PAM Publications

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This is a collection of Publications for the Department of Policy Analysis and Management.

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    Family Man in the Other America: New Opportunities, Motivations, and Supports for Paternal Caregiving
    Waller, Maureen (2009)
    This analysis draws on longitudinal, qualitative interviews with disadvantaged mothers and fathers who participated in the Fragile Families Study (a U.S. birth cohort study) to examine how issues related to men’s employment, social support, skills, and motivation facilitated their care of young children in different relationship contexts. Interviews with parents indicate that while some motivated and skilled men actively chose to become caregivers with the support of mothers, others developed new motivations, skills, and parenting supports in response to situations in which they were out of work or the mother was experiencing challenges. These findings suggest that disadvantaged men who assume caregiving responsibilities take different paths to involvement in the early years after their child’s birth. Policies that overlook paternal caregivers may not only miss the opportunity to support relationships that benefit at-risk children but also unintentionally undermine this involvement.
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    Evaluation Policy and Evaluation Practice: Where Do We Go From Here?
    Trochim, William (Wiley Periodicals Inc., 2009)
    The author develops the basic idea of evaluation policy, describes a practical model for development and revision of evaluation policies (including a taxonomy, structure, and set of principles), and suggests critical challenges and opportunities for the future of evaluation policy. An evaluation policy is any rule or principle that a group or organization uses to guide its decisions and actions when doing evaluation. Every entity that engages in evaluation, including government agencies, private businesses, and nonprofit organizations, has evaluation policies. Sometimes they are explicit and written; more often they are implicit and ad hoc principles or norms that have simply evolved over time.
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    Developing a conceptual framework for an evaluation system for the NIAID HIV/AIDS clinical trials networks
    Trochim, William (2009)
    Globally, health research organizations are called upon to re-examine their policies and practices to more efficiently and effectively address current scientific and social needs, as well as increasing public demands for accountability. Through a case study approach, the authors examine an effort undertaken by the National Institute of Allergy & Infectious Diseases (part of the National Institutes of Health, Department of Health & Human Services, United States Government) to develop an evaluation system for its recently restructured HIV/AIDS clinical trials program. The challenges in designing, operationalizing, and managing global clinical trials programs are considered in the context of large scale scientific research initiatives. Through a process of extensive stakeholder input, a framework of success factors was developed that enables both a prospective view of the elements that must be addressed in an evaluation of this research and a current state assessment of the extent to which the goals of the restructuring are understood by stakeholders across the DAIDS clinical research networks.
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    Evaluation Policy and Evaluation Practice
    Trochim, William (Wiley Periodicals Inc., 2009)
    Evaluation policy is of considerable importance, especially in relation to the limited amount of attention it receives as a general topic in the mainstream evaluation literature. Evaluation policies matter for several reasons, among them that they can profoundly affect evaluation practice, they underlie many recent and current controversies about evaluation, and they may be a lever for change that can have far-reaching effects for practice. This chapter gives an overview of several issues regarding evaluation policy, including defining it, identifying possible facets of evaluation policy, describing how it is established, and outlining the potentially greater role for evaluators in shaping the evaluation policies that influence evaluation practice.
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    Evaluation Policy and Evaluation Practice
    Trochim, William (2009)
    Three issues for evaluation policy and practice are described: evaluation policy dimensions, evaluation policy instruments, and the political and economic environment for evaluation policy. Selected future directions are outlined, including the need to describe the evaluation policy landscape, further articulate an evaluation policy taxonomy, and develop and implement tactics for influencing evaluation policy, with particular attention to the role of professional associations.
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    The Role of Evaluation in Research-Practice Integration: Working Toward the "Golden Spike
    Trochim, William (2009)
    Program evaluation and planning is at the heart of efforts to integrate the domains of practice and research. Traditionally, research and practice have operated in independent spheres with practitioners focused on the implementation of programs that affect individual behavior and researchers focused on the development and testing of theory. Evidence-based practice (EBP), practice-based evidence, and translational research have attempted to unite these worlds, and although significant advances have been made, there is a continued need to find mechanisms that enable a seamless connection between knowledge generation and application. We propose a method that builds on the traditions of theory-driven evaluation, logic modeling, and systems science and uses evaluation and program planning as the bridging mechanism between research and practice. Included in this approach are methods that aid in the explicit expression of implicit theories, management of evaluation resources, and linkage of program theory and evaluation measures to a research evidence base.
