Health Services Administration Commons^™

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.

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.

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 …

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 …

Single-Payer National Health Insurance: Physicians' Views, Danny Mccormick, David U. Himmelstein, Stephanie Woolhandler, David H. Bor

Publications and Research

Background
Forty-one million Americans have no health insurance and, despite the growth of managed care, medical costs are again increasing rapidly. One proposed solution is a single-payer health care financing system with universal coverage. Yet, physicians' views of such a system have not been well studied.

Methods
We surveyed a random sample of physicians (from the American Medical Association Masterfile) in Massachusetts, regarding their views on a single-payer health care financing system and other financing and physician work-life issues that such a system might affect.

Results
Of 1787 physicians, 904 (50.6%) responded to our survey. When asked which structure would …

Pressure Ulcer Development And Prevention In Long-Term Care Facilities In Virginia: A Descriptive Survey, Audrey D. Arthur

Community & Environmental Health Theses & Dissertations

The development of pressure ulcers is a common occurrence among older persons who may be temporarily immobilized or confined to a bed. An estimated 60,000 deaths annually can be attributed to complications from pressure ulcers. Guidelines recommended by the Agency for Health Care Policy and Research have been disseminated nationally and continue to be recommended as the standard of care for pressure ulcer prevention. In spite of the use of the recommended guidelines, pressure ulcer rates persist, suggesting there are other factors contributing to pressure ulcer development in long-term care facilities.

A survey was conducted to investigate which provider related …

Lack Of Chart Reminder Effectiveness On Family Medicine Resident Jnc-Vi And Ncep Iii Guideline Knowledge And Attitudes, Paul S. Echlin, Ross Eg Upshur, Tsveti P. Markova

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

The literature demonstrates that medical residents and practicing physicians have an attitudinal-behavioral discordance concerning their positive attitudes towards clinical practice guidelines (CPG), and the implementation of these guidelines into clinical practice patterns.

Methods

A pilot study was performed to determine if change in a previously identified CPG compliance factor (accessibility) would produce a significant increase in family medicine resident knowledge and attitude toward the guidelines. The primary study intervention involved placing a summary of the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) and the National Cholesterol …

Advancing Toward Universal Coverage: Are States Able To Take The Lead?, Lisa Dubay, Christina Moylan, Thomas R. Oliver

Journal of Health Care Law and Policy

No abstract provided.

Promise And Perils Of State-Based Road To Universal Health Insurance In The U.S., Carol S. Weissert

Journal of Health Care Law and Policy

No abstract provided.

Unequal Access: The Crisis Of Health Care Inequality For Low-Income African-American Residents Of The District Of Columbia, Robyn Whipple Diaz

Journal of Health Care Law and Policy

No abstract provided.

Medicare At 40: A Mid-Life Crisis?, Nancy-Ann Deparle

Journal of Health Care Law and Policy

No abstract provided.

Medicaid: Issues And Challenges For Health Coverage Of The Low-Income Population, Diane Rowland

Journal of Health Care Law and Policy

No abstract provided.

Bridging Silos, Part Ii: Di, Ssi, Medicare, And Medicaid Issues And Initiatives, Karen Matherlee

National Health Policy Forum

The second of two papers on the general topic of public disability and health benefits, this background paper lays out some key issues confronting the Social Security Disability Insurance, Supplemental Security Income, Medicare, and Medicaid programs. It also discusses major initiatives to address those issues, in light of growing administrative, fiscal, and other problems.

Bridging Silos, Part I: Linkages Among The Di, Ssi, Medicare, And Medicaid Programs, Karen Matherlee

National Health Policy Forum

This paper, the first of two on the general topic of public disability and health benefits, centers on the fundamentals of the Disability Insurance and Supplemental Security Income programs and their relationships with Medicare and Medicaid. In addition to looking at the programs’ definitions, distinctions, and overlaps, it reviews the effects on them of the Ticket to Work and Work Incentives Improvement Act of 1999 and, to a lesser extent, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.

