Health Policy Commons^™

Addressing Disparities In Health And Health Care: Issues For Reform, Marsha Lillie-Blanton

Health Policy and Management Congressional Testimonies

The testimony focuses on the role of health insurance in reducing disparities in health care and in health status, two distinct but related challenges. Disparities in health care – whether in insurance coverage, access, or quality of care – are one of many factors producing inequalities in health status in the U.S. Eliminating disparities in health among segments of the population (e.g., by race/ethnicity, education, income, gender, geographic location) was one of two overarching goals of Healthy People 2010, the federal government’s blueprint for what it wanted to achieve in health by the end of this decade.

Primer On Medicare Advantage Payments In 2008, Brian Biles, Emily Adrion

Health Policy and Management Faculty Publications

The Medicare Modernization Act of 2003 (MMA) included provision intended to increase the role of private health plans in Medicare. These provisions, building on policies adopted earlier in 1997 and 2000, set Medicare Advantage (MA) plan benchmark rates at levels higher than average costs 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 policies total over $8.5 billion in 2008 and over $82 billion over the five year period between 2009 and 2013.

This briefing paper outlines the three major Medicare policies that generate these extra …

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 …

Career Goals Of Trainee Physicians In Internal Medicine, Muhammad Junaid Patel, Mehmood Riaz, M. Tariq, Sajjad Jamil, Tayyaba Ansari, M. Shoaib Khan, Abdul Jawwad Samdani, Syed Imran Ayaz, Ayesha Sorathia, Jaweed Akhtar

Section of Internal Medicine

OBJECTIVE: To survey Internal Medicine trainees' future career choices and factors influencing their decision-making.

DESIGN: Cross-sectional study.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from November 2006 to January 2007.

SUBJECTS AND METHODS: A standard questionnaire was administered to the residents and Interns working in the Department of Internal Medicine of The Aga Khan University Hospital. The questionnaire covered demographic details, specialty choice, work-time distribution and factors influencing career choice. Descriptive statistics were applied.

RESULTS: A total of 49 doctors participated with 57% females; and 43% males, having 33% interns and 67% residents. A minority (22%) …

Global Health And Politics: Julia Alvarez’ Saving The World, Amrita Das

The Coastal Review

Julia Alvarez’ novel Saving the World (2006) is a comment on the politics of Global Health. Alvarez reconstructs the tale of Isabel Sendales y Gomez, the lone female participant in the early 19th century’s Spanish Royal Expedition to eradicate smallpox around the world, mainly in the Spanish colonies. The historical narrative is paralleled by the tale of Alma Rodríguez, a 21st Century Dominican American author who is faced with a similar situation, aiding in an idealistic project to eradicate AIDS in the Dominican Republic. Alvarez’ work throws into sharp relief what happens when the philanthropic ideals of healing the world …

Grantee-Level Estimates Show That 31 Percent Of All Health Centers Would Fail To Meet Tier Two Status Under Hrsa's Proposed Mua/Mup/Hpsa Designation Regulations, Peter Shin, Leighton C. Ku, Emily Jones, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In April of 2008, we issued a research brief which analyzed the impact on various federal programs of a February 29, 2008 Notice of Proposed Rulemaking (NPRM) regarding the designation of Medically Underserved Populations and Health Professional Shortage Areas. Among its findings, the report estimated that resources for one-third of community health center sites would be jeopardized by this rule change because they could not attain a sufficiently high priority status, even under the newly-proposed, higher-scoring Tier 2 methodology. On May 1, 2008, we issued a revision in response to an April 21, 2008 clarification notice from the Health Resources …

Building A High-Quality Language Services Program Toolkit, Jennifer Trott, Catherine West, Priti Shah, Marsha Regenstein

Health Policy and Management Faculty Publications

Ten hospitals with racially and ethnically diverse patient populations participated in the Robert Wood Johnson Foundation's "Speaking Together: National Language Services Network," a program aimed at improving the quality and availability of health care language services for patients with limited English proficiency (LEP). This toolkit provides advice to hospitals on improving quality and accessibility of language services.

Harnessing Knowledge To Ensure Food Safety: Opportunities To Improve The Nation's Food Safety Information Infrastructure, Michael R. Taylor, Michael B. Batz

Health Policy and Management Faculty Publications

Those working in the food industry face an abundance of information generated by diverse institutions and individuals.

