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As a country, the United States spends significantly more on healthcare than other advanced industrialized countries, and Americans have comparably worse health outcomes. Both are developments of the last four decades. In this paper, we look at how change in antitrust and patent law and thus change in market power in the largest four subsectors of healthcare, hospitals, physician groups, prescription drugs, and net medical insurance, have contributed to the increasing cost of medical care in the United States. We show that the annual rent – the degree to which health care is overpriced as a result of market power – was between 2.47 and 4.30 percent of GDP in 2016 – truly a big cost for big medicine. [ABSTRACT FROM AUTHOR]

With the implementation of the Affordable Care Act (ACA), many homeless persons who previously lacked health insurance gained medical coverage. This paper describes the experiences of homeless persons in accessing and using primary care services, post-implementation of the ACA. Twenty-six semi-structured interviews were completed with homeless persons and primary care providers/staff. Via thematic analysis, themes were identified, categorized by: factors which influence primary care access and use patterns, and strategies to promote consistent primary care use. Maintaining insurance and leveraging systems-based strategies to support primary care access and use may address health disparities and promote health equity. [ABSTRACT FROM AUTHOR]

This paper investigates the influence of goal awareness and IT self-efficacy on job satisfaction based on the motivation sequence model, goal-setting theory, and social cognitive theory. Using a large-scale field survey of healthcare enterprise resource planning (ERP) system users (n = 352), this study investigates these relationships and provides important insight to healthcare ERP system researchers and managers. Both goal awareness and IT self-efficacy influence positive job satisfaction of healthcare ERP system users, as expected. Furthermore, the influence of goal awareness is stronger when the role of ERP systems is highly perceived for decision-making of the job. There was no interaction effect between goal awareness and IT self-efficacy in thepost hocanalysis. The model is significantly supported by the empirical test with the large number of field data from healthcare ERP system users in the healthcare company. Practical and academic implications are discussed in the paper. [ABSTRACT FROM AUTHOR]

Concern is growing in the United States regarding the potential for health insurance benefit designs to discriminate against persons living with HIV as research demonstrates that such practices are occurring. A recent complaint filed against health insurers in seven states alleges that some health insurance companies have been using benefit designs that discourage enrollment of people living with HIV either by not covering essential HIV medications or by requiring cost-sharing for these prohibitively expensive medications. Legislators across the country have reacted by introducing legislation to address these growing problems. This paper describes Assembly Bill 339, legislation passed in California in 2015 and going into effect on 1 January 2017, which provides protection for people living with HIV by requiring coverage for single-tablet regimens to manage HIV while placing a cap on patient cost-sharing. Given California’s size and influence, and the uncertainty of the future of the Affordable Care Act, this legislation has the potential to influence the national policy debate. [ABSTRACT FROM PUBLISHER]

The success of the Affordable Care Act (ACA) and its policy goal of increasing health insurance coverage across the United States, particularly for low income populations, rests in part on community-based outreach activities focused on consumer education and strategies to encourage sign–up. This paper draws on focus group data collected to evaluate and learn from one such community effort, located in a two-state region with significant political opposition to the ACA. Specifically, the research objectives were to better understand low income consumers’ experiences with ACA marketplaces during the initial sign–up period, both barriers and facilitators, and to learn what improvements they recommend for future outreach efforts. Focus group results show very limited knowledge of basic insurance concepts as well as the ACA. Participants reported numerous technological and related access barriers, which further complicated sign–up and caused them to lose confidence and become suspicious of the process. When asked how best to provide information and assistance to individuals such as themselves, participants pointed to several reasons conventional outreach might not be effective and suggested alternative strategies. Although public attention has focused on technical aspects of ACA sign–up, our findings suggest that future obstacles for those who remain uninsured are also likely to be related to perceptions and culturally–based understandings of “Obamacare” and how insurance works. This study underscores the importance of incorporating trusted, community relationships into efforts to expand coverage. [ABSTRACT FROM PUBLISHER]

