Health Policy Commons^™

Ensuring The Use Of Federal Assets In Public Health Emergencies: The Role Of The Federal Tort Claims Act In Enabling The Responsiveness Of Federally Funded Community Health Centers, Rebecca L. Katz, Melissa M. Goldstein, A. Seiji Hayashi

Health Policy and Management Faculty Publications

No abstract provided.

Aging, Primary Care, And Self-Sufficiency: Health Care Workforce Challenges Ahead, Fitzhugh Mullan, Seble Frehywot, Laura J. Jolley

Health Policy and Management Faculty Publications

A combination of "environmental factors" in the U.S. has led to an increased demand for health care professionals. However, there has been a significant decrease in the number of U.S. medical graduates selecting careers in family medicine and general internal medicine, thus driving demand for international medical graduates. At the heart of our national workforce policy needs to be good domestic and foreign policies, such as self-sufficiency approaches that include strategies to incentivize rural and underserved practice for U.S. medical graduates.

Low Health Literacy: Implications For National Health Policy, John A. Vernon, Antonio Trujillo, Sara J. Rosenbaum, Barbara Debuono

Health Policy and Management Faculty Publications

Securing appropriate healthcare hinges on having the necessary skills to read and fill out medical and health insurance forms, communicate with healthcare providers, and follow basic instructions and medical advice. At virtually every point along the healthcare services spectrum, the healthcare system behaves in a way that requires patients to read and understand important healthcare information. This information is dense, technical, and has jargon-filled language. Examples include completing health insurance applications, reading signs in hospitals and clinics about where to go and where to sign in, and following written and oral instructions in brochures and pamphlets, as well as prescription …

Barriers To Serving The Vulnerable: Thoughts Of A Former Public Official, Christine Ferguson

Health Policy and Management Faculty Publications

In an environment of limited resources, the question of who is deserving and undeserving of assistance becomes critical. Policymakers’ biases about whether a health condition is self-inflicted, as well as their perceptions about whether treatments are truly effective, play a major role—often unstated—in the allocation of resources.

Assumed Equity: Early Observations From The First Hospital Disparities Collaborative, Bruce Siegel, Jennifer K. Bretsch, Vickie Sears, Marsha Regenstein, Marcia J. Wilson

Health Policy and Management Faculty Publications

Disparities in healthcare represent a failure in the equity domain of quality. Although disparities have been well documented, little has been written about how hospitals might use improved data collection and quality improvement techniques to eliminate disparities. This article describes early findings from the planning phase of the first hospital-based disparities collaborative. The authors also discuss the changes in policy and practice that may speed hospitals in placing disparities and equity on their quality agendas.

An Assessment Of Legal Issues Raised In "High Performing" Health Plan Quality And Efficiency Tiering Arrangements: Can The Patient Be Saved?, Sara J. Rosenbaum, Sarah Kornblet, Phyllis Borzi

Health Policy and Management Faculty Publications

A legal analysis released by The George Washington University School of Public Health and Health Services and the Robert Wood Johnson Foundation affirms the legality under federal and state law of physician ranking systems used by health plan provider networks. This analysis examines seven types of possible legal allegations against physicians tiering, concluding how the approach is undertaken plays a significant role in determining legal backlash.

Achieving Family Health Literacy: The Case For Insuring Children, Sara J. Rosenbaum, Peter Shin, Barbara Debuono

Health Policy and Management Faculty Publications

One aspect of the SCHIP reauthorization debate that has received more limited attention than it deserves is the relationship between children's health insurance coverage and family health literacy. That is, to what extent is children's health insurance associated with higher health literacy, and to what extent is reduced parental health literacy linked to lower rates of health insurance among children? This association is extremely important, since there is strong evidence of a link between health literacy and the appropriate use of health care. Evidence suggests that when previously uninsured children are covered by health insurance, parents at all income levels …

Assessing The Effects Of Federal Pediatric Drug Safety Policies, Avi Dor, Taylor Burke, Ramona Whittington, Taylor Clark, Ruth Lopert, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

This policy analysis examines the effectiveness of pediatric exclusivity, one of the policy approaches the federal government uses to promote drug safety for children. Federal policy in this area is highly complex, and provisions related to pediatric drug safety, including pediatric exclusivity, are set to expire in 2007. Following a policy overview, this analysis summarizes the impact of pediatric exclusivity and reports on the results of our effort to shed light on the economic value of pediatric exclusivity. The analysis concludes with a discussion of options for further promoting a safe environment for drug use in children.

