Enrollment Decisions Research Articles

Demand for social health insurance: Evidence from the Chinese New Rural Cooperative Medical Scheme

This paper assesses the determinants of the enrolment in the New Rural Cooperative Medical Scheme (NRCMS), a heavily subsidized voluntary health insurance scheme in rural China. The analyses focus on the relationship between insurance purchase and health facility choice based on data drawn from the China Health and Nutrition Survey (CHNS). The results show that households from villages that reported use of village clinics are more likely to be insured compared with households from villages that reported use of county hospitals. The results indicate that the perception of quality of care is an important factor affecting people's enrolment decisions. The NRCMS is expected to help patients obtain better quality health services from higher-tier of the healthcare system that are unaffordable otherwise. However, given the prevailing fee-for-service payment mechanism for health care, the insurance may also drive up the healthcare cost and direct patients to use more expensive and unnecessary hospital care.

Admission testing for higher education: A multi-cohort study on the validity of high-fidelity curriculum-sampling tests.

We investigated the validity of curriculum-sampling tests for admission to higher education in two studies. Curriculum-sampling tests mimic representative parts of an academic program to predict future academic achievement. In the first study, we investigated the predictive validity of a curriculum-sampling test for first year academic achievement across three cohorts of undergraduate psychology applicants and for academic achievement after three years in one cohort. We also studied the relationship between the test scores and enrollment decisions. In the second study, we examined the cognitive and noncognitive construct saturation of curriculum-sampling tests in a sample of psychology students. The curriculum-sampling tests showed high predictive validity for first year and third year academic achievement, mostly comparable to the predictive validity of high school GPA. In addition, curriculum-sampling test scores showed incremental validity over high school GPA. Applicants who scored low on the curriculum-sampling tests decided not to enroll in the program more often, indicating that curriculum-sampling admission tests may also promote self-selection. Contrary to expectations, the curriculum-sampling tests scores did not show any relationships with cognitive ability, but there were some indications for noncognitive saturation, mostly for perceived test competence. So, curriculum-sampling tests can serve as efficient admission tests that yield high predictive validity. Furthermore, when self-selection or student-program fit are major objectives of admission procedures, curriculum-sampling test may be preferred over or may be used in addition to high school GPA.

Perceptions of and decision making about clinical trials in adolescent and young adults with Cancer: a qualitative analysis

BackgroundAdolescent and young adults (AYA) enrolment rates into cancer clinical trials (CCT) are the lowest of any age group globally. As AYA have distinct biological, psychosocial and relational needs, we aimed to explore any unique factors influencing their CCT decision-making process, including AYA-specific perceptions or attitudes towards CCT.MethodsQualitative interpretive descriptive methodology was used to explore AYA perceptions and decision-making related to CCT. An analytic approach conducive to inductive imagining and exploratory questioning was used in order to generate insights and interpret data.ResultsA total of 21 AYA were interviewed (median age: 31 (18–39)). Twelve (57%) participants had previously been approached to participate in CCT. Major themes influencing trial enrolment decisions were: 1) severity of illness/urgency for new treatment 2) side effect profile of investigational drug in the short and long term (e.g., impact on future quality of life) 3) who approached patient for trial participation (oncologist vs. other) 4) additional information found on-line about the trial and investigators, and 5) family, friends and peer group opinion regarding the CCT.ConclusionsSeveral psychosocial and relational factors were identified as influencing AYA CCT decisions, some of which are unique to this demographic. Specific strategies to address barriers to CCT and enable supportive decision-making include: 1) involving family in decision-making and 2) helping AYA appreciate short- and long-term implications of trial participation. Finally, exploring social networking and general education about CCT that AYA can independently access may increase participation.

Gender bias in households’ educational expenditures: Does the stage of schooling matter?

Gender gaps in educational outcomes still exist, especially in Sub-Saharan Africa. This incidence could be attributed to an uneven allocation of household resources towards the schooling of boys and girls. Utilising the household level data from the latest wave of the Ghana Living Standards Survey, the paper sheds light on gender bias in households’ educational expenditures using a ‘Hurdle or Two-Part Model’ estimation strategy. The two-part model unpacks the key sources of gender bias in household’s expenditure allocations. A number of interesting findings emerge: The study established a significant pro-male bias in both the enrollment decision and the conditional expenditure decision among the cohort of individuals in the post-secondary schooling age while only the former source of bias is present in the senior-secondary schooling age cohort. Strikingly, however, no gender bias is found in the positive expenditure decision for boys and girls belonging to the basic education school-going age cohort, even though a pro-male bias operates in the conditional educational expenditure decision for children in the primary school-going age group. Contrary to earlier findings, we find a pro-female bias in a household’s decision of how much to spend conditional upon enrolling boys and girls for the cohort of children in the junior secondary schooling age. These findings have important implications for policy action.

