Medicaid, Managed Care, and Kids. 12th Annual Herbert Lourie Memorial Lecture on Health Policy

This policy brief talks about what managed care for Medicaid is, how it influences kids, and how it relates to the State Child Health Insurance Program (CHIP). It focuses on what we have learned over the last 20 years through research about cost, use, and quality. It also discusses some of the expectations we had for children covered by Medicaid managed care. Finally, it talks abaout the future of Medicaid managed care and the implications for CHIP.

Medicaid, Managed Care, and Kids. 12th Annual Herbert Lourie Memorial Lecture on Health Policy

This policy brief talks about what managed care for Medicaid is, how it influences kids, and how it relates to the State Child Health Insurance Program (CHIP). It focuses on what we have learned over the last 20 years through research about cost, use, and quality. It also discusses some of the expectations we had for children covered by Medicaid managed care. Finally, it talks about the future of Medicaid managed care and the implications for CHIP

How Managed Care Affects Medicaid Utilization: A Synthetic Difference-in-Differences Zero-Inflated Count Model

We develop a synthetic difference-in-differences statistical design to apply to experimental data for adult women living in Hennepin County, Minnesota, to estimate the impact of Medicaid managed care on various modes of medical care use. Because the outcomes of interest are utilization counts with many persons using none of a particular mode of care we use count regression models that are adjusted for excessive zeros. We find no reductions in physician visits or hospital inpatient and emergency department care use, but reductions in hospital outpatient care. Simulations designed to judge the economic significance of our results suggest a program effect that is a savings of about ten percent

Unfinished Business: Inadequate Health Coverage for Privately Insured, Seriously Ill Children

During the 1980s and 1990s there were great increases of health insurance coverage for poor children through the Children’s Health Insurance Program (CHIP) and extended Medicaid eligibility. Problems remain for the small number of children with serious medical conditions whose care is a high proportion of total health care expenditures on children. We report on the adequacy of health insurance coverage for a sample of children with serious and rare illnesses treated at the single tertiary care pediatric hospital in Indiana. One-third of privately insured children in our data had inadequate insurance. Compared to families with inadequate health insurance families with adequate insurance were 50 percent less likely to delay care for themselves and 67 percent less likely to delay care for a child. Our research identifies policy relevant deficiencies in private health coverage for seriously ill children ineligible for either Medicaid or CHIP

The Impact of Hospital Quality-Related Practices on Health Outcomes

In this paper we analyze the cross-sectional relationship between hospital quality scores calculated by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) and risk-adjusted indicators of outcomes and quality--mortality, rates of surgical/medical misadventures, adverse drug reactions, and length of stay--calculated from Nationwide Inpatient Sample discharge records. The results suggest that greater adherence to JCAHO accreditation standards is not associated with reduced mortality or lower probability of avoidable hospital or physician-caused adverse outcomes. Other hospital characteristics, such as teaching/non-teaching and urban/rural status, also exhibit little or no correlation with risk-adjusted survival and adverse-event probabilities

Pharmaceuticals and the Elderly: A Comparative Analysis

This paper compares and contrasts outpatient pharmaceutical policies for the elderly in seven OECD nations: Australia, Canada, Germany, Japan, New Zealand, the United Kingdom, and the United States. Each country is facing an increasing financial burden due to rapidly growing numbers of elderly citizens, in number and as a percentage of population, and rising drug costs. As a result, they are struggling to balance varying levels of commitment to providing drugs for the elderly with the need to contain costs. Although each country\u27s healthcare system is unique, the methods that each country is using to control rising pharmaceutical costs are similar. Many countries are gravitating toward the use of last-dollar rather than first-dollar coverage. All provide inpatient pharmaceutical coverage

Using the community psychology competencies to address sexual assault on a college campus

