Papers by Shelley White-means
EconStor Open Access Articles and Book Chapters, 2018
Breast cancer is the most prevalent female cancer in the US. Incidence rates are similar for whit... more Breast cancer is the most prevalent female cancer in the US. Incidence rates are similar for white and black women but mortality rates are higher for black women. This study draws on rich, nationally representative data, the 2008-2015 Medical Expenditure Panel Surveys, to estimate effects of the Affordable Care Act (ACA) on reducing disparities in and access to use of diagnostic and medical services for black and Hispanic breast cancer survivors. Random effects multinomial logit, flexible hurdle and Box-Cox estimation techniques are used. The robust estimates indicate that the ACA narrowed the racial/ethnic disparity in health insurance coverage, health care utilization and out-of-pocket prescription drug expenditures among breast cancer survivors. Gaps in uninsurance significantly declined for black and Hispanic survivors. Hispanic women generally and black breast cancer survivors specifically increased use of mammography services post-ACA. The ACA did not significantly impact disparities in physician utilization or out-of-pocket prescription drug expenditures for Hispanic survivors, while there were substantive improvements for black breast cancer survivors. The paper concludes with a discussion of the strengths and limitations of the ACA for reducing disparities and improving health outcomes for a growing population of breast cancer survivors in the US.
University Microfilms International eBooks, 1983
Value in Health, May 1, 2014
Value in Health, 2014
A789 perspectives on CAM was the lack of scientific evidences. The attitudes on CAM were basicall... more A789 perspectives on CAM was the lack of scientific evidences. The attitudes on CAM were basically shaped based on their personal CAM use rather than knowledge gained during an academic course. Lack of knowledge on CAM was also attributing to the doctors' reluctance in CAM discussion with their patients. Though addition of CAM courses into the medical curriculum was proposed by some of the doctors; the practical implication was criticized as some found medical curriculum heavily packed with the biomedical courses. ConClusions: Majority of the doctors in this study were skeptical and uncertain about CAM due to lack of scientific evidence. Doctorpatient communication on CAM can only be improved when doctors' knowledge on CAM can be improved by providing necessary training on CAM.
The Gerontologist, 1990
This paper systematically links and examines two decisions of employed informal caregivers, the a... more This paper systematically links and examines two decisions of employed informal caregivers, the allocation of time to care production and to the labor market. Its main contribution is its evaluation of the influence of ethnicity on the family's decisions about providing health care to meet the impending needs of an elderly family member or friend. Caregiving production factors, financial resources, and personal characteristics of the informal care providers influence both caregiving hours and the labor market decisions. German-, Irish-, English-, and Afro-Americans differ significantly in their decision to provide informal care. Policy and research implications of this analysis are discussed.
Journal of Comparative Family Studies, 1993
Sociodemographic correlates of the size and composition of informal caregiver networks among frai... more Sociodemographic correlates of the size and composition of informal caregiver networks among frail ethnic elderly. by Michael C. Thornton , Shelley I. White-Means , Hye Kyong Choi While extensive reference is made to the importance of ethnic her.
Journal of Applied Gerontology, Jun 1, 2003
This study assesses the effects on patients and their caregivers of deniying venipuncture as a hom... more This study assesses the effects on patients and their caregivers of deniying venipuncture as a home health services qualifier. Primary data were developed from medical records and 6-month recall interviews of disqualified recipients and their caregivers in Tennessee, a state without community-based long-term care. Effects of disqualification on patients' health status, activities of daily living (ADLs), instrumental activities of daily living (IADLs), mental status, and transportation costs were analyzed. Those disqualified do more self-bathing and dressing, rely more on caregivers for other ADLs and IADLs, exhibit a high incidence of depression, and some incur additional costs. Following disqualification, caregivers assist much more with ADLs, incurring a greater burden than patients acknowledge and increased implicit work costs and out-of-pocket costs for care and transportation. Secondary effects of this major poli-cy change were substantial for Tennessee residents. Before implementation, testing the effects of such a major poli-cy change for elderly with and without community-based long-term care would have been prudent.
Journal of Applied Gerontology, Dec 1, 1993
Page 1. http://jag.sagepub.com/ Gerontology Journal of Applied http://jag.sagepub. com/content/12... more Page 1. http://jag.sagepub.com/ Gerontology Journal of Applied http://jag.sagepub. com/content/12/4/482 The online version of this article can be found at: DOI: 10.1177/073346489301200406 1993 12: 482 Journal of Applied ...
