Medicine and Health Sciences Commons^™

The Federal-State Medicaid Match: An Ongoing Tug-Of-War Over Practice And Policy, Karen Matherlee

National Health Policy Forum

Reviewing Medicaid match issues since the latter 1980s, this issue brief traces ways in which some states have used creative financing to get more Medicaid matching dollars than they otherwise would qualify for from the federal government. It explores the latest mechanism, states' use of so-called intergovernmental transfers of funds (to avoid established upper payment limits) to increase their matches, triggering efforts by the Senate Finance Committee and the federal Medicaid agency to ban such transfers.

An Analysis Of Risk Factors Associated With High Rates Of Cesarean Births In Three Selected Northeast Tennessee Hospitals., Karen Stewart-Hall

Electronic Theses and Dissertations

This study consists of an analysis of hospital discharge data from three Northeast Tennessee hospitals to identify maternal demographic factors that may be linked to higher rates of cesarean sections in this region of Appalachia. Maternal age, race, insurance status, length of stay, and birth weight were evaluated to identify regional trends in the prevalence of these factors over a two-year period.

There were 1,678 (23.3%) singleton live births by cesarean section of which 7.6% were repeat cesarean section deliveries. Less than one percent of the 7,181 births were vaginal births after cesarean (VBAC) delivery. Overall, insurance and maternal age …

Caring For The Elderly: Oregon's Pioneers (Portland, Oregon), Nora Super, Lisa Sprague

National Health Policy Forum

This site visit looked at the continuum of care for its elderly and disabled citizens in the first state ever to secure Section 1915(c) and (d) waivers under Medicaid to support home- and community-based services. More than three-quarters of Oregon's Medicaid clients now receive care in these settings. Site visitors were briefed on the history and development of long-term care in the state as well as the various care settings available. Panels discussed strategies and partnerships focused on alleviating workforce shortages and highlighted Oregon nurses' authority to delegate certain caregiving tasks to laypeople. Multnomah County staff described county-level activities, especially …

Emerging Issues In The Use Of Binding Arbitration To Resolve Disputes Between Individuals And Health Plans, Karl Polzer

National Health Policy Forum

After briefly describing the federal legal framework fostering the growth of binding arbitration, this paper identifies controversies surrounding arbitration as well as arguments supporting and opposing its use. The paper describes the use of arbitration among certain types of collectively bargained employee health plans regulated under the Employee Retirement Income Security Act of 1974 (ERISA), by health maintenance organizations (HMOs) in California, and by a large employer operating a self-insured ERISA health plan. Evidence cited by the California Supreme Court that the largest HMO in California operated its mandatory arbitration program in an unfair way is presented, along with the …

Schip In The Formative Years: An Update, Judith D. Moore

National Health Policy Forum

This issue brief examines the status of the State Children's Health Insurance Program (SCHIP) three years after authorizing legislation was enacted. Topics addressed include enrollment and retention of children in new programs, funding allotments and expenditures, evaluation activities planned and underway, the interaction of Medicaid and SCHIP, and problems common across many states.

Medicare+Choice: Where To From Here?, Nora Super

National Health Policy Forum

This issue brief examines Medicare+Choice (M+C) plan participation, benefit coverage, and enrollment and the factors that have contributed to plans' decisions to participate in or withdraw from certain markets. In addition, the issue brief explores what has been happening to M+C enrollees in terms of costs, benefits, and continuity of care. Lastly, the issue brief examines the reasons that alternative plan options — such as preferred provider organizations (PPOs) and provider-sponsored organizations (PSOs) — have not taken hold. Legislative proposals that might affect the future of M+C are also discussed.

Community-Based Nursing Education At The Campsite, M. Susan Jones, Donna Bussey, Carrie Morgan

Nursing Faculty Publications

No abstract provided.

