The Oregon Health Insurance Experiment: Evidence from the First Year

In 2008, a group of uninsured low-income adults in Oregon was selected by lottery to be given the chance to apply for Medicaid. This lottery provides an opportunity to gauge the effects of expanding access to public health insurance on the health care use, financial strain, and health of low-income adults using a randomized controlled design. In the year after random assignment, the treatment group selected by the lottery was about 25 percentage points more likely to have insurance than the control group that was not selected. We find that in this first year, the treatment group had substantively and statistically significantly higher health care utilization (including primary and preventive care as well as hospitalizations), lower out-of-pocket medical expenditures and medical debt (including fewer bills sent to collection), and better self-reported physical and mental health than the control group.National Institutes of Health. Department of Health and Human ServicesCalifornia HealthCare FoundationJohn D. and Catherine T. MacArthur FoundationNational Institute on Aging (P30AG012810)National Institute on Aging (RC2AGO36631)National Institute on Aging (R01AG0345151)Robert Wood Johnson FoundationAlfred P. Sloan FoundationSmith Richardson FoundationUnited States. Social Security Administration (grant 5 RRC 08098400-03-00 to the National Bureau of Economic Research as part of the SSA Retirement Research Consortium)Centers for Medicare & Medicaid Services (U.S.

Briefing: Missing Persons: Minorities in the Health Professions September 20, 2004

DR. LOUIS W. SULLIVAN: Missing Persons: Minorities in the Health Professions is a detailed look at what this commission has found. Unfortunately, the title of this report is the reality facing our nation. The facts of the US health professions remains separate and unequal is hazardous to our nation’s health. It has been my pleasure to work with 15 fine experts in health, education, law, public policy and other fields who have dedicated their lives over the past 15 months to this effort. We have included leaders from medicine, dentistry and nursing, and have also reached outside of academia and health systems to include members from business, journalism, law and government to ensure a broad representation and thinking. Under charge from the Kellogg Foundation, this commission was formed to develop solutions. The Kellogg Foundation established this commission to be free from any institutional or bureaucratic restraints, and go directly to the public to get a closer look at what was keeping talented minority students away from the health professions. To complete this task, we traveled around the nation, we held six field hearings, we examined dozens of scientific studies and commissioned two papers to help better understand the problem and arrive at realistic solutions. We examined many individuals and organizations

The systematic guideline review: method, rationale, and test on chronic heart failure

Background: Evidence-based guidelines have the potential to improve healthcare. However, their de-novo-development requires substantial resources-especially for complex conditions, and adaptation may be biased by contextually influenced recommendations in source guidelines. In this paper we describe a new approach to guideline development-the systematic guideline review method (SGR), and its application in the development of an evidence-based guideline for family physicians on chronic heart failure (CHF). Methods: A systematic search for guidelines was carried out. Evidence-based guidelines on CHF management in adults in ambulatory care published in English or German between the years 2000 and 2004 were included. Guidelines on acute or right heart failure were excluded. Eligibility was assessed by two reviewers, methodological quality of selected guidelines was appraised using the AGREE instrument, and a framework of relevant clinical questions for diagnostics and treatment was derived. Data were extracted into evidence tables, systematically compared by means of a consistency analysis and synthesized in a preliminary draft. Most relevant primary sources were re-assessed to verify the cited evidence. Evidence and recommendations were summarized in a draft guideline. Results: Of 16 included guidelines five were of good quality. A total of 35 recommendations were systematically compared: 25/35 were consistent, 9/35 inconsistent, and 1/35 un-rateable (derived from a single guideline). Of the 25 consistencies, 14 were based on consensus, seven on evidence and four differed in grading. Major inconsistencies were found in 3/9 of the inconsistent recommendations. We re-evaluated the evidence for 17 recommendations (evidence-based, differing evidence levels and minor inconsistencies) - the majority was congruent. Incongruity was found where the stated evidence could not be verified in the cited primary sources, or where the evaluation in the source guidelines focused on treatment benefits and underestimated the risks. The draft guideline was completed in 8.5 man-months. The main limitation to this study was the lack of a second reviewer. Conclusion: The systematic guideline review including framework development, consistency analysis and validation is an effective, valid, and resource saving-approach to the development of evidence-based guidelines

Social justice and out-of-school science learning: Exploring equity in science television, science clubs and maker spaces

