Digital Commons Network^™

Strengthening Immigrants' Health Access: Current Opportunities, Leighton C. Ku

Health Policy and Management Issue Briefs

This brief summarizes key opportunities helping the nation’s newcomers in gaining health insurance coverage and health access that are possible under the current law. Provisions of the Affordable Care Act (ACA) will help millions of legal immigrants gain access to affordable health insurance coverage. At the same time, however, immigrants will also face new responsibilities. Like citizens, lawfully present immigrants will be responsible for having health insurance coverage or paying a tax penalty, although some are exempt. Rules about immigrants’ access to health insurance benefits are often complicated because they depend on specific immigration categories, as well as eligibility for …

A Profile Of Community Health Center Patients: Implications For Policy, Peter Shin, Carmen Alvarez, Jessica Sharac, Sara J. Rosenbaum, Amanda Van Vleet, Julia Paradise, Rachel Garfield

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Community health centers are a key source of comprehensive primary care in medically underserved communities across the country, and their role is expected to grow as health coverage expands under the Affordable Care Act (ACA). To sharpen understanding of the health center patient population, this brief compares it to the overall low-income population, using data from the Health Center Patient Survey and the National Health Interview Survey,respectively. The pre-ACA profile of health center patients that emerges sets the stage for measuring change following implementation of the reform law and can inform health center policy, planning, and assessment moving forward.

How Medicaid Expansions And Future Community Health Center Funding Will Shape Capacity To Meet The Nation's Primary Care Needs, Leighton C. Ku, Julia Zur, Emily Jones, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

A new report by Drs. L. Ku, J. Zur, E. Jones, P. Shin and S. Rosenbaum examines the impact of federal and state policy decisions on community health centers and their ability to continue providing primary care to the nation's poorest residents. The report estimates that under a worst-case scenario the nation's health centers would be forced to contract, leaving an estimated 1 million low-income people without access to health care services by 2020.

Assessing The Potential Impact Of The Affordable Care Act On Uninsured Community Health Center Patients: A Nationwide And State-By-State Analysis, Peter Shin, Jessica Sharac, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In this brief, we estimate the number of uninsured community health center (CHC) patients who would gain coverage under the Affordable Care Act using data from the 2009 HRSA Survey of CHC patients and 2011 Uniform Data System. We find that were all states to implement the Affordable Care Act Medicaid expansion, an estimated 5 million uninsured health center patients – or two-thirds of all uninsured patients served by CHCs nationally – would be eligible for coverage. However, over one million uninsured patients – 72% of whom live in southern states – who would have been eligible for coverage will …

How The Trans Pacific Partnership Agreement Could Undermine Pharmac And Threaten Access To Affordable Medicines And Health Equity In New Zealand, Deborah Gleeson, Ruth Lopert, Papaarangi Reid

Health Policy and Management Faculty Publications

New Zealand's Pharmaceutical Management Agency (PHARMAC) has been highly successful in facilitating affordable access to medicines through a combination of aggressive price negotiations, innovative procurement mechanisms, and careful evaluation of value for money. Recently the US government, through the establishment of a series of bilateral and plurilateral “free” trade agreements, has attempted to constrain the pharmaceutical access programs of other countries in order to promote the interests of the pharmaceutical industry. The Trans Pacific Partnership Agreement (TPPA) represents the latest example; through the TPPA the US is seeking to eliminate therapeutic reference pricing, introduce appeals processes for pharmaceutical companies to …

Providing Outreach And Enrollment Assistance: Lessons Learned From Community Health Centers In Massachusetts, Julia Paradise, Sara J. Rosenbaum, Peter Shin, Jessica Sharac, Carmen Alvarez, Julia Zur, Leighton Ku

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In 2006, major health care reform legislation was enacted in Massachusetts. In many ways a prototype for the Affordable Care Act (ACA), the Massachusetts law required nearly all state residents to obtain health insurance, and made insurance accessible and affordable by reforming the health insurance market and providing subsidies for coverage through expansions of Medicaid and CHIP and a new program for low-income adults who are not eligible for Medicaid, known as Commonwealth Care. The law also created the “Connector,” which, like the ACA’s health insurance Marketplaces, is designed to facilitate and simplify access to insurance for individuals, families, and …

Providing Outreach And Enrollment Assistance: Lessons Learned From Community Health Centers In Massachusetts, Julia Paradise, Sara J. Rosenbaum, Peter Shin, Jessica Sharac, Carmen Alvarez, Julia Zur, Leighton C. Ku

