Public Health Commons^™

Medicaid Financing: How The Fmap Formula Works And Why It Falls Short, Christie Provost Peters

National Health Policy Forum

Medicaid costs for health and long-term care services for low-income individuals are substantial. As a result, each state’s “match rate,” or federal medical assistance percentage (FMAP), which determines the share of Medicaid benefit costs the federal government pays, has enormous implications for state budgets and state economies, as well as for Medicaid beneficiaries and providers. Shifts in the FMAP from year to year, even minor ones, can mean the gain or loss of tens or hundreds of millions of federal matching dollars, depending on the size of the state’s Medicaid program. This paper explains the FMAP formula, examines the limitations …

Primary Care Physician Supply, Physician Compensation, And Medicare Fees: What Is The Connection?, Laura A. Dummit

National Health Policy Forum

Primary care, a cornerstone of several health reform efforts, is believed by many to be in a crisis because of inadequate supply to meet future demand. This belief has focused attention on the adequacy of primary care physician supply and ways to boost access to primary care. One suggested approach is to raise Medicare fees for primary care services. Whether higher Medicare fees would increase physician interest in primary care specialties by reducing compensation disparities between primary care and other specialties has not been established. Further, many questions remain about the assumptions underlying these policy concerns. Is there really a …

A New Application Of Spatiotemporal Analysis For Detecting Demographic Variations In Aids Mortality: An Example From Florida, Yuwen Chiu, Chiehwen Ed Hsu

Chiehwen Ed Hsu

The purpose of the present study was to characterize, geographically and temporally, the patterns of acquired immune deficiency syndrome (AIDS) death disparity in 67 Florida jurisdictions, and to determine if the detected trends varied according to age, race, and sex. The space-time scan statistic proposed by Kulldorff et al was used to examine the excess AIDS deaths that occurred between 1987 and 2004. Results were geographically referenced in maps using EpiInfo and EpiMap made available by the Centers for Disease Control. Miami-Dade and the nearby counties including Broward, Martin, and Palm Beach are the most likely clusters (observed/expected: 1505.16) with …

Tending To Richmond's Children: Community Strategies To Bridge Service Gaps, Judith D. Moore, Jessamyn Taylor

National Health Policy Forum

The National Health Policy Forum sponsored a site visit to Richmond, Virginia, in October 2008 to explore social and environmental determinants of children’s health, including the impacts that poverty and exposure to lead-based paint have on birth outcomes, child development, and school readiness; and the community's efforts to address them. Though not large in population terms, Richmond faces many of the social and economic problems often common in larger urban areas—concentrated poverty, migration of wealth and services to the surrounding counties, a high infant mortality rate, and troubled schools. The site visit explored community strategies to improve birth outcomes and …

Medicaid And Mental Health Services, Cynthia Shirk

National Health Policy Forum

Medicaid is the largest payer of mental health services in the United States, contributing more than any other private or public source of funding. This background paper highlights the variety of services and supports needed by individuals with mental illness and Medicaid’s increasing role in mental health coverage. It provides an overview of Medicaid coverage of mental health services and identifies some of the key challenges in providing that coverage.

Covering All Kids: States Setting The Pace, Jennifer Ryan, Safiya Mojerie

National Health Policy Forum

Providing health insurance coverage for the uninsured is a challenge that has remained unresolved for decades. In the absence of a national solution, states have initiated their own efforts to expand access to health insurance coverage, particularly for children. This issue brief provides a history and status of state universal children’s coverage initiatives and features several states that appear to be setting the pace by developing successful strategies for expansion and cultivating the political will and leadership needed to institute them. In highlighting some of the key lessons that can be learned from states’ experiences, this paper may inform the …

Community-Based Long-Term Care In Milwaukee: Wisconsin Still Ahead, Judith D. Moore, Carol O'Shaughnessy, Lisa Sprague

National Health Policy Forum

The National Health Policy Forum has made two site visits to Wisconsin in two years. The first, in August 2007, focused on an overview of Family Care, the state's managed long-term care program, and looking at service delivery in a rural setting. The August 2008 site visit focused on the operations of MCOs and Family Care service providers in the urban environment of Milwaukee. Issues examined included the link between housing and social services, care management, capitation and rate-setting, measuring quality, and integrating people with disabilities into a program that initially targeted the elderly.

Strong As The Weakest Link: Medical Response To A Catastrophic Event, Eileen Salinsky

National Health Policy Forum

Natural disasters and acts of terrorism have placed a spotlight on the ability of health care providers to surge in response to catastrophic conditions. This paper reviews the status of efforts to develop the capacity and capabilities of the health care system to respond to disasters and other mass casualty events. Strategies for adapting routine medical practices and protocols to the demands posed by extraordinary circumstances and scarce resources are summarized. Existing federal roles, responsibilities, and assets relative to the contributions of state and local government and the private sector are described, including specific programmatic activities such as the Strategic …

Medicare Demonstrations, Amanda Cassidy

National Health Policy Forum

This publication provides an overview of Medicare demonstration projects, including what they are, how and by whom they are initiated, and how they differ from research projects. This document highlights several significant demonstrations in Medicare history and outlines several current demonstration projects. Key considerations in designing, implementing and evaluating demonstrations are mentioned.