This paper considers the affect of health insurance on children in the United States. Four topics are addressed. First, estimates of the number of children with no insurance or discontinuous coverage are presented. Second, consequences of being uninsured or having gaps in health insurance are considered. Third, a summary of barriers to increasing the extent and continuity of children's health insurance is outlined. Fourth, implications for policy and research are briefl y discussed. It has been well established that heath care in the United States is not the main determinant of health status of the population (McGinnis and Foege, 1993). As a nation, we spend by far more than any other country, yet our population has worse health status as measured by numerous indicators among the 30 developed countries comprising the Organization for Economic Cooperation and Development (Schroeder, 2007). This is due, in part, to determinants of health status that are not addressed by the health care system such as genetic predispositions and, more importantly, lifestyle choices (e.g., diet, physical activity, tobacco, alcohol and drug use, sexual practices, among others), and environmental and social factors (e.g., poverty, employment, housing, socially disintegrated communities, etc.). The ways in which the U.S. health care system is structured and the kinds of health care services that are emphasized (e.g., tertiary care versus primary and secondary prevention), further limit the extent to which health care contributes to health promotion and disease prevention. Nevertheless, availability and accessibility to consistent and high quality health care does influence the health status of the U.S. population, particularly for those at increased risk of various health problems and those with special health care needs (Hoffman and Paradise, 2008) , both of which disproportionately affect poor and minority youth. Indeed, universal health insurance coverage for theelderly may explain, at least in part, why one measure of health status for which the U.S. ranks higher thanmany nations in the Organization for Economic Cooperation and Development is life expectancy among those over 65 years of age (Schroeder, 2007). This paper considers the affect of health insurance on children in the United States. Four topics are addressed. First, estimates of the number of children with no insurance or discontinuous coverage are presented. Second, consequences of being uninsured or having gaps in health insurance are considered. Third, a summary of barriers to increasing the extent and continuity of children's health insurance is outlined. Fourth, implications for policy and research are briefl y discussed. [ABSTRACT FROM AUTHOR]

Drug abuse and addiction continues to negatively impact many lives in this country. The United States health care system has grappled with how to best serve this vulnerable population. Since the personal and societal costs of addiction are high, all recent iterations of the United States strategic health plans (such as Healthy People 2010) have prioritized this area for improvement. At the local level, health care providers who care for those with addictions are challenged with shrinking insurance coverage for services, a difficult patient population, lack of treatment options, growing ranks of indigent patients, as well as a plethora of additional management challenges. It is known that successful treatment is integrally linked with patient satisfaction with services. The most critical factors in successful addiction treatment (from a patient's perspective) are (1) their belief that the counselor cares about them and, (2) their belief that they can recover. This paper reports a case study in the use of a patient satisfaction survey as a quality management/service refinement tool within a methadone treatment setting. Results indicate that the use of the survey itself provides patients with a tangible cue supporting the presence of the critical success factors. Further, the use of a survey provides a baseline for future measurements and trending. The paper concludes with a discussion of the marketing and organizational implications of incorporating the patient satisfaction survey into the ongoing delivery program for addiction services. [ABSTRACT FROM AUTHOR]

This paper examines the feasibility of achieving U.S. health care reform and prognosis for success. In order to accomplish the task, this paper provides a check list of major problems which emerge continually in the field. In compiling a list of major problems, a tentative list of eight are presented. These problems include the following: unnecessary administrative costs; other major industrial countries can provide adequate health care at a lower rate of the national budget than does the U.S.; increase in malpractice insurance; shortage of primary care physicians in the rural and inner city areas; failure of health insurance; abundance of technology; distribution of care; and increase in health care costs. According to the author, these eight major problems give some indication to the complexity of the issues involved in the health care reform. These problems should be viewed in the context of the five major participant groups in health care: consumers, politicians, physicians and other health care providers, employers, and insurance companies. This paper briefly discusses the affected participants. It also provides a brief review of the proposed solutions to the problem of health care reform.