Parental Health Insurance Coverage As Child Health Policy: Evidence From The Literature, Sara J. Rosenbaum, Ramona Whittington

Health Policy and Management Faculty Publications

One of the policy questions expected to receive considerable attention during the State Children's Health Insurance Program (SCHIP) reauthorization process is whether — and if so, under what circumstances — to permit states to use SCHIP funds to cover parents. In 2006, the average Medicaid income eligibility level for coverage of working parents stood at 65% of the federal poverty level, and 15 states and the District of Columbia set income eligibility levels for this group at 100 percent of the federal poverty level or higher.1 In 2005, 8 states used some portion of their SCHIP allotment funding, in combination …

Payments To Medicare Advantage Plans Exceed Fee-For-Service Costs: Options For Medicare Savings From 2008 Through 2012, Brian Biles, Emily Adrion

Health Policy and Management Faculty Publications

The Medicare Modernization Act of 2003 (MMA) and the Deficit Reduction Act (DRA) of 2005 include provision intended to increase the role of private health plans in Medicare. These provisions set Medicare Advantage plan payment rates at levels higher than average costs would be in tradition free-for-service Medicare in every county in the nation. The total amount of extra payments to Medicare Advantage plans resulting from these provisions is projected to total over $8 billion in 2008 and $70 billion over the five year period, 2008 to 2012.

This briefing paper outlines the specific MMA and DRA provisions that generate …

Mandating Hpv Vaccination--Private Rights, Public Good, Alexandra M. Stewart

Health Policy and Management Informal Communications

New York State's regulations require health care workers who have direct contact with patients or who may expose patients to disease to be vaccinated against seasonal and H1N1 influenza. Courts must take into account constitutional guarantees of personal autonomy, freedom of contract, and freedom of religion when reviewing the current lawsuits. These rights, however, have been constrained when they conflict with government measures that are intended to protect the community's health and safety. Health care workers have a profound effect on patients' health. Although they have the same rights as all private citizens, it is likely that courts will continue …

An Initial Assessment Of The Effects Of Medicaid Documentation Requirements On Health Centers And Their Patients, Peter Shin, Brad Finnegan, Lauren Hughes, Sara J. Rosenbaum

Health Policy and Management Issue Briefs

This policy brief presents the initial effects of recent federal Medicaid reforms on health centers and their patients. Specifically, this report examines the impact of changes in federal Medicaid policy, contained in the Deficit Reduction Act of 2006 (DRA), which requires applicants and recipients to document both their citizenship or legal U.S. residence and proof of their personal identity.

Oversight Hearings On Science And Environmental Regulatory Decisions, David Michaels

Health Policy and Management Congressional Testimonies

No abstract provided.

The Continuing Cost Of Privatization: Extra Payments To Medicare Advantage Plans: Updated Tables For 2007: February 2007 Ma Plan Enrollment, 2007 Ma And Ffs Payment Rates, Brian Biles, Emily Adrion

Health Policy and Management Faculty Publications

No abstract provided.

Does Hipaa Preemption Pose A Legal Barrier To Health Information Transparency And Interoperability?, Sara J. Rosenbaum, Phyllis Borzi, Taylor Burke, Sonia W. Nath

Health Policy and Management Faculty Publications

This paper summarizes the results of a review of nearly 500 judicial opinions decided as of fall 2006, involving access to protected health information (PHI) and privacy of medical information under the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA). This review was undertaken to determine whether HIPAA, which permits application of state privacy laws that are more stringent than the federal privacy standard, acts as a legal barrier to the creation of interoperable health information systems that permit transparency of health information. The availability of transparent and complete information regarding health system performance has been recognized as …

Health And Security In Foreign Policy, Rebecca L. Katz, Daniel A. Singer

Health Policy and Management Faculty Publications

No abstract provided.

