Health Policy Commons^™

Racial Disparities In The Use Of Cardiac Revascularization: Does Local Hospital Capacity Matter?, Suhui Li, Arnold Chen, Katherine H. Mead

Health Policy and Management Faculty Publications

Objective: To assess the extent to which the observed racial disparities in cardiac revascularization use can be explained by the variation across counties where patients live, and how the within-county racial disparities is associated with the local hospital capacity.

Data Sources: Administrative data from Pennsylvania Health Care Cost Containment Council (PHC4) between 1995 and 2006.

Study Design: The study sample included 207,570 Medicare patients admitted to hospital for acute myocardial infarction (AMI). We identified the use of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) procedures within three months after the patient’s initial admission for AMI. Multi-level hierarchical …

Moving Forward To 2014: Global Ihr (2005) Implementation, Julie E. Fischer, Rebecca L. Katz

Health Policy and Management Faculty Publications

No abstract provided.

Principles To Consider For The Implementation Of A Community Health Needs Assessment Process, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

No abstract provided.

Community Health Centers In An Era Of Health Reform: An Overview And Key Challenges To Health Center Growth, Susan F. Wood, Debora Goetz Goldberg, Brian K. Bruen, Kay Johnson, Holly Mead, Peter Shin, Tishra Beeson, Julie Lewis, Shavon Artis, Katherine J. Hayes, Merle Cunningham, Xiaoxiao Lu, Trent White, Sara Rosenbaum

Health Policy and Management Faculty Publications

No abstract provided.

Health Centers And Family Planning: Results Of A Nationwide Study, Susan Wood, Debora Goetz Goldberg, Tishra Beeson, Brian K. Bruen, Kay Johnson, Holly Mead, Peter Shin, Julie Lewis, Shavon Artis, Katherine Hayes, Merle Cunningham, Xiaoxiao Lu, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Community health centers (CHCs) provided primary health care to over 20 million patients in 2011, 60% of whom are women and 25% of whom are women of childbearing age. Health centers play a central role in women's health, because of their mission to furnish a full range of primary and preventive care services, including family planning and birth control for women of reproductive age. As a result of the Affordable Care Act, which provide for historic insurance expansions, broad first-dollar coverage of family planning services, and direct investment in CHCs, it is projected that health center capacity will virtually double …

Poor Immigrants Use Public Benefits At A Lower Rate Than Poor Native-Born Citizens, Leighton Ku, Brian K. Bruen

Health Policy and Management Faculty Publications

No abstract provided.

Embedding Concepts Of Sex And Gender Health Differences Into Medical Curricula, Virginia M. Miller, Morrisa Rice, Londa Schiebinger, Marjorie R. Jenkins, Janice Werbinski, Ana Nunez, Susan Wood, Lynne T. Shuster

Health Policy and Management Faculty Publications

Sex, a biological variable, and gender, a cultural variable, define the individual and affect all aspects of disease prevention, development, diagnosis, progression, and treatment. Sex and gender are essential elements of individualized medicine. However, medical education rarely considers such topics beyond the physiology of reproduction. To reduce health care disparities and to provide optimal, cost-effective medical care for individuals, concepts of sex and gender health need to become embedded into education and training of health professionals. In September 2012, Mayo Clinic hosted a 2-day workshop bringing together leading experts from 13 U.S. schools of medicine and schools of public health, …

Community Health Centers In An Era Of Health Reform: An Overview And Key Challenges To Health Center Growth, Peter Shin, Jessica Sharac, Carmen Alvarez, Sara J. Rosenbaum, Julia Paradise

Health Policy and Management Faculty Publications

Over 1,100 federally funded community health centers play a vital role in ensuring access to health care for a predominantly low-income population in medically underserved communities. Health centers’ ability to provide comprehensive primary care and improve access to high-quality care while holding down health care cost growth has been well-documented. As health reform spurs coverage expansion and efforts to improve quality, the nation’s reliance on health centers is likely to grow.

In the Affordable Care Act (ACA), Congress invested $11 billion over five years to expand the health center program, to broaden access to care in lower-income communities as coverage …

E-Learning In Medical Education In Resource Constrained Low- And Middle-Income Countries, Seble Frehywot, Yianna Vovides, Zohray Talib, Nadia Mikhail, Heather Ross, Hannah Wohltjen, Selam Bedada, Kristine Korhumel, Abdel Karim Koumare, James Scott

Health Policy and Management Faculty Publications

Background

In the face of severe faculty shortages in resource-constrained countries, medical schools look to e-learning for improved access to medical education. This paper summarizes the literature on e-learning in low- and middle-income countries (LMIC), and presents the spectrum of tools and strategies used.

