Effect of child care subsidies on price and quality of care for low -income families

This dissertation examines the effect of regulations, resource and referral agencies, and subsidies on price and quality of care in child care centers. This research is based on a carefully developed conceptual framework that incorporates the factors affecting the demand and supply of child care. The first step in developing this framework is sketching out the structural equations. The structural equations help us understand the underlying behavior of individuals and firms making a decision. The exogenous variables are vector of attributes relating to family characteristics, child characteristics, regulations, subsidy, community characteristics and prices of inputs. Based on the structural equations, reduced form equations are estimated to find the effect of each of the exogenous variables on each of the endogenous variables. Reduced form equations help us answer public policy questions. The sample for this study is from the 1990 Profile of Child Care Settings (PCCS) data in which 2,089 center based programs were interviewed. Child/Staff Ratio (Group Level): Results indicate that among subsidies, only the state subsidy per child in poverty has a significant effect on the child/staff ratio at the group level. Presence of resource and referral agencies also increase the child/staff ratio at the group level. Also when the maximum center group size regulation for 25-36 months becomes more stringent, the child/staff ratio at the group level decreases. Child/Staff Ratio (Center Level): When the regulations for the maximum child/staff ratio for age groups 13-24 months and 37-60 months become lax, the child/staff ratio for the center increases. As the regulation for maximum group size for infants becomes stringent, the child/staff ratio decreases. An interesting finding is that as the regulations for maximum group size for age groups 13-24 months and 25-36 months become stringent, the child/staff ratio for the center increases. Another significant finding is that when a center is located in a rural area the child/staff ratio is significantly lower. Center Weighted Average Hourly Fees: Maximum group size regulations for age groups 25-36 months and 37-60 months have a negative effect on center hourly fee. Maximum child staff regulations for age groups 13-24 months and 37-60 months have a negative effect on center hourly fee. Maximum child staff regulations for age groups 0-12 months and 25-36 months have a positive effect on center hourly fee. Findings also indicate that the center average hourly price is lower when there is a resource and referral agency present. Cost adjusted prekindergarten funds and JOBS child care subsidies have a negative effect on average hourly fee. Cost adjusted social services block grant and state subsidy per child in poverty have a positive effect on the average hourly price. A major finding of this dissertation is the interaction of subsidy and regulatory variables. Another major finding is that child/staff ratio at the group level is lower when there is an interaction between geographic location and nature of center sponsorship.

The impact of income and social status on population health: a scenario based simulation for nursing students

The development of critical thinking and communication skills is an essential part of Baccalaureate and Practical Nursing education. Scenario-based simulation, a form of experiential learning, directly engages students in the learning process. This teaching learning method has been shown to increase students’ understanding of the influence of their personal beliefs and values when working with clients and to improve therapeutic communication and critical thinking skills. Students in both the BN (Collaborative) and PN Programs at the Centre for Nursing Studies demonstrate a strong theoretical understanding of the impact of income and social status on population health but often experience difficulty applying this knowledge to the clinical situations involving clients and families. The purpose of the project was to develop a scenario-based simulation activity to provide nursing students with first-hand experiences of the impact of income and social status on health service accessibility. A literature review and stakeholder consultations were conducted to inform the project. The findings of these initiatives and Kolb’s Experiential Learning Theory were used to guide all aspects of the project. This report is an account of how the income and social status simulation and its accompanying materials were developed. This project provided an excellent learning opportunity that demonstrated the use of advanced nursing competencies.

Essays on the Role of Government Incentives in the Private Provision of Social Goods

The economic rationale for public intervention into private markets through price mechanisms is twofold: to correct market failures and to redistribute resources. Financial incentives are one such price mechanism. In this dissertation, I specifically address the role of financial incentives in providing social goods in two separate contexts: a redistributive policy that enables low income working families to access affordable childcare in the US and an experimental pay-for-performance intervention to improve population health outcomes in rural India. In the first two papers, I investigate the effects of government incentives for providing grandchild care on grandmothers’ short- and long-term outcomes. In the third paper, coauthored with Manoj Mohanan, Grant Miller, Katherine Donato, and Marcos Vera-Hernandez, we use an experimental framework to consider the the effects of financial incentives in improving maternal and child health outcomes in the Indian state of Karnataka.

