Health Policy Commons^™

Affirmative Action, Cuban Style, Fitzhugh Mullan

Health Policy and Management Faculty Publications

Twenty-five percent of the U.S. population is black, Hispanic, or Native American, whereas only 6.1 percent of the nation’s physicians come from these backgrounds. Students from these minority groups simply don’t get into medical school as often as their majority peers, which results in a scarcity of minority physicians. This inequity translates into suffering and death, as documented by the Institute of Medicine. Poorer health outcomes in minority populations have been linked to lack of access to care, lower rates of therapeutic procedures, and language barriers. Since physicians from minority groups practice disproportionately in minority communities, they are an important …

Integrating Hiv Prevention Services Into The Clinical Care Setting In Medicaid And Ryan White Care Act Programs: Legal, Financial, And Organizational Issues, John Palen, Jeffrey Levi, Sara E. Wilensky, Jennifer Kates

Health Policy and Management Faculty Publications

This policy brief examines the structural-level opportunities and challenges associated with the delivery of HIV prevention services in or closely linked to the clinical care setting. It focuses on two of the major public programs for HIV care in the U.S: Medicaid, the nation's major public health program for low-income Americans, and the largest source of public financing for HIV/AIDS care in the U.S.; and the Ryan White CARE Act, the nation's only HIV-specific care and support services grant program which operates as the payer of last resort at the state and local level. Together, these programs provide care and …

The Effects Of Copayments On The Use Of Medical Services And Prescription Drugs In Utah's Medicaid Program, Leighton Ku, Elaine Deschamps, Judi Hilman

Health Policy and Management Faculty Publications

In recent years, a number of states have increased cost-sharing for low-income Medicaid beneficiaries as one approach to Medicaid cost-containment. While copayments have been most commonly applied to prescription drugs, they also have been assessed for other services, such as physician visits, hospital admission, or outpatient clinic use.

Prior research has found that when low-income patients are required to pay more for health care services or for prescription drugs, they use fewer services or medications.[2] In some cases, their health could deteriorate, with the result that they may subsequently require more expensive emergency room or inpatient hospital care. While …

Hearing Their Voices: Lessons From The Breast And Cervical Cancer Prevention And Treatment Act (Bccpta), Kyle Kenney, Sarah C. Blake, Kathleen A. Maloy, Usha Ranji, Alina Salganicoff

Health Policy and Management Faculty Publications

This brief provides: 1) an overview of California breast and cervical cancer screening programs for low-income women, 2) description of California's implementation of the BCCPTA and state-funded treatment coverage, and 3) findings from a series of 15 focus groups with low-income women in San Diego and San Francisco discussions conducted to learn more about BCCPTA coverage and its implementation in California. The purpose of the study was to hear directly from women in California about their experiences, knowledge, and opinions of breast and cervical cancer screening and treatment services after the implementation of the BCCPTA.

Bursting At The Seams: Improving Patient Flow To Help America's Emergency Departments, Marcia J. Wilson, Khoa Nguyen

Health Policy and Management Faculty Publications

From 1992 to 2002, the number of annual ED visits increased 23 percent in the U.S., while the number of EDs decreased by 15 percent. Many EDs are overwhelmed by the number of patients needing their services, with 62 percent of the nation's EDs reporting being "at" or "over" operating capacity. Almost daily, newspaper headlines across the country relay stories about patients waiting for hours in the ED before being seen and tales of ambulances being diverted from one hospital to the next due to overcrowding. But while much of the blame for this situation has been placed on broader …

Medicare Advantage: Déjà Vu All Over Again?, Brian Biles, Geraldine Dallek, Lauren Hersch Nicholas

Health Policy and Management Faculty Publications

The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 expands the role of private health plans in Medicare through prescription drug plans and a revised Medicare+Choice (M+C), renamed Medicare Advantage, program. This paper discusses the factors responsible for the failure of M+C to develop as intended in 1997 and analyzes the challenges for MMA implementation in light of these factors. They include making a complex program understandable to beneficiaries; addressing plans? efforts to avoid enrolling high-cost beneficiaries; ensuring stability of benefits, providers, and plans; dealing with beneficiaries enrolled in unsuitable plans; providing equity of health benefits throughout the …

