Health Policy Commons^™

Social Actors Fight The Rising Tide Of Hiv In U.S. Southern Poor, Courtenay Sprague, Sara E. Simon

Center for Peace, Democracy and Development Publications

The greatest number of persons living with HIV in the United States are now living in the South, and they face poorer health outcomes and increased AIDS-related deaths as compared to the rest of the country. The southern United States has a disproportionate share of low-income individuals, with many lacking access to health care and health insurance. Health facilities are also comparatively fewer and more difficult to reach than in other areas of the United States. The impacts of this already poor health infrastructure on low-income people living with HIV in the South can be life-threatening.

This policy brief summarizes …

Understanding Hiv Care Delays In The Us South And The Role Of The Social-Level In Hiv Care Engagement/Retention: A Qualitative Study, Courtenay Sprague, Sara E. Simon

Center for Peace, Democracy and Development Publications

Introduction: In a significant geographical shift in the distribution of HIV infection, the US South - comprising 17 states - now has the greatest number of adults and adolescents with HIV (PLHIV) in the nation. More than 60% of PLHIV are not in HIV care in Alabama and Mississippi, contrasted with a national figure of 25%. Poorer HIV outcomes raise concerns about HIV-related inequities for southern PLHIV, which warrant further study. This qualitative study sought to understand experiences of low-income PLHIV on the AIDS Drug Assistance Program in engagement and retention in continuous HIV care in two sites in Alabama. …

Kebutuhan Jaminan Kesehatan Masyarakat Di Wiliyah Perdesaan, Arif Kurniawan, Arih Diyaning Intiasari

Kesmas

Jaminan kesehatan adalah salah satu cara untuk mengurangi beban pembiayaan kesehatan yang dikeluarkan masyarakat. Sebagian besar masyarakat perdesaan di Kabupaten Banyumas yang mempunyai tingkat kemampuan membayar pelayanan kesehatan rendah belum mempunyai jaminan kesehatan. Penelitian ini bertujuan untuk menganalisis kebutuhan jaminan dan faktor-faktor yang memengaruhi kesehatan masyarakat daerah. Penelitian ini merupakan penelitian observasional dengan desain studi cross sectional. Populasi penelitian adalah seluruh kepala keluarga diKabupaten Banyumas dengan jumlah sampel 130 orang. Metode analisis yang digunakan meliputi analisis univariat, bivariat, dan multivariat. Penelitian menemukan bahwa sebagian besar masyarakat Kabupaten Banyumas (72,3%) membutuhkan jaminan kesehatan daerah (Jamkesda). Terdapat hubungan antara pendidikan, pengetahuan, pendapatan, …

Tingkat Kepuasan Karyawan Perusahaan Swasta Dalam Pelayanan Jaminan Sosial Tenaga Kerja (Jamsostek), Matias Siagian

Kesmas

Penelitian ini berbentuk penelitian deskriptif yang mengkaji masalah pelaksanaan program Jaminan Sosial Tenaga Kerja (Jamsostek) sebagai hak karyawan. Penelitian ini bertujuan mengetahui tingkat kepuasan karyawan yang bermukim di desa Mulyorejo, sebuah desa industri, dalam pelayanan Jamsostek khususnya Jaminan Pemeliharaan Kesehatan, Jaminan Kecelakaan Kerja, dan Jaminan Kematian. Sampel penelitian terdiri dari 70 keluarga karyawan peserta Jamsostek. Data dikumpulkan dengan menggunakan kuesioner dan dianalisis dengan menggunakan statistik deskriptif. Tingkat kepuasan karyawan diukur dengan skala likert. Hasil penelitian menyimpulkan, secara umum pelayanan Jamsostek belum memuaskan. Sosialisasi belum memuaskan karyawan. Dari tiga pelayanan yang diteliti, hanya satu yang memuaskan, yaitu Jaminan Kematian, sedangkan pelayanan …