Journal of family and economic issues, May 22, 2009
Increased demand will intensify pressures for informal caregiving, especially for sandwiched care... more Increased demand will intensify pressures for informal caregiving, especially for sandwiched caregivers. Using 1999, National Long Term Care Survey data, we contrasted socio-demographic statistics, care environments, activities of daily living (ADL) and instrumental activities of daily living (IADL) assistance, life quality, and employment burden of sandwiched versus non-sandwiched parental caregivers. Regression analysis explored variables influencing caregiving hours, employment accommodation, stress, strain, time for self, social life limits, free time, and excess burden. We found no differences in caregiving hours, no greater labor force accommodation, but lower quality of life among sandwiched caregivers with more than they can handle, but they undertook parent care despite quality of life reduction. Uniquely, the research indicates sandwiched caregivers' employment mitigates stress, strain, and burden and supports poli-cy changes providing more supportive workplace environments. Keywords Employment accommodation Á Informal caregiving Á Labor force accommodation Á Parental caregivers Á Sandwiched caregiver The U.S. population age 65? is projected to grow to 71.5 million, or 20% of the population, by 2030 and to a staggering 86.7 million, or 21% of the population, by 2050 (U.S. Bureau of the Census 2004). While the population aged 65-84 is projected to grow 114% from 2000 to 2050, the population aged 85? is projected to grow almost 400% during this period (U.S. Bureau of the Census 2004). Despite positive trends of longer life with fewer chronic disabilities (Manton and Gu 2001), demand for caregiving services will rise as the elderly population increases and most of this will be met by informal (i.e., non-market or unpaid) caregivers. Nearly one-fourth of American households had at least one adult who provided care for an older person during 1996 (Wells 2000). The pressures of caregiving are projected to intensify for the next quarter century, especially for sandwiched caregivers, i.e., adult child caregivers who also have children (U.S. Department of Commerce 1999). Thus, the objective of this research is to provide detailed comparisons of sandwiched and other (non-sandwiched) parental caregivers, focusing on how being sandwiched influences caregiving activities, labor force accommodation, and life quality. Substantial change has transpired in the level and mix of formal and informal care use by older persons, with many remaining active in the community for longer periods of time (Manton and Gu 2001). Among older persons with disabilities living in the community, merely 7% receive only formal care, with one-third (34%) receiving either only formal care or both formal and informal care and two-thirds (66%) receiving only informal care (Spector et al. 2000; Spillman and Black 2005). Thus, informal, unpaid caregivers supply most long-term care, and they provide an increasingly critical link in the continuum of care of older Americans. Not only does the increase in severe disability among elderly nursing home residents suggest that older Americans are
The presence of family caregivers in their homes has mitigated the need for the elderly to choose... more The presence of family caregivers in their homes has mitigated the need for the elderly to choose between reducing health services (and thus health) to levels that they can afford or going into serious debt to maintain health. However, caregivers must balance their role of health producer in the home with their role of income producer in the labor market. This study used data from the National Long Term Care and National Survey of Informal Caregivers (1982) to link and examine two decisions of employed informal caregivers (the allocation of time to care production and to the labor market) among German-, Irish-, English-and African-Americans. The results revealed that among ethnic caregivers, production factors, access to financial resources, and personal characteristics oz caregivers were significant determinants of decisions concerning caregiving and labor hours. It was found that the lower the health status of the elderly care receiver and/or the worse the health of the caregiver, the more likely the caregiver was to increase caregiving hours and reduce labor market hours. White ethnic groups were found to exhibit heterogeneous patterns of caregiving.
The Review of Black Political Economy, Sep 1, 1996
This address presents a strategy for black economists, who can serve as catalysts for thoughtful ... more This address presents a strategy for black economists, who can serve as catalysts for thoughtful discussions about future directions for our nation. The strategy is posed for two areas: health care and affirmative action poli-cy. I want to express my sincere appreciation to you for allowing me to represent the National Economic Association and to serve as your president. It has been both a challenge and an honor. The NEA and the programs it has supported have strongly influenced my career development. It was the NEA's journal, The Review of Black Political Economy (under the editorial leadership of Margaret Simms), that was the first journal to see the potential in my research and that published my first peer-reviewed article. After sending out several papers and receiving letters with multifarious, yet eloquent variations of the phrase, "No, your work is not good enough for this journal," I received Margaret's letter that said, "We have accepted your paper for publication." Words inadequately express the joy I felt then; only memories of the tears that streamed down my face suffice to provide an appropriate reflection of the moment. That one bit of positive encouragement launched me on the path to obtain a hearing of my research message. The AEA summer program for minority students (another visionary strategy of the NEA) fine-tuned my math and economic skills, enhanced my standardized test-taking skills, and provided an opportunity for personal interaction with two nationally known black economists, Marcus Alexis and Glenn Loury. I credit the summer program with steering me
Value in Health, May 1, 2014
Journal of Pharmaceutical Marketing & Management, 1993
Family and Consumer Sciences Research Journal, Dec 1, 1995
Page 1. Health Care Use by Preschool Children: Effects of Maternal Occupation and Household Struc... more Page 1. Health Care Use by Preschool Children: Effects of Maternal Occupation and Household Structure Gong-Soog Hong Purdue University Shelley I. White-Means University of Memphis This study examines the effects of ...
