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Depression: A Decade Of Progress, More To Do, Veronica V. Goff
Depression: A Decade Of Progress, More To Do, Veronica V. Goff
National Health Policy Forum
This issue brief discusses the most recent findings on depression prevalence and cost; examines trends in outpatient treatment, including the dramatic growth in antidepressant use; discusses efforts to improve treatment in primary care; and explores possible public policy avenues for improving treatment access and quality.
U.S. Childhood Vaccine Availability: Legal, Regulatory, And Economic Complexities, Robin J. Strongin
U.S. Childhood Vaccine Availability: Legal, Regulatory, And Economic Complexities, Robin J. Strongin
National Health Policy Forum
Despite the vital role they play in public health, childhood vaccines travel a complicated road from laboratory to provider and patient. From the fall of 2000 until well into 2002, a combination of factors, including market dynamics, legal challenges, and regulatory hurdles, led to a shortage of some childhood vaccines. This paper examines each of these factors, focusing on the important roles of both the public and the private sectors.
Prescription Drugs In Nursing Homes: Managing Costs And Quality In A Complex Environment, Dan Mendelson, Rajeev Ramchand, Richard Abramson, Anne Tumlinson
Prescription Drugs In Nursing Homes: Managing Costs And Quality In A Complex Environment, Dan Mendelson, Rajeev Ramchand, Richard Abramson, Anne Tumlinson
National Health Policy Forum
This issue brief provides a description of prescription drug use in nursing homes and a summary of policy issues in this area. It first profiles the nursing home pharmaceutical market, outlining the major trends in demographics and drug utilization, the supply chain by which drugs go from manufacturers to pharmacies to nursing home residents, and the alternative arrangements by which prescription drugs in nursing homes are financed. The paper then provides a synopsis of current policy issues, focusing in turn on cost containment and quality improvement initiatives.
The Medicare And Medicaid Intersection: Caring For Arizona's Seniors, Nora Super, Lisa Sprague, Judith D. Moore
The Medicare And Medicaid Intersection: Caring For Arizona's Seniors, Nora Super, Lisa Sprague, Judith D. Moore
National Health Policy Forum
This site visit to Phoenix examined the interplay between Medicare and Medicaid and how payment streams and regulatory requirements affect the delivery of health and long-term care services. The visit explored trends related to Medicare+Choice plan participation, physician acceptance of Medicare patients, and care management for individuals with chronic illnesses, such as Alzheimer’s disease. It also considered Arizona’s capitated Medicaid long-term care program, which recently implemented competitive bidding among plans in Maricopa County.
Running On Empty: The State Budget Crisis Worsens, Randy Desonia
Running On Empty: The State Budget Crisis Worsens, Randy Desonia
National Health Policy Forum
This issue brief reviews the status of state budget shortfalls and their growing impact on the Medicaid program. It describes the magnitude of the shortfalls, the forces behind them, and how states have responded with spending cuts and tax increases. It also discusses how long the budget crisis is expected to continue and what budget balancing options remain for fiscal year 2003.
Medigap: Prevalence, Premiums, And Opportunities For Reform, Nora Super
Medigap: Prevalence, Premiums, And Opportunities For Reform, Nora Super
National Health Policy Forum
This issue brief provides an overview of Medicare's coverage gaps and the primary sources of supplemental coverage for Medicare beneficiaries. It focuses particularly on the Medigap market: the effects of standardization, recent premium trends and rating practices, and options for reform. It considers Medigap within the context of Medicare prescription drug proposals and efforts to reform the entire Medicare program.
