Health Policy Commons^™

The Essential Health Benefits Provisions Of The Affordable Care Act: Implications For People With Disabilities, Sara J. Rosenbaum, Joel B. Teitelbaum, Katherine J. Hayes

Health Policy and Management Faculty Publications

In establishing minimum coverage standards for health insurance plans, the Affordable Care Act includes an "essential health benefits" statute that directs the U.S. Secretary of Health and Human Services not to make coverage decisions, determine reimbursement rates, establish incentive programs, or design benefits in ways that discriminate against individuals because of their age, disability, or expected length of life. This issue brief examines how this statute will help Americans with disabilities, who currently are subject to discrimination by insurers based on health status and health care need. The authors also discuss the complex issues involved in implementing the essential benefits …

A State-In-Society Approach To The Nonprofit Sector: Welfare Services In Japan, Mary Alice Haddad

Mary Alice Haddad

This article uses the case of Japan to advocate for a new theoretical approach to the study of the nonprofit sector. In particular, it examines how theoretical models based on the European and North American experiences have difficulty explaining the relationship between the nonprofit sector and the state in Japan, and argues that a state-in-society approach is better suited to explaining complex state–society relations in diverse cultural contexts. It does this by examining the evolution of social welfare service provision in Japan. This article is motivated to explain an apparent paradox: Japan’s recent efforts toward greater government decentralization and privatization …

Why Doctors Order Too Many Tests (It's Not Just To Avoid Lawsuits), Jesse M. Pines, Zachary F. Meisel

Health Policy and Management Informal Communications

Advanced radiology tests such as CT scans, MRIs and ultrasounds have dramatically changed how patients are diagnosed and treated. Just a decade ago, patients were still being subjected to exploratory surgery, in which a surgeon cuts open the abdomen to look for problems; today, CT scans allow doctors to make diagnoses without a scalpel.

Who Are The Health Center Patients Who Risk Losing Care Under The House Of Representatives' Proposed Fy 2011 Spending Reductions?, Sara J. Rosenbaum, Peter Shin, Leighton C. Ku

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

On February 20, 2011, the United States House of Representatives approved more than $61 billion in discretionary spending reductions for the remainder of FY 2011. The legislation includes $1.3 billion in direct spending cuts for community health centers. Using the NACHC patient estimates, we present evidence on the characteristics of patients whose continuing access to health center services is at risk. We arrived at these estimates using data from the Uniform Data System (UDS), the federal reporting system in which all health centers must participate, as well as national estimates from the Medical Expenditure Panel Survey (MEPS), and published reports …

Who Are The Health Center Pati Ents Who Risk Losing Care Under The House Of Representatives’ Pr Oposed Fy 2011 Spending Reductions?, Sara J. Rosenbaum, Peter Shin, Leighton C. Ku

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

No abstract provided.

The States' Next Challenge--Securing Primary Care For Expanded Medicaid Populations, Leighton C. Ku, Karen Jones, Peter Shin, Brian K. Bruen, Katherine J. Hayes

Health Policy and Management Faculty Publications

In the coming years, the United States must address both an expansion of Medicaid coverage and an unexpected shortage of primary care physicians. Under the Patient Protection and Affordable Care Act (ACA), the Medicaid eligibility threshold for nonelderly adults will rise to 133% of the federal poverty level (about $30,000 for a family of four) in 2014. States with restrictive Medicaid eligibility requirements and high rates of uninsured residents will expand coverage substantially, while programs in states with higher current Medicaid eligibility thresholds and fewer uninsured residents will grow less. However, since many of the states with the largest anticipated …

Mcdonald's Medicine: Are We Too Impatient To Wait For Care?, Zachary F. Meisel, Jesse M. Pines

Health Policy and Management Informal Communications

The prospect of waiting for health care is not only distasteful to Americans, it's downright threatening: indeed, the specter of Canadian-style waiting lists for certain tests and procedures evoked enough American-style fear that it became a key Republican talking point to challenge the concept of government-subsidized health care.