The Power To Block The Affordable Care Act: What Are The Limits?, John D. Kraemer, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Though Supreme Court upheld most parts of the Affordable Care Act (ACA), Congress’ goals in enacting it could still be frustrated by non-implementation. During his campaign for president, Governor Romney promised “to issue Obamacare waivers to all fifty states.” While such blanket waivers would likely violate the Constitution’s Take Care Clause, the ACA does permit other waivers. To be lawful, however, they must meet certain requirements designed to enhance access and lower cost. A president who opposes the ACA might be able to limit its implementation by refusing to issue premium subsidies in federally operated insurance exchanges, and this might …

The Patient Protection And Affordable Care Act: Why It Is Important For Women’S Health, Mary Fanning

Journal of Interdisciplinary Feminist Thought

President Barack Obama signed into law the Patient Protection and Affordable Care Act (ACA) on March 23, 2010 ending the long history of disparity in access to health care services between insured and uninsured persons. Disparity between women and men in obtaining health insurance coverage is also corrected in the act. Women’s organizations that have focused attention on women’s distinctive health needs over the past century and a half laid the foundation for provisions in the legislation that address women’s health. This article addresses health insurance coverage, its impact on health, the particular challenges women have confronted in seeking coverage, …

The Quest For Universal Health Coverage: Achieving Social Protection For All In Mexico, Felicia Marie Knaul, Eduardo GonzáLez-Pier, Octavio GóMez-DantéS, David GarcíA-Junco, HéCtor Arreola-Ornelas, Mariana Barraza-LloréNs, Rosa Sandoval,, Francisco Caballero, Mauricio HernáNdez-Avila, Mercedes Juan, David Kershenobich, Gustavo Nigenda, Enrique Ruelas, Jaime SepúLveda, Roberto Tapia, Guillermo SoberóN, SalomóN Chertorivski, Julio Frenk

Aboriginal Policy Research Consortium International (APRCi)

Mexico is reaching universal health coverage in 2012. A national health insurance programme called Seguro Popular, introduced in 2003, is providing access to a package of comprehensive health services with financial protection for more than 50 million Mexicans previously excluded from insurance. Universal coverage in Mexico is synonymous with social protection of health. This report analyses the road to universal coverage along three dimensions of protection: against health risks, for patients through quality assurance of health care, and against the financial consequences of disease and injury. We present a conceptual discussion of the transition from labour-based social security to social …

Justice Roberts’ America, Robin West

Georgetown Law Faculty Publications and Other Works

Less than a week after the Roberts Court issued its decision in National Federation of Independent Business v Sebelius, Jeffrey Toobin, writing in The New Yorker, compared the first part of Chief Justice John Roberts's opinion, in which he found that the Commerce Clause did not authorize Congress to enact the "individual mandate" section of the Affordable Care Act (ACA) that requires all individuals to buy health insurance, with an Ayn Rand screed, noting that the pivotal sections of the argument were long on libertarian rhetoric but short on citations of authority. Roberts held (although "held" might be …

What Is The Optimal Subsidy For Exercise? Informing Health Insurance Companies' Fitness Reimbursement Programs, Molly E. Frean

Economics Honors Projects

Health care costs account for 17% of US GDP and many programs and policies seek to reduce these costs. This paper focuses on exercise as preventive care due to its immense physiological benefits. I model the profit-maximizing choice of health insurance companies to subsidize exercise and the utility-maximizing choice of individuals to engage in exercise using a traditional principal-agent framework. I then use principles from behavioral economics and psychology to critique these models and provide further insight into understanding our underconsumption of such preventive services. I end with an evaluation of current programs and suggestions for improvement using empirical findings.