Medicaid And Schip Waivers, Cynthia Shirk

National Health Policy Forum

No abstract provided.

Shaping Medicaid And Schip Through Waivers: The Fundamentals, Cynthia Shirk

National Health Policy Forum

The use of waivers has become one of the key vehicles for innovation in Medicaid and the State Children’s Health Insurance Program (SCHIP). This background paper examines the use of research, demonstration, and program waiver authorities to test new approaches to the delivery of and payment for health care and long-term care services. The paper reviews the statutory basis and mechanics of demonstrations and program waivers, as well as their history and political context in shaping Medicaid and SCHIP. It also explores the ways the changing state-federal relationship and the ever-growing demand for state flexibility have driven waiver policy. Finally, …

The Fundamentals Of Medicare Demonstrations, Amanda Cassidy

National Health Policy Forum

Demonstrations are experiments that test Medicare policy changes without permanently changing the Medicare program. They allow policymakers to learn about the potential impact and operational challenges of a proposed modification to Medicare, but in a more controlled environment and on a limited basis. Since demonstrations can affect hundreds of thousands of beneficiaries and providers and involve millions of dollars, they are often controversial. This paper describes the basics of Medicare demonstrations, including what they are, how they are initiated, and why they are undertaken. The paper also explores the relationship between demonstrations and other research projects. The primary challenges in …

The Changing Role Of Physicians In Disaster Management And Hospital Incident Command, F. Matthew Mihelic, M. David Stockton, Stephen A. Cole, Gregory H. Blake

Faculty Publications

Recent changes in governmental policy toward disaster medicine and hospital incident command foreshadow a significant change in the role that physicians will play in disaster preparedness and response. The distinct discipline of Disaster Medicine has received authoritative recognition and promotion in the recent Homeland Security Presidential Directive 21, and recently established guidelines for incident command within hospitals have included a new position designated as “Medical/Technical Specialist(s)” that will assist the Incident Commander in disaster-related decision-making. This is a multidisciplinary position, and its functions can be filled by one or more individuals. As physician training and competency in Disaster Medicine increases, …

Designing A Successful Pbrn In Public Health: Key Concepts, Glen P. Mays, Sharla A. Smith

Glen Mays

Successful public health practice-based research networks (PBRNs) will require organizational, financial, and intellectual resources that allow practitioners and researchers to mount relevant studies in real-world public health settings. This brief outlines characteristics likely to be important to the success of public health PBRNs, based on the experience of PBRNs in other practice settings

The Aging Services Network: Accomplishments And Challenges In Serving A Growing Elderly Population, Carol O'Shaughnessy

National Health Policy Forum

In 1965, Congress enacted the Older Americans Act, establishing a federal agency and state agencies to address the social services needs of the aging population. The mission of the Older Americans Act is broad: to help older people maintain maximum independence in their homes and communities and to promote a continuum of care for the vulnerable elderly. In successive amendments, the Act created area agencies on aging and a host of service programs. The “aging services network,” broadly described, refers to the agencies, programs, and activities that are sponsored by the Older Americans Act. The Act’s funding for services is …

Pediatric Safety And Quality, Susan R. Lacey, Janis B. Smith, Karen Cox

Manuscripts, Articles, Book Chapters and Other Papers

Excerpt

Pediatric care is complex due to developmental and dependency issues associated with children. How these factors impact the specific processes of care is an area of science in which little is known. We are only beginning to understand the relationship between nurse staffing and adverse events in hospitalized children; effects that may be compounded by inadequate numbers of pediatric nurses. Throughout health care providing safe and high quality patient care continues to provide significant challenges. Efforts to improve the safety and quality of care are resource intensive and take continued commitment not only by those who deliver care, but …

Competition And Collaboration, Chicago-Style, Laura A. Dummit, Lisa Sprague

National Health Policy Forum

The National Health Policy Forum sponsored a site visit to Chicago, Illinois, March 16-18, 2008 to consider how competition and collaboration have shaped Chicago?s health care market. Chicago is a study of contrasts between wealth and poverty and between large, internationally known facilities and struggling community hospitals. The stressed state of the county health system concerned all of the stakeholders and may be an impetus for increased cooperation among the haves and the have nots. No longer waiting for state health reform efforts, key players were working to shore up needed providers and develop a more equitable distribution of resources, …

Finding Order In Complexity: A Typology Of Local Public Health Delivery Systems, Glen Mays

Glen Mays

Public health decision-makers and researchers currently lack an evidence-based framework for describing, classifying, and comparing public health delivery systems based on their organizational components, operational characteristics, and division of responsibility. Related typologies developed in the health services sector have proven extremely valuable for policy and administrative decision-making as well as for ongoing research. Performance assessment, quality improvement, and accreditation activities are now blossoming in public health—adding urgency to the need for classification and comparison frameworks. This brief describes a newly-developed empirical typology for local public health systems and highlights its policy and managerial applications.

