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PubMedDate not supplied

The clouded future of Medicaid.

Medicaid has become the nation's most important health coverage program, covering more individuals and costing more than Medicare. Because Medicaid finances the health care for society's most challenging cases, it deserves the characterization: "the workhorse of the U.S. health care system." A chief difficulty is that the program is housed within state governments, which means its fiscal fate is tied to the well-being of state economies. State revenues tend to decline just when health care spending and Medicaid spending reach their highest points. States have numerous strategies they employ to reduce the rate of growth in Medicaid spending, though none have strategies to halt relentless cost pressures. The policy challenge today is to survive this difficult period with the least damage to vulnerable individuals, families, and safety net providers.

Budgets↗
PubMed1998

Public information; communications with state and foreign government officials--FDA. Proposed rule.

The Food and Drug Administration (FDA) is proposing to amend its regulations governing communications with State and foreign government officials. The proposed rule would permit FDA to disclose confidential commercial information to international organizations having responsibility to facilitate global or regional harmonization of standards and requirements. These disclosures would, in almost all instances, occur only with the consent of the person providing the confidential commercial information to FDA. The proposed rule would also streamline the process for FDA officials to disclose certain nonpublic, predecisional documents (such as draft rules and guidance documents) to State and foreign government officials. The proposal does not alter current procedures for sharing documents that contain confidential commercial information. These changes are intended to facilitate information exchanges with State and foreign governments and certain international organizations.

Device Approval↗
PubMedDate not supplied

Power of information: closing the gap between research and policy.

States play an increasing role in setting U.S. health policy. A survey of 292 state government policymakers finds that officials are overwhelmed by the volume of information they receive and have a strong preference for information that is concise and more relevant to current debates. Younger officials are more likely to use electronic information, while older policymakers prefer printed material. Organizations of government professionals are trusted sources of information, and state agencies are a key source of data and information. Policymakers expressed a strong desire for tools to help them identify research on specific topics.

Adult↗
PubMed1994

Mental health services under health reform: the less government, the better.

Federal and state governments are now rapidly preparing to restructure the delivery and financing of health care services in the United States. Unfortunately, the bureaucratic structures promised under managed competition do not acknowledge the successes of private sector "market-regulated" programs. A needlessly costly and burdensome system could evolve that will undermine the goals of improved access and quality of care.

Competitive Medical Plans↗
PubMed1996

Collection of biological materials in biodiversity prospecting in India: problems and solutions.

Forests are the chief resource for the collection and exploration of biological materials. The past few decades have witnessed a large scale deforestation in India due to substantial pressures generated by population growth, leading to demand for more land for agriculture, urbanization and industrial activities, in addition to increased demand for fuel wood and timber. This has resulted in the loss of soil cover, habitat destruction, environmental degradation and ecological imbalance. This scenario has created a progressive awareness for the conservation and restoration of habitats and, thus, the declaration of many forest areas into protected zones, such as national parks, biosphere reserves, etc., including the protection of some marine areas, by both the National and State Governments. Normally, permission for biological collecting is not granted in these protected areas. In India, forests are a State subject and grant for collection permission is vested with the State Forest Departments. In the absence of any rules, regulations and guidelines, either from National or State Governments, forest authorities impose their terms and conditions, which are arbitrary and even contradictory at times, in the process of granting collecting permits. A set of new rules to be applied throughout the country is needed.

Commerce↗
PubMedDate not supplied

Disparities and quality improvement: federal policy levers.

Using a quality improvement framework to address racial and ethnic disparities in health care highlights multiple opportunities for federal and state governments to exert policy leverage, particularly through their roles as purchasers and regulators. Under such a framework, federal and state governments can expand their roles in collecting race/ethnicity data; define universal and meaningful race/ethnicity categories; more broadly disseminate standards for cultural competence; and demand the reduction of disparities through leveraging their status as collectively the largest U.S. health care payer.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2006

Future directions for Victoria's public maternity services: is this "what women want"?

