enhance older residents' feelings of safety. Increasing access to local financial institutions may help attenuate neighborhood-based contributors to inequalities in health and well-being among the older adult population. [ABSTRACT FROM AUTHOR]

The financialization of the U.S. economy has had important implications for household well-being, but the mechanisms connecting financialization and precarity have not been fully identified. This research identifies mortgage foreclosure as a nexus connecting macro-level financialization to an array of downstream consequences for homeowners and asks (1) how mortgage securitization, a key technology of financialization, enabled new foreclosure practices; and (2) how these practices affect housing precarity among homeowners at risk of foreclosure. To answer these questions, I analyze court records, interviews with key participants, and primary source documents to examine the evolution of mortgage foreclosure in Cook County, Illinois, from 1992 to 2006. I find that as mortgage securitization transformed the social and economic relations between borrowers and lenders, foreclosure became actively managed as both a driver of costs and a source of profits, and loan administrators and their attorneys worked to reduce costly borrower protections. These changes increased housing precarity by making foreclosure more frequent and more rapid. [ABSTRACT FROM AUTHOR]

Little is known about nursing home (NH) financial status in the United States even though most NH care is publicly funded. To address this gap, this descriptive study used 2019 Medicare cost reports to examine NH revenues, expenditures, net income, related-party expenses, expense categories, and capital structure. After a cleaning process for all free-standing NHs, a study population of 11,752 NHs was examined. NHs had total net revenues of US$126 billion and a profit of US$730 million (0.58%) in 2019. When US$6.4 billion in disallowed costs and US$3.9 billion in non-cash depreciation expenses were excluded, the profit margin was 8.84 percent. About 77 percent of NHs reported US$11 billion in payments to related-party organizations (9.54% of net revenues). Overall spending for direct care was 66 percent of net revenues, including 27 percent on nursing, in contrast to 34 percent spent on administration, capital, other, and profits. Finally, NHs had long-term debts that outweighed their total available financing. The study shows the value of analyzing cost reports. It indicates the need to ensure greater accuracy and completeness of cost reports, financial transparency, and accountability for government funding, with implications for policy changes to improve rate setting and spending limits. [ABSTRACT FROM AUTHOR]

Background: The Patient Protection and Affordable Care Act (ACA) established the Hospital Quality Initiative in 2010 to enhance patient safety, reduce hospital readmissions, improve quality, and minimize healthcare costs. In response, this study aims to systematically review the literature and conduct a meta-analysis to estimate the average cost of procedure-specific 30-day risk-standardized unplanned readmissions for Acute Myocardial Infarction (AMI), Heart Failure (HF), Pneumonia, Coronary Artery Bypass Graft (CABG), and Total Hip Arthroplasty and/or Total Knee Arthroplasty (THA/TKA). Methods: Eligibility Criteria: This study included English language original research papers from the USA, encompassing various study designs. Exclusion criteria comprise studies lacking empirical evidence on hospital financial performance. Information Sources: A comprehensive search using relevant keywords was conducted across databases from January 1990 to December 2019 (updated in March 2021), covering peer-reviewed articles and gray literature. Risk of Bias: Bias in the included studies was assessed considering study design, adjustment for confounding factors, and potential effect modifiers. Synthesis of Results: The review adhered to PRISMA guidelines. Employing Monte Carlo simulations, a meta-analysis was conducted with 100,000 simulated samples. Results indicated mean 30-day readmission costs: USD 16,037.08 (95% CI, USD 15,196.01–16,870.06) overall, USD 6852.97 (95% CI, USD 6684.44–7021.08) for AMI, USD 9817.42 (95% CI, USD 9575.82–10,060.43) for HF, and USD 21,346.50 (95% CI, USD 20,818.14–21,871.85) for THA/TKA. Discussion: Despite the financial challenges that hospitals face due to the ACA and the Hospital Readmissions Reduction Program, this meta-analysis contributes valuable insights into the consistent cost trends associated with 30-day readmissions. Conclusions: This systematic review and meta-analysis provide comprehensive insights into the financial implications of 30-day readmissions for specific medical conditions, enhancing our understanding of the nexus between healthcare quality and financial performance. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review examined the effects of tax-time saving interventions that promote saving with tax refunds from relevant experimental or quasi-experimental studies of interventions aimed toward low- and moderate-income adults delivered when filing U.S. income taxes. Method: A systematic review process was used to search for published and unpublished studies from sources through September 2021. Two reviewers screened studies, extracted data and assessed risk of bias, and effects on savings rate and amount were synthesized using robust variance estimation. Results: This review included 14 unique studies. Five studies reporting 13 effect sizes for savings amount found a small, statistically significant effect (d = 0.06, 95% CI [0.05, 0.08]). Nine studies reporting 35 effect sizes found no statistically significant effect for savings rate (LOR = 4.11, 95% CI [0.42, 40.44]). Discussion: Results suggest some evidence that tax-time savings can be a relatively simple method for increasing the amount low- to moderate-income adults save. [ABSTRACT FROM AUTHOR]

