Health Policy Commons^™

Language Barriers To Health Care Access Among Medicare Beneficiaries, Ninez A. Ponce, Leighton C. Ku, William E. Cunningham, E. Richard Brown

Health Policy and Management Faculty Publications

This study examined language barriers to health care access among a population-based sample of Medicare seniors in California in 2001 and 2003. Results indicate that Medicare beneficiaries with limited English proficiency (LEP) had less access to a usual source of care and were less likely to receive preventive cancer screening tests. LEP Medicare beneficiaries who also were covered by Medicaid tended to fare better than those without Medicaid. This could be due to federal civil rights rules that require Medicaid health care providers to offer free language assistance, but exclude from these requirements physicians who provide only Medicare services. Findings …

Health Centers Reauthorization: An Overview Of Achievements And Challenges, Sara J. Rosenbaum, Peter Shin

Health Policy and Management Faculty Publications

Since the establishment of the first health center in 1965, health centers have evolved into an essential component of the health care safety net. Today, over 1,000 federally funded and "look-alike" health centers serve 14.3 million people, three-quarters of whom are uninsured or covered by Medicaid. As the nation's largest primary care system, health centers care for one in five low-income uninsured persons and one in nine Medicaid beneficiaries.

From Schip Benefit Design To Individual Coverage Decisions, Anne R. Markus, Sara J. Rosenbaum, Ruth E. K. Stein, Jill Joseph

Health Policy and Management Issue Briefs

The majority of states have implemented separate SCHIP (S-SCHIP) programs that significantly depart from Medicaid and resemble less comprehensive commercial products. This difference in program design may result in S-SCHIP potentially being less responsive to children with special needs (CSHCNs). This study explores how responsive insurers are to these higher than average needs. We found that, with one exception, insurers did not agree on the coverage of any specific service, but overall they provided coverage beyond state limits and exclusions. Second, the less acute the childhood condition, the more frequently insurers imposed exclusions. Finally, in the majority of states, some …

Medicaid And Health Information: Current And Emerging Legal Issues, Sara J. Rosenbaum, Patricia Mactaggart, Phyllis Borzi

Health Policy and Management Faculty Publications

Legal questions are an inevitable byproduct of significant technology change in health care such as that underway as a result of health information technology (HIT). This article examines several important existing and emerging legal questions in a Medicaid context. First, do the Centers for Medicare & Medicaid Services (CMS) and State Medicaid agencies, have a fiduciary obligation to adopt and fully use health information technology given its potential to improve health care quality while reducing racial, ethnic, and socioeconomic disparities in health and health care? Second, how can Medicaid privacy standards be reconciled with the Health Insurance Portability and Accountability …

Designing Employer-Sponsored Mental Health Benefits, Rachel Sethi, Joanne Jee, Lisa Chimento, D. Richard Mauery

Health Policy and Management Faculty Publications

No abstract provided.

Race, Ethnicity, And Language Of Patients: Hospital Practices Regarding Collection Of Information To Address Disparities In Health Care, Marsha Regenstein, Donna Sickler

Health Policy and Management Faculty Publications

2003 Institute of Medicine (IOM) report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, identified strong evidence of disparities in the health care of racial and ethnic minorities not explained by differences in health insurance coverage and income. Among ways to eliminate these inequalities the IOM report recommended enhanced collection of patient race and ethnicity data. National Public Health and Hospital Institute researchers surveyed 500 non-federal acute care hospitals on their collection of patient race, ethnicity and preferred language information to understand data collection practices in the U.S. hospital industry. The researchers also surveyed 64 safety net hospitals …

A Dose Of Reality: Assessing The Federal Trade Commission/Department Of Justice Report In An Uninsured, Underserved, And Vulnerable Population Context, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Despite the size of their report, the Federal Trade Commission and Department of Justice pay virtually no attention to tens of millions of uninsured and underinsured persons. By focusing on an increasingly rarified group of health care customers—healthy, affluent, and highly insured—the report takes on an untethered quality, with only the slightest tip of the hat to its own limitations. Furthermore, the report overstates the extent of legal constraints on the market, in particular, the degree to which the market is free to select its customers and tailor its goods and services to the best risks. By miscasting the legal …

The Epidemiology Of U.S. Immunization Law: Translating Cdc Immunization Guidelines Into Practice: State Laws Related To The Use Of Standing Orders Covering Immunization Practice, Alexandra M. Stewart, Marisa A. Cox, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

This pilot study examines how five states -- Georgia, Massachusetts, New York, Oregon, and Texas – approach the legal question of delegation of medical practice powers in an immunization practice context.