Teaching Medicaid: A Tool For Health Law Teachers (2004 Update), Sara J. Rosenbaum, David Rousseau

Health Policy and Management Faculty Posters and Presentations

A teaching guide examining: (1) Medicaid's role as a health insurer: major themes; (2) Eligibility and services; (3) Where do Medicaid expenditures go and how; (4) Important are they to the health care system?; (5) Medicaid as health care payer and its role in supporting the health care safety net; (6) Medicaid's role in state financing; (7) Medicaid's role as a legal entitlement; (8) Does Medicaid need reform and if so, what should reform accomplish?

Medicaid Prescription Drug Spending And Use, Brian Bruen, Arunabh Ghosh

Health Policy and Management Issue Briefs

No abstract provided.

Economic Stress And The Safety Net: A Health Center Update, Sara J. Rosenbaum, Peter Shin, Julie S. Darnell

Health Policy and Management Faculty Publications

Federally funded health centers provided care to 11.3 million patients in 2002, the vast majority of whom were either uninsured (39%) or covered by Medicaid (34%). This paper provides new information on the demographic profile of health center patients and the revenue sources available for financing their care, including recent increases in federal discretionary funding. It examines the impact of the recent economic downturn on health centers in selected communities, exploring the effect of elevated unemployment levels among lower wage workers, declining private health insurance coverage, and widespread state cutbacks in Medicaid – the single most important source of health …

Walking A Tightrope: The State Of The Safety Net In Ten U.S. Communities, Marsha Regenstein, Lea Nolan, Marcia J. Wilson, Holly Mead, Bruce Siegel

Health Policy and Management Faculty Publications

This report presents the findings from the Urgent Matters safety net assessments and identifies common characteristics, opportunities and challenges for communities that wish to better serve the health care needs of uninsured and underserved individuals. It also illustrates differences across many of the communities, especially in terms of the structure and financing of their safety nets. It is a companion report to the individual safety net assessments and provides an overarching perspective of problems that affect safety nets across the country.

Olmstead V. L.C. And The Americans With Disabilities Act: Implications For Public Health Policy And Practice, Joel B. Teitelbaum, Taylor Burke, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

This installment of Law and the Public’s Health examines the meaning of Olmstead v. L.C. for public health agencies administering personal health care programs. Handed down by the U.S. Supreme Court in 1999, Olmstead was a landmark decision that interpreted the Americans with Disabilities Act (ADA or the Act) as it applies to public programs and thus is of great relevance to many public health agencies. Following an overview of the decision and its interpretation by lower federal courts, this column concludes with a discussion of the implications of Olmstead and its progeny for public health policy and practice.

Monitoring The Health Care Safety Net: Developing Data-Driven Capabilities To Support Policymaking, Robin M. Weinick, Peter Shin

Health Policy and Management Faculty Publications

Health care organizations are now emphasizing evidence-based medicine, which involves using research findings on the effectiveness of various practices to help make treatment decisions for patients. A parallel practice that is receiving increased attention is using data and the findings from data analysis to inform the policymaking process. The data-driven policy framework presented here involves an explicit statement of priorities and policy questions to be answered by new and existing data and provides general guidance for using data to support the process of developing policy options for the health care safety net.

An Assessment Of The Safety Net In San Diego, California, Khoa Nguyen, Peter Shin, Marsha Regenstein, Marcia J. Wilson, Kyle Kenney, Karen C. Jones

Health Policy and Management Faculty Publications

This report examines key issues that shape the health care network available to uninsured and underserved residents in San Diego. It provides background on the San Diego health care safety net and describes key characteristics of the populations served by the safety net. It then outlines the structure of the safety net and funding mechanisms that support health care safety net services. The report also includes an analysis of key challenges facing providers of primary and specialty care services and specific barriers that some populations face in trying to access them.

