Yunwei Gai

Relationship between local family physician supply and influenza vaccination after controlling for individual and neighborhood effects

BACKGROUND Family physicians (FPs) play an important role in influenza vaccination. We investigated how local FP supply is associated with influenza vaccination, controlling for both individual-level and county-level characteristics. METHODS The 2008-2010 individual-level data from the Behavioral Risk Factor Surveillance System were merged with county-level data from the Area Resource File (n = 985,157). Multivariate logistic analyses were performed to predict influenza vaccination using the number of FPs per 1000 population as the key predictor, adjusting for individual-level demographic, socioeconomic, and health information, as well as county-level racial composition and income level. Additional analyses were performed across racial/ethnic and employment status categories. RESULTS Increasing local FP supply was associated with higher odds (adjusted odds ratio [aOR], 1.58; 95% confidence interval [CI], 1.49-1.67) and varied across racial/ethnic groups (Hispanic: aOR, 2.05, 95% CI, 1.55-2.72; non-Hispanic white: aOR, 1.57, 95% CI, 1.48-1.66; non-Hispanic black: aOR, 1.49, 95% CI, 1.18-1.89), employment status categories, and county types. CONCLUSIONS FP supply was significantly associated with influenza vaccination. The association was greatest among those who were Hispanic, residing in a rural area, or out of work. Our findings lend support to initiatives aimed at increasing the FP supply, particularly among disadvantaged populations.

Limited Access to Healthcare among Hispanics in the US-Mexico Border Region.

OBJECTIVE Using large national databases, we investigated how living in the US-Mexico border region further limited access to healthcare among the non-elderly Hispanic adult population after controlling individual and county-level characteristics. METHODS The 2008-2012 individual-level data of non-elderly Hispanic adults from the Behavioral Risk Factor Surveillance System (BRFSS) were merged with county-level data from Area Health Resources File (AHRF). Multivariate logistic analyses were performed to predict insurance status and access to doctors using residency in the US-Mexico border region as the key predictor, adjusting individual and county-level factors. RESULTS Controlling only individual characteristic, Hispanics living in the US-Mexico border region had significantly lower odds of having health insurance (adjusted odds ratio [AOR] = 0.51; 95% confidence interval [CI], 0.49-0.54) and access to doctors (AOR = 0.69; 95% CI, 0.66-0.72). After including county-level measurements of healthcare system capacity and other local characteristics, the border region continued to be associated with lower likelihood of healthcare access. CONCLUSION Hispanic residents in the U.S.-Mexico border had less access to healthcare than their inland counterparts. The findings highlight unique features in this region and support policies and initiatives to improve minority healthcare access, particularly among disadvantaged populations in this region.

Health Insurance, Job Lock, and the Supply of Self‐Employment

Unlike most wage earners, self‐employed Americans have limited access to health insurance and face higher costs. Thus, social commentators and policymakers argue that many potential entrepreneurs are “locked” into their current jobs for fear of losing their health coverage even though they could be more productive in self‐employment. Using a large data set for the period 2000–2008, we find the availability of employer‐provided health insurance to be negatively correlated to the likelihood of self‐employment in the long run, but the effect to be mediated by individual and family health status. However, we find employer‐provided health insurance to have no significant effect on the probability of switching in the short run. Finally, we find differences in the magnitude of the effects between our samples of husbands and wives.

Factors associated with first-time use of preventive services in the United States.

OBJECTIVE To examine factors associated with first-time use of preventive services based on the Behavioral Model of Health Services Use. METHODS Nine panels of the Medical Expenditure Panel Survey were merged to identify first-time users of 8 preventive services: blood pressure check, cholesterol screening, colonoscopy, flu vaccination, routine physical, Pap smear, mammogram, and clinical breast examination. Multivariate logistic regressions and sample weights were used. RESULTS Insurance coverage, access to care, and racial/ethnic minorities are associated with higher odds of first-time use. Findings based on cross-sectional data may not be valid for first-time use. CONCLUSIONS Increased insurance coverage, better access to care, and a focus on minority population can help nonusers of preventive care to make the transition.

Patterns of Representation in WTO Committee Chairs, 1995–2012

This paper sets out to examine the pattern of WTO committee chair appointments by nationality since the WTOs founding in 1995. Chairs of the General Council (GC), subsidiary and negotiating committees play important roles in the outcome of trade negotiations and in administrative and implementation issues in Geneva. The GC selects most committee chairs, and must consider the balance of member representation and the quality of the candidates in its choices. Regression results indicate that the selection of a chair by nationality generally reflects the countrys mission size in Geneva, the countrys years of experience as a WTO member, and its economic interests in trade. The experience of individuals and continuity in committee leadership also appear to play important roles. Among developing countries, emerging markets (EMs) tend to have the largest proportional representation. The GC thus appears to follow a human capital model of chair selection, geographical constraints and especially development status balance considerations. Continued investments among all WTO members, but especially EM and other developing countries, in WTO representation and leadership capacity will be required in order to promote multilateral trade liberalization in the future.