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 …

Medicaid's Disproportionate Share Hospital Program: Complex Structure, Critical Payments, Robert E. Mechanic

National Health Policy Forum

This background paper describes the history and political evolution of Medicaid’s disproportionate share hospital (DSH) program and examines DSH as it exists today. It highlights the importance of DSH payments for the viability of safety net hospitals and considers the consequences of states’ creative financing strategies for maximizing federal Medicaid matching funds. Finally, this paper reviews several options for improving the structure and effectiveness of the DSH program.

What's Happening: September, 2004, Maine Medical Center

What's Happening

No abstract provided.

Purchasing Pharmaceuticals (Health, Nutrition And Population (Hnp) Discussion Paper), Ulrika Enemark, Anita Alban, Enrique Seoane-Vazquez

Pharmacy Faculty Books and Book Chapters

This paper discusses the purchasing of pharmaceuticals as a key component of costeffective and equitable healthcare delivery. Pharmaceuticals account for a high, sometimes the dominant share of health expenditures in developing countries, but the desired health outcomes can only be achieved if the adequate medicines reach the right people and are used in the correct way. This requires purchasing arrangements that take into account the information asymmetry between patients and providers, ensure selection of effective, safe and affordable medicines and set economic incentives in a way that encourages rational drug use. The organizational and institutional frameworks define the roles of …

Managing Unmanageable Physicians: Leadership, Stewardship, And Disruptive Behavior, Tim Keogh, William Martin

College of Business Faculty and Staff Works

Physician and health care leaders are seeking guidance and support on how to address disruptive behavior that has an impact on safety, quality, and performance. This article equips leaders with a model and process to prevent and address disruptive behavior.

Fundamentals Of Community Health Centers, Jessamyn Taylor

National Health Policy Forum

This background paper examines the dominant model of federal grant funding for primary care in the health care safety net: the community health center. It describes the history of the health center program and highlights key policy issues influencing health centers, such as Medicaid payment policies and medically underserved area designations. The paper also examines the recent presidential initiative to expand health centers, including a review of the process used to identify new grantees, an assessment of remaining gaps in capacity, an exploration of continuing challenges, and a discussion of unresolved policy questions.

A Report From The Forum Session "Implementing The New Medicare Drug Benefit: Challenges And Opportunities For States", Judith D. Moore

National Health Policy Forum

The National Health Policy Forum convened a meeting on July 22, 2004 to discuss state-based challenges associated with implementing the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). The meeting brought together an extremely insightful and experienced group of current and former state officials and other experts to discuss key issues. In keeping with its tradition of promoting a frank, off-the-record exchange on health policy issues, NHPF does not normally prepare written summaries or reports of meetings. However, because this meeting provided vivid illustrations of the importance of state-federal collaboration for the successful implementation of the new Medicare drug benefit, …

Fundamentals Of The Prescription Drug Market, Christie Provost Peters

National Health Policy Forum

This background paper is a primer on the prescription drug market. It provides information on the fundamentals of the pharmaceutical industry and various marketplace stakeholders, including manufacturers, retailers, consumers, regulators, researchers, and purchasers. This paper also examines the various ways the federal government interacts with the pharmaceutical market. Due to the breadth of material addressed, some complex issues and relationships are presented in broad conceptual terms without extensive technical detail.

Tick-Tock: Preparing For The Next Influenza Pandemic, Eileen Salinsky

National Health Policy Forum

This paper describes the nature of pandemic influenza and highlights key challenges for responding to this disease threat. It explains how an influenza pandemic would differ from annual influenza outbreaks and examines how a pandemic virus could emerge. It also explores important issues involved in pandemic preparedness capabilities, including disease surveillance, vaccine production and distribution, antiviral stockpiling, health care system readiness, and public health containment measures. The national pandemic preparedness plan is briefly reviewed, and unresolved policy issues related to the plan’s implementation are identified.

