Public Health Commons^™

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.

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.

Nurse Workforce: Condition Critical, Wakina Scott

National Health Policy Forum

This issue brief provides an overview of the current nursing shortage. It discusses the multiple factors that make this shortage in the nurse workforce different from earlier ones. It also examines steps taken by nursing schools, the health care industry, the federal government, and states to address this issue.

Youth Violence Prevention: How Does The Health Care Sector Respond?, Anthony S. Raden

National Health Policy Forum

This background paper examines the health care sector's response to the complex problems associated with youth violence, identifies the unique challenges health professionals face in dealing with young victims and perpetrators of violence, and raises questions about the ability of health professionals in various types of practice settings to assume a more proactive role in preventing youth violence.

Quality Improvement Tools In Disease Management, Lisa E. Paddock, Amy L. Phillips, Peter Chodoff

College of Population Health Faculty Papers

Disease management programs require constant monitoring to assure quality and address problems efficiently. To initiate continuous quality improvement in a disease management program, there are several methods available to identify potential problems within the program that may be affecting quality. Some common quality improvement instruments include the Plan-Do-Check-Act model, check sheets, and so forth. Whatever model is used, Statistical Process Control using flow charts, histograms, Pareto diagrams, scatter diagrams, control charts, and cause-and-effect diagrams provides a better understanding about how the organization's processes are functioning. These tools facilitate problem recognition and allow an organization to meet established standards of quality …

The Field Of Disease Management At The Crossroads: An Interview With David B. Nash, Md, Mba, T. J. Basting

College of Population Health Faculty Papers

As David B. Nash, MD, MBA, takes the helm of Disease Management as Editor-in-Chief, the practice of disease management—now a decade old—depends on its practitioners to continue to provide "economic proof of concept." This effort to accrue the credibility needed to design and fund programs will provide further evidence that new technologies can be integrated into care programs across large populations to reduce costs while improving healthcare and access to it.

State-Based Pharmaceutical Assistance Programs: Temporary Fix Or Lessons For Medicare?, Robin J. Strongin

National Health Policy Forum

By early 2001, more than one-half of the states had established some type of pharmaceutical assistance programs for the elderly. This issue brief considers specific program parameters, such as eligibility criteria, cost-sharing arrangements, program administration, and marketing and outreach. It also considers programs in the broader context of a future Medicare outpatient prescription drug benefit.

Tanf And Work Support Services: On The Job In Greater Philadelphia, Lisa Sprague

National Health Policy Forum

This site visit looked at programs in the greater Philadelphia area to move welfare recipients into employment and support services aimed at keeping them employed. Four years after implementation of the Personal Responsibility and Work Opportunity Reconciliation Act, welfare caseloads were much reduced, but challenges remained. Pennsylvania officials described their plans to assist beneficiaries who would reach their five-year lifetime cash assistance limit beginning in 2002. Site visitors met with state and county assistance office staff, employers, consumer advocates, and employment and training contractors. They participated in discussions of how work support services, such as medical assistance, child care, and …

Quality In The Making: Perspectives On Programs And Progress, Lisa Sprague

National Health Policy Forum

This background paper considered the evolution of quality evaluation efforts, tracing their development from early initiatives to keep track of patients after surgery through the various guidelines, surveys, and measurement tools currently in use. It looked at both quality assurance and quality improvement strategies, highlighting the different philosophies that guide them. The paper examined the roles of purchasers, providers, consumers, and governments in furthering a quality agenda. Both regulatory and voluntary approaches were assessed.

The Health Care Safety Net In A Time Of Fiscal Pressures, Richard Hegner

National Health Policy Forum

This background paper reviewed the role played by the health care safety net in serving the nation's uninsured, underinsured, and indigent populations as well as those Americans who experience problems in obtaining access to health care. Against the backdrop of the March 2000 Institute of Medicine report, America's Health Care Safety Net: Intact But Endangered, the paper examined the recurrent choice in U.S. health policy between underwriting public insurance and subsidizing direct provision of health care. It recounted a number of reasons for direct federal interest in the safety net — including the important role played by Medicaid, the major …

A Health System Analysis Approach To Health Outcomes In Medicare Clients With Chronic Illnesses, Christine A. Elnitsky

Health Services Research Dissertations

Since 1863, outcomes measurement efforts have provided information to health care consumers, administrators, and policymakers in assessing concerns about access, quality and costs. With a growing population of older adults with chronic illnesses, cost-cutting strategies in health delivery systems, and federal endorsement of managed care systems, researchers have begun to evaluate the impact of different delivery system organizations on health. The current study combines two areas of health services research to provide the first published hierarchical analysis of the influence of delivery system factors, and a profile of population and community characteristics and utilization factors, on perceived health outcomes of …

Welfare Reform And The Well-Being Of Families: Successes To Date And Challenges Ahead, Jane Koppelman

