Effects of substance abuse on housing stability of homeless mentally Ill persons in supported housing, by MS Hurlburt, RL Hough and PA Wood.
OBJECTIVE: The study examined two-year housing outcomes of homeless mentally ill clients who took part in an experimental investigation of supported housing. The relationships between housing outcomes and client characteristics, such as gender, psychiatric diagnosis, and substance use, were of primary interest. METHODS: A two-factor, longitudinal design was used. Homeless clients in San Diego County who were diagnosed as having chronic and severe mental illness were randomly assigned to four experimental conditions. Half of the clients were given better access to independent housing through Section 8 rent subsidy certificates. All clients received flexible case management, but half were provided more comprehensive case management services. The housing of each individual over a two-year period was classified in one of three categories: stable independent housing, stable housing in another setting in the community, or unstable housing. RESULTS: Clients with access to Section 8 housing certificates were much more likely to achieve independent housing than clients without access to Section 8 certificates, but no differences emerged across the two different levels of case management. Housing stability was strongly mediated by several covariates, especially the presence of problems with drugs or alcohol. CONCLUSIONS: Supported housing interventions can be very successful tools for stabilizing homeless mentally ill individuals in independent community settings. Advantages include the low level of restrictiveness of these settings and the preference of many clients for independent housing. However, the success of supported housing projects is likely to depend strongly on the specific characteristics of the population being served.
Estimates of Crowd-Out from a Public Health Insurance Expansion Using Administrative Data, by Laura Dague, Thomas DeLeire, Donna Friedsam, Daphne Kuo, Lindsey Leininger, Sarah Meier, and Kristen Voskuil (NBER)
We use a combination of administrative and survey data to estimate the fraction of individuals newly enrolled in public health coverage (Wisconsin’s combined Medicaid and CHIP program) that had access to private, employer-sponsored health insurance at the time of their enrollment and the fraction that dropped this coverage. We estimate that after expansion of eligibility for public coverage, approximately 20% of new enrollees had access to private health insurance at the time of enrollment and that only 8% dropped this coverage (with the remaining 12% having both private and public coverage). We also identify an “upper bound” estimate, which suggests that the percentage of new enrollees with private insurance coverage at the time of enrollment is, at most, 27%. These estimates of crowd-out are relatively low compared with estimates from the literature based on Medicaid and CHIP expansions, although based both on different data and on a different method.
The Independent Payment Advisory Board — Congress’s “Good Deed”, by Henry Aaron (NEJM)
Reforming Medicare by Reforming Incentives, by Alain C. Enthoven (NEJM)