New Project

The Effect of Flexner-Era Medical School Closures on Physician Geographic Distribution and Population Health

Ethan Schmick, Marquette University

Abstract  This paper studies the impact of Flexner Era (1905-1915) medical school closures on physicians per capita and mortality. The Flexner Era was characterized by an increase in medical school standards and saw the number of medical schools in the United States decline by 40%, due to closures and mergers. The Flexner Era culminated with the release of the Flexner Report (1910), which recommended the closure of all but 28 medical schools in the United States. We begin by documenting the time-path of physician concentration at the county-level from 1900-2020. To do this we make use of publicly available full-count U.S. Census data from 1900-1940 and restricted access long-form Census and ACS data from 1950-2020. We next construct a measure of how impacted each county was by Flexner Era medical school closures based on proximity to closures and the number of graduates from closed schools. Our results indicate that counties more impacted by school closures had relatively fewer physicians per capita in the post-Flexner Era – a result that persisted until at least 1940. We plan to extend this analysis to 2020 using the restricted access Census data to determine if these results persisted into the modern era. We also plan to examine how the decrease in physician concentration resulting from Flexner-era school closures impacted population health by studying mortality. This research might speak to the historical origins of the current physician shortage for underserved areas and people and furthers our understanding of the relationship between health care providers and population health.

New NCHS Project

Meghan Jenkins Morales recently started a project entitled HUD Rental Assistance and Healthy Aging in the Current Long-Term Care Landscape.

Abstract In the United States, population aging is coinciding with a growing affordable housing crisis. The Department of Housing and Urban Development (HUD) provides rental assistance to roughly 1.6 million older adults, but assistance falls substantially short of demand with only 33% of income eligible older households receiving assistance. Given the scope and importance of HUD rental assistance programs in the US, it is surprising how little we know about the health and long-term care (LTC) needs of older HUD renters. Recent studies have found that HUD rental assistance is associated with improved self-rated health, psychological well-being (Fenelon et al., 2017), and healthcare access (Simon, Fenelon, Helms, Lloyd, & Rossen, 2017), but these studies either do not include or do not specifically examine these effects among older adults. To address this gap in the literature, this project will examine if receiving HUD rental assistance promotes healthy aging. Data on low-income renters age 60 and older from 18 years (1999-2016) of pooled cross-sectional NHIS-HUD data will be used to describe and compare the health/functioning, healthcare access/use, and adverse health events experienced by older HUD renters compared to unassisted low-income older renters (Aim 1). Multivariate regression models will also be used to examine healthy aging outcomes among older renters currently living in HUD housing, compared to older renters who will enter HUD housing within two years, the average HUD waitlist duration (Aim 2). This “pseudo waitlist” control group method (comparing concurrent to future HUD recipients) accounts for selection into HUD assistance, a common limitation of prior work. The results of this project will help improve services to older HUD renters and inform the development of service systems that integrate housing and health

New AHRQ Project

Madeline Reed recently started a project entitled. The Liquidity Sensitivity of Out-of-Pocket Health Care Expenditure: Effects from the Earned Income Tax Credit
Abstract: Out-of-pocket costs have grown dramatically in the last decade, contributing to households having to devote a greater share of their income to health care. Even among households with coverage through their employer, delaying of care due to cost is common. Health plans with deductibles have steep spot prices for cost-sharing early in coverage periods, which may drive individuals who are not financially prepared to defer expenses until they have the money to pay. This study uses monthly medical expenditures from 2011 to 2016 to answer the research question: Is there an association between increased income and health care utilization among individuals in private health plans? This research investigates how access to liquidity effects the timing of health care use among individuals with different deductible plans


New LEHD Project

Florence Honore started a new project entitled:  Management and Organizational Practices, Business Dynamism, Employee Sorting, and Entrepreneurship
We anchor our project on the intersection of the literature on management and organizational practices and on entrepreneurship. We will focus on three main research questions: how do management and organizational practices relate to the rate and direction of entrepreneurial spinouts generated from an establishment? How do organizational practices influence the extent to which firms attract or lose employees, as well as the characteristics of employees who join and depart an establishment? How does early employees’ industry experience affect the managerial practices adopted by new establishments? How long does this effect persist? Answering these research questions will contribute to the debate on the drivers of business dynamism and it should lead to a much better understanding of why it may be changing over time and what the prospects for the future are. Furthermore, the study will improve our understanding of why employees decide to found new firms, and, more broadly, the relationship between management at incumbent firms and the rate and direction of entrepreneurial activity. Finally, the study will improve our understanding of how early employees affect the adoption of managerial practices in new establishments. Our primary data sources for the three research questions will be the LEHD, the LBD, the BRB, the ASM, the CM and the MOPS survey.