Health Policy and Management Faculty Publications

Six years ago, Massachusetts implemented a broad expansion of health coverage to the uninsured population in the state. Understanding that outreach and enrollment assistance would be essential to the success of the expansion, state policymakers provided for public education campaigns, but also for person-to-person, hands-on assistance, especially in communities with large numbers of uninsured people. Community health centers play a central role in this effort. As states and communities gear up to provide outreach and enrollment assistance under the ACA, the experience of the Massachusetts health centers offers lessons that can help inform current efforts to reach and enroll millions …

Racial Disparity In Duration Of Patient Visits To The Emergency Department: Teaching Versus Non-Teaching Hospital, Zeynal Karaca, Herbert S. Wong

Health Policy and Management Faculty Publications

Introduction: The sources of racial disparity in duration of patients’ visits to emergency departments (EDs) have not been documented well enough for policymakers to distinguish patient-related factors from hospital- or area-related factors. This study explores the racial disparity in duration of routine visits to EDs at teaching and non-teaching hospitals.

Methods: We performed retrospective data analyses and multivariate regression analyses to investigate the racial disparity in duration of routine ED visits at teaching and non-teaching hospitals. The Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) were used in the analyses. The data include 4.3 million routine ED …

The Bipartisan Senate Immigration Bill: Implications For Health Coverage And Health Access, Leighton C. Ku

Health Policy and Management Issue Briefs

No abstract provided.

Racial Disparities In The Use Of Cardiac Revascularization: Does Local Hospital Capacity Matter?, Suhui Li, Arnold Chen, Holly Mead

Health Policy and Management Faculty Publications

Objective

To assess the extent to which the observed racial disparities in cardiac revascularization use can be explained by the variation across counties where patients live, and how the within-county racial disparities is associated with the local hospital capacity.

Data Sources

Administrative data from Pennsylvania Health Care Cost Containment Council (PHC4) between 1995 and 2006.

Study Design

The study sample included 207,570 Medicare patients admitted to hospital for acute myocardial infarction (AMI). We identified the use of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) procedures within three months after the patient’s initial admission for AMI. Multi-level hierarchical …

Triglyceride/Hdl Ratio As A Screening Tool For Predicting Success At Reducing Anti-Diabetic Medications Following Weight Loss., Ghanshyam P. S. Shantha, Anita A. Kumar, Scott Kahan, Pavan K. Irukulla, Lawrence J. Cheskin

Health Policy and Management Faculty Publications

Background and Objectives

Intentional weight loss, by reducing insulin resistance, results in both better glycemic control and decreased need for anti-diabetic medications. However, not everyone who is successful with weight loss is able to reduce anti-diabetic medication use. In this retrospective cohort study, we assessed the predictive accuracy of baseline triglyceride (TGL)/HDL ratio, a marker of insulin resistance, to screen patients for success in reducing anti-diabetic medication use with weight loss.

Methods

Case records of 121 overweight and obese attendees at two outpatient weight management centers were analyzed. The weight loss intervention consisted of a calorie-restricted diet (~1000Kcal/day deficit), a …

Racial Disparities In The Use Of Cardiac Revascularization: Does Local Hospital Capacity Matter?, Suhui Li, Arnold Chen, Katherine H. Mead

Health Policy and Management Faculty Publications

Objective: To assess the extent to which the observed racial disparities in cardiac revascularization use can be explained by the variation across counties where patients live, and how the within-county racial disparities is associated with the local hospital capacity.

Data Sources: Administrative data from Pennsylvania Health Care Cost Containment Council (PHC4) between 1995 and 2006.

Study Design: The study sample included 207,570 Medicare patients admitted to hospital for acute myocardial infarction (AMI). We identified the use of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) procedures within three months after the patient’s initial admission for AMI. Multi-level hierarchical …

Comprehensive Immigration Reform And Health Care: Cbo's Analysis Of S. 744, Leighton C. Ku

Health Policy and Management Issue Briefs

No abstract provided.

Quality Of Care In Community Health Centers And Factors Associated With Performance, Julia Paradise, Peter Shin, Jessica Sharac, Sara J. Rosenbaum, Kaiser Commission On Medicaid And The Uninsured

Health Policy and Management Issue Briefs

This study examines quality performance among community health centers (CHC) on three key measures of primary and preventive care — diabetes and blood pressure control and timely Pap tests — using quality in Medicaid managed care organizations (MCO) as a benchmark. The study also identifies factors that differ significantly between high- and lower-performing health centers. Most health centers perform better than 75% of all Medicaid MCOs on the two chronic care measures, and more than 1 in 10 exceed this benchmark on all three quality measures. Few health centers lag behind average Medicaid MCO performance on all three measures. Lower-performing …

Quality Of Care In Community Health Centers And Factors Associated With Performance, Peter Shin, Jessica Sharac, Sara J. Rosenbaum, Julia Paradise

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Federally funded community health centers are a key source of comprehensive primary care for medically underserved communities, serving more than 20 million patients in 2011. The Affordable Care Act (ACA) expanded the health center program significantly to help meet the increased demand for health care that is expected as millions of the uninsured gain health coverage, beginning in 2014. Especially given health centers’ growing role, evidence of the quality of care they provide is of keen interest. Most research shows high performance by health centers relative to various standards, but some gaps have also been found, and suitable benchmarks for …

Moving Forward To 2014: Global Ihr (2005) Implementation, Julie E. Fischer, Rebecca L. Katz

Health Policy and Management Faculty Publications

No abstract provided.