Assessing Clinical Education In Nursing: The Development Of The Clinical Education Inventory, Marcia Ann Miller

All-Inclusive List of Electronic Theses and Dissertations

The purpose of this study was to construct a valid and reliable comprehensive instrument entitled the Clinical Education Inventory (CEI) that measures nursing students' perceptions of clinical nursing education. The comprehensive instrument developed during this study evaluates multiple facets of clinical nursing education and reduces the need to survey the students using several tools each semester. Ill The method for this study was adapted from the work ofDeVellis (1991) for scale development. Item generation was optimized through requesting existing tools from nursing programs across the United States. Thirteen programs contributed 34 tools. After the review by the expert panel for …

What's Happening: August, 2004, Maine Medical Center

What's Happening

No abstract provided.

The Promise And The Reality Of Long-Term Care Insurance, Randy Desonia

National Health Policy Forum

The aging of the nation’s population will create a surge in the need for long-term care services, putting pressure on existing funding sources and fueling demand for more. This paper examines one financing option—private long-term care insurance—and summarizes its brief history and the several critical precedents that have influenced the products as currently sold. Other topics discussed include the challenges to encouraging sales growth as well as increasing the role of this type of insurance in paying for long-term care.

What's Happening: July, 2004, Maine Medical Center

What's Happening

No abstract provided.

Designing And Implementing A Balanced Scorecard: Lessons Learned In Nonprofit Implementation, Andra Gumbus, Tom Wilson

WCBT Faculty Publications

The balanced scorecard has been referred to as the management innovation of the century, and extensive articles have been written using case studies of organizations that use this performance measurement system. This article addresses the key issues of design and implementation with a step-by-step guide to how to design a balanced scorecard and lessons to avoid implementation problems in government and nonprofit settings.

Gaining Compliance And Losing Weight: The Role Of The Service Provider In Health Care Services, Stephanie Dellande, Mary C. Gilly, John L. Graham

Business Faculty Articles and Research

This research provides and empirically tests a conceptualization of health care services in which customer compliance outside of the service organization is necessary for successful health outcomes. Using data from service providers and customers in a weight-loss clinic, the authors examine the provider's role in gaining customer compliance. They find that provider expertise and attitudinal homophily play a role in bringing about customer role clarity, ability, and motivation. This study demonstrates that compliance leads to goal attainment, which results in satisfaction. More important, compliance also leads to satisfaction directly; consumers who comply with program requirements have greater satisfaction with the …

What's Happening: June, 2004, Maine Medical Center

What's Happening

No abstract provided.

The Economics Of Quality: Changing Incentives In Cincinnati, Lisa Sprague, Nora Super

National Health Policy Forum

This site visit focused on private market dynamics and quality improvement initiatives. Cincinnati is characterized by strong players in all sectors of the market: employers such as Procter and Gamble and General Electric, hospital systems, health plans, and physician groups with the power to “push back” in contract negotiations. The city is a pilot site for Bridges to Excellence, a pay-for-performance initiative spearheaded by GE. Cincinnati Children’s Hospital Medical Center is a grantee under the Robert Wood Johnson Foundation’s Pursuing Perfection program. Among the issues explored were physician supply, incentive structures, specialty hospitals, and information technology.

Consumer Cost Sharing In Private Health Insurance: On The Threshold Of Change, Veronica V. Goff

National Health Policy Forum

Employers are asking employees to pay more for health care through higher premium contributions, share of contribution, and out-of-pocket maximums, along with variations in deductibles, copays, and coinsurance based on choice of providers, networks, drugs, and other services. This issue brief examines consumer cost-sharing trends in private insurance, discusses the outlook for cost sharing in employment-based benefits, and considers public policies to support health care markets for consumers.

Medicare's Chronic Care Improvement Pilot Program: What Is Its Potential?, Nora Super

National Health Policy Forum

This paper describes the voluntary chronic care improvement program under traditional fee-for-service Medicare as authorized by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 (Public Law 108-173; section 721). This brief analyzes the emerging issues raised by this new program, including which chronic conditions and regional areas will be targeted, the types of entities that may participate, the physician’s role in care management, and the adoption and use of health information technology and evidence-based clinical guidelines.

