Medicine and Health Sciences Commons^™

Retooling Tax Subsidies For Health Coverage: Old Ideas, New Politics, Karl Polzer

National Health Policy Forum

This paper describes the tax treatment of health coverage and health care spending and explores the potential impact of recent tax reform proposals. The paper summarizes the criticisms of the current system and analyzes various alternatives including capping the open-ended tax exclusion of health benefits provided by employers and unions, eliminating the exclusion, and establishing a tax credit.

Physician Organizations Assuming Risk: Market And Policy Implications, Sandra Foote, Lisa Sprague

National Health Policy Forum

This issue brief looks at capitation contracting between physician groups and health plans and ways in which financial risk and functional responsibilities may be apportioned. It traces the evolution of capitation contracting in California and the legislative and regulatory issues that have arisen.

Site Visit To Southern California — Plans And Providers: Risk, Accountability, And Staying Power, Lisa Sprague

National Health Policy Forum

This site visit was the second of two focused on managed care operations and market dynamics in California, a state notable for high HMO market penetration and intense competition. In southern California, large physician groups and independent practice associations were highly visible and influential. They had assumed significant financial risk and care management responsibility for patients in HMO plans. The result was a distinctly different model of managed care than existed in other regions of the country. The visit included meetings with leaders from physician organizations and managed care organizations in San Diego and Orange counties, as well as an …

Site Visit To Utah And Nevada — Essential Community Health Services On The Frontier, Karen Matherlee, Michael Anzick

National Health Policy Forum

From the opening dinner to the closing summary, this site visit explored the delivery and financing of essential community services for vulnerable populations in the frontier West. A sequel to the Forum's March 30-31, 1998, urban-centered site visit to Philadelphia, Providing Community-Based Primary Care: Nursing Centers, CHCs, and Other Initiatives, the visit spanned 493 miles. It included overview presentations, bus briefings, facility tours, telehealth demonstrations, panel discussions, and wrap-up reviews. Topics included the Utah health marketplace, the demands of emergency preparedness, the development of a patchwork of services along a continuum ranging from preventive care to tertiary referrals and follow-up, …

The State Children's Health Insurance Program: How Much Latitude Do The States Really Have?, Richard Hegner

National Health Policy Forum

The State Children's Health Insurance Program (CHIP) — a major program to cover low-income, uninsured children — was passed as part of the Balanced Budget Act of 1997. Its passage was part of a trend of a shifting balance of power between the federal and state governments, particularly in the policy areas of health and social welfare. This issue brief explores the degree of freedom afforded the states by CHIP, the factors guiding state decision making and planning, and the factors influencing the states' various decisions about CHIP. It also discusses state options in four basic areas: participation or nonparticipation …

Protecting The Confidentiality Of Health Information, Nora Super

National Health Policy Forum

This issue brief focuses on the legislation aimed at protecting the confidentiality of health information. It provides an overview of legislation being considered in 1998 and focuses on three key issues: controlling access to health information, conducting research, and preempting state laws.

Communicating To Beneficiaries About Medicare+Choice: Opportunities And Pitfalls, Nora Super

National Health Policy Forum

This issue brief explores the opportunities and potential pitfalls in communicating to beneficiaries about Medicare+Choice. This issue brief also looks at the difficulties inherent in communicating complex information to a diverse group of older individuals as well as at communications and programmatic challenges related to information overload, marketing concerns, lack of uniform standards, lack of infrastructure, and the vulnerability of various subpopulations.

Medicare Coverage And Technology Diffusion: Past, Present, And Future, Robin J. Strongin

National Health Policy Forum

This issue brief provides an overview of the Medicare coverage process. Coverage involves deciding whether or not to pay for a particular service or product. This brief examines Medicare's coverage determination process, which includes technology assessment, payment determination, and the demand for evidence. Options for improving the coverage determination process are reviewed.

Erisa Health Plan Denials: Exploring Models For External Review, Karl Polzer

National Health Policy Forum

This paper outlines the current process under the Employee Retirement Income and Security Act (ERISA) by which plan participants can appeal a claim denial as well as changes to the claims procedure requirements being considered by the Department of Labor. It describes state legislative activity in this area and summarizes research describing practices currently in place among managed health care organization. The paper also describes two existing models for external review of managed care plan decisions, one used by the Medicare program and another by the state of Florida.