We cannot take access to equitable out-of-school science learning for granted. Data compiled in 2012 show that between a fifth (22% in Brazil) and half (52% in China and the United States) of people in China, Japan, South Korea, India, Malaysia, the United States, the European Union, and Brazil visited zoos, aquaria, and science museums (National Science Foundation, 2012). But research suggests participation in out-of-school science learning is far from equitable and is marked by advantage, not least the social axes of age, social class, and ethnicity (Dawson, 2014a, 2014b; National Science Foundation, 2012; OECD, 2012). For instance, in the UK data suggest that the two-thirds of the population who took part in out-of-school science learning activities1 in the previous year were more affluent (upper and middle classes) and from the White ethnic majority (Ipsos MORI, 2014). If we believe that out-of-school science learning provides valuable educational, cultural, social and political opportunities, then we must take questions of equity seriously. Ideas from social justice can help us understand how equity issues are woven through out-of-school science learning practices. In this paper, I outline how social justice theories, in combination with the concepts of infrastructure access, literacies and community acceptance, can be used to think about equity in out-of-school science learning. I apply these ideas to out-of-school science learning via television, science clubs and maker spaces, looking at research as well as illustrative examples to see how equity challenges are being addressed in practice. I argue that out-of-school science learning practices can be understood on a spectrum from weak to strong models of social justice. Thinking about social justice as a spectrum helps us think through what equitable out-of-school science learning practices might involve, both to analyze existing practices and, importantly, to imagine new, more inclusive ones. Out-of-school science learning is a broad term, used to describe quite different activities, participants, aims, and practices. It can mean enjoying science festivals, watching science documentaries, pursing science-related hobbies as well as activities focused on engineering, mathematics, or technology (see, e.g., Bonney et al., 2009; Dingwall & Aldridge, 2006; Kaiser, Durant, Levenson, Wiehe, & Linett, 2013). In this paper, I focus primarily on the contrasting worlds of television and science clubs as out-of-school science learning contexts2. I use “science” as an umbrella term for science, technology, engineering, or mathematics related subjects. However, I add a caveat to how I use the term out-of-school. Because “out-of-school” invokes the idea of school, there can be a tendency to focus on youth as participants and activities that are for, by, or with youth. But of course adults may not consider their television watching an “out-of-school” activity. Thus, I note here that I keep both adults and youth in mind when writing about equity and out-of-school science learning

The Politics of Paying for Health Reform: Zombies, Payroll Taxes, and the Holy Grail

Outlines the political and institutional contexts for efforts to finance universal health coverage. Analyzes the political feasibility and consequences of various funding options and their implications for cost control. Includes international comparisons

Physician–Patient Communication About Prescription Medication Nonadherence: A 50-state Study of America’s Seniors

CONTEXT: Understanding and improving the quality of medication management is particularly important in the context of the Medicare prescription drug benefit that took effect last January 2006. OBJECTIVE: To determine the prevalence of physician–patient dialogue about medication cost and medication adherence among elderly adults nationwide. DESIGN: Cross-sectional survey. PARTICIPANTS: National stratified random sample of community-dwelling Medicare beneficiaries aged 65 and older. MAIN OUTCOME MEASURES: Rates of physician–patient dialogue about nonadherence and cost-related medication switching. RESULTS: Forty-one percent of seniors reported taking five or more prescription medications, and more than half has 2 or more prescribing physicians. Thirty-two percent overall and 24% of those with 3 or more chronic conditions reported not having talked with their doctor about all their different medicines in the last 12 months. Of seniors reporting skipping doses or stopping a medication because of side effects or perceived nonefficacy, 27% had not talked with a physician about it. Of those reporting cost-related nonadherence, 39% had not talked with a physician about it. Thirty-eight percent of those with cost-related nonadherence reported switching to a lower priced drug, and in a multivariable model, having had a discussion about drug cost was significantly associated with this switch (odds ratio [OR] 5.04, 95% confidence interval [CI] 4.28–5.93, P < .001). CONCLUSIONS: We show that there is a communication gap between seniors and their physicians around prescription medications. This communication problem is an important quality and safety issue, and takes on added salience as physicians and patients confront new challenges associated with coverage under new Medicare prescription drug plans. Meeting these challenges will require that more attention be devoted to medication management during all clinical encounters

The impact of obesity on time spent with the provider and number of medications managed during office-based physician visits using a cross-sectional, national health survey

<p>Abstract</p> <p>Background</p> <p>Obesity is associated with morbidity, mortality, and increased health care costs. Few studies have examined the impact of obesity on outpatient office visits. The purpose of this study was to determine if outpatient visits by obese persons required more time with the provider and more prescription medication management compared to visits made by non-obese persons.</p> <p>Methods</p> <p>Obesity status was determined for 9,280 patient visits made by persons aged 18 years or older in the 2006 National Ambulatory Medical Care Survey. Multivariate analyses compared obese and non-obese visits, stratified by sex, for duration of the visit and the number of medications mentioned at the visit.</p> <p>Results</p> <p>Average duration of visit was higher among visits with patients determined to be obese. However, these differences were not considered significant after statistical testing. Visits made by obese female patients were significantly more likely to involve more than two prescription medications (OR 1.26, 95% CI 1.05 - 1.51) and visits made by obese male patients were significantly more likely to involve more than two prescription medications (OR 1.46, 95% CI 1.16 - 1.83) as compared to visits made by non-obese patients.</p> <p>Conclusion</p> <p>Time spent with the provider was found to be greater among visits with obese patients, but not significantly different from visits with non-obese patients. The number of medications for each visit was found to be significantly greater for visits where the patient was considered to be obese. Increased time for the visit and increased numbers of medication for each visit translate into increased costs. These findings document the impact of obesity on our health care system and have great implications on medical care cost and planning.</p

Beyond The Horizon

Student affairs professionals have an obligation and an opportunity to support students moving through the college-years stages of psychosocial development by helping them use technology in approrpriate ways