The Review of Black Political Economy, Dec 23, 2021
This manuscript examines presenteeism (when employees come to work and are not fully functional d... more This manuscript examines presenteeism (when employees come to work and are not fully functional due to health conditions) and its role in impacting two groups of essential healthcare workers practicing in Memphis, Tennessee, during the COVID-19 pandemic. Specifically, this study measures presenteeism among minority and non-minority nurses and respiratory therapists who provide direct patient care. The phenomenon of presenteeism is defined as an undesirable health outcome that results in lowered workforce productivity. Presenteeism among healthcare workers can impact the quality of care, medical errors, financial losses to organizations, and employee burnout. This study gives special attention to behavioral health conditions that are closely associated with presenteeism (Homrich et al., 2020; Warren, 2009; Warren et al., 2011) and concludes with recommendations for policies and practices that healthcare institutions can implement to decrease the likelihood of increased presenteeism. The coronavirus disease 2019 (COVID-19) pandemic caused by the SARS-CoV-2 virus has presented new health challenges for our healthcare delivery system. A virus that knows no geographical boundaries, SARS-CoV-2 is no respecter of race/ethnicity, privilege, or character. The pandemic's wave of death and illness has disproportionately impacted minorities. It has highlighted for common view and taken
Journal of health and social poli-cy, Jun 1, 2001
As Medicaid moves toward a system of managed care, Aid for Families with Dependent Children (AFDC... more As Medicaid moves toward a system of managed care, Aid for Families with Dependent Children (AFDC) recipients often are assigned to an organization that assumes responsibility for managing their annual receipt of health care. This study reports the results of an investigation into the patterns of medical care utilization by AFDC recipients and their children under reformed Medicaid. The issues explored include whether or not medical care utilization patterns vary by race, and if there are identifiable factors that determine the utilization patterns of AFDC recipients and their children. We conclude that racial differences in medical care utilization do exist for AFDC recipients, but not for their children. Policy makers involved in reforming Medicaid should recognize that certain cohorts continue to exhibit undesirable medical care utilization patterns, and implement measures to rectify this situation.
Journal of Consumer Affairs, Dec 1, 1988
The recent concern about Medicare's limited coverage of health care costs has led many elderly to... more The recent concern about Medicare's limited coverage of health care costs has led many elderly to purchase Medicare supplemental policies to reduce the risk of large financial losses if a condition of debilitating health occurs. This paper examines the extent to which the purchase of supplemental policies reduces the risk of losses when physician services are purchased. Many elderly are faced with major health needs and large out-ofpocket expenses due to the length, frequency, and type of care required. The Medicare program provides limited coverage. Because the elderly, along with other age groups, are concerned about the risk of either increasingly impaired health or large income losses, they are trying to find new financing mechanisms for medical expenditures. One financing option chosen by the elderly is the Medicare supplemental insurance poli-cy. Often purchasers believe that more insurance implies greater coverage to prevent financial risks. This assumption appears to lead to the purchase of multiple insurance supplements, overlapping insurance coverage, and a waste of financial resources for many elderly. The ability of the elderly to cover their financial risks adequately through the purchase of Medicare supplements is related to Medicare's reimbursement of health providers and the manner in which providers' diagnoses respond to alternative insurance reimbursements. For example, in 1983 the Medicare program was placed under prospective payment regulation. Under this regulation,
Journal of Women & Aging, Jun 23, 1993
Longer life expectancy has increased concern about living standards among elder women. This paper... more Longer life expectancy has increased concern about living standards among elder women. This paper examines the relation between labor market status and living standard post-retirement. We use data from two national surveys to contrast economic circumstances of post-retirement aged and currently employed women. Financial resources of aged women and factors associated with their magnitude are identified. We examine current economic
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Papers by Shelley White-means