Vaccination With Recombinant Aspartic Hemoglobinase Reduces Parasitic Load And Blood Loss After Hookworm Infection In Dogs, Alex Loukas, Jeffrey M. Bethony, Susana Mendez, Ricardo T. Fujiwara, Gaddam Narsa Goud, Najju Ranjit, Bin Zhan, Karen Jones, Maria Elena Bottazzi, Peter J. Hotez

Health Policy and Management Faculty Publications

Background

Hookworms infect 730 million people in developing countries where they are a leading cause of intestinal blood loss and iron-deficiency anemia. At the site of attachment to the host, adult hookworms ingest blood and lyse the erythrocytes to release hemoglobin. The parasites subsequently digest hemoglobin in their intestines using a cascade of proteolysis that begins with the Ancylostoma caninum aspartic protease 1, APR-1.

Methods and Findings

We show that vaccination of dogs with recombinant Ac-APR-1 induced antibody and cellular responses and resulted in significantly reduced hookworm burdens (p = 0.056) and fecal egg counts (p = …

Medicaid's Role In Treating Children In Military Families, Peter Shin, Sara J. Rosenbaum, D. Richard Mauery

Health Policy and Management Faculty Publications

This analysis examines Medicaid's role in meeting the health care needs of children in military families who receive their health insurance coverage through TRICARE. TRICARE is the Department of Defense's worldwide health insurance program for active duty and retired military service members and their families. The 2000-2002 National Survey of Children with Special Health Care Needs, as well as a series of semi-structured telephone interviews, were used to assess Medicaid's role as a supplemental insurer for military children with special health care needs (CSHCN).

America's Public Hospitals And Health Systems, 2003: Results Of The Annual Naph Hospital Characteristics Survey, Jennifer Huang, Joshua Silbert, Marsha Regenstein

Health Policy and Management Faculty Publications

In 2003, members of the National Association of Public Hospitals and Health Systems continued to offer millions of uninsured and underserved individuals access to the medical services so critical for lifelong health and well-being. Delivering these services was difficult, however, given the economic downtown early in the decade and the resulting inadequacies associated with safety net financing. This report examines the operations and activities of NAPH members in 2003, presents the financial challenges they faced, describes the clinical and community services they provided, and profiles the patients they served.

How Medical Claims Simplification Can Impede Delivery Of Child Developmental Services, Anne R. Markus, Sara J. Rosenbaum, Alexandra M. Stewart, Marisa A. Cox

Health Policy and Management Faculty Publications

This report examines HIPAA administrative standardization and the process of modifying the standardized codes. It assesses the implications of HIPAA standardization for payment of Medicaid-covered early childhood preventive and developmental services, drawing on findings from a 50-state, point-in-time review of readily available state HIPAA compliance documents conducted in December 2004.

Achieving "Readiness" In Medi-Cal's Managed Care Expansion For Persons With Disabilities: Issues And Process, Sara J. Rosenbaum, Sara E. Wilensky, Peter Shin

Health Policy and Management Faculty Publications

This Policy Brief examines issues that can be expected to arise as California moves to significantly expand the use of mandatory managed care arrangements for Medi-Cal enrollees with disabilities. This analysis is based on information gleaned from more than a decade of Medicaid managed care specification analyses for the federal government and private funders, focusing on both the general beneficiary population and persons with chronic illnesses and disabilities. This Policy Brief also reflects experiences in furnishing technical assistance to state purchasers and in developing model managed care purchasing specifications for both general and special needs managed care populations for both …

Reducing Obesity Risks During Childhood: The Role Of Public And Private Health Insurance, Sara J. Rosenbaum, Sara E. Wilensky, Marisa A. Cox, D. Brad Wright

Health Policy and Management Faculty Publications

In a widely publicized decision issued in 2004, the United States Department of Health and Human Services removed language from the Medicare Coverage Issues Manual which stated that obesity is not an illness, a pronouncement that paves the way for Medicare coverage of evidence-based obesity treatments. This determination by HHS also has important implications for public and private insurance coverage of health care services and interventions that have the potential to reduce the risk of lifelong obesity in children.