Statement On Essential Benefits, Sara J. Rosenbaum

Health Policy and Management Faculty Posters and Presentations

The essential health benefits statute is unique. Because its legislative history is quite limited, the text itself takes on particular importance. The provisions of the statute differ significantly from the highly detailed coverage terms of Medicare Parts A and B. Similarly, its provisions differ from the coverage provisions of the Employee Retirement Income Security Act, which governs virtually all private employer-sponsored health benefit plans and which (with the important exception of the insured small group market) remains unaffected by the essential health benefits provision. In referencing broad benefit categories, the essential health benefits statute bears some resemblance to the structure …

Determinants Of Health Care Use Among Rural, Low-Income Mothers And Children: A Simultaneous Systems Approach To Negative Binomial Regression Modeling, Swetha Valluri

Masters Theses 1911 - February 2014

The determinants of health care use among rural, low-income mothers and their children were assessed using a multi-state, longitudinal data set, Rural Families Speak. The results indicate that rural mothers’ decisions regarding health care utilization for themselves and for their child can be best modeled using a simultaneous systems approach to negative binomial regression. Mothers’ visits to a health care provider increased with higher self-assessed depression scores, increased number of child’s doctor visits, greater numbers of total children in the household, greater numbers of chronic conditions, need for prenatal or post-partum care, development of a new medical condition, and …

Caffeinated Coffee, Decaffeinated Coffee And Endometrial Cancer Risk: A Prospective Cohort Study Among Us Postmenopausal Women, Ayush Giri, Susan R. Sturgeon, Nicole Luisi, Elizabeth Bertone-Johnson, Raji Balasubramanian, Katherine W. Reeves

Biostatistics and Epidemiology Faculty Publications Series

There is plausible biological evidence as well as epidemiologic evidence to suggest coffee consumption may lower endometrial cancer risk. We evaluated the associations between self-reported total coffee, caffeinated coffee and decaffeinated coffee, and endometrial cancer risk using the Women’s Health Initiative Observational Study Research Materials obtained from the National Heart, Lung, and Blood Institute Biological Specimen and Data Repository Coordinating Center. Our primary analyses included 45,696 women and 427 incident endometrial cancer cases, diagnosed over a total of 342,927 person-years of follow-up. We used Cox-proportional hazard models to evaluate coffee consumption and endometrial cancer risk. Overall, we did not find …

Scaling Up The Integration Of Tuberculosis Screening Into Reproductive Health Services, Aphia Ii Or Project In Kenya

Reproductive Health

The Population Council’s APHIA II Operations Research and Kenya’s Ministry of Health implemented a pilot project in five facilities across Nairobi Province in 2010 with the aim of improving access to care and treatment for tuberculosis (TB) for women during postnatal care (PNC) services. As tuberculosis persists in Kenya, integration of screening and referrals within postnatal care services will increase case detection and treatment for those infected. Integration of TB screening is likely to be scaled up throughout PNC and maternal and child health services in Kenya. Strong linkages between health services, training, and supervision, and simple provider tools will …

What Are The Options? Pricing And Taxation Policy Reforms To Redress Excessive Alcohol Consumption And Related Harms In Australia, Natacha Carragher, Jenny Chalmers

Aboriginal Policy Research Consortium International (APRCi)

Increasing community and political concern about excessive alcohol consumption and related harms in Australia has prompted calls for the introduction of tighter regulatory controls. From an evidence-based, research perspective, measures which increase alcohol prices and taxes, in particular, are considered most effective for reducing alcohol consumption and related harms. Accordingly, this report presents a review of pricing and taxation policy levers that have been considered and/or implemented nationally

and internationally. These policies include: alcohol taxation and differential price by beverage; special/additional taxation on alcopops; minimum pricing; and bans on price discounts and promotions. Industry response to these policy initiatives is …

Using The Commons To Facilitate Health Communication, Anna Liebzeit, Karen Adams, Mat Jakobi

Aboriginal Policy Research Consortium International (APRCi)

No abstract provided.

