Health Policy Commons^™

The Utility Of Trouble: Leveling The Playing Field: Giving Municipal Officials The Tools To Moderate Health Insurance Costs, Robert L. Carey

Edward J. Collins Center for Public Management Publications

According to the research, Boston could have reduced its 2010 health premiums by between 15.6 and 17.1 percent, for a savings of between $41.4 and $45.4 million by joining the state’s Group Insurance Commission, more widely known as the GIC. The City is unable to join the GIC, however, without first receiving 70% union approval, according to state law. This requirement and the associated tradeoffs involved are a major barrier to municipal participation in the GIC. Several cities and towns including Boston have called for cities and towns to have the same ability as the state to design health insurance …

Controlling The Cost Of Municipal Health Insurance: Lessons From Springfield, Robert L. Carey

Edward J. Collins Center for Public Management Publications

The study finds that, by joining the Group Insurance Commission (GIC), Springfield cut increases in its health care costs an estimated $14 million to $18 million over two years. It saved an additional $5 million per year by requiring eligible municipal retirees to enroll in Medicare Part B as a precondition of receiving supplemental health coverage from the City. These two actions, together, reduced increases in the City’s health care costs an estimated 15-19% annually, on average, with savings growth each year due to compounding. Furthermore, the study estimates that if the GIC continues its past pattern of keeping its …

Stepping Up: Managing Diversity In Challenging Times, Carol Hardy-Fanta

Publications from the Center for Women in Politics and Public Policy

Since its launch in 2008, Commonwealth Compact has grown steadily, employing several strategies to promote diversity statewide. The Benchmarks initiative has collected data, analyzed in this report, on a significant portion of the state workforce. Guided by Stephen Crosby, dean of the McCormack Graduate School of Policy and Global Studies at UMass Boston, Commonwealth Compact has conducted newsmaking surveys of public opinion and of boards of directors statewide. In addition, it has convened ongoing coalitions with its higher education partners, and established a collaborative of local business schools aimed specifically at increasing faculty diversity. The Compact has sponsored or co-sponsored …

Parenting From Prison: Family Relationships Of Incarcerated Women In Massachusetts, Erika Kates, Sylvia Mignon, Paige Ransford

Publications from the Center for Women in Politics and Public Policy

Historically in the United States, there has been little concern about the needs of incarcerated women and their family members, especially children. This began to change with the tremendous increase in the number of incarcerated women. The rate of women’s incarceration increased dramatically during the 1980s and today the number of female inmates continues to rise faster than the number of male inmates. In 1986, 19,812 women were incarcerated in the United States and this number rose in 1991 to 38,796. Today, over 112,000 women are incarcerated in state or federal facilities (Sabol et al., 2007; Snell 1994). While in …

Call To Action: A Pay Equity Resource Guide, Kacie Kelly

Publications from the Center for Women in Politics and Public Policy

Women continue to enter the workforce at record levels and laws on the state and federal levels prohibit gender discrimination in the workplace. Yet employment discrimination persists and women’s wages remain lower than men’s wages for comparable positions and occupations. With the 2005 publication of GETTING EVEN: Why Women Don’t Get Paid as Much as Men and What To Do About It by Economist and former Massachusetts Lieutenant Governor Evelyn Murphy, the issue of wage equity is finally receiving the widespread and sustained attention it deserves.

This resource guide provides an overview of the issues related to the wage gap …

Women’S Municipal Leadership In Massachusetts, Paige Ransford, Miriam Lazewatsky

Publications from the Center for Women in Politics and Public Policy

The Center for Women in Politics and Public Policy (CWPPP) at UMass Boston’s McCormack Graduate School of Policy Studies has been tracking the election of women at the municipal level in Massachusetts since 1996. In 2003, the Project expanded to include all New England states. CWPPP remains the only research center in the United States that regularly tracks women’s political representation at the local level.

Women Of Talent: Gender And Government Appointments In Massachusetts, 2002–2007, Carol Hardy-Fanta, Kacie Kelly

Publications from the Center for Women in Politics and Public Policy

Despite the high educational and occupational attainment—and considerable talent—of women in Massachusetts, the state ranks just 22nd in the nation on women's overall share of top executive, legislative, and judicial posts, compared to their share of the population. The goals of this study were to (1) calculate the percentage of women holding senior-level positions in state government at these four points in time; (2) analyze the distribution of appointments by type of position and executive office; (3) provide possible explanations for the status of women’s representation in these positions; and (4) offer recommendations that will serve to promote the appointment …