Methods

Researchers reviewed literature using terms related to e-learning and pre-service education of health professionals in LMIC. Search terms were connected using the Boolean Operators “AND” and “OR” to capture all relevant article suggestions. Using standard decision criteria, reviewers narrowed the article suggestions to a final 124 relevant articles.

Results

Of the relevant articles found, most …

Ensuring The Health Care Needs Of Women: A Checklist For Health Exchanges, Paula Johnson, Therese Fitzgerald, Laura Cohen, Susan F. Wood, D. Richard Mauery, Trenton M. White, Alina Salganicoff, Usha Ranji

Health Policy and Management Faculty Publications

To inform the development of the state health insurance Exchanges under the Affordable Care Act, this checklist identifies key coverage, affordability and access issues that are important for women. Based on lessons learned from women’s health research and the Massachusetts experience, the checklist considers essential health benefits, implementation of no-cost preventive services including contraception, provider networks and affordability, outreach and enrollment efforts, and the importance of including gender and other demographic characteristics in data collection and reporting standards. It was jointly authored by policy experts at the Kaiser Family Foundation, The Connors Center for Women’s Health and Gender Biology at …

Increased Use Of Dental Services By Children Covered By Medicaid: 2000-2010, Leighton C. Ku, Jessica Sharac, Brian K. Bruen, Megan Thomas, Laurie Norris

Health Policy and Management Faculty Publications

This report analyzes the use of dental services by children enrolled in Medicaid from federal fiscal years (FFY) 2000 to 2010. The number and percent of children receiving dental services under Medicaid climbed continuously over the decade. In FFY 2000, 6.3 million children ages 1 to 20 were reported to receive some form of dental care (either preventive or treatment); the number more than doubled to 15.4 million by FFY 2010. Part of the increase was because the overall number of children covered by Medicaid rose by 12 million (50%), but the percentage of children who received dental care climbed …

Readiness For Meaningful Use Of Health Information Technology And Patient Centered Medical Home Recognition Survey Results, Peter Shin, Jessica Sharac

Health Policy and Management Faculty Publications

Objective. Determine the factors that impact HIT use and MU readiness for community health centers (CHCs).

Background. The HITECH Act allocates funds to Medicaid and Medicare providers to encourage the adoption of electronic health records (EHR), in an effort to improve health care quality and patient outcomes, and to reduce health care costs.

Methods. We surveyed CHCs on their Readiness for Meaningful Use (MU) of Health Information Technology (HIT) and Patient Centered Medical Home (PCMH) Recognition, then we combined responses with 2009 Uniform Data System data to determine which factors impact use of HIT and MU readiness.

Results. Nearly 70% …

State Foodborne Illness Surveillance And Response Laws: Compilation And Analysis, Stephanie David, Jenna Burton, Chris Chadwick, Rebecca Katz

Health Policy and Management Faculty Publications

Objective

To document and assess the variation in state legislation relating to foodborne disease surveillance and outbreak response for all 50 states and the District of Columbia by creating a database and appendix of laws and regulations that will be made available to researchers and policymakers.

Introduction

Foodborne illnesses sicken 48 million and kill 3,000 Americans every year, presenting an enduring threat to the public’s health. In just the past three years alone, the United States has experienced at least four major multistate outbreaks in food. Despite this growing problem, efforts to prevent foodborne illness pose a particular public health …

Coverage Of Medicaid Preventive Services For Adults: A National Review, Sara E. Wilensky, Elizabeth A. Gray

Health Policy and Management Faculty Publications

No abstract provided.

Medicaid Coverage For Individuals In Jail Pending Disposition: Opportunities For Improved Health And Health Care At Lower Costs, Marsha Regenstein, Jade Christie-Maples

Health Policy and Management Faculty Publications

The Patient Protection and Affordable Care Act (ACA) provides an unprecedented opportunity for millions of poor men and women to obtain insurance coverage to address their substantial acute, chronic, physical and behavioral health care needs. The ACA raises Medicaid eligibility levels to 133 percent of poverty, thereby enabling adults with or without children to qualify for coverage. A substantial percentage of the newly eligible population will be jail-involved individuals – people who have had interactions with the legal system over the course of a year, including as an inmate at a county or city jail. Many of these individuals are …

Health Care Reform And Women's Insurance Coverage For Breast And Cervical Cancer Screening, Alice R. Levy, Brian K. Bruen, Leighton C. Ku

Health Policy and Management Faculty Publications

INTRODUCTION:

The Patient Protection and Affordable Care Act of 2010 (ACA) will increase insurance coverage for US citizens and for breast and cervical cancer screening through insurance expansions and regulatory changes. The primary objective of this study was to estimate the number of low-income women who would gain health insurance after implementation of the ACA and thus be able to obtain cancer screening. A secondary objective was to estimate the size and characteristics of the uninsured low-income population and the number of women who would still need National Breast and Cervical Cancer Early Detection Program (NBCCEDP) services.

