Public Health Commons^™

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

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

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 Reauthorization In 2002:What Are The Issues For Tribal Communities And Indian Families?, Kathleen A. Maloy

Health Policy and Management Issue Briefs

American Indian tribes have new options under the 1996 Welfare Reform legislation that created Temporary Assistance for Needy Families (TANF), a block grant enacted to replace the Aid to Families with Dependent Children (AFDC). TANF, which expires in September of this year, provides cash assistance to poor families with children, including poor American Indian Families, and gives tribes the option to design and administer their own family assistance programs following approval of the plan by the Department of Health and Human Services. As Congress considers TANF reauthorization, three new publications prepared for the Kaiser Family Foundation provide insight into the …

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

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

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

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.

Diagnostic And Therapeutic Procedures Among Australian Hospital Patients Identified As Indigenous, Joan Cunningham

Aboriginal Policy Research Consortium International (APRCi)

Objectives: To determine whether hospital patients identified as Indigenous are less likely than other inpatients to have a principal procedure recorded, and the extent to which any disparity in procedure use can be explained by differences in patient, episode and hospital characteristics. Design: Retrospective analysis of routinely collected administrative data from the National Hospital Morbidity Database (NHMD). Setting: Australian public and private hospitals. Patients: All patients included in the NHMD whose episode type was recorded as acute and whose separation occurred between 1 July 1997 and 30 June 1998. Patients admitted for routine dialysis treatment were excluded. Main outcome measure: …

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 …

Managed Healthcare And Integrated Delivery Systems: A Model For Getting Ahead Of The Change Curve, Philip Sheridan Carney

Theses Digitization Project

Managed care became the dominant model for moderating healthcare costs in the 1990's. The later half of this past decade witnessed early signs of a return to escalating premiums. Providers and consumers have reacted negatively to perceptions of health plan micro-management and restriction of choice.

Providers Choices In Web-Medical Records: An Analysis Of Trade-Offs Made By Physicians In San Bernardino County, Jay Eriah Shankar

Theses Digitization Project

This thesis concluded that offering physicians an appropriate Web-based transcription service should be well received and improve their medical record management and patient care.

Characteristic Differences Between Parents/Guardians Who Keep Immunization Records And Those Who Do Not, Rebecca Bonilla Mangual

Theses Digitization Project

No abstract provided.

Barriers To Initiation And Continuation Of Vision Care Among Diabetics, Jennifer Eilleen Werner

Theses Digitization Project

No abstract provided.

Delays In The Emergency Department And Their Effects On The Ambulance Provider, Simon Peter Moore

Theses Digitization Project

This thesis is a case analysis of the nature of delays in emergency room admissions and the effects on ambulance dispatching and availability as it occurred in Southern California.

The Hand Center: Considerations Related To The Design, Planning, Staffing, And Marketing, Marcia L. Miller

Community & Environmental Health Theses & Dissertations

A therapist intent on planning a hand therapy center has no resources that are specific to this specialty area of practice. There are contributions utilized to plan occupational and physical therapy departments that can be synthesized to a degree in the planning of a hand therapy center. The practice of hand therapy incorporates a high degree of physical interaction, with close proximity to the patient and handling by the therapist. This paper explores the unique requirements of a hand therapy department. In order to determine hand therapists' preferences for equipment and space utilization a survey was developed and distributed to …

Access To Pediatric Services Under Medicaid Managed Care In The District Of Columbia, Karen Shaw, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

No abstract provided.

Meeting Employees' Information Needs In An Evolving Health Care Marketplace, Lise Rybowski

National Health Policy Forum

This background paper explores the role of information in an evolving health care marketplace. It notes that, in a softening economy, many employers seeking relief from escalating health care expenses shift costs onto employees. Some try to make their retreat more palatable by offering employees both more options for how and where they receive health care and more control over how and where the money is spent. This paper discusses the changes that are likely to occur over the next decade in the ways that people make decisions about health plans and providers, the implications for consumers' information needs, and …

The Disappearing State Surpluses: How Come, How Long, And How Will They Affect Social Service Programs?, Randy Desonia

National Health Policy Forum

This issue brief focuses on the impact of budget shortfalls being experienced by many states after several years of strong revenue growth. It describes the structure and sources of state revenues and spending and the causes of the shortfall. It also summarizes the fiscal trends and federal policies that could result in significant budget shortfalls in the future.

Primary Care Case Management: Lessons For Medicare?, Lisa Sprague

National Health Policy Forum

This issue brief looks at primary care case management (PCCM) as a tool that states have used to manage the delivery of care to their Medicaid populations, an alternative to contracting with commercial managed care plans. (States had found PCCM a flexible means of advancing state policy goals, including quality improvement, disease management, and coverage of special-needs populations.) The issue brief considers provider and beneficiary perspectives on PCCM as well as state agency objectives and accomplishments. Finally, it raises the question of adapting the PCCM model for Medicare.