Guided by an intersectional feminism framework, we used three‐wave, dyadic survey data from a nationally representative sample of 1625 U.S. different‐gender newlywed couples to test three research questions. First, as balanced power is considered a key concept for relational well‐being in feminism, we examined developmental trajectories in husbands' and wives' perception of power (im)balance. Second, considering money as a major influence on power and aggression, we examined how financial behaviors relate to power (im)balance and in turn relational aggression—a type of intimate partner violence that is controlling and manipulative in nature. Third, informed by the intersectionality between gender and socioeconomic status (SES), we examined gender differences and SES disparities in the associations among financial behaviors, developmental trajectories of perception of power (im)balance, and relational aggression. Our findings demonstrate that newlywed different‐gender couples are experiencing power struggles, where two partners diminish each other's influence over time. We also found that healthy financial behaviors are associated with balanced power and, in turn, less relational aggression (especially for wives and in lower‐SES households). Taken collectively, we continue calling for efforts to facilitate money management skills and promote balanced marital power. [ABSTRACT FROM AUTHOR]

Initial paramedic education must have sufficient rigor and appropriate resources to prepare graduates to provide lifesaving prehospital care. Despite required national paramedic accreditation, there is substantial variability in paramedic pass rates that may be related to program infrastructure and clinical support. Our objective was to evaluate US paramedic program resources and identify common deficiencies that may affect program completion. We conducted a cross-sectional mixed methods analysis of the 2018 Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions annual report, focusing on program Resource Assessment Matrices (RAM). The RAM is a 360-degree evaluation completed by program personnel, advisory committee members, and currently enrolled students to identify program resource deficiencies affecting educational delivery. The analysis included all paramedic programs that reported graduating students in 2018. Resource deficiencies were categorized into ten categories: faculty, medical director, support personnel, curriculum, financial resources, facilities, clinical resources, field resources, learning resources, and physician interaction. Descriptive statistics of resource deficiency categories were conducted, followed by a thematic analysis of deficiencies to identify commonalities. Themes were generated from evaluating individual deficiencies, paired with program-reported analysis and action plans for each entry. Data from 626 programs were included (response rate = 100%), with 143 programs reporting at least one resource deficiency (23%). A total of 406 deficiencies were identified in the ten categories. The largest categories (n = 406) were medical director (14%), facilities (13%), financial resources (13%), support personnel (11%), and physician interaction (11%). The thematic analysis demonstrated that a lack of medical director engagement in educational activities, inadequate facility resources, and a lack of available financial resources affected the educational environment. Additionally, programs reported poor data collection due to program director turnover. Resource deficiencies were frequent for programs graduating paramedic students in 2018. Common themes identified were a need for medical director engagement, facility problems, and financial resources. Considering the pivotal role of EMS physicians in prehospital care, a consistent theme throughout the analysis involved challenges with medical director and physician interactions. Future work is needed to determine best practices for paramedic programs to ensure adequate resource availability for initial paramedic education. [ABSTRACT FROM AUTHOR]

