The promise and limits of racial/ethnic concordance in physician-patient interaction

Although some scholars suggest that racial/ethnic concordance between physicians and patients will do much to eliminate disparities in medical care, the evidence for concordance effects is mixed. Using nationally representative data with an oversample of blacks and Latinos, this study examines a variety of topics, including beliefs about and preferences for concordance, the effects of concordance on patient experiences, and interactions between expectations and experiences. The results point to the limited effects of concordance in general but illuminate for whom concordance matters most. The results encourage more nuanced and contingent theories. They suggest that racial/ethnic concordance holds little salience in the minds of most black and Latino patients and that discordance has little effect. Nevertheless, there is some evidence that concordance has a positive effect among those who prefer concordance-thus the apparent effects of concordance might reflect the effects of patient choice more than concordance per se. The conclusion sketches policy implications, including the merits of promoting concordance among targeted groups of patients, even in the absence of overall effects on disparities.     

Medical care of individuals residing in substance abuse and recovery homes: an analysis of need and utilization

The current study examined medical care need and utilization patterns among a substance abusing and recovering population (n = 876), investigating factors such as employment and drug use categories (e.g., pharmaceutical use, cocaine use, heroin use, alcohol use). It was found that those who were unemployed needed and utilized greater medical care than those who were employed. Results indicated that heroin, cocaine, and/or alcohol use was not predictive of medical care need or utilization, whereas pharmaceutical drug use was predictive of medical care need and utilization. Trauma and risky use of substances were not significant predictors of medical care need or utilization whereas the suicide severity composite was significant. Potential implications for misuse of medical services (e.g., to obtain pharmaceutical drugs of use) and federal medical care expenditure allocation are discussed.     

Globalization, secessionism, and autonomy

This paper analyzes the relationship between the persistence and growth of secessionist parties in democratic countries and economic globalization, controlling for political and economic factors. The implications of secessionist persistence for decentralization are also examined. The paper finds that globalization is positively related to secessionist vote growth, while there is some evidence that economic conditions also impact secessionist parties in systematic ways. Secessionist support is also substantially affected by policy changes. Central governments have offered autonomy more often to regions with secessionist parties than to regions without such parties, though often the offers take the form of symmetrical countrywide decentralization.     

Narcissistic Features in Young Adolescents: Relations to Aggression and Internalizing Symptoms

Recent research and theory suggest narcissistic features contribute to aggression in adults. The present study examined the association of narcissistic features with aggression and internalizing symptoms in 233 students of 5th–8th grade at three inner-city schools. A factor analysis of the Narcissistic Personality Inventory in this sample revealed three factors: Adaptive Narcissism, Exploitativeness, and Exhibitionism. Regression analyses were used to predict the association of these three narcissistic features with self-, teacher-, and peer-reported aggression and self-reported internalizing symptoms. Results indicate narcissistic exploitativeness positively predicted self-reported proactive aggression, and narcissistic exhibitionism positively predicted internalizing symptoms. Narcissism and self-esteem interacted to predict teacher-reported aggression and self-reported internalizing symptoms. Results are discussed in the context of existing theories of narcissism, threatened egotism, and self-perception bias.     

Procedural Contexts, Party Strategy, and Conditional Party Voting in the U.S. House of Representatives, 1971–2000

In this article, we provide a critical review of the evidence and arguments about party polarization in the House of Representatives during the late 20th century. We show that inferences about party polarization are significantly affected by voting reform in the early 1970s. We observe that a decomposed roll-call record alters our view of the timing of changes in party polarization and therefore requires that we reconsider explanations of the trend. We revisit explanations of party polarization and establish a strong case for placing substantial emphasis on party strategies in explanations of party polarization in floor behavior during the 1980s and 1990s.     