The Voting Rights Act And The Election Of Nonwhite Officials, Pei-Te Lien, Dianne M. Pinderhughes, Carol Hardy-Fanta, Christine M. Sierra

Publications from the Center for Women in Politics and Public Policy

Voting Rights Act (VRA) is one of the most important—if not the most important—public policies developed over the last half century to increase access to the U.S. political system for people of color. The VRA also provides an important context for understanding the ascension of nonwhite groups into the elected leadership of the nation (Browning, Marshall, and Tabb 1984; Davidson and Grofman 1994; Menifield 2001; Mc-Clain and Stewart 2002; Segura and Bowler 2005; Bositis 2006). This essay assesses the present-day significance of the VRA for the political representation of communities of color by examining the implications of majority-minority districts and …

A Trade-Off Proposal For Funding Long-Term Care, Yung-Ping Chen

Gerontology Institute Publications

Long-term care can be a depressing subject. Most of us tend not to think about it. However, we cannot long avoid it as the 76 million baby boomers begin reaching older ages in a few short years. According to projections, in 40 years, those aged 65 to 84 (numbering 31.6 million in 2005) will more than double, and those 85 plus (about 5.1 million in 2005), who are more at risk of dependency, will more than triple (U.S. Census Bureau, 2004 and 2006). Heavy reliance on Medicaid, already the second largest budget item in most states, would not appear viable. …

A Seat At The Table? Racial/Ethnic & Gender Diversity On Corporate, Hospital, Education, Cultural & State Boards, Carol Hardy-Fanta Phd, Donna Stewartson

Publications from the Center for Women in Politics and Public Policy

As part of its larger Diversity Initiative, the McCormack Graduate School of Policy Studies at UMass Boston has undertaken a number of projects. The first was a public opinion survey conducted around the time of the November 2006 elections. The report, Transformation and Taking Stock: A Summary of Selected Findings from the McCormack Graduate School Diversity Survey, included a comprehensive look at race relations in the Commonwealth at a time of significant transition—demographically and politically. This report was followed by A Benchmark Report on Diversity in State and Local Government, which focused on the percentage of positions filled …

A Benchmark Report On Diversity In State And Local Government, Carol Hardy-Fanta Phd

Publications from the Center for Women in Politics and Public Policy

The Pipeline to Public Service Initiative asked the McCormack Graduate School’s Center for Women in Politics & Public Policy at the University of Massachusetts Boston to ascertain the racial diversity in state and local government. The project had the following three goals:

--To identify the race (and gender) of those holding top-level positions filled through gubernatorial appointments, e.g., secretaries, commissioners, directors, deputy commissioners/directors, and undersecretaries, in the Commonwealth’s executive offices and major departments.

--To compile the same information for members of the most influential boards and commissions in the Commonwealth filled through gubernatorial appointments.

--To assess the diversity of elected …

Minority Women In The Healthcare Workforce In New England, Carol Hardy-Fanta, Erika Kates, Helen Levine, Kate Peery-Wolf

Publications from the Center for Women in Politics and Public Policy

Research on health disparities affecting people of color typically focuses on their health status, health treatment and health outcomes with a particular emphasis on the relatively high rates of morbidity and mortality from selected diseases for ethnic and racial minority groups. This fact sheet offers a different but related focus on gender and race/ethnicity in the health care workforce. Our rationale is that the Sullivan Commission on Diversity in the Healthcare Workforce concluded that the lack of minority doctors, nurses and dentists is a significant cause of racial/ethnic health disparities and that the ability to recruit, train and retain minority …

Project Child Health Impact Assessment, Unyi Agba, Kristina Chung, David Diehl, Marisol Olivera, Yolanda Perez

Emerging Leaders Program Team Projects

The 2005 Project Child Health Impact Assessment (CHIA) at the Boston Medical Center (BMC) for the UMass Emerging Leaders Program (ELP) is closely related to one that members of the 2004 ELP cohort assisted with. The 2004 project team provided BMC with preliminary research regarding similar concepts in Europe, Canada and the United States. With this research in hand, the Project CHIA team at BMC decided to research, develop, write and publish pilot analyses that illustrated the impact of public policy on children's health. The 2005 ELP team was asked to provide guidance regarding a communications strategy for these pilot …

“As Tough As It Gets”: Women In Boston Politics, 1921-2004, Kristen A. Petersen, Carol Hardy-Fanta Phd, Karla Armenoff