Priorities in school choice: The case of the Boston mechanism in Barcelona

The Boston mechanism is a school allocation procedure that is widely used around the world and has been criticized for its incentive problems. In order to resolve overdemands for a given school, most often priority is given to families living in the neighborhood of the school. Using a very rich data set on school applications for the case of the Boston mechanism in Barcelona, we exploit an unexpected change in the definition of neighborhood. This change allows us to identify that a large fraction of families systematically ranks first high priority schools, neighborhood schools in this case. Additional data on school enrollment decisions and census data shows that some seemingly unsophisticated parents are high income families that can rank hard-to-get schools because they can afford the outside option of a private school in case they do not get in. This sheds light on important inequalities beyond parents' lack of sophistication found in the literature.

Where are the returns to lifelong learning?

Participation in formal education during adulthood (ages 25–54) is a key part of lifelong learning. Employing unique longitudinal data for Australia, we highlight the prevalence of such study, the varied reasons for undertaking it (consumption, career development, job and home disruption), and investigate whether it is socially valuable. Our more detailed estimates of the labour market return to adult education (wage rates, employment, hours of work and occupational status) confirm previous studies that generally found such returns to be small and isolated. We contribute to this literature by also estimating the effect of adult education on job satisfaction and satisfaction with employment opportunities. Increases in satisfaction help rationalise the education enrolment decisions of these adults.

An Investigation of Parents' Decisions to Transfer Children From Regular to Special Schools

AbstractOften within frameworks of inclusive education policy and legislation, many countries continue to provide both special and regular schools as options for students with disability. One persistent explanation for the maintenance of dual systems is the school choice that it offers parents. Enrolment decisions can be ongoing, and parents may have to, or decide to, reassess their schooling choice. One example of this scenario is the decision to transfer from a regular to a special school. The aim of this study was to gain a deeper understanding of the decision‐making process of parents who transferred their child from regular to special school. Eighty parents from Queensland, Australia, completed a survey which collected information about their decision‐making in this regard. A factor analysis was undertaken with survey items relating to (1) reasons for leaving regular school, (2) hopes for special school, and (3) the decision‐making process. Clear factors emerged as underlying dimensions in parental decision‐making, including those relating to (1) learning, (2) emotional states, (3) school culture, and (4) the difficulties associated with decision‐making. Results indicate that parents' decision‐making is influenced by negative experiences in the mainstream and high expectations for segregated schooling. Emotional strain in regular schools was strongly linked to an exclusionary school culture, and there was an important association between learning and well‐being. Implications of these findings for parents, teachers, and other educators are discussed.

Choosing College in the 2000s: An Updated Analysis Using the Conditional Logistic Choice Model

In this paper I investigate the college enrollment decisions of a nationally representative cohort of students who first attended in the mid-2000s. I find that while cost, distance, and match continued to be important in the choice between colleges, characteristics of the most-likely college choice appear less important in the choice of whether to enroll at all when controlling for student characteristics and local labor market conditions. Subpopulation analyses on students with high SAT scores and students with low family income, two groups that remain the focus of many financial aid policies, indicate some differences in the way these particular students chose college. Extending prior work by modeling discrete steps in the enrollment decision process—application and enrollment conditional on application—I find choice characteristics were most significant in the application stage. These results support other research that shows students may self-select out of potentially better college matches due to lack of information about actual costs or limited geographic opportunity.

PHP3 - Perceived Value of Health Insurance and Enrollment Decision Among Low-Income Population

Individual mandate is one of the key features of the Affordable Care Act. This study assesses the uninsured rate in various subgroups and describes the differences between the uninsured and the insured focusing on individuals’ attitudes toward risk. The 2014 Medical Expenditure Panel Survey-Household Component (MEPS-HC) full year consolidated data file were analyzed. The study included people in poverty who were eligible neither for public coverage nor for employer-sponsored insurance. Factors predicting likelihood of being uninsured were examined using a logit model. The study included 2,258 individuals. Thirty four percent of the sample remained uninsured. The uninsured were likely to have lower demand for insurance and perceived value of insurance. Zero doctor visit was the strongest predictor of likelihood of being uninsured. It appears that adverse selection exists in individual insurance market. The outreach efforts should focus on increasing perceived value of health insurance.