Sailing Schip Through Troubled Waters, Jennifer Ryan

National Health Policy Forum

As the State Children’s Health Insurance Program (SCHIP) enters its sixth year of operation, states have continued their commitment to children’s coverage and to reaching out to the uninsured. This issue brief explores the current status of SCHIP in light of fiscal pressures that have been created by the state budget crisis. It highlights some of the key successes in the program thus far and notes several examples of state initiatives to serve particularly vulnerable populations and collect outcomes data and information about access to care.

Rural Health Care In The Electronic Age (Danville, Pa), Lisa Sprague, Nora Super

National Health Policy Forum

This site visit to the Geisinger Health System in central Pennsylvania explored the use of technology in providing health care to an aging, rural population with a high index of chronic-care needs. The agenda included an in-depth examination of Geisinger’s electronic medical record and its use in various domains of care, including outpatient clinics, disease management, and non-Geisinger medical practices and community hospitals. The program also highlighted specific care management initiatives in the areas of radiology, stroke, and obesity. Geisinger’s advantages as an integrated system dominant in its market, with the resources to invest in technology were weighed in considering …

2001 Michigan Hospital Cqi/Tqm Study, Colleen L. Croxall

Wayne State University Dissertations

In recent years, there has been significant interest in the application of total quality management/continuous quality improvement (TQM/CQI) within health care organizations. The health care industry, in its quest to improve outcomes with fewer resources, began to look at CQI/TQM as a possible solution. To date, the most comprehensive and enthusiastic response to efforts to improve quality while containing or lowering costs is reflected in hospitals' commitment to continuous quality improvement/total quality management (CQI/TQM). The health care industry, particularly hospitals, has embraced the concepts of CQI/TQM with the belief that adoption will lead to an improvement in both the quality …

Decreasing Barriers For Teens: Evaluation Of A New Teenage Pregnancy Prevention Strategy In School-Based Clinics, Abbey C. Sidebottom, Amanda Birnbaum, Sarah S. Nafstad

Department of Public Health Scholarship and Creative Works

Sidebottom et al seek to evaluate the effects of the change in distribution systems on students' receipt of requested contraceptives and demand for contraceptive school-based clinics (SBC). The result of the study reveals that the average number of requests per student was higher under the voucher system, possibly as a consequence of expires vouchers resulting in repeated requests. The findings also suggest that SBCs could go a step further in reducing adolescents' barriers to accessing contraceptives by adopting an on-site direct delivery system..

Dually Eligible For Medicare And Medicaid: Two For One Or Double Jeopardy?, Jennifer Ryan, Nora Super

National Health Policy Forum

This issue brief describes the characteristics of the population of individuals known as “dual eligibles,” who are eligible for health insurance coverage through both Medicare and Medicaid. It also looks at the differences between “full Medicaid” and “supplemental Medicaid” dual eligibles and the ongoing challenges associated with enrollment and eligibility, integration and coordination, and managed care. The paper presents several examples of integrated care programs designed to better serve the dual-eligible population, including the Program of All-Inclusive Care for the Elderly, Evercare, social health maintenance organizations, and state/federal initiatives such as the Wisconsin Partnership Program, Texas STAR+PLUS, and others. Finally, …

Medical Response For Terrorist And Public Health Threats: One Region's Experience (Pittsburgh), Eileen Salinsky, Lisa Sprague

National Health Policy Forum

This site visit, planned and convened in conjunction with the Agency for Healthcare Research and Quality’s User Liaison Program, examined the efforts underway in the greater Pittsburgh area to develop emergency medical response capabilities for mass causality events. The site visit explored efforts to improve infectious disease surveillance capabilities and looked at the Region 13 collaborative’s development of a regionalized approach to emergency management planning and response. Hospital preparedness activities were also studied, including a discussion of lessons learned from a recent drill to test response to a radiological event and an exploration of conceptual frameworks to guide hospital planning …

Shaping Public Programs Through Medicare, Medicaid, And Schip Waivers: The Fundamentals, Cynthia Shirk

National Health Policy Forum

This background paper examines the use of research, demonstration, and program waiver authorities to test new approaches to the delivery of and payment for health care services in federally financed health coverage programs such as Medicare, Medicaid, and the State Children’s Health Insurance Program. The paper also looks at the mechanics of waivers as well as their history and political context in shaping public programs. In addition, it explores the ways the changing state-federal relationship and the ever-growing demand for state flexibility have driven waiver policy.