This Report assesses the implications of the 2004 HHS obesity ruling into the context of public and private health insurance for …

An Assessment Of Hospital-Sponsored Health Care For The Uninsured In Polk County/Des Moines, Iowa, Lea Nolan, Marsha Regenstein, Marisa A. Cox

Health Policy and Management Faculty Publications

Health care providers in Polk County are faced with increasing numbers of low-income, uninsured patients who do not have the resources to pay for their health care out of pocket. At the same time, state and local funding sources are limited, and are insufficient to ensure that these individuals have access to the health services that they require. Community leaders are extremely interested in developing information to understand the magnitude of the uninsured problem in Polk County and to identify health care delivery strategies to better serve this population. A Blue Ribbon Steering Committee was convened in October 2004 to …

Stresses To The Safety Net: The Public Hospital Perspective, Marsha Regenstein, Jennifer Huang

Health Policy and Management Faculty Publications

Every year, more than 10 million people receive care from public hospitals and health systems – a complex and diverse set of providers that share a mission to deliver health services to individuals, regardless of insurance coverage or ability to pay. Together with federally funded health centers, free clinics, public health departments and scores of individual physicians and other health practitioners, public hospitals provide critical access points for the nation's uninsured population and form a vast patchwork of providers that is commonly referred to as the health care safety net. Despite their importance, there is no single or stable source …

Caring For Patients With Diabetes At Safety Net Hospitals And Health Systems: What The Patients Say About Their Care, Marsha Regenstein, Jennifer Huang, Dean Schillinger, Daniel Lessler, Brendan Reilly, Melanie Brunt, Jolene Johnson, John Piette

Health Policy and Management Faculty Publications

In 2002, with support from The Commonwealth Fund, the National Public Health and Hospital Institute (NPHHI) created a consortium of safety net hospital systems to work together to address common concerns regarding the care of patients with diabetes. As part of that project, NPHHI conducted a survey of patients with diabetes who received at least some of their care from four Consortium hospital systems: Cambridge Health Alliance; Community Health Network of San Francisco/San Francisco General Hospital; Cook County Bureau of Health Services; and LSU/Medical Center of Louisiana at New Orleans. Patients were surveyed on multiple domains of care, including overall …

A Killer Flu? Scientific Experts Estimate That "Inevitable" Major Epidemic Of New Influenza Virus Strain Could Result In Millions Of Deaths If Preventive Actions Are Not Taken, Margaret A. Hamburg, Shelley A. Hearne, Jeffrey Levi, Kim Elliott, Laura M. Segal, Michael J. Earls

Health Policy and Management Faculty Publications

No abstract provided.

Charting The Legal Environment Of Health Information, Sara J. Rosenbaum, Phyllis Borzi, Lee Repasch, Taylor Burke, John F. Benevelli

Health Policy and Management Faculty Publications

Over the past several years, increased attention has been focused on the importance of health information to health care quality improvement. The level of focus on health information has increased with the advent of electronic medical records and electronic health information systems designed to facilitate the use of health care data. Although these systems are still in their relative infancy, they hold enormous promise for revolutionizing the availability and use of health information to improve clinical performance, empower employers and consumers to better understand health plan choices and facilitate health claims administration. Their potential has been a catalyst for change …

Legal Issues In Health Information: Implications For Public Health Practice And Policy, Sara J. Rosenbaum, Taylor Burke, John F. Benevelli, Phyllis Borzi, Lee Repasch

Health Policy and Management Faculty Publications

Working in support of the availability of a viable primary care workforce for underserved communities is an important priority for the Health Resources and Services Administration (HRSA). Demand for primary care services will continue to increase, especially when considering calls for an overhaul of the national health care system and the increased needs of the many that in recent months have become unemployed and lost insurance benefits. In addition, there are still serious problems with the unequal distribution of health care professionals to rural and inner city urban areas. Many inner-city and rural communities continue to struggle to recruit and …

Act Now For Your Tomorrow: Final Report Of The National Commission On Nursing Workforce For Long-Term Care, Edward Howard, Brian Biles, Robyn Stone, Paul Wing, Kristin Mccloskey, Tim M. Henderson