Expanding Health Coverage For The Uninsured: Fundamentals Of The Tax Credit Option, Beth Fuchs, Julie James
Expanding Health Coverage For The Uninsured: Fundamentals Of The Tax Credit Option, Beth Fuchs, Julie James
National Health Policy Forum
This paper seeks to provide the basics for understanding the current debate over tax credits as a vehicle for reducing the number of uninsured Americans and focuses attention on some of the associated issues: How is health insurance treated under current tax law? Why tax credits and not deductions? What are the major issues in designing tax credits? Who should be eligible and for what size credit? What changes, if any, would be needed to the insurance market to ensure that policies are available and affordable for people eligible for tax credits? What are the major issues related to administering …
Schip Turns Five: Taking Stock, Moving Ahead, Jennifer Ryan
Schip Turns Five: Taking Stock, Moving Ahead, Jennifer Ryan
National Health Policy Forum
This issue brief notes the five-year anniversary of the effective date of Title XXI of the Social Security Act, the State Children's Health Insurance Program (SCHIP). It looks at the successes of the program, as well as some of the obstacles SCHIP will face as it moves from childhood into adolescence and attempts to maintain its effectiveness in providing health coverage to uninsured children and families. The paper explores the critical funding impasse created by the downturns in the economy and the financing structure of the SCHIP statute. It also highlights the emerging issue of program retention and the need …
Federal Child Care Funding For Low-Income Families: How Much Is Needed?, Jane Koppelman
Federal Child Care Funding For Low-Income Families: How Much Is Needed?, Jane Koppelman
National Health Policy Forum
With reauthorization of the 1996 welfare reform law being debated, this paper looks at the Temporary Assistance for Needy Families block grant and the Child Care and Development Fund — key components of congressional proposals to set a dollar amount for government spending on child care. This issue brief provides background on current child care use, arrangements, and cost, as well as research findings on the measurement of quality in child care programs.
Hatch-Waxman, Generics, And Patents: Balancing Prescription Drug Innovation, Competition, And Affordability, Robin J. Strongin
Hatch-Waxman, Generics, And Patents: Balancing Prescription Drug Innovation, Competition, And Affordability, Robin J. Strongin
National Health Policy Forum
This paper explores the complex connections among intellectual property protection, competition, and access to affordable prescription drug products. It focuses on several provisions of the Drug Price Competition and Patent Term Restoration Act of 1984 (Hatch-Waxman) and discusses the debate swirling around its reform. An overview of landmark intellectual property laws and a description of the generic drug approval process are also included.
Managing Advanced Illness: A Quality And Cost Challenge To Medicare, Medicaid, And Private Insurers, Karen Matherlee
Managing Advanced Illness: A Quality And Cost Challenge To Medicare, Medicaid, And Private Insurers, Karen Matherlee
National Health Policy Forum
This issue brief examines approaches to delivering and financing health services for persons with advanced chronic illness. It focuses on the nature and structure of the Medicare hospice benefit and its use as a model for Medicaid and other federal programs. The paper also looks at palliative-care approaches along the continuum of inpatient and post-acute services and raises cost, quality, and access issues for end-of-life care. In addition, it provides an overview of coverage through private insurance, including indemnity, point-of-service, and preferred-provider-organization products.
1115 Ways To Waive Medicaid And Schip Rules, Jennifer Ryan
1115 Ways To Waive Medicaid And Schip Rules, Jennifer Ryan
National Health Policy Forum
This issue brief explores the history and context of the Section 1115 Medicaid waiver authority, discusses the Health Insurance Flexibility and Accountability (HIFA) initiative under way in the Bush administration, and considers some of the potential impacts that HIFA could have on state budgets and access to health care for low-income families. Finally, it considers the future of Section 1115 waivers as a vehicle for modifying Medicaid and the State Children's Health Insurance Program.
Improving Oral Health: Promise And Prospects, Jennifer Ryan
Improving Oral Health: Promise And Prospects, Jennifer Ryan
National Health Policy Forum
This background paper examines the variety of issues affecting access to oral health care in the United States. It considers the possibilities and challenges presented by public financing sources for dental care for low-income children and families—including Medicaid, the State Children’s Health Insurance Program, and other safety net programs—and reviews a sampling of privately funded efforts at improving oral health access. The paper illustrates some of the major barriers to dental care, particularly the shortage of dentists willing to serve low-income and uninsured patients and the overall lack of growth in the dental workforce. It also considers the changing roles …
Will The Nation Be Ready For The Next Bioterrorism Attack? Mending Gaps In The Public Health Infrastructure, Eileen Salinsky
Will The Nation Be Ready For The Next Bioterrorism Attack? Mending Gaps In The Public Health Infrastructure, Eileen Salinsky
National Health Policy Forum
This paper provides an overview of critical weaknesses in public health preparedness capabilities and discusses policy initiatives to address these shortcomings. It examines developmental needs related to communication and coordination, information systems, laboratories, the development and distribution of vaccines and other countermeasures, emergency medical preparedness and response, and the public health workforce. The paper summarizes the status of federal and state plans to respond to these developmental needs and touches on the challenges likely to emerge as these plans are implemented.
