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Articles 391 - 420 of 456

Full-Text Articles in Law

Medicare+Choice: Where To From Here?, Nora Super Sep 2000

Medicare+Choice: Where To From Here?, Nora Super

National Health Policy Forum

This issue brief examines Medicare+Choice (M+C) plan participation, benefit coverage, and enrollment and the factors that have contributed to plans' decisions to participate in or withdraw from certain markets. In addition, the issue brief explores what has been happening to M+C enrollees in terms of costs, benefits, and continuity of care. Lastly, the issue brief examines the reasons that alternative plan options — such as preferred provider organizations (PPOs) and provider-sponsored organizations (PSOs) — have not taken hold. Legislative proposals that might affect the future of M+C are also discussed.

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The Asthma Epidemic: Prospects For Controlling An Escalating Public Health Crisis, Richard Hegner Sep 2000

The Asthma Epidemic: Prospects For Controlling An Escalating Public Health Crisis, Richard Hegner

National Health Policy Forum

This background paper examines the dimensions of the recent asthma epidemic and what could be done to contain it. Information about the prevalence and consequences of asthma across demographic groups is presented. Factors that impede the control of asthma are also identified. The paper also examines the possible causes of asthma and the asthma epidemic as well as new theories about the relationship of asthma to overall advances in health care and economic development. It also discusses the economic implications of asthma and possible cost avoidances linked to better asthma management. The paper concludes with discussions of asthma and public …

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Insuring Virginia's Children: Local Outreach And Enrollment (Northern Virginia), Lisa Sprague, Judith D. Moore Aug 2000

Insuring Virginia's Children: Local Outreach And Enrollment (Northern Virginia), Lisa Sprague, Judith D. Moore

National Health Policy Forum

This one-day visit to a nearby jurisdiction was designed to allow participation by federal staff who have been unable to commit the three days required by a typical Forum site visit. Site visitors were given an overview of health care in Virginia and an introduction to the Children's Medical Income Security Program (CMSIP) as well as its proposed replacement, the Family Access to Medical Insurance Security program (FAMIS). A panel representing community organizations and providers shared their experience, touching on provider concerns, coordination of outreach efforts across counties, and assistance for clients after they are enrolled. The group visited the …

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Outpatient Commitment In Mental Health: Is Coercion The Price Of Community Services?, Coimbra Sirica Jul 2000

Outpatient Commitment In Mental Health: Is Coercion The Price Of Community Services?, Coimbra Sirica

National Health Policy Forum

This paper reviews the debate over civil commitment to outpatient settings of people with mental illness who are considered too ill and/or too dangerous to be left on their own in their communities. The choices of two states — Maryland and New York — in dealing with this issue are reviewed. Alternative ways of drawing people into treatment and keeping them there are also discussed.

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Hcfa's Outpatient Pps: Finally Ready To Roll?, Karen Matherlee Jun 2000

Hcfa's Outpatient Pps: Finally Ready To Roll?, Karen Matherlee

National Health Policy Forum

This issue brief centers on hospital outpatient department services, scheduled to be on a prospective payment system (PPS) July 1, 2000, 17 years after enactment of legislation mandating PPS for hospital inpatient services. It looks at the challenges to providers and patients, including coding and other process issues, redistribution of payments, and changes in beneficiary co-payments.

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Using Schip To Subsidize Employment-Based Coverage: How Far Can This Strategy Go?, Karl Polzer Jun 2000

Using Schip To Subsidize Employment-Based Coverage: How Far Can This Strategy Go?, Karl Polzer

National Health Policy Forum

This background paper examines and analyzes early efforts by states to subsidize employment-based health insurance under the State Children's Health Insurance Program (SCHIP), which offers states a more generous funding rate than under Medicaid. As the Health Care Financing Administration prepares to issue regulations governing SCHIP, the paper summarizes complaints by state officials that federal rules governing how job-based coverage might be subsidized under the program are overly complex and rigid. After interviewing officials at the federal level and in six states as well as a variety of researchers and policy experts, the author considered whether and to what extent …

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Pharmaceutical Marketplace Dynamics, Robin J. Strongin May 2000

Pharmaceutical Marketplace Dynamics, Robin J. Strongin

National Health Policy Forum

This issue brief provides a profile of the pharmaceutical industry and explores topics such as competition, generics, intellectual property, research and development, pricing, and distribution. It also discusses government programs such as the Department of Veterans' Affairs federal supply schedule and Medicaid rebates.