Grandmothers provide a significant amount of childcare in the US, but little is known about how this informal, and often uncompensated, time transfer impacts their economic and health outcomes. The first two chapters of this dissertation address the impact of federally funded, state-level means-tested programs that compensate grandparent-provided childcare on the retirement security of older women, an economically vulnerable group of considerable policy interest. I use the variation in the availability and generosity of childcare subsidies to model the effect of government payments for grandchild care on grandmothers’ time use, income, earnings, interfamily transfers, and health outcomes. After establishing that more generous government payments induce grandmothers to provide more hours of childcare, I find that grandmothers adjust their behavior by reducing their formal labor supply and earnings. Grandmothers make up for lost earnings by claiming Social Security earlier, increasing their reliance on Supplemental Security Income (SSI) and reducing financial transfers to their children. While the policy does not appear to negatively impact grandmothers’ immediate economic well-being, there are significant costs to the state, in terms of both up-front costs for care payments and long-term costs as a result of grandmothers’ increased reliance on social insurance.

The final paper, The Role of Non-Cognitive Traits in Response to Financial Incentives: Evidence from a Randomized Control Trial of Obstetrics Care Providers in India, is coauthored with Manoj Mohanan, Grant Miller, Katherine Donato and Marcos Vera-Hernandez. We report the results from “Improving Maternal and Child Health in India: Evaluating Demand and Supply Side Strategies” (IMACHINE), a randomized controlled experiment designed to test the effectiveness of supply-side incentives for private obstetrics care providers in rural Karnataka, India. In particular, the experimental design compares two different types of incentives: (1) those based on the quality of inputs providers offer their patients (inputs contracts) and (2) those based on the reduction of incidence of four adverse maternal and neonatal health outcomes (outcomes contracts). Along with studying the relative effectiveness of the different financial incentives, we also investigate the role of provider characteristics, preferences, expectations and non-cognitive traits in mitigating the effects of incentive contracts.

We find that both contract types input incentive contracts reduce rates of post-partum hemorrhage, the leading cause of maternal mortality in India by about 20%. We also find some evidence of multitasking as output incentive contract providers reduce the level of postnatal newborn care received by their patients. We find that patient health improvements in response to both contract types are concentrated among higher trained providers. We find improvements in patient care to be concentrated among the lower trained providers. Contrary to our expectations, we also find improvements in patient health to be concentrated among the most risk averse providers, while more patient providers respond relatively little to the incentives, and these difference are most evident in the outputs contract arm. The results are opposite for patient care outcomes; risk averse providers have significantly lower rates of patient care and more patient providers provide higher quality care in response to the outputs contract. We find evidence that overconfidence among providers about their expectations about possible improvements reduces the effectiveness of both types of incentive contracts for improving both patient outcomes and patient care. Finally, we find no heterogeneous response based on non-cognitive traits.

Exploring Perceptions of Middle Class Urban Indian Women Regarding Socio-Cultural Deterrents Influencing Participation in Adult and Continuing Educational Programs

Unlike its childhood counterpart, adult and continuing education is a voluntary activity, where adult learners partake in educational programs for the sake of realizing some explicit or implicit goal. The purpose of this study was to explore the association between socio-cultural influences and deterrents to participation of middle class urban Indian women in adult and continuing educational programs. Darkenwald and Merriam’s (1982) theory of non-participation was selected as the theoretical lens used to guide this study. This study involved collecting qualitative data to analyze participant views and was collected through 16 semi-structured interviews to explore participants’ individual perceptions concerning socio-cultural deterrents influencing participation of middle class urban Indian women in adult and continuing educational programs. Qualitative data were analyzed to discover emerging themes and sub-themes. In the second phase of the study, a modified Deterrent to Participation Scale – General (DPS-G) was used to measure data collected from the surveys completed by participants, that included specific demographic questions. Descriptive statistics were used to examine the relationships between the demographic questions and the deterrent identified on the DPS-G. The interview and survey data were used convergently to understand the relationship between socio-cultural influences and deterrents impacting participant participation in adult and continuing educational programs. The findings of the study indicated that the biggest socio-cultural influence deterring participation among middle class urban Indian women in adult and continuing educational programs is marriage. It is an Indian social norm that comes with a set of pre-defined roles and expectations, and married women find themselves consumed by fulfilling the marital and familial expectations and responsibilities and participation in adult and continuing educational program is furthest from their mind. Middle class urban Indian women do realize the importance of educational pursuits, but do not feel that they can, after marriage. They are open, however, to pursuing adult educational programs in the form of short-term skill development programs leading to income generation, although they would lead primarily to home-based work enterprises.