The Asthma Epidemic: Prospects For Controlling An Escalating Public Health Crisis, Richard Hegner

National Health Policy Forum

This background paper examines the dimensions of the recent asthma epidemic and what could be done to contain it. Information about the prevalence and consequences of asthma across demographic groups is presented. Factors that impede the control of asthma are also identified. The paper also examines the possible causes of asthma and the asthma epidemic as well as new theories about the relationship of asthma to overall advances in health care and economic development. It also discusses the economic implications of asthma and possible cost avoidances linked to better asthma management. The paper concludes with discussions of asthma and public …

Readiness For Health Promotion, Colleen Murphy-Southwick Ph.D., Tom Seekins Ph.D., University Of Montana Rural Institute Rural Institute

Health and Wellness

There is growing interest in health promotion, wellness, and the prevention of secondary conditions among people with disabilities. In rural areas where there is limited access to health care providers knowledgeable about disability, managing one’s own health and wellness and using strategies to prevent secondary conditions may be particularly important (Offner, Seekins & Clark, 1992; Seekins, 1992; Center for Disability Policy and Research, 1995; Seekins, Clay & Ravesloot, 1994; Seekins, et al., 1999).

Insuring Virginia's Children: Local Outreach And Enrollment (Northern Virginia), Lisa Sprague, Judith D. Moore

National Health Policy Forum

This one-day visit to a nearby jurisdiction was designed to allow participation by federal staff who have been unable to commit the three days required by a typical Forum site visit. Site visitors were given an overview of health care in Virginia and an introduction to the Children's Medical Income Security Program (CMSIP) as well as its proposed replacement, the Family Access to Medical Insurance Security program (FAMIS). A panel representing community organizations and providers shared their experience, touching on provider concerns, coordination of outreach efforts across counties, and assistance for clients after they are enrolled. The group visited the …

Outpatient Commitment In Mental Health: Is Coercion The Price Of Community Services?, Coimbra Sirica

National Health Policy Forum

This paper reviews the debate over civil commitment to outpatient settings of people with mental illness who are considered too ill and/or too dangerous to be left on their own in their communities. The choices of two states — Maryland and New York — in dealing with this issue are reviewed. Alternative ways of drawing people into treatment and keeping them there are also discussed.

Hcfa's Outpatient Pps: Finally Ready To Roll?, Karen Matherlee

National Health Policy Forum

This issue brief centers on hospital outpatient department services, scheduled to be on a prospective payment system (PPS) July 1, 2000, 17 years after enactment of legislation mandating PPS for hospital inpatient services. It looks at the challenges to providers and patients, including coding and other process issues, redistribution of payments, and changes in beneficiary co-payments.

Using Schip To Subsidize Employment-Based Coverage: How Far Can This Strategy Go?, Karl Polzer

National Health Policy Forum

This background paper examines and analyzes early efforts by states to subsidize employment-based health insurance under the State Children's Health Insurance Program (SCHIP), which offers states a more generous funding rate than under Medicaid. As the Health Care Financing Administration prepares to issue regulations governing SCHIP, the paper summarizes complaints by state officials that federal rules governing how job-based coverage might be subsidized under the program are overly complex and rigid. After interviewing officials at the federal level and in six states as well as a variety of researchers and policy experts, the author considered whether and to what extent …

Pharmaceutical Marketplace Dynamics, Robin J. Strongin

National Health Policy Forum

This issue brief provides a profile of the pharmaceutical industry and explores topics such as competition, generics, intellectual property, research and development, pricing, and distribution. It also discusses government programs such as the Department of Veterans' Affairs federal supply schedule and Medicaid rebates.

Trends. Controlling Aids Through Control, Ibpp Editor

International Bulletin of Political Psychology

This article discusses the concept of political control and public health in the context of the HIV/AIDS epidemic.