An Assessment Of The Safety Net In Atlanta, Georgia, Jennel Harvey, Marsha Regenstein, Karen C. Jones

Health Policy and Management Faculty Publications

This report examines issues that shape the health care network available to uninsured and underserved residents in Atlanta. It provides background on the Atlanta health care safety net and describes key characteristics of the populations served by the safety net. It then outlines the structure of the safety net and funding mechanisms that support health care safety net services. The report also includes an analysis of challenges facing providers of primary and specialty care services and specific barriers that some populations face in trying to access them.

An Assessment Of The Safety Net In Fairfax County, Virginia, Lea Nolan, Lissette Vaquerano, Karen C. Jones, Marsha Regenstein

Health Policy and Management Faculty Publications

This report examines key issues that shape the health care network available to uninsured and underserved residents in Fairfax County. It provides background on the health care safety net and describes key characteristics of the populations served by the safety net. It then outlines the structure of the safety net and funding mechanisms that support health care safety net services. The report also includes an analysis of key challenges facing providers of primary and specialty care services and specific barriers that some populations face in trying to access them.

An Assessment Of The Safety Net In Boston, Massachusetts, Holly Mead, Peter Shin, Marsha Regenstein, Kyle Kenney, Karen C. Jones

Health Policy and Management Faculty Publications

This report examines key issues that shape the health care network available to uninsured and underserved residents in Boston. It provides background on the Boston health care safety net and describes key characteristics of the populations served by the safety net. It then outlines the structure of the safety net and funding mechanisms that support health care safety net services. The report also includes an analysis of key challenges facing providers of primary and specialty care services and specific barriers that some populations face in trying to access them.

An Assessment Of The Safety Net In Phoenix, Arizona, Lea Nolan, Lissette Vaquerano, Marsha Regenstein, Karen C. Jones

Health Policy and Management Faculty Publications

This report examines key issues that shape the health care network available to uninsured and underserved residents in Phoenix. It provides background on the Phoenix health care safety net and describes key characteristics of the populations served by the safety net. It then outlines the structure of the safety net and funding mechanisms that support health care safety net services. The report also includes an analysis of key challenges facing providers of primary and specialty care services and specific barriers that some populations face in trying to access them.

An Assessment Of The Safety Net In San Antonio, Texas, Marcia Wilson, Peter Shin, Marsha Regenstein, Karen C. Jones

Health Policy and Management Faculty Publications

This report examines key issues that shape the health care network available to uninsured and underserved residents in San Antonio. It provides background on the San Antonio health care safety net and describes key characteristics of the populations served by the safety net. It then outlines the structure of the safety net and funding mechanisms that support health care safety net services. The report also includes an analysis of key challenges facing providers of primary and specialty care services and specific barriers that some populations face in trying to access them.

An Assessment Of The Safety Net In Memphis, Tennessee, Lea Nolan, Jennel Harvey, Karen C. Jones, Marsha Regenstein

Health Policy and Management Faculty Publications

This report examines key issues that shape the health care network available to uninsured and underserved residents in Memphis. It provides background on the Memphis health care safety net and describes key characteristics of the population served by the safety net. It then outlines the structure of the safety net and funding mechanisms that support safety net services. The report also includes an analysis of key challenges facing providers of primary and specialty care services and specific barriers that some populations face in trying to access them.

An Assessment Of The Safety Net In Detroit, Michigan, Marsha Regenstein, Khoa Nguyen, Karen C. Jones, Kyle Kenney

Health Policy and Management Faculty Publications

This report examines key issues that shape the health care network available to uninsured and underserved residents in Detroit. It provides background on the Detroit health care safety net and describes key characteristics of the populations served by the safety net. It then outlines the structure of the safety net and funding mechanisms that support health care safety net services. The report also includes an analysis of key challenges facing providers of primary and specialty care services and specific barriers that some populations face in trying to access them.