Previous research indicates home health nurses (HHNs) worry that current home health care trends are threatening their ability to provide high-quality nursing care. High-quality nursing requires patient-centered and culture-sensitive care. These 2 attributes are indicators of high-quality nursing care. In this qualitative study, 20 HHNs were interviewed to discover their insights into 2 research questions: What barriers affect HHNs' ability to provide patient-centered, culture-sensitive, high-quality nursing care and how do these barriers affect HHNs and patients? Participants were professional HHNs who provided skilled intermittent care to diverse patient populations in their homes. Participants believed that a lack of time, high productivity requirements, pay-per-visit compensation, documentation burden, EMR systems, and the "industrialization" of HHNs' practice create structural barriers to high-quality home health nursing. Medicare was perceived as contributing to the barriers with burdensome documentation requirements and regulations that impeded holistic patient-centered care. Nurse participants indicated that the effects of these barriers were nurse stress, burnout, moral distress, and intent to leave; lower patient outcomes and satisfaction; and healthcare disparities. Additional research about the structural barriers were reviewed and found to support the nurses' perceptions of barriers to high-quality nursing care. In a value-based purchasing system, agencies need to support high-quality nursing care by tackling the barriers to its practice. To address the barriers comprehensively, agencies can institute policies that mirror the American Nurses Credentialing Center's Pathway to Excellence ®. Medicare policy makers should examine how present policies adversely affect high-quality nursing care. [ABSTRACT FROM AUTHOR]

The Indian Health Service (IHS) faces severe workforce shortages due to underfunding and underdevelopment of clinical training programs. Unlike other direct federal health care systems that have implemented clinical training paradigms as central parts of their success, the IHS has no formalized process for developing such programs internally or in partnership with academic institutions. While the Indian Health Care Improvement Act (IHCIA) authorizes mechanisms by which the IHS can support overall workforce development, a critical portion of the act (U.S. Code 1616p) intended for developing clinical training programs within the agency remains unfunded. Here, we review the funding challenges of the IHCIA, as well as its authorized and funded workforce development programs that have only partially addressed workforce shortages. We propose that through additional funding to 1616p, the IHS could implement clinical training programs needed to prepare a larger workforce more capable of meeting the needs of American Indian/Alaska Native communities. [ABSTRACT FROM AUTHOR]

To examine long-term care out-of-pocket payments by dementia status and residential setting. Compare monthly out-of-pocket long-term care expenses paid to facilities and helpers, total monthly out-of-pocket long-term expenses and as a percentage of monthly income by dementia status and residential status (community, residential facility, and nursing home). US Nationwide, 2019 National Health and Aging Trends Study (NHATS) respondents aged ≥70 years. We analyzed respondent-level data from the nationally representative 2019 NHATS. Weighted descriptive statistics were calculated for long-term care payments by source and summarized by dementia status and the respondent's residential status. Among 4505 respondents aged ≥70 years, 1750 (38.8%) had possible or probable dementia and 2755 (61.2%) had no dementia. The median monthly out-of-pocket long-term care expenses for persons with dementia was $1465 for those living in nursing homes, and $2925 for those living in other residential facilities, much higher than those with dementia living in the community ($260). Although these are similar to the median out-of-pocket payments for persons without dementia by setting, those with dementia were at greater risk of facing catastrophic out-of-pocket expenses for long-term care than those without dementia, with the 75th percentile value of out-of-pocket payment at $4566 among dementia adults living in non–nursing home residential care facilities, and $7500 for those in nursing homes, compared to $3694 and $3100 among those without dementia. At median, these expenses accounted for 100% of monthly income of respondents with dementia living in facilities. Persons with dementia living in facilities often face substantial financial burdens from high out-of-pocket long-term care expenses. Policies that provide sufficient financial assistance are needed to address long-term care–related financial burdens experienced by older adults and their families, especially for those with dementia. [ABSTRACT FROM AUTHOR]

