Public Health Commons^™

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 …

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.

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 …

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 …

Racial And Ethnic Disparities In Access To Health Insurance And Health Care, Ucla Center For Health Policy Research, The Henry J. Kaiser Family Foundation

Native Health Database Full Text

Racial and ethnic groups in the United States continue to experience major differences in health status compared to the majority white population. Although many factors affect health status, the lack of health insurance and other barriers to obtaining health services markedly diminish minorities' use of both preventive services and medical treatments. This report, produced in collaboration with the UCLA Center for Health Policy Research, examines health insurance coverage and access to physician services among African Americans, Latinos, Asian Americans and Pacific Islanders, and American Indians and Alaska Natives. By pooling national survey data over two years, information about particular minority …

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, …

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 …

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.

Rural Managed Care And Disability: A National Perspective, Colleen Murphy-Southwick Ph.D., Tom Seekins Ph.D., University Of Montana Rural Institute Rural Institute

Health and Wellness

Rural access to health care has historically been a concern in the United States. In the late 1980s and early 1990s, lower rural reimbursements for the same services provided in urban areas contributed to a substantial decline in the number of rural hospitals and health care providers. Rural Americans with and without disabilities experienced the negative consequences of those changes. The rapid introduction of managed care is producing explosive changes in the marginal, aging, rural medical care services sector. Managed care policies directly affect both access to medical services by people with disabilities and the economic infrastructure of small rural …

Rural Managed Care And Disability: Emerging Issues From Preliminary Interviews And Case Studies, Colleen Murphy-Southwick Ph.D., Tom Seekins Ph.D., University Of Montana Rural Institute Rural Institute

Health and Wellness

Since the 1980s, rural access to health care information, resources and services has become increasingly problematic. The shift toward managed care complicates the picture. While some argue that managed care will devastate rural health services due to sparsely populated areas’ high costs and low profit margins, others suggest that market forces will make the health care system more efficient and re-distribute resources now concentrated in urban areas toward rural areas. Managed care is penetrating public programs

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.

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 …

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.

Attributional Style And Disability Outcome, Craig Ravesloot Ph.D., Quincy-Robyn Young, Tom Seekins Ph.D., Ann Szalda-Petree Ph.D., University Of Montana Rural Institute

Health and Wellness

Disability is both a very personal and social issue. In 1999, The World Health Organization (WHO) published their latest revisions to the ICIDH-2. This document includes the latest conceptual developments in understanding the structure and process of disabling conditions. The document highlights that disability outcome occurs within a dynamic system characterized by the impairment itself, environmental and personal factors (World Health Organization, 1999).

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 …

The Effects Of An Educational Intervention On Calcium Intake And Bone Mineral Content In Young Women With Low Calcium Intake., B. Peterson, R. Klesges, E. Kaufman, Theodore Cooper, C. Vukadonovich

Selected Works Temporary Series

No abstract provided.

The Effects Of An Educational Intervention On Calcium Intake And Bone Mineral Content In Young Women With Low Calcium Intake., B. Peterson, R. Klesges, E. Kaufman, Theodore Cooper, C. Vukadonovich

Departmental Papers (Psych)

No abstract provided.

Men's Health: How Men Understand The Concept Of Health And How This Understanding Shapes Actions, Craig T. Thompson

Theses : Honours

The purpose of this research was to explore how men understand the concept of health, and how this understanding shapes actions. This dissertation developed as a result of both working at a Community Health Centre, and having an awareness that in Australia, statistics indicate that men's health is steadily deteriorating. A theoretical framework implementing the concepts of health, socialisation (masculinity) and cognition was utilised to guide the research. The research involved interviewing six male participants, who were university students ranging in age from 20 to 40 years. Participants were questioned regarding their perceptions of health and health management. Interview transcripts …

Regional Differences In Indian Health 1998-1999, Indian Health Service

Native Health Database Full Text

This document contains tables and charts that describe the Indian Health Service (IHS) program and the health status of American Indians and Alaska Natives residing in the IHS area. The information is grouped into five major categories: 1) IHS structures, 2) population statistics, 3) natality and infant/maternal mortality statistics, 4) general mortality statistics, and 5) patient care statistics.

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 …

A Participatory Evaluation Of The Life-Skills Training Programme In Myanmar, Unicef, Population Council

Poverty, Gender, and Youth

In 1993 UNICEF/Myanmar launched an innovative project aimed at preventing the further spread of HIV/AIDS through the promotion of reproductive health. One of the activities undertaken was life-skills training for women and youth, conducted in collaboration with the Myanmar Red Cross Society (MRCS) and the Myanmar Maternal and Child Welfare Association (MMCWA). The objective of the training activities was to encourage and promote informed decision-making and care-seeking behavior among youth and women. The training aims to provide detailed and accurate information concerning sexuality, birth spacing, sexually transmitted diseases, and HIV/AIDS, and to provide skills for youth and women to enable …

Risk Factors Associated With Infant Mortality Among Very Low Birthweight Infants Of Teenage Mothers In San Bernardino County, C. Letitia Henry

Loma Linda University Electronic Theses, Dissertations & Projects

Background. Typically, infant mortality decreases as maternal age increases in teenagers. In contrast to these national data, San Bernardino County (SBC) experienced a different phenomenon in 1989-1994 among very low birthweight (VLBW) infants. The infant mortality rate (IMR) of VLBW infants born to mothers under 17 years old (283 per 1000 live births) was significantly lower than the IMR of VLBW infants born to mothers between the ages of 17-19 years old (430 per 1000 live births) (p = .02).

Purpose. The purpose of the study was to explain the discrepancy between IMRs of VLBW infants of younger teenage mothers …

Northwest Tribal Registry--Seattle Indian Health Board Record Linkage Project., J. Bettles, D. Robertson, F.C. Romero, T. Becker, P. Stehr-Green

Native Health Database Full Text

In the last ten years several reports using a variety of health data sets have shown a high proportion of racial misclassification for Northwest American Indians and Alaskan Natives (AI/ANs). The result of this has been an underestimation of the burden of various diseases among Northwest AI/ANs. To address health issues related to misclassification, the Northwest Tribal Epidemiology Center has developed the Northwest Tribal Registry (NTR), which contains a demographic data set of 135,060 Northwest AI/ANs, and which can be used for record linkage studies to ascertain accurate disease rates for Northwest AI/ANs.

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.

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 …

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.

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.

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 …

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.

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.