BACKGROUND: Several state governments are once again reviewing policies for the provision of maternity care. This paper presents findings from a state-wide Victorian survey of recent mothers conducted in 2000 regarding women's experiences of antenatal care. We also offer some reflections on the way in which results from this and earlier Victorian surveys have been used, somewhat selectively, to support the State Government's new framework for maternity services, while other issues highlighted in the survey results have been overlooked. DESIGN: Population-based postal survey mailed to Victorian women who gave birth in a 2-week period in September 1999, 5-6 months after childbirth. RESULTS: 42% of women attending a public hospital clinic described their antenatal care as "very good" compared with 73% of women attending a birth centre, 59% attending private practitioners for antenatal care but receiving public intrapartum care (combined care), 56% attending a midwives clinic, 53% receiving shared care and 84% of women receiving private maternity care. The social characteristics of women enrolling in different models of care do not explain these differences. Immigrant women were much less likely to be happy with their care in pregnancy than Australian-born women, with no improvement in ratings of care over more than a decade.

Adolescent↗
PubMed1982

The University of Wisconsin Clinical Practice Plan.

The evolution and structure of the University of Wisconsin Clinical Practice Plan (CPP) is described, along with political and economic factors that have influenced its development. Comparison of clinical faculty numbers, average clinical earnings, average clinical base salaries, and average research funding per clinical faculty member in 1958, 1968, and 1978 (all in 1978 dollars) reveals a trend of rapid initial growth followed by a marked slowing of growth. This suggests that the CPP is reaching a stage of continued slow growth. Further analysis of the data also suggests the effect on the CPP of changes in federal and state government funding of medical research, medical education, and health care for indigents. The effects of these fluctuations in federal and state government funding of these three areas on CPP income and expenses have made long-range planning and budgeting for the CPP difficult.

Faculty, Medical↗
PubMed1996

The impact of state-level restrictions on abortion.

This research examines 23 different laws passed by state governments in an effort to restrict the number of abortions. It assesses both laws passed and laws actually enforced after the Supreme Court permitted states to restrict access to abortion in 1989. None of the policy actions by state governments has had a significant impact on the incidence of abortion from 1982 to 1992. Abortion rates continue to reflect past abortion rates, the number of abortion providers, whether the state funds abortions for Medicaid-eligible women, urbanism, and racial composition of the population. Recent restrictive policies have not affected these trends.

Abortion, Induced↗
PubMed1997

Assisted living: opportunities for partnerships in caring.

Throughout the United States, a variety of state government bodies license or certify assisted-living facilities. States have taken a variety of approaches in setting standards and protecting consumers. Consumers will respond to innovative solutions that enable elders to remain independent while assuring peace of mind of their adult children.

Aged↗
PubMed1975

Federal and state pesticide regulations and legislation.

The combined research, education, and regulatory efforts of federal and state governments have made possible an impressive record of abundant production while imposing minimal harm to human health and the environment. Considering that approximately one billion pounds of pesticides are being applied in the United States annually to control about 2000 pest species, the safety record is remarkable. The increased public concern about environmental values and long-term health effects is constructive and is resulting in some of the regulatory changes discussed in this article. The Federal Environmental Pesticide Control Act can result in an improved and expanded joint effort by federal and state governments to limit the misuse of pesticides while permitting their use to facilitate increased production of food, feed, and fiber; provide protection from spoilage; improve health; and control nuisance insects and unwanted plants. Implementation of current regulations, plus those in the process of being enacted under authority of the new federal act, will be complex and costly. Regulations will control the registration, labeling, distribution, storage, use and application, and disposal of pesticides. A small segment of our society would like to have the use of all chemicals banned. A few individuals oppose all government controls. However, the vast majority of agricultural producer groups, representatives of industry, and the public support the need for pesticide regulations. Only through continued legal controls over pesticides may we hope to retain their use. Our society has gained tremendous benefits from the use of pesticides to prevent disease and to increase the production of food and fiber. Our need to use pesticides will continue to increase for the foreseeable future. Government agencies responsible for protecting human health and the environment must make sound judgments on an individual basis in evaluating the evidence concerning both the benefits and risks of using pesticides.