Completing The Recipe For Children's Health: New Variations On Key Ingredients: A Report From The Workshop On June 28, 2007, Jennifer Ryan

National Health Policy Forum

This paper offers a broad overview of the issues surrounding the social and environmental determinants of children’s health. These issues were explored during a discussion convened by the National Health Policy Forum on June 28, 2007, among a group of individuals concerned about the influences beyond medical care on the health of children. The paper considers the policy and financing tensions that exist across programs and populations that make addressing the full range of influences challenging. It also highlights some of the community-based initiatives that have been successful in providing services to children and families, as described during the workshop. …

Pharmacogenomics: A Primer For Policymakers, Leslie Tucker

National Health Policy Forum

Researchers are exploring how genetic variations among individuals may help explain why a drug can work well in some people and poorly (or not at all) in others, including those who appear to have the same disease. Pharmacogenomics, as this new field is called, aims to help physicians make use of genetic tests to distinguish among patients whose genetic characteristics predispose them to respond in certain ways to certain medicines. If physicians can use this information to quickly and reliably choose the appropriate drug at the most effective dose for each patient, they may produce better patient outcomes and save …

To The Bitter End: Disparities In End-Of-Life Care, Alberto Coustasse, Theresa Quiroz, Sue G. Lurie

Management Faculty Research

Although technological advancements have provided the means to sustain life and provide care regardless of whether the treatment is appropriate and compassionate given the condition of the patient, bioethical, legal, and moral concerns related to disparities in care still arise in the United States. These concerns call into question the necessity to continue life-sustaining or palliative care treatments when patients and/or families are faced with end-of-life decisions. This study will focus on various historical, clinical cultural, and ethical issues that have placed this dilemma into a controversial public spectrum, by using case studies retrieved from referenced literature, which illustrate disparities …

Central Northern Adelaide Health Service Annual Report 2007-2008, The Queen Elizabeth Hospital

The Queen Elizabeth Hospital

The Central Northern Adelaide Health Service is the largest of South Australia’s health regions, employing more than 16,000 staff* across around 200 separate health units and services* (*figures as at December 2008). The region brings together four major acute hospitals (Royal Adelaide, Lyell McEwin, The Queen Elizabeth and Modbury Hospitals), along with the Hampstead and St Margaret’s Rehabilitation Hospitals and a significant number of mental health and primary health care services. The region also delivers two major, state-wide health services – BreastScreen SA and the SA Dental Service – and has an annual operating budget in excess of $1.5 billion.

Burn Disaster Response Planning: An Urban Region's Approach, Roger W. Yurt, Eliot J. Lazar, Nicole E. Leahy, Nicholas V. Cagliuso

Nicholas V. Cagliuso Sr., Ph.D.

The objective of this study was to describe a draft response plan for the tiered triage, treatment, or transportation of 400 adult and pediatric victims (50/million population) of a burn disaster for the first 3 to 5 days after injury using regional resources. Review of meeting minutes and the 11 deliverables of the draft response plan was performed. The draft burn disaster response plan developed for NYC recommended: 1) City hospitals or regional burn centers within a 60- mile distance be designated as tiered Burn Disaster Receiving Hospitals (BDRH); 2) these hospitals be divided into a four-tier system, based on …

Need For Performance Metrics In Hospital Emergency Management, Eliot J. Lazar, Nicholas V. Cagliuso, Kristine M. Gebbie

Nicholas V. Cagliuso Sr., Ph.D.

An extraordinary number of health care quality and patient safety indicators have been developed for hospitals and other health care institutions; however, few meaningful indicators exist for comprehensive assessment of hospital emergency management. Although health care institutions have invested considerable resources in emergency management preparedness, the need for universally accepted, evidence-based performance metrics to measure these efforts remains largely unfulfilled. We suggest that this can be remediated through the application of traditional health care quality paradigms, coupled with novel analytic approaches to develop meaningful performance data in hospital emergency management.

Student Health Services, John A. Swenson, Pat Campbell

UND Departmental Histories

This departmental history was written on the occasion of the UND Quasquicentennial in 2008.

Listening To The Stars: The Constellation Model Of Collaborative Social Change, Tonya Surman, Mark Surman

Social Space

There has been much talk about social sector partnerships and networks. Tonya Surman and Mark Surman explain how the ‘constellation model’, developed for the Canadian Partnership for Children’s Health and the Environment, offers an innovative approach to organising such collaborative efforts.

Nurses’ Experience Of Leadership In Assisted Living: A Situational Analysis, Carole H. Bergeron

Antioch University Dissertations & Theses

This study concentrates on the voice of registered nurses as they describe their experiences of leadership within the nontraditional, non-institutional, non-hospital environment of assisted living. It further expounds upon regulatory and corporate information as context for the nurses’ leadership experiences. The desire to hear nurses describe their personal experiences of leadership influenced the decision to use grounded theory as a methodological process. The belief that voice requires context to be most effectively understood influenced, in turn, the addition of a situational analysis approach to the grounded theory methodology. As a result, interviews and scrutiny of contextual elements form the core …