Reinventing Medicaid: Hoosier Healthwise And Children's Health Insurance In Indiana, Judith D. Moore, Lisa Sprague

National Health Policy Forum

This site visit explored the factors that have made Indiana so successful in enrolling children in its Medicaid and SCHIP plans under the brand name Hoosier Healthwise. Site visitors met with legislators and state officials to gain understanding of the genesis and development of Hoosier Healthwise and its aggressive outreach component. A panel of representatives from partner organizations engaged in enrolling children provided further insight into this process. The site visit participants traveled to observe enrollment and operations in both urban (Marion) and rural (Clay) county offices. They also met with health care executives at hospitals, clinics, and neighborhood health …

Dispelling The Myths And Stigma Of Mental Illness: The Surgeon General's Report On Mental Health, Richard Hegner

National Health Policy Forum

This paper summarizes the key findings of "Mental Health: A Report of the Surgeon General," which was released on December 13, 1999, by U.S. Surgeon General David Satcher. Topics include the significance of mental illness, the effectiveness of diagnosis and treatment, the widespread lack of treatment, access problems and their causes, the significance of stigma, and the prevention of mental illness.

Site Visit To Seattle — University Of Washington Academic Medical Center, Karen Matherlee

National Health Policy Forum

The event was part of a series of three site visits leading to an April 27–28, 2000, conference in Annapolis, Maryland, on hospital-based health care systems in transition after enactment of the Balanced Budget Act of 1997 (BBA) and the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA). The site visit focused on the challenges the University of Washington (UW) faces in carrying out its three missions of delivery of health services (with emphasis on the safety net), health professions education, and health science and clinical research. It probed the effects of the BBA on these missions …

Applying Science To Public Policy: The Context Of The Surgeon General's Report On Mental Health, Richard Hegner

National Health Policy Forum

Intended to provide public policy context for the December 1999 Surgeon General's Report on Mental Health, this background paper discusses the historic skepticism about the efficacy of treatment of mental illness in this country, insurance practices that have discriminated against mental illness and the reasons for them, the disproportionate share of mental health funding provided by government sources such as Medicaid and state general revenues, the role of state and local public government as providers of catastrophic coverage for mental illness, the cascading cost-shifting game in mental health finance, obstacles to needed treatment (including popular attitudes toward mental illness), the …

Site Visit To Detroit — Henry Ford Health System, Lisa Sprague

National Health Policy Forum

This event was one in a series of three site visits leading to an April 27–28, 2000, conference in Annapolis, Maryland, on hospital-based health care systems in transition after the enactment of the Balanced Budget Act of 1997 (BBA) and the Medicare, Medicaid, SCHIP Balanced Budget Refinement Act of 1999 (BBRA). The site visit explored the responses of a large integrated system, the Henry Ford Health System, to the BBA and how the BBA has interacted with other changes in the system's local market and state Medicaid program. Panel presentations highlighted financing and information systems, the integration of diversified services, …

Site Visit To Richmond And Hampton Roads — Bon Secours Health System, Inc., Nora Super

National Health Policy Forum

The first in a series of three site visits leading to an April 27–28, 2000, conference in Annapolis, Maryland, on hospital-based health care systems in transition after the enactment of the Balanced Budget Act of 1997 (BBA) and the Medicare, Medicaid, SCHIP Balanced Budget Refinement Act of 1999 (BBRA). The site visit was designed to better understand how changing payment incentives — particularly the move to prospective payment systems for postacute services — has affected the ability to implement a continuum of care across delivery sites. It examined the Bon Secours Health System's operations in Virginia, which include four hospitals …

Improving Quality And Preventing Error In Medical Practice, Lisa Sprague

National Health Policy Forum

Drawing on the Institute of Medicine's report To Err Is Human, this issue brief looks at quality-improvement and error-reduction efforts at the institutional, regional, and state levels and analyzes the roles of government and the private sector in bringing such efforts into national focus. Questions considered include whether error reporting should be mandatory or voluntary, who should perform error analysis, and the role of the individual in an institutional accountability model.

