Stretching the Safety Net to Serve Undocumented Immigrants: Community Responses to Health Needs

Examines the ability of communities to provide health care for both legal and undocumented immigrant patients. Looks at community diversity, political climate, and advocacy groups. Based on site visits to twelve nationally representative communities

Public Health Workforce Shortages Imperil Nation's Health

Examines from a community-based perspective the scope of the shortages in the public health workforce; contributing factors such as inadequate funding, salaries, and benefits; and strategies for training, recruiting, and retaining public health workers

Safety Net hospital Emergency Departments: Creating Safety Valves for Non-urgent Care

Outlines how safety-net hospitals are addressing the rise in emergency department visits for non-urgent care, such as re-directing patients to outpatient clinics or community health centers and adding primary care capacity. Discusses policy implications

The Esso refinery, Everett, Mass., an analysis and evaluation of its public relations policies and practices

Thesis (M.S.)--Boston University Includes bibliographical references (leaves 147-148)

Public and Private Health Care Financing with Alternate Public Rationing

We develop a model to analyze health care nancing arrangements and under alternative public sector rationing rules. Health care is demanded by individuals varying in income and severity of illness. There is a limited supply of health care resources used to treat individuals, causing some individuals to go untreated. We examine outcomes under full public finance, full private finance, and mixed, parallel public and private finance under two rationing rules for the public sector: needs-based rationing and random rationing. Insurers (both public and private) must bid to obtain the necessary health care resources to treat their beneficiaries. While the public insurer's ability-to-pay is limited by its (fixed) budget, the private insurer's willingness-to-pay re ects the individuals' willingness-to-pay for care. When permitted, the private sector supplies supplementary health care to those willing and able to pay. The introduction of private insurance diverts treatment from relatively poor to relatively rich individuals. Moreover, if the public insurer allocates care according to need, the average severity of the untreated is higher in a mixed system than in a pure public system. While we can unambiguously sign most comparative static effects for a general set of distribution functions for income and severity, a complete analysis of the relationship between public sector rationing and the scope for a private health insurance market requires distributional assumptions. For a bivariate uniform distribution function we nd that the private health insurance market is smaller when the public sector rations according to need as compared to random allocation of health care.health care financing, rationing rules

Pursuing Cost Containment in a Pluralistic Payer Environment: From the Aftermath of Clinton’s Failure at Health Care Reform to the Balanced Budget Act of 1997

Following a decade in which Medicare operated as the leading ‘change agent’ within the US health care system, the private sector rose to the fore in the mid 1990s. The failure of President Clinton’s attempt at comprehensive, public sector-led reform left managed care as the solution for cost control. And for a period it worked, largely because managed care organizations were able to both squeeze payments to selective networks of medical providers and significantly reduce inpatient hospital stays. There was a lot of ‘fat’ in the nation’s convoluted health care system that could be (and was) eliminated through competitive negotiations between medical providers and insurers, employers, or managed care organizations. One of our primary arguments in this article is that managed care operated partly as a systematic suppression of price discrimination or differential pricing (often referred to as ‘cost shifting’), as managed care organizations qua purchasing agents prevented hospitals and physicians from summarily raising prices to private payers to meet their financial requirements. Over time, however, managed care fell victim to inflated expectations, its own initial success, and larger fiscal forces. During this same period, Republicans and Democrats struggled to reach a consensus over the future direction of Medicare. Their disagreements contributed to the impasse over budget policy in 1995 and the infamous partial federal government shutdown. After President Clinton’s reelection in 1996, partisan disagreements over Medicare dissipated. And, in 1997, Congress and the president passed the Balanced Budget Act of 1997, which emerged as a massive piece of patchwork legislation that sought to balance the federal budget, rein in Medicare spending, and increase the number of the programme’s beneficiaries in private health plans