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PubMed1989

Class mortality differentials, income distribution and trends in poverty 1921-1981.

The official figures which appear to show a widening of class differences in health in England and Wales during the post-war period have been controversial partly because they do not fit with common perceptions of what has happened to differences in the standard of living. As a result, a great deal of effort has gone into investigating suggested weaknesses in the decennial social class mortality data. Though initially plausible, the artifactual and selective explanations of the widening mortality differences which were put forward have not usually been borne out by closer investigations. The only fault in the broad picture presented by the official data which we do perhaps need to bear in mind is the tendency for a narrowing of mortality differentials among younger women to be masked by the widening among older women. This paper is an attempt to look at the other side of the coin--namely, to investigate trends in differences in the standard of living in relation to mortality differentials. It concludes that trends in mortality differences have not been related to trends in class differences in average earnings, but have been fairly clearly related to trends in relative poverty. Relative poverty and class differences in mortality declined before the war but have both increased, decade by decade, since the war. Younger women have perhaps been protected from the increase in relative poverty during much of the post-war period by their increased economic activity rates and the relative improvement in earnings of women in poorly paid manual occupations.

Adult↗
PubMed1997

Physician profiling and capitated income distribution.

Increasingly, gastroenterologists are addressing the practice issues of physician profiling and capitation. This article describes a method to easily create practice-generated physician profiles that are used in quality of care management and contracting decisions. These profiles are also used as part of a method for capitation revenue distribution that is described and that has been used by the author's practice for over 3 years. This capitation revenue distribution methodology properly rewards the provision of cost-effective care and bonuses desirable to physician-patient relationships, while protecting against under- or over-utilization.

Capitation Fee↗
PubMed1985

Distribution of income sources of recent retirees: findings from the New Beneficiary Survey.

Using data from the New Beneficiary Survey, this article examines income received by the newly retired from assets, employer-provided pensions, and social security. Today's retirees commonly possess pension or asset income to supplement social security. The proportions with asset income were 83 percent for married men and their wives and 69 percent for the unmarried. The proportions with pension income were 56 percent for the married couples and 42 percent for the unmarried. The article finds that up through the middle of the income distribution, social security remains the main income component. In addition to these traditional income sources of the retired, the data also highlight the important role of earnings among many of the new beneficiaries--44 percent of the married couples and 27 percent of the unmarried had current earnings.

Aged↗
PubMed1978

Paying for medical care: the burden on the disabled. The relationship between the distribution of income and the distributions of medical services and payments.

The study measures the economic vulnerability of disabled persons whose impaired health interfered with their earning ability. This population segment, about one sixth of the total population, represents the extreme both in terms of sensitivity to health problems and losses in economic power. The major findings are given in a nutshell. 1) Inadequate income did not bar the disabled individuals from contact with the medical care system except in the case of the weakest among the weak, the aging women without husbands. This finding suggests that the restraining effect of income can become strong enough to overcome the concern with ill-health, although the inhibiting effect of economic constraints weakens when the concerns with health problems intensifies. (2) Once contact with the health care system had been extablished, there was no evidence to suggest that lack of means to pay for medical services had restricted the quantity of services rendered to the disabled, although inability to pay might have affected the setting in which care was provided. 3) The needed medical care was obtained at a considerable financial sacrifice. As Table 6 shows, the level of direct out-of-pocket payments imposed a heavy burden on low and moderate income households, and this burden eased gradually as household income-levels increased.

Adolescent↗
PubMed1995

The distribution of OASDI taxes and benefits by income decile.

On average, persons receiving Social Security benefits tend to have lower current incomes than do persons paying Social Security taxes. This article documents OASDI's income distributional patterns by dividing the 1992 Current Population Survey population into 10 income deciles and tabulating benefits received and taxes paid by each decile. The benefits and taxes, when compared with non-Social Security income, are progressive: as income rises from decile to decile, the ratio of benefits to income falls, and, except at the highest deciles, the ratio of taxes to income rises. A large component of the current income distributional pattern is associated with age: the young on average receive more income and pay more taxes; the old on average receive more benefits. However, when benefits and taxes are tabulated for income deciles within specific age groups, a general progressivity is still observable, although it is weaker than that for the population as a whole.

Adolescent↗
PubMed1987

Changes in the distribution of American family incomes, 1947 to 1984.

The American family income distribution now lies at the center of several controversies. Some observers argue that the American middle class is vanishing, but U.S. census income statistics show income inequality has not changed appreciably since 1947. A second controversy involves whether average living standards have risen or fallen since the major oil price increase of 1973-74. These controversies can be partially resolved by understanding the sharp slowdown in the growth of workers' wages which occurred after 1973 and the demographic trends which kept per capita living standards rising despite stagnant wages, including more working women and low birthrates.

Adult↗
PubMed1997

The relationship of income inequality to mortality: does the choice of indicator matter?