New Data: National Sample Survey of Registered Nurses (NSSRN)

The Census Bureau recently announced that researchers can apply for access to the National Sample Survey of Registered Nurses (NSSRN).   Sponsored by the U.S. Department of Health and Human Services’ Health Resources and Services Administration, the National Sample Survey of Registered Nurses examines the characteristics of registered nurses and their experiences in the nursing field.The survey is in its tenth cycle.

RDC Webinar: Micro-Level Determinants of White-Black Segregation (3-31)

Amber Crowell (Sociology, CSU Fresno) will present her research titled “The Micro-Level Determinants of White-Black Segregation: Beyond Spatial Assimilation and Place Stratification.” Her presentation will be on March 31st at 1:00 ET.

Abstract: In this study we undertake a quantitative analysis of the locational attainments of Black households in metropolitan areas of the United States using restricted-use microdata and new methods for segregation analysis. Using a superior reformulation of the separation index, a well-known measure of residential segregation, we disaggregate the index into individual locational outcomes and analyze the household-level characteristics that affect Black locational attainments and directly predict overall White-Black segregation in 25 of the largest metropolitan areas. The advantage of disaggregating the separation index is that we can not only micromodel segregation, but we can also perform regression standardization and decomposition analysis to test prevailing theoretical arguments on the microlevel determinants of segregation. We find that while some factors, such as education and income, affect Black locational attainments in ways that align with the spatial assimilation hypothesis, race group membership is a major primary contributor to overall levels of White-Black segregation, which lends support to the place stratification framework. Additionally, we find that contrary to traditional assimilation theory, U.S.-born Black householders experience more segregation from White householders than foreign-born Black householders. We argue that this finding could potentially be understood through segmented assimilation theory, which posits that there are multiple assimilation trajectories in a racially stratified society. For Black households, spatial assimilation can mean increased residential separation from White households.

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IRS-Census Income Measurement Workshop (3-29)

The Second IRS-Census Income Measurement Workshop is scheduled for March 29, 2021. The workshop will feature selected papers from authors representing many areas of the IRS, Census, and other government agencies, as well as academic and private-sector experts on income reporting, administrative records, and poverty measurement.

NEW Data: Criminal Justice and COVID

Criminal Justice Administrative Records System is a data set that follow individual through the criminal justice system.  In partnership with the U.S. Census Bureau, these data can been linked with survey and administrative records from many social and economic domains –

Household Pulse Survey provides timely data to help understand the experiences of American households during the coronavirus pandemic. The data provide insight on education, employment, food security, health, housing, social security benefits, household spending, and transportation.

The Small Business Pulse Survey (SBPS) measures the effect of changing business conditions during the Coronavirus pandemic on our nation’s small businesses. SBPS complements existing U.S. Census Bureau data collections by providing high-frequency, detailed information on the challenges small businesses are facing during the Coronavirus pandemic.  The survey includes information on small business operations and finances, requests and receipt of assistance, and measures of overall well-being and expectations for recovery.  Data is available by sector and state for the fifty most populous Metropolitan Statistical Areas (MSAs).

The Decennial Census Digitization and Linkage project (DCDL) is an initiative to produce linked restricted microdata files from the decennial censuses of 1960 through 1990. Background, work plan, and data dissemination details can be found in this working paper. The project will ultimately produce a longitudinal data infrastructure that covers most of the U.S. population since 1940.

RDC Reopens

The Wisconsin RDC started allowing researchers back into the lab at the end of August  on a strictly limited basis. Researchers schedule their lab time the week prior to wanting to work; only two researchers are allowed in the RDC space at one time; researchers are required to wear face coverings and work at assigned cubicles Additionally, alcohol wipes and hand sanitizer are provided to keep the work spaces clean and researchers as safe as possible