Ensuring the safety of food is critically important to the public's health and a challenge for policy-makers seeking to enhance the government's role in this arena. Although the food industry has an inherent duty to make food safe, the effectiveness of what they do is highly dependent on the quality of the information they receive on potential hazards and good practices.

In this context, the Robert Wood Johnson Foundation funded a project under the auspices of the Food Safety Research Consortium to examine …

Sistem Anggaran Rumah Sakit Yang Berorientasi Kinerja Untuk Meningkatkan Kualitas Keuangan Publik, Wahyu Sulistiadi

Kesmas

Upaya meningkatkan mutu pelayanan terbaik dan untuk memperbaiki standar pelayanan, manajemen di rumah sakit perlu memperhatikan kinerja pencapaian unit-unit pelaksana pelayanan kesehatan tersebut. Salah satu upaya mengalokasikan sumber daya rumah sakit dalam pengendalian kinerja pelayanan rumah sakit adalah sistem anggaran. Kebanyakan rumah sakit yang merupakan keuangan publik masih mengandalkan sistem anggaran tradisional dalam perencanaan anggarannya. Sistem anggaran rumah sakit berorientasi pada kinerja (performance budgeting) merupakan upaya terobosan prinsip anggaran tradisional yang kerap dilakukan. Walaupun ada kesulitan dalam menentukan output measurement, sistem anggaran ini dapat diandalkan dalam reformasi keuangan rumah sakit karena memiliki banyak kelebihan dalam akuntabilitas keuangan rumah sakit.

In …

Highlights: Analysis Of The Proposed Rule On Designation Of Medically Underserved Populations And Health Professional Shortage Areas, Peter Shin, Leighton C. Ku, Emily Jones, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

For decades, the federal government has targeted health care funding, resources and staff to meet the health care needs of areas designated as "medically underserved areas" and "health professional shortage areas." Areas that qualify may, for example, receive federal funding to support the establishment and operation of community health centers, or receive National Health Service Corps (NHSC) physicians and clinicians. In addition, physicians who practice in these health shortage areas may receive higher payments under Medicare. These designations thus affect the availability of health care in thousands of urban and rural areas all across the United States. Community health centers …

Analysis Of The Proposed Rule On Designation Of Medically Underserved Populations And Health Professional Shortage Areas, Peter Shin, Leighton C. Ku, Emily Jones, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Numerous safety net programs and health care providers depend on Medically Underserved Area and Population (MUA/P) and Health Professional Shortage (HPSA) designations to qualify for federal funding, physician subsidies and placement, and health-related investments to improve access to care for communities and populations at high risk of poor health. These resources are particularly critical for federally-qualified health centers at a time when the number of uninsured is growing and the capacity of the safety net shrinking. On February 29, 2008, the Department of Health and Human Services (HHS) released a proposed regulation to alter the way these designations are made. …

¨En Este País No Se Habla Con La Verdad¨: Investigando La Falta De Educación Sexual En El Ecuador¨, Laney Rupp

Independent Study Project (ISP) Collection

No abstract provided.

Artificial Transitive Fatty Acid (Tfa) Ban In Restaurants In Us Cities: Nyc-Doh Tfa Ban As A Model For Proactive Public Health Policy, Vidia S. Ramdeen

Master in Public Administration Theses

Today, restaurants, including all eateries that operate within New York City, as well as restaurants across the country, regularly use a rather large amount of an artery-clogging agent, commonly found within their vital ingredients. Artificial transitive fatty acid, or trans-fat as known to the consumer, is the target of the NYC Board of Health and Mental Hygiene, medical experts, and health conscious consumers, for permanent removal from all NYC restaurant menus by July 2008. Specifically, the NYC health code now requires that all establishments holding a NYC Health Department permit, including all restaurants, caterers, stationary hot and cold vendors, and …

South Africa’S Unsung “She-Roes”: A Practicum Study Of Npo Grandmothers Against Poverty And Aids, Khayelitsha Township, Cape Town, Rachel Pryzby

Independent Study Project (ISP) Collection

Across Africa, the AIDS pandemic has forced HIV+ individuals and orphaned children into the care of elderly women. Though this has occurred in millions of families, little support has been offered for the grandmothers supporting children and grandchildren on a limited income. This study reports on a practicum study at Grandmothers Against Poverty and AIDS (GAPA), the first African organization to recognize the important role played by grandmothers in light of HIV/AIDS. The study was conducted in April 2008 at the GAPA center in Khayelitsha Township, Cape Town. The main objective of the study was to evaluate the organization’s origin, …

