Health Policy Commons^™

Berbagai Faktor Yang Berhubungan Dengan Beban Biaya Obat Pasien Rawat Inap Program Askeskin, Di Cirebon Tahun 2005, Lucya Agung Susilawati, Hasbullah Thabrany

Kesmas

Askeskin membayar klaim pengobatan rumah sakit untuk penduduk miskin dengan tarif yang ditetapkan. Namun, resep obat tidak terdaftar yang tidak boleh dibebankan pada pasien justru menjadi beban rumah sakit. Inisiatif pimpinan RSUD Gunung Jati menyediakan dana pendamping menjadi beban secara finansial. Pada tahun 2005, rujukan pasien rawat inap kelas III, meningkat 153% dan beban pasien luar kota meningkat 331%. Tujuan penelitian ini mengetahui faktor faktor yang mempengaruhi beban RS menutupi biaya perawatan, khususnya obat non DPHO yang tidak dapat diklaim ke Askes. Penelitian menggunakan sumber data catatan medik, catatan klaim dan studi kualitatif wawancara mendalam. Ditemukan bahwa pasien luar yang …

Nongovernmental Program Replication And Implementation: What Can Community-Based Programs To Support The Uninsured Learn From Other Communities?, Raymond J. Higbea

Dissertations

This research study evaluated the replication and implementation of Project Access (a nongovernmental, structured program providing physician and health care services to the working-poor) in Grand Rapids, Michigan. A mixed methodological approach was used and included quantitative and qualitative methodologies. The qualitative method used was a self-administered mailed survey of all Project Access enrollees. This survey evaluated the enrollee's perceived health and lifestyle function, access to physician services, access and adherence to prescribed medication regimen, and barriers to physician services during the year pre- and post-enrollment in Project Access. The survey also evaluated the amount enrollees were able or willing …

Fairness Issues In Law And Mental Health: Directions For Future Social Work Research, Jose B. Ashford, Jane Holschuh

The Journal of Sociology & Social Welfare

Concepts from the procedural justice literature in social psychology are examined that offer useful guidance for social work researchers with interests in investigating informal adjudications, speciality treatment courts, and other areas of the administrative process previously neglected in mental health services research. These theoretical concepts are offered as an alternative to the therapeutic jurisprudence framework being adopted by some social workers in the field of law and mental health. The issues outlined in this paper also draw on the health services and psychotherapy literature to highlight issues involving process and procedure as social justice and their significance for advancing a …

Review Of The Rise And Fall Of Hmos: An American Health Care Revolution. Jan Gregoire Coombs. Reviewed By Lisa S. Patchner., Lisa S. Patchner

The Journal of Sociology & Social Welfare

Book review of Jan Gregoire Coombs, The Rise and Fall of HMOs: An American Health Care Revolution. Madison, WI: University of Wisconsin Press, 2005. $35.00 hardcover.

Ethiopian Language Policy And Health Promotion In Oromia, Begna Dugassa

The Journal of Sociology & Social Welfare

In the time of HIV/AIDS, epidemics for which we have no vaccination or cure, public health is bound entirely to depend on the traditional health education strategies to stop or contain this disease. This reality demands that we travel extra miles and thoroughly employ every health promotion tool at our disposal. The Ottawa Charter for health promotion stressed the need for public policy to create supportive social conditions for health. This necessitates a commitment to enduring social conditions for health and raises topics that have been neglected by the traditional public health scholars. A close examination of the colonial language …

Health Care Poverty, Lisa Raiz

The Journal of Sociology & Social Welfare

This paper introduces and describes health care poverty. Underinsurance and its consequences for access to health care are highlighted. Definitions of underinsurance and its prevalence are presented. Groups that experience disproportionate barriers to obtaining medical care are identified. Manifestations of underinsurance are explicated and their relationship to receipt of medical care, such as vaccinations and medications is discussed. A refraining of the health care debate is suggested with emphasis moving from uninsurance to access to health care.

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.

Accès Aux Médicaments À Madagascar : L’Etat, La Pharmacie, Et L’Usager, Peter Olds

Independent Study Project (ISP) Collection

No abstract provided.

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 …

Persepsi Stakeholders Tentang Kinerja Fungsi Sistem Penelitian Kesehatan Nasional, Anni Yulianti

Kesmas

Analisis kinerja fungsi sistem penelitian kesehatan nasional (SPKN) diperlukan untuk identifikasi penguatan dan peningkatan sistem yang mendukung pencapaian pemerataan kesehatan. Penelitian ini bertujuan mengukur skor kinerja fungsi utama SPKN yang meliputi pengelola, pendanaan, mengumpulkan dan memelihara sumber, produksi dan penggunaan riset berdasarkan pendapat stakeholders (peneliti, pembuat kebijakan, dan pengguna). Sumber data yang digunakan adalah pilot study WHO di Jakarta dan Makassar WHO dengan ukuran sampel 278 responden. Analisis dilakukan terhadap skor rata-rata 6 dimensi pendapat meliputi lingkungan; pandangan sistem, pembuatan, penggunaan, akses literur ilmiah dan media. Metoda analsis meliputi analisis kuantitatif univariat dan cross tabulasi tanpa uji statistik dan analisis …

Unintended Consequences In Public Policy: Formulation And Implementation Of Michigan’S Safe Delivery Of Newborns Law, Anne Julie Hacker

Dissertations

It is generally believed that social policy is the result of careful research and planning on the part of officials. Yet there often exists a gap between theformulation and implementation of many social policies. This gap brings with it conflict, which in turn may result in unintended consequences. Theseconsequences may be so antithetical to the formulators' original intent as to make the policy implementation paradoxical.

