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Item The Effect of Charter Schools on Districts’ Student Composition, Costs, and Efficiency: The Case of New York State(Elsevier, 2019) Buerger, Christian; Bifulco, Robert; School of Public and Environmental AffairsCharter schools can influence a school district's costs by reducing economies of scale and by changing the share of high cost students a district serves, but might also increase the district's efficiency through competition. Utilizing data for New York State school districts from 1998/99 to 2013/14, we estimate difference-in-differences models to assess the effect of charter schools on enrollment and student composition. Then, we estimate an expenditure function, using data prior to the charter school program, to measure the costs associated with reaching a given performance standard for students in various need categories and different enrollments. Next, using the entire data set, we run a second expenditure function to determine changes in efficiency associated with charter school entry. We find that charter schools increase the cost of providing education, and that these cost increases are larger than short-run efficiency gains, but are offset by efficiency gains in the long term.Item Hospice use among nursing home and non-nursing home patients(Springer, 2015-02) Unroe, Kathleen T.; Sachs, Greg A.; Dennis, M.E.; Hickman, Susan E.; Stump, Timothy E.; Tu, Wanzhu; Callahan, Christopher; Department of Medicine, IU School of MedicineBACKGROUND: For nursing home patients, hospice use and associated costs have grown dramatically. A better understanding of hospice in all care settings, especially how patients move across settings, is needed to inform debates about appropriateness of use and potential policy reform. OBJECTIVE: Our aim was to describe characteristics and utilization of hospice among nursing home and non-nursing home patients. DESIGN AND PARTICIPANTS: Medicare, Medicaid and Minimum Data Set data, 1999-2008, were merged for 3,771 hospice patients aged 65 years and above from a safety net health system. Patients were classified into four groups who received hospice: 1) only in nursing homes; 2) outside of nursing homes; 3) crossover patients utilizing hospice in both settings; and 4) "near-transition" patients who received hospice within 30 days of a nursing home stay. MAIN MEASURES: Differences in demographics, hospice diagnoses and length of stay, utilization and costs are presented with descriptive statistics. KEY RESULTS: Nursing home hospice patients were older, and more likely to be women and to have dementia (p < 0.0001). Nearly one-third (32.3 %) of crossover patients had hospice stays > 6 months, compared with the other groups (16 % of nursing home hospice only, 10.7 % of non-nursing home hospice and 7.6 % of those with near transitions) (p < 0.0001). Overall, 27.7 % of patients had a hospice stay <1 week, but there were marked differences between groups-48 % of near-transition patients vs. 7.4 % of crossover patients had these short hospice stays (p < 0.0001). Crossover and near-transition hospice patients had higher costs to Medicare compared to other groups (p < 0.05). CONCLUSIONS: Dichotomizing hospice users only into nursing home vs. non-nursing home patients is difficult, due to transitions across settings. Hospice patients with transitions accrue higher costs. The impact of changes to the hospice benefit on patients who live or move through nursing homes near the end of life should be carefully considered.