Study Design The current study used a phenomenological qualitative design to investigate leadership competencies and mentoring needs of physical and occupational therapy leaders. Objectives The purpose of the study was to evaluate leadership competencies of physical and occupational therapy leaders based on years of leadership experience and determine their mentoring needs for developing leadership competencies. Background Personnel shortages are a major issue in health care, and health care organizations should focus on professional development of health care leaders for better staff retention. Methods and Measures Nonprobability convenience sampling was used to recruit physical and occupational therapists currently working as therapy leaders in the United States. A self-developed, two-part structured interview guide was created and contained three demographic questions regarding leadership and four open-ended questions. Before the interview, participants reviewed the National Center for Healthcare Leadership Health Leadership Competency Model 3.0, which discusses seven domains of leadership competency, and the interview guide. Interviews took ∼30 to 45 minutes and were conducted using Zoom. NVivo software was used to code interviews for themes, and identified themes were grouped into five categories of years of leadership experience. Results Twenty-five physical and occupational therapists participated in the study. Participants in all five experience categories identified collaboration and communication as leadership competencies they possessed. Other identified competencies were analytical thinking, team leadership, accountability, and professional and social responsibility. Human resource management, financial skills, and relationship and network development were identified as mentoring needs for developing leadership competencies by participants in all categories. Information technology management and self-confidence were also identified. Conclusions By determining the current leadership competencies and mentoring needs, the results of the current study may be useful for establishing leaders who can address personnel shortages in health care. [ABSTRACT FROM AUTHOR]

Due to the rise in scams perpetrated against older adults, Adult Protective Service workers are more frequently involved in investigating these matters. One significant aspect of scam involvement is the assessment of informed financial decision-making. This study examined 175 consecutive scam cases APS workers investigated using a 10-item financial-decision making tool. Two-thirds of the sample displayed deficits in decision-making. The decision-making tool was effective in differentiating those rated as having deficits from those without deficits. Analysis of each scored item found differences between groups on six of the seven items. A review of the item responses illustrates the types of deficits in understanding and appreciation of the scam and its impact on the older person and their family. [ABSTRACT FROM AUTHOR]

This study examined the association of multiple mental health measures with involuntary delayed retirement (IDR) in working older adults (≥ 65 years) in the USA. Data were derived from the Health and Retirement Study, focusing on two combined waves of working older adults in 2010 and 2012. IDR was measured as the desire to stop working but the inability to do so due to financial constraints. In addition, mental health outcomes included depression, anxiety, anger-in, and anger-out. Using Stata 16.0, primary analyses were conducted for descriptive statistics and multivariable logistic regression. The odds ratios were reported with 95% confidence intervals (CIs). Older adults who reported IDR were more likely to have depression (OR = 3.20, CI = 1.03–9.88), anxiety (OR = 2.12, CI = 1.00–5.18), and anger-in (OR = 1.71, CI = 1.12–2.60) compared to those who did not report IDR. However, IDR was not significantly associated with anger-out in older adults who worked past the traditional retirement age. The findings suggest that IDR is likely to act as a stressor and affects the mental health of older adults aged 65 and more. Policymakers should pay more attention to helping older adults maintain positive mental health even if they are required to work past retirement age. [ABSTRACT FROM AUTHOR]

Objective. The objective of this research is to appraise current practice in hospitals against the ‘Framework to achieve value in healthcare’ (the Framework) and to identify additional contributory factors that support or hinder its application. Methods. A multi-site case study was undertaken with five hospitals in Australia, the USA and UK using purposeful sampling to identify hospitals to participate. Data collection took place between September and November 2022. The hospitals included in the study had Process Improvement (PI) programs of more than 5 years duration, with strong executive engagement and broad outcomes measurement, including financial benefits. All hospitals were acute public hospitals or private, not for profit. Results. All hospitals indicated current practice according to Steps 1–5 for some part of their PI programs. All hospitals indicated that they were more likely to include financial benefits measurement for activities aimed specifically at improving cost rather than reducing non-value adding activities or improving the value of clinical care. Step 5 (reinvestment of cost savings) of the Framework is dependent on the accomplishment of Step 4 (measurement and realisation of financial benefits) and the contributory elements are important in supporting hospitals to utilise the Framework. Conclusions. The ‘Framework to achieve value in healthcare’ provides a practical guide for hospitals to reduce non-value adding activities, improve the value of clinical care and reduce costs. Further research is indicated to establish its reliability in hospitals in other countries and hospitals that do not have an established PI program. [ABSTRACT FROM AUTHOR]

