Policy brief (UCLA Center for Health Policy Research)最新文献

While the Patient Protection and Affordable Care Act (ACA), signed into law in 2010, expanded health insurance coverage to millions of Californians, it did not extend eligibility for coverage to undocumented U.S. residents. Federal policy prohibits the use of federal funds to provide Medicaid to undocumented individuals. In 2015, the state of California extended Medi-Cal (California's Medicaid program) to undocumented children using state funds, and policies to extend eligibility to undocumented adults have been proposed. This policy brief includes the latest data from the California Health Interview Survey (CHIS) on the health insurance, demographics, health status, and access to care of undocumented low-income Californians ages 19-64. The data indicate that the great majority of these undocumented adults are working, live in families with children, and report being relatively healthy. However, significant disparities exist in access to health care between this group and their documented counterparts. This overview of undocumented low-income adult residents of California provides insights into the implications of extending full-scope Medi-Cal eligibility to this population, who currently have very limited options for affordable health insurance coverage and experience access disparities.

The Workforce Education and Training component of California's Mental Health Services Act, which passed in 2004, has infused funding into the public mental health system. However, funding has not kept pace with an existing behavioral health workforce shortage crisis, the rapid growth of an aging population, and the historical lack of geriatric training in higher education for the helping professions. This policy brief draws on recent study findings, state planning documents, and a review of the literature to describe gaps and deficiencies in the behavioral health workforce that serves older adults in California. The brief offers recommendations to the following specific audiences for improving workforce preparation and distribution: state policymakers and administrators; educational institutions, accrediting bodies, and licensing boards; and county mental health/behavioral health departments and their contracted providers.

This policy brief describes civic engagement among California adolescents in high school. Using data from the California Health Interview Survey (CHIS), the study found that the most common civic engagement activity among California high school teens is volunteering. Latino teens and those from low-income families have lower rates of civic engagement. Higher rates of civic engagement are associated with better health status, fewer days of missed school due to health, better grades, and greater perceived likelihood of attending college. Strategies to increase adolescent civic engagement could help promote healthy development. Policymakers, schools, and community organizations can promote civic engagement among all youth by expanding programs, encouraging youth participation in school and community organizations, and engaging youth who have not traditionally been included in civic activities.

This policy brief examines differences in health care access, health behaviors, and health outcomes by sexual orientation among California adults. Using data from the California Health Interview Survey, the study finds that although lesbian, gay, and bisexual women and men have similar or better rates of insurance coverage compared to straight women and men, they are more likely to experience delays in getting needed health care. Lesbians, bisexual women, and bisexual men have higher rates of smoking and binge drinking than straight women and men; however, gay men are less likely to consume sugary beverages and to be physically inactive. Lesbians and bisexuals had poorer health status and higher rates of disability than straight adults. Future research is needed to explain these disparities, as well as to identify health care and structural interventions that will improve access to care and health outcomes for this population.

This policy brief describes physical activity among California children and adolescents. Using data from the California Health Interview Survey (CHIS), the study found that only 31 percent of children ages 5-11 and 18 percent of adolescents ages 12-17 meet the physical activity guidelines of engaging in at least one hour of physical activity every day. Neighborhood characteristics, including safety and proximity to parks, are related to physical activity levels among youth. Also, among older children, boys are more active than girls. Additional efforts by state and local policymakers, as well as communities, are needed to promote physical activity to increase the proportion of children and adolescents achieving recommended amounts of physical activity.

This policy brief describes two types of walking among California adults: walking for transportation and walking for leisure. Using data from the 2013-14 California Health Interview Survey, the study found that the prevalence of both types of walking has increased since 2003. The prevalence of walking for both transportation and leisure varies withage, income, race/ethnicity, and neighborhood safety and cohesion. Additional efforts by state and local policymakers, as well as by communities, are needed to reduce disparities and promote walking among adults.

As Medi-Cal enrollment expanded during the early years of ACA expansion (2014 and 2015), county health department spending in California also swelled. For most counties and regions in the state, the two measures tracked closely. However, exceptions in Northern California (with high enrollment and low spending growth) and Central California (low enrollment but high spending growth) show that other factors may also have had an effect. Importantly, if Medi-Cal is turned into a capped block-grant program at the federal level, counties would be heavily impacted and could be left with budget shortages.

Adult vaccination rates in the United States are consistently lower than the National Healthy People 2020 goals. Barriers to adult vaccination include inconsistency of insurance coverage of adult vaccines and difficulty in accessing vaccines. To help address the gap in adult access to vaccines, in 2016 the Department of Health Care Services--which administers the Medi-Cal program (California’s version of Medicaid)--implemented the All Plan Letter (APL) 16-009, which requires coverage of recommended adult vaccines as a pharmacy benefit. Adult Medi-Cal patients can now receive the vaccines recommended for their age and underlying health conditions, and they can do so not only at a provider’s office but also at local pharmacies, improving access and convenience. This policy brief recommends expanding coverage of all adult vaccines as a pharmacy benefit of all public and commercial insurance plans.

Parks After Dark (PAD) is an innovative Los Angeles County (County) strategy for building resilient communities that re-envisions parks as community hubs. PAD began in 2010 at three parks and expanded to twenty-three parks in 2017, evolving into a key County prevention and intervention strategy to promote health, safety, equity, and family and community well-being through cross-sector collaborations. The parks selected for PAD participation are located in communities that, compared to Los Angeles County as a whole, experience higher rates of violence, economic hardship, and obesity and have fewer resources for physical activity and social gathering (see Parks After Dark Evaluation Report, May 2017). For an eight-week period each summer, PAD extends hours of park operation from 6:00 to 10:00 p.m. at participating parks. The program provides opportunities for community members to come together in a safe and welcoming space where they can access quality programming and a variety of health and social resources. PAD offers sports and recreational activities (e.g., swimming, dance), family entertainment (e.g., movies, concerts, arts and crafts, free meals), cultural and educational programming (e.g., healthy cooking, financial literacy), and employment and volunteer opportunities for youth and adults. PAD also provides resource fairs at which numerous government and community-based organizations connect participants with health, social, economic, and legal resources. Throughout all events, Deputy Sheriffs patrol and engage in activities alongside participants, ensuring safety and fostering positive interactions between law enforcement and community members. PAD is led by the County Department of Parks and Recreation (DPR), with strong support from partners, including the County Board of Supervisors, Chief Executive Office (CEO), Department of Public Health (DPH), Sheriff’s Department (LASD), Probation Department, Workforce Development Aging and Community Services (WDACS), and many other government and community-based organizations. This brief focuses on 2017 outcomes and highlights innovative strategies.

This policy brief examines patterns of sugary beverage consumption among children and adolescents in California. Using data from the California Health Interview Survey (CHIS), this study found that while sugary beverage consumption decreased among adolescents ages 12-17 between 2011-12 and 2013-14, it increased among children under age 12 between 2009 and 2013-14. The trend among children under age 12 may be attributed to a shift in sugary beverage consumption from soda to sports and energy drinks. Establishing and strengthening policies that focus on reducing consumption of sugary beverages could counter the increasing consumption trend among younger children as well as result in further reductions in consumption among teens.