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    The Relationship between Auto Insurance Rate Regulation and Insured Loss Costs: An Empirical Analysis
    Tennyson, Sharon (2009)
    This study points out a potential unintended effect of efforts to enhance affordability of insurance prices by regulating rates: It may ultimately lead to higher insurance costs. This is because rate regulation that suppresses insurance prices below competitive levels, or provides significant premium subsidies for some consumers, creates a variety of incentive distortions in the market. The article summarizes the theoretical arguments for this effect and provides empirical evidence of cost-increasing effects of rate regulation. The analysis uses state-level data on automobile insurance costs and claims rates for the period 1990 through 1998, and employs empirical methods that control for the possible reverse causation of high insurance costs leading to consumer demand for rate regulation. We find that bodily injury and property damage liability loss costs are higher in rate-regulated states, and that the bodily injury to property damage liability claims ratio is higher in regulated states.
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    The Emergence and Potential Consequences of First Party Insurance Bad Faith Liability
    Tennyson, Sharon (2009)
    This article discusses the approaches to first-party insurance bad-faith law that have been taken by the states, using legal and economic reasoning to illuminate the potential benefits and costs of different approaches. Theory suggests that allowing policyholders to recover damages over and above the value of the insurance benefit owed will provide insurers with added incentives to engage in fair claims settlement. However, excessive or uncertain liability for insurance bad faith might create incentives for policyholders to file questionable claims and disincentives for insurers to investigate claims for fraud. The article analyzes a large dataset of first-party automobile insurance claims to investigate whether these adverse effects appear to have empirical relevance. The data show that claim characteristics in states that permit tort-based bad faith differ from those in other states. The findings are consistent with the idea that permitting tort-based firstparty insurance bad-faith settlements might reduce insurer incentives to challenge disputable claims.
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    Do State Cost Control Policies Reduce Medicaid Prescription Drug Spending?
    Tennyson, Sharon (2009)
    We present the first systematic analysis of state policies limiting prescription drug access under Medicaid during 1990–2004, documenting their impact on states’Medicaid prescription spending growth.We see substantial variation in the number and type of policies used by states, but a clear upward trend in restrictions over time. Analysis of state level annual spending growth shows that these restrictions have in general helped contain Medicaid prescription drug costs and that some approaches, such as the use of preferred drug lists (PDLs) and tiered copayment systems, may have been more effective than others.
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    State Prescription Drug Policies, Cost Barriers and the Use of Acute Care Services by Medicaid Beneficiaries
    Tennyson, Sharon (2009)
    This paper examines the relationship between Medicaid pharmacy benefit restrictions and reports of prescription cost barriers by beneficiaries, and the relationship between prescription cost barriers and hospitalizations. The analysis uses data for adult Medicaid beneficiaries from the 2000–2001 and 2003 Community Tracking Survey household surveys, combined with data on states’ Medicaid pharmacy benefit restrictions and characteristics of local health-care markets. Estimation results show that state Medicaid restrictions are associated with a higher incidence of reported drug cost barriers and that Medicaid recipients who report prescription cost barriers experience a greater number of hospitalizations.
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    Analyzing the Role for a Consumer Financial Protection Agency
    Tennyson, Sharon (2009)
    In the debate over the proposed establishment of a new Consumer Financial Protection Agency, much attention has been given to discussion of whether consumers are irrational or incompetent and therefore need paternalistic regulators to look after them, and whether inadequate consumer protection regulation was a contributor to the financial crisis. Arguments over these questions are misplaced. Consumer protection regulation is commonplace in financial markets, and is essential even where consumers are fully rational and financial crises are distant. The potential role for a CFPA should first be examined based on consideration of the benefits and shortcomings of current consumer protection regulation, and how a dedicated consumer protection regulator would be likely to change things. Specific details of proposed legislation that affect the structure and authority of a CFPA should be evaluated separately rather than being used to determine whether such an agency is a good idea or a bad one. Consideration of the general principles for and against establishment of an independent CFPA may help to illuminate the strengths and weaknesses of specific legislative proposals.
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    Patient education and the impact of new medical research
    Simon, Kosali (Elsevier, 2009)
    We examine the impact that medical research published in peer-reviewed journals has on the practice of medicine. We exploit the release of a recent New England Journal of Medicine article which demonstrated that the risks of attempting a vaginal birth after having a previous C-section birth (VBAC) were higher than previously thought. We find that immediately following this article, the national VBAC rate dropped by 16% and this change was largest among more educated mothers, particularly those with a graduate degree.
