Health Policy Commons^™

Assessment Of Maine's Long-Term Care Needs Baseline Report: Demographics And Use Of Long Term Care Services In Maine, Stuart Bratesman Mpp, Julie T. Fralich Mba, Karen Mauney, Catherine Mcguire Bs, Louise Olsen, Jasper Ziller

Disability & Aging

In 2006, the Office of Elder Services requested the assistance of the Muskie School in developing an assessment of long term care service use in Maine. This report provides baseline information on the demographic characteristics, participant characteristics and service use trends for people accessing long term care services in this State.

For purposes of this report, we have excluded people with MR/DD. Long term care services do not include community support services for people with mental illness.

In this report, long term care services include:

• Nursing Facility Services
• Private Non-medical Institutions
• Consumer Directed Attendant Services
• Day Health Services
• Elder and …

Barriers To Medicare Hospice Utilization: A Qualitative Study Of Maine's Medicare Hospice Providers, Judith B. Tupper Dhed, Ches, Cpps

Disability & Aging

This report, prepared for the Maine Hospice Council and funded by the Carpenter Foundation, presents findings of a qualitative study of barriers to hospice utilization. This study includes the perspectives of all 26 Medicare certified hospice providers in Maine. Significant findings of the qualitative study include: A continuing need to educate the general public about hospice and the Medicare benefit. Maine health care providers have low referral rates to the hospice programs and often misunderstand the regulations and guidelines of the hospice benefit. The referral process to hospice programs is based on fragile systems of communication, fraught with potential miscues, …

Addressing Potential Conflicts Of Interest Arising From The Multiple Roles Of Colorado’S Community Centered Boards, Maureen Booth Mrp, Ma, Eileen Griffin Jd

Disability & Aging

This document summarizes the information we gathered, our analysis of potential conflicts of interest, and recommendations for addressing opportunities for improvement. The information we gathered is based on document review, input from stakeholders, and a review of practices in four other states.

Women Of Talent: Gender And Government Appointments In Massachusetts, 2002–2007, Carol Hardy-Fanta, Kacie Kelly

Publications from the Center for Women in Politics and Public Policy

Despite the high educational and occupational attainment—and considerable talent—of women in Massachusetts, the state ranks just 22nd in the nation on women's overall share of top executive, legislative, and judicial posts, compared to their share of the population. The goals of this study were to (1) calculate the percentage of women holding senior-level positions in state government at these four points in time; (2) analyze the distribution of appointments by type of position and executive office; (3) provide possible explanations for the status of women’s representation in these positions; and (4) offer recommendations that will serve to promote the appointment …

Low Health Literacy: Implications For National Health Policy, John A. Vernon, Antonio Trujillo, Sara J. Rosenbaum, Barbara Debuono

Health Policy and Management Faculty Publications

Securing appropriate healthcare hinges on having the necessary skills to read and fill out medical and health insurance forms, communicate with healthcare providers, and follow basic instructions and medical advice. At virtually every point along the healthcare services spectrum, the healthcare system behaves in a way that requires patients to read and understand important healthcare information. This information is dense, technical, and has jargon-filled language. Examples include completing health insurance applications, reading signs in hospitals and clinics about where to go and where to sign in, and following written and oral instructions in brochures and pamphlets, as well as prescription …

Barriers To Serving The Vulnerable: Thoughts Of A Former Public Official, Christine Ferguson

Health Policy and Management Faculty Publications

In an environment of limited resources, the question of who is deserving and undeserving of assistance becomes critical. Policymakers’ biases about whether a health condition is self-inflicted, as well as their perceptions about whether treatments are truly effective, play a major role—often unstated—in the allocation of resources.

Assumed Equity: Early Observations From The First Hospital Disparities Collaborative, Bruce Siegel, Jennifer K. Bretsch, Vickie Sears, Marsha Regenstein, Marcia J. Wilson

Health Policy and Management Faculty Publications

Disparities in healthcare represent a failure in the equity domain of quality. Although disparities have been well documented, little has been written about how hospitals might use improved data collection and quality improvement techniques to eliminate disparities. This article describes early findings from the planning phase of the first hospital-based disparities collaborative. The authors also discuss the changes in policy and practice that may speed hospitals in placing disparities and equity on their quality agendas.

