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Twelve-Month Outcomes of a Group-Randomized Community Health Advocate-Led Smoking Cessation Intervention in Public Housing
Lower rates of smoking cessation are a major reason for the higher prevalence of smoking among socioeconomically disadvantaged adults. Because barriers to quitting are both more numerous and severe, socioeconomically disadvantaged smokers may benefit from more intensive intervention. We sought to determine whether a smoking cessation intervention delivered by public housing residents trained as Tobacco Treatment Advocates (TTAs) could increase utilization of cessation resources and increase abstinence.
We conducted a group-randomized trial among Boston public housing residents who were interested in quitting smoking. Participants at control sites received standard cessation materials and a one-time visit from a TTA who provided basic counseling and information about cessation resources. Participants at intervention sites were eligible for multiple visits by a TTA who employed motivational interviewing, cessation counseling, and navigation to encourage smokers to utilize cessation treatment (Smokers' Quitline and clinic-based programs). Utilization and 7-day and 30-day point prevalence abstinence were assessed at 12 months. Self-reported abstinence was biochemically verified.
Intervention participants (n = 121) were more likely than control participants (n = 129) to both utilize treatment programs (adjusted odds ratio [aOR]: 2.15; 95% confidence interval [CI]: 0.93-4.91) and 7-day and 30-day point prevalence abstinence (aOR: 2.60 (1.72-3.94); 2.98 (1.56-5.68), respectively). Mediation analysis indicated that the higher level of utilization did not explain the intervention effect.
An intervention delivered by peer health advocates was able to increase utilization of treatment programs and smoking abstinence among public housing residents. Future studies of similar types of interventions should identify the key mechanisms responsible for success.
In order to narrow the large and growing socioeconomic disparity in smoking rates, more effective cessation interventions are needed for low-income smokers. Individual culturally-relevant coaching provided in smokers' residences may help overcome the heightened barriers to cessation experienced by this group of smokers. In this study among smokers residing in public housing, an intervention delivered by peer health advocates trained in motivational interviewing, basic smoking cessation skills, and client navigation significantly increased abstinence at 12 months. Future research should address whether these findings are replicable in other settings both within and outside of public housing.
Journal Article
Lectures on public economics
\"This classic introduction to public finance remains the best advanced-level textbook on the subject ever written. First published in 1980, Lectures on Public Economics still tops reading lists at many leading universities despite the fact that the book has been out of print for years. This new edition makes it readily available again to a new generation of students and practitioners in public economics.The lectures presented here examine the behavioral responses of households and firms to tax changes. Topics include the effects of taxation on labor supply, savings, risk-taking, the firm, debt, and economic growth. The book then delves into normative questions such as the design of tax systems, optimal taxation, public sector pricing, and public goods, including local public goods.Written by two of the world's preeminent economists, this edition of Lectures on Public Economics features a new introduction by Anthony Atkinson and Joseph Stiglitz that discusses the latest developments in the field and areas for future research. The definitive advanced-level textbook on public economics Examines the effects of taxation on households and firms Covers tax system design, optimal taxation, public sector pricing, and more Includes suggestions for further reading Additional resources available online \"-- Provided by publisher.
Book
Public Spending and Democracy in Classical Athens
In his On the Glory of Athens, Plutarch complained that the Athenian people spent more on the production of dramatic festivals and \"the misfortunes of Medeas and Electras than they did on maintaining their empire and fighting for their liberty against the Persians.\" This view of the Athenians' misplaced priorities became orthodoxy with the publication of August Böckh's 1817 book Die Staatshaushaltung der Athener [The Public Economy of Athens], which criticized the classical Athenian dēmos for spending more on festivals than on wars and for levying unjust taxes to pay for their bloated government. But were the Athenians' priorities really as misplaced as ancient and modern historians believed?Drawing on lines of evidence not available in Böckh's time, Public Spending and Democracy in Classical Athens calculates the real costs of religion, politics, and war to settle the long-standing debate about what the ancient Athenians valued most highly. David M. Pritchard explains that, in Athenian democracy, voters had full control over public spending. When they voted for a bill, they always knew its cost and how much they normally spent on such bills. Therefore, the sums they chose to spend on festivals, politics, and the armed forces reflected the order of the priorities that they had set for their state. By calculating these sums, Pritchard convincingly demonstrates that it was not religion or politics but war that was the overriding priority of the Athenian people.
eBook
Tax Systems
Despite its theoretical elegance, the standard optimal tax model has significant limitations. In this book, Joel Slemrod and Christian Gillitzer argue that tax analysis must move beyond the emphasis on optimal tax rates and bases to consider such aspects of taxation as administration, compliance, and remittance. Slemrod and Gillitzer explore what they term a tax-systems approach, which takes tax evasion seriously; revisits the issue of remittance, or who writes the check to cover tax liability (employer or employee, retailer or consumer); incorporates administrative and compliance costs; recognizes a range of behavioral responses to tax rates; considers nonstandard instruments, including tax base breadth and enforcement effort; and acknowledges that tighter enforcement is sometimes a more socially desirable way to raise revenue than an increase in statutory tax rates. Policy makers, Slemrod and Gillitzer argue, would be well advised to recognize the interrelationship of tax rates, bases, enforcement, and administration, and acknowledge that tax policy is really tax-systems policy.