Government Agencies↗
PubMed1991

The Medicaid maze: states and hospitals take new paths in search of funding.

No longer are health care providers simply warning state governments of impending Medicaid troubles. They now are actively pitching in to try to help find solutions to what has become a nationwide crisis. Federal mandates expanding Medicaid eligibility, an increase in unemployment and medical indigency, and providers' attempts to obtain equitable reimbursement are compelling state governments to get creative. It's none too soon: In FY 1990, states spent $662 billion more on Medicaid than they had originally budgeted, while federal and state Medicaid spending is expected to increase by 25 percent in FY 1991.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2001

Public policies to promote community-based and interdisciplinary health professions education.

CONTEXT: Many rural and inner-city communities in the United States have persistent shortages of health professionals. In addition, health services are increasingly delivered in community-based settings by interdisciplinary teams. Yet, health professions students in the US continue to receive most of their training in urban hospitals. OBJECTIVE: To assess the extent to which national and state government programs in the US that fund health professions education provide financial resources for community-based and interdisciplinary education in the health professions. METHODS: Literature review. FINDINGS: Most national and state government funding provided to health professions schools and clinical training sites in the US is not targeted to community-based and interdisciplinary education. Nationally, the Bureau of Health Professions, however, does administer some targeted grant programs. In addition, a number of states are addressing these needs through targeted appropriations to health professions schools and Medicaid payments to clinical training sites. RECOMMENDATIONS: The US experience with government funding of health professions education suggests several questions that policymakers in other nations should consider and several principles for developing effective policies to promote community-based and interdisciplinary education.

Journal Article↗
PubMed1994

Information, market government, and health policy: a study of health data organizations in the states.

Information is essential to the success of market-oriented policies. Information on health care costs and quality is collected and distributed by state governments through health data organizations (HDOs) to enhance competition and lower costs in the medical industry and to improve consumer choice among medical alternatives. This article examines the information collected, produced, and distributed by state health data organizations in Colorado and Pennsylvania. Findings reveal that information was not the objective determinant of choice and competition as market-oriented policy designers had hoped. Nor did market-oriented bureaucracies produce and distribute data readily accessible for public choice. Instead, information produced and distributed by these HDOs was the result of political and bureaucratic exercises that conform much more to classic interest group policymaking and captured bureaucracies than to contemporary market-oriented government ideals. The findings underscore the extraordinary difficulties facing federal-level policy designers as they contemplate introducing market-oriented health care policies on the national level.

Colorado↗
PubMed2003

Access to breast prostheses via a government-funded service in Victoria, Australia. Experience of women and service providers.

For many women, the only alternative to breast reconstruction following a mastectomy is to use external prostheses, which need replacing regularly at a cost of up to $395 per prosthesis. Commonwealth and state governments across Australia have responded to this need by providing subsidies to assist in the purchase of breast prostheses. However, current arrangements have been highly variable and sometimes difficult to access. As part of a larger review of breast prosthesis services in Victoria, Australia, the aim of this research was to evaluate client satisfaction among Victorian women who accessed funds through the State Government's Aids and Equipment Program, compare the responses of the program service providers with the experiences of clients accessing funding, and identify opportunities to improve service provision.

Aged↗
PubMed1998

The reforming states group and the promotion of federalism.

Since 1991, leaders in health policy from the legislative and executive branches of state government have come together, with financial support and staff collaboration from the Milbank Memorial Fund, to share their experiences and to work on practical solutions to pressing health care problems. What began with a handful of states at the forefront of health reform is now the Reforming States Group (RSG), a bipartisan, voluntary association that includes leaders from over 40 states. This article describes the origins, history, and future prospects of the RSG.

Child↗