On the basis of a study of forty health care delivery institutions in Florida, California, and New Jersey, this paper examines the interaction between the immigration and health systems in the USA. We investigate barriers to care encountered by the foreign born, especially unauthorized immigrants, and the systemic contradictions between demand for their labour and the absence of an effective immigration policy. Lack of access and high costs have forced the uninsured poor into a series of coping strategies, which we describe in relation to commercial medicine. We highlight regional differences and the importance of local politics and history in shaping health care alternatives for the foreign born. [ABSTRACT FROM AUTHOR]

The recent influx of immigrants aged 65 and older in the United States triggers an increasing need to understand older immigrants' dental services use. This paper uses data (n = 9,617) from the 2004 and 2006 waves of the Health and Retirement Study to examine the dental services use of older Americans. In particular, this study focuses on differences in dental services use between immigrants and natives and potential contributing factors. Multivariate logistic regression analyses showed, contrary to expectation, that older immigrants were more likely to use dental services than older natives despite numerous barriers (odds ratio = 1.30 in 2004). The results in 2006 confirmed these findings. The results from 2004 and 2006 analyses showed dental insurance coverage, sex, and marital status were associated differently with dental services use for immigrants and natives. Implications for current oral health policies and future research of older Americans are discussed, as well as methods for meeting older immigrants' growing dental services needs. [ABSTRACT FROM AUTHOR]

This paper examines the extent to which US citizenship status affects the probability of a person's having a usual source of care and the predictors associated with access to health care among non-citizens. The research is founded on the analysis of data from the 2005 California Health Interview Survey (CHIS) (n = 33,187 adults, ages 18–64). Guided by a modified Andersen model of access to health care, the researchers conducted a series of logistic regression analyses using the survey data to compare native-born citizens with non-citizens who were 1.6 times less likely to access a usual source of care. Among non-citizens, insurance status, shorter duration of residence in the United States, and lower levels of English proficiency were related to a lower probability of having a usual source of care. Based on this research it is argued that affordable health care and health insurance options and access to culturally and linguistically sensitive services are needed to increase access to health care among these identified subgroups of non-citizens. [ABSTRACT FROM AUTHOR]

This paper describes initiatives to privatize the Medicare program over the last 10 years and the implications of these initiatives for the future of retirement security. Our analysis focuses on the privatization provisions of the Medicare Modernization Act, which is largely designed to benefit the corporate health care sector without containing costs or significantly reducing the threat of rising health care costs to the economic security of current and future retirees. In fact, as designed, the Medicare Modernization Act is likely to increase the threat to retirement security in the years ahead. We conclude with a series of policy alternatives to the neoliberal agenda for the privatization of Medicare. [ABSTRACT FROM AUTHOR]

Introduction: This paper describes correlates of use and expenditures for therapies (physical, occupational, speech or home health services) among children in the US. Methods: It examined data from the Medical Expenditure Panel Survey, a nationally-representative US sample. The characteristics of users and described patterns of expenditures were examined. Results: Use is quite low, only 3.8% of children use services or 4.3% once the use that occurs in the special education system is included. Children more likely to use therapy include those with presumably greater need: children with chronic conditions, functional limitations and/or a history of hospitalizations or injuries. There is a significant interaction of minority status and having a functional limitation. Expenditures are low when examined across the child population. Among a small proportion of high users, therapy expenditures account for a large proportion of overall health expenditures. Conclusions: The educational system adds only slightly to the overall rate of use. In general use appears to be related to the need for such services. Some children, likely including racial/ethnic minority children, may under-use services. Lack of insurance is not related to less use, perhaps because there are other ways to get some services (family care or services provided through the public health system) or because not all insurers cover therapy services. Therapy expenditures account for a high proportion of overall expenditures among the high users of therapy whereas, for the entire child population, therapy expenditures account for a very small part of overall health expenditures. [ABSTRACT FROM AUTHOR]