Reexamining efficient rent-seeking in laboratory markets

Given Millner and Pratt's (1989) finding of behavior inconsistent with theory, we reexamine efficient rent-seeking in experimental markets. We show that (a) when r = 3, no Nash equilibrium exists and therefore behavior has no theoretical benchmark to judge consistency, and (b) when r = 1, with a new experimental design utilizing an explicit expected payoff matrix, rent-seeking behavior is consistent with both Nash equilibrium and dissipation hypotheses.The authors gratefully acknowledge the financial support of The John A. Walker College of Business, Appalachian State University. Cliff Nowell provided generous advice. John Willingham supplied valuable research assistance. Michael Pratt and Gordon Tullock provided helpful comments on an earlier version of the paper.     

Competitive-share group formation in rent-seeking contests

We examine the possibility of forming a competitive-share group in rent-seeking contests. The competitive-share group has the following characteristics: (a) the group is treated as a single player competing with the nonmembers to win the rent, (b) the members choose their outlays noncooperatively, and (c) the members compete to take larger shares of the rent. We show that the competitive-share group is always formed voluntarily. One important consequence of such group formation is that rent dissipation is less relative to individual rent seeking — in other words, the social cost associated with rent seeking is less.     

Is There a “Singles Tax”? The Relative Income Tax Treatment of Single Households

The existence of a "marriage tax," in which many married couples pay more taxes when married than their combined taxes as single individuals, is well known. However, largely lost in the attention devoted to married taxpayers is the treatment of single taxpayers. This article examines the relative tax treatment of single and married taxpayers. Various types of representative taxpayers are constructed, and the difference in income taxes paid by single taxpayers and married taxpayers is calculated. These calculations show that there is a "singles tax"; that is, a single individual typically pays a greater income tax liability than a married couple with identical income, especially when the main transfer programs are considered.     

Casino-related deaths in Atlantic City, New Jersey 1982-1986

The first legalized casino-hotel opened in Atlantic City, New Jersey in 1978. Annually, more than 30 million people visit the "Gambling Capitol of the East Coast." As a result of this growing influx of people, the Atlantic County Medical Examiner's Office began compiling statistics in 1982 of casino-related deaths. Data on 398 casino-related deaths occurring in 1982-1986 were collected and analyzed: 83% of the total number of fatalities were sudden cardiac deaths. Most of the victims were elderly white retired men who had previously diagnosed medical conditions. Many of the victims' underlying medical problems are of a type known to be associated with compulsive gambling. The majority of deaths occurred during the afternoon hours on weekends in October, January, and May. Of the victims, 86% were from New Jersey, New York, and Pennsylvania. For Atlantic City, a gambling community known to have a relatively high rate of crime and drug-trafficking, only 1% of all deaths were homicides. We speculate that the stress of gambling activities may induce sudden cardiac death. We therefore recommend that communities planning to legalize casino gambling mandate that gambling establishments provide emergency health care services for their patrons.     

Neighborhood Opportunity and Location Affordability for Low-Income Renter Families

Abstract

We use the Location Affordability Index (LAI) and the newly developed Child Opportunity Index (COI) to assess, for the first time, the tradeoff between neighborhood opportunity and housing/transportation affordability facing low-income renter families in the 100 largest metropolitan areas. In addition to describing the opportunity/affordability relationship, we explore the level of balance between neighborhoods’ relative cost burden and their corresponding opportunity levels to determine whether children of different racial/ethnic groups are more (or less) likely to experience cost-opportunity imbalance. Our multilevel analyses show that housing affordability is largely accounted for by the neighborhood opportunity structure within each metropolitan area. The metropolitan characteristics examined account for only a small proportion of the between-metro variance in the opportunity/affordability gradient for housing, presumably because the neighborhood opportunity structure already reflects metro area factors such as fragmentation and segregation. On the other hand, transportation affordability shows a weaker association with neighborhood opportunity. The COI/LAI association is much weaker for transportation than for housing, and a large part of the variation in the transportation gradient occurs at the metropolitan area level, not the neighborhood level. Sprawl is particularly associated with transportation affordability, with lower sprawl areas having lower transportation-cost burden. We discuss the implications of the empirical findings for defining affordability in housing assistance programs. We recommend that housing policy for low-income renter families adopt an expanded notion of affordability (housing, transportation, and opportunity) and explicitly consider equity (e.g. cost-opportunity imbalance) in the implementation of this expanded affordability definition.