Affordable Care Act Litigation: The Supreme Court And The Future Of Health Care Reform, Lawrence O. Gostin, Kelli K. Garcia

Georgetown Law Faculty Publications and Other Works

In Florida v. HHS, a lawsuit brought on behalf of 26 states challenging the constitutionality of the Patient Protection and Affordable Care Act (ACA), the Supreme Court will determine the future direction of health care reform in the United States. During the unprecedented 5-1/2 hours of oral arguments, the Court will hear 4 issues: the individual purchase mandate, severability, the Medicaid expansion and the Anti-Injunction Act.

The states challenging the ACA maintain that the purchase mandate uniquely penalizes individuals for failing to purchase insurance. Uninsured individuals, however, rarely do nothing. Instead, they self-insure, rely on family, and cost-shift to …

Postmortems On The Affordable Care Act (Book Review), Rick Mayes

Political Science Faculty Publications

Nearly two years after the Affordable Care Act became law, books are appearing by Washington insiders who detail how the legislation came about. The two reviewed here discuss and dissect topics related to the health reform law from decidedly different points of view.

The Way It Was In Health Policy, And Probably Will Be: Learning Lessons By Rashi Fein (Book Review), Rick Mayes

Political Science Faculty Publications

Learning Lessons by Rashi Fein is an enjoyable memoir from a scholar and policy adviser unlike any other. Fein’s influential involvement in health care policy dates back to John F. Kennedy’s administration, and his career as a leading health economist paralleled the significant growth in the political influence of health economists following the enactment of Medicare and Medicaid in 1965. Now an emeritus professor of the economics of medicine at Harvard Medical School, Fein writes here about the lessons he learned in medicine, economics, and public policy. His view of the policy process, as a way of coming to …

Risky Business: Effectiveness Of State Market-Based Health Programs, Christopher Stream, Nathan Myers

Public Policy and Leadership Faculty Research

Since the 1990s, state governments have been leaders of health care reform. Today, approximately 47 million people are without health insurance. As health care costs and uninsurance levels continue to rise, states are pursuing a variety of government- and market-based strategies to address this growing social problem. Health care research has indicated that state-based programs have proven to be successful in extending access to coverage. However, the question remains as to whether the market-based programs have had a positive impact on state health care. Advocates for market-based state health programs argue that the reforms benefit the greater good because they …

Fragmentation In Mental Health Benefits And Services: A Preliminary Examination Into Consumption And Outcomes, Barak D. Richman, Daniel Grossman, Frank Sloan

Faculty Scholarship

In this chapter, we examine consumption patterns and health outcomes within a health insurance system in which mental health benefits are administered under a carved-out insurance plan. Using a comprehensive dataset of health claims, including insurance claims for both mental and physical health services, we examine both heterogeneity of consumption and variation in outcomes. Consumption variation addresses the regularly overlooked question of how equal insurance and access does not translate into equitable consumption. Outcomes variation yields insights into the potential harms of disparate consumption and of uncoordinated care. We find that even when insurance and access are held constant, consumption …

Gendered Disparities In Take-Ups Of Employee Health Benefits, Jennifer Reid Keene, Anastasia H. Prokos

Sociology Faculty Research

Using a sample of 2,271 workers from the 2002 National Study of the Changing Workforce whose employers offered personal health insurance, this article investigates the gendered nature of health insurance benefit take-ups. These analyses include family and employment characteristics in addition to employers’ contributions to health insurance premiums, a measure that is unexamined in sociological analyses of health benefits. Progressive logistic regression models predict the effects of gender and family characteristics. Results indicate that women with employed spouses are less likely to take up their own health benefits than are comparable men, net of basic employment characteristics. Gender differences disappear, …

The Development Of An Unequal Social Safety Net: A Case Study Of The Employer-Based Health Insurance (Non) System, H. Luke Shaefer, Elizabeth D. Sammons

The Journal of Sociology & Social Welfare

The U.S. social safety net exacerbates labor market inequalities rather than ameliorating them. This paper traces this theme within an important historical case study: the emergence of the employer-based health insurance system. Employers became the dominant and tax-preferred provider of health insurance in the United States without any federal legislative action. Understanding how this happened may inform current reform efforts. This case study highlights two important factors. The first is path dependency, discussed by Skocpol (1992) and Pierson (2000). They argue that the ambiguous divisions of power and a pluralistic governance framework favor incremental processes of social policy formation in …

