Health Services Administration Commons^™

The U.S. Health Workforce: Definitions, Dollars, And Dilemmas, Karen Matherlee

National Health Policy Forum

This background paper provides a comprehensive view of the structure of the health workforce. It explores public and private insurance coverage and payment policies, as well as discretionary grant programs, that govern it. The paper also looks at health workforce concerns: supplies of certain types of physicians, health workforce mix, challenges from complementary and alternative medicine, shortages of nurses and pharmacists (and some other practitioners), maldistribution issues, and lack of diversity in response to demographic changes. It presents proposals that are on the table to reform the health workforce, at a time when it is demanding greater attention from health …

Is Community Care A Civil Right? The Unfolding Saga Of The Olmstead Decision, Randy Desonia

National Health Policy Forum

This paper lays the groundwork for understanding the implications of the historic U.S. Supreme Court decision in the case of Olmstead v. L.C., which has far-reaching consequences for the long-term care of people with disabilities. The paper reviews the critical components influencing the case: the Medicaid program’s role in funding community-based long-term care; the Americans with Disabilities Act, which serves as the statutory basis for the decision; and the Court’s legal reasoning. The paper also describes the federal and state responses to the ruling and concludes with a brief discussion of some legal issues that will be debated in the …

Who Will Pay For The Adverse Events Resulting From Smallpox Vaccination? Liability And Compensation Issues, Robin J. Strongin, Eileen Salinsky

National Health Policy Forum

This paper summarizes liability and compensation concerns surrounding the smallpox vaccination program announced by President Bush on December 13, 2002. The paper examines the nature of adverse health events that are likely to occur in connection with the smallpox vaccine, assesses the liability protections that have been established for organizations and individuals participating in the vaccination program, and discusses the compensation mechanisms being considered to address the damages incurred by volunteers who may suffer from adverse vaccine reactions. Specifically, the implications of the Federal Tort Claims Act, workers’ compensation programs, and the creation of a new no-fault compensation fund are …

Reasonable Modification Or Fundamental Alteration? Recent Developments In Ada Caselaw And Implications For Behavioral Health Policy, Sara J. Rosenbaum, Joel B. Teitelbaum, D. Richard Mauery, Alexandra M. Stewart

Center for Integrated Behavioral Health Policy

No abstract provided.

Converging On Nursing Home Quality, Lisa Sprague

National Health Policy Forum

This paper looks at nursing home quality initiatives, built around public reporting of quality data, that have been inaugurated by the Centers for Medicare and Medicaid Services and the California HealthCare Foundation. How the projects were developed is explored, along with preliminary indicators of their impact on consumers and providers and likely next steps in their evolution.

Message Deleted? Resolving Physician-Patient E-Mail Through Contract Law, Michael Mccann

Law Faculty Scholarship

This article examines the impact of e-mail on the physician-patient relationship, and how contract law can resolve the uncertainties incumbent in this nascent form of communication. Significantly, courts have yet to indicate when the physician-patient relationship begins by e-mail, or to what extent e-mail affects the duties of the relationship. Instead of waiting for judicial guidance, physicians and patients can employ specialized contracts to clarify the role that e-mail plays in their relationship. As a result, more physicians and patients will regard e-mail correspondence as a valuable means of communication, and a tool for improving the quality of health care …

The Impact Of Asthma Self-Management Education Programs On The Health Outcomes: A Meta-Analysis (Systemic Review) Of Randomized Controlled Trials, Surender Gaddam

Theses Digitization Project

An attempt has been made in this study to critically appraise, systematically review and gather together the results obtained in individual trials and examine the strength of evidence supporting the component for Education for a Partnership in Asthma Care of the National Asthma Education and Prevention Program (NAEPP) to test whether health outcomes are influenced by education and self-management programs.

Physician Incentives: Managed Care And Ethics, Douglas A. Mains, Alberto Coustasse, Kristine Lykens

Management Faculty Research

The authors review the principle features of the managed care system in an effort to understand the ethical assumptions inherent in managed care. The interrelationships among physician incentives, responsibilities of patients and the physician-patient relationship are examined in light of the ethical concerns identified in the managed care system. The managed care system creates ethical tensions for those who influence the allocation of scare resources. Managed care's administrative controls have increasingly changed the doctor-patient relationship to the businessperson-consumer relationship. Managed care goals of quality and access demand that physicians be both patient advocate and organizational advocate, even though these roles …

Seniors Count Follow-Up Study, Nina M. Silverstein, Heather Connors, May Jawad

Gerontology Institute Publications

Seniors Count is an ongoing outreach initiative under the direction of Boston Mayor Thomas M. Menino with the leadership and support of Joyce Williams, Boston's Commissioner on Affairs of the Elderly. The program's purpose is to "identify and reach out to those members of the city's elderly population who live in private housing arrangements and help provide them with the information and services they [may] need" (Boston Commission on Affairs of the Elderly, 2002). Since the program's inception in 1999, it has reached over 5,500 community-dwelling elders in the City of Boston (Boston Commission on Affairs of the Elderly, 2002). …

Depression: A Decade Of Progress, More To Do, Veronica V. Goff

National Health Policy Forum

This issue brief discusses the most recent findings on depression prevalence and cost; examines trends in outpatient treatment, including the dramatic growth in antidepressant use; discusses efforts to improve treatment in primary care; and explores possible public policy avenues for improving treatment access and quality.