The relationship between an individual's financial behavior and financial satisfaction is well known. Less evidence is available about how these two constructs interplay within couples. This considered, the current paper aims to (a) examine whether individuals' financial satisfaction is influenced by their own financial behavior (actor effect) and their partner's financial behavior (partner effect); (b) examine whether these two effects vary between husbands and wives; and (c) verify how couples' bank account status (i.e., only joint bank accounts, only separate bank accounts, both joint and separate bank accounts) moderate these effects. The current study draws 1,475 heterosexual early married couples from Couple Relationships and Transition Experiences study and modeled dyadic data through an Actor Partner Interdependence Model. Results indicate that actor's financial behavior is associated only with one's own financial satisfaction (actor effect) and not one's partner's financial satisfaction (partner effect). This holds for both wives and husbands. Furthermore, individuals who hold only joint bank account(s) are more likely to have financial behaviors similar to their partner than individuals who hold only separate bank accounts or both joint and separate accounts. Couples who hold only separate accounts are more likely to engage in less positive financial behavior than their counterparts. Implications for relationship therapists and financial professionals are discussed. [ABSTRACT FROM AUTHOR]

A series of structural constitutional arguments lodged in multiple cases against Centers for Medicare and Medicaid Services' (CMS) authorities to negotiate prescription drug prices via the 2022 Inflation Reduction Act threaten the legitimacy of CMS program and federal agency powers. [ABSTRACT FROM AUTHOR]

Entrepreneurs are hailed as economic heroes and drivers of job growth. Yet an analysis of Current Population Survey data of U.S. residents between ages 50--64 demonstrates that entrepreneurs disproportionately lack health insurance and workplace retirement savings program coverage. Finding that nearly 1 in 10 adults in this age range are self-employed, this study documents disparities by self-employment incorporation status, gender, and race and ethnicity. Using a financial capability perspective, program and policy actions to reduce these disparities are highlighted. If enacted, more entrepreneurship could be unlocked. [ABSTRACT FROM AUTHOR]

The author reflects on the care economy in the healthcare sector like disability care, personal care, and education as a catalyst for inclusive and sustainability growth. Other topics include how the care economy affects employer-employee relations, as well as how a robust care economy fosters gender parity, workforce participation, and social cohesion.

This study examines the goals of medical aid-in-dying (MAID) legislation introduced to the US Congress from 1994–2020 using a policy mapping analysis approach. Using congress.gov, we identified 98 bills, 23 bills were analyzed in this study. Most of the bills aimed to restrict the use of federal funds, to regulate the drugs commonly used for MAID, to prohibit the development of policies or practices supporting MAID, and to regulate practitioners' roles in MAID. In practice, these bills would limit patient access to MAID by restricting drugs, funds, health care services, legal assistance, policy, and research. These findings suggest there lacks congressional support for MAID, even though polls of the public are divided yet favorable. Policymakers who support MAID should consider affirmative policies that 1) prevent MAID policies from discriminating against vulnerable groups, 2) support funding to study the use of MAID, and 3) build avenues to allow all qualified people to access MAID in places where it is legal. [ABSTRACT FROM AUTHOR]

This study investigates the association between insurance coverage denial and delays in care during pregnancy and postpartum. An online survey was administered in March and April 2022 to women who were either pregnant or within 1 year postpartum (n = 1,113). The outcome was delayed care, measured at four time points: during pregnancy and 1 week, 2 to 6 weeks, and after 7 weeks postpartum. The key covariate was insurance coverage denial by providers during pregnancy. Delayed care due to having an unaccepted insurance and being "out-of-network" was more pronounced at 1 week postpartum with 3.37 times and 3.47 times greater odds and in 2 to 6 weeks postpartum with 5.74 times and 2.97 times greater odds, respectively. The association between insurance denial and delays in care encapsulated transportation, rural residency, time issues, and financial constraints. The findings suggest that coverage denial is associated with significant delays in care, providing practical implications for effective perinatal care. [ABSTRACT FROM AUTHOR]

