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Knowledge Translation (KT) is the exchange, synthesis, and ethically-sound application of knowledge. A case study methodology is used to examine KT at the organizational level of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program. The study used purposeful sampling to select WIC informants from state WIC agencies to participate in semi-structured interviews about their individual experiences during the 2009 WIC regulation change process. Thematic coding of retrospective semi-structured interviews with key informants from WIC state agencies revealed key components of the state-level WIC regulation implementation process, and key constructs of Organizational Readiness for Knowledge Translation in the WIC program. WIC informants highlight that decisions made by WIC state agencies regarding how to appraise, synthesize, and adapt evidence or regulation change are constrained by the KT decisions made by federal agencies. WIC state agencies should assess their level of readiness for KT in terms of 1) innovation readiness; 2) personal readiness; and 3) institutional readiness. This WIC case study can help decision-makers to understand the KT process of implementing evidence-informed regulation changes, identify factors that could influence states' ability to be prepared for implementing changes, and gauge "practicality" of future WIC regulation changes. [ABSTRACT FROM AUTHOR]

Objectives: To assess knowledge and understanding of cost-sharing responsibilities and whether that knowledge and understanding influence actual and perceived use of healthcare services., Study Design: A 3000-person random sample was drawn from a state employee database in Massachusetts., Methods: Survey responses and claims analyses were used to assess knowledge of cost sharing and healthcare utilization over a 3-year study period. Trend models and logistic regression were used., Results: Nearly two-thirds of respondents (62%) accurately recalled the percentage of premium that they paid; 67% recalled the correct copayment for a doctor's visit. Younger, less educated, and lower-income employees recalled their copayment more accurately than older, more educated, higher-income colleagues. Half of the respondents accurately reported the copayment amount for an emergency department visit. Greater knowledge of overall healthcare costs was positively associated with higher utilization of office visits (P <.01). Knowledge of specific office visit and emergency department copayments had no significant relationship with utilization. Self-reported delays and reductions in utilization were much more pronounced than the actual claims data indicated., Conclusions: Employees were reasonably well informed about their cost-sharing responsibilities. Knowledge of costs was associated with higher office visit utilization during the study period. Respondents who were more knowledgeable about their specific copayments for office visits and emergency department visits also were more likely to behave in what appeared to be a more cost-efficient manner, with more office visits and fewer emergency department visits.

The Commonwealth Health Insurance Connector Authority is the centerpiece of Massachusetts' ambitious health care reforms, which were implemented beginning in 2006. The Connector is an independent quasi-governmental agency created by the Massachusetts legislature to facilitate the purchase of affordable, high-quality health insurance by small businesses and individuals without access to employer-sponsored coverage. This issue brief describes the structure and functions of the Connector, providing a primer to policymakers interested in exploring similar reforms at the state and national level. The authors describe how the Connector works to promote administrative ease, eliminate paperwork, offer portability of coverage, and provide some standardization and choice of plans. National policymakers looking to achieve similar policy goals may find some of the structural components and functions of the Connector to be transferable to a national health reform model, say the authors.

Health insurance premiums have risen steadily in recent years, and many employers are coping by increasing employee premium contributions. The danger with cost shifting is that a substantial number of employees will refuse offered insurance because of the escalating contribution required of them. The authors surveyed employees regarding what aspects of their insurance benefits they would be willing to give up if their policies were to be substantially trimmed. The responses were varied and influenced by income, education, current contribution to premium, and health status. Interestingly, few employees outside of unions strategize with their employers about how best to structure health insurance benefits to keep them affordable.