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This literature review broadly examines disability in Alzheimer's disease (AD). The paper addresses the various types of disability in AD, as well as the presumed causes and the economic and social costs of such disability. The influence of various types of treatment of disability, particularly pharmacological is addressed, as are directions for future research. [ABSTRACT FROM AUTHOR]

The United States is the only western industrialized nation that fails to provide universal coverage and the only nation where health care for the majority of the population is financed by for-profit, minimally regulated private insurance companies. These arrangements leave one-sixth of the population uninsured at any given time, and they leave others at risk of losing insurance as a result of normal lVe course events. Political theorists of the welfare state usually attribute the failure of national health insurance in the United States to broader forces of American political development, but they ignore the distinctive character of the health care financing arrangements that do exist Medical sociologists emphasize the way that physicians parlayed their professional expertise into legal, institutional, and economic power but not the way this power was asserted in the political arena. This paper proposes a theory of stakeholder mobilization as the primary obstacle to national health insurance. The evidence supports the argument that powerful stakeholder groups, first the American Medical Association, then organizations of insurance companies and employer groups, have been able to defeat every effort to enact national health insurance across an entire century because they had superior resources and an organizational structure that closely mirrored the federated arrangements of the American state. The exception occurred when the AFL-CIO, with its national leadership, state federations and union locals, mobilized on behalf of Medicare. [ABSTRACT FROM AUTHOR]

This article comments on a research paper "Pathways to Medicine Use." In that article the authors employed path analysis to predict the use of prescribed and nonprescribed drugs by a sample of 2,378 adults from the Baltimore SMSA. Three sets of independent variables were included in the analysis: "predisposing" variables such as age, sex, and race; "enabling" variables, have Medicare, have Medicaid, perceived availability of care, drug expense, economic class, and time to MD; "need for care" variables, perceived morbidity, and anxiety. In their discussion of the findings, for example, they argue that women". . . did report more anxiety, and it is mainly through this intervening variable that they use more prescribed medicines." Yet the indirect effect of sex through anxiety is only about .03, with the remaining .04 of what they label indirect effect consisting of non-causal association. Similarly, they conclude that "nonwhites have somewhat lower rates of medicine use than whites, directly and indirectly. through the link of Medicaid to perceived morbidity . . ., suggesting that there were some cultural differences in regard to use of medicines."

Objective To assess and compare health system performance across six middle-income countries that are strengthening their health systems in pursuit of universal health coverage. Design Cross-sectional analysis from the World Health Organization Study on global AGEing and adult health, collected between 2007 and 2010. Setting Six middle-income countries: China, Ghana, India, Mexico, Russia and South Africa. Participants Nationally representative sample of adults aged 50 years and older. Main outcome measures We present achievement against key indicators of health system performance across effectiveness, cost, access, patient-centredness and equity domains. Results We found areas of poor performance in prevention and management of chronic conditions, such as hypertension control and cancer screening coverage. We also found that cost remains a barrier to healthcare access in spite of insurance schemes. Finally, we found evidence of disparities across many indicators, particularly in the effectiveness and patient centredness domains. Conclusions These findings identify important focus areas for action and shared learning as these countries move towards achieving universal health coverage. [ABSTRACT FROM AUTHOR]

The article discusses the role of state-level politics and funding allocations for children's health insurance programs (CHIPs) in the U.S. The author cites factors for reduced CHIP spending including Republican power in state legislatures and governorships. The article lists aspects associated with greater CHIP spending such as professionalized state legislatures, strong state financial abilities, and states with a history of social policy innovation. The author presents theoretical arguments about social policy development including power resource theory, institutional arrangements, logic of industrialism, race, and ethnicity. Quantitative data is analyzed from the U.S. Centers for Medicare and Medicaid Services (CMS)'s Statistical Abstract of the United States from 1998 to 2008.

The author provides preliminary and provocative results regarding the impact of health insurance mandates on the propensity of entrepreneurs to start new organizations. In keeping with a well-observed propensity for individuals to adjust their economic calculations in anticipation of future costs/benefits, the evidence suggests that when confronted with such mandates, potential entrepreneurs may either abandon entrepreneurial ambitions or seek to minimize mandate costs through jurisdictional arbitrage with appreciable implications for state and national level approaches to health care, health insurance provision, and workers. [ABSTRACT FROM AUTHOR]

Compared to older beneficiaries, disabled workers who become eligible for Medicare 25 months after they are deemed eligible for Social Security Disability Insurance (SSDI), receive little research attention or policy consideration. This is unfortunate, because of the special medical and vocational needs, high healthcare costs, and rapid growth of this population. Although disabled workers comprise only 14.1% of the total Medicare population, they account for about 17% ($71.6 billion) of total program expenditures. This review article finds that disabled workers are a medically heterogeneous population, with relatively high rates of psychiatric and cognitive conditions. Poor health, low incomes, and lack of access to affordable supplemental coverage make this group particularly vulnerable to program limitations and policy changes. Coverage gaps and co-payments may limit access to critical health services, including preventive services, rehabilitation, adaptive technology, personal assistance, and prescription drugs. Access to stable and affordable health insurance coverage is an essential part of return to work programming for SSDI beneficiaries. [ABSTRACT FROM AUTHOR]

Legislation, such as the federal Personal Responsibility and Work Opportunity Reconciliation Act (1996), the Balanced Budget Act of 1997, and the authorization of federally-funded health insurance coverage for children (State Children's Health Insurance or SCHIP) continues the shift of assigning increased power and responsibility for health and human services "safety net" programs from the federal level to the state level. Known as "devolution," this complex shifting of responsibility and accountability continues to evolve with increasing transference of authority, control, and administration of social programs to local governments, such changes require an informed citizenry and, hence, demand grassroots capacity building activities around public policy issues. This article describes a project designed to build the capacity of community-based organizations in several cities in Mississippi to become involved in health care policy activities. The primary purpose of this project was to inform and organize community members around improving health policies for low-income children and families. [ABSTRACT FROM AUTHOR]

Deinstitutionalization has been government policy with respect to the mentally ill for more than two decades. During this time, the inpatient populations of the nation's state and county mental hospitals have fallen by nearly 75%. The mechanisms by which these declines have taken place are a matter of signal importance for present and future mental health policy. In this article, I compare the effects of the Community Mental Health Center (CMHC) Program on inpatient decline, with the effects of the Medicaid program on the reduction in state hospital censuses. The results indicate that Medicaid had a much stronger effect than the CMHC program, and suggest that the structure of reimbursement schedules, rather than the philosophy of community care, was decisive in promoting deinstitutionalization. [ABSTRACT FROM AUTHOR]