States' Roles in Shaping High Performance Health Systems

Analyzes results from the State Health Policies Aimed at Promoting Excellent Systems survey and a review of current research on efforts to improve state healthcare systems, with a focus on coverage; quality, safety, and value; and infrastructure

Why Not the Best? Results From the National Scorecard on U.S. Health System Performance, 2011

Assesses the U.S. healthcare system's average performance in 2007-09 as measured by forty-two indicators of health outcomes, quality, access, efficiency, and equity compared with the 2006 and 2008 scorecards and with domestic and international benchmarks

Innovations that Address Socioeconomic, Cultural, and Geographic Barriers to Preventive Oral Health Care

This report focuses on nine oral health innovations that integrate service delivery and workforce models in order to reduce or eliminate socioeconomic, geographic, and cultural barriers to care. Two additional reports in this series describe the remaining programs that provide care in non-dental settings and care to young children. Although the programs are diverse in their approaches as well as in the specific characteristics of the communities they serve, a common factor among them is the implementation of multiple strategies to increase the number of children from low-income families who access preventive care, and also to engage families and communities in investing in and prioritizing oral health. For low-income children and their families, the barriers that must be addressed to increase access to preventive oral health care are numerous. For example, even children covered by public insurance programs face a shortage of dentists that accept Medicaid and who specialize in pediatric dentistry.(Guay, 2004).The effects of poverty intersect with other barriers such as living in remote geographic areas and community-wide history of poor access to dental care in populations such as recent immigrants . Overcoming these barriers requires creative strategies that address transportation barriers; establish welcoming environments for oral health care; and are linguistically and culturally relevant. Each of these nine programs is based on such strategies, including:-Expanding the dental workforce through training new types of providers or adding new providers to their workforce to increase reach and community presence;-Implementing new strategies to increase the cost-effectiveness of care so that more oral health care services are available and accessible;-Providing training and technical assistance that increase opportunities for and competence in delivering oral health education and care to children;-Developing creative service delivery models that address transportation and cultural barriers as well as the fear and stigma associated with dental care that may arise in communities with historically poor access.The findings from the EAs of these programs are synthesized to highlight diverse and innovative strategies for overcoming barriers to access that have potential for rigorous evaluation that could emerge as best practices. If proven effective, these innovative program elements could then be disseminated and replicated to increase access for populations in need of preventive oral health care

Securing a Healthy Future: The Commonwealth Fund State Scorecard on Child Health System Performance, 2011

Ranks states on twenty indicators of healthcare access, affordability, prevention and treatment, potential for healthy lives, and health system equity for children. Examines the need for targeted initiatives and policy implications for better performance

Addressing Resource Gaps in the U.S. Health Care Safety Net: An Assessment of the Free Clinic Network

Based on a survey of free clinics serving uninsured low-income patients, examines the resource constraints limiting the expansion of healthcare services provided, including the high costs of labs, equipment, and medication. Makes recommendations

Environmental Implications of the Health Care Service Sector

This report analyzes the environmental effects associated with activities undertaken and influenced by the health care service sector. It is one part of a larger study to better understand the environmental effects of service sector activities and the implications for management strategies. Considerable analysis has documented the service sector's contribution to domestic economic conditions, yet little analysis has been performed on the broad impacts service firms have on environmental quality. For this study the authors developed a framework to examine the nature of service sector industries' influence on environmental quality. Three primary types of influence were identified: direct impacts, upstream impacts, and downstream impacts. In addition, indirect impacts induced by service sector activities include their influence over settlement patterns and indirect influences over other sectors of the economy. In their initial analysis, the authors noted that many functions performed in the service sector also are commonly found in other sectors. The impacts of these activities have been analyzed separately from those unique to the health care sector, as they present different challenges. Health care is one of the largest U.S. industries, employing one in nine workers and costing one in seven dollars generated in the economy. Functions performed in the industry that are common in other sectors include: transportation; laundry; food services; facility cleaning; heating and cooling; and photographic processing. Activities unique to the health care industry include: infectious waste generation and disposal; medical waste incineration; equipment sterilization; dental fillings; ritual mercury usage; x-ray diagnosis; nuclear medicine; pharmaceutical usage and disposal; and drinking water fluoridation. The industry has considerable leverage upstream on its suppliers, which is important to managing risks from the use of goods commonly used in the industry, including: mercury-containing products, polyvinyl chloride plastics, latex gloves, and syringe needles. The authors identified a number of areas for potential environmental management initiatives: controlling emissions from on-site "production" type functions; mercury use; the environmental consequences of infection control measures; pollution prevention through substitution of alternative health care services; and research and data collection.

Collaborating to Create Elder Friendly Communities in New Hampshire: A Scan of the Current Landscape

The fact that the population of the United States is aging is no surprise; the demographic projections are well documented. There have never been as many older adults living as there are today, and this number will only increase. Northern New England is aging more rapidly than the rest of the country, with Vermont, Maine, and New Hampshire having the oldest populations in term of median age (U.S. Census, 2014). New Hampshire is expected to be the fastest aging state in New England through 2030, with nearly one-third of its population being over the age of 65 (Norton, 2011). This phenomenon is anticipated to place substantial pressure on publicly-funded health programs and long-term services and supports in the Granite State. But the story of the aging of the population is not only about increased numbers. As longevity increases, the average age of the older population will see a dramatic increase. The number of persons over the age of 85 in the United States is expected to increase five-fold by 2040. As the possibility for functional limitations and disability increases with age, the need for long-term, formal, and informal supports is expected to increase as the number of older adults, particularly those over the age of 85 increases. In addition, women continue to live longer than men; on average, life expectancy for women is three years longer than for men. These factors create a complex picture of aging, which includes a growing population of older adults, a majority of whom will be women; and a growing number of those over the age of 85, who are more likely to require some type of assistance as they age. It is a mistake to look at our aging population in a singular way. Although we tend to make generalizations about older adults, as a group, they are more physiologically and socially diverse than any other age group (Brummel-Smith & Mosqueda, 2003). As we age, we become more and more diverse, as there are no two people who have had the same life experiences, shaping who we are over our lifetimes. The baby boomers (those born between 1946 and 1964) are likely to be the most diverse cohort of older adults we have seen to date, and it is likely that they will redefine our conception of age and aging. Older adults bring a diverse set of skills, talents, and knowledge that should be tapped as a significant natural resource to support a new and exciting vision of aging

HITECH Revisited

Assesses the 2009 Health Information Technology for Economic and Clinical Health Act, which offers incentives to adopt and meaningfully use electronic health records. Recommendations include revised criteria, incremental approaches, and targeted policies