Ecologic studies in the U.S. and elsewhere in the world have demonstrated that income inequality is strongly related to mortality and life expectancy: the greater the dispersion of income within a given society, the lower the life expectancy. However, these empirical studies have been criticized on the grounds that the choice of indicator may have influenced positive findings. Using a cross-sectional, ecologic design, we tested the relationships of six different income inequality indicators to total mortality rates in the 50 U.S. states. The following summary measures of income distribution were examined: the Gini coefficient; the decile ratio; the proportions of total income earned by the bottom 50%, 60%, and 70% of households; the Robin Hood Index; the Atkinson Index; and Theil's entropy measure. All were highly correlated with each other (Pearson r > or = 0.94), and all were strongly associated with mortality (Pearson r ranging from 0.50 to 0.66), even after adjustment for median income and poverty. Thus, the choice of income distribution measure does not appear to alter the conclusion that income inequality is linked to higher mortality. Furthermore, adjustment for taxes and transfers, as well as household size (using equivalence scales), made no difference to the income inequality/mortality association. From a policy perspective, the alternative income distribution measures perform differently under varying types of income transfers, so that theoretical considerations should guide the selection of an indicator to assess the impact of social and economic policies that address income inequality.

Cross-Sectional Studies↗
PubMed1993

Proposals to modify the taxation of Social Security benefits: options and distributional effects.

This article presents simulation estimates of the income-distributional effects in 1994 of several proposals to modify the taxation of Social Security benefits under the Federal personal income tax. Under the benefit-taxation provisions that have been in effect since 1984, up to 50 percent of benefits are included in taxable income for taxpayers with incomes above certain thresholds. In 1994 about 20 percent of beneficiary families will pay a larger income tax as a result of these provisions. Because of the benefit taxation thresholds, the affected families are concentrated in the upper half of the income distribution: about 70 percent of these families have incomes that put them in the top 30 percent of families by income. If the current taxation thresholds were kept and the percentage of benefits includable in taxable income were raised above 50 percent, the tax effect would remain concentrated on the upper income families. If, on the other hand, the percentage includable were kept at 50 percent while the taxation thresholds were lowered or eliminated, more beneficiary families with incomes in the middle deciles would become affected. The lowest income beneficiary families, however, would remain unaffected, because their benefits would be protected from income taxation by exemptions and the standard deduction. The simulations indicate that only a very few families in the bottom 20 percent of families by income would be affected even if the benefit taxation thresholds were eliminated entirely.

Insurance Benefits↗
PubMedDate not supplied

[Income inequality and health: the case of Rio de Janeiro].

This ecological analysis addresses the association between income inequality and health status in the municipality of Rio de Janeiro. Data were analyzed using geo-processing and multiple regression techniques. The following health indicators were used: infant mortality rate; standardized mortality rate; life expectancy at birth; and homicide rate among 15-29-year-old males. Patterns of income inequality were assessed through income distribution indicators: Gini index, Robin Hood index, and top 10 %/bottom 40% average income ratio. The results indicate significant correlations between income distribution indicators and health indicators, providing additional empirical evidence of the association between health status and income inequality. For the homicide rate, the effect of the indicator "density of slum residents" was also relevant, suggesting that further deterioration in health standards may be due to social disruption of deprived communities and the resultant increase in criminal activity. The geo-epidemiological analysis presented here highlights the association between adverse health outcomes and residential concentration of poverty. Social policies focused on slum residents are needed to reduce the harmful effects of relative deprivation.

Adolescent↗
PubMed1996

Socioeconomic status and weight control practices among 20- to 45-year-old women.

OBJECTIVES: This study examined the relationship between socioeconomic status (SES) and weight control practices in women. METHODS: SES, defined by family income, was examined in an economically diverse sample of 998 women in relation to dieting practices by means of multivariate regression analyses controlling for age, ethnicity, smoking, and body mass index. RESULTS: SES was positively associated with healthy, but not unhealthy, weight control practices; inversely related to energy and fat intake; and positively associated with weight concern and perceived social support for healthy eating and exercise. SES gradients were particularly striking at the low end of the income distribution (i.e., family income < or = $10,000 per year). The SES gradient in body mass index persisted in analyses controlling for attitudes and behaviors. CONCLUSIONS: Economic deprivation may contribute to high rates of obesity among lower SES women. The reasons for this require further research.

Adult↗
PubMed1994

Distributive effects of benefits and taxes.

In light of the growing federal deficit, pressure is mounting to cut federal spending. If the budget for social security programs is cut, who will suffer? This article presents the results of a study that investigated the degree to which taxes and public income transfers change the level of income, the degree of inequality in income distribution, and the poverty rates of various demographic groups. Major findings are that public income transfers are more powerful than taxes in equalizing the income distribution and that poverty reduction through non-means-tested transfer programs is more effective among elderly people, white people, and people in married-couple families, whereas poverty reduction through means-tested transfer programs is more effective among nonelderly people, black people, and people in female-headed families. Implications for social work practice are discussed.

Black or African American↗
PubMedDate not supplied

Physician compensation based on performance appraisal.

Physician compensation in a group practice setting has long been a subject of discussion and time investment, both on the part of managers and physicians. With a changing external environment, including Medicare fee freeze, capitation, and other forms of discounted, contractual medicine, former income distribution plans may not serve group practices well anymore. The ability of group practices to attract, retain, and develop physicians is at least partially dependent upon physician compensation structure. Taking into consideration marketplace characteristics for different specialties and offering equity in the compensation process are important features of any income distribution plan. This paper emphasizes a longstanding business tool, performance appraisal, which may be a key future determinant of physician compensation. The utilization of performance appraisal in establishing physician compensation is discussed and a sample performance appraisal instrument is included as a model.

Employee Performance Appraisal↗