National Health Policy Forum

This issue brief discusses a key issue in evaluating the 1996 Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA): the status of families after the implementation of this landmark welfare reform program. The new block grant program to states to administer the Temporary Assistance to Needy Families(TANF) program has been extremely effective when measured by lower welfare rolls and higher work rates and earnings for recipients. However, an equally important dimension described by the paper is what is known about longer-term effects and the status of people who have left welfare, with special emphasis on how children have …

Welfare Reform And Substance Abuse: Innovative State Strategies, Ginger P. Parra

National Health Policy Forum

This issue brief highlights key facts about the impact of substance abuse on welfare reform and recipients of Temporary Assistance to Needy Families, or TANF. After outlining some of the data on the incidence of substance abuse as well as its costs and treatment, it concludes by describing innovative state welfare programs attempting to lower barriers to employment and self-sufficiency.

Chief Medical Officers' Perceptions Of Disease Management Programs, Gang Xu, Lisa E. Paddock, John P. O'Connor, David B. Nash, Mark Zitter

College of Population Health Faculty Papers

The purpose of this article is to examine chief medical officers' (CMOs) perception of disease management programs. Five open-ended questions, each addressing a major issue in the development of disease management programs, were given to 31 CMOs who attended a series of invitation-only conferences on disease management in the fall of 1999. Qualitative data analysis was conducted using the transcripts on each of the issues. Overall, the CMOs viewed the emergence of capitated disease management programs positively. They considered the population of a program to be the contractual patients and/or those at risk for the target disease. On the issue …

Measurement Of The Impact Of Winona Health Online, David B. Nash, David Shulkin, Florence Comite, Ron Loeppke, Bruce Van Cleave, Robert Kane, Jon Christianson, Douglas Pousma

College of Population Health Faculty Papers

The purpose of this article is to present the methodology to study the clinical and financial outcomes associated with the use of Winona Health Online, a novel community-wide interactive healthcare Website in Winona, Minnesota. Outcome methodology was developed by the University of Minnesota School of Public Health and the Carlson School of Management in cooperation with nationally recognized outcomes and disease state management experts, healthcare practitioners in Winona, statisticians, and health economists. The main areas of measurement include health status, satisfaction, cost and utilization of services, and clinical quality.

Probabilities Of Transition Among Health States For Older Adults, Paula Diehr, Donald L. Patrick

UW Biostatistics Working Paper Series

Goal: To estimate the probabilities of transition among self-rated health states for older adults, and examine how they vary by age and sex. Methods: We used self-rated health (Excellent, Very Good, Good, Fair, Poor, Dead) collected in two longitudinal studies of older adults (Mean age 75) to estimate the probability of transition in two years. We used the estimates to project future health for selected cohorts.

Findings: These older adults were most likely to be in the same health state 2 years later, but a substantial proportion changed in both directions. Transition probabilities varied by initial health state, age and …

Making A Difference For Children Affected By Aids: Baseline Findings From Operations Research In Uganda, Laelia Gilborn, Rebecca Nyonyintono, Robert Kabumbuli, Gabriel Jagwe-Wadda

HIV and AIDS

Many organizations and programs have begun to provide services and support to AIDS-orphaned children in East and southern Africa. Typical program components include the provision of school fees and supplies, supplementary feeding, home-visiting programs in which community members visit and assist affected children, and vocational training. However, few of these programs have been formally evaluated for impact. This paper reports on baseline findings from a study of two programs for AIDS-affected children and their families implemented by PLAN International in the Luwero and Tororo districts of Uganda. One program, referred to as orphan support, provides educational, health, and nutritional assistance …

Massachusetts Adult Tobacco Survey: Tobacco Use And Attitudes After Seven Years Of The Massachusetts Tobacco Control Program, Technical Report & Tables 1993 — 2000, Lois Biener, Amy Nyman, Anthony M. Roman, Catherine A. Flynn, Alison B. Albers

Center for Survey Research Publications

The Massachusetts Tobacco Control Program was launched in October of 1993. At that time, the Center for Survey Research conducted the Massachusetts Tobacco Survey (MTS), a comprehensive survey of adults and teens living in Massachusetts. The purpose of the survey was to collect baseline data on the prevalence of tobacco use among adults and teens in the Commonwealth and on issues related to the likelihood of smoking cessation or initiation. The survey also assessed the prevalence of restrictive smoking policies, and attitudes about tobacco control measures. The baseline data serve as a standard against which the impact of various programs …

Influencing Reproductive Health Policy And Programs In The Philippines: Implementing An Advocacy Model For Utilization Of Operations Research, Saniata Masulit, Marilou P. Costello, Sahar Hegazi

Reproductive Health

This project tested a model of operations research (OR) dissemination and utilization targeting program managers in Mindanao, the second largest island of the Philippines. The model combines capacity-building with the use of innovative advocacy approaches to disseminate OR results, by creating a network of policy champions who will advocate the use of OR findings through a variety of strategies after they have been provided with information on the advocacy issue and their presentation skills enhanced. The project demonstrated that this type of network could lead to significant program changes, but also revealed that there is no single strategy or approach …