Nursing Home Ownership And Public Policy: An Historical Analysis, K. R. Kaffenberger

Graduate Doctoral Dissertations

In the early days of the United States, care of the disabled elderly outside the home meant the public almshouse. By the 1920s, private, nonprofit homes for the aged were prevalent. More recently, private, for-profit facilities have grown to dominate the field.

For-profit ownership has been controversial. Underlying the controversy is the concern that quality might be lowered in order to enhance profit.

This study asks why most nursing homes are privately owned and why most privately owned nursing homes are operated for profit. It does so with reference to The Nonprofit Economy, in which Burton Weisbrod describes a …

Site Visit To New Jersey — State And County Experiences With Welfare Reform And Access To Health Care, Michael Anzick, Richard Hegner

National Health Policy Forum

This site visit was the second in a series to examine what is occurring at the state and local level with respect to welfare reform, Medicaid, public health, and safety net and other supportive services. During this visit, policymaker discovered how state officials, directors, and front-line staff at urban and suburban county welfare offices are working with clients to move them off the welfare rolls into jobs and providing the support services necessary for job retention; heard from clients about how programmatic changes are affecting them and their families; learned how the role of safety net health care and temporary …

How Do Hmos Achieve Savings? The Effectiveness Of One Organization's Strategies., Ann B. Flood, Allen M. Fremont, K Jin, David M. Bott

Dartmouth Scholarship

To examine how a group practice used organizational strategies rather than provider-level incentives to achieve savings for health maintenance organization (HMO) compared to fee-for-service (FFS) patients. A large group practice with a group model HMO also treating FFS patients. Data sources were all patient encounter records, demographic files, and clinic records covering 3.5 years (1986-1989). The clinic's procedures to record services and charges were identical for FFS and HMO patients. All FFS and HMO patients under age 65 who received any outpatient services during approximately 100,000 episodes of the seven study illnesses were eligible.

Dual Diagnoses: The Challenge Of Serving People With Concurrent Mental Illness And Substance Abuse Problems, Richard Hegner

National Health Policy Forum

This paper describes the prevalence of comorbid mental disorders in the population and discusses what is known about causality and relapse. The relationship between dual diagnosis and homelessness and crime is also discussed. The paper also explores options for improving treatment among the dually diagnosed.

Increasing The Federal Cigarette Tax: A Means Of Reducing Consumption?, Lauren Tran, Richard Hegner

National Health Policy Forum

This issue brief probes the economic issues associated with tobacco and cigarettes. It examines the possible effectiveness of a tax increase as a strategy to reduce cigarette consumption, especially among young people, and the likely ramifications of a tax increase for the tobacco industry.

Restructuring The Va Health Care System: Safety Net, Training, And Other Considerations, Barbara Skydell

National Health Policy Forum

This paper provides an historical overview of the modern Veterans Administration (VA) healthcare system and describes the multiple missions of the VA — patient care, health professions education, research, and medical preparedness. The VA's reform plan, which addresses issues related to decentralization, management and oversight, resource allocation, eligibility reform, and primary/ambulatory care, is also described and discussed. Challenges facing the VA as it transitions to a greater focus on prevention, primary care, and care management are also addressed.

The Federal Employees Health Benefits Program: What Lessons Can It Offer Policymakers?, Karl Polzer

National Health Policy Forum

This paper provides an historical overview of the Federal Employees Health Benefits (FEHB) program and its marketplace dynamics. It also reviews key program features and issues, including payments to health plans, strategies used to mitigate the opportunities for risk selection, and costs.

Interprofessional Working And Continuing Medical Education., Linda Headrick, Peter Wilcock, Paul Batalden

Dartmouth Scholarship

No abstract provided.