eBook
Technical Efficiency of Public and Private Hospitals in Beijing, China: A Comparative Study
Objective: With the participation of private hospitals in the health system, improving hospital efficiency becomes more important. This study aimed to evaluate the technical efficiency of public and private hospitals in Beijing, China, and analyze the influencing factors of hospitals’ technical efficiency, and thus provide policy implications to improve the efficiency of public and private hospitals. Method: This study used a data set of 154–232 hospitals from “Beijing’s Health and Family Planning Statistical Yearbooks” in 2012–2017. The data envelopment analysis (DEA) model was employed to measure technical efficiency. The propensity score matching (PSM) method was used for matching “post-randomization” to directly compare the efficiency of public and private hospitals, and the Tobit regression was conducted to analyze the influencing factors of technical efficiency in public and private hospitals. Results: The technical efficiency, pure technical efficiency and scale efficiency of public hospitals were higher than those of private hospitals during 2012–2017. After matching propensity scores, although the scale efficiency of public hospitals remained higher than that of their private counterparts, the pure technical efficiency of public hospitals was lower than that of private hospitals. Panel Tobit regression indicated that many hospital characteristics such as service type, level, and governance body affected public hospitals’ efficiency, while only the geographical location had an impact on private hospitals’ efficiency. For public hospitals in Beijing, those with lower average outpatient and inpatient costs per capita had better performance in technical efficiency, and bed occupancy rate, annual visits per doctor, and the ratio of doctors to nurses also showed a positive sign with technical efficiency. For private hospitals, the average length of stay was negatively associated with technical efficiency, but the bed occupancy rate, annual visits per doctor, and average outpatient cost were positively associated with technical efficiency. Conclusions: To improve technical efficiency, public hospitals should focus on improving the management standards, including the rational structure of doctors and nurses as well as appropriate reduction of hospitalization expenses. Private hospitals should expand their scale with proper restructuring, mergers, and acquisitions, and pay special attention to shortening the average length of stay and increasing the bed occupancy rate.
Journal Article
The public wealth of nations : how management of public assets can boost or bust economic growth
\"When you look around the world it's almost as if Thatcher/Reagan economic revolution never happened. The largest pool of wealth in the world - a global total that is twice the world's total pension savings, and ten times the total of all the sovereign wealth funds on the planet - is still comprised of commercial assets that are held in public ownership. And yet, while this is the largest pool of assets in the world, is also one of the murkiest - what goes on inside them is often not even properly known by the governments who own them. In most countries this vast portfolio is both a fiscal and political burden on society. If professionally managed it could generate an annual yield of 2.7 trillion dollars, more than current global spending on infrastructure: transport, power, water and communications. While traditional state control of assets has often proved inefficient, privatization is not always a panacea, as it offers opportunities for quick enrichment, crony capitalism, outright corruption, or dysfunctional regulation. To privatise or nationalise is simply the wrong argument. What matters is whether those assets are managed effectively - in a way that can generate a return that can fund the much needed investments in infrastructure that will boost overall economic growth. Based on both economic research and hands-on experience from many countries, the authors argue that publicly owned commercial assets need to be taken out of the direct and distorting control of politicians and placed under professional management in a 'National Wealth Fund'. Such a move would trigger much needed structural reforms in national economies, thus resurrect strained government finances, bolster ailing economic growth and improve the fabric of democratic institutions. \"-- Provided by publisher.
Book
Establishing reference costs for the health benefit packages under universal health coverage in India: cost of health services in India (CHSI) protocol
IntroductionTo achieve universal health coverage, the Government of India has introduced Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB - PMJAY), a large tax-funded national health insurance scheme for the provision of secondary and tertiary care services in public and private hospitals. AB - PMJAY reimburses care for 1573 health benefit packages (HBPs). HBPs are designed to cover the treatment of diseases/conditions with high incidence/prevalence or which contribute to high out-of-pocket expenditure. However, there is a dearth of reference cost data against which provider payment rates can be assessed.Methods and analysisThe CHSI (Cost of Health Services in India) study will collect cost data from 13 Indian states covering 52 public and 40 private hospitals, using a mixed economic costing methodology (top-down and bottom-up), to generate unit costs for the HBPs. States will be sampled to capture economic status, development indicators and health service utilisation heterogeneity. The public sector hospitals will be chosen at secondary and tertiary care level. One tertiary facility will be selected from each state. At secondary level, three districts per state will be selected randomly from the district composite development score ranking. The private sector hospital sample will be stratified by nature of ownership (for-profit and not-for-profit), type of city (tier 1, 2 or 3) and size of the hospital (number of beds). Average costs for each HBP will be calculated across the different facility types. Multiple scenarios will be used to suggest rates which could be negotiated with the providers. Overall, the study will provide economic cost data for price setting, strategic purchasing, health technology assessment and a national cost database of India.Ethics and disseminationThe approval has been obtained from the Institutional Ethics Committee and Institutional Collaborative Committee of the Post Graduate Institute of Medical Education and Research, Chandigarh, India. The results shall be disseminated in conferences and peer-reviewed articles.
Journal Article