The Medicare And Medicaid Intersection: Caring For Arizona's Seniors, Nora Super, Lisa Sprague, Judith D. Moore

National Health Policy Forum

This site visit to Phoenix examined the interplay between Medicare and Medicaid and how payment streams and regulatory requirements affect the delivery of health and long-term care services. The visit explored trends related to Medicare+Choice plan participation, physician acceptance of Medicare patients, and care management for individuals with chronic illnesses, such as Alzheimer’s disease. It also considered Arizona’s capitated Medicaid long-term care program, which recently implemented competitive bidding among plans in Maricopa County.

Prescription Drugs In Nursing Homes: Managing Costs And Quality In A Complex Environment, Dan Mendelson, Rajeev Ramchand, Richard Abramson, Anne Tumlinson

National Health Policy Forum

This issue brief provides a description of prescription drug use in nursing homes and a summary of policy issues in this area. It first profiles the nursing home pharmaceutical market, outlining the major trends in demographics and drug utilization, the supply chain by which drugs go from manufacturers to pharmacies to nursing home residents, and the alternative arrangements by which prescription drugs in nursing homes are financed. The paper then provides a synopsis of current policy issues, focusing in turn on cost containment and quality improvement initiatives.

U.S. Childhood Vaccine Availability: Legal, Regulatory, And Economic Complexities, Robin J. Strongin

National Health Policy Forum

Despite the vital role they play in public health, childhood vaccines travel a complicated road from laboratory to provider and patient. From the fall of 2000 until well into 2002, a combination of factors, including market dynamics, legal challenges, and regulatory hurdles, led to a shortage of some childhood vaccines. This paper examines each of these factors, focusing on the important roles of both the public and the private sectors.

Running On Empty: The State Budget Crisis Worsens, Randy Desonia

National Health Policy Forum

This issue brief reviews the status of state budget shortfalls and their growing impact on the Medicaid program. It describes the magnitude of the shortfalls, the forces behind them, and how states have responded with spending cuts and tax increases. It also discusses how long the budget crisis is expected to continue and what budget balancing options remain for fiscal year 2003.

Relationship Between Low Quality-Of-Care Scores And Hmos' Subsequent Public Disclosure Of Quality-Of-Care Scores, Danny Mccormick, David U. Himmelstein, Steffie Woolhandler, Sidney M. Wolfe, David H. Bor

Publications and Research

Context Public disclosure of quality data on health maintenance organizations (HMOs) might improve public accountability, inform consumer decision making, and promote quality improvement. But, because disclosure is voluntary, some HMOs could subvert these objectives by refusing to release unfavorable data.

Objective To determine the association between HMO quality of care and withdrawal from public disclosure of quality-of-care data the subsequent year.

Design and Setting Retrospective cohort study of administrative and quality-of-care data on HMOs from the National Committee for Quality Assurance (NCQA) annual Quality Compass databases for 1997, 1998, and 1999, including Health Plan Employer Data and Information Set (HEDIS) …

Medigap: Prevalence, Premiums, And Opportunities For Reform, Nora Super

National Health Policy Forum

This issue brief provides an overview of Medicare's coverage gaps and the primary sources of supplemental coverage for Medicare beneficiaries. It focuses particularly on the Medigap market: the effects of standardization, recent premium trends and rating practices, and options for reform. It considers Medigap within the context of Medicare prescription drug proposals and efforts to reform the entire Medicare program.

Erisa Health Plans: Key Structural Variations And Their Effect On Liability, Phyllis Borzi

Health Policy and Management Faculty Publications

No abstract provided.

State Eligibility Rules Under Separate State Schip Programs--Implications For Children's Access To Health Care, Sara Rosenbaum, Anne Rossier Markus

Health Policy and Management Issue Briefs

This Policy Brief is the fourth in a series of reports1 issued by the George Washington University Center for Health Services Research and Policy that examine the design of separately-administered State Children’s Health Insurance Programs (SCHIP) that is, programs that operate directly under the authority of the federal SCHIP statute rather than expansions of state Medicaid programs.2 These Policy Briefs also consider the implications of states’ design choices for children’s access to health care.