West Bank And Gaza: Stress The Importance And Cost-Effectiveness Of Postpartum Care, Frontiers In Reproductive Health

Reproductive Health

To assess maternal health care in the West Bank and Gaza, the Health, Development, Information, and Policy Institute conducted a study from May to August 2000. This study served as a baseline for the Pilot Health Project (PHP), which seeks to improve antenatal and postpartum services in three areas of the West Bank and Gaza. Seven local and international agencies are implementing PHP in collaboration with the Palestinian Ministry of Health and with funding from the U.S. Agency for International Development. Data sources for the baseline study consisted of service statistics, interviews with health-care providers, and exit interviews with antenatal, …

Cisjordania Y Gaza: Subraye La Importancia De La Atención Postparto Y Su Cost-Efectividad, Frontiers In Reproductive Health

Reproductive Health

El Instituto de Salud, Desarrollo, Información y Políticas realizó un estudio de mayo a agosto de 2000 para evaluar la atención a la salud materna en Cisjordania y Gaza. Dicho estudio sirvió de línea basal para el Proyecto Piloto de Salud (PHP, por sus siglas en inglés), cuyo objetivo es mejorar los servicios prenatales y postparto en tres áreas de esa región. Siete agencias locales e internacionales implementan el PHP con la colaboración del Ministerio de Salud palestino y el patrocinio de la Agencia de los Estados Unidos para el Desarrollo Internacional. Las fuentes de la información para el estudio …

Integrating Adolescent Livelihood Activities Within A Reproductive Health Program For Urban Slum Dwellers In India, Dale Huntington, Mary Philip Sebastian, Nirmala Sevlam, Barbara Mensch, Sahar Hegazi

Reproductive Health

The Population Council's Frontiers in Reproductive Health Program and the Policy and Research Division are collaborating with CARE India to conduct an operations research study to examine the feasibility and impact of adding livelihood counseling and training, savings activities, and follow-up support to the ongoing reproductive health program for adolescents. The short-term objective is to foster the development of alternative socialization processes for adolescent girls that encourage positive sexual and reproductive health behaviors. As noted in this project update, the study will produce a replicable model for CARE India and other agencies to use in adding livelihood activities to adolescent …

Kenya Update: Frontiers Adolescent Reproductive Health Project, Frontiers In Reproductive Health

Reproductive Health

The Kenya Adolescent Reproductive Health Project (KARHP) was launched in October 1999 in Busia and Vihiga districts as a three-year operations research study to determine the feasibility, cost, and effectiveness of implementing systematic interventions that address the reproductive health (RH) needs of adolescents aged 10–19 years. This USAID-funded project is part of the Population Council’s Frontiers in Reproductive Health Program’s global operations research. PATH (Program for Appropriate Technology in Health) is implementing the project, in collaboration with the Ministries of Health, Education, and Home Affairs, Heritage, and Sports. The objective of the study is to establish the effectiveness of interventions …

Extending Operations Research To Social Marketing Programs, Teresa De Vargas

Reproductive Health

CEMOPLAF of Quito, Ecuador sells reproductive health products to pharmacies and other outlets to contribute to its sustainability. However, the nonprofit agency lacked basic information regarding the program’s profitability, niche, and quality. Operations research was conducted to provide this information, including a financial analysis of the marketing program and two market research studies. Each study included a capacity-building component so that CEMOPLAF could conduct similar research in the future without technical assistance. A regional conference attended by nongovernmental organizations provided an opportunity to share sustainability tools and lessons learned.

Operations Research In Reproductive Health And Family Planning At The Cairo Demographic Center, Magdi A. Ibrahim, James R. Foreit, M.E. Khan

Reproductive Health

This report evaluates the effectiveness of a two-year training program at the Cairo Demographic Center to increase the number of researchers using operations research (OR), and to help institutionalize the ability of the Center to offer training in operations research in reproductive health. It also provides feedback for OR curriculum development. The project trained researchers with program and policymaking responsibilities and provided participants with the experience of designing an OR project, and built participants’ skills in communicating research results to managers. Participant evaluations showed that, overall, the course met its objectives. The training that the students received in OR has …

An Assessment Of Selected Sub-Systems Of The Egyptian Norplant® Program, Fatma El-Zanaty, Laila Nawar, Ramadan Hamed

Reproductive Health

The Egyptian Ministry of Health and Population and FRONTIERS discussed the need for investigating service delivery aspects of the Egyptian NORPLANT® program. This study emerged from those consultations. The study provides a comprehensive assessment of the program: how services are administered and used through the ongoing Introduction Program as it approaches five years of operation. The report lists major findings with program implications and offers recommendations regarding quality of care; tracking and locating NORPLANT® users; program sustainability; and information, education, and communication strategies.