Hospitals are perpetually challenged by concurrently improving the quality of healthcare and maintaining financial solvency. Both issues are among the top concerns for hospital executives across the United States, yet some have questioned if the efforts to enhance quality are financially sustainable. Thus, the aim of this study is to examine if efforts to improve quality in the hospital setting have a corresponding association with hospital profitability. Recent and directly relevant research on this topic is very limited, leaving practitioners uncertain about the wisdom of their investments in interventions which enhance quality and patient safety. We assessed if eight different quality measures were associated with our targeted measure of hospital profitability: the net patient revenue per adjusted discharge. Using multivariate regression, we found that improving quality was significantly associated with our targeted measure of hospital profitability: the net patient revenue per adjusted discharge. Significant findings were reported for seven of eight quality measures tested, including the HCAHPS Summary Star Rating (p < 0.001), Hospital Compare Overall Rating (p < 0.001), All-Cause Hospital-Wide Readmission Rate (p < 0.01), Total Performance Score (p < 0.001), Safety Domain Score (p < 0.01), Person and Community Engagement Domain Score (p < 0.001), and the Efficiency and Cost Reduction Score (p < 0.001). Failing to address quality and patient safety issues is costly for US hospitals. We believe our findings support the premise that increased attention to the quality of care delivered as well as patients' perceptions of care may allow hospitals to accentuate profitability and advance a hospital's financial position. [ABSTRACT FROM AUTHOR]

Posttraumatic stress disorder (PTSD) is a prevalent consequence of physical and sexual intimate partner violence (IPV); however, little is known about the unique contributions of economic IPV. Furthermore, women's economic self-sufficiency may explicate the potential relationship between economic IPV and PTSD symptoms. Guided by the Stress Process Theory and Intersectionality, this study examined associations between economic IPV and women's PTSD symptoms and assessed economic self-sufficiency as a mediator. Participants were 255 adult women experiencing IPV recruited from metropolitan Baltimore, MD, and the state of CT who participated in two different studies. Participants completed surveys on IPV, economic self-sufficiency, and PTSD. Path analyses were conducted to examine direct and indirect associations of economic IPV with economic self-sufficiency and PTSD. Economic IPV was uniquely associated with PTSD symptoms while controlling for other forms of IPV. Economic self-sufficiency significantly partially mediated the association between economic IPV and PTSD symptoms such that economic IPV was associated with PTSD symptoms through economic self-sufficiency. Economic IPV may limit women's ability to make autonomous decisions related to finances, which could be distressing. The mental health impact of economic IPV may be particularly debilitating for women with low economic self-sufficiency as their posttraumatic stress occurs within the context of feeling unable to meet their financial goals and also having a partner control their economic resources. Fostering economic empowerment and asset building may be a strengths-based approach to reduce the PTSD symptomatology among women experiencing IPV. [ABSTRACT FROM AUTHOR]

Governments around the world accumulate fiscal reserves to prepare for exogenous shocks such as recessions. Using data from 2004 to 2016 for state governments in the United States, we estimate empirical models controlling for time-variant and -invariant state characteristics. Our results show that savings increase at the expense of spending in specific categories and that fiscal reserves also support only certain expenditure functions. Further, we find that the relationship between savings and spending differs over the business cycle as fiscal reserves increase during times of economic prosperity and decrease during economic declines. [ABSTRACT FROM AUTHOR]

