Medicine and Health Sciences Commons^™

The Road To Universal Health Coverage In Massachusetts: A Story In Three Parts, John E. Mcdonough

New England Journal of Public Policy

In 1988, the Massachusetts Legislature passed a new law, a “play or pay” employer mandate, requiring all employers with six or more workers to provide health insurance coverage for their employees. A few years later, with Medicaid identified as a “Budget Buster,” the Weld administration sought deregulation as the way to cut costs and expand access by establishing MassHealth, which dropped the employer mandate and expanded Medicaid, and eventually distinguished Massachusetts as the state with the greatest percent of covered citizens. But MassHealth enrollment has declined as premium costs have risen, and the Uncompensated Care Pool is once again faced …

Labor's Response To Hospital And Workplace Transformation, Enid Eckstein

New England Journal of Public Policy

The health care industry and the nation's hospitals are in the throes of revolutionary change. The shift to managed care resulted in fundamental changes in the delivery of care and the structure of health care, For the past ten years, hospitals have actively been merging and creating large-scale integrated delivery systems. Employers, eager to expand market share and reduce costs, are engaged in radical reorganization of the hospital and the structure of work from which no group is immune. Physicians, nurses, technicians, and housekeepers are all affected by these changes. Hospitals are reducing their personnel, shifting work outside the hospital, …

Workplace Education At The Bottom Rungs, Andrés Torres

New England Journal of Public Policy

In the late 1980s, observers of the Massachusetts hospital industry were predicting a severe shortfall in skilled technical workers. The Worker Education Program (WEP) emerged as one of several responses to this projected labor shortage. It was premised on the idea of an internal solution to the need for workforce development, shifting the focus from external recruitment to upgrading of incumbents — nutrition, maintenance, clerical, and secretarial staff— and from traditional classroom training to workplace education. Other features of the WEP model made it an extremely interesting experiment: it was operated by labor-management partnership, it was located statewide in nine …

Alcoholism: A Barrier To Empowerment For Women, Marion Brink

New England Journal of Public Policy

Women's increasing economic power has encouraged the promotion of their drinking as fashionable. However, women are more vulnerable to the impact of alcohol, and the stigma attached to alcoholism is greater for them than it is for men. As a consequence, a woman — and those around her — will deny her alcoholism until she has lost much more than her male counterparts. When, or if, she seeks help for this devastating disease, she finds a lack of woman-specific programs and facilities. This article notes the barriers to recovery for women and offers some suggestions for breaking them down. Two …

Aids And New England Hospitals, Jesse Green, Neil Wintfeld, Madeleine Singer, Kevin Schulman

New England Journal of Public Policy

The Centers for Disease Control projects that nine thousand persons with AIDS will be alive in New England in 1991, representing a sevenfold increase from 1986. Our analysis indicates that more than 2 percent of medical/surgical beds in New England will be used for AIDS care by 1991, representing 766 fully occupied hospital beds. The direct cost of providing hospital care to New England's AIDS patients is projected to be $195.2 million in 1991, reflecting 3 percent of all hospital inpatient costs in the region.

AIDS treatment is very unevenly distributed among hospitals in New England. Just twenty hospitals (8 …

Medical Care Of Aids In New England: Costs And Implications, Stewart J. Landers, George R. Seage Iii

New England Journal of Public Policy

This article presents an overview of cost issues related to AIDS. Data from the Massachusetts Cost of AIDS Study are combined with epidemiological projections to estimate the cost of treating people diagnosed with AIDS in New England. Aggregate inpatient, ambulatory, and home care costs are estimated to be $96.9 million and $524.8 million through 1987 and 1991, respectively. These estimates represent a relatively small percentage of total health care costs for all illnesses over the same time period.

The authors find that the cost of treating AIDS does not affect all health care providers uniformly and therefore argue that appropriate …