Cash-on-Hand and College Enrollment: Evidence from Population Tax Data and the Earned Income Tax Credit

We estimate causal effects of cash-on-hand on college enrollment decisions of students from low-income families. Using population-level, administrative data from US income tax returns, we exploit variation in tax refunds received in the spring of the high school senior year. The variation in tax refunds results from the kink point between the phase-in and maximum credit portions of the Earned Income Tax Credit schedule. The results suggest tax refunds received in the spring of the high school senior year have meaningful effects on college enrollment. (JEL D14, H24, I22, I23, I24)

Perceived Value of Health Insurance and Enrollment Decision among Low-Income Population

The individual mandate is one of the key features of the Affordable Care Act (ACA) and has contributed to a substantial decrease in the overall uninsured rate. We examined the relationship between the individual's insurance status and his/her attitude towards risk and uncertainty among the nonelderly adults, without employer-sponsored insurance (ESI) sources and who are most likely to benefit from the ACA. A descriptive, cross-sectional study was conducted using the 2014 full-year consolidated data file from the Household Component of the Medical Expenditure Panel Survey-Household Component (MEPS-HC). This study included 4,848 individuals, aged 18-64 years, with incomes between 138-400 % of the Federal Poverty Level (FPL), and without access to public coverage or ESI. We examined the factors associated with the likelihood of being uninsured using a logit model. We found that the proportion of the uninsured among the low-income nonelderly adults without ESI (31.1%) was much higher than the one among the nonelderly adults (14.3%). The uninsured adults were likely to have lower demand for insurance and perceived value of insurance and were less likely to visit a doctor or to fill prescription drugs. More rigorous outreach efforts focusing on increasing perceived value of health insurance could contribute to an increased insurance coverage among low-income populations.

THE AFFORDABLE CARE ACT AND COLLEGE ENROLLMENT DECISIONS

We investigate the effect of the expansion of the federal dependent coverage mandate for young adults under the Affordable Care Act (ACA) on college enrollment decisions of young Americans. The expansion removes the requirement that young individuals need to be enrolled as full‐time students in order to remain on their parents' health insurance past the age of 18 and expands the coverage mandate to age 26 irrespective of student status. This changes the incentives for the full‐time college enrollment decisions of young individuals. We use panel data from the Survey of Income and Program Participation (SIPP) for the years 2003–2013 and estimate that the dependent coverage expansion under the ACA decreases the probability to enroll as full‐time student by 3 percentage points using a difference‐in‐differences framework. Furthermore, we find that part‐time college enrollment is unaffected by the new policy. The results are robust to changes in the model specification and become stronger when we increase the sample overlap between treatment and control groups using trimming based on propensity scores. (JEL C35, I23, I10, I18)

The Affordable Care Act and College Enrollment Decisions

We investigate the effect of the extension of the federal dependent coverage mandate for young adults under the Affordable Care Act (ACA) on the college enrollment decisions of young Americans. The ACA removes the conditionality that young individuals need to be enrolled as full-time students in order to be able to remain on their parents' health insurance past the age of 18 and extends the coverage mandate to age 26 irrespective of student status. This expansion of the coverage mandate will change the incentives for the full-time and part-time college enrollment decisions of young individuals. We use panel data from the Survey of Income and Program Participation (SIPP) for the years 2008 to 2013 and estimate that the dependent coverage expansion under the ACA decreases the probability to enroll as full-time student by 2 to 3 percentage points. Furthermore we find that part-time college enrollment is unaffected by the new policy. The results from a difference-in-differences model are robust to changes in the model specification and become stronger when we increase the sample overlap between treatment and control groups using various propensity score methods.

Kids, College, and Capital: Parental Financial Support and College Choice

Parents vary in both their willingness and ability to pay for their children’s college expenses, yet there is little research on how adolescents’ expectations of future financial support from parents affect their college enrollment decisions. Using data from the High School Longitudinal Study, I fill this gap in the literature by examining the predictors of parents’ plans to pay for college and estimating the effect of having a parent that plans to pay for college on an adolescent’s probability of college attendance. The results suggest that after parents’ ability to pay is taken into account, social class remains a strong predictor of whether parents plan to pay for their children’s college education. Additionally, parent’s plans to pay for college have a measurable impact on children’s college enrollment as long as the child is aware of or agrees with the parent’s plans. Therefore, it is likely that socioeconomic differences in parents’ pledges of financial support to adolescents contribute to postsecondary stratification. The results from this study suggest that policymakers and researchers who are concerned about educational inequality should pay greater attention to the role of parental financial support in structuring children’s ability to access college.

