Community Health and Preventive Medicine Commons^™

Bridging Silos, Part I: Linkages Among The Di, Ssi, Medicare, And Medicaid Programs, Karen Matherlee

National Health Policy Forum

This paper, the first of two on the general topic of public disability and health benefits, centers on the fundamentals of the Disability Insurance and Supplemental Security Income programs and their relationships with Medicare and Medicaid. In addition to looking at the programs’ definitions, distinctions, and overlaps, it reviews the effects on them of the Ticket to Work and Work Incentives Improvement Act of 1999 and, to a lesser extent, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.

Bridging Silos, Part Ii: Di, Ssi, Medicare, And Medicaid Issues And Initiatives, Karen Matherlee

National Health Policy Forum

The second of two papers on the general topic of public disability and health benefits, this background paper lays out some key issues confronting the Social Security Disability Insurance, Supplemental Security Income, Medicare, and Medicaid programs. It also discusses major initiatives to address those issues, in light of growing administrative, fiscal, and other problems.

Sailing Schip Through Troubled Waters, Jennifer Ryan

National Health Policy Forum

As the State Children’s Health Insurance Program (SCHIP) enters its sixth year of operation, states have continued their commitment to children’s coverage and to reaching out to the uninsured. This issue brief explores the current status of SCHIP in light of fiscal pressures that have been created by the state budget crisis. It highlights some of the key successes in the program thus far and notes several examples of state initiatives to serve particularly vulnerable populations and collect outcomes data and information about access to care.

Rural Health Care In The Electronic Age (Danville, Pa), Lisa Sprague, Nora Super

National Health Policy Forum

This site visit to the Geisinger Health System in central Pennsylvania explored the use of technology in providing health care to an aging, rural population with a high index of chronic-care needs. The agenda included an in-depth examination of Geisinger’s electronic medical record and its use in various domains of care, including outpatient clinics, disease management, and non-Geisinger medical practices and community hospitals. The program also highlighted specific care management initiatives in the areas of radiology, stroke, and obesity. Geisinger’s advantages as an integrated system dominant in its market, with the resources to invest in technology were weighed in considering …

Decreasing Barriers For Teens: Evaluation Of A New Teenage Pregnancy Prevention Strategy In School-Based Clinics, Abbey C. Sidebottom, Amanda Birnbaum, Sarah S. Nafstad

Department of Public Health Scholarship and Creative Works

Sidebottom et al seek to evaluate the effects of the change in distribution systems on students' receipt of requested contraceptives and demand for contraceptive school-based clinics (SBC). The result of the study reveals that the average number of requests per student was higher under the voucher system, possibly as a consequence of expires vouchers resulting in repeated requests. The findings also suggest that SBCs could go a step further in reducing adolescents' barriers to accessing contraceptives by adopting an on-site direct delivery system..

Dually Eligible For Medicare And Medicaid: Two For One Or Double Jeopardy?, Jennifer Ryan, Nora Super

National Health Policy Forum

This issue brief describes the characteristics of the population of individuals known as “dual eligibles,” who are eligible for health insurance coverage through both Medicare and Medicaid. It also looks at the differences between “full Medicaid” and “supplemental Medicaid” dual eligibles and the ongoing challenges associated with enrollment and eligibility, integration and coordination, and managed care. The paper presents several examples of integrated care programs designed to better serve the dual-eligible population, including the Program of All-Inclusive Care for the Elderly, Evercare, social health maintenance organizations, and state/federal initiatives such as the Wisconsin Partnership Program, Texas STAR+PLUS, and others. Finally, …

Medical Response For Terrorist And Public Health Threats: One Region's Experience (Pittsburgh), Eileen Salinsky, Lisa Sprague

National Health Policy Forum

This site visit, planned and convened in conjunction with the Agency for Healthcare Research and Quality’s User Liaison Program, examined the efforts underway in the greater Pittsburgh area to develop emergency medical response capabilities for mass causality events. The site visit explored efforts to improve infectious disease surveillance capabilities and looked at the Region 13 collaborative’s development of a regionalized approach to emergency management planning and response. Hospital preparedness activities were also studied, including a discussion of lessons learned from a recent drill to test response to a radiological event and an exploration of conceptual frameworks to guide hospital planning …

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

National Health Policy Forum

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 services in federally financed health coverage programs such as Medicare, Medicaid, and the State Children’s Health Insurance Program. The paper also looks at the mechanics of waivers as well as their history and political context in shaping public programs. In addition, it explores the ways the changing state-federal relationship and the ever-growing demand for state flexibility have driven waiver policy.