Site Visit To Philadelphia — Providing Community-Based Primary Care: Nursing Centers, Chcs, And Other Initiatives, Karen Matherlee

National Health Policy Forum

This site visit provided federal congressional and agency health staff opportunities to visit facilities and engage in discussions on essential community health services. Focused on community-based primary care in a managed care environment, it featured delivery and financing concerns relating to nursing centers, community health centers, public-mission hospitals, and homeless services. In examining the impact of managed care in a rapidly changing health marketplace, it explored the implementation of the Medicaid HealthChoices program in the city as well as access to and delivery of care to persons with neither public nor private insurance. It also looked at the role of …

Mental Health Parity: 1998 National And State Perspectives, Bruce Lubotsky Levin, Ardis Hanson, Richard Coe, Ann C. Taylor

Ardis Hanson

The federal Mental Health Parity Act of 1996 requires insurers to offer the same benefits for mental disorders and substance abuse as they would for physical disorders, including any annual or lifetime limitations and restrictions placed upon such coverage. To date, twenty states across the nation have enacted parity laws for mental health and/or substance abuse benefits. This report summarizes the essential issues facing the state of Florida in the development of state mental health parity legislation, including an examination of the experiences of other states, a look at potential benefits, and a discussion of the impact of managed care …

A Longitudinal Study Of Hospitalization Rates For Patients With Chronic Disease: Results From The Medical Outcomes Study., Eugene C. Nelson, Colleen A. Mchorney, Willard G. Manning, W H. Rogers

Dartmouth Scholarship

To prospectively compare inpatient and outpatient utilization rates between prepaid (PPD) and fee-for-service (FFS) insurance coverage for patients with chronic disease. Data from the Medical Outcomes Study, a longitudinal observational study of chronic disease patients conducted in Boston, Chicago, and Los Angeles.A four-year prospective study of resource utilization among 1,681 patients under treatment for hypertension, diabetes, myocardial infarction, or congestive heart failure in the practices of 367 clinicians.

Site Visit To Northern California — Risk, Accountability, And Staying Power In Next-Generation Managed Care, Lisa Sprague, Sandra Foote

National Health Policy Forum

This three-day site visit looked at private health insurance and delivery of care in a market notable for high managed care penetration, relatively low premium costs, and sophisticated provider groups. Federal congressional and regulatory staff heard from health insurance purchasers (both public and private), health plans, hospital systems, and physician groups about the changing relationships and accountabilities in this market and the ways various organizations were positioning themselves to survive the turmoil and emerge the stronger for it. Participants also heard from two county health programs about how competition and realignment in the private market were impacting safety-net services for …

Health Care Quality: From Data To Accountability, Mary Darby

National Health Policy Forum

This paper discussed the evolution of quality measurement and reporting activities as well as efforts to develop accountability for delivering high-quality care. It examined (a) initiatives in the professional arena, such as accreditation and performance measurement by independent accrediting bodies; (b) activities of market proponents, who have preferred to concentrate on making data available to purchasers and consumers that would enable them to choose high- quality plans and providers; and (c) attempts by the public sector to secure quality through regulation and oversight. An exploration of the successes, limitations, overlaps, and gaps in quality assurance initiatives, the paper was published …

Effectiveness Of Case Management With Severely And Persistently Mentally Ill People, Kevin M. Gorey

Social Work Publications

This meta-analytic review synthesizes the findings of 24 published studies dealing with the effectiveness of case management with the severely and persistently mentally ill. Summative findings were: (1) Overall, case management interventions are effective--75% of the clients who participate in them do better than the average client who does not; (2) The estimated preventive fraction (e.g., prevention of re-hospitalization) among clients who experience relatively intense case management service (case loads of 15 or less, 89%) is nearly 30% greater than that estimated among similar clients receiving less intensive service; and (3) Various case management practice models did not differ significantly …

Gorey, K. Association Between Socioeconomic Status And Cancer Incidence In Toronto, Ontario: Possible Confounding Of Cancer Mortality By Incidence And Survival, Kevin M. Gorey

Social Work Publications

OBJECTIVE: To observe the association between socioeconomic status (SES) and cancer incidence in a cohort of Canadians.

DESIGN: Cases of primary malignant cancer (83,666) that arose in metropolitan Toronto, Ont., from 1986 to 1993 were ascertained by the Ontario Cancer Registry and linked by residence at the time of diagnosis to a census-based measure of SES. Socioeconomic quintile areas were then compared by cancer incidence.

RESULTS: Significant associations between SES and cancer incidence in the hypothesized direction--greater incidence in low-income areas--were observed for 15 of 23 cancer sites.