Implementasi Program Asuransi Kesehatan Masyarakat Miskin Di Nusa Tenggara Timur, Tri Rini Puji Lestari

Kesmas

Kesehatan merupakan hak asasi manusia, sehingga upaya pelayanan pengobatan untuk penduduk miskin tidak boleh dipandang sebagai sesuatu yang konsumsi, tetapi sebagai investasi untuk mencapai masyarakat yang sejahtera. Penelitian ini bertujuan mendapatkan informasi tentang akses penduduk miskin pada pelayanan rumah sakit melalui program Askeskin di Nusa Tenggara Timur (NTT). Penelitian menggunakan pendekatan kualitatif dengan informan kunci adalah pejabat di RSU Prof. DR. W.Z. Johannes NTT dan PT Askes cabang Kupang. Hasil penelitian memperlihatkan bahwa jumlah kartu yang diterbitkan tidak sesuai dengan realita jumlah maskin dan ada oknum tidak maskin yang menggunakan fasilitas Askeskin. Juga ditemukan beberapa obat yang tercantum dalam formularium …

The Effectiveness And Adoption Of Market-Based State Health Care Expansion Programs, Nathan Gregory Myers

UNLV Theses, Dissertations, Professional Papers, and Capstones

Market-based state health expansion programs are alternatives to government programs like Medicaid and SCHIP which also seek to expand access to health insurance for uninsured populations. These programs either utilize the private health insurance market or function according to market principles. The market-based policies at issue in this research are state high-risk health insurance pools, limited benefit plans, group purchasing arrangements, reinsurance programs, and Health Insurance Flexibility and Accountability waivers. This research addresses two separate but related research questions: (1) Do these market-based programs provide general economic and social benefits for the citizens of a state? (2) What role does …

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 …

Our Troubled Health Care System: Why Is It So Hard To Fix?, Judy Feder

Center for Policy Research

This brief draws heavily on Judith Feder, 2004, "Crowd-Out and the Politics of Health Reform," The Journal of Law, Medicine, and Ethics 32(3): 461-464. We all know that affordable health care is now back on the political agenda, and it's about time! Because all of us--families, businesses, and governments--are struggling with the ever-increasing costs of care. Every year about a million people are added to the rolls of the uninsured. In 2006, it was even more, over 2 million. The number of people without health insurance coverage has reached more than 47 million. People *with* insurance are seeing their benefits …

The Health Insurance Debate In Canada: Lessons For The United States?, Mary Anne Bobinski

Faculty Articles

This Essay begins with an intentionally ambiguous title. Are comparisons to Canada relevant and useful for policy-makers in the United States and, if so, what lessons can we learn? Part II of this Essay highlights some of the risks and benefits of cross-border comparisons between the United States and Canada. In Part III, I analyze some of the key data points often cited in comparing the two health care systems. Part IV explores the current Canadian debate about private health insurance. Finally, in Part V, I focus on the lessons from Canada for the health insurance debate in the United …

The Truth About Moral Hazard And Adverse Selection., Mark V. Pauly

Center for Policy Research

This brief is actually going to have two levels. One level will go with the advertised title, and I’ll tell you my current views on the truth about moral hazard and adverse selection. Adverse selection will serve as somewhat of a handmaid of moral hazard, as you will see. That’s one level. The other level, though, which continues to surprise me, is that these two topics—they’re two buzzwords from insurance theory—have generated an enormous amount of policy interest and, yes, passion. Some people passionately believe some things about moral hazard that others passionately disbelieve. And so as part of this …

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 …

Update - September 2005, Loma Linda University Center For Christian Bioethics

Update

In this issue:

