An Assessment of Hospital-Sponsored Health Care for the Uninsured in Polk County/Des Moines, Iowa

Health care providers in Polk County are faced with increasing numbers of low-income, uninsured patients who do not have the resources to pay for their health care out of pocket. At the same time, state and local funding sources are limited, and are insufficient to ensure that these individuals have access to the health services that they require. Community leaders are extremely interested in developing information to understand the magnitude of the uninsured problem in Polk County and to identify health care delivery strategies to better serve this population. A Blue Ribbon Steering Committee was convened in October 2004 to examine how hospital-sponsored health care is currently delivered to the uninsured in Polk County. The Committee\u27s goal was to create a participatory process to plan an effective and sustaining model to deliver core safety net services to the County\u27s uninsured. To assist them with these tasks, researchers from The George Washington University\u27s School of Public Health and Health Services, Department of Health Policy, were retained to conduct an assessment of hospital-sponsored health care services delivered to Polk County\u27s uninsured. This assessment is designed to highlight key issues affecting access to care for uninsured and underinsured residents, and to present potential policy options for restructuring hospital-based services in the county

Health Insurance Benefits Advisors: Understanding Responsibilities, Regulations, Restrictions and the Relevance to Implementing the Affordable Care Act

This brief describes the operational differences among six different types of benefits advisors including: 1) Commercial agents and brokers, 2) Medicaid enrollment brokers, 3) navigators, 4) non-navigator assistance personnel (or in-person assisters), 5) certified applications assisters, and 6) health center outreach and enrollment assistance workers. We will address: 1) the role of each benefits advisor 2) the health plans with which benefits advisors are authorized to work 3) training requirements, 4) compensation 5) conflict of interest requirements, and 6) the impact benefits advisors have on consumer enrollment decisions

Influenza Vaccination of the Health Care Workforce: A Literature Review

Since 1981, the Centers for Disease Control and Prevention (CDC) has recommended that all health care workers (HCWs) receive an annual influenza vaccination. The Healthy People objectives aimed for 60% coverage of HCW influenza vaccination by 2010 and 90% coverage by 2020. Although influenza vaccine uptake among HCWs has trended upward over the past several years, the percentage of immunized HCWs has remained approximately 40% between 2004 and 2008. In order to complete the literature review, researchers identified and analyzed peer reviewed literature, news articles, professional organization position statements, and institutional policies published between 1991 and 2011. In the absence of evidence from the United States experience, materials relevant to Canada, France and the United Kingdom were reviewed. Defining Health Care Workers and Settings: The healthcare workforce could be individuals who have direct exposure or have the potential for indirect exposure to patients or infectious materials including: body substances, contaminated medical supplies and equipment, environmental surfaces or air. They may be paid or unpaid, an employee, contractor, volunteer, visitor, or student. Health care workers work in a broad range of institutional and community settings. Health Care Workers Impact Patient Safety: HCWs who have direct contact with patients are the primary source of infectious disease outbreaks in health-care facilities. During an average season, 23% of HCWs are infected with the virus, show mild symptoms, and continue to work despite being infectious. Over the past 30 years, nosocomial influenza outbreaks have been documented throughout the United States and abroad. Strategies to Encourage Voluntary Vaccination Among HCWs: Healthcare facilities, and government and professional organizations have developed and supported various strategies to encourage voluntary influenza vaccination among HCWs, including: 1) educational and promotional campaigns, 2) increased access to the seasonal influenza vaccine, 3) declination statements, and 4) health programs that incorporate several strategies. State–Mandated School Immunization and Exemption Policies: State laws that require vaccination as a condition for school attendance translate national recommendations into immunization practice. These laws have proven to be the most effective mechanism to protect children and their families from the effects of vaccine-preventable disease. Historical and modern examination of school vaccination laws provides a context for understanding the benefits of compulsory vaccination policy when applied to the health workforce. All jurisdictions include opt-out or exemption provisions that permit parents to refuse immunizations for their children for one of three reasons: 1) medical contraindication, 2) religious beliefs, or 3) personal, moral, or philosophical beliefs. Two jurisdictions employ declination statements as a fourth option to allow refusal. 1 Mandatory Influenza Vaccination Policies in Healthcare Facilities: Beginning in 2004, healthcare facilities and local health departments began to require influenza vaccination as a condition of employment. Currently, 87 facilities in 30 states and the District of Columbia have implemented HCW mandatory influenza vaccination programs. Professional and Government Organizations Position Statements Related to Health Care Worker Influenza Vaccination: Several professional, government, non-profit organizations have indicated their support of mandatory influenza vaccination of HCWs as the most effective strategy to protect patients. However, the largest health care union, representing several categories of the health care workforce, opposes mandatory influenza vaccination. Health Care Workers’ Attitudes and Beliefs Related to Influenza Vaccination: The workforce continues to present several common arguments against influenza vaccination, including: 1) fear, 2) a belief in popular myths and misinformation, and 3) inconvenience. However, others accept the vaccination as an effective method to protect themselves, their families, and their patients