Differential Impacts Of Smoke-Free Laws On Indoor Air Quality, Kiyoung Lee, Ellen J. Hahn, Nick Pieper, Chizimuzo T.C. Okoli, James Repace, Adewale Troutman

Nursing Faculty Publications

The authors assessed the impacts of two different smoke-free laws on indoor air quality. They compared the indoor air quality of 10 hospitality venues in Lexington and Louisville, Kentucky, before and after the smoke-free laws went into effect. Real-time measurements of particulate matter with aerodynamic diameter of 2.5 µm or smaller (PM_2.5) were made. One Lexington establishment was excluded from the analysis of results because of apparent smoking violation after the law went into effect. The average indoor PM_2.5 concentrations in the nine Lexington venues decreased 91 percent, from 199 to 18 µg/m³. The average …

Children Served By Mainecare, 2007: Survey Findings, Deborah Thayer Mba, Nathaniel J. Anderson Ms, Mph

Population Health & Health Policy

This report presents findings from a telephone survey of children currently enrolled in or recently disenrolled from MaineCare, the State‘s Medicaid and State Children‘s Health Insurance Program (SCHIP). The sample was randomly selected, and stratified to include children enrolled in MaineCare through the Medicaid eligibility category, and through two SCHIP eligibility categories, Medicaid Expansion and the Separate Child Health Program (CHP). 1 These three eligibility categories include children ages 18 or under living in households with income up to 200% of the Federal Poverty Level. Income eligibility limits are lowest for the Medicaid eligibility category, followed by the Medicaid Expansion …

Cms' Medicaid Regulations: Implications For Children With Special Health Care Needs, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

The Centers for Medicare and Medicaid Services (CMS) is currently engaged in a policy initiative that should serve as a reminder of the power of a single federal administrative agency to change the course of national health policy. Through a virtual deluge of regulations and policy issuances, CMS has sought to redirect the course of Medicaid; in a number of respects, the course that CMS has sought to chart for the program is not only poorly thought out and ill-considered, but would actually propel the program in a direction directly contrary to both longstanding federal statutory provisions and recent decisions …

Political Economy, Moral Economy And The Medicare Modernization Act Of 2003, Judie Svihula

The Journal of Sociology & Social Welfare

Through the lens of political and moral economy, I examined the dominant values and actors in the legislative process of the Medicare Modernization Act of 2003. In my content analysis of federal hearings, I found that witnesses from government agencies, Congress and think tanks had almost equal presence at the hearings. Witnesses who were invited by Congress to testify at the hearings expressed twice as much support for private interests than for the general Medicare population or low-income beneficiaries. Few expressed concern for the uninsured population. Witnesses offered almost four times as many expressions of support for market rationalism than …

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.

Tracing The History Of Medicare Home Health Care: The Impact Of Policy On Benefit Use, Joan K. Davitt, Sunha Choi

The Journal of Sociology & Social Welfare

We trace key policy changes that affected use of the Medicare home health benefit from the 1980s through the prospective payment system implemented in 2000, analyzing the impact on three measures of home care use: expenditures, users and visits. We demonstrate the impact of policies generated in the legislative, the judicial, and the executive branches of government and the gaming behavior of home health agencies in response to policy changes. Our analysis suggests that the policy itself and the implementation process are critical to understanding benefit use. The incentives in the policies and agency reactions had the potential to generate …

How Does Investment In Community Health Centers Affect The Economy?, Peter Shin, Brad Finnegan, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

The economic slowdown that began in 2007 has prompted policymakers to focus on investments that can produce rapid economic gains in communities. Building on a previous analysis, this Research Brief estimates that a $250 million appropriations increase in the community health centers program would yield health care for an additional 1.8 million patients and a nationwide four-to-one return on investment:

• nearly $1 billion in direct community economic benefits, and
• over $1.1 billion in indirect benefits in jobs and other community investments.