Average Wholesale Price For Prescription Drugs: Is There A More Appropriate Pricing Mechanism?, Dawn Gencarelli
Average Wholesale Price For Prescription Drugs: Is There A More Appropriate Pricing Mechanism?, Dawn Gencarelli
National Health Policy Forum
This paper defines the average wholesale price (AWP), an important benchmark for prescription drug pricing and reimbursement. The paper briefly explains the AWP's various uses in the pricing of prescription drugs, highlights some of the problems that have emerged as a result of the way it is reported and used, and explores some of the possibilities for reform. The paper also contains a glossary of commonly used terms, as well as an appendix that lists the state Medicaid reimbursement formulas.
Contracting For Quality: Medicare's Quality Improvement Organizations, Lisa Sprague
Contracting For Quality: Medicare's Quality Improvement Organizations, Lisa Sprague
National Health Policy Forum
This paper examines the role of quality improvement organizations (QIOs, formerly known as PROs, or peer review organizations) in improving the quality of medical care delivered to Medicare beneficiaries in both fee-for-service and managed care environments. It looks at the expansion of the QIOs' portfolio in their seventh contract cycle to include quality improvement activities in nursing homes, home health services, and physicians' offices as well as responsibilities for public education. The paper explores the evolution of QIOs, changes in their priorities over time, and the projects in which they are engaged. It also considers their role in the formulation …
The Federal-State Struggle Over Medicaid Matching Funds: An Update, Karen Matherlee
The Federal-State Struggle Over Medicaid Matching Funds: An Update, Karen Matherlee
National Health Policy Forum
This background paper updates NHPF Issue Brief No. 760, "The Federal-State Medicaid Match: An Ongoing Tug-of-War over Practice and Policy," December 15, 2000. The paper presents actions taken since then by the Centers for Medicare and Medicaid Services, Department of Health and Human Services, to address what the Bush administration calls abusive funding practices used by states to draw federal Medicaid matching funds. Tracing the Clinton and Bush administrations' policies, the document reviews final regulations, published in January 2001 and January 2002, on these practices. The paper also reports on a lawsuit filed in federal court to block …
How Vulnerable Is The Nation's Food Supply? Linking Food Safety And Food Security, Robin J. Strongin
How Vulnerable Is The Nation's Food Supply? Linking Food Safety And Food Security, Robin J. Strongin
National Health Policy Forum
This paper reviews the food safety regulatory apparatus in place today, especially the activities of the two lead agencies in assuring food safety — the Food and Drug Administration within the Department of Health and Human Services and the Food Safety and Inspection Service within the Department of Agriculture. It examines the system's strengths and vulnerabilities, particularly in light of the post–September 11 environment that includes the heightened threat of terrorism. The paper also touches upon legislative and budgetary proposals aimed at improving food security, including the growing but debated interest in a single food safety agency.
Public Health Emergency Preparedness: Fundamentals Of The "System", Eileen Salinsky
Public Health Emergency Preparedness: Fundamentals Of The "System", Eileen Salinsky
National Health Policy Forum
This paper examines the existing public health infrastructure, with an emphasis on the resources and activities necessary for public health emergency preparedness and response. It provides a brief historical overview of the evolution of public health and contrasts public health interventions with medicine and health care services. The paper summarizes the broad range of activities that constitute public health practice today and provides a more detailed review of functions and services that are critical to emergency response capabilities. It explores the legal foundation for public health authorities, discussing constitutional, federal, and state public health law. The paper also summarizes how …
Child And Family Health Initiatives In The Bay Area, Jennifer Ryan, Wakina Scott
Child And Family Health Initiatives In The Bay Area, Jennifer Ryan, Wakina Scott
National Health Policy Forum
This site visit to the San Francisco Bay Area provided an opportunity to study locally based health initiatives in Santa Clara, Alameda, and San Francisco Counties that were designed to reach beyond the existing structures of the Medi-Cal and Healthy Families programs. Site visitors had the opportunity to interact with health care providers, state officials, and consumer advocates, as well as leaders in health coverage innovation. They also met with many of the leaders of the three local initiatives; visited Asian Health Services (AHS), a local clinic that has been serving the Asian community for over 25 years; and toured …
Pharmacy Benefits: New Concepts In Plan Design, Veronica V. Goff
Pharmacy Benefits: New Concepts In Plan Design, Veronica V. Goff
National Health Policy Forum
This issue brief examines changes to prescription drug benefit coverage in large-employer plans and implications for a Medicare prescription drug benefit. The brief discusses reasons behind employer benefit plan redesign and recent coverage trends, as well as potential paths to modernize benefits.