Publications from the Center for Women in Politics and Public Policy

This study seeks to answer the question: Given the wealth of talent and resources women possess—and the state offers—why is it so tough for women to gain representation in Boston City Hall? To answer this question, and to document the efforts women have made over almost 100 years, we examine the history of women who have run for and won—or lost—election to the Boston City Council in the 20th century. How does the structure and culture of a given urban political arena (i.e., “Boston politics”) affect women’s opportunities as elected officials? What is women’s political culture and how has it …

Hiv/Aids Among Women Of Color In Massachusetts, Erika Kates, Helen Levine, Lakay Cornell

Publications from the Center for Women in Politics and Public Policy

According to a recent report on the status of women in Massachusetts, the Commonwealth has an “extraordinarily high” incidence of women of color with HIV/AIDS. Over 4,200 women are infected and women of color account for a disproportionately high number of these cases.

Back To The Future: The Future Of Long-Term Care In Massachusetts, Deborah H. Thomson, John J. Ford

Gerontology Institute Publications

The state of Massachusetts, like the rest of the United States, is facing an approaching crisis in long-term care. Over the next few decades the number of Massachusetts residents age 65 and older will soar. As these numbers increase, so will the need for long-term care.

Massachusetts is ill prepared to provide the services that will be needed. Our current system of health care benefits leaves many elders with gaps in coverage. Those individuals who need long-term services often impoverish themselves and their spouses before the state pays for their care. Others languish on waiting lists to receive services. Our …

Long-Term Care: Informed By Research, Francis G. Caro

Gerontology Institute Publications

Health services research has contributed to health policy and service developments that have led to major improvements in the quality of long-term care in the United States. This policy brief highlights a few areas in which publicly and privately funded research has informed the long-term care field.

Cuba, Social Policy At A Crossroads: Maintaining Priorities, Transforming Practice, Miren Uriarte

Gastón Institute Publications

From the beginning of the Cuban revolution in 1959, the model of social development has underscored equity across society and universal access. Full responsibility rests on government to fund and deliver social entitlements. These values have framed the development and implementation of social policy during the last 40 years. During this time Cuba has instituted free and universally accessible health care and education and has built on its formerly weak pension system to develop a universal and government sponsored one.

Cuba's safety net of benefits includes protection of workers' employment and housing, food subsidies, utilities and other necessities, and mechanisms …

The Citizens Health Prescription: Coping With Rising Drug Costs, Shannon Cadres

New England Journal of Public Policy

Prescription drug prices have climbed to unaffordable levels in recent years, creating a serious public policy problem for lawmakers at both the state and federal levels. The U.S. Medicare program only covers the costs of inpatient prescription drugs, and only seventy-five percent of beneficiaries are receiving coverage through some other means. But because of the tremendous power of the pharmaceutical industry on Capitol Hill, lawmakers in Washington have been unable to agree upon a workable solution. As a result, many states are experimenting with different strategies to provide some relief. Massachusetts has attempted to solve the problem through the Prescription …

Environmental Public Health Awaits Rediscovery, Anthony Robbins, Phyllis Freeman

New England Journal of Public Policy

Preventing environmental exposures that threaten human health remains among the best but least attended to opportunities to improve everyone’s health. For more than a decade, medical care concerns, exacerbated by voracious competition among medical empires and the implacably growing number of uninsured, have often been misconstrued as constituting a complete agenda for health system reform. The authors explain the predicament from an historical perspective — how defining events moved U.S. health policy away from protecting the public against dangerous exposures toward unrealistic expectations that doctors will fix whatever goes wrong, at least for individuals with ample medical insurance. They explain …

Working Paper: Elders In Massachusetts Prefer Paid Caregivers, Francis G. Caro

Gerontology Institute Publications

Older Massachusetts residents would rather have paid professionals provide their long-term care than their own children, according to a recent UMass Poll of 461 Massachusetts residents.

Toward Improved Support For Research On Delivery Of Home- And Community-Based Long-Term Care, Francis G. Caro

Gerontology Institute Publications

Stronger and more consistent support is needed for research on long-term care. A greater investment in research will strengthen the ability of public and private organizations to provide effective and efficient assistance to people with disabilities and their informal caregivers. This paper provides a rationale for stronger research funding for the field and outlines several options to strengthen research.

