Issue brief (Center for Studying Health System Change)最新文献

Twenty percent of all uninsured persons are offered health insurance by their employer or a family member's employer but choose not to enroll in the offered plan(s). Most persons who do not "take up" or enroll in available employer-sponsored coverage cite cost as the main reason why. This Issue Brief, based on two surveys conducted as part of the Center for Studying Health System Change's (HSC) Community Tracking Study, presents new findings on who declines employer-sponsored coverage and is uninsured as a result. Given the importance of cost in an individual's decision whether to enroll in employer-sponsored coverage, policy makers need to consider ways to address the problem identified by this study: low take-up rates among lower-income workers.

Market forces and recent policy changes are rocking the health care system, according to a panel of Wall Street analysts who track health care companies. In the fourth annual Wall Street roundtable convened by the Center for Studying Health System Change (HSC), analysts discussed the reasons behind improved health plan profitability, providers' struggles to maintain--let alone increase--market power, trends in consolidation and the dramatic impact of federal legislation on all sectors of the industry. This Issue Brief reports on how the analysts see these and other forces playing out in the future.

People without health insurance have historically received medical care from the safety net, which among many kinds of providers includes physicians who voluntarily provide uncompensated care. With 43 million Americans uninsured today--a group that has grown by 1 million a year for the last decade--the health care safety net is increasingly critical as a way for the medically indigent to get services. However, there are signs that the safety net is weakening because of certain changes in the health care system. This Issue Brief discusses Center for Studying Health System Change (HSC) findings from its Community Tracking Study indicating that higher managed care penetration is associated with both physicians providing less charity care and less access to care for the uninsured.

A major research project of the Center for Studying Health System Change (HSC) analyzes how the health system is evolving in 60 communities across the United States and the effects of those changes on people. Underway since 1996, the Community Tracking Study, which is funded exclusively by the The Robert Wood Johnson Foundation, is a longitudinal project that relies on periodic site visits and surveys of households, physicians and employers. The study is intended to provide a sound information base for decisions made by health care leaders. This Issue Brief provides an update of the study's design and research agenda.

Despite a rash of troubles in 1998, physician organizations--formed in response to managed care plans--can thrive if they are locally owned, physician-run and rationally sized, said panelists at a recent roundtable organized by the Center for Studying Health System Change (HSC). The panelists also noted the market's slow progress toward global capitation as a way of compensating physician organizations, and the generally weak state of information systems required to support the goals behind capitation: accountability, efficiency and quality. This Issue Brief reports on governance, physician-hospital relationships, capital needs, compensation and other developments covered at the roundtable.

Security analysts took a hard look at the latest trends in the health care industry at the third annual Health System Change Wall Street roundtable held earlier this year. The roundtable focused on costs and premiums, evolving financial relationships among industry leaders, industry consolidation and pharmaceutical and technology development. The analysts' conclusions: some market strategies--including vertical integration, provider risk-sharing and equity arrangements and the use of formularies to rein in drug costs--haven't worked out as expected. Health plans and provider organizations have yet to find a magic bullet for controlling costs while responding to purchasers' and consumers' demands for broader choice. This Issue Brief reports on the trends discussed at the roundtable.

Millions of Medicaid beneficiaries have recently moved into private managed care plans across the country. Public health departments--which have acted as providers of primary care and other services for some Medicaid patients--are often not explicitly included in contracts between these designated Medicaid plans and the states. As a result, many of the 3,000 city and county public health agencies nationwide have lost both patients and significant revenue to plans. This Issue Brief describes how public health departments are adapting to this shift in state policy. According to our research conducted in 1997, many are de-emphasizing the delivery of direct health care services in favor of core public health functions, such as investigating community health problems and health promotion. Some are initiating new partnerships with Medicaid managed care plans.

A substantial number of Americans--41 million people--do not have health insurance; this represents a 16 percent increase in the uninsured since 1990. Further, many studies show that the uninsured have significantly more difficulty than the insured in getting needed care. This Issue Brief discusses Health System Change (HSC) findings from its Community Tracking Study showing that the ability of those without coverage to get needed care varies considerably across communities. In addition, HSC's study shows that the personal characteristics of the uninsured explain very little of this regional variation. These findings are the first step in helping decision makers understand how the dynamics of communities and the safety nets within them affect the medically indigents' ability to obtain needed care.

The State Children's Health Insurance Program (CHIP), enacted one year ago this August, is the largest expansion of health insurance in more than three decades. One of the measures of its success will be whether state officials are able to enroll children who are eligible. Research conducted by Health System Change (HSC) shows that uninsured children are a diverse group, and that for CHIP to be successful, policy makers will need to target programs to specific groups and local market conditions. This Issue Brief discusses why children lack health insurance and the implications for implementing CHIP.

Although managed care plans have had success in controlling costs, they now face challenges on many fronts, including tighter profit margins, pressure for broader provider networks, increasing clout of hospitals and physicians and more demand for consumer protection regulation. Underlying these trends is a fundamental conflict between health plans and consumers, who are demanding--and, in many cases, getting--greater control over their health care delivery and services. This Issue Brief reports on a roundtable convened by the Center for Studying Health System Change to discuss these trends and conflicts and how they may play out over the next number of years. (1) Managed care challenges, (2) Redefining care delivery, (3) Investing in information systems, (4) Center survey findings about managed care, (5) Who's in control, (6) HCFA as a value purchaser, (7) Backlash fueled by many groups, (8) What about the future.