Advancing Community Health Worker Practice and Utilization: The Focus on Financing

There is a growing interest in the use of community health workers in various roles in the US health care system. These workers go by various titles and names -- including promotora and community health advisor -- but all assist members of the communities they serve. As the role of these workers becomes more accepted and desirable in the overall system of care, they face the challenges of moving from being an exceptional add-on to the system to being more a part of the mainstream. Issues such as educational preparation, formal credentialing, licensure and compensation are all part of this process. In particular, various organizations are interested in but challenged by the need for sustainable financing of the CHW position. It is time to explore and develop viable financing arrangements that go beyond short-term grants.To address these concerns, this research was undertaken to study sustainable financing mechanisms for community health workers. The focus is on existing and emerging funding, reimbursement and payment policies for community health workers. The study seeks to identify promising examples and models of payment programs for community health workers generally in the United States. To the authors' knowledge, this is the first national project with this exclusive focus.The audiences for this report include community health workers, directors of programs that employ or work with community health workers, and administrators of public and private coverage programs such as health plans, insurance companies and state Medicaid programs seeking options for improving health care access and quality at the same or lower costs. Businesses, non-profit organizations and consumers exploring the possibilities of using the services community health workers could provide might also be interested in the findings

Integrating Food Policy with Growing Health and Wellness Concerns: An Analytical Literature Review of the Issues Affecting Government, Industry, and Civil Society

Over the past few years, there has been growing global interest in the link between food and health. This paper provides a review of some of the recent literature describing these linkages. The first section provides an overview of findings that link the consumption of fruits and vegetables, meat, eggs, whole-grains, alcohol, sugar, dairy, fish, pulses, soy, and nuts to coronary heart disease, cancer, stroke, and diabetes. The authors then summarize various international and domestic non-government organizations' views about these issues. The third section centres on the food industry and its responses to growing health concerns. The fourth section is an overview of public policy relating to food and health, including the use of food policy to change consumption behaviour and address obesity. This section also includes a discussion of the relevance of policies designed to discourage smoking to the current debate on obesity. The Conclusion highlights ways in which Canadian food policy can be adapted in order to better promote health and wellness.Food Consumption/Nutrition/Food Safety, Health Economics and Policy, Agribusiness,

Assessing Needs of Care in European Nations. ENEPRI Policy Brief No. 14, 28 December 2012

This Policy Brief presents the research questions, main results and policy implications and recommendations of the seven Work Packages that formed the basis of the ANCIEN research project, financed under the 7th EU Research Framework Programme of the European Commission. Carried out over a 44-month period and involving 20 partners from EU member states, the project principally concerns the future of long-term care (LTC) for the elderly in Europe and addresses two questions in particular: How will need, demand, supply and use of LTC develop? How do different systems of LTC perform

Modelling dynamic choice: Private health insurance in Australia, CHERE Research Report 24

This study investigates the role of dynamic, discrete choice modelling in the context of private hospital insurance in Australia. This is achieved with the use of a unique panel data set of young Australian women ? The Australian Longitudinal Study on Women?s Health (or ALSWH). Very few (if any) private health insurance studies in Australia have used panel data due to the limited availability of longitudinal data sets. Yet panel data allows two important innovations ? it allows a researcher to control for unobserved heterogeneity across individuals and facilitates dynamic modelling that would otherwise require long time series data. Both these innovations are a feature of the dynamic, random effects probit model I propose here. Using the ALSWH data set I find that the choice to purchase private hospital insurance is strongly determined by income, access to hospitals and inertia in choice. I also find family formation, pregnancy, education, exercise levels and country of birth to be significant drivers of choice. Interestingly, I find little evidence of adverse selection in this sample of young women, as those more likely to be insured have higher self-reported health and few chronic conditions. Overall, I find the dynamic specification with state dependence effects provides an important insight into consumer behaviour, with young women exhibiting statistically and economically large amounts of inertia in choice. Women who were in cover in 1996 or 2000 were more likely to be covered in 2003. Conversely, women without cover were unlikely to move into cover despite a wide range of Australian Government incentives. As policy makers consider the future of private health care, researchers must consider dynamic studies as way to fully gauge consumer behaviour.private health insurance, Australia

An Exploratory Analysis of Pharmaceutical Price Disparities and Their Implications Among Six Developed Nations

In our study of 43 drugs, prescription drug prices in several wealthy nations (Australia, Canada, France, Germany, and the U.K.) were much lower than in the U.S. on average, well below relative per capita GDP. There was relatively little difference among the five foreign nations. All this is consistent with previous research. After separating less-unique from more unique drugs, however, important new findings emerged. Relative prices for less-unique drugs, which are subject to strong competition, were at about half the U.S. level. We suggest that this reflects the exercise of monopsony power that does not exist in the U.S., where buyers as well as sellers compete. On the other hand, relative prices for highly unique drugs tended to be approximately proportional to per capita GDP or higher. Remarkably, biotech drugs were priced at or above U.S. levels in Canada and France

mHealth: A Utilization Review by Feature Classification for Sustained Use

mHealth is a fast growing segment for healthcare. However, there has been little research into the specific elements of mHealth that can drive continued use for optimization of the potential benefits. The purpose of this case study was to use the Delone and McLean Information System Model as a framework for classification of mHealth functionality and then to review the utilization of those categories over a six month period of time. A sample of 137 pediatric diabetics was reviewed. The activation rate was high at 94.9% indicating an interest in using mHealth. There was higher utilization of system features in the group of users with 60.3% of total uses being related to a system feature. There also were specific use patterns between gender with male patients consisting of 66.2% of the overall uses. Future applications should focus on system features and customization by gender to support sustained use

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How Can We Move Clinical Genomics Beyond the Hype?

Examines the debate over increased use of genetic testing, due in part to lax regulation, and its consequences: wasteful spending, patient harm, and health system challenges. Makes recommendations for implementation of and data on promising technologies