Goal: This study investigated the association between Lean and performance outcomes in U.S. public hospitals. Public hospitals face substantial pressure to deliver high-quality care with limited resources. Lean-based management systems can provide these hospitals with alternative approaches to improve efficiency and effectiveness. Prior research shows that Lean can have positive impacts in hospitals ranging in ownership type, but more study is needed, specifically in publicly owned hospitals. Methods: We performed multivariable regressions using data from the 2017 National Survey of Lean/Transformational Performance Improvement. The data were linked to publicly available hospital performance data from the Agency for Healthcare Research and Quality and the Centers for Medicare & Medicaid Services. We examined 11 outcomes measuring financial performance, quality of care, and patient experience and their associations with Lean adoption. We also explored potential drivers of positive outcomes by examining Lean implementation in each hospital, measured as the number of units using Lean tools and practices; leader commitment to Lean principles; Lean training and education among physicians, nurses, and managers; and use of a daily management system among C-suite leaders and managers. Principal Findings: Lean adoption and implementation were associated with improved performance in U.S. public hospitals. Compared with hospitals that did not adopt Lean, those that did had significantly lower adjusted inpatient expenses per discharge and higher-than-average national scores on the appropriate use of medical imaging and timeliness of care. The study results also showed marginally significant improvements in patient experience and hospital earnings before interest, taxes, depreciation, and amortization margins. Focusing on these select outcomes, we found that drivers of such improvements involved the extent of Lean implementation, as reflected by leadership commitment, daily management, and training/education while controlling for the number of years using Lean. Practical Applications: Lean is a method of continuous improvement centered around a culture of providing high-value care for patients. Our findings provide insight into the potential benefits of Lean in U.S. public hospitals. Notably, they suggest that leader buy-in is key to success. When executives and managers support Lean initiatives and provide proper training for the workforce, improved financial and operational performance can result. This commitment, starting with upper management, may also play a broader role in the effort to reform healthcare while having a positive impact on patient care in U.S. public hospitals. [ABSTRACT FROM AUTHOR]

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The purpose of this study is to shed light on the effects of the CEO pay ratio and say‐on‐pay votes on directors' concerns about CEO pay equity. Investigation of the pay ratio disclosure rule offers opportunities to gain insights into whether equity perceptions associated with mandated pay ratio disclosure have significant effects on remuneration decisions in organizations. We conduct an online experiment with practicing corporate directors to examine the effects of CEO pay ratio disclosures and say‐on‐pay (SOP) votes on director decisions. Results indicate that CEO pay ratio disclosures significantly influence directors' decisions regarding executive compensation, leading directors to be less willing to increase CEO pay when the pay ratio is above the industry average pay ratio. Results also demonstrate that say‐on‐pay votes only influence directors' compensation decisions when the CEO pay ratio is above the industry average. Directors in firms with pay ratios that are above the industry average are less willing to increase CEO pay when they anticipate shareholder votes against a CEO pay increase than when they anticipate positive SOP voting outcomes. Directors in firms with CEO pay ratios that are below the industry average, however, are willing to increase CEO pay regardless of SOP voting outcomes. [ABSTRACT FROM AUTHOR]

Most research on employee stock plan participation investigates the effects of such forms of ownership on employee attitudes, leaving our understanding of the individual differences that contribute to employee ownership largely unknown. Drawing from the consumer behavior literature, our study explores the effect of organization‐based identity on the decision to participate in an employee stock purchase plan. The study was conducted in a newly public firm where we examine the effect of organization‐based identity on the purchase decision in two time periods. The first point in time was the initial public offering (IPO), when the employee has little information on how the firm's stock will perform in the market. The second point in time was the first quarter following the IPO, when employees have market data to help them with decision‐making. Results indicate that, as predicted, organization‐based identity is associated with participation in an employee stock purchase plan, at both points in time, above and beyond the influence of several economic and psychological predictors reported in prior studies. [ABSTRACT FROM AUTHOR]

Researchers have shown that if couples manage their money in sound ways, their marriages may benefit. Scholars have also shown that the quality of a marriage may precede positive financial behaviors. Previous studies have not determined the directionality of these processes, but researchers have assumed that it flows from financial variables to marital satisfaction. Utilizing a sample of U.S. mixed-gender, newlywed dyads (N = 1220), we examined which is a stronger association: financial processes predicting marital processes or marital processes predicting financial processes. Specifically, we estimated three dyadic, structural equation models to examine cross-lagged associations between husbands' and wives' own financial behaviors and their own marital satisfaction, between husbands' and wives' own financial communication and their own marital satisfaction, and between husbands' and wives' own financial behaviors and their own financial communication across two waves of data. We found that husbands' marital satisfaction predicted rank-order change in their reports of financial communication more strongly than the reverse. Furthermore, we found that wives' financial behaviors predicted rank-order change in their reports of financial communication more strongly than the reverse. These results have implications for theory, future research, and improving the financial and marital wellbeing of U.S. mixed-gender, newlywed couples. [ABSTRACT FROM AUTHOR]