Clinical Outcomes in 3343 Children and Adults with Rheumatic Heart Disease from 14 Low and Middle Income Countries: 2-Year Follow-up of the Global Rheumatic Heart Disease Registry (the REMEDY study)

BACKGROUND: -There are few contemporary data on the mortality and morbidity associated with rheumatic heart disease (RHD) or information on their predictors. We report the two year follow-up of individuals with RHD from 14 low and middle income countries in Africa and Asia.

METHODS: -Between January 2010 and November 2012, we enrolled 3343 patients from 25 centers in 14 countries and followed them for two years to assess mortality, congestive heart failure (CHF), stroke or transient ischemic attack (TIA), recurrent acute rheumatic fever (ARF), and infective endocarditis (IE).

RESULTS: -Vital status at 24 months was known for 2960 (88.5%) patients. Two thirds were female. Although patients were young (median age 28 years, interquartile range 18 to 40), the two year case fatality rate was high (500 deaths, 16.9%). Mortality rate was 116.3/1000 patient-years in the first year and 65.4/1000 patient-years in the second year. Median age at death was 28.7 years. Independent predictors of death were severe valve disease (hazard ratio (HR) 2.36, 95% confidence interval (CI) 1.80-3.11), CHF (HR 2.16, 95% CI 1.70-2.72), New York Heart Association functional class III/IV (HR 1.67, 95% CI 1.32-2.10), atrial fibrillation (AF) (HR 1.40, 95% CI 1.10-1.78) and older age (HR 1.02, 95% CI 1.01-1.02 per year increase) at enrolment. Post-primary education (HR 0.67, 95% CI 0.54-0.85) and female sex (HR 0.65, 95%CI 0.52-0.80) were associated with lower risk of death. 204 (6.9%) had new CHF (incidence, 38.42/1000 patient-years), 46 (1.6%) had a stroke or TIA (8.45/1000 patient-years), 19 (0.6%) had ARF (3.49/1000 patient-years), and 20 (0.7%) had IE (3.65/1000 patient-years). Previous stroke and older age were independent predictors of stroke/TIA or systemic embolism. Patients from low and lower-middle income countries had significantly higher age- and sex-adjusted mortality compared to patients from upper-middle income countries. Valve surgery was significantly more common in upper-middle income than in lower-middle- or low-income countries.

CONCLUSIONS: -Patients with clinical RHD have high mortality and morbidity despite being young; those from low and lower-middle income countries had a poorer prognosis associated with advanced disease and low education. Programs focused on early detection and treatment of clinical RHD are required to improve outcomes.

A descentralização das políticas de desenvolvimento rural: uma análise da experiência do Rio Grande do Norte

MATOS FILHO, João. A descentralização das Políticas de desenvolvimento rural - uma análise da experiência do Rio Grande do Norte. 2002. 259f. Tese (Doutorado em Ciências Econômicas)– Instituto de Economia da Universidade Estadual de Campinas, Campinas, 2002.

Iowa Highway Programs, Finances, and Progress, 1951

(a) Iowa has a total of 101,620 miles of rural roads, both primary and secondary. (b) On January 1, 1951, a total of 68,869 miles of these rural roads were surfaced - mostly with gravel and crushed stone. (c) Additional roads are being surfaced at the rate of 2676 miles per year. (d) Iowa's highway program provides for a surfaced road to every reasonably located rural home and a paved or other type of dustless surface on all primary roads. (e) Iowa's highway funds come 26.0 per cent from property taxes, 63.5 per cent from road use taxes, 10.5 per cent from Federal aid. (f) Annual income under present laws, available for highway construction, is approximately For primary roads ----------------- $24,000,000 For secondary roads---------------- $41,967,000 (g) Iowa's highway improvements are being paid for as built. No new bonds are being issued. (h) Unobligated available farm to market road funds are rapidly being placed under contract. (i) The letting of highway contracts is increasing rapidly. (j)- Iowa's highway program is estimated to cost $945,000,000 and will require twenty years to build. These are the highlights of Iowa's highway program. The details will follow in succeeding paragraphs.

Iowa Highway Programs, Finances, and Progress, 1952

(a) Iowa has a total of 101,620 miles of rural roads, both primary and secondary. (b) On January 1, 1952, a total of 71,493 miles of these rural roads were surfaced - mostly with gravel and crushed stone. (c) Additional roads are being surfaced at the rate of 2662 miles per year. (d) Iowa's highway program provides for a surfaced road to every reasonably located rural home and a paved or other type of dustless surface on all primary roads. (e) Iowa's highway funds come 26.0 per cent from property taxes, 63.5 per cent from road use taxes, 10.5 per cent from Federal aid. (f) Annual income under present laws, available for highway construction, is approximately For primary roads------------------$23,000,000 For secondary roads---------------- 41,967,000 (g) Iowa's highway improvements are being paid for as built. No new bonds are being issued. (h) The surplus of farm to market road funds created during and immediately following the War have now been placed under contract, with only a minimum working balance remaining in the fund. (i) Iowa's highway program was estimated to cost $945,000,000 and to require twenty years to build, by the 1948 Legislative Committee. This estimate would now have to be increased due to price increases and higher required standards. These are the highlights of Iowa's highway program. The details will follow in succeeding paragraphs.