What's Happening: May, 2004, Maine Medical Center

What's Happening

No abstract provided.

Veterans' Health Care: Balancing Resources And Responsibilities, Lisa Sprague

National Health Policy Forum

This paper looks at the health care benefits and services administered by the U.S. Department of Veterans Affairs. It examines management strategies adopted within the department to allocate resources, structure benefits, and improve quality. Some recommendations made by the General Accounting Office and the President’s Task Force to Improve Health Care Delivery for Our Nation’s Veterans are reviewed, in particular the emphasis of the latter on increased collaboration with the Department of Defense. Long-term proposals to balance service commitments and financing also are considered.

What's Happening: April, 2004, Maine Medical Center

What's Happening

No abstract provided.

Necessary But Not Sufficient? Physician Volunteerism And The Health Care Safety Net, Eileen Salinsky

National Health Policy Forum

This paper examines the role of physician-sponsored charity care in meeting the health care needs of the uninsured. The paper provides an overview of current charity care levels by medical specialties and geographic regions, discusses limitations in available data, and describes the settings in which charity care is provided. The paper also summarizes the factors that motivate physicians to provide volunteer services, as well as the barriers that hinder volunteer activities, including malpractice insurance concerns. Also discussed are a range of public policies, both existing and considered, that support volunteer activities, with a particular emphasis on the expansion of Federal …

What's Happening: March, 2004, Maine Medical Center

What's Happening

No abstract provided.

Designing A Strategy To Effectively Communicate The Balanced Scorecard, Andra Gumbus, Bridget Lyons, Tom Wilson

WCBT Faculty Publications

As increasing numbers of organizations adopt the balanced scorecard (BSC) to align strategy with operations and measure progress toward meeting strategic goals, the importance of successful communication of the scorecard throughout the organization has become apparent. Successful implementation and effective use of the BSC occurs when organizational stakeholders recognize its role, use, and benefits. In the March/April 2003 issue of Cost Management, we detailed how Bridgeport Hospital, a member of Yale New Haven Health System (YNHHS), adopted the BSC and used the scorecard to align capital investment decisions with strategy.1 In this article, we will profile how the hospital designed …

The Health Care Safety Net In South Carolina: A Test Of Tenacity, Jennifer Ryan, Randy Desonia

National Health Policy Forum

This site visit to the state of South Carolina provided an opportunity to experience and understand the unique makeup of the health care safety net in a southern state. Site visitors had the opportunity to interact with health care providers, state officials, faith-based organizations and leaders of provider-driven volunteer initiatives. They also learned about the challenges of access to care in rural areas and among diverse population groups. The group visited the Sea Island Medical Center and Our Lady of Mercy Community Outreach and Wellness House; a migrant farm worker camp on Johns Island; and a “medical home” site, Medical …

What's Happening: February, 2004, Maine Medical Center

What's Happening

No abstract provided.

Patient Satisfaction And Disease Specific Quality Of Life After Uterine Artery Embolization, Wendy J. Smith, Elizabeth Upton, Elizabeth J. Shuster, Arnold J. Klein, Martin L. Schwartz

Faculty Publications - College of Medical Science

Objectives: This study was undertaken to evaluate changes in fibroid specific symptom severity and health-related quality of life (HRQOL) after uterine artery embolization (UAE) and to consider the impact of these changes on satisfaction with the procedure.

Study design: A validated, fibroid specific, symptom, and HRQOL questionnaire was mailed to 80 women who had undergone UAE from 1998 through 2002. Pre- and postprocedure symptom severity and HRQOL scores were obtained. The primary outcome measure was change in fibroid symptoms and HRQOL after UAE. Secondary outcomes included objective measures of patient satisfaction, and the decrease in uterine volume after UAE.

Children's Mercy Annual Report 2003, Children's Mercy Hospital

Children's Mercy Annual Reports

Annual report for The Children's Mercy Hospital in Kansas City MO, a pediatric medical center.

What's Happening: January, 2004, Maine Medical Center

What's Happening

No abstract provided.