The Mental Health Workforce: A Primer

[Excerpt] Congress has held hearings and introduced legislation addressing the interrelated topics of the quality of mental health care, access to mental health care, and the cost of mental health care. The mental health workforce is a key component of each of these topics. The quality of mental health care depends partially on the skills of the people providing the care. Access to mental health care relies on, among other things, the number of appropriately skilled providers available to provide care. The cost of mental health care depends in part on the wages of the people providing care. Thus an understanding of the mental health workforce may be helpful in crafting policy and conducting oversight. This report aims to provide such an understanding as a foundation for further discussion of mental health policy

The Mental Health Workforce: A Primer

[Excerpt] Congress has held hearings and some Members have introduced legislation addressing the interrelated topics of the quality of mental health care, access to mental health care, and the cost of mental health care. The mental health workforce is a key component of each of these topics. The quality of mental health care depends partially on the skills of the people providing the care. Access to mental health care relies on, among other things, the number of appropriately skilled providers available to provide care. The cost of mental health care depends in part on the wages of the people providing care. Thus an understanding of the mental health workforce may be helpful in crafting policy and conducting oversight. This report aims to provide such an understanding as a foundation for further discussion of mental health policy

Health Care Spending: Context and Policy

[Excerpt] The United States spends a large and growing share of national income on health care. In 2007, health spending is expected to approach $2.3 trillion and account for more than 16Health care costs put significant pressure on the federal budget — both directly, through spending on Medicare, Medicaid, and other federal benefits, and indirectly, through tax expenditures for health insurance and expenses. The Congressional Budget Office projects that spending for Medicare, Medicaid, and the State Children’s Health Insurance Program will total$634 billion and account for about 23% of federal outlays in 2007. Federal tax expenditures for health benefits; health coverage for military personnel, veterans, and federal employees; and spending by Public Health Service agencies are expected to add $272 billion in costs. Given competing constituent interests and the complex interdependence of public and private benefits and actors, policymakers face difficult challenges in helping to ensure access to health care and health insurance without exacerbating federal budget pressures or contributing to marketwide inflation. Three broad policy directions have both promise and limitations for addressing health spending: (1) changing health care, (2) changing federal programs, and (3) changing tax policy. The first, changing health care, considers the potential for influencing spending by improving the quality and delivery of health care services. A key limitation of this direction is uncertainty about whether any particular change will reduce or increase health spending. The second direction, changing federal programs, focuses more narrowly on federal spending for federal benefits. To influence spending, policymakers can set budgets for programs, services, or beneficiaries. They can change eligibility rules or program benefits. And they can change other program features, including payment methods and amounts, and how beneficiaries obtain coverage. In this category, the primary challenge is balancing explicit tradeoffs between competing goals regarding access and spending. The final direction, changing tax policy, focuses both on making health care more affordable for individuals and families, and on influencing consumers’ choices as they purchase health insurance and health care. A key benefit of tax subsidies — including exclusions, credits, deductions, and tax-advantaged accounts — relates to flexibility. In general, these tools help consumers buy the health insurance and health care they prefer. A drawback is that tax subsidies may drive up consumer demand and spending on the one hand, while failing to help ensure access to health coverage on the other. This report will be updated

Transforming the Workforce to Provide Better Chronic Care: The Role of Nurse Care Managers in Rhode Island

This series explores the evolution of primary care systems to better meet the needs of consumers with complex health conditions. It demonstrates that changes in the workforce are required to empower consumers to better manage their health.The series is a collaboration of the National Academy for State Health Policy and the AARP Public Policy Institute. We recognize that it takes a team of skilled professionals to deliver improved chronic care. In this series, we focus on how registered nurses -- who make up the largest segment of the health care workforce -- are being deployed in ambulatory delivery systems to take on new roles. Future series will focus on other members of the health care team.We selected six initiatives that offer replicable policy strategies to develop, implement, and sustain patient-centered approaches to care. Each case study highlights one of these initiatives and provides policy recommendations and an "on-the-ground" look at the work of its nurses

Can This Marriage Be Saved?