Rural Managed Care And Disability: A National Perspective, Colleen Murphy-Southwick Ph.D., Tom Seekins Ph.D., University Of Montana Rural Institute Rural Institute

Health and Wellness

Rural access to health care has historically been a concern in the United States. In the late 1980s and early 1990s, lower rural reimbursements for the same services provided in urban areas contributed to a substantial decline in the number of rural hospitals and health care providers. Rural Americans with and without disabilities experienced the negative consequences of those changes. The rapid introduction of managed care is producing explosive changes in the marginal, aging, rural medical care services sector. Managed care policies directly affect both access to medical services by people with disabilities and the economic infrastructure of small rural …

Rural Managed Care And Disability: Emerging Issues From Preliminary Interviews And Case Studies, Colleen Murphy-Southwick Ph.D., Tom Seekins Ph.D., University Of Montana Rural Institute Rural Institute

Health and Wellness

Since the 1980s, rural access to health care information, resources and services has become increasingly problematic. The shift toward managed care complicates the picture. While some argue that managed care will devastate rural health services due to sparsely populated areas’ high costs and low profit margins, others suggest that market forces will make the health care system more efficient and re-distribute resources now concentrated in urban areas toward rural areas. Managed care is penetrating public programs

Physician Connectivity: Electronic Prescribing, Robin J. Strongin

National Health Policy Forum

This issue brief focuses on physician connectivity — the electronic linking of physicians with online resources such as clinical databases and sophisticated formulary systems. As physician connectivity increasingly allows physicians to prescribe online via a handheld computer complete with formulary information as well as patient data and drug information, this issue brief examines the issues raised by this technological advance within the broader context of online prescribing.

Site Visit To Arizona — Managed Medicaid: Arizona's Ahcccs Experience, Nora Super, Lisa Sprague, Judith D. Moore

National Health Policy Forum

This site visit featured a review of a unique Medicaid managed care system, the Arizona Health Care Cost Containment System (AHCCCS), which has operated as a research and demonstration waiver since its inception in 1982. Site visitors heard from speakers who provided historical and background information, a discussion of competitive bidding, contracting and performance management, and insights into the delivery of behavioral health under the mandatory AHCCCS program. The group also heard discussions about services to the uninsured and Arizona's safety net providers. Other topics covered during the visit included the state's KidsCare program under the State Child Health Insurance …

Reshaping Ahcs' Role In Biomedical Research, Karen Matherlee

National Health Policy Forum

This issue brief explores the reconfiguration of academic health centers (AHCs) in response to health marketplace and other pressures. It reviews four roles AHCs play in medical innovation: (a) development of new drugs, devices, diagnostic techniques, and therapeutic procedures; (b) adoption of new technologies, instruments, and drugs; (c) evaluation of new technologies; and (d) assessment of the need for new modalities and monitoring of their initial uses. The paper examines ways in which these roles are enhanced or threatened by evolving economic forces in the public and private sectors.

Balancing Public Health Against Individual Liberty: The Ethics Of Smoking Regulations, Thaddeus Mason Pope

Faculty Scholarship

Ten years ago, philosopher Robert E. Goodin published "No Smoking: The Ethical Issues." Goodin argued that the liberty of smokers can be justifiably limited for two reasons: to prevent harm to third persons and to prevent harm to smokers themselves under circumstances which make their decision to smoke substantially non-autonomous. In this article Thaddeus Pope reexamines the harm principle and the soft paternalism principle in light of more recent legal developments, gives them additional content, and carefully demarcates the justificatory scope of each. Pope also defines and defends a third liberty-limiting principle, hard paternalism, arguing that the liberty of smokers …

Increasing Obesity In Brazil: Predicting A New Peak Of Cardiovascular Diseases, Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

Male Pattern Baldness And Coronary Heart Disease: The Physicians' Health Study, Paulo A. Lotufo

Paulo A Lotufo

Is baldness a risk factor for heart attack? Aim: To examine the association between male pattern baldness and the risk of coronary heart disease (CHD) events. Desing, setting and participants:Retrospective cohort study among 22,071 US male physicians aged 40 to 84 years enrolled in the Physicians' Health Study. Of these, 19,112 were free of CHD at baseline and completed a questionnaire at the 11-year follow-up concerning their pattern of hair loss at age 45 years. Response options included no hair loss, frontal baldness only, or frontal baldness with mild, moderate, or severe vertex baldness. Main outcome measures: Coronary heart disease …