Report On The Minors’ Abortion Rights Project, J. Shoshanna Ehrlich, Carol Hardy-Fanta, Jamie Ann Sabino

Publications from the Center for Women in Politics and Public Policy

The goal of this study was to learn more about the experience of minors in states with parental involvement laws who do not involve their parents in their abortion decision, and must therefore seek judicial authorization for an abortion, and to use this knowledge to explore ways to minimize the burden of these laws. At the outset, it should be made clear that having this goal does not indicate that we support imposing third-party involvement requirements on teens seeking to abort. Our research, as well as the work of others (much of which is cited in this report), raises serious …

Providing Low-Cost Assistive Equipment Through Home Care Services: The Massachusetts Assistive Equipment Demonstration, Alison S. Gottlieb, Francis G. Caro

Gerontology Institute Publications

This report describes the Massachusetts Assistive Equipment Demonstration, a collaborative project funded by the Robert Wood Johnson’s Home Care Research Initiative and carried out collaboratively by the Gerontology Institute at the University of Massachusetts Boston and the Executive Office of Elder Affairs (EOEA). The purpose of the demonstration was to systematically encourage the use of low-cost assistive equipment among elderly clients through existing case management resources, thereby extending the effectiveness of the Massachusetts home care program by supplementing formal services with expanded use of assistive equipment.

Nursing Homes To Medicare Waiver Programs In Vermont, Joseph Murray

New England Journal of Public Policy

This research examines the differences between nursing home residents and those who were able to leave nursing homes with the help of the Medicaid Waiver Program in Vermont. Ninety individuals who reentered the community with the aid of such waivers were compared with a random sample of nursing home residents through the use of the Nursing Home Minimum Data Set. The researchers found divergence in four key areas: cognition, continence, treatment categories, and desire to return to the community. Typically, those who left nursing homes for the community were cognitively intact, had moderate continence, received rehabilitative or clinically complex treatments, …

Nursing Home Ownership And Public Policy: An Historical Analysis, K. R. Kaffenberger

Graduate Doctoral Dissertations

In the early days of the United States, care of the disabled elderly outside the home meant the public almshouse. By the 1920s, private, nonprofit homes for the aged were prevalent. More recently, private, for-profit facilities have grown to dominate the field.

For-profit ownership has been controversial. Underlying the controversy is the concern that quality might be lowered in order to enhance profit.

This study asks why most nursing homes are privately owned and why most privately owned nursing homes are operated for profit. It does so with reference to The Nonprofit Economy, in which Burton Weisbrod describes a …

The Professional Decline Of Physicians In The Era Of Managed Care, Aimee E. Marlow

New England Journal of Public Policy

Physicians have long enjoyed prestige, power, and autonomy, but the rise of managed care organizations has drastically changed their status. Many doctors are in thrall to the financial well-being of the corporations that employ them, their knowledge and expertise controlled and manipulated in the interest of profit maximization. This article investigates the professional decline of physicians, citing the use of gag clauses, incentives to withhold care, and the breakdown of their authority. In an effort to regain some measure of control, physicians have taken their concerns to the public, supporting state and federal legislation that attempts to curb questionable managed …

Institutional Design And Regulatory Performance: Rethinking State Certificate Of Need Programs, Robert Hackey, Peter Fuller

New England Journal of Public Policy

The success of state efforts to control rising health care costs depends on the incentives contained in the legislative design of regulatory policies and in the administrative capacity and autonomy of state agencies. States have regulated the construction and expansion of health care facilities and services for more than two decades through "certificate of need" (CON) programs designed to limit the diffusion of expensive new medical technologies and to avoid the duplication of health care facilities. Although the cost-control record of state certificate of need programs has been widely criticized, Rhode Island's experience with a reformed CON process from 1985 …

The Potential Impact Of Workforce Development Legislation On Cbos, Edwin Meléndez

New England Journal of Public Policy

The proposed congressional legislation revamping the employment and training system will result in budget cuts, program consolidation, and block grants for the states. These changes are potentially harmful to community-based organizations (CBOs) because (J ) they eliminate categorical funding that traditionally has required contracting with organizations which specialize in servicing the disadvantaged, and (2) they introduce stricter performance standards that may be unattainable for many small-scale operations. However, the adoption of best practices in serving non-English-speaking and poor populations, increasing connections to emerging government intermediaries in labor markets, and establishing greater linkages to postsecondary educational institutions may offer CBOs the …

We Are The Roots: The Culture Of Home Health Aides, Ruth Glasser, Jeremy Brecher

New England Journal of Public Policy

This article focuses on the contributions of its workers' culture to the success of Cooperative Home Care Associates (CHCA). It examines what the home healthaides bring to the culture of the company, how their contribution develops through their experience with the company, and how their heritage contributes to their CHCA work and to the company as an organization. This is one segment of a larger study that will deal with the background and history of CHCA, the vision of the founders and its implementation, the role of organizational policy, and the contribution of management philosophy to its accomplishment.