The Epidemiology of U.S. Immunization Law: Translating CDC Immunization Guidelines into Practice: State Laws Related to the Use of Standing Orders Covering Immunization Practice

This pilot study examines how five states -- Georgia, Massachusetts, New York, Oregon, and Texas – approach the legal question of delegation of medical practice powers in an immunization practice context

The Epidemiology of U.S. Immunization Law: Mandated Coverage of Immunizations Under State Health Insurance Laws

Immunizations represent both basic clinical care as well as an essential public health activity with population-wide health implications, and for a number of reasons, the focus on national immunization policy has intensified in recent years. Insurers and employee health plans may cover immunization services as a matter of benefit design choice. Federal and state insurance laws also may mandate coverage of one or more classes of immunization services. For approximately 100 million persons who are members of state-regulated health insurance plans, state law plays a primary role in determining coverage. Thus the extent of state immunization health insurance mandates is essential in examining the overall adequacy of health insurance financing for immunization services. This analysis is part of a comprehensive study of the epidemiology of U.S. immunization law. It provides a detailed assessment of state immunization statutes in force as of winter 2003

The Epidemiology of U.S. Immunization Law: A National Study for the National Immunizations Program, Centers for Disease Control and Prevention: Medicaid Coverage of Immunizations for Non-Institutionalized Adults

As a health policy matter, coverage of immunizations and their administration for all ages at levels recommended by the Advisory Committee on Immunization Practices (ACIP) has grown in importance for several reasons: 1) the growing attention to both manmade and naturally occurring public health threats; 2) recognition of the value of immunization to society; and 3) the relatively high cost of at least certain immunization services in relation to personal income. No population stands to benefit more from immunization coverage than low income persons. Studies suggest that adult immunization status is particularly low, and that financial barriers play a role, especially for low income persons. Medicaid is the nation-s single largest source of health insurance for children and adults. Eligibility for adults is linked to both membership in a recognized categorical status and low income, including individuals age 65 and over, adults (mostly women) in families with children, individuals with disabilities, pregnant women, and certain other categorical groups. This review is the second in a series of studies which describes the different health insurance coverage options available to individuals and families in the United States for acquiring medically appropriate immunizations. This report analyses the provision of immunization services to adult beneficiaries of Medicaid. Coverage and payment information was reviewed from every state, while data from the District of Columbia was unobtainable

How Medical Claims Simplification Can Impede Delivery of Child Developmental Services

This report examines HIPAA administrative standardization and the process of modifying the standardized codes. It assesses the implications of HIPAA standardization for payment of Medicaid-covered early childhood preventive and developmental services, drawing on findings from a 50-state, point-in-time review of readily available state HIPAA compliance documents conducted in December 2004

Reducing Obesity Risks During Childhood: The Role of Public and Private Health Insurance

In a widely publicized decision issued in 2004, the United States Department of Health and Human Services removed language from the Medicare Coverage Issues Manual which stated that obesity is not an illness, a pronouncement that paves the way for Medicare coverage of evidence-based obesity treatments. This determination by HHS also has important implications for public and private insurance coverage of health care services and interventions that have the potential to reduce the risk of lifelong obesity in children. This Report assesses the implications of the 2004 HHS obesity ruling into the context of public and private health insurance for children. It begins with an overview of what is known about obesity risk in childhood, as well as its short-term and long-term health consequences and then reviews the evidence of effective health interventions for children at risk. The Report then considers the implications of the 2004 decision for private health insurance coverage for children, followed by a more extended discussion of its implications for children covered under Medicaid and the State Children\u27s Health Insurance Program (SCHIP). The Report concludes with a discussion of strategies for engaging both public and private insurers in a systematic effort to increase investment in preventive health services for children at risk of obesity