Non-Physician Clinicians In 47 Sub-Saharan African Countries, Fitzhugh Mullan, Seble Frehywot

Health Policy and Management Faculty Publications

Many countries have health-care providers who are not trained as physicians but who take on many of the diagnostic and clinical functions of medical doctors. We identified non-physician clinicians (NPCs) in 25 of 47 countries in sub-Saharan Africa, although their roles varied widely between countries. In nine countries, numbers of NPCs equalled or exceeded numbers of physicians. In general NPCs were trained with less cost than were physicians, and for only 3–4 years after secondary school. All NPCs did basic diagnosis and medical treatment, but some were trained in specialty activities such as caesarean section, ophthalmology, and anaesthesia. Many NPCs …

What Is Fair? Choice, Fairness And Transparency In Access To Prescription Medicines In The United States And Australia, Ruth Lopert, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

The importance of prescription drugs to modern medical practice, coupled with their increasing costs, has strengthened imperatives for national health policies that ensure safety and quality, facilitate affordable access, and promote rational use. Australia has made universal and affordable prescription drug coverage a priority for decades, within a policy framework that emphasizes equity and increasing transparency in coverage design and payment decisions. By contrast, the U.S. lacks such a national policy. Furthermore, federal Medicare reforms aimed at making appropriate drug coverage affordable and accessible employs two icons of the U.S. perception of fairness--the right to choose and the right to …

Hpv Vaccination: Should It Be Recommended Or Required?, Alexandra M. Stewart

Health Policy and Management Faculty Publications

Legislation introduced by two members of the District of Columbia Council on January 9, 2007 would require all girls to be vaccinated against the human papillomavirus (HPV), the primary cause of cervical cancer, by the time they enter the sixth grade, unless a parent or guardian specifically "opts out" of the mandate. A similar bill was introduced last week in Virginia, and Maryland and West Virginia are poised to consider legislation. To place the proposals in a broader context, this paper reviews some of the scientific, legal, ethical and financial issues surrounding the HPV vaccine and compulsory vaccinations.

An Analysis Of Propsed Rules Restricting Federal Medicaid Payments For Publicly Supported Healthcare Services, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

During its 47-year existence, Medicaid has been the subject of countless analyses, articles, books, and studies, in view of its sheer size (federal expenditures standing at $190 billion in FY 2006),[1] its complexity (more than five dozen separate federal eligibility categories), and its importance in the American healthcare system. Medicaid funds nearly 40% of all births,[2] covers about one-third of all children,[3] and is the primary source of healthcare financing for persons with severe and chronic physical and mental disabilities.[4] Medicaid virtually enables the operation of public healthcare providers, such as school-based clinics, community health centers, and public hospitals, whose …

Health Information Technology In The United States: The Information Base For Progress, David Blumenthal, Catherine M. Desroches, Karen Donelan, Sara J. Rosenbaum, Timothy Ferris

Health Policy and Management Faculty Publications

Health information technology (HIT) has the potential to advance health care quality by helping patients with acute and chronic conditions receive recommended care, diminishing disparities in treatment and reducing medical errors. Nevertheless, HIT dissemination has not occurred rapidly, due in part to the high costs of electronic health record (EHR) systems for providers of care—including the upfront capital investment, ongoing maintenance and short-term productivity loss. Also, many observers are concerned that, if HIT follows patterns observed with other new medical technologies, HIT and EHRs may diffuse in ways that systematically disadvantage vulnerable patient populations, thus increasing or maintaining existing disparities …

Strategies For Improving Access To Comprehensive Obesity Prevention And Treatment Services For Medicaid-Enrolled Children, Sara E. Wilensky, Ramona Whittington, Sara J. Rosenbaum

Health Policy and Management Issue Briefs

This policy brief builds on our prior work for the Robert Wood Johnson Foundation. In 2005, The George Washington University School of Public Health and Health Services (GW) evaluated the role of public and private insurance in financing preventive care and treatment for at-risk and obese children. One of the key findings from that report was that Medicaid's existing Early and Periodic Screening Diagnostic and Treatment (EPSDT) coverage standards provide for comprehensive, obesity-related pediatric health care interventions. Using data drawn from state Medicaid programs, this report examines the extent to which state programs use the Medicaid EPSDT benefit to address …

The Heart Of The Matter: The Relationship Between Communities, Cardiovascular Services, And Racial And Ethnic Gaps In Care, Marsha Regenstein, Holly Mead, Anthony Lara

Health Policy and Management Faculty Publications

Racial and ethnic disparities in cardiovascular care are greatly influenced by market factors and how the health care system is organized. This study examines key health system factors that contribute to disparities in cardiac care among racial and ethnic minorities in the United States. A market assessment, consisting of site visits, interviews, and data collection from key health care providers in 10 communities, was undertaken to identify common characteristics in the health care markets and to explore how these factors may drive disparities in cardiac care.