Should I Stay or Should I Go? Open Enrollment Decisions and Student Achievement Trajectories

ObjectiveAnalyze achievement trajectories of students who transfer out of their district of residence via Colorado's interdistrict open enrollment policy.MethodsDrawing on a data set containing annual individual‐level records from the universe of students attending Colorado public schools between 2005–2006 and 2009–2010, we estimate the achievement trajectories of open enrollment participants via ordinary least squares (OLS) models containing student fixed effects.Results and ConclusionOur analyses indicate that the achievement of open enrollment participants gradually declines in the years leading up to their transfer. After open enrolling, students whose participation is stable through the duration they are observed in our data exhibit small achievement gains, but those who reenroll in their district of residence exhibit additional small declines. On average, those who use open enrollment as a long‐term education option tend to enroll in districts that are more advantaged on traditional measures of educational quality than their district of residence.

Does a provider payment method affect membership retention in a health insurance scheme? a mixed method study of Ghana\u2019s capitation payment for primary care

BackgroundGhana introduced a National Health Insurance Scheme (NHIS) in 2003 applying fee-for-service method for paying NHIS-credentialed health care providers. The National Health Insurance Authority (NHIA) later introduced diagnosis-related-grouping (DRG) payment to contain cost without much success. The NHIA then introduced capitation payment, a decision that attracted complaints of falling enrolment and renewal rates from stakeholders. This study was done to provide evidence on this trend to guide policy debate on the issue.MethodsWe applied mixed method design to the study. We did a trend analysis of NHIS membership data in Ashanti, Volta and Central regions to assess growth rate; performed independent-sample t-test to compare sample means of the three regions and analysed data from individual in-depth interviews to determine any relationship between capitation payment and subscribers’ renewal decision.ResultsResults of new enrolment data analysis showed differences in mean growth rates between Ashanti (M = 30.15, SE 3.03) and Volta (M = 40.72, SE 3.10), p = 0.041; r = 0. 15; and between Ashanti and Central (M = 47.38, SE6.49) p = 0.043; r = 0. 42. Analysis of membership renewal data, however, showed no significant differences in mean growth rates between Ashanti (M = 65.47, SE 6.67) and Volta (M = 69.29, SE 5.04), p = 0.660; r = 0.03; and between Ashanti and Central (M = 50.51, SE 9.49), p = 0.233. Analysis of both new enrolment and renewal data also showed no significant differences in mean growth rates between Ashanti (M = − 13.76, SE 17.68) and Volta (M = 5.48, SE 5.50), p = 0.329; and between Ashanti and Central (M = − 6.47, SE 12.68), p = 0.746. However, capitation payment had some effect in Ashanti compared with Volta (r = 0. 12) and Central (r = 0. 14); but could not be sustained beyond 2012. Responses from the in-depth interviews did not also show that capitation payment is a key factor in subscribers’ renewal decision.ConclusionCapitation payment had a small but unsustainable effect on membership growth rate in the Ashanti region. Factors other than capitation payment may have played a more significant role in subscribers’ enrolment and renewal decisions in the Ashanti region of Ghana.

Political economy of hope as a cultural facet of biomedicalization: A qualitative examination of constraints to hospice utilization among U.S. end-stage cancer patients

A growing body of social science literature is devoted to describing processes of biomedicalization. The issue of biomedicalization is especially relevant for individuals suffering from end-stage cancer and hoping that aggressive end-of-life interventions, which are riddled with uncertainty around quantity or quality of life, will produce a ‘cure’. To examine hospice underutilization among end-stage cancer patients, we apply the anthropological concept ‘political economy of hope,’ which describes how personal and collective ‘hope’ is associated with the political and economic structures that produce biomedicalization processes. Previous studies have examined hospice underutilization among end-stage cancer patients and have identified barriers stemming from patient and physician characteristics or health insurance reimbursement policies. Yet, these studies do not provide an organized synthesis of how barriers articulate, how they are part of the longitudinal decision-making process, or describe the sociocultural context surrounding hospice care enrollment decisions. This paper focuses on US-specific mechanisms and is based on qualitative, in-depth, interviews with physicians at an academic hospital (N = 24). We find that hospice underutilization results from a web of interconnected constraints surrounding end-stage cancer patients. Our research reveals how hospice care contradicts the political and economic structures associated with end-stage cancer care and illustrates how end-stage cancer patients are transformed into a form of biovalue, a fundamental commodity sustaining the political economy of hope.