The Medicare Prescription Drug Proposals And Health Insurance Risk, Dawn Gencarelli

National Health Policy Forum

In order to facilitate a better understanding of the complex issues raised by Senate and House proposals to establish a prescription drug benefit for Medicare beneficiaries, this paper briefly addresses some fundamentals of the health insurance market, defines key risk-sharing mechanisms, including risk corridors and reinsurance, and identifies the relevant risk provisions in the bills. Other issues related to cost management strategies and program design, which may have an impact on cost and adverse selection, are also discussed.

Wic Reauthorization: Opportunities For Improving The Nutritional Status Of Women, Infants, And Children, Harriette Fox, Margaret Mcmanus, Harry Schmidt

National Health Policy Forum

This paper examines the main reform issues affecting the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which is coming up for reauthorization this year. The paper provides background information on the WIC program, including its dramatic growth in participation and funding. It also reviews WIC’s link to health care and its impact on health outcomes. A series of considerations for WIC’s future are raised, including food package and program eligibility changes, nutrition education strategies to reduce obesity, financial risks and health consequences of relying on infant formula rebates, and new opportunities for research and demonstration.

All The News That’S Fat To Print: The American "Obesity Epidemic" And The Media, Natalie Boero

Faculty Publications, Sociology

Increasingly the term epidemic is being used to describe the current prevalence of fatness in the United States. Skyrocketing rates of obesity among all groups of Americans, particularly children, the poor, and minorities, have become a major public health concern. Indeed, it is difficult to open a newspaper or magazine without encountering a discussion of the expanding American waistline and the health problems associated therewith. In this paper I use 751 New York Times articles on obesity to examine the media construction of the obesity epidemic. I show that there is not one dominant discourse (i.e. medicine) constructing this epidemic, …

Barriers And Best Practices: Marketing Health Promotion For People With Disabilities, Craig Ravesloot Ph.D., University Of Montana Rural Institute

Health and Wellness

Health promotion for people with disabilities attracts a diverse audience: people with disabilities themselves, policymakers, service providers and others. This Guideline discusses our research on effective strategies for marketing and promoting RTC: Rural’s two health promotion programs: Living Well with a Disability (an eight-week workshop) and the New Directions physical activity program. It also describes the barriers people with disabilities anticipate when they consider participating in a health promotion program. If marketing strategies address these barriers, more people with disabilities may participate in health promotion activities. Secondary conditions are the medical and psycho-social conditions people with disabilities often experience following …

Marketing Health Promotion For People With Disabilities, Craig Ravesloot Ph.D., University Of Montana Rural Institute

Health and Wellness

Healthy People 2010 is the blueprint for improving the health and well being of all Americans. Its overall focus is to decrease health risks and to increase the proportion of people engaging in healthy behaviors. For the first time, Healthy People includes a chapter on the health of people with disabilities. Chapter Six specifically addresses secondary conditions as a public health concern. Secondary conditions are medical and psycho-social conditions people often experience following the onset of disabilities or chronic illnesses. Our research suggests people with disabilities annually experience 14 secondary conditions that limit their health and independence.

Marketing Health Promotion For People With Disabilities, Craig Ravesloot Ph.D., University Of Montana Rural Institute

Health and Wellness

Healthy People 2010 is the blueprint for improving the health and well being of all Americans. Its overall focus is to decrease health risks and to increase the proportion of people engaging in healthy behaviors. For the first time, Healthy People includes a chapter on the health of people with disabilities. Chapter Six specifically addresses secondary conditions as a public health concern. Secondary conditions are medical and psycho-social conditions people often experience following the onset of disabilities or chronic illnesses. Our research suggests people with disabilities annually experience 14 secondary conditions that limit their health and independence.

Obesity In America: A Growing Threat, Eileen Salinsky, Wakina Scott

National Health Policy Forum

This background paper seeks to clarify the nature and causes of the obesity epidemic in the United States and provides an overview of the associated economic and health costs. The paper summarizes existing federal programs and policies that address obesity and examines new and emerging policy strategies to battle the bulging American silhouette. Topics explored include population-based prevention, federal food- and nutrition-assistance programs, Medicare and Medicaid payment policies, school health initiatives, and publicly funded biomedical research.

The Geography Of Medicare: Explaining Differences In Payment And Costs, Nora Super

National Health Policy Forum

This issue brief examines the sources of variation in Medicare payment and costs across different geographic areas and different sites of care. It discusses the payment policies that address variation in the cost of providing care, such as input price adjustments and special payments to hospitals. It also considers differences due to beneficiaries’ health status and in physician practice patterns. Finally, it explores policy options to address Medicare geographic variation.