Principles To Consider For The Implementation Of A Community Health Needs Assessment Process, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

No abstract provided.

Habilitative Services Coverage For Children Under The Essential Health Benefit Provisions Of The Affordable Care Act, Sara J. Rosenbaum

Health Policy and Management Issue Briefs

No abstract provided.

Developing Standardized Language For Use In Lgbt Health Research, Vaibhav Jain, Marisa Workman, Sara Mostafa, Abigail Wolfe, Stefania Davia, Natalie Terens, Keith Li, Blaine Parrish

GW Research Days 2013

BACKGROUND: In the past two decades, the LGBT community in the United States has been more visible, active, and positively accepted by society. As acceptance progresses, research interests on the LGBT population have increased, driving the need for standard language for researchers to share for comparative and community-based participatory research. "What term is right?" is often the question researchers ask a very diverse LGBT community. In August 2012, the District of Columbia's Office of LGBT Affairs identified incongruent language in a number of published reports commissioned by the Mayor's Office. The Office realized the importance of standardized language for health …

Health Centers And Family Planning: Results Of A Nationwide Study, Susan Wood, Debora Goetz Goldberg, Tishra Beeson, Brian K. Bruen, Kay Johnson, Holly Mead, Peter Shin, Julie Lewis, Shavon Artis, Katherine Hayes, Merle Cunningham, Xiaoxiao Lu, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Community health centers (CHCs) provided primary health care to over 20 million patients in 2011, 60% of whom are women and 25% of whom are women of childbearing age. Health centers play a central role in women's health, because of their mission to furnish a full range of primary and preventive care services, including family planning and birth control for women of reproductive age. As a result of the Affordable Care Act, which provide for historic insurance expansions, broad first-dollar coverage of family planning services, and direct investment in CHCs, it is projected that health center capacity will virtually double …

Community Health Centers In An Era Of Health Reform: An Overview And Key Challenges To Health Center Growth, Susan F. Wood, Debora Goetz Goldberg, Brian K. Bruen, Kay Johnson, Holly Mead, Peter Shin, Tishra Beeson, Julie Lewis, Shavon Artis, Katherine J. Hayes, Merle Cunningham, Xiaoxiao Lu, Trent White, Sara Rosenbaum

Health Policy and Management Faculty Publications

No abstract provided.

Assessing The Potential Impact Of Sequestration On Community Health Centers, Patients, And Medically Underserved Communities, Peter Shin, Jessica Sharac, Carmen Alvarez, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

A new report by the Peter Shin, Jessica Sharac, Carmen Alvarez, and Sara Rosenbaum examines the potential impact of sequestration on community health centers and their patients and communities. "Assessing the Potential Impact of Sequestration on Community Health Centers, Patients, and Medically Underserved Communities" estimates that the nation's 1,200 federally funded health centers will lose $120 million in grant funding, and that this funding drop can be expected to translate into 900,000 fewer patients served and 3 million fewer visits. The analysis shows that the cuts will disproportionately impact the poorest Americans, children, young families, and members of ethnic and …

Poor Immigrants Use Public Benefits At A Lower Rate Than Poor Native-Born Citizens, Leighton Ku, Brian K. Bruen

Health Policy and Management Faculty Publications

No abstract provided.

Community Health Centers In An Era Of Health Reform: An Overview And Key Challenges To Health Center Growth, Peter Shin, Jessica Sharac, Carmen Alvarez, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Today, over 1,100 federally funded community health centers play a vital role in ensuring access to health care for a predominantly low-income population in medically underserved communities. Health centers’ ability to provide comprehensive primary care and improve access to high-quality care while holding down health care cost growth has been well-documented. As health reform spurs coverage expansion and efforts to improve quality, the nation’s reliance on health centers is likely to grow.