Abstract WP307: Patients’ and Surrogates’ Experiences and Views of Consent in Acute Stroke Trials

Introduction: Informed consent for clinical trials in acute stroke is challenging. Enrollment decisions must be made quickly, in stressful situations, and typically by a surrogate. Moreover, trials are complex and unfamiliar. Understanding patients’ and surrogates’ experiences may help maximize respect for them while facilitating important studies. Methods: Telephone interviews were conducted with consented patients or surrogates for patients enrolled in acute stroke trials at 3 US sites between 2011 and 2016. Interviews assessed trial recall, experiences with consent, and preferences regarding consent. Questions were primarily closed-ended. Descriptive statistics were calculated, and bivariate analyses (Fisher’s exact) were conducted to examine predictors of consent preference. Results: Eighty-four respondents (69 surrogates, 15 patients) across 3 sites and 10 trials were interviewed and included in final analysis. Nine did not recall enrollment, and only about half (53%) recalled that the trial involved an intervention. Of 75 respondents who remembered enrolling, 65 (87%) remembered signing a consent form, 52 (80%) of whom said they read at least some of it. Most respondents reported being treated respectfully during consent. Only 12 respondents (16%) wished they had been enrolled in the trial without prospective consent. Individuals with low health literacy were less likely to prefer enrollment without consent (p<0.0007) but more likely to wish they had not had to sign a consent form (p<0.0001). Forty-six (61%) recalled someone talking with them about the study after enrollment. Conclusions: Patients and surrogates in stroke trials reported mostly positive consent experiences and generally appreciated having been asked for consent prior to enrollment. Recall of trial details, however, was low, and post-enrollment contact was recalled to be somewhat infrequent. Further work may help to identify the most context-appropriate strategies.

Planning Today for Tomorrow's Research: Analysis of Factors Influencing Participation in a Pediatric Cancer Research Biorepository.

Biobanks have become a powerful tool that fosters biomedical research. The success of biobanks depends upon people's perception and willingness to donate their samples for research. This is the first biorepository in Egypt, hence, little is known about the beliefs and attitudes of parents toward participation. To investigate the level of willingness of Egyptians to donate samples of their children and themselves for research and the different factors influencing participation. A structured questionnaire was designed covering multiple items expected to affect the enrollment decision. This was conducted in-person, and data collected included demographic data, socioeconomic, and educational level. In addition, in the case of refusal, participants were asked about reasons behind their decision. Only about 3.1% of patients have not been enrolled in the project, and 0.3% have withdrawn. Three demographic factors were found having disparate trends in the decision-making process to participate or not: father's education (p = 0.0001), mother's education (p = 0.0001), and father's age (p = 0.034). Egyptian parents were willing to donate their samples as well as their children's samples in our research biorepository. The idea of participation was presented in an interview during which the consent form was explained in a comprehensive transparent way allowing participants the right to refuse or withdraw at any time. Still, different communication approaches are needed with older, more highly educated parents to encourage them to participate.

Testing a Social Innovation in Financial Aid for Low-Income Students: Experimental Evidence from Italy

This paper presents the results of a randomized controlled trial aimed at testing the effectiveness of an innovative intervention of asset building (Percorsi) on high school students' transition to the university. Contrary to most traditional forms of financial aid, the tested intervention is expected to enhance an active involvement of the families and imposes a strong conditionality in the use of the benefits. The experiment, called ACHAB (Affording College with the Help of Asset Building) has been carried out in the province of Torino (Northwest Italy) between 2014 and 2017. For the evaluation purpose, an ad hoc survey has been carried out to collect longitudinal information on enrolment decisions and academic performances (number of exams and persistence) during the first semester and at the beginning of the second year. External data and applicant baseline information were used to perform a multidimensional targeting strategy aimed at identifying the 'target population', i.e. those students who were at risk of giving up their university enrolment decisions because of economic reasons. The experimental results point to the existence of positive and significant effects of the program on university enrolment and sizeable and significant positive effects on academic performance and university persistence. The effects of the program are significantly larger for students coming from vocational schools than for students who completed technical or general secondary schools.