The Love And Belonging Healthcare Needs Of Hiv Infected African-American Men Upon Admission To An Aids Dedicated Nursing Home., Sheldon Fields

Sheldon D. Fields

The purpose of this study was to describe the love and belonging healthcare needs of HIV infected African-American men upon admission to an AIDS dedicated nursing home. Subjects were 73 (N=73) African-American men 26 to 60 years of age that were admitted to an AIDS dedicated nursing home in the Southern New England area between 1995 and 1999. Most of the men were single (n = 39) and estranged from their immediate families. Many of these men did not have a family member supportive of discharge (n = 60) and did not desire discharge back out into the community (n …

Doing It Rite: Exploring A Decade Of Health Coverage Innovation (Rhode Island), Jennifer Ryan, Ginger P. Parra

National Health Policy Forum

This site visit to the state of Rhode Island provided an opportunity to experience and understand the decade of health coverage innovation that has resulted in near universal coverage for children. Site visitors had the opportunity to interact with health care providers, state officials, and consumer advocates, as well as other leaders in health care community. The group also visited the Thundermist Health Center in Woonsocket; a school based health clinic at Woonsocket High School; the HELP Lead Safe Center in South Providence; and a local provider, St. Joseph’s Hospital for Specialty Care, that houses several preventive care clinics and …

Disease Management To Population-Based Health: Steps In The Right Direction?, Lisa Sprague

National Health Policy Forum

This issue brief reviews the evolution of the disease management model and the ways it relates to care coordination and case management approaches. It also looks at examples of population-based disease management programs operating in both the private and public sectors and reviews the evidence of their success. Finally, the paper considers the policy implications of adapting this model to a Medicare fee-for-service population.

Medicaid Prescription Drug Coverage: State Efforts To Control Costs, Dawn Gencarelli

National Health Policy Forum

This paper provides a brief summary of the Medicaid prescription drug benefit. It explains the mechanisms being used by states to control their prescription drug spending within the Medicaid program. The paper also highlights some of the concerns that have been expressed with these mechanisms and the litigation that has been initiated in several states as a result of these efforts. It takes a closer look at three states with cost containment strategies that have been the focus of increased scrutiny.

Nevada "Nurselessness": An Acute Or Chronic Condition? An Examination Of The Etiology And Possible Treatment Alternatives, Jeanine Warren-Newmon

UNLV Theses, Dissertations, Professional Papers, and Capstones

Data released by the Department of Health and Human Services in February, 2001, revealed that Nevada has the lowest number of registered nurses per 100,000 population in the nation. The state’s population is growing faster than the nursing programs are currently able to produce new graduates. Current predictions are that the existing nursing shortage will become more severe and have a longer duration than has ever before been experienced. While there may not be one single identifiable causative factor, the aging nursing workforce, low unemployment, and the universal nature of the shortage magnify the problem. This paper focuses on the …

The U.S. Health Workforce: Definitions, Dollars, And Dilemmas, Karen Matherlee

National Health Policy Forum

This background paper provides a comprehensive view of the structure of the health workforce. It explores public and private insurance coverage and payment policies, as well as discretionary grant programs, that govern it. The paper also looks at health workforce concerns: supplies of certain types of physicians, health workforce mix, challenges from complementary and alternative medicine, shortages of nurses and pharmacists (and some other practitioners), maldistribution issues, and lack of diversity in response to demographic changes. It presents proposals that are on the table to reform the health workforce, at a time when it is demanding greater attention from health …

Reauthorizing Head Start: The Future Federal Role In Preschool Programs For The Poor, Jane Koppelman

National Health Policy Forum

This paper describes the implications of President Bush’s proposal to devolve authority for running the Head Start program to the states and to alter the organization and funding of all government early childhood programs—with the goal of improving the school readiness skills of low-income children. The administration plan to allow states to mix Head Start funds with state-funded preschool money and, if desired, child care monies to create a more uniform early childhood care system with an educational focus raises numerous questions. This paper addresses questions raised by this plan, including the potential quality of these new systems, the extent …

Fatal Injuries In The United States Involving Respirators, 1984-1995, Anthony Suruda, William Milliken, Dale Stephenson, Richard Sesek

Dale J. Stephenson

There is little published information concerning the epidemiology of fatal injuries involving respiratory protection. We compiled a case series from U.S. Occupational Safety and Health Administration investigation reports from 1984 through 1995. For the 12-year period there were 41 incidents resulting in 45 deaths due to asphyxiation or chemical poisoning while wearing a respirator. There were 23 deaths related to airline respirators, 17 deaths involving use of negative pressure (air purifying) respirators, and 5 deaths involving self-contained breathing apparatus. Among the 23 deaths involving airline respirators, 15 were associated with compatible connection couplings for breathable air and inert gases. Three …