Market forces in health care are paradoxically pulling physicians and hospitals apart and together at the same time. What are these forces and trends? Is the long-standing marriage of interdependence and productivity between them destined to fail, or can it be saved and even strengthened by emerging delivery and governance models in the so-called "market revolution" of consumer-driven health care? What are the implications for health care policy and practice? These are issues we explore in this Arizona Health Futures Policy Primer

Importance of health care issues in 2005 presidential elections in Croatia

Health and health care provision are among the most important and politically sensitive public service areas. Politicians carefully incorporate health care program changes in their political agendas to gain votes. However, knowing health care priorities of the electoral body is not useful only to politicians, but also to health policy makers, as it enables them to target the most problematic areas in health care. We conducted a telephone survey of representative sample of voters (n=643) immediately before the presidential elections in Croatia in 2005, to determine the possible differences in health care priorities between left-wing and right-wing voters, and found a high level of homogeneity in their opinions. Health care organization, corruption, and financing issues were identified as the top priorities by both left- and right-wing voters. This agreement in voters' expectations, probably caused by a similar frame of mind of Croatian citizens inherited from pre-democratic times of self-government, could be used by health policy makers to rationally invest the means and efforts in dealing with the most problematic health care issues

Options for finance in primary care in Australia

A number of policy initiatives aimed at reform of primary health care financing are currently either being debated nationally, or trialled in different jurisdictions. Commonwealth Government austerity and an interest from a wide range of stakeholders to mobilise capital from different parts of the economy have provided an incentive to explore new finance policy options for primary health care. However, recent reviews of primary health care finance have focused on contrasting the different payment systems, rather than the financing of primary health care in a more systemic sense. Finance is more than just an approach to payment, reflecting the flows of capital that structure service. Debates centred on payment systems (such as fee-for-service, salaries, capitation, pay for performance and activity–based funding) tend to eclipse the conceptual underpinnings of primary health care finance. This issues brief explores policy options that move beyond payment systems. It approaches primary health care from a deeper perspective with a focus on how to link objectives to outcomes through different financing approaches. For example, the separation of primary health care payment systems (mostly fee for service) from hospital payment systems (activity-based funding) creates numerous boundaries between parts of the sector. Although different payment systems separate health care into discrete segments, the lived reality for many people managing their health care is that they need to move across these fragmented elements of the system, with little overall sense of outcome. This issues brief will identify ways to consider primary health care finance policy options, by focusing on the objectives of different financing systems, how they connect to financial tools (such as impact investing), with a focus on health outcomes. It aims to broaden and deepen debate about primary health care finance. It is anticipated that the issues brief will also be a starting point for a structured debate through policy engagement events between policy makers, academics and practitioners about new models of finance for primary health

Who Pays for Health Care Reform?

In this second of three chapters on the distinctive policy dynamics of particular areas of social provision, Susan Giaimo addresses the issue of whether the success of the reformed welfare state in the shape of payers’ and policy makers’ cost‐containment projects have had as their price the sacrifice of equity and solidarity. These questions are explored through the lens of health care reform in Britain, Germany, and the US since the late 1980s: each a country with a distinctive health care system, which undertook major reform initiatives designed to control health care outlays, and addressed the efficiency and equity goals in markedly different ways. Section I provides a broad background to situate the contemporary politics of health care reform, explaining how and why health care systems in Western countries have come under the stress of increasing cost pressures even as governments and employers have become more apprehensive about the possible effects of the welfare state on economic competitiveness. Section 2 develops the argument in greater depth, explaining how existing health care and political systems provide different opportunities or constraints for payers and the state to pursue unilateral cost‐containment strategies, how health care institutions themselves shape policy preferences and strategies of payers, and how some systems require compromise solutions that reconcile equity with efficiency. Section 3 presents each country\u27s case, and the concluding section considers the broader lessons from health care reform for the contemporary politics of welfare state adjustment