This qualitative research study examines the ambiguities, challenges, or boundaries that policy formulators placed on practitioners responsible for implementing Michigan's Safe Delivery of Newborns Act and that ultimately created unintended consequences indicative of a public …

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 …

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 …

Providing Uninsured Adults With Free Or Low-Cost Primary Care: Does It Influence Their Use Of Hospital Emergency Departments?, Anne G. Zahradnik

Dissertations

This study analyzes one component of the health care safety net to determine whether or not being enrolled in a free or low-cost primary care physician access program subsequently affects emergency room utilization by uninsured adults ages 18 through 64. Those individual decisions are analyzed from both public goods and rational choice schemas. Additionally, physician access programs of different formats (a low-cost physician referral program and a freewalk-in clinic) are analyzed and compared for relative effectiveness. The study is a quantitative analysis of more than 40,000 individual patient records rather than relying on qualitative patient recall or on analyzing broad …

Pursuing Cost Containment In A Pluralistic Payer Environment: From The Aftermath Of Clinton’S Failure At Health Care Reform To The Balanced Budget Act Of 1997, Rick Mayes, Robert E. Hurley

Political Science Faculty Publications

Following a decade in which Medicare operated as the leading ‘change agent’ within the US health care system, the private sector rose to the fore in the mid 1990s. The failure of President Clinton’s attempt at comprehensive, public sector-led reform left managed care as the solution for cost control. And for a period it worked, largely because managed care organizations were able to both squeeze payments to selective networks of medical providers and significantly reduce inpatient hospital stays. There was a lot of ‘fat’ in the nation’s convoluted health care system that could be (and was) eliminated through competitive negotiations …

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 …

Taking Liberties, Matt Kozusko

English and Creative Writing Faculty Publications

The 'place' scholars have assigned to the stage in early modern London is as much a reflection of the procedures of contemporary literary criticism as a reflection of the cultural function of popular drama in the early modern period. Modern critics are often not engaged in re-examining available data, preferring instead to rest on a conjectural paradigm or heuristic that has hardened, over the past couple of decades, into a New Historicist version of 'fact'. Critics have collapsed boundaries and important distinctions in London jurisdiction and geography in the interest of a unified critical narrative that characterizes the theatre as …

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.

Creating Progam Logic Models: A Toolkit For State Flex Programs, John A. Gale Ms, Andrew F. Coburn Phd, Stephanie Loux Ms

Population Health & Health Policy

A logic modeling toolkit developed by the Flex Monitoring Team is available for use by state Medicare Rural Hospital Flexibility Programs (Flex Programs) in planning for and managing their Flex programs. The use of the Program Logic Model (PLM) Toolkit will provide states with a tool to assist in:

Planning, managing, reporting on, and assessing their Flex Program goals, activities, and accomplishments;

• Developing buy-in among key Flex Program stakeholders;
• Clarifying the underlying program assumptions;
• Identifying and defining measurable outcomes;
• Linking state-level Flex Program strategies and activities to specific and measurable outcomes; and
• Reporting program results to both internal and external …

Data Integration And Storage: Managing And Using Home And Community-Based Services Data For Quality Improvement, Carolyn E. Gray Mph, Maureen Booth Mrp, Ma

Disability & Aging

This paper reports on data integration from a program manager’s perspective. The paper is not meant to be an exhaustive research document, nor does it single out any one correct approach. The paper is meant to facilitate communication between program units and analytic staff and serve as one reference for states as they continue to improve upon data collection techniques and use this information for ongoing quality management and improvement.

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 …

The War On Drugs V. The War On Pain: Do Controlled Prescribing Laws Have A Role?, Susanne F. Homant

Dissertations

The illegal use of prescription drugs and the under-treatment of chronic pain are both considered serious public health issues in this country. Strong medicines classified as controlled substances by the DEA are often used to treat chronic pain conditions and are also known to be diverted to non-medical uses, thus a solution to one problem may happen at the expense o f the other. Prescription Monitoring Programs (PMPs) are public policies that are felt by many to address diversion of controlled substances, and are generally welcomed by law enforcement as an excellent tool in the war against drugs. A number …

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.

Survey Findings: Children Served By Mainecare, 2005, Catherine Ormond, Deborah Thayer

Disability & Aging

No abstract provided.

The Impact Of Inequalities In Economic Performance On Their Health-Care Services Between Urban And Rural Areas In China, Lei Zhang

Theses

No abstract provided.