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Reinventing Medicaid: Hoosier Healthwise And Children's Health Insurance In Indiana, Judith D. Moore, Lisa Sprague Apr 2000

Reinventing Medicaid: Hoosier Healthwise And Children's Health Insurance In Indiana, Judith D. Moore, Lisa Sprague

National Health Policy Forum

This site visit explored the factors that have made Indiana so successful in enrolling children in its Medicaid and SCHIP plans under the brand name Hoosier Healthwise. Site visitors met with legislators and state officials to gain understanding of the genesis and development of Hoosier Healthwise and its aggressive outreach component. A panel of representatives from partner organizations engaged in enrolling children provided further insight into this process. The site visit participants traveled to observe enrollment and operations in both urban (Marion) and rural (Clay) county offices. They also met with health care executives at hospitals, clinics, and neighborhood health …

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Dispelling The Myths And Stigma Of Mental Illness: The Surgeon General's Report On Mental Health, Richard Hegner Apr 2000

Dispelling The Myths And Stigma Of Mental Illness: The Surgeon General's Report On Mental Health, Richard Hegner

National Health Policy Forum

This paper summarizes the key findings of "Mental Health: A Report of the Surgeon General," which was released on December 13, 1999, by U.S. Surgeon General David Satcher. Topics include the significance of mental illness, the effectiveness of diagnosis and treatment, the widespread lack of treatment, access problems and their causes, the significance of stigma, and the prevention of mental illness.

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Site Visit To Seattle — University Of Washington Academic Medical Center, Karen Matherlee Apr 2000

Site Visit To Seattle — University Of Washington Academic Medical Center, Karen Matherlee

National Health Policy Forum

The event was part of a series of three site visits leading to an April 27–28, 2000, conference in Annapolis, Maryland, on hospital-based health care systems in transition after enactment of the Balanced Budget Act of 1997 (BBA) and the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA). The site visit focused on the challenges the University of Washington (UW) faces in carrying out its three missions of delivery of health services (with emphasis on the safety net), health professions education, and health science and clinical research. It probed the effects of the BBA on these missions …

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Applying Science To Public Policy: The Context Of The Surgeon General's Report On Mental Health, Richard Hegner Apr 2000

Applying Science To Public Policy: The Context Of The Surgeon General's Report On Mental Health, Richard Hegner

National Health Policy Forum

Intended to provide public policy context for the December 1999 Surgeon General's Report on Mental Health, this background paper discusses the historic skepticism about the efficacy of treatment of mental illness in this country, insurance practices that have discriminated against mental illness and the reasons for them, the disproportionate share of mental health funding provided by government sources such as Medicaid and state general revenues, the role of state and local public government as providers of catastrophic coverage for mental illness, the cascading cost-shifting game in mental health finance, obstacles to needed treatment (including popular attitudes toward mental illness), the …

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Site Visit To Detroit — Henry Ford Health System, Lisa Sprague Mar 2000

Site Visit To Detroit — Henry Ford Health System, Lisa Sprague

National Health Policy Forum

This event was one in a series of three site visits leading to an April 27–28, 2000, conference in Annapolis, Maryland, on hospital-based health care systems in transition after the enactment of the Balanced Budget Act of 1997 (BBA) and the Medicare, Medicaid, SCHIP Balanced Budget Refinement Act of 1999 (BBRA). The site visit explored the responses of a large integrated system, the Henry Ford Health System, to the BBA and how the BBA has interacted with other changes in the system's local market and state Medicaid program. Panel presentations highlighted financing and information systems, the integration of diversified services, …

