Charlotte Muller

Paid work and unpaid help by caregivers of the disabled and frail elders.

Informal caregiving by women, and to a lesser extent by men, is a major source of assistance for the chronically disabled and most dependent older persons living in the community. However, because womens commitment to career employment may diminish, this source of help at the time when (according to demographic trends) the number of very old Americans will increase, the effect of employment on the time they devote to informal caregiving is an important social and economic issue. This study examines two related research questions: 1) how the time allocated to paid work affects the time devoted to unpaid caregiving and 2) how caregiving responsibilities affect work outside the home. The results differ for full-time and part-time work. Estimating a simultaneous equation model, it was found that 1) full-time employment by caregivers reduces the time they allocate to providing unpaid help by 20 hours a week and 2) female caregivers were much less likely than their male counterparts to have full-time jobs. Results also indicate that 1) part-time employment by caregivers has no statistically significant effect on caregiving and 2) caregiving has no effect on womens part-time employment.

Economic Costs of Schizophrenia: A Postdischarge Study

Measurement of the costs of health care and work loss of chronic mental patients is a vital link between clinical care and political decisions. If costs associated with poor outcomes of deinstitutionalized patients are identified, the margin for investing in programs that could improve outcomes without raising overall costs is also identified. This study analyzed direct and indirect costs in the first year after 119 chronic schizophrenics, drawn from public and voluntary hospitals serving Manhattans upper West Side, were discharged from the hospital. The main elements in direct costs were community aftercare, rehospitalizations, and general medical care. Wage loss was used as the measure of indirect costs and was based on comparison with national figures for similar age/ sex/ethnic groups. The risk of rehospitalization is the principal factor affecting direct costs. Wage loss because of unemployment was substantial. Because use of vocational rehabilitation services was low, these findings suggest the importance of developing employment opportunities and appropriate work environments.

Does Having More Time After Retirement Change the Demand for Physician Services

Various aspects of the demand for ambulatory services of physicians have been studied by researchers, but so far the effect of increased availability of nonwork time due to retirement on demand has not been examined. This study investigated whether discouraging early retirement (which was the intent of the 1983 Amendments to the Social Security Act) will reduce the use of medical services because persons who continue to work have less time than retirees for visits to doctors. This study found that, for men whose health does not interfere with work and who have had no in-hospital care in the study year, retirement does not increase the demand for ambulatory services when compared with being a part-time or full-time employee. However, compared with full-time self-employment, retirement increases the probability of using any physician services in the year by 14% and the number of physician visits by two visits. Although the self-employed have more control over their work time than employees, they may be more affected than employees by the loss of output and earnings associated with absence from the workplace.

Health as a Reason or a Rationalization for Being Retired

Many studies of the decision to retire have found that self-reported poor health increases the probability of retirement. Yet doubts have been expressed as to whether such reported deterioration in health is a reason rather than a socially acceptable justification for not working. This issue has important implications for public policy.

Cost Factors in Urban Telemedicine

This paper reports on the cost effectiveness of a pediatric primary care system utilizing nurse practitioners (NPs) linked to a physician consultant through bidirectional interactive cable television. In addition, it discusses ways in which multiple uses enhance the economic feasibility of a telemedicine consultation link in a given geographic area. The overall consultation rate during periods of remote physician coverage was 21 per cent, compared with 24 per cent during on-site coverage. The telephone became a partial substitute for the TV for some uses but could not replace it in diagnostic decisions. As telemedicine is obviously underutilized in a one-satellite system, we compare a five-satellite network with other ways of delivering service. The resulting estimated cost of

Interpersonal Understanding in the Elderly The Influence of Age-Integrated and Age-Segregated Housing

18.50 an hour, or 2/3 of the cost of a physician providing direct care, includes a TV component of

Financing fertility-related health services in the United States, 1972-1973: a preliminary projection.

5.30 an hour of use in a 1,750-hour year. The critical factor is that the NP can be a physician substitute if there is TV backup. The TV appears to prevent unnecessary referrals compared to a physician on site. Whether TV increases the length of the consult compared to the phone for conditions of equal severity is not entirely clear. If TV is compared to transporting a patient to a central place, the implicit value of transport time and disutility required to justify using TV is

The long-term care marketplace: an analysis of deficiencies and potential reform by means of incentive reimbursement.

7.55 per consult in a five-clinic network. Geographic and other barriers to physician availability enhance the potential for application of telemedicine.

Reproductive efficiency as a social indicator.

The present study examined the effects of self-selected age-segregated and age-integrated housing conditions on levels of interpersonal understanding (i.e., social perspectivism) among women 65 to 74 years and 75 and older. A third group of women, 40 to 49 years, was studied in order to establish a middle-aged comparison group. The central findings were that subjects from age-integrated housing had significantly higher levels of interpersonal understanding than subjects from age-segregated housing, and the younger group of elderly subjects had significantly higher levels of interpersonal understanding than the older group.

Capital expenditures and the availability of funds.

2 debates over national policy are currently underway: 1) a major review of the national policies has been demanded by virtually all segments of the American people; and 2) an evaluation has been undertaken of policies which influence the growth of U.S. population, of the kinds of changes in population growth, and distribution which would be socially and economically desirable, and of the means available and acceptable to bring about the desired changes. Crucial to these policy discussions are the nature and scope of health services. This article d escribes preliminary research to estimate the costs to U.S. society of f ertility-related health services. Fertility control through voluntary sterilization, contraception, pregnancy termination, and medical treatment of infertility make up 1 group of services; maternity care forms a 2nd group; and pediatric care is a 3rd essential service. It is clear from this study that many fertility-related health services are not covered by private health plans and that additional expenditure is needed to upgrade hospital services and improve health care. The study also raises questions about deficits in service to people who are not re ached by the medical care system at all and those who receive care of low quality. Women, especially those in the low-income bracket, need more aid. The range of costs shown here suggests that comprehensive financing of fertility-related health services is well within the nations fiscal capabilities.