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Poor birth and infant outcomes and pronounced racial disparities persist in Allegheny County, Pennsylvania, despite robust maternal and child health and social service systems. The authors use predictive models of which interventions women are likely to participate in, develop a causal inference framework to estimate the effectiveness of those interventions, and reveal how that effectiveness varies for women with different risk and other factors.
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In 2020, the Immediate Office of the Secretary of the Department of Health and Human Services (HHS) sought to identify measures that could improve the ability of the United States and other countries to learn from international comparisons of health system performance. To inform the identification of measures for international comparison that could eventually be proposed to the Organisation for Economic Co-operation and Development (OECD), RAND Corporation researchers worked with a diverse group of 15 experts in quality measurement, clinical care, and health economics to generate and prioritize potential measure constructs that align with HHS priorities and are particularly promising for international comparisons. Eight measure constructs were identified as having the most promise for international comparison, but they will require additional development work to establish their operational definitions and specifications to ensure that any measure developed is valid and feasible for international comparisons of health system performance. This report is designed to lay a strong foundation for these future refinements by noting the degree of consensus among experts about the importance, scientific acceptability, perceived feasibility, and usability of measure constructs; summarizing the strengths and limitations of the measure constructs; and providing additional context that can be useful for informing the selection of measure constructs that might ultimately be developed into measures and proposed to OECD for consideration.
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The farm household model, in which decisions about production and consumption are made simultaneously, lies at the heart of many models of development. Empirically modelling these simultaneous choices is not straightforward. The vast majority of empirical studies assume that farm households behave as if markets are complete in which case decision-making simplifies to a recursive system where consumption choices can be treated as if they are made after all production decisions. Previous empirical tests of this assumption have relied on restrictions on production decisions. We develop a new approach to testing based on household consumption choices and implement the procedure using data from rural Indonesia. Relative to production-side tests, the consumption-based test is well-suited to identifying those farm households in any setting whose behavior is consistent with complete markets and those for whom the assumption is rejected. We find the recursion assumption is not rejected for larger farmers but is rejected for small farmers. The tests are straightforward to implement and the results of the tests provide new opportunities to identify the behaviors that households adopt in the face of incomplete markets.
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With the goal of creating job opportunities that would otherwise not exist, many states, including Pennsylvania, have attracted film production by offering competing incentives that lower costs. Although Pennsylvania's Film Production Tax Credit (FPTC) has attracted film productions to Pennsylvania and, specifically, to Pittsburgh, the economic contribution of the resulting industry and the factors restricting or catalyzing the industry's growth are unclear. In addition, there remains uncertainty around how Pennsylvania, specifically, can remain competitive in attracting film productions and what resources may enhance the growth of the film industry in the state. To address these uncertainties and inform future policy debates, the authors of this report conducted a mixed-methods study consisting of an environmental scan, semi-structured interviews, and quantitative analysis. The findings of this study describe a nuanced picture in four areas: (1) the filming location decision, (2) the economic contribution of the film industry, (3) the film industry workforce, and (4) state film policy. Drawing on these findings, the authors discuss their broader implications and recommend strategies to retain or enhance the competitiveness of the film industry in Pennsylvania. The results and recommendations of this report are intended to inform the decisionmaking of stakeholders both at the state level (including state legislators and government officials) and at the local level (including officials in the state's film offices, city and county economic development offices, local workforce development boards, and local educational institutions).
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Despite efforts to address the opioid crisis, opioid-related overdoses remain a significant contributor to mortality. State efforts to reduce overdose deaths by removing barriers to naloxone have recently focused on pharmacy channels, but the specifics of these laws and the contexts in which they are implemented vary widely. In this paper, we use novel methods robust to heterogeneous effects across states and time-varying policy effects to estimate the effects on naloxone pharmacy distribution of two types of laws: laws authorizing non-patient-specific prescription distribution of naloxone and laws granting pharmacists prescriptive authority for naloxone. We find that both types of laws significantly increase the volume of naloxone dispensed through pharmacies. However, relative to laws authorizing non-patient-specific prescription distribution, effects are significantly larger for pharmacist prescriptive authority laws. These larger effects only partially derive from increased naloxone prescribing by pharmacists. We also estimate large, significant increases in pharmacy dispensation of naloxone prescribed by non-pharmacist prescribers, with particularly large increases among family medicine physicians, with particularly large increases among family medicine physicians. The relative benefits of pharmacist prescriptive authority laws versus non-patient-specific distribution are larger among Non-Hispanic Black individuals, suggesting an important role of these policies for reducing disparities in access to naloxone.
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"U.S. Department of Defense (DoD) spending on private-sector services has increased steadily over the past several decades to more than 60 percent of its overall budget. This growth has led to greater congressional interest in DoD's contracting practices, including the number of contracts for inherently governmental functions, contract management, contractor accountability, and contract waste, fraud, and abuse. Specifically, it has sought more oversight of the services purchased and the labor used to provide them, with the goal of increasing DoD's buying leverage and improving contractor performance. In 2008, legislation mandated the development of the DoD Inventory of Contracted Services (ICS), a database to collect information on the activities performed under DoD service contracts. Since that time, Congress has expressed concern about the methods DoD uses to collect this information and whether the ICS is useful to policymakers and DoD stakeholders. RAND was asked to conduct the congressionally mandated review of the system's data, gaps between the ICS data and congressional and other stakeholder needs, and whether the same or more useful information could be obtained from other sources. The study also included an assessment of legislative intent in mandating DoD to establish the ICS, a detailed evaluation of the current ICS metrics and data collection procedures, the development of alternative metrics drawing on different data sources, and illustrative analyses testing the validity of these alternative metrics and their corresponding data outputs."--Publisher's description.
Defense contracts --- Public contracts --- Contracting out --- Inventories --- Management. --- United States. --- Procurement --- Evaluation.
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