Journal of health & social policy最新文献

This study presents the perceptions of a sample of homeless people, living on the streets, in Allegheny County, Pennsylvania. Questions were asked that elicited their opinions about drug addiction, housing and treatment needs. Two-thirds of the 225 persons interviewed in 2000 and 2001 reported that they were not eligible for treatment or housing. Forty-two percent of those who received treatment for substance use disorders reported that their treatment was ineffective because aftercare and residential supports were not available to them. The major findings of this study were: That service eligibility requirements were a barrier to adequate care; and that more homeless persons would consider treatment if housing placement was part of the continuum of services.

The lack of adequate health insurance affects one's ability to access care, which directly affects one's health. In the 21st century, there are 44 million people in the United States without health care insurance. The majority of people without health care insurance are working people under age 65, because most people over age 65 are retired and have health insurance through the federal Medicare program. Maintaining a healthy population makes good business sense because healthy people are more able to work, buy goods, and pay taxes that contribute to a healthy economy and strong government. We must understand, through provider "cost shifting," the American public is already "footing the bill" for the uninsured. However, the actual amount is hidden and passed on to consumers in payments to insurance companies through raised premiums, deductibles, co-payments, exclusions from coverage, and direct out-of-pocket payments to providers (e.g., physicians, hospitals). Ironically, the very working poor who are uninsured and underinsured help fund the health insurance of select federally protected groups through taxation. A huge gap exists in the current United States system of health care wherein there is no cogent benefit, only a vicious cycle as the insured continue to pay more for their care to help compensate provider losses due to the uninsured. This in turn causes a growing rank of uninsured individuals that lack access to adequate health care. The purpose of this article is to assert an alternative to the current U.S. health care insurance system. It takes advantage of structures already in place to promote a "win-win" American health system premised on a workable tiered universal health care system in which there is a benefit to the major populace. As an emanation of a diverse society, the proposed system does not advocate a one-payer universal system that is not amenable to the U.S. health care, social, or political environment.

Three policies of health care rationing are discussed. The premise underlying their analysis is that all welfare systems must ration health care. This raises the question as to how the problem ought best to be resolved. But before thinking about normatively appealing answers it might be helpful to study how the problem is dealt with in the real world. For such a study brings to light several advantages and drawbacks of various rationing schemes which would be hard to consider in the abstract alone, but whose knowledge may be highly relevant for any designation of adequate solutions.

States are ranked based on the potential of their small group health insurance reforms to enhance health insurance uptake. Reforms were quantified based on their market impact potential. Five dimensions of reforms were identified, Access Improvement, Premium Reduction, Premium Differential Reduction, Continuity of Coverage, and Enhancing Valued Plan Features. The reform indices representing these dimensions were developed based on document review of state statutes, combined with actuarial judgment to identify and assign scores to market-relevant regulations in line with their impact potential. The distribution of the states' reform scores and rankings show wide variation in the depth and focus of their reforms. Only seven of the top ten states on the Total Reform index had consistently higher scores on two or more reform dimensions. The conceptual linkages between specific regulations and the documented small group market problems lead to normative expectations of an association between the depth of state reforms and the prevalence of uninsurance.

Mental disorders are the leading cause of disability worldwide, according to the World Health Organization (WHO, 1996). In a report on health indicators of premature death and disability, the World Bank concluded that mental health problems account for 8.1% of the global burden of disease (GBD). Industrialized nations have taken different approaches in applying innovations to mental health care and mental health care policy. This paper uses the K. McInnis-Dittrich model of policy analysis (Ginsberg, 1994) to analyze the approaches of the United Kingdom (U.K.) and the United States (U.S.) to mental health treatment, specifically examining the effects of the U.K.'s national practice guidelines and the U.S.'s lack of similar guidelines. Recommendations for changes in current U.S. mental health policy are presented.

Small group health insurance statutes of 48 states and the District of Columbia, as of 1999, were reviewed. Reform provisions judged to have some relevance for the market are catalogued and total 74 distinct regulations. Judgment of market relevance was based on actuarial experience at a leading health insurance company. The regulations are categorized under: (1) Access improvement; (2) Pricing and Rating Reforms; (3) Improving stability of coverage; and (4) Improving valued features of plans. The nuances and variety of these regulations, adopted in various combinations by the states, are discussed. The complexity of the reform scenario suggests the need for impact studies that take into account the totality of reform. Past studies have evaluated the impact of selected major reforms in isolation, and, thus, have been inadequate to provide definitive conclusions on the reforms' impact.

Three hundred and thirty-six people representing three ethnic groups (White, Asian, and Afro-Caribbean) were asked to rank their preferences concerning various incentives that might induce them to agree to the posthumous donation of their body parts. A conjoint analysis of the responses suggested that 'self centred' options (notably upfront cash payments and priority on waiting lists) were generally more popular than 'altruistic' alternatives. Members of the sample already possessing donor cards were more knowledgeable about the issue of organ transplantation than others, were less squeamish, and had relatives who favoured organ donation. The strength of a person's desire to donate body parts was related positively to self-respect and whether the individual was 'religious'; and negatively to (i) squeamishness and (ii) having relatives who objected to transplantation. Altruistic preferences vis-à-vis organ donation were associated with knowledgeability, self-esteem, family background, low levels of squeamishness, and the extent to which a person experienced 'helper's high.' People who were financially well-off were the most self-centred in the organ donation context. Overall the results imply substantial disparities between public policy and contemporary public opinion regarding transplant donation incentives.

This study examined state policies for certificate of need or moratoria for new building, renovation, and remodeling of long-term care (LTC) providers, using a telephone survey of state officials in between 1990 and 2002. In 2002, the vast majority of states still continue to regulate the supply of nursing homes, hospital-based nursing homes, and facilities for the mentally retarded/developmentally disabled. Surprisingly, 18 percent of states regulate the supply of residential care facilities, 35 percent regulate home health agencies, and 37 percent regulate hospices. These state efforts to control supply are primarily based on cost containment strategies and assuring the appropriate distribution of LTC services. Where limits are placed on home and community service providers, however, access could be negatively impacted.

The existence of discrimination against America's gay and lesbian citizens is widely supported in the research literature of many disciplines. This article provides a specific analysis of this discrimination and demonstrates the stark contrast between the discrimination of gays and lesbians in American society and the social justice concepts of equality and fairness. The works of Rawls, and later the works of Nussbaum, provide the theoretical framework highlighting the factors related to this discrimination and inequality. In the concluding section, specific implications for future policy development are presented that are designed to ensure that gays and lesbians are not further discriminated against. Areas examined include civil unions, gay marriages, adoptions, hate crime legislation and cessation of the U.S. military's "Don't Ask, Don't Tell, Don't Pursue" policy, advocating for inclusion of open gays and lesbians in military positions and commandership.

This study examines associations between hospitalization for ambulatory care sensitive (ACS) conditions and insurance status for working age adults, and for people age 65 and older. ACS hospitalization is a recognized indicator of access to primary care. Using data from the 1997 U.S. Nationwide Inpatient Sample and the U.S. Census, we calculate population-based rates of ACS hospitalization. We also use the 1997 Medical Expenditure Panel Survey to calculate the prevalence of ACS conditions in the groups studied. Among working age adults, those receiving Medicaid and the uninsured had higher ACS hospitalization rates than insured individuals, even after adjusting for the prevalence of ACS conditions. Among Medicare beneficiaries, those who also received Medicaid benefits had higher ACS hospitalization rates than others, again after adjusting for the prevalence of ACS conditions; those with private insurance supplementing Medicare had lower ACS hospitalization rates.