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Site Visit To Richmond And Hampton Roads — Bon Secours Health System, Inc., Nora Super Mar 2000

Site Visit To Richmond And Hampton Roads — Bon Secours Health System, Inc., Nora Super

National Health Policy Forum

The first in a series of three site visits leading to an April 27–28, 2000, conference in Annapolis, Maryland, on hospital-based health care systems in transition after the enactment of the Balanced Budget Act of 1997 (BBA) and the Medicare, Medicaid, SCHIP Balanced Budget Refinement Act of 1999 (BBRA). The site visit was designed to better understand how changing payment incentives — particularly the move to prospective payment systems for postacute services — has affected the ability to implement a continuum of care across delivery sites. It examined the Bon Secours Health System's operations in Virginia, which include four hospitals …

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Improving Quality And Preventing Error In Medical Practice, Lisa Sprague Mar 2000

Improving Quality And Preventing Error In Medical Practice, Lisa Sprague

National Health Policy Forum

Drawing on the Institute of Medicine's report To Err Is Human, this issue brief looks at quality-improvement and error-reduction efforts at the institutional, regional, and state levels and analyzes the roles of government and the private sector in bringing such efforts into national focus. Questions considered include whether error reporting should be mandatory or voluntary, who should perform error analysis, and the role of the individual in an institutional accountability model.

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Physician Connectivity: Electronic Prescribing, Robin J. Strongin Feb 2000

Physician Connectivity: Electronic Prescribing, Robin J. Strongin

National Health Policy Forum

This issue brief focuses on physician connectivity — the electronic linking of physicians with online resources such as clinical databases and sophisticated formulary systems. As physician connectivity increasingly allows physicians to prescribe online via a handheld computer complete with formulary information as well as patient data and drug information, this issue brief examines the issues raised by this technological advance within the broader context of online prescribing.

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Site Visit To Arizona — Managed Medicaid: Arizona's Ahcccs Experience, Nora Super, Lisa Sprague, Judith D. Moore Jan 2000

Site Visit To Arizona — Managed Medicaid: Arizona's Ahcccs Experience, Nora Super, Lisa Sprague, Judith D. Moore

National Health Policy Forum

This site visit featured a review of a unique Medicaid managed care system, the Arizona Health Care Cost Containment System (AHCCCS), which has operated as a research and demonstration waiver since its inception in 1982. Site visitors heard from speakers who provided historical and background information, a discussion of competitive bidding, contracting and performance management, and insights into the delivery of behavioral health under the mandatory AHCCCS program. The group also heard discussions about services to the uninsured and Arizona's safety net providers. Other topics covered during the visit included the state's KidsCare program under the State Child Health Insurance …

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Reshaping Ahcs' Role In Biomedical Research, Karen Matherlee Jan 2000

Reshaping Ahcs' Role In Biomedical Research, Karen Matherlee

National Health Policy Forum

This issue brief explores the reconfiguration of academic health centers (AHCs) in response to health marketplace and other pressures. It reviews four roles AHCs play in medical innovation: (a) development of new drugs, devices, diagnostic techniques, and therapeutic procedures; (b) adoption of new technologies, instruments, and drugs; (c) evaluation of new technologies; and (d) assessment of the need for new modalities and monitoring of their initial uses. The paper examines ways in which these roles are enhanced or threatened by evolving economic forces in the public and private sectors.