-- Just Care: Rationing in a Public Health Crisis
-- Editorial
-- Graduate profiles
-- Jack W. Provonsha Lecture Series: Physician-Assisted Suicide: A Religious Perspective

Universal Coverage And The American Health Care System Crisis (Again), Rick Mayes

Political Science Faculty Publications

Ten years after President Clinton’s ambitious attempt at comprehensive health care reform died, several old and new issues with the health care system have emerged. First, the number of uninsured Americans rose to 43.6 million in 2002—and the numbers have since increased. Also, the costs for those who do not have insurance are rapidly increasing. In addition health care related problems are one of the leading causes of personal bankruptcy in the United States. Finally, the government’s two primary health insurance programs—Medicare and Medicaid—are experiencing considerable financial strain. Dr. Mayes examines these problems in depth before and revisits President Clinton’s …

Women, Poverty, Access To Health Care, And The Perils Of Symbolic Reform, Mary Anne Bobinski, Phyllis Griffin Epps

Faculty Articles

This article looks at health care through gendered eyes. We sift though available data on access to health care, health status, and health treatments to determine whether men and women experience health care differently in the United States. While we do not doubt that overt gender-based discrimination occasionally occurs in health care, this article focuses on the importance of unintended consequences and unconscious bias. We also explore the impact of symbolism about women's roles on the process of health care reform. The results have important implications for policy makers, advocates, and health care providers.

The United States has a large …

Trust And Betrayal In The Medical Marketplace, Maxwell Gregg Bloche

Georgetown Law Faculty Publications and Other Works

The author argues in this Comment that disingenuity as first resort is an unwise approach to the conflict between our ex ante and our later, illness-endangered selves. Not only does rationing by tacit deceit raise a host of moral problems, it will not work, over the long haul, because markets reward deceit's unmasking. The honesty about clinical limit-setting that some bioethicists urge may not be fully within our reach. But more candor is possible than we now achieve, and the more conscious we are about decisions to impose limits, the more inclined we will be to accept them without experiencing …

Race And Discretion In American Medicine, Maxwell Gregg Bloche

Georgetown Law Faculty Publications and Other Works

The author’s focus in this article is on racial disparities in medical care provision--that is, on differences in the services that clinically similar patients receive when they present to the health care system. Racial disparities in health status, which is not greatly influenced (on a population-wide basis) by medical care, are beyond his scope here. Disparities in medical care access-potential patients' ability, financial and otherwise, to gain entry to the health care system in the first place, are also outside his focus. The author begins this article by putting the problem of racial disparities in medical care provision within the …

Does Chronic Illness Affect The Adequacy Of Health Insurance Coverage?, Kevin T. Stroupe, Eleanor D. Kinney, Thomas J. Kniesner

Center for Policy Research

Although chronically ill individuals need protection against high medical expenses, they often have difficulty obtaining adequate insurance coverage due to medical underwriting practices used to classify and price risks and to define and limit coverage for individuals and groups. Using data from healthy and chronically ill individuals in Indiana, we found that illness decreased the probability of having adequate insurance, particularly among single individuals. Chronic illness decreased the probability of having adequate coverage by about 10 percentage points among all individuals and by about 25 percentage points among single individuals. Pre-existing condition exclusions were a major source of inadequate insurance. …

Rights And Efficiency In American Health Law, Maxwell Gregg Bloche

Georgetown Law Faculty Publications and Other Works

During the 1960s and 1970s, the individual rights revolution that swept through American society remade much of the nation's health law in its image. Sick people acquired the right to be told of the risks and benefits of proposed treatments and then to give thumbs-up or thumbs-down to their doctors' decisions. Successful suits for medical negligence went from rare to commonplace. Elderly and poor Americans achieved statutory rights of access to publicly funded healthcare, and courts burnished these rights with myriad procedural protections. The critically ill and their families won the right to refuse aggressive, life-sustaining treatments. Psychiatric patients acquired …