The Effect of Marine Protected Areas on Fishers' Income in the Philippines

The fisheries sector is vital to the Philippine economy, providing substantial employment and income, contributing export earnings, and meeting local food security and nutrition requirements. To protect coastal and marine habitat and to sustain fisheries, over 1000 marine protected areas (MPAs) have been established, in the Philippines. This paper provides empirical evidence on the variance of net revenues linked with MPA establishment and the possible range of relocation costs for fishing effort displaced by an MPA. A total of 424 households were randomly selected from 18 barangays (villages) adjacent to MPAs in three regions in the Philippines. Results show that incomes decrease significantly for both fulltime and seasonal types of fishers after 1-3 years of MPA establishment. The loss occurring through MPA is higher than expected and at least on the short run (up to 4 years) the spill-over effect does not compensate. This information helped to determine the necessary conditional cash transfers for coastal communities who are highly dependent on coastal and marine resources.

A descentralização das políticas de desenvolvimento rural: uma análise da experiência do Rio Grande do Norte

MATOS FILHO, João. A descentralização das Políticas de desenvolvimento rural - uma análise da experiência do Rio Grande do Norte. 2002. 259f. Tese (Doutorado em Ciências Econômicas)– Instituto de Economia da Universidade Estadual de Campinas, Campinas, 2002.

Iowa Finance Authority Low-Income Housing Tax Credit Program 2007 Qualified Allocation Plan, April 3, 2008

As the Housing Credit Agency responsible for allocating Tax Credits in the State of Iowa, IFA must adopt a written Qualified Allocation Plan (QAP). The purpose of the QAP is to set forth the criteria that IFA will use in evaluating and monitoring Projects submitted to it by the Developer/Ownership Entity for consideration in making an allocation of Tax Credits. The Governor must approve the QAP after the public has had the opportunity to comment through a public hearing.

Iowa Finance Authority Low-Income Housing Tax Credit Program 2008 Qualified Allocation Plan, June 14, 2007

As the Housing Credit Agency responsible for allocating Tax Credits in the State of Iowa, IFA must adopt a written Qualified Allocation Plan (QAP). The purpose of the QAP is to set forth the criteria that IFA will use in evaluating and monitoring Projects submitted to it by the Developer/Ownership Entity for consideration in making an allocation of Tax Credits. The Governor must approve the QAP after the public has had the opportunity to comment through a public hearing.

Iowa Finance Authority Low-Income Housing Tax Credit Program 2009 First Amended Qualified Allocation Plan, February 10, 2012

As the Housing Credit Agency responsible for allocating Tax Credits in the State of Iowa, IFA must adopt a written Qualified Allocation Plan (QAP). The purpose of the QAP is to set forth the criteria that IFA will use in evaluating and monitoring Projects submitted to it by the Developer/Ownership Entity for consideration in making an allocation of Tax Credits. The Governor must approve the QAP after the public has had the opportunity to comment through a public hearing.

Iowa Finance Authority Low-Income Housing Tax Credit Program 2009 Second Amended Qualified Allocation Plan, October 14, 2008

As the Housing Credit Agency responsible for allocating Tax Credits in the State of Iowa, IFA must adopt a written Qualified Allocation Plan (QAP). The purpose of the QAP is to set forth the criteria that IFA will use in evaluating and monitoring Projects submitted to it by the Developer/Ownership Entity for consideration in making an allocation of Tax Credits. The Governor must approve the QAP after the public has had the opportunity to comment through a public hearing.

Iowa Finance Authority Low-Income Housing Tax Credit Program 2009 Qualified Allocation Plan, July 10, 2008

As the Housing Credit Agency responsible for allocating Tax Credits in the State of Iowa, IFA must adopt a written Qualified Allocation Plan (QAP). The purpose of the QAP is to set forth the criteria that IFA will use in evaluating and monitoring Projects submitted to it by the Developer/Ownership Entity for consideration in making an allocation of Tax Credits. The Governor must approve the QAP after the public has had the opportunity to comment through a public hearing.