Issue brief (Massachusetts Health Policy Forum)最新文献

On January 1, 2006, the Centers for Medicare and Medicaid Services (CMS) implemented the Medicare Drug Benefit, or "Medicare Part D." The program offers prescription drug coverage for the one million Medicare beneficiaries in Massachusetts. Part D affects Massachusetts state health programs and beneficiaries in a number of ways. The program: (1) provides prescription drug insurance, including catastrophic coverage, through a choice of private prescription drug plans (PDPs) or integrated Medicare Advantage (MA-PD) health plans; (2) shifts prescription drug coverage for dual-eligible Medicare / Medicaid beneficiaries from Medicaid to Medicare Part D drug plans; (3) requires a maintenance-of-effort, or "clawback" payments from states to CMS designed to capture a portion of states' Medicaid savings to help finance the benefit; (4) offers additional help for premiums and cost sharing to low income beneficiaries through the Low Income Subsidy (LIS); and (5) provides a subsidy to employer groups that maintain their own prescription drug coverage for retired beneficiaries. This paper summarizes the activities involved in implementing Medicare Part D, the impact it has had on Massachusetts health programs, and the experiences of beneficiaries and others conducting outreach and enrollment. The data are drawn from interviews with officials and documents provided by state health programs, CMS and the Social Security Administration, and representatives of provider and advocacy groups involved in the enrollment and ongoing support of Medicare beneficiaries.

In 2005, more than 56 percent of Massachusetts adults were overweight, a 40 percent increase from rates reported in 1990. Overall, nearly 21 percent of Massachusetts adults are obese. Both Blacks and Hispanics in the state are more likely than whites to be both overweight and obese, whereas Asians are the least likely to be overweight or obese. Nationally, rates of overweight and obesity are even higher. Obesity is a risk factor for multiple serious health problems in adults, including heart disease, hardening of the arteries, high cholesterol, high blood pressure, certain types of cancer, stroke, diabetes, muscle and bone disorders and gallbladder disease. In Massachusetts, it is estimated that direct costs for obesity-related medical expenditures came to a total of $1.8 billion (4.7% of total medical expenditures) in 2003. Medical expenditures for obese people are estimated to be 25-27% higher than normal weight people, and 44% higher among people who are very obese. Costs are largely attributed to higher rates of coronary heart disease, hypertension and diabetes, and longer hospital stays. Indirect costs associated with obesity approached $3.9 billion in 1995 reflecting 39.2 million lost workdays, 239 million restricted activity days, 89.5 million hospital bed-days, and 62.6 million physician visits. Causes of obesity include the wide availability of unhealthy foods, increased consumption, changing eating habits, high-calorie beverages, advertising and lack of physical activity. Although a number federal, state and local programs, policies and initiatives aimed at curbing the obesity epidemic have been implemented, more needs to be done. What is the responsibility of government in curbing the obesity epidemic, and how much of the burden should be left up to the individual? These important questions will be discussed at the Massachusetts Health Policy Forum on January 23, 2007. Overweight and obesity continue to climb steadily in the United States among both adults and children, increasing the risk for a host of physical, psychosocial and economic problems. This paper details the issues associated with being overweight or obese, with a focus on Massachusetts. The discussion begins with a general description and definition of this public health epidemic. Next, an examination of factors that contribute to overweight and obesity and associated costs to individuals, families and society is given, followed by a discussion of programs and policy options, both nationally and in the Commonwealth that are aimed at addressing this crisis.

This paper will address the current pandemic threat from avian and other influenza viruses, the treatments available, federal, state and local response and planning, and the policy implications should a pandemic occur. The paper concludes with some discussion about where we are and where we need to go, and some recommendations for policymakers and legislators grappling with the issue of pandemic planning.

This issue brief outlines five strategies for improving the quality of treatment in Massachusetts: (1) Engaging detoxification clients in a broader continuum of treatment, (2) Improving retention in treatment, (3) Providing client/family-centered services, (4) Increasing the use of evidence-based treatment approaches, and (5) Supporting recovery to address the chronic nature of substance use disorders. These strategies are essential to maximizing the impact of our substance abuse dollars. We need to do it right and then expand access to treatment more broadly and fill the treatment gap. Although not the focus of this report we need to think harder about upfront prevention and efforts to encourage more people to seek care. Part of the public strategy also requires better coordination between BSAS, MassHealth, provider organizations, and other state agencies, including criminal justice and mental health agencies. Through these efforts we can reduce the costs and consequences of substance abuse and build a healthier, more productive community.

On June 18th, Maine governor John Baldacci signed into law a comprehensive health care initiative know as Dirigo Health. Dirigo is Latin for "I lead", the state motto. Dirigo is often referred to as Maine's new universal coverage law. The law seeks to achieve universal access to coverage by integrating access, cost, and quality initiatives. While Dirigo responds to and takes advantage of particular circumstances in Maine, it has naturally drawn a great deal of interest from other states seeking to deal with similar problems. This issue brief provides an overview of Dirigo Health and outlines areas that might inform the health policy debate in Massachusetts (and perhaps other states as well).