Emergency Preparedness From A Health Perspective: Preparing For Bioterrorism At The Federal, State, And Local Levels, Robin J. Strongin

National Health Policy Forum

Despite the good intentions prior to and in the aftermath of the terrorist attacks of September 11, 2001, the existence of significant gaps in the country's preparedness became increasingly clear in the weeks that followed. This background paper provides an overview of the state of bioterrorism preparedness at all levels of government, identifying both the gaps and the steps being taken to close them. A series of reference materials, including a suggested reading list and Web site addresses, are listed at the end of the paper.

Health Insurance Family Style: Public Approaches To Reaching The Uninsured, Jennifer Ryan

National Health Policy Forum

This issue brief explores existing and potential opportunities to further expand the availability of health coverage for the uninsured and the underinsured, given downturns in the economy and the resulting state budget shortfalls. It also considers the implications of the Health Insurance Flexibility and Accountability (HIFA) initiative announced in August 2001 by the Centers for Medicare and Medicaid Services. Finally, the issue brief describes legislative options for health care reform being debated in Washington, including tax credit incentives, employer-based coverage subsidies and the potential for additional federal funding for public coverage expansions through Medicaid and the State Children's Health Insurance …

Mission Possible? Maintaining The Safety Net In Urban And Rural Colorado, Karen Matherlee

National Health Policy Forum

This site visit examined urban safety-net concerns in Denver and rural safety-net issues in three communities in the eastern part of Colorado. The Denver segment featured Denver Health, an integrated health system that provides a continuum of services to diverse vulnerable populations. It explored delivery and financing issues for the system itself and in relation to payers, providers, and consumers (particularly through Community Voices) in its catchment area. The eastern Colorado segment focused on delivery and financing issues in Rocky Ford (community health center/migrant health services concerns), Limon (certified rural health center topics), and Hugo (critical-access hospital matters). The visit …

W-2 In 2001: Wisconsin Works At Welfare Reform, Jennifer Ryan, Randy Desonia

National Health Policy Forum

This site visit took federal participants to Wisconsin, widely regarded as one of the pioneers of welfare reform. This site visit focused on Wisconsin Works (W-2), a statewide effort to reduce the state's welfare caseload and send clients to work. In particular, site visitors examined welfare reform policy, service delivery, and financing issues in Milwaukee, at that time the home of 85 percent of W-2 participants. Site visit participants heard from state officials, private-sector representatives, researchers, and advocates on the structure of W-2, its operating policies, and the effects of program implementation on low-income families. They toured a variety of …

Medicare Coverage: Lessons From The Past, Questions For The Future, Robin J. Strongin

National Health Policy Forum

This paper describes the Medicare coverage process for emerging technologies and the ways it has changed over time. Issues addressed include both the national coverage process and local medical review policies, which account for 90 percent of the coverage determinations. The paper also includes a discussion of the relationship between the coverage process and technology assessment, payment systems and the ongoing debate over coverage criteria and levels of evidence.

Income Support Policy And The U.S. Child Support System, Jane Koppelman

National Health Policy Forum

This paper examines the economic profile of custodial and noncustodial parents and the status of the federal/state child support enforcement system. It discusses the reasons for the historically low rate of child support collection; the prospects for new computerized systems to improve the rates of both paternities established and payments collected; ways the system can sustain funding; and the extent to which child support payments can improve the well-being of low-income families.

Pharmacy Benefit Managers: A Model For Medicare?, Veronica V. Goff

National Health Policy Forum

This issue brief uses large-employer experiences with pharmacy benefit managers (PBMs) to shed light on their potential as Medicare outpatient drug benefit administrators. PBM management techniques are discussed, as well as employer perspectives on PBM strengths and weaknesses and lessons learned. Considerations for Medicare policy are also examined. The brief built on a previous NHPF issue brief entitled The ABCs of PBMs.

Teaching | Learning | Investigating | Discovering | Treating | Healing, Douglas J. Macmaster Jr., Paul C. Brucker

Thomas Jefferson University Administrative Documents and Reports

2001 Annual report of Thomas Jefferson University.

A Longitudinal Study Examining The Stability Of Occupational Stressors Identified By Nursing Home Administrators, Gay Lynne Andrucci-Armstrong

Health Services Research Dissertations

As a result of the ever changing and expanding role of the nursing home administrator in conjunction with the stricter legislation governing nursing facilities over the past decade and the graying of America, a study specific to this population was warranted. The purpose of this study is to determine the relative change in the self-reported occupational stressors of nursing home administrators over a five year period (December 1994 to June 1999) secondary to the increased regulatory climate of the nursing home industry.

This study was carried out in three phases and included all practicing nursing home administrators in Virginia. Phase …

Federal And State Perspectives On Gme Reform, Karen Matherlee

National Health Policy Forum

This issue brief examines financial support of graduate medical education (GME), a standard budget item in the federal Medicare program and in some state Medicaid programs. It looks at objections to the way in which GME dollars are distributed, especially in terms of variations in Medicare GME payments across states. It explores various reform proposals that are circulating to address this and other GME problems and the odds for major reform.