An Assessment Of Legal Issues Raised In "High Performing" Health Plan Quality And Efficiency Tiering Arrangements: Can The Patient Be Saved?, Sara J. Rosenbaum, Sarah Kornblet, Phyllis Borzi

Health Policy and Management Faculty Publications

A legal analysis released by The George Washington University School of Public Health and Health Services and the Robert Wood Johnson Foundation affirms the legality under federal and state law of physician ranking systems used by health plan provider networks. This analysis examines seven types of possible legal allegations against physicians tiering, concluding how the approach is undertaken plays a significant role in determining legal backlash.

Diabetes Treatments And Moral Hazard, Jonathan Klick, Thomas Stratmann

All Faculty Scholarship

In the face of rising rates of diabetes, many states have passed laws requiring health insurance plans to cover medical treatments for the disease. Although supporters of the mandates expect them to improve the health of diabetics, the mandates have the potential to generate a moral hazard to the extent that medical treatments might displace individual behavioral improvements. Another possibility is that the mandates do little to improve insurance coverage for most individuals, as previous research on benefit mandates has suggested that mandates often duplicate what plans already cover. To examine the effects of these mandates, we employ a triple-differences …

The Voting Rights Act And The Election Of Nonwhite Officials, Pei-Te Lien, Dianne M. Pinderhughes, Carol Hardy-Fanta, Christine M. Sierra

Publications from the Center for Women in Politics and Public Policy

Voting Rights Act (VRA) is one of the most important—if not the most important—public policies developed over the last half century to increase access to the U.S. political system for people of color. The VRA also provides an important context for understanding the ascension of nonwhite groups into the elected leadership of the nation (Browning, Marshall, and Tabb 1984; Davidson and Grofman 1994; Menifield 2001; Mc-Clain and Stewart 2002; Segura and Bowler 2005; Bositis 2006). This essay assesses the present-day significance of the VRA for the political representation of communities of color by examining the implications of majority-minority districts and …

Achieving Family Health Literacy: The Case For Insuring Children, Sara J. Rosenbaum, Peter Shin, Barbara Debuono

Health Policy and Management Faculty Publications

One aspect of the SCHIP reauthorization debate that has received more limited attention than it deserves is the relationship between children's health insurance coverage and family health literacy. That is, to what extent is children's health insurance associated with higher health literacy, and to what extent is reduced parental health literacy linked to lower rates of health insurance among children? This association is extremely important, since there is strong evidence of a link between health literacy and the appropriate use of health care. Evidence suggests that when previously uninsured children are covered by health insurance, parents at all income levels …

Assessing The Effects Of Federal Pediatric Drug Safety Policies, Avi Dor, Taylor Burke, Ramona Whittington, Taylor Clark, Ruth Lopert, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

This policy analysis examines the effectiveness of pediatric exclusivity, one of the policy approaches the federal government uses to promote drug safety for children. Federal policy in this area is highly complex, and provisions related to pediatric drug safety, including pediatric exclusivity, are set to expire in 2007. Following a policy overview, this analysis summarizes the impact of pediatric exclusivity and reports on the results of our effort to shed light on the economic value of pediatric exclusivity. The analysis concludes with a discussion of options for further promoting a safe environment for drug use in children.

Payments To Medicare Advantage Plans Exceed Fee-For-Service Costs: Options For Medicare Savings From 2008 Through 2012, Brian Biles, Emily Adrion

Health Policy and Management Faculty Publications

The Medicare Modernization Act of 2003 (MMA) and the Deficit Reduction Act (DRA) of 2005 include provision intended to increase the role of private health plans in Medicare. These provisions set Medicare Advantage plan payment rates at levels higher than average costs would be in tradition free-for-service Medicare in every county in the nation. The total amount of extra payments to Medicare Advantage plans resulting from these provisions is projected to total over $8 billion in 2008 and $70 billion over the five year period, 2008 to 2012.

This briefing paper outlines the specific MMA and DRA provisions that generate …

Parental Health Insurance Coverage As Child Health Policy: Evidence From The Literature, Sara J. Rosenbaum, Ramona Whittington

Health Policy and Management Faculty Publications

One of the policy questions expected to receive considerable attention during the State Children's Health Insurance Program (SCHIP) reauthorization process is whether — and if so, under what circumstances — to permit states to use SCHIP funds to cover parents. In 2006, the average Medicaid income eligibility level for coverage of working parents stood at 65% of the federal poverty level, and 15 states and the District of Columbia set income eligibility levels for this group at 100 percent of the federal poverty level or higher.1 In 2005, 8 states used some portion of their SCHIP allotment funding, in combination …

Maine State Employee Survey On Disability, Commission On Disability And Employment, Department Of Financial And Administrative Services Bureau Of Human Resources, Muskie School Of Public Service University Of Southern Maine

Disability & Aging

The Executive Order regarding Maine State Government as a Model Employer of people with disabilities was signed on February 24, 2006. The order included several action steps, including a survey of State employees to ascertain the prevalence of workers with disabilities in State employment.