METHODS:

We used …

State Health Insurance Exchange Laws: The First Generation, Sara J. Rosenbaum, Nancy Lopez, Taylor Burke, Mark Dorley

Health Policy and Management Faculty Publications

No abstract provided.

Coordinating And Integrating Care For Safety Net Patients: Lessons From Six Communities, Leighton C. Ku, Marsha Regenstein, Peter Shin, Holly Mead, Alice R. Levy, Kate Buchanan, Fraser Rothenberg Byrne

Health Policy and Management Faculty Publications

This report examines efforts to improve the coordination of health care among safety net providers in six communities (Austin, TX; Brooklyn, NY; Indianapolis, IN; Marshfield, WI; San Francisco, CA; and St. Louis, MO), based on case study site visits and a roundtable discussion. Across the communities, we identified three approaches to improving coordination: (1) collaboration of providers using a coordinating organization, (2) coordination facilitated by Medicaid managed care plans, and (3) development of highly integrated care systems. These represent models that could be used by different communities, based on their local circumstances. Successful development of coordination approaches involved shared commitment …

Multi-State Plans Under The Affordable Care Act, Trish Riley, Jane H. Thorpe

Health Policy and Management Faculty Publications

New state health insurance exchanges that are developing under The Patient Protection and Affordable Care Act (ACA) will offer consumers a choice of private health plans known as qualified health plans (QHPs). Under the law, in every state, two of those must be multi-state plans or MSPs. These plans will be administered by the federal Office of Personnel Management (OPM). The MSPs must meet the same requirements as other QHPs. As with other QHPs, people enrolled in the plans will be eligible for premium tax credits and cost sharing assistance if their income is less than 400 percent of poverty …

Health Information Privacy In The Correctional Environment, Melissa M. Goldstein

Health Policy and Management Faculty Publications

Information technology is considered a transformative element in health care because it facilitates the transparency and sharing of health information, which have always been central to the practice of medicine and the delivery of high-quality care. The widespread use of electronic health records (EHRs) and electronic health information exchange, among other technologies, is considered essential to improving the quality of care, reducing medical errors, reducing health disparities, and advancing the delivery of patient-centered medical care.

Community Health Centers: The Challenge Of Growing To Meet The Need For Primary Care In Medically Underserved Communities, Tishra Beeson, Sara J. Rosenbaum, Jessica Sharac, Peter Shin, Julia Paradise

Health Policy and Management Faculty Publications

This policy brief profiles health centers and the patients they serve, discusses how health centers are funded, and traces the history of health center growth. It closely examines the recent reduction in both federal appropriations and state grants for health centers, state cutbacks in benefits for adult Medicaid beneficiaries, and the anticipated impact of President Obama's FY 2013 request for federal funding for health centers. Finally, it looks ahead to both the challenges and opportunities health centers face as the nation prepares for 2014, when the ACA will be fully implemented.

Medicaid And Community Health Centers: The Relationship Between Coverage For Adults And Primary Care Capacity In Medically Underserved Communities, Peter Shin, Sara J. Rosenbaum, Brian K. Bruen, Alice (Xiao-Xiao) Lu, Rachel Arguello, Jennifer Tolbert

Health Policy and Management Faculty Publications

Community health centers play an important role in providing care to uninsured and low-income individuals living in medically underserved communities. They rely on many different revenue sources and, over time, Medicaid has become a central source of funding for most health centers. To better understand how Medicaid influences health center practice, this paper compares the strength of health centers in states that have expanded Medicaid coverage for adults to health centers in states with more limited Medicaid coverage for adults. Differences between the two groups of health centers help shed light on the implications of broader Medicaid coverage for low-income …

Intentional Weight Loss And Dose Reductions Of Anti-Diabtetic Medications: A Retrospective Cohort Study, Anita Ashok Kumar, Ghanshyam Palamaner Subash Shantha, Scott Kahan, Rohit Joshua Samson, Nelson David Boddu, Lawrence Jay Cheskin

Health Policy and Management Faculty Publications

Background and Aim

Intentional weight loss, primarily by improving insulin resistance, is known to decrease the need for anti-diabetic medications. In this study, we assess the magnitude of weight loss that resulted in dose reductions or discontinuation of anti-diabetic medications in overweight or obese patients with type 2 diabetes (DM) undergoing weight loss treatment.