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Balancing Public Health Against Individual Liberty: The Ethics Of Smoking Regulations, Thaddeus Mason Pope Jan 2000

Balancing Public Health Against Individual Liberty: The Ethics Of Smoking Regulations, Thaddeus Mason Pope

Faculty Scholarship

Ten years ago, philosopher Robert E. Goodin published "No Smoking: The Ethical Issues." Goodin argued that the liberty of smokers can be justifiably limited for two reasons: to prevent harm to third persons and to prevent harm to smokers themselves under circumstances which make their decision to smoke substantially non-autonomous. In this article Thaddeus Pope reexamines the harm principle and the soft paternalism principle in light of more recent legal developments, gives them additional content, and carefully demarcates the justificatory scope of each. Pope also defines and defends a third liberty-limiting principle, hard paternalism, arguing that the liberty of smokers …

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Erisa Health Plan Liability: Issues And Options For Reform, Karl Polzer Jan 2000

Erisa Health Plan Liability: Issues And Options For Reform, Karl Polzer

National Health Policy Forum

This background paper was written as congressional conferees faced the task of resolving differences between patient protection bills by the U.S. House of Representatives and U.S. Senate in late 1999. In order to discuss the principal issues facing policymakers and options for reform, it begins by describing problems raised by the federal law governing private-sector employee health plans (the Employee Retirement Income Security Act of 1974) from a consumer perspective. It then discusses approaches proposed by the Clinton administration and the House and Senate to give consumers greater ability to challenge health plan coverage decisions, focusing in particular on issues …

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Medicare Competitive Pricing: Lessons Being Learned In Phoenix And Kansas City, Nora Super Nov 1999

Medicare Competitive Pricing: Lessons Being Learned In Phoenix And Kansas City, Nora Super

National Health Policy Forum

Written as policymakers scrutinized two Medicare competitive bidding demonstration projects set to take place in Phoenix and Kansas City, this issue brief analyzes two demonstration projects designed to test whether Medicare could pay health plans in a competitive manner. The brief reviews decisions made by the Competitive Pricing Advisory Commission (CPAC), including design considerations such as plan eligibility and participation, the standard benefit package, the bidding process, and the government contribution to premiums. It also looks at the reasons for opposition to the project and the relationship of this demonstration to broader efforts to reform the Medicare program.

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The Public Stake In Biomedical Research: A Policy Perspective, Karen Matherlee Nov 1999

The Public Stake In Biomedical Research: A Policy Perspective, Karen Matherlee

National Health Policy Forum

An introduction to a Forum series on biomedical research policy issues, this paper provides background on the organization and structure of both public and private research entities. It outlines the federal components, from the National Institutes of Health (NIH) to the Department of Veterans Affairs. It also looks at the rapid growth in pharmaceutical, biotechnology, and medical device research and development and the varying responses from managed care plans, practice-based research networks, and contract research organizations. After laying out various tensions in the field, such as competition among disease-oriented advocates, alignment of different priorities, allocation of dollars between basic and …

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The Abcs Of Pbms, Robin J. Strongin Oct 1999

The Abcs Of Pbms, Robin J. Strongin

National Health Policy Forum

This issue brief describes the evolution of the pharmacy benefit manager (PBM) industry since the late 1960s and outlines current business practices in the areas of payment, services, drug formularies, and rebates. Tools of the trade, such as cost-sharing and generic substitution, used to control costs and improve quality are also discussed.

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Chip And Medicaid Outreach And Enrollment: A Hands-On Look At Marketing And Applications, Judith D. Moore Oct 1999

Chip And Medicaid Outreach And Enrollment: A Hands-On Look At Marketing And Applications, Judith D. Moore

National Health Policy Forum

The State Children's Health Insurance Program (SCHIP or CHIP), enacted as part of the Balanced Budget Act (BBA) in 1997, has enrolled eligible low-income children in innovative ways and tackled a variety of challenges to make sure that families know about the new program. This issue brief describes the outreach, application, and enrollment process for both SCHIP and Medicaid, analyzing the difficulty in simplifying applications, and noting problems that states must solve around systems design, immigration issues, and the stigma sometimes associated with government programs.