CONCLUSIONS: These findings, together with the recently observed consistent pattern of significant …

Manuel De Recherche Opérationnelle En Matière De Planification Familiale, Andrew A. Fisher, John E. Laing, John E. Stoeckel, John Townsend

Reproductive Health

Le Manuel de recherche opérationnelle en matière de planification familiale, publié pour la première fois en anglais par le Population Council en 1984, se basait sur des projets de recherche en Asie. Cette seconde édition contient des sections révisées et développées. Le cas échéant, des exemples d'Amérique latine et d'Afrique ont été ajoutés. Le chapitre d'introduction comprend une exposé actualisé sur le processus de la recherche opérationnelle (RO) en matière de santé et planification familiale. De nouveaux chapitres concernent le choix du type d’intervention à tester dans une étude RO ainsi que les principaux éléments constituant un programme d'intervention. Le …

Assessing The Quality Of Reproductive Health Services, Raeda Al Qutob, Salah Mawajdeh, Laila Nawar, Salama Saidi, Firas Raad

Reproductive Health

This paper offers a broad definition of quality of care and presents a comprehensive conceptual framework for the assessment of quality of reproductive health services and methodological approaches for its measurement. It presents three studies that were conducted between 1990 and 1991 by members of the regional Reproductive Health Working Group from Egypt, Jordan, and Tunisia. The studies provide examples of applications of the framework and its measurement using multiple data sources. Selected findings are presented to illustrate comparative results between countries. Based on the lessons learned from the studies, examples of reproductive health interventions that may improve the quality …

Seminar On Male Involvement In Reproductive Health In Egypt: Summary Of Research Findings And Future Directions, Nahla G. Abdel-Tawab

Reproductive Health

As more work in the area of male involvement in reproductive health (RH) is expected in Egypt, it is important that researchers and donor agencies become aware of existing studies, topics covered, and main research findings so duplication can be avoided. It is also important that policymakers and program managers learn about the results of existing studies so they can use those results in designing more effective policies to increase male involvement in Egypt. To address this need, the Population Council’s ANE OR/TA Project organized a seminar on “Disseminating Results of Research on Male Involvement in Reproductive Health in Egypt” …

Strengthening The Research Capacity Of Planned Parenthood Association Of Ghana, Robert A. Miller

Reproductive Health

The Planned Parenthood Association of Ghana (PPAG) is one of the most active nongovernmental organizations delivering reproductive health (RH) services in Ghana, focusing particularly on youth issues and services. USAID suggested to the Population Council’s Africa OR/TA Project II staff that PPAG might benefit from technical assistance. A large and well-funded IPPF program to promote sexual health among youth of the Volta Region offered a good opportunity to begin OR work. Earlier, the program was envisioned as a demonstration educational program of five years duration. Further discussions suggested that this program was unlikely to be duplicated anywhere, because of its …

Youth Centres In Ghana: Assessment Of The Planned Parenthood Association Of Ghana Programme, Evam Kofi Glover, Annabel Erulkar, Joana Nerquaye-Tetteh

Reproductive Health

The sexual and reproductive health of adolescents has become a major public concern, particularly with the advent of HIV/AIDS. Many organizations have tried to find strategies to reach youth with reproductive health (RH) information and services through various service delivery models. One such model has been the multipurpose youth center approach. Multipurpose youth centers typically include recreational or vocational services as entry points for RH and family planning (FP) information and services. There is some evidence in a variety of African settings (notably Kenya and Zimbabwe) suggesting that these centers are underutilized and not cost-effective. As a result, the Planned …

Reproductive Health Operations Research, 1995–1998, James R. Foreit, Federico R. Leon, Ricardo Vernon, Timothy D.N. King, Deborah L. Billings, A.B Friedman, Janie Benson

Reproductive Health

This book presents in-depth reports on promising new interventions that have been developed and important programmatic changes that have been achieved by operations research in Latin America between 1995 and 1998. The INOPAL III project has made advances in five areas including access and quality of services, integration of family planning and other reproductive health services, financial sustainability, post-abortion care, and emergency contraception. Each of these topics are represented by at least three studies conducted in two or more countries. The operations research projects discussed under each topic are not replications of a single study. They use different research designs …