In the Affordable Care Act (ACA), Congress invested $11 billion over five years to expand the health center program, to broaden access to care in lower-income communities as …

Embedding Concepts Of Sex And Gender Health Differences Into Medical Curricula, Virginia M. Miller, Morrisa Rice, Londa Schiebinger, Marjorie R. Jenkins, Janice Werbinski, Ana Nunez, Susan Wood, Lynne T. Shuster

Health Policy and Management Faculty Publications

Sex, a biological variable, and gender, a cultural variable, define the individual and affect all aspects of disease prevention, development, diagnosis, progression, and treatment. Sex and gender are essential elements of individualized medicine. However, medical education rarely considers such topics beyond the physiology of reproduction. To reduce health care disparities and to provide optimal, cost-effective medical care for individuals, concepts of sex and gender health need to become embedded into education and training of health professionals. In September 2012, Mayo Clinic hosted a 2-day workshop bringing together leading experts from 13 U.S. schools of medicine and schools of public health, …

Community Health Centers In An Era Of Health Reform: An Overview And Key Challenges To Health Center Growth, Peter Shin, Jessica Sharac, Carmen Alvarez, Sara J. Rosenbaum, Julia Paradise

Health Policy and Management Faculty Publications

Over 1,100 federally funded community health centers play a vital role in ensuring access to health care for a predominantly low-income population in medically underserved communities. Health centers’ ability to provide comprehensive primary care and improve access to high-quality care while holding down health care cost growth has been well-documented. As health reform spurs coverage expansion and efforts to improve quality, the nation’s reliance on health centers is likely to grow.

In the Affordable Care Act (ACA), Congress invested $11 billion over five years to expand the health center program, to broaden access to care in lower-income communities as coverage …

E-Learning In Medical Education In Resource Constrained Low- And Middle-Income Countries, Seble Frehywot, Yianna Vovides, Zohray Talib, Nadia Mikhail, Heather Ross, Hannah Wohltjen, Selam Bedada, Kristine Korhumel, Abdel Karim Koumare, James Scott

Health Policy and Management Faculty Publications

Background

In the face of severe faculty shortages in resource-constrained countries, medical schools look to e-learning for improved access to medical education. This paper summarizes the literature on e-learning in low- and middle-income countries (LMIC), and presents the spectrum of tools and strategies used.

Methods

Researchers reviewed literature using terms related to e-learning and pre-service education of health professionals in LMIC. Search terms were connected using the Boolean Operators “AND” and “OR” to capture all relevant article suggestions. Using standard decision criteria, reviewers narrowed the article suggestions to a final 124 relevant articles.

Results

Of the relevant articles found, most …

Ensuring The Health Care Needs Of Women: A Checklist For Health Exchanges, Paula Johnson, Therese Fitzgerald, Laura Cohen, Susan F. Wood, D. Richard Mauery, Trenton M. White, Alina Salganicoff, Usha Ranji

Health Policy and Management Faculty Publications

To inform the development of the state health insurance Exchanges under the Affordable Care Act, this checklist identifies key coverage, affordability and access issues that are important for women. Based on lessons learned from women’s health research and the Massachusetts experience, the checklist considers essential health benefits, implementation of no-cost preventive services including contraception, provider networks and affordability, outreach and enrollment efforts, and the importance of including gender and other demographic characteristics in data collection and reporting standards. It was jointly authored by policy experts at the Kaiser Family Foundation, The Connors Center for Women’s Health and Gender Biology at …

Increased Use Of Dental Services By Children Covered By Medicaid: 2000-2010, Leighton C. Ku, Jessica Sharac, Brian K. Bruen, Megan Thomas, Laurie Norris

Health Policy and Management Faculty Publications

This report analyzes the use of dental services by children enrolled in Medicaid from federal fiscal years (FFY) 2000 to 2010. The number and percent of children receiving dental services under Medicaid climbed continuously over the decade. In FFY 2000, 6.3 million children ages 1 to 20 were reported to receive some form of dental care (either preventive or treatment); the number more than doubled to 15.4 million by FFY 2010. Part of the increase was because the overall number of children covered by Medicaid rose by 12 million (50%), but the percentage of children who received dental care climbed …

Readiness For Meaningful Use Of Health Information Technology And Patient Centered Medical Home Recognition Survey Results, Peter Shin, Jessica Sharac

Health Policy and Management Faculty Publications

Objective. Determine the factors that impact HIT use and MU readiness for community health centers (CHCs).

Background. The HITECH Act allocates funds to Medicaid and Medicare providers to encourage the adoption of electronic health records (EHR), in an effort to improve health care quality and patient outcomes, and to reduce health care costs.

Methods. We surveyed CHCs on their Readiness for Meaningful Use (MU) of Health Information Technology (HIT) and Patient Centered Medical Home (PCMH) Recognition, then we combined responses with 2009 Uniform Data System data to determine which factors impact use of HIT and MU readiness.

Results. Nearly 70% …