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Site Visit To Baltimore And Fort Detrick, Maryland — Preparing For A Bioterrorist Incident: Linking The Public Health And Medical Communities, Robin J. Strongin Oct 1999

Site Visit To Baltimore And Fort Detrick, Maryland — Preparing For A Bioterrorist Incident: Linking The Public Health And Medical Communities, Robin J. Strongin

National Health Policy Forum

As follow-up to the NHPF's February 1999 session entitled "Biological Terrorism: Is the Health Care Community Prepared?" the Forum organized a site visit on October 4 and 5, 1999, to Baltimore and Fort Detrick, Maryland. The site visit provided federal congressional and agency staff with the opportunity to learn first-hand how one local area is preparing for the possibility of a bioterrorist incident. Several themes were stressed throughout the two days, including the following: distinguishing bioterrorism from chemical terrorism, understanding the relationships between various agencies and institutions and their related funding streams, determining how the federal government can …

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A Chicken (Nugget?) In Every Pot: What's At Stake In The Budget Debate, Karl Polzer Sep 1999

A Chicken (Nugget?) In Every Pot: What's At Stake In The Budget Debate, Karl Polzer

National Health Policy Forum

This paper explores various aspects of the 1999 budget debate fueled in large part by federal agencies' projection of a $2.9 trillion surplus over 10 years. The tax bill, which would provide about $400 billion in tax relief, is also discussed; special attention is given to the health care provisions of this legislation.

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The Nursing Center In Concept And Practice: Delivery And Financing Issues In Serving Vulnerable People, Karen Matherlee Sep 1999

The Nursing Center In Concept And Practice: Delivery And Financing Issues In Serving Vulnerable People, Karen Matherlee

National Health Policy Forum

This issue brief looks at ways in which nurse-managed centers — with support from the Health Resources and Services Administration and private foundations — are carving a role in providing preventive and primary care to vulnerable populations. Two case studies — one in Philadelphia and the other in the Utah-Nevada border area — llustrate nursing centers' mission, outreach, services, workforce, payment concerns, and educational tie-ins.

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Mental Health Coverage Parity: Separating Wheat From Chaff, Karl Polzer Jul 1999

Mental Health Coverage Parity: Separating Wheat From Chaff, Karl Polzer

National Health Policy Forum

This paper examines the issue of mandating parity in coverage of mental health services in the context of the growing use by private-sector employers of managed behavioral health care providers. Existing parity laws are reviewed, along with estimates of the costs of parity. The tools used by behavioral health care firms to manage care and costs are also discussed.

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Access To Home Health Services Under Medicare's Interim Payment System, Nora Super Jul 1999

Access To Home Health Services Under Medicare's Interim Payment System, Nora Super

National Health Policy Forum

This issue brief explores the impact of the interim payment system (IPS) for home health agencies established under the Balanced Budget Act of 1997 (BBA). IPS was intended to constrain program outlays by imposing limits on spending per beneficiary and spending per visit in the existing cost-based reimbursement system. This issue brief examines the impact of the IPS on access to home health care, including home health agencies' responses to the payment system and its impact on provider availability and, ultimately, access to care for the sickest or most expensive populations

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Implementing The Bba: The Challenge Of Moving Medicare Post-Acute Services To Pps, Karen Matherlee Jul 1999

Implementing The Bba: The Challenge Of Moving Medicare Post-Acute Services To Pps, Karen Matherlee

National Health Policy Forum

This issue brief examines the challenge of putting skilled nursing facilities (SNFs), medical rehabilitation units, and home health under prospective payment, requiring the development of classification systems for each. It looks at the three-year phase-in of SNF resource utilization groups (RUGs) that began July 1, 1998 and the debate over classification systems for medical rehabilitation facilities and home health. The paper goes beyond issues of classification to consider coordination problems in placing these post-acute services under Medicare PPS.

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Canada's Generalist Training: Are There Lessons For The United States?, Lee Hawkins Jun 1999

Canada's Generalist Training: Are There Lessons For The United States?, Lee Hawkins

National Health Policy Forum

Addressing the premise of an inappropriate skewing of the U.S. medical education system toward specialty medicine, this issue brief compares and contrasts the U.S. and Canadian graduate medical education (GME) systems, including the organization and financing of each. The issue brief also explores various lessons that might be learned from the Canadian GME system, such as full integration of primary care and GME and the use of incentives to achieve desired policy goals.

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