Health Policy Report. Federal policies and the poor.
Explore the source record for details and available documents.
Budgets↗
SEARCH · Search PubMed
Results for “federal policy”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
The labor impacts of policy change in health care: how federal policy transformed home health organizations and their labor practices.
Health care organizations are highly labor-intensive; policies designed to stimulate organizational change are likely to have labor impacts. This paper examines the labor effects of policy change in home health care. Major federal home care policy trends since 1980 have spurred the evolution of the typical home care provider toward greater organizational and market rationality. Greater managerial sophistication has introduced changes in management/labor relations. Survey data from the 1986 DRG Impact Study are used to show how the pressure of cost-containment policies has pushed agencies to cut labor costs by increasing workloads, managerial supervision, and control of the work process. Research on the effects of recent policy change in health care has to date focused primarily on potential client effects. Labor impacts are rarely examined and are poorly understood at the time that policy is made. Findings in this article suggest that these issues deserve greater, more systematic attention, because unanticipated labor impacts may prove to be significant impediments to the realization of intended policy goals.
Allied Health Personnel↗
Medicaid, the uninsured, and national health spending: federal policy implications.
Implications are discussed for Federal policy of "gap-filling" initiatives at the State and Federal level to deal with the problem of the uninsured. Measures currently under active consideration that involve expansions of Medicaid and employment-related insurance are considered in the light of recent studies of the uninsured and recent simulations of their cost and coverage impacts. The limited impact of these gap-filling measures on additional national health spending, in contrast to program costs and Federal outlays, is emphasized. Placing greater emphasis on this broader societal perspective could assist Federal policymakers in developing an acceptable strategy for covering the uninsured.
Costs and Cost Analysis↗
Does federal policy support the use of scientific evidence in school-based prevention programs?
Since 1998, federal policy has explicitly required the use of "evidence-based" prevention programs in schools. We review how this policy has been implemented through state recipients of the Safe and Drug Free Schools (SDFS) Program, and how other federal and private agencies have supported the policy by providing guidance about the scientific evidence for specific programs' effectiveness. We report data from a survey of SDFS state office directors, and we compare and contrast the most popular lists of effective programs. State offices supply the infrastructure for administering the SDFS Program, providing technical assistance to local school districts, monitoring the implementation of federal policy at the local level, and determining funding eligibility based on compliance. We found that states rely heavily on federal lists to determine whether school districts are meeting federal policy requirements, particularly the National Registry of Effective Programs and Practices (NREPP). Both SDFS and NREPP are changing, however, and the changes do not bode well for the transfer of prevention science to schools. Conclusions and recommendations are presented.
Data Collection↗
Federal policy for the protection of human subjects. Final rule.
This document sets forth a common Federal Policy for the Protection of Human Subjects (Model Policy) accepted by the Office of Science and Technology Policy and promulgated in regulation by each of the listed Departments and Agencies. A Proposed Federal Policy for the Protection of Human Subjects published November 10, 1988 (53 FR 45661) has been revised in response to public comments. The Policy as revised is now set forth as a common final rule. For related documents, see other sections of this Federal Register part.
Behavioral Research↗
Fetal tissue transplantation research and federal policy: a growing wall of separation.
The federal moratorium on fetal tissue transplantation research is creating an ever growing wall of separation between public and private research. This federal policy is based on undocumented psychological assumptions about what motivates women to have abortions, neglects to consider the suffering that could be prevented by allowing such research, disregards the fact that other forms of fetal research are performed at federal expense, infringes on the scientific freedom of federally employed scientists and compromises the federal government's ability to control the quality of research. Efforts must be made to legally dismantle this wall before it further impedes the goals of medical research.
Aborted Fetus↗
Social context and personal expenditures for health care: federal policy and the experience of older adults in the 1970s.
The relationship between the intent and the outcome of legislated social policy is discussed. Specifically, this study documents some effects of federal health reimbursement and income policy in the late 1960s and early 1970s on health care behavior and expenditures in the decade 1970-1980. The Longitudinal Retirement History Study (LRHS), containing information on a panel of 6,270 men and unmarried women aged 58 to 63 in 1969, was used to provide information on the personal health expenditures in this decade. Medicare and Medicaid and the indexing of Social Security became operational at the beginning of the study, which permitted the exploration of intended and observed effects of legislation