Sexual assault on college campuses is a national issue, with a recent report from the White House estimating that 20% of women will experience a sexual assault during college.  Students at Wichita State University formed a campus organization to bring visibility to both community psychology and address this important problem.  The Community Psychology Association is comprised of both graduate and undergraduate students, and members utilized three community psychology competencies: ecological perspectives, information dissemination/building public awareness, and community organizing and community advocacy in their work to improve resources and campus support for this issue.  Community Psychology Association members utilized focus groups with campus students, faculty, and staff to facilitate discussions on sexual assault, campus safety, and university and administrative accountability.  Content analysis revealed multiple themes that were used to generate a larger campus discussion and promote change in campus policies. As a result of these activities, major changes occurred at Wichita State, including data driven programming for interventions regarding sexual assault, changes in leadership in the offices of Title IX and Student Affairs, support for a CDC grant, and overall increased organizational awareness for sexual assault survivors.  This study highlights the importance of applying community psychology principles and concepts to research and action to ultimately have a positive and tangible impact on the local community

Using the community psychology competencies to address sexual assault on a college campus

Sexual assault on college campuses is a national issue, with a recent report from the White House estimating that 20% of women will experience a sexual assault during college.  Students at Wichita State University formed a campus organization to bring visibility to both community psychology and address this important problem.  The Community Psychology Association is comprised of both graduate and undergraduate students, and members utilized three community psychology competencies: ecological perspectives, information dissemination/building public awareness, and community organizing and community advocacy in their work to improve resources and campus support for this issue.  Community Psychology Association members utilized focus groups with campus students, faculty, and staff to facilitate discussions on sexual assault, campus safety, and university and administrative accountability.  Content analysis revealed multiple themes that were used to generate a larger campus discussion and promote change in campus policies. As a result of these activities, major changes occurred at Wichita State, including data driven programming for interventions regarding sexual assault, changes in leadership in the offices of Title IX and Student Affairs, support for a CDC grant, and overall increased organizational awareness for sexual assault survivors.  This study highlights the importance of applying community psychology principles and concepts to research and action to ultimately have a positive and tangible impact on the local community

Assessing variation in utilization for acute myocardial infarction in New York State

a b s t r a c t Background: Wide variations exist in healthcare expenditures, though most prior studies have assessed aggregate utilization. We sought to examine healthcare utilization variation in New York State by assessing hospitals in peer groups of similar capabilities. Methods: Using charge data in New York State from the 2008 Statewide Planning and Research Cooperative System (SPARCS) and cost-to-charge ratios at the cost-center level drawn from Institutional Cost Reports, we calculated total, routine, and ancillary costs for patients discharged with an acute myocardial infarction (AMI) diagnosis in 2008. We assessed the correlation of these cost data to Hospital Referral Region (HRR) Medicare reimbursement data from the 2007 Dartmouth Atlas of Health Care. After describing hospital level cost variability, we examined characteristics associated with higher costs within peer groups of similar cardiac care capabilities. Results: We found greater costs in hospitals providing the highest level of cardiovascular services, with cardiac surgery capable hospitals and non-invasive hospitals having total costs of $21,166 and$9268 per AMI discharge, and ancillary costs of $12,006 and$4167 per AMI discharge, respectively. Substantial variability in utilization existed in all levels of hospitals and across individual departmental cost centers. The two factors most frequently associated with higher total and ancillary costs across peer groups were patient case mix index and major or minor teaching status. Conclusions: Significant variation in cost per AMI discharge exists even within peer groups of hospitals with similar cardiac care capabilities. Implications: These findings support measurement and analysis at the hospital level to further understand the reasons for variation in utilization

Eureka and beyond: mining's impact on African urbanisation

This collection brings separate literatures on mining and urbanisation together at a time when both artisanal and large-scale mining are expanding in many African economies. While much has been written about contestation over land and mineral rights, the impact of mining on settlement, notably its catalytic and fluctuating effects on migration and urban growth, has been largely ignored. African nation-states’ urbanisation trends have shown considerable variation over the past half century. The current surge in ‘new’ mining countries and the slow-down in ‘old’ mining countries are generating some remarkable settlement patterns and welfare outcomes. Presently, the African continent is a laboratory of national mining experiences. This special issue on African mining and urbanisation encompasses a wide cross-section of country case studies: beginning with the historical experiences of mining in Southern Africa (South Africa, Zambia, Zimbabwe), followed by more recent mineralizing trends in comparatively new mineral-producing countries (Tanzania) and an established West African gold producer (Ghana), before turning to the influence of conflict minerals (Angola, the Democratic Republic of Congo and Sierra Leone)