Health Policy and Management Faculty Publications

The nursing workforce shortage faced by long-term care providers stems from factors both outside and inside the organization and operation of long-term care services. The nursing shortage diminishes quality of care and increases the costs of providing services. Resolution of the long-term care nursing workforce challenge will require improvement of the recruitment and retention of nurses. The leadership for the efforts to improve the long-term care workforce must come from the community itself. New and sustained leadership for action by long-term care leaders is the critical factor necessary to the development of the recommended initiatives and the achievement of the …

Migrant And Seasonal Farmworkers: Health Insurance Coverage And Access To Care, Sara J. Rosenbaum, Peter Shin

Health Policy and Management Faculty Publications

Migrant and seasonal farmworkers are an integral support to the nation's agricultural industry. Nearly three million workers earn their living through migrant or seasonal farm labor. Migrant and seasonal farmworkers and their families confront health challenges stemming from the nature of their work, their extreme poverty and mobility, and living and working arrangements that impede access to health coverage and care. This brief provides an overview of migrant and seasonal farmworkers and the health challenges they face and considers options for improving their health coverage and access to care.

National Security And U.S. Child Health Policy: The Origins And Continuing Role Of Medicaid And Epsdt, Sara J. Rosenbaum, D. Richard Mauery, Peter Shin, Julia Hidalgo

Health Policy and Management Issue Briefs

Medicaid has touched the lives of half of all of the low income young adults of prime military service age. The roots of Medicaid's unique child health eligibility and coverage policies can be traced to a seminal, 1964 government study entitled One Third of a Nation: A Report on Young Men Found Unqualified for Military Service. This study analyzed the underlying causes of the astounding 50 percent rejection rate among the young men drafted into the military in 1962. It documented pervasive evidence of treatable and correctable physical, mental, and developmental conditions, and its findings influenced the course of Medicaid …

A Nation's Health At Risk Iii: Growing Uninsured, Budget Cutbacks Challenge President's Initiative To Put A Health Center In Every Poor County, Michelle Proser, Peter Shin, Dan Hawkins

Health Policy and Management Faculty Publications

No abstract provided.

Perfecting Patient Flow: America's Safety Net Hospitals And Emergency Department Crowding, Marcia J. Wilson, Bruce Siegel, Mike Williams

Health Policy and Management Faculty Publications

Emergency department crowding and delays have become major issues for America's safety net hospitals and health systems. Many facilities are experiencing increasing wait times, a need to "board" admitted patients in emergency department (ED) hallways, and rising numbers of hours spent on "diversion" or "bypass." These trends result from increased patient demand at a time when the number of emergency departments has declined and hospital inpatient capacity has lagged. Other factors also may contribute to the crisis. Patients without access to medical specialists may view the ED as the quickest route to specialized services. Overburdened physicians may be more likely …

Assessing Legal Implications Of Using Health Data To Improve Health Care Quality And Eliminate Health Care Disparities, Sara J. Rosenbaum, Michael W. Painter

Health Policy and Management Faculty Publications

Information is — and always has been — essential to virtually all aspects of health care. Clinical treatment as well as coverage, payment, care quality, and certainly one's own personal health care decisions all depend profoundly on robust, accurate, appropriate, timely, private and secure information. Further, the ability to conduct largescale health services research is inextricably linked to information, as is the ability to measure population health and conduct surveillance of public health risks.

Managed Mental Health Care: Findings From The Literature, 1990–2005, D. Richard Mauery, Lissette Vaquerano, Rachel Sethi, Joanne Jee, Lisa Chimento

Health Policy and Management Faculty Publications

No abstract provided.

The Epidemiology Of U.S. Immunization Law: Immunization Requirements For Staff And Residents Of Long-Term Care Facilities Under State Laws/Regulations, Alexandra M. Stewart, Marisa A. Cox, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Medically appropriate, timely immunizations are an important component of the medical plans for approximately 1.6 million individuals who reside in the nation's long-term care (LTC) facilities. Increasing the immunization rates among these persons is a recognized public health goal. LTC facility residents are often members of high risk groups and are more susceptible to infectious diseases. The elderly, many of whom reside in LTC facilities, comprise 90% of the 36,000 annual deaths from influenza. Immunizations are equally important for employees of LTC facilities. Immunizations not only improve the individual's health status, but staff who have direct contact with residents represent …

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 …