This paper explores historical and recent trends in the delivery of residential adolescent substance abuse treatment, looking specifically at the impact of managed care on the service delivery system. Three historical eras are conceptualized by the authors: (1) an era prior to managed care in which services were provided on a fee for service basis by health insurance companies and lengths of stay were relatively longer; (2) an era of managed care in which services were funded through managed care organizations and lengths of stay were significantly reduced; and (3) the current era in which residential services are provided through self-pay and through other service systems. Awareness of these changes is important for all practitioners who provide services to adolescents and demonstrate the need to advocates for residential substance abuse services for all adolescents. [ABSTRACT FROM AUTHOR]

As health care costs have been rising, especially for prescription drugs, employers have curtailed access to employer-sponsored retiree health insurance, especially for future retirees. This paper studies the question whether declining access has already translated into measurable loss of coverage for retirees. Based on data from the Current Population Survey and the Medical Expenditures Panel Survey, we find that retirees have lost health insurance and prescription drug coverage since 1996. The declines are especially pronounced for men before age 65 and for all Medicare-eligible retirees between the ages of 65 and 74. Our results also suggest that coverage will decline in the future. [ABSTRACT FROM PUBLISHER]

This paper presents a qualitative analysis of states' small group health insurance reforms that impact small group premiums, mostly enacted by the states during 1996-99, following the federal Health Insurance Portability and Accountability Act in 1996. It draws from an intensive review of statutes of 48 states and the District of Columbia as of 1999. It analyses regulations related to insurer pricing and rating practices concerning rating criteria and rating bands, pricing incentives, premium stability from year to year, minimum loss rations, re- insurance and carve-out coverage for the medically uninsurable. It also covers regulations targeting employer purchasing and coverage practices such as pooled purchasing and adverse selection. This is the second of a two-part series analyzing states' small group market reforms, the first being devoted to state reforms to promote access and improving the value of health plans offered in this market (Xirasagar et al. 2004). The variety in pricing and rating reforms illustrate the differences in the depth of reforms across states, and represent a far wider range of potential acth- anal combinations than the sample of reforms documented in past literature. [ABSTRACT FROM AUTHOR]

Medicaid is a US government insurance programme designed primarily for poor individuals, with expenditures that rose more than 13% in 2002. Thirty-five states have programmes allowing individuals to incur medical expenses at a rate that would make them poor enough to meet Medicaid eligibility criteria. This paper examines the cost of providing care to those spending-down to Medicaid compared to those eligible without spending-down. This longitudinal cohort study compiled inpatient, outpatient and Medicaid data from three academic Infectious Diseases clinics serving approximately 40% of the reported HIV-positive population in North Carolina. Participants included all HIV-positive patients who received care in one of three clinics and received Medicaid coverage at any time from 1996 to 2000 (1,495 individuals). Overall, those who needed to spend-down to Medicaid incurred higher medical costs, following a distinctive pattern of high costs when initially qualified and when ending coverage, and low costs while on spend-down. US states may wish to consider expanding Medicaid's categorically eligible criteria or significantly reducing the frequency with which persons must spend-down to become eligible for Medicaid. [ABSTRACT FROM AUTHOR]

One of the worst forms of inequality in the health care field is the inequality suffered by children. In 1996, over 14.5 million children lived in poverty in the United States. Children who live in poverty are less likely to have health insurance and have less access to health care and thus are more likely to suffer negative outcomes in health care. The Congress of the United States in 1997 enacted the State Children's Health Insurance Program (S-CHIP) to expand health insurance coverage for children. This paper examines the major features of the program, actions undertaken by the state governments under this program to expand health insurance coverage for children, and provides some preliminary analysis of the potential positive and negative impact of the program. [ABSTRACT FROM AUTHOR]

