William Evans

• Nurse Staffing and Adverse Hospital Events
  Ended (2004-01-01 - 2006-01-31)
  RWJF
  

• Length of Postpartum Hospital Stays and the Health of Mothers and Their Newborns
  Current (2006-04-15 - 2009-03-31)
  EKS-NICHD
  Abstract

  Between 1995 and 1997, 32 states passed laws requiring insurance carriers to provide minimum postpartum length of stays and a similar federal law went into effect on January 1, 1998. A number of authors have demonstrated that these laws increased average postpartum hospital length of stay, decreased the fraction of mothers and infants discharged 'early', and increased hospitalization costs. There is however limited evidence about the impact of these laws on the health of the mother and her newborn, and estimates from these studies provide conflicting results.

  In this proposal, we outline a research program that uses a restricted-use data set of California births to examine the impact of one of these laws. The California Newborns’ and Mothers’ Health Act of 1997 (NMHA), which went into effect on August 26, 1997, mandated that insurance carriers provide coverage for at least a 48 hour hospital stays for normal deliveries and at least a 96 hour hospital stays for cesarean deliveries. The California law is similar to many other state laws and is nearly identical in scope to the federal law that went into effect in 1998. Both the California and federal laws explicitly excluded Medicaid births from coverage.

  The data for this project will be administrative records of all mothers and newborns discharged from hospitals in California between January 1, 1995 through the end of 2000, merged with the child’s state vital statistics (birth and death) records. We have been granted permission to access this data by the state office responsible for data distribution and our research protocol and data safety plan has been approved by both the California State Committee for the Protection of Human Subjects and the University of Maryland. Using an interrupted time series design, we plan to examine the following questions about the California early discharge law: What was the impact of the NMHA on average postpartum length of stay and the fraction of patients discharged early? How does the program’s impact vary by patient and hospital characteristics? Were there spillovers to uncovered groups such as Medicaid patients? Did the law improve health outcomes of mothers and their infants? Did the law alter re-admission rates for mothers and infants? Did the law alter neonatal mortality rates?

• The Socioeconomic Impact of Native American Casinos.
  Ended (2003-01-01 - 2007-12-31)
  EKS-NICHD
  Abstract

  Native Americans living on reservations have historically been one of the poorest groups in the United States. In the late 1980s, a series of legal rulings and accompanying Federal legislation allowed tribes in some states to run casinos on reservations. As a result of these laws, about 200 of the 556 federally-recognized tribes run about 310 gaming centers, of which 220 are Las Vegas-style casinos with slot machines and/or table games. Given the large number of tribes that have embraced casino gaming as an economic development program, it is worth considering whether Indians on reservations have benefited from these operations. As the legal and legislative controversies surrounding tribal-owned gaming persist, the interest in this question continues to grow. The authors of this proposal are currently involved in the first nationwide evaluation of the social and economic impact of Native American-owned gaming operations on tribes and their surrounding communities. Using aggregate tribe-level data from the Bureau of Indian Affairs, Evans and Topoleski demonstrate that on average, five years after a tribe opens a casino, reservation population increased 20 percent, employment rose by 55 percent, the employment to population ratio increased by 25 percent, and the percentage of workers living in poverty fell by a third. In this proposal, we outline a research program that uses restricted-use data from the 1990 and 2000 Census long- form samples to examine the impact of gambling on people who live on or near reservations. The long-form samples are sent to one in six households and contain a wealth of social, demographic, and economic information about households and their members. Public-use versions of this data do not contain enough geographic detail to place households in particular tribes or on reservations, but detailed geographic data are available on restricted-use versions of the data set, available for use at the Center for Economic Studies at the U.S. Census Bureau, a few miles from the University of Maryland Campus. Given the structure of most operations and the available data, we plan to investigate the following questions concerning the impact of gaming. • What is the impact of Native American-owned gaming operations on the employment, wages, earnings, and incomes of those living on or near reservations? Who benefits most from gaming operations Indians or non Indians, males or females, high or low educated, established residents or new residents? • As gaming operations have brought more money and jobs into tribes, has the historically poor housing stock on reservations improved? • Has the rapid economic change on reservations generated by casinos changed family life through fertility, marriage, or divorce? • Is educational attainment increasing as tribes use gaming profits to foster human capital accumulation?