The Medicare Prescription Drug Proposals And Health Insurance Risk, Dawn Gencarelli

National Health Policy Forum

In order to facilitate a better understanding of the complex issues raised by Senate and House proposals to establish a prescription drug benefit for Medicare beneficiaries, this paper briefly addresses some fundamentals of the health insurance market, defines key risk-sharing mechanisms, including risk corridors and reinsurance, and identifies the relevant risk provisions in the bills. Other issues related to cost management strategies and program design, which may have an impact on cost and adverse selection, are also discussed.

Wic Reauthorization: Opportunities For Improving The Nutritional Status Of Women, Infants, And Children, Harriette Fox, Margaret Mcmanus, Harry Schmidt

National Health Policy Forum

This paper examines the main reform issues affecting the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which is coming up for reauthorization this year. The paper provides background information on the WIC program, including its dramatic growth in participation and funding. It also reviews WIC’s link to health care and its impact on health outcomes. A series of considerations for WIC’s future are raised, including food package and program eligibility changes, nutrition education strategies to reduce obesity, financial risks and health consequences of relying on infant formula rebates, and new opportunities for research and demonstration.

Obesity In America: A Growing Threat, Eileen Salinsky, Wakina Scott

National Health Policy Forum

This background paper seeks to clarify the nature and causes of the obesity epidemic in the United States and provides an overview of the associated economic and health costs. The paper summarizes existing federal programs and policies that address obesity and examines new and emerging policy strategies to battle the bulging American silhouette. Topics explored include population-based prevention, federal food- and nutrition-assistance programs, Medicare and Medicaid payment policies, school health initiatives, and publicly funded biomedical research.

The Geography Of Medicare: Explaining Differences In Payment And Costs, Nora Super

National Health Policy Forum

This issue brief examines the sources of variation in Medicare payment and costs across different geographic areas and different sites of care. It discusses the payment policies that address variation in the cost of providing care, such as input price adjustments and special payments to hospitals. It also considers differences due to beneficiaries’ health status and in physician practice patterns. Finally, it explores policy options to address Medicare geographic variation.

Doing It Rite: Exploring A Decade Of Health Coverage Innovation (Rhode Island), Jennifer Ryan, Ginger P. Parra

National Health Policy Forum

This site visit to the state of Rhode Island provided an opportunity to experience and understand the decade of health coverage innovation that has resulted in near universal coverage for children. Site visitors had the opportunity to interact with health care providers, state officials, and consumer advocates, as well as other leaders in health care community. The group also visited the Thundermist Health Center in Woonsocket; a school based health clinic at Woonsocket High School; the HELP Lead Safe Center in South Providence; and a local provider, St. Joseph’s Hospital for Specialty Care, that houses several preventive care clinics and …

Disease Management To Population-Based Health: Steps In The Right Direction?, Lisa Sprague

National Health Policy Forum

This issue brief reviews the evolution of the disease management model and the ways it relates to care coordination and case management approaches. It also looks at examples of population-based disease management programs operating in both the private and public sectors and reviews the evidence of their success. Finally, the paper considers the policy implications of adapting this model to a Medicare fee-for-service population.

Medicaid Prescription Drug Coverage: State Efforts To Control Costs, Dawn Gencarelli

National Health Policy Forum

This paper provides a brief summary of the Medicaid prescription drug benefit. It explains the mechanisms being used by states to control their prescription drug spending within the Medicaid program. The paper also highlights some of the concerns that have been expressed with these mechanisms and the litigation that has been initiated in several states as a result of these efforts. It takes a closer look at three states with cost containment strategies that have been the focus of increased scrutiny.

Reauthorizing Head Start: The Future Federal Role In Preschool Programs For The Poor, Jane Koppelman

National Health Policy Forum

This paper describes the implications of President Bush’s proposal to devolve authority for running the Head Start program to the states and to alter the organization and funding of all government early childhood programs—with the goal of improving the school readiness skills of low-income children. The administration plan to allow states to mix Head Start funds with state-funded preschool money and, if desired, child care monies to create a more uniform early childhood care system with an educational focus raises numerous questions. This paper addresses questions raised by this plan, including the potential quality of these new systems, the extent …