The article presents several news related to various universities in the U.S. Indiana University of Pennsylvania has acquired the United Mine Workers of America District 2 Collection. The collection consists of almost 400 boxes and includes papers associated with the presidencies of John Brophy and James Mark and executive files including presidential correspondence, injunctions and other documents. The Knight Library at the University of Oregon has opened the Records of the International Woodworkers of America to researchers. The records, which span from 1936 to 1987 and till nearly 600 linear feet, consist primarily of correspondence, minutes, proceedings, negotiation files, expired contracts, legal and financial documents and officer and departmental records. In addition to the union's basic activities, such as organizing, negotiations, litigation, and strikes, the collection documents the conflict between the red bloc and white bloc forces in the union during the 1940s and 1950s. Papers from the presidency of Keith Johnson deal with Canadian softwood lumber imports, national health insurance, labor law reform, affirmative action, occupational safety and health and other issues.

This study summarizes historical changes among clients entering drug treatment in their sociodemographic characteristics and important pretreament behaviors, such as work activity, criminal behavior, drug use, prior drug treatment, and health insurance. Data are drawn from three major studies of drug abuse treatment clients: the Drug Abuse Reporting Program (DARP), 19694972 the Treatment Outcome Prospective Study (TOPS), 1979-1981; and the Drug Abuse Treatment Outcome Study (DATOS), 1991-1993. The mix of drug treatment clients and their interaction with the drug treatment system changed substantially over the past three decades. Because data items are most directly comparable between TOPS and DATOS, the focus of this paper is on changes within the past decade. The most conspicuous change is in types and numbers of drugs used by clients entering treatment. Multiple drug use declined since the late 1970s, while reports of cocaine use since TOPS more than doubled among clients in the long-term residential and outpatient treatment modalities, and increased 1½ times among methadone clients. Other differences in treatment populations include decreases in clients' working full-time and in reports of suicidal ideation and attempts and predatory crime. Data from such studies as DARP, TOPS, and DATOS are valuable in historical, contextual, policy, and evaluative frameworks. The changing nature of the drug treatment client population-from sociodemographics to drug use and multiple treatment problem seventies-highlights the complexity of issues and difficulties encountered by those attempting to treat clients or plan treatment strategies. [ABSTRACT FROM AUTHOR]

This paper examines the impact that the lack of health insurance has on children and their families. A random sample of families of children who were newly enrolled in a children's health insurance program were interviewed by telephone and asked about the children's health status, the amount of unmet need and delayed care for a number of services, consequences of unmet need and delayed care, usual activities, and the effect on the lack of health insurance. Data were analyzed by using both quantitative and qualitative methods. We found that uninsured children had experienced considerable unmet need and delayed care that increased as the time without insurance increased. The parents reported some adverse consequences. The children were also found to be limited in the extent to which they could participate in various activities specifically because they lacked health insurance. Finally, the parents reported considerable stress and worry associated with their children's lack of coverage. We conclude that being without health insurance has broad consequences for America's children. [ABSTRACT FROM AUTHOR]

The aged are the heaviest users of physician services. An aging population and escalation in medical costs have pressured Medicare budgets, which have increased fastest in Part B physician reimbursement Policy responses include adoption of the Resource Based Relative Value Scale (RBRVS) for physician payment. This paper considers receipt of Medicare revenues by large medical groups and expectations of how groups will fare under RBRVS. In a 73-percent sample of U.S. large group practices, Medicare coverage accounted for one-fourth of clients, Medicare-related revenues for slightly more than one-fourth of revenues, suggesting a slightly higher revenue intensity for Medicare clients, hut showing no evidence of truly disproportionate revenues from Medicare users. Medicare shares of revenues are explained by factors related to Medicare clientele and geriatric service provision. Overly-strict Medicare assignment policy may control costs by limiting access to needed care, rather than by limiting overpayments to physicians. Expectations as to how groups will fare under RBRVS are not found to be related to reliance on Medicare, rather to group auspices and ability to contain costs under Medicare payment. The findings are important not only to physician payment under RBRVS but also under health care reform. [ABSTRACT FROM AUTHOR]