Transitions Along The Continuum Of Care: Elderly And Disabled Persons In New York, Lisa Sprague, Nora Super
Transitions Along The Continuum Of Care: Elderly And Disabled Persons In New York, Lisa Sprague, Nora Super
National Health Policy Forum
This site visit examined transitions along the continuum of care for elderly and disabled persons in New York. The state offers its residents an extensive array of services, including nursing homes, home health care, personal care, and community-based services. New York spends more than any other state on its Medicaid program, which is reflected in a comprehensive benefit package, full-cost reimbursement of hospitals, high nursing home rates, and extensive coverage of personal care services. Site visitors were briefed on the history and development of long-term care in the state as well as the various care settings available. Panels discussed transitions …
Welfare Reform In Maryland: Flexibility In Action, Jennifer Ryan, Judith D. Moore
Welfare Reform In Maryland: Flexibility In Action, Jennifer Ryan, Judith D. Moore
National Health Policy Forum
This site visit took federal participants on a tour around Maryland, providing a three-way comparison of suburban, urban, and rural service delivery in a diverse state. The site visit focused on the Family Investment Program, a statewide effort to reduce the state's welfare caseload through temporary cash assistance (TCA) and other needed supports to help customers become self-sufficient. In particular, site visitors examined rural perspectives on reform, substance abuse assessment and treatment innovations, and fatherhood and family support initiatives. The group heard from state officials, researchers, advocates, and a variety of direct service providers about the successes and challenges of …
Promoting Marriage As Welfare Policy: Looking At A Public Role In Private Lives, Jane Koppelman
Promoting Marriage As Welfare Policy: Looking At A Public Role In Private Lives, Jane Koppelman
National Health Policy Forum
This issue brief discusses the interest in and politics surrounding government's using welfare reform legislation to carve out a stronger role in promoting marriage. It examines trends in family formation, their impact on society, and the effect of single parenting, divorce, and stepparenting on child well-being. The paper also looks at the treatment of marriage in current government programs, new state activities to promote marriage, proposals for a stronger government role, and marriage experts' expectations for the success of marriage education programs.
From Diagnosis To Payment: The Dynamics Of Coding Systems For Hospital, Physician, And Other Health Services, Karen Matherlee
From Diagnosis To Payment: The Dynamics Of Coding Systems For Hospital, Physician, And Other Health Services, Karen Matherlee
National Health Policy Forum
This background paper reviews the two principal coding systems used to describe health services in the United States: ICD-9-CM and HCPCS, a combination of CPT-4 and national and local codes. It probes the relationships of these coding systems to payment policy, administrative simplification under HIPAA, and other concerns. The paper also addresses four coding issues: governance of CPT; adoption of ICD-10-CM; the appropriateness, accuracy, and responsiveness to change of the codes themselves; and the degree of documentation needed to monitor health services and determine payment.
Who Will Be There To Care? The Growing Gap Between Caregiver Supply And Demand, Nora Super
Who Will Be There To Care? The Growing Gap Between Caregiver Supply And Demand, Nora Super
National Health Policy Forum
This paper examines the increasing demand for long-term care services and the concurrent decrease in the supply of paid and unpaid caregivers. It considers workforce trends for paraprofessionals, such as certified nursing assistants, home health aides, and personal care attendants, as well as several public and private efforts to address staff shortages and quality-of-care. The paper explores the sociodemographic factors that have affected the demand for and supply of informal care provided by family and friends. It also reviewes policy proposals designed to provide support for family caregivers and/or to give choices to consumers.
Managed Care: As Good As It Gets? (Los Angeles), Lisa Sprague
Managed Care: As Good As It Gets? (Los Angeles), Lisa Sprague
National Health Policy Forum
This site visit was a return trip to southern California to examine the state of managed care. Between the Forum's last visit (in late 1998) and this one, the marketplace underwent considerable change, including significant movement away from global capitation, the collapse of physician practice management firms, and the development of new insurance products. Site visitors were briefed on managed care trends in the state, and panel discussions focused on issues related to physician group solvency, employer and consumer expectations, managed care regulation, and plan and provider strategies for surviving and prospering in the difficult southern California market. Site visitors …