Maine’s Bureau of Human Resources and the Commission on Disability and Employment were named to oversee this survey. The University of Southern Maine’s Muskie School of Public Service administered the survey and analyzed results. Each of these three organizations are members of an Executive Order Working Group designed to overall all action steps under the Executive …

A Trade-Off Proposal For Funding Long-Term Care, Yung-Ping Chen

Gerontology Institute Publications

Long-term care can be a depressing subject. Most of us tend not to think about it. However, we cannot long avoid it as the 76 million baby boomers begin reaching older ages in a few short years. According to projections, in 40 years, those aged 65 to 84 (numbering 31.6 million in 2005) will more than double, and those 85 plus (about 5.1 million in 2005), who are more at risk of dependency, will more than triple (U.S. Census Bureau, 2004 and 2006). Heavy reliance on Medicaid, already the second largest budget item in most states, would not appear viable. …

Medical Malpractice Reform And Physicians In High-Risk Specialties, Jonathan Klick, Thomas Stratmann

All Faculty Scholarship

If medical malpractice reform affects the supply of physicians, the effects will be concentrated in specialties facing high liability exposure. Many doctors are likely to be indifferent regarding reform, because their likelihood of being sued is low. This difference can be exploited to isolate the causal effect of medical malpractice reform on the supply of doctors in high-risk specialties, by using doctors in low-risk specialties as a contemporaneous within-state control group. Using this triple-differences design to control for unobserved effects that correlate with the passage of medical malpractice reform, we show that only caps on noneconomic damages have a statistically …

A Seat At The Table? Racial/Ethnic & Gender Diversity On Corporate, Hospital, Education, Cultural & State Boards, Carol Hardy-Fanta Phd, Donna Stewartson

Publications from the Center for Women in Politics and Public Policy

As part of its larger Diversity Initiative, the McCormack Graduate School of Policy Studies at UMass Boston has undertaken a number of projects. The first was a public opinion survey conducted around the time of the November 2006 elections. The report, Transformation and Taking Stock: A Summary of Selected Findings from the McCormack Graduate School Diversity Survey, included a comprehensive look at race relations in the Commonwealth at a time of significant transition—demographically and politically. This report was followed by A Benchmark Report on Diversity in State and Local Government, which focused on the percentage of positions filled …

Mandating Hpv Vaccination--Private Rights, Public Good, Alexandra M. Stewart

Health Policy and Management Informal Communications

New York State's regulations require health care workers who have direct contact with patients or who may expose patients to disease to be vaccinated against seasonal and H1N1 influenza. Courts must take into account constitutional guarantees of personal autonomy, freedom of contract, and freedom of religion when reviewing the current lawsuits. These rights, however, have been constrained when they conflict with government measures that are intended to protect the community's health and safety. Health care workers have a profound effect on patients' health. Although they have the same rights as all private citizens, it is likely that courts will continue …

Oversight Hearings On Science And Environmental Regulatory Decisions, David Michaels

Health Policy and Management Congressional Testimonies

No abstract provided.

An Initial Assessment Of The Effects Of Medicaid Documentation Requirements On Health Centers And Their Patients, Peter Shin, Brad Finnegan, Lauren Hughes, Sara J. Rosenbaum

Health Policy and Management Issue Briefs

This policy brief presents the initial effects of recent federal Medicaid reforms on health centers and their patients. Specifically, this report examines the impact of changes in federal Medicaid policy, contained in the Deficit Reduction Act of 2006 (DRA), which requires applicants and recipients to document both their citizenship or legal U.S. residence and proof of their personal identity.

The Continuing Cost Of Privatization: Extra Payments To Medicare Advantage Plans: Updated Tables For 2007: February 2007 Ma Plan Enrollment, 2007 Ma And Ffs Payment Rates, Brian Biles, Emily Adrion

Health Policy and Management Faculty Publications

No abstract provided.