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    Older adults place lower value on choice relative to young adults
    Simon, Kosali (2009)
    Choice is highly valued in modern society, from the supermarket to the hospital; however, it remains unknown whether older and younger adults place the same value on increased choice. The current investigation tested whether 53 older ( M age = 75.44 years) versus 53 younger adults ( M age = 19.58 years) placed lower value on increased choice by examining the monetary amounts they were willing to pay for increased prescription drug coverage options — important given the recently implemented Medicare prescription drug program. Results indicate that older adults placed lower value on increasing choice sets relative to younger adults, who placed progressively higher value on increasingly larger choice sets. These results are discussed regarding their implications for theory and policy.
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    Do State Cost Control Policies Reduce Medicaid Prescription Drug Spending?
    Simon, Kosali (2009)
    We present the first systematic analysis of state policies limiting prescription drug access under Medicaid during 1990–2004, documenting their impact on states’Medicaid prescription spending growth.We see substantial variation in the number and type of policies used by states, but a clear upward trend in restrictions over time. Analysis of state level annual spending growth shows that these restrictions have in general helped contain Medicaid prescription drug costs and that some approaches, such as the use of preferred drug lists (PDLs) and tiered copayment systems, may have been more effective than others.
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    The Impact of Income on the Weight of Elderly Americans
    Simon, Kosali (2009)
    This paper estimates the impact of income on the body weight and clinical weight classification of elderly Americans using a natural experiment that led otherwise identical retirees to receive significantly different Social Security payments based on their year of birth. We estimate models of instrumental variables using data from the National Health Interview Surveys and find no significant effect of income on weight. The confidence intervals rule out even moderate effects of income on weight and on the probability of being underweight or obese, especially for men. For example, they indicate that the income elasticity of body mass index is not greater in absolute value than 0.06 for men or 0.14 for women.
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    Navigating the “New” Market: How Attitudes Towards Partner Characteristics Shape Union Formation
    Sassler, Sharon (2009)
    Trends in divorce and nonmarital childbearing suggest that the marriage market is increasingly filled with people who have been married and/or have children. This study examines the effect of personal attitudes on entrance into a union with a partner who has been previously married or has children. Using data from two waves of the National Survey of Families and Households, the authors find that men who hold more positive attitudes about marrying someone who already has children are more likely to enter a union with a single mother. Willingness to marry someone with children also has a positive impact on women’s entry into a union with a man who has children, though only if he has not been married before. Men who express greater acceptance about marriage to someone who has been married are more likely to enter a union with a previously married woman, though only if she is childless. There is no parallel effect for women.
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    Planned Parenthood? Fertility Intentions and Experiences among Cohabiting Couples
    Sassler, Sharon (2009)
    Most research on nonmarital births focuses on disadvantaged populations. This study examined the childbearing expectations and experiences of a workingclass sample, drawing on in-depth interviews with 30 cohabiting couples. Few couples in the sample were attempting to conceive; most desired to defer parenting. Three responses emerged to how a pregnancy would be resolved. The largest group would be dismayed but would bear the child. A smaller set indicated that it would terminate a pregnancy. The third group disagreed on the outcome. Relationship context and partner attributes were key factors in fertility decisions. Couples who believed that they had a future together were most likely to agree that they would have the child, though not necessarily preceded by marriage; they were the most consistent users of contraception. Couples of the second and third groups (termination, nonconcurrence) were less regular or less effective contraceptors. Results are discussed in light of public policy interest in reducing nonmarital births.
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    Intergenerational Patterns of Union Formation and Marital Quality
    Sassler, Sharon (2009)
    The authors examine whether young adults who experienced their parents’ divorce and new relationships have different relationship trajectories than those who spent their childhoods living with biological parents in marriedcouple families. The analysis is based on longitudinal reports from more than 1,500 children from Wave 1 of the 1987-1988 National Survey of Families and Households who were ages 18 to 34 at Wave 3 (in 2001-2002). The results suggest that parents’ intimate relationships serve as templates for their children. Children of divorce had elevated rates of cohabitation as adults, relative to marriage. But union outcomes were not uniform for all children who experienced parental divorce. Those whose parents cohabited following divorce exhibited elevated odds of cohabiting themselves, compared to young adults whose parents remarried without first cohabiting or remained in stable marriages. Parental cohabitation also undermines relationship quality and stability among married or dating young adults.
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    Measuring Contact between Children and Nonresident Fathers
    Peters, Elizabeth (Lawrence Erlbaum & Associates, 2009)