Is Community Care A Civil Right? The Unfolding Saga Of The Olmstead Decision, Randy Desonia

National Health Policy Forum

This paper lays the groundwork for understanding the implications of the historic U.S. Supreme Court decision in the case of Olmstead v. L.C., which has far-reaching consequences for the long-term care of people with disabilities. The paper reviews the critical components influencing the case: the Medicaid program’s role in funding community-based long-term care; the Americans with Disabilities Act, which serves as the statutory basis for the decision; and the Court’s legal reasoning. The paper also describes the federal and state responses to the ruling and concludes with a brief discussion of some legal issues that will be debated in the …

Who Will Pay For The Adverse Events Resulting From Smallpox Vaccination? Liability And Compensation Issues, Robin J. Strongin, Eileen Salinsky

National Health Policy Forum

This paper summarizes liability and compensation concerns surrounding the smallpox vaccination program announced by President Bush on December 13, 2002. The paper examines the nature of adverse health events that are likely to occur in connection with the smallpox vaccine, assesses the liability protections that have been established for organizations and individuals participating in the vaccination program, and discusses the compensation mechanisms being considered to address the damages incurred by volunteers who may suffer from adverse vaccine reactions. Specifically, the implications of the Federal Tort Claims Act, workers’ compensation programs, and the creation of a new no-fault compensation fund are …

A Cost-Effectiveness Analysis Of A Community-Based Health Promotion Intervention For Adults With Mobility Impairments: Living Well With A Disability, Craig Ravesloot Ph.D., Tom Seekins Ph.D., Catherine Ipsen M.A., Steve Seninger Ph.D., Colleen Murphy-Southwick Ph.D., Lisa Brennan M.L.S., Rita K. Fjeld M.A., Glen W. White Ph.D., Ann Branstetter Ph.D., Vivian Chapman M.A., Amanda Jay M.A., James A. Bovaird M.A., Janet Marquis Ph.D., University Of Montana Rural Institute

Health and Wellness

This document reports on research conducted by the University of Montana and the University of Kansas for the Office of Disability and Health at the Centers for Disease Control and Prevention. The research project, conducted between August 1,1997 and July 31, 2001, was conducted in four separate but related studies. The research was conducted in eight States. We contracted with nine centers for independent living (CIL) to conduct 34 Living Well with a Disability health promotion workshops and to collect outcome measures. These programs included 246 individuals. In the first study, we evaluated the effectiveness and cost outcomes of the …

Introduction Of A Waterless Alcohol-Based Hand Rub In A Long-Term Care Facility, Lona Mody, Mcneil A. Shelly, Rongjun Sun, Bradley Suzanne, Carol A. Kauffman

Sociology & Criminology Faculty Publications

OBJECTIVE:

To examine the impact of introduction of an alcohol-based hand rub on hand hygiene knowledge and compliance and hand colonization of healthcare workers (HCWs) in a long-term-care facility (LTCF).

METHODS:

Two floors of an LTCF participated. Ward A used the hand rub as an adjunct to soap and water; ward B was the control. HCWs' hands were cultured using the bag-broth technique for Staphylococcus aureus, gram-negative bacilli (GNB), Candida, and vancomycin-resistant enterococci (VRE). HCWs completed a questionnaire at baseline and after an educational intervention and introduction of rub.

RESULTS:

Hand hygiene practices, knowledge, and opinions did not change after …

Converging On Nursing Home Quality, Lisa Sprague

National Health Policy Forum

This paper looks at nursing home quality initiatives, built around public reporting of quality data, that have been inaugurated by the Centers for Medicare and Medicaid Services and the California HealthCare Foundation. How the projects were developed is explored, along with preliminary indicators of their impact on consumers and providers and likely next steps in their evolution.

Associations Between Perceived Family Meal Environment And Parent Intake Of Fruit,Vegetables, And Fat, Kerri N. Boutelle, Amanda Birnbaum, Leslie Lytle, David M. Murray, Mary T. Story

Department of Public Health Scholarship and Creative Works

Objective

To describe the family mealtime environment and assess associations with adult fruit, vegetable, and fat intake.

Design

Telephone survey.

Participants

A convenience sample of 277 adults in the Minneapolis/St. Paul area were recruited through 4 schools. The sample was 85% female and 70% married. The mean number of children in the household was 2.6 (range 1 to 9).

Variables Measured

Adult fruit and vegetable intake, fat intake, and perceptions of the mealtime environment.

Analysis

Descriptive and mixed-model linear regression.

Results

Participants reported that the television was frequently on during dinner meals and almost one third felt that their family …