Payments To Medicare Advantage Plans Exceed Fee-For-Service Costs: Options For Medicare Savings From 2007 Through 2011, Brian Biles, Emily Adrion

Health Policy and Management Faculty Publications

The Medicare Modernization Act of 2003 (MMA) and the Deficit Reduction Act (DRA) of 2005 include provision intended to increase the role of private health plans in Medicare. These provisions set Medicare Advantage plan payment rates at levels higher than average costs would be in tradition free-for-service Medicare in every county in the nation. The total amount of extra payments to Medicare Advantage plans resulting from these provisions is projected at $5.7 billion in 2007 and nearly $30 billion over the five year period, 2007 to 2011.

This briefing paper outlines the specific MMA and DRA provisions that generate these …

Defined-Contribution Plans And Limited-Benefit Arrangements: Implications For Medicaid Beneficiaries, Sara J. Rosenbaum

Health Policy and Management Issue Briefs

This Policy Brief explores the implications of state Medicaid reforms – whether implemented either as §1115 demonstrations or as part of state plan flexibility measures under the Deficit Reduction Act of 2005 (P.L. 109-171) – that limit benefits, coverage, and payments for medically necessary health care. Following a background and overview, the Policy Brief identifies a series of considerations that come into play when states approach the issue of benefit re-design, particularly in the context of developing coverage innovations that utilize "consumerdriven" and "defined-contribution" arrangements. As used in this Policy Brief, the term "defined-contribution" means the payment of a flat, …

Update On The Status Of The Medicaid Prospective Payment System In The States, Roger Schwartz, Peter Shin, Megan Reilly

Health Policy and Management Faculty Publications

The Benefits Improvement and Protection Act of 2000 replaced the traditional cost-based reimbursement system for federally-qualified health centers (FQHCs) with a new prospective payment system. States were also allowed to implement an alternative payment methodology (APM) as long as it did not pay less than what FQHCs would have received under PPS and the affected FQHC agreed to the APM. Although changes in payment policies were to take effect in 2001, states were slow to implement them and most only did so after one or two years. With little or no oversight by the federal government, the National Association of …

International Medical Graduates In Family Medicine In The United States Of America: An Exploration Of Professional Characteristics And Attitudes, Amanda L. Morris, Robert L. Phillips, George E. Fryer, Larry A. Green, Fitzhugh Mullan

Health Policy and Management Faculty Publications

Background

The number of international medical graduates (IMGs) entering family medicine in the United States of America has steadily increased since 1997. Previous research has examined practice locations of these IMGs and their role in providing care to underserved populations. To our knowledge, research does not exist comparing professional profiles, credentials and attitudes among IMG and United States medical graduate (USMG) family physicians in the United States. The objective of this study is to determine, at the time when a large influx of IMGs into family medicine began, whether differences existed between USMG and IMG family physicians in regard to …

The Legality Of Collecting And Disclosing Patient Race And Ethnicity Data, Sara J. Rosenbaum, Taylor Burke, Sonia W. Nath, Jennifer Santos, Dana Thomas

Health Policy and Management Issue Briefs

This policy brief weighs whether the collection of patient data by race or ethnicity, as part of a program of quality improvement, violates the law.

Managed Care And Medi-Cal Beneficiaries With Disabilities: Assessing Current State Practice In A Changing Federal Policy Environment, Sara J. Rosenbaum, Sara E. Wilensky, Peter Shin, Ramona Whittington

Health Policy and Management Faculty Publications

This analysis, prepared for The California Endowment, is a follow-on report to our earlier work that raised issues to be considered before moving persons with disabilities into compulsory Medicaid managed care plans and reviewed the extent to which California's legal framework addressed the concerns identified. In this report, the George Washington University School of Public Health and Health Services examines how other states have addressed issues that arise in designing, implementing and overseeing compulsory managed care systems for persons with disabilities and serious and chronic health conditions. The experiences of other states that have developed these types of arrangements offer …

Laying The Foundation: Health System Reform In New York State And The Primary Care Imperative, Sara J. Rosenbaum, Peter Shin, Ramona Whittington

Health Policy and Management Faculty Publications

New York State has embarked on a substantial effort to restructure its health care system as a result of rapidly escalating health care expenditures, especially with respect to Medicaid expenditures for institutional health care. But it is impossible to alter these high cost health expenditures without strengthening and expanding the primary care foundation on which New York's health system rests.