An Assessment Of The Safety Net In Lincoln, Nebraska, Lea Nolan, Lissette Vaquerano, Karen C. Jones, Marsha Regenstein

Health Policy and Management Faculty Publications

This report examines key issues that shape the health care network available to uninsured and under-served residents in Lincoln. It provides background on the Lincoln health care safety net and describes key characteristics of the populations served by the safety net. It then outlines the structure of the safety net and funding mechanisms that support health care safety net services. The report also includes an analysis of key challenges facing providers of primary and specialty care services and specific barriers that some populations face in trying to access them.

The safety net assessment team's analysis of the Lincoln safety net …

An Assessment Of The Safety Net In Queens, New York, Holly Mead, Marsha Regenstein, Karen C. Jones

Health Policy and Management Faculty Publications

This report examines key issues that shape the healthcare network available to uninsured and underserved residents in Queens. It provides background on the Queens health care safety net and describes key characteristics of the populations served by the safety net. It then outlines the structure of the safety net and funding mechanisms that support health care safety net services. The report also includes an analysis of key challenges facing providers of primary and specialty care services and specific barriers that some populations face in trying to access them.

Analysis Of State Laws Permitting Intoxication Exclusions In Insurance Contracts And Their Judicial Enforcement, Sara J. Rosenbaum, Henry Van Dyck, Mandy Bartoshesky, Joel B. Teitelbaum

Health Policy and Management Issue Briefs

This Policy Brief reviews judicial decisions construing state laws that permit insurers to include intoxication exclusionary clauses in their insurance policies. The cases and state laws examined in this analysis span health, life, disability, accidental death and dismemberment (AD&D), workers compensation, and unemployment insurance. Some variant of the intoxication exclusionary clause appears across all of these products, depending on the state. The widespread nature of such laws has its roots in the 1947 Uniform Accident and Sickness Policy Provision Law (UPPL), a model statute whose broader public policy purpose was to avoid the use of insurance to protect against the …

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

Health Policy and Management Congressional Testimonies

No abstract provided.

Emtala: Dedicating An Emergency Department Near You, Brian Kamoie

Health Policy and Management Faculty Publications

This article offers a brief history of healthcare civil rights, describes a range of healthcare issues that have a civil rights component, and discusses the need for an expanded civil rights framework to guide the provision of health care. Unequal health care based on race and ethnicity has received renewed attention over the past several years, but healthcare discrimination based on socioeconomic status, disability, age, and gender also deserve careful attention.

Covering The Uninsured: What Is It Worth?, Wilhelmine Miller, Elizabeth Richardson Vigdor, Willard G. Manning

Health Policy and Management Faculty Publications

One out of six Americans under age sixty-five lacks health insurance, a situation that imposes sizable hidden costs upon society. The poorer health and shorter lives of those without coverage account for most of these costs. Other impacts are manifested by Medicare and disability support payments, demands on the public health infrastructure, and losses of local health service capacity. We conclude that the estimated value of health forgone each year because of uninsurance ($65?$130 billion) constitutes a lower-bound estimate of economic losses resulting from the present level of uninsurance nationally.

Public Health Insurance Design For Children: The Evolution From Medicaid To Schip, Sara J. Rosenbaum, Anne R. Markus, Colleen Sonosky

Health Policy and Management Faculty Publications

In 2005 Medicaid will turn 40, a momentous event in the life of the largest and most complex of all means-tested public entitlement programs. Since 1997, Medicaid has co-existed with the State Children’s Health Insurance Program (SCHIP), a small program which covers a fraction of the number of Medicaid enrolled children but whose legislative structure looms large against its much beleaguered companion. To the unpracticed eye, SCHIP and Medicaid appear to be quite similar in design; in reality however, their differences could not be more profound, and it is in these differences that clear directions for Medicaid’s possible future become …

Schip-Enrolled Children With Special Health Care Needs: An Assessment Of Coordination Efforts Between State Schip And Title V Programs, Anne R. Markus, Sara J. Rosenbaum, Soeurette Cyprien

Health Policy and Management Faculty Publications

This study explores how the State Children's Health Insurance Program serves children with special needs and assesses the role of the Title V Maternal and Child Health Services Block Grant program in filling in gaps in coverage. It also discusses the implications of state choices on publicly-funded health coverage for pediatric health care.