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Articles 211 - 240 of 348

Full-Text Articles in Health Services Research

The Economics Of Quality: Changing Incentives In Cincinnati, Lisa Sprague, Nora Super May 2004

The Economics Of Quality: Changing Incentives In Cincinnati, Lisa Sprague, Nora Super

National Health Policy Forum

This site visit focused on private market dynamics and quality improvement initiatives. Cincinnati is characterized by strong players in all sectors of the market: employers such as Procter and Gamble and General Electric, hospital systems, health plans, and physician groups with the power to “push back” in contract negotiations. The city is a pilot site for Bridges to Excellence, a pay-for-performance initiative spearheaded by GE. Cincinnati Children’s Hospital Medical Center is a grantee under the Robert Wood Johnson Foundation’s Pursuing Perfection program. Among the issues explored were physician supply, incentive structures, specialty hospitals, and information technology.

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Consumer Cost Sharing In Private Health Insurance: On The Threshold Of Change, Veronica V. Goff May 2004

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.

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Medicare's Chronic Care Improvement Pilot Program: What Is Its Potential?, Nora Super May 2004

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.

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Veterans' Health Care: Balancing Resources And Responsibilities, Lisa Sprague Apr 2004

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.

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Necessary But Not Sufficient? Physician Volunteerism And The Health Care Safety Net, Eileen Salinsky Mar 2004

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 …

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The Health Care Safety Net In South Carolina: A Test Of Tenacity, Jennifer Ryan, Randy Desonia Feb 2004

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 …

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Democratic Ideas To Address The Problem Of Americans Without Health Insurance, Jeanne Lambrew Jan 2004

Democratic Ideas To Address The Problem Of Americans Without Health Insurance, Jeanne Lambrew

Health Policy and Management Congressional Testimonies

No abstract provided.

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Mental Health Of Incarcerated Juveniles In Nevada: Final Report, Nevada Institute For Children's Rerearch And Policy, University Of Nevada, Las Vegas, Jennifer Petsonius, Denise Tanata, Michelle Chino Dr Dec 2003

Mental Health Of Incarcerated Juveniles In Nevada: Final Report, Nevada Institute For Children's Rerearch And Policy, University Of Nevada, Las Vegas, Jennifer Petsonius, Denise Tanata, Michelle Chino Dr

Nevada Institute for Children's Research and Policy Reports

The prevalence of mental health problems in the juvenile offender population is substantially higher than that of the general population (Cocozza & Skowyra, 2000). Studies estimate that one in five juvenile offenders has serious mental health problems, which is nearly twice the rate of occurrence of mental illness in children and adults in the general population (NMHA Fact Sheet #l). However, there have been several methodological problems encountered in previous research. These include the use of inconsistent definitions and measurements of mental illness; the use of biased, nonrandom samples, a reliance on retrospective case report data, and the use of …

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Bridging Silos, Part Ii: Di, Ssi, Medicare, And Medicaid Issues And Initiatives, Karen Matherlee Nov 2003

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.

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Bridging Silos, Part I: Linkages Among The Di, Ssi, Medicare, And Medicaid Programs, Karen Matherlee Nov 2003

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.

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Sailing Schip Through Troubled Waters, Jennifer Ryan Nov 2003

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.

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Rural Health Care In The Electronic Age (Danville, Pa), Lisa Sprague, Nora Super Nov 2003

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 …

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Dually Eligible For Medicare And Medicaid: Two For One Or Double Jeopardy?, Jennifer Ryan, Nora Super Sep 2003

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, …

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Medical Response For Terrorist And Public Health Threats: One Region's Experience (Pittsburgh), Eileen Salinsky, Lisa Sprague Sep 2003

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 …

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Shaping Public Programs Through Medicare, Medicaid, And Schip Waivers: The Fundamentals, Cynthia Shirk Sep 2003

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.

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The Medicare Prescription Drug Proposals And Health Insurance Risk, Dawn Gencarelli Sep 2003

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.

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Wic Reauthorization: Opportunities For Improving The Nutritional Status Of Women, Infants, And Children, Harriette Fox, Margaret Mcmanus, Harry Schmidt Aug 2003

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.

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Obesity In America: A Growing Threat, Eileen Salinsky, Wakina Scott Jul 2003

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.

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The Geography Of Medicare: Explaining Differences In Payment And Costs, Nora Super Jul 2003

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.

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Doing It Rite: Exploring A Decade Of Health Coverage Innovation (Rhode Island), Jennifer Ryan, Ginger P. Parra May 2003

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 …

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Disease Management To Population-Based Health: Steps In The Right Direction?, Lisa Sprague May 2003

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.

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Medicaid Prescription Drug Coverage: State Efforts To Control Costs, Dawn Gencarelli May 2003

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.

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Reauthorizing Head Start: The Future Federal Role In Preschool Programs For The Poor, Jane Koppelman Apr 2003

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 …

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The U.S. Health Workforce: Definitions, Dollars, And Dilemmas, Karen Matherlee Apr 2003

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 …

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Is Community Care A Civil Right? The Unfolding Saga Of The Olmstead Decision, Randy Desonia Mar 2003

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 …

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Who Will Pay For The Adverse Events Resulting From Smallpox Vaccination? Liability And Compensation Issues, Robin J. Strongin, Eileen Salinsky Mar 2003

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 …

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Converging On Nursing Home Quality, Lisa Sprague Jan 2003

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.

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

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The Medicare And Medicaid Intersection: Caring For Arizona's Seniors, Nora Super, Lisa Sprague, Judith D. Moore Nov 2002

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.

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Prescription Drugs In Nursing Homes: Managing Costs And Quality In A Complex Environment, Dan Mendelson, Rajeev Ramchand, Richard Abramson, Anne Tumlinson Nov 2002

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.

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