Indigenous Communities And Evidence Building, Holly Echo-Hawk

Aboriginal Policy Research Consortium International (APRCi)

Indigenous populations in the U.S. and Pacific Islands are underrepresented in mental health and substance abuse research, are underserved, and have limited access to mainstream providers. Often, they receive care that is low quality and culturally inappropriate, resulting in compromised service outcomes. The First Nations Behavioral Health Association (U.S.) and the Pacific Substance Abuse and Mental Health Collaborating Council (Pacific Jurisdictions), have developed a Compendium of Best Practices for American Indian/Alaska Native and Pacific Island Populations. The private and public sector’s increasing reliance on evidence-based practices (EBP) leaves many Indigenous commu- nities at a disadvantage. For example, funding sources may …

Darke County Community Health Assessment, Center For Urban And Public Affairs, Wright State University

Public Health

In 2011, APRI (formerly CUPA) conducted a community health assessment for the Darke County Health Department (DCHD). The survey was based upon the Behavioral Risk Factor Surveillance System (BRFSS) conducted by the Centers for Disease Control and Prevention (CDC), as well as health assessments conducted by neighboring counties and priority health needs within the county. The purpose of the health needs assessment is to assess the prevalence of disease and behavioral risk factors,assess broad community health issues and shape a broader definition of community health, monitor the impact of community health action plans and trends in behavioral modifications and provide …

Increasing Access To Safe Abortion In Rural Maharashtra: Outcomes Of A Comprehensive Abortion Care Model, Shireen J. Jejeebhoy, A.J. Francis Zavier, Rajib Acharya, Shveta Kalyanwala

Reproductive Health

This assessment of a Comprehensive Abortion Care (CAC) model was conducted by the Population Council on behalf of the Consortium for Safe Abortions in India. The goal of the Consortium is to increase access to legal, safe, and comprehensive abortion services, including post-abortion family planning, in the public health system, and especially among the rural poor. This report describes the CAC model implemented in Aurangabad district, Maharashtra, and examines the extent to which the model improved (a) the availability and quality of abortion services in public sector facilities, and (b) women’s awareness and experiences with regard to abortion services. It …

Community Health Workers Can Effectively Provide Information And Referrals To People Living With Hiv In Their Communities, Population Council

Reproductive Health

A number of studies reported high levels of sexually transmitted infections among people living with HIV (PLHIV). Unfortunately, prevention interventions targeting PLHIV in the community are not common in Kenya, and most PLHIV who are not on ART have limited access to prevention information and risk-reduction counseling. The Population Council’s APHIA II Operations Research Project conducted a research project to address these gaps. This study was conducted in 2010 in collaboration with the International Center for Reproductive Health and the National AIDS and STI Control Programme. The findings show that the intervention had a number of positive outcomes and concludes …

Linking Hiv-Positive Family Planning Clients To Treatment And Care Services In Kenya, Wilson Liambila, Francis Obare, Harriet Birungi, Ruth Wayua Muia, Joyce Wanderi Maina, Mary N. Maina, Christine Awuor, Ibrahim Mohammed

Reproductive Health

A project from the Population Council’s USAID-funded FRONTIERS program found that integrating HIV counseling and testing into family planning (FP) services was feasible and acceptable to clients and providers, and led to significant improvement in the quality of care provided. However, a major limitation was that FP clients who tested HIV-positive were not actively linked to care and treatment services, including antiretroviral treatment, and screening and management of sexually transmitted infections. A new initiative aimed to design and test a referral framework for linking HIV-positive FP clients to treatment and care in selected health facilities; assess the acceptability of the …

In Search Of The Less Hazardous Cigarette, Michael Givel

Michael S. Givel

Since the 1950s, despite considerable and long-term tobacco industry and government efforts, attempts to develop a less risky cigarette that reduces harmful ingredients, generally or specifically, have failed. Moreover, even under ideal conditions with adequate scientific testing, the efficacy of purportedly reducing the severe health effects cannot be scientifically verified for up to 20 years after the introduction of a product on the market. A key and central provision in the 2009 U.S. Food and Drug Administration (FDA) legislation is to reduce the risk or harm of cigarettes. Because creating a less risky cigarette is not currently possible, this renders …

Deconstructing Social Constructionist Theory In Tobacco Policy: The Case Of The Less Hazardous Cigarette, Michael Givel

Michael S. Givel

Scholars in tobacco control have utilized a social construction approach to test and explain tobacco control policy and advocacy. Some recent tobacco control policy research has contended that Philip Morris's support of the U.S. Food and Drug Administration (FDA) regulation of tobacco (including purportedly reducing the harm of cigarettes) is to obtain the social construction goal of a socially responsible company. However, the primary motivation for Philip Morris's support of proposed FDA regulation and harm reduction for cigarettes was to maintain the company's market stability and profitability implemented by U.S. political process and institutions. In tandem with this, Philip Morris …