Structural Adjustment Programs And The Delivery Of Health Care In The Third World, Bianca Brunelli

Pell Scholars and Senior Theses

World Bank and International Monetary Fund became involved in the 1982 Third World debt crisis in order to solve global economic difficulties. While these institutions were not created for this purpose, after a series of economic shocks in the 1970s, they swept in order to alleviate the economic difficulties Third World countries faced. By following a strict regime of neoliberal inspired policies, they attempted to alleviate the debt crunch. Despite intentions, the World Bank’s and IMF’s involvement has exacerbated poverty in the Third World. As demonstrated, key factors in structural adjustment programs have impeded health care delivery and have contributed …

Defining Programmatic Access To Healthcare For People With Disabilities, Nancy R. Mudrick, Silvia Yee

Social Work - All Scholarship

People with disabilities face disability-related barriers that affect their receipt of health care. These often are discussed in terms of three categories: financial, structural, and programmatic barriers. Financial barriers may involve the lack of insurance, inability to pay for care, or coverage limitations for such items as durable medical equipment and medication. Structural barriers primarily arise from the architectural characteristics of health care delivery settings, such as parking location, building entrances, stairs and ramps, and bathrooms. Programmatic barriers are barriers involving the processes used to deliver health care. This category is the least understood, yet an important factor for access …

Dental Hygienists' Contributions To Improving The Nation's Oral Health Through School-Based Initiatives From 1970 Through 1999: A Historical Review, Gayle B. Mccombs, Cynthia C. Gadbury-Amyot, Rebecca S. Wilder, Karen O. Skaff, Margaret Lappan Green

Dental Hygiene Faculty Publications

PURPOSE: The purpose of this literature review is to document the contributions dental hygienists have made over the past 3 decades to improve the nation's oral health. This historical review encompasses selected literature that acknowledged dental Hygienists' direct involvement in U.S. school-based or school-linked oral health programs from 1970-1999.

METHODS: Five researchers independently searched MEDLINE, PubMed, and other electronic databases to identify relevant literature for the years 1970-1999. The search aimed to locate articles authored by or that documented dental Hygienists' involvement as "service provider" in U.S. school-based oral health programs. For the purpose of this review, service provider was …

Does Hipaa Preemption Pose A Legal Barrier To Health Information Transparency And Interoperability?, Sara J. Rosenbaum, Phyllis Borzi, Taylor Burke, Sonia W. Nath

Health Policy and Management Faculty Publications

This paper summarizes the results of a review of nearly 500 judicial opinions decided as of fall 2006, involving access to protected health information (PHI) and privacy of medical information under the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA). This review was undertaken to determine whether HIPAA, which permits application of state privacy laws that are more stringent than the federal privacy standard, acts as a legal barrier to the creation of interoperable health information systems that permit transparency of health information. The availability of transparent and complete information regarding health system performance has been recognized as …

Health And Security In Foreign Policy, Rebecca L. Katz, Daniel A. Singer

Health Policy and Management Faculty Publications

No abstract provided.

A Benchmark Report On Diversity In State And Local Government, Carol Hardy-Fanta Phd

Publications from the Center for Women in Politics and Public Policy

The Pipeline to Public Service Initiative asked the McCormack Graduate School’s Center for Women in Politics & Public Policy at the University of Massachusetts Boston to ascertain the racial diversity in state and local government. The project had the following three goals:

--To identify the race (and gender) of those holding top-level positions filled through gubernatorial appointments, e.g., secretaries, commissioners, directors, deputy commissioners/directors, and undersecretaries, in the Commonwealth’s executive offices and major departments.

--To compile the same information for members of the most influential boards and commissions in the Commonwealth filled through gubernatorial appointments.

--To assess the diversity of elected …

Final Report Technical Assistance To Improve Quality Oversight Of The Oklahoma Advantage Waiver, Maureen Booth, Louise Olsen

Disability & Aging

No abstract provided.

The Health Insurance Debate In Canada: Lessons For The United States?, Mary Anne Bobinski

Faculty Articles

This Essay begins with an intentionally ambiguous title. Are comparisons to Canada relevant and useful for policy-makers in the United States and, if so, what lessons can we learn? Part II of this Essay highlights some of the risks and benefits of cross-border comparisons between the United States and Canada. In Part III, I analyze some of the key data points often cited in comparing the two health care systems. Part IV explores the current Canadian debate about private health insurance. Finally, in Part V, I focus on the lessons from Canada for the health insurance debate in the United …