On a state-by-state basis, each $1 million in federal appropriations would assure care for an additional 8,400 patients and …

Regulasi Pengendalian Masalah Rokok Di Indonesia, Anhari Achadi

Kesmas

Regulasi pengendalian masalah merokok di Indonesia ada dalam bentuk peraturan perundang-undangan yang dihasilkan oleh Badan Legislatif maupun peraturan yang dikeluarkan oleh Badan Eksekutif. Perundang-undangan paling tinggi yang mengatur masalah merokok berupa Peraturan Pemerintah yang berlaku saat ini adalah PP No 19 tahun 2003. Peraturan Pemerintah tersebut merupakan amandemen Peraturan Pemerintah sebelumnya, yaitu PP No 39 Tahun 2000, yang juga merupakan bentuk amandemen dari PP sebelumnya lagi, yaitu PP No 81 Tahun 1999. PP No 19 Tahun 2003 yang mengatur beberapa hal penting yang meliputi a) kandungan kadar nikotin dan tar; b) persyaratan produksi dan penjualan rokok; c) persyaratan iklan dan …

Analisis Beban Biaya Sendiri Pasien Rawat Inap Peserta Askes Di Rsud Dr. Achmad Diponegoro, Putussibau, Kalimantan Barat, Johanes Eko Kristiyadi

Kesmas

PT. Askes asuradur yang mengelola asuransi wajib pegawai negeri sipil yang dalam peraturannya membolehkan peserta membayar beban biaya sendiri (out of pocket) karena perbedaan antara tarif rumah sakit dengan tarif paket Askes. Penelitian ini bertujuan untuk mengetahui berbagai faktor yang berpengaruh dan model prediksi beban biaya sendiri pasien rawat inap peserta Askes di RSUD dr. Achmad Diponegoro-Putussibau, Kabupaten Kapuas Hulu, Propinsi Kalimantan Barat, tahun 2005. Rancangan penelitian yang digunakan adalah survei dengan sampel sebesar 257 pasien rawat inap tahun 2005. Dfitemukan Rata-rata beban biaya sendiri sebesar Rp. 215.472atau 20,84 % dari rata-rata biaya perawatan sesuai tariff RSUD. Beban minimum dan …

Health Information Privacy, Patient Safety, And Health Care Quality: Issues And Challenges In The Context Of Treatment For Mental Health And Substance Use, J. Zoe Beckerman, Joy Pritts, Eric Goplerud, Jacqueline C. Leifer, Phyllis Borzi, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

No abstract provided.

Vision Exams For Children Prior To Entering School, Brad Finnegan, Peter Shin

Health Policy and Management Faculty Publications

Children's vision problems are very common, affecting nearly 15 million children. Early screening and detection are essential in treating eye disorders in children. This fact sheet discusses statistical data associated with Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) of vision/eye conditions, and provides recommendations from the National Commission on Vision and Health.

Access To Comprehensive Vision Care Services Under Schip, Brad Finnegan, Peter Shin

Health Policy and Management Faculty Publications

Vision services are generally classified as optional benefits in Medicaid and SCHIP, and access to vision care services may vary due to lack of uniform coverage and benefit design across states. Although children enrolled in Medicaid are generally able to obtain access to vision care services through the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit, states that operate separate SCHIP programs are not mandated to cover EPSDT benefits. A GAO report found that states tend to place more limits on vision benefits in SCHIP than in Medicaid and in ten states limit the number of exams and corrective …

Health Centers: An Overview And Analysis Of Their Experiences With Private Health Insurance, Peter Shin, Brad Finnegan, Jessica Sharac, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Steady growth in the number of uninsured and under-insured has sparked health reform proposals at the national and state levels. With many proposals emphasizing expanded access to private health insurance among the low-income population through the use of tax credits and an emphasis on stable and continuous primary care as a key to improving health care access, the interaction between health centers and private health insurance becomes an important aspect of national health policy. This policy brief provides an overview of health centers, with a special focus on the relationship between health centers and private health insurance.

Urban Containment Policies And Physical Activity A Time–Series Analysis Of Metropolitan Areas, 1990–2002, Semra Aytur, Daniel A. Rodriguez, Kelly R. Evenson, Diane J. Catellier

Health Management & Policy

Background: Urban containment policies attempt to manage the location, character, and timing of growth to support a variety of goals such as compact development, preservation of greenspace, and efficient use of infrastructure. Despite prior research evaluating the effects of urban containment policies on land use, housing, and transportation outcomes, the public health implications of these policies remain unexplored. This ecologic study examines relationships among urban containment policies, state adoption of growthmanagement legislation, and population levels of leisure and transportation-related physical activity in 63 large metropolitan statistical areas from 1990 to 2002. Methods: Multiple data sources were combined, including surveys of …

Resuscitating A Healthcare Charity, R Akhileswaran, Seet Ai Mee

Social Space

When government funding policies change, voluntary welfare organisations that depend largely on subsidies to run their services can find their survival at stake. Dr R Akhileswaran and Dr Seet Ai Mee present the case study of HCA Hospice Care.

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.