Expanding Health Coverage For The Uninsured: Fundamentals Of The Tax Credit Option, Beth Fuchs, Julie James

National Health Policy Forum

This paper seeks to provide the basics for understanding the current debate over tax credits as a vehicle for reducing the number of uninsured Americans and focuses attention on some of the associated issues: How is health insurance treated under current tax law? Why tax credits and not deductions? What are the major issues in designing tax credits? Who should be eligible and for what size credit? What changes, if any, would be needed to the insurance market to ensure that policies are available and affordable for people eligible for tax credits? What are the major issues related to administering …

Schip Turns Five: Taking Stock, Moving Ahead, Jennifer Ryan

National Health Policy Forum

This issue brief notes the five-year anniversary of the effective date of Title XXI of the Social Security Act, the State Children's Health Insurance Program (SCHIP). It looks at the successes of the program, as well as some of the obstacles SCHIP will face as it moves from childhood into adolescence and attempts to maintain its effectiveness in providing health coverage to uninsured children and families. The paper explores the critical funding impasse created by the downturns in the economy and the financing structure of the SCHIP statute. It also highlights the emerging issue of program retention and the need …

Journey To Destination 2005, Andra Gumbus, Bridget M. Lyons, Dorothy E. Bellhouse

WCBT Faculty Publications

Bridgeport Hospital and Healthcare Services (BHHS) in Bridgeport, Conn., a part of the Yale New Haven Health System (YNHHS), embraced the balanced scorecard because it had been experiencing a loss in revenue and income due to managed care penetration in the local marketplace. This hospital is not alone in facing financial pressures. The balanced scorecard provides the framework for measuring performance in a complex and changing medical environment. Still retaining financial measures, the following drivers of financial success are incorporated into Bridgeport's scorecard: quality clinical outcomes; expert clinical care providers; satisfied patients, doctors, and staff; and volume and market-share growth. …

Federal Child Care Funding For Low-Income Families: How Much Is Needed?, Jane Koppelman

National Health Policy Forum

With reauthorization of the 1996 welfare reform law being debated, this paper looks at the Temporary Assistance for Needy Families block grant and the Child Care and Development Fund — key components of congressional proposals to set a dollar amount for government spending on child care. This issue brief provides background on current child care use, arrangements, and cost, as well as research findings on the measurement of quality in child care programs.

Justification For The Continuance Of A Pediatric Physician's Office Laboratory, Veronica C. Santilli

Seton Hall University Dissertations and Theses (ETDs)

The continued viability of the Physician's Office Laboratory (POL) has been questioned because of barriers imposed by managed care organizations, oversight by regulatory agencies and competition for professionally trained laboratory staff. Pediatricians view the POL as an important adjunct to quality healthcare services for children and do not consider the POL as a "profit center", whose priority is generation of revenues for the The practice. parents of pediatric patients consider an on-site laboratory a convenience and valuable service. Through an analysis of patients' satisfaction, physicians' perceptions of enhancement to quality care, managed care reimbursement data and costs associated with maintenance …

Retirees And Pharmaceutical Costs: Is There Really A Crisis?, Justine Maiello

Seton Hall University Dissertations and Theses (ETDs)

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School-Based Health Centers And Managed Care Arrangements: A Review Of State Models And Implementation Issues, Jennel Harvey, Lissette Vaquerano, Lea Nolan, Colleen Sonosky

Health Policy and Management Faculty Publications

No abstract provided.

Building Jefferson's Future, Douglas J. Macmaster Jr., Paul C. Brucker

Thomas Jefferson University Administrative Documents and Reports

2002 Annual report of Thomas Jefferson University.

Jefferson Medical College Annual Report, 2002, Thomas J. Nasca

Jefferson Medical College Administrative Documents and Reports

No abstract provided.

Hatch-Waxman, Generics, And Patents: Balancing Prescription Drug Innovation, Competition, And Affordability, Robin J. Strongin

National Health Policy Forum

This paper explores the complex connections among intellectual property protection, competition, and access to affordable prescription drug products. It focuses on several provisions of the Drug Price Competition and Patent Term Restoration Act of 1984 (Hatch-Waxman) and discusses the debate swirling around its reform. An overview of landmark intellectual property laws and a description of the generic drug approval process are also included.

Managing Advanced Illness: A Quality And Cost Challenge To Medicare, Medicaid, And Private Insurers, Karen Matherlee

National Health Policy Forum

This issue brief examines approaches to delivering and financing health services for persons with advanced chronic illness. It focuses on the nature and structure of the Medicare hospice benefit and its use as a model for Medicaid and other federal programs. The paper also looks at palliative-care approaches along the continuum of inpatient and post-acute services and raises cost, quality, and access issues for end-of-life care. In addition, it provides an overview of coverage through private insurance, including indemnity, point-of-service, and preferred-provider-organization products.

1115 Ways To Waive Medicaid And Schip Rules, Jennifer Ryan

National Health Policy Forum

This issue brief explores the history and context of the Section 1115 Medicaid waiver authority, discusses the Health Insurance Flexibility and Accountability (HIFA) initiative under way in the Bush administration, and considers some of the potential impacts that HIFA could have on state budgets and access to health care for low-income families. Finally, it considers the future of Section 1115 waivers as a vehicle for modifying Medicaid and the State Children's Health Insurance Program.