Methods

Case records of 50 overweight or obese patients with DM who successfully decreased dosage or discontinued diabetes medications after losing weight via attendance at two University-based, outpatient weight management centers were analyzed. Follow-up visits, weight reduction interventions, and decisions for dose reductions or discontinuation of …

Examining The Evidentiary Basis Of Congress's Commerce Clause Power To Address Individuals' Health Insurance Status, Sara J. Rosenbaum, Leighton C. Ku, Paula M. Lantz, Holly Mead, Michal Mcdowell

Health Policy and Management Faculty Publications

Chief among the issues that the United States Supreme Court considers in United States Department of Health and Human Services et al. v Florida et al. is the questionof whether Congress has the constitutional power to apply a “minimum essential coverage requirement” on most nonelderly Americans. Opponents of the provision (referred to under the Act as the “Individual Responsibility” requirement) argue that compelling individuals to buy affordable health insurance coverage exceeds Congressional powers. By contrast, the United States Department of Justice and supporters of the law assert that the minimum coverage requirement is consistent with a long line of Supreme …

Quality Incentives For Federally Qualified Health Centers, Rural Health Clinics And Free Clinics: A Report To Congress, Leighton C. Ku, Merle Cunningham, Debora Goetz Goldberg, Julie S. Darnell, Martin Hiller, Peter Shin, Alice R. Levy, Kate Buchanan, Fraser Rothenberg Byrne

Health Policy and Management Faculty Publications

This report to Congress is submitted pursuant to Section 13113(b) of the American Recovery and Reinvestment Act of 2009 (hereafter, the Recovery Act), under Title XIII, also known as the Health Information Technology for Economic and Clinical Health Act or the HITECH Act. The Section requires the Secretary of Health and Human Services to provide a study that examines methods to create efficient reimbursement incentives for improving health care quality in federally qualified health centers, rural health clinics, and free clinics.

The report discusses current initiatives and incentives that apply to these categories of primary care clinics and the current …

Saving Money: The Massachusetts Tobacco Cessation Medicaid Benefit: A Policy Paper, Leighton C. Ku, David Zauche, E. Ripley Forbes

Health Policy and Management Faculty Publications

In the United States, about 70% of smokers want to quit and 50% make a quit attempt each year. Unfortunately, only a small percent are successful, due in part to the lack of easy access to tobacco dependence treatments that have been proven effective. In light of the societal costs of tobacco-related illness, government must do everything it can to encourage and enable smokers to quit.

The tobacco use landscape in this country has changed in recent years -- people with lower income and education levels have a much higher probability of smoking. For instance, the smoking rate for those …

The Return On Investment Of A Medicaid Tobacco Cessation Program In Massachusetts, Patrick Richard, Kristina West, Leighton Ku

Health Policy and Management Faculty Publications

Background and Objective

A high proportion of low-income people insured by the Medicaid program smoke. Earlier research concerning a comprehensive tobacco cessation program implemented by the state of Massachusetts indicated that it was successful in reducing smoking prevalence and those who received tobacco cessation benefits had lower rates of in-patient admissions for cardiovascular conditions, including acute myocardial infarction, coronary atherosclerosis and non-specific chest pain. This study estimates the costs of the tobacco cessation benefit and the short-term Medicaid savings attributable to the aversion of inpatient hospitalization for cardiovascular conditions.

Methods

A cost-benefit analysis approach was used to estimate the program's …

Improving Patient Flow And Reducing Emergency Department Crowding: A Guide For Hospitals, Megan Mchugh, Kevin Vandyke, Mark Mcclelland, Dina Moss

Health Policy and Management Faculty Publications

No abstract provided.

A Survey Of Sub-Saharan African Medical Schools, Candice Chen, Eric Buch, Travis Wasserman, Seble Frehywot, Fitzhugh Mullan, Francis Omaswa, S. R. Greysen, Joseph C. Kolars, Delanyo Dovlo, Diaa El Gali Abu Bakr, Abraham Abraham Haileamlak, Abdel K. Koumare, Emiola O. Olapade-Olaopa

Health Policy and Management Faculty Publications

Background

Sub-Saharan Africa suffers a disproportionate share of the world's burden of disease while having some of the world's greatest health care workforce shortages. Doctors are an important component of any high functioning health care system. However, efforts to strengthen the doctor workforce in the region have been limited by a small number of medical schools with limited enrolments, international migration of graduates, poor geographic distribution of doctors, and insufficient data on medical schools. The goal of the Sub-Saharan African Medical Schools Study (SAMSS) is to increase the level of understanding and expand the baseline data on medical schools in …

Duration Of Patients’ Visits To The Hospital Emergency Department, Zeynal Karaca, Herbert S. Wong, Ryan L. Mutter

Health Policy and Management Faculty Publications

Background

Length of stay is an important indicator of quality of care in Emergency Departments (ED). This study explores the duration of patients’ visits to the ED for which they are treated and released (T&R).

Methods

Retrospective data analysis and multivariate regression analysis were conducted to investigate the duration of T&R ED visits. Duration for each visit was computed by taking the difference between admission and discharge times. The Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) for 2008 were used in the analysis.

Results

The mean duration of T&R ED visit was 195.7 minutes. The average …