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

The Affordable Care Act (ACA) has already resulted in expanded eligibility for Medicaid in 27 states, including California, as of 2014. One major concern about the Medicaid expansion is that a high level of need among the newly eligible may lead to runaway costs, which could overwhelm state budgets when federal subsidies no longer cover 100 percent of the expansion population's costs in 2017. Although cost increases as a result of the newly eligible are likely, an even more important question is whether these increases will be temporary or permanent. Evidence from California's Low Income Health Program (LIHP) suggests that cost and utilization increases among newly eligible Medicaid beneficiaries will be mostly temporary. This policy brief presents data showing a significant decline in the use of hospital inpatient care and in emergency room visits after one year of enrollment in LIHP, and a stable, not increasing, rate of outpatient service use. Because LIHP provided health care coverage from 2011 to 2013 in advance of the full Medicaid expansion, our findings suggest that early and significant investments in infrastructure and in improving the process of care delivery can effectively address the pent-up demand for health care services of previously uninsured populations.

This policy brief reports the findings of a systematic review conducted by the Community Health Innovations in Prevention for Seniors (CHIPS) project. The project identified successful programs for increasing the use of two or more clinical preventive services for vulnerable, underserved populations ages 50 years and older within community settings. The CHIPS project also used the RE-AIM Framework to evaluate the readiness and feasibility of implementing these programs within real-world settings. Policy recommendations focus on expanding and sustaining clinical preventive services in the community and reaching diverse populations, bridging the traditional silos of clinical care and community-based services, and providing financial incentives to clinical providers and community-based organizations to support preventive services coverage.

More than 300,000 California children ages 4 to 11 have mental health needs, yet only one-fourth of them received mental health care in 2007 and 2009. Health insurance coverage and a usual source of care typically facilitate mental health service use; however, this is not the case for children with mental health needs. This policy brief identifies children at risk for mental health needs and highlights some barriers to their receiving mental health services. Childhood is a vital time for the promotion of positive mental health among children, as well as for supporting at-risk families in order to avert the early onset of some disorders and help reduce the severity of others. To reduce the potential burden and lifelong difficulties of untreated mental health needs, it is critical that mental health problems in young children be identified and addressed early.

Increasing diabetes prevalence has been found to be a primary driver of increased health care costs in the United States. This policy brief examines the impact of diabetes on hospitalizations and related hospitalization costs in California. Using 2011 hospital patient discharge data and annual financial data from the Office of Statewide Health Planning and Development (OSHPD), this study found that patients with diabetes represented 31 percent of hospitalizations in California in 2011 among patients 35 years or older, including 39 percent of African-American and Asian-American patients and 43 percent of Latino patients. Moreover, these hospitalizations cost nearly $2,200 more per hospitalization than those for patients without diabetes, regardless of the primary reason for the hospitalization. Given that approximately 90-95 percent of diagnosed diabetes among adults is type 2 diabetes and is therefore preventable, public health measures can and should be taken to relieve the burden of type 2 diabetes. Such measures include promoting a healthy diet and regular physical activity and providing adequate access to primary and specialty care.

Community health centers (CHCs) are a cornerstone of the health care safety net. They are the primary source of care for many low-income populations, including both those newly insured under the Affordable Care Act (ACA) and those who were left out and will remain uninsured. The ACA provides challenges and opportunities for CHCs, which will require significant changes in infrastructure and care delivery approaches to meet those challenges. This policy brief assesses the progress made by CHCs in Los Angeles County in meeting a number of key indicators of ACA readiness in early 2014. The authors find that 39 percent of CHCs are well prepared, 23 percent have made some progress, and the rest are at the initial phases of preparation and/or lack adequate resources to meet the requirements. The latter group of CHCs require help to embark on strategic improvements in infrastructure and care delivery.

More than 35,000 dentists were licensed to practice in California in 2012, a number higher than in any other state and representing about 15.6 percent of the total number of dentists nationwide. Despite these numbers, concerns over a sufficient supply of dentists in the state have not diminished. These concerns are due in part to the uneven distribution of dentists in areas with the highest level of need, as well as to demographic and practice characteristics that may limit availability of the dental workforce. This policy brief provides an overview of changes in selected demographic and practice characteristics of California dentists from 2008 to 2012, as well as in the distribution of dentists in California regions. The findings indicate an outward migration of dentists from California, a slowly aging workforce, and low dentist-to-population ratios in some regions of California. These findings highlight the need for the continuation and fine-tuning of policies aimed at both attracting young dentists to areas with low supply and retaining existing dentists in the state.

This policy brief looks at the financial burdens imposed on older Californians when adult children return home, often due to a crisis not of their own making, to live with their parents. The findings show that on average in California, the amount of money that older adults need in order to maintain a minimally decent standard of living while supporting one adult child in their home increases their expenses by a minimum of 50 percent. Low-income older adults are usually on fixed incomes, so helping an adult child can provide the child with a critical safety net but at the cost of the parents' own financial well-being. Policy approaches to assisting this vulnerable population of older adults include implementing reforms to increase Supplemental Security Income (SSI), improving the availability of affordable housing, assuring that all eligible nonelderly adults obtain health insurance through health care reform's expansion of Medi-Cal and subsidies, and increasing food assistance through SNAP and senior meal programs.

The home care industry is growing rapidly and coincides with increases in the growth of the elderly population, who are more frequently chronically ill and disabled and need assistance. This policy brief provides a profile of the home care industry and patients/consumers of these services in California, assessing available data on licensure and certification as a mechanism for promoting safety and quality of care. The findings indicate a dearth of information on the characteristics and care delivery of home care agencies and individual providers of nonmedical home care. The findings also illustrate that licensure and certification of home health agencies may enhance the capacity for improvements in quality of care. Establishing licensure and basic safety standards for home care agencies is a reasonable public health policy for reducing the potential for adverse consequences among the growing aging and disabled populations.

The economic recession that began in California in 2008 did not affect all counties equally. Using data from several years of the California Health Interview Survey, this policy brief examines the differences between 2007 and 2009 for the populations who were uninsured "for all or part of the prior year." During this time period, counties with high unemployment and lower household income saw the highest growth in the uninsured population, due to a large drop in job-based coverage and only a small increase in public coverage. Compared to the uninsured population in California in 2007, Californians who were uninsured for all or part of 2009 were older, more likely to be U.S.-born citizens, had lower household incomes, and were more likely to be unemployed and looking for work.

The success of health care reform implementation in 2014 partly depends on more efficient delivery of care to the millions of California residents eligible to gain insurance. Emerging evidence supports the effectiveness of the patient-centered medical home (PCMH) as a potential model of care delivery, which improves health outcomes and reduces costs. Among other principles, PCMH entails receipt of care from a personal doctor, who coordinates the patient's care and develops an individualized treatment plan for the patient. These principles are particularly essential in delivery of care to those with chronic conditions who require more intensive care management. Using the 2009 California Health Interview Survey (CHIS 2009), this policy brief indicates that patients who reported meeting these fundamental PCMH principles were more likely to have visited the doctor and to have received flu shots, and they also had better communication with providers than those who did not report meeting these PCMH principles. The data also showed that uninsured individuals, Medi-Cal beneficiaries, those at or below 133% of the federal poverty level, Latinos, and Asian-Americans were less likely to report meeting all three PCMH principles. These findings highlight the population groups that would most benefit from the PCMH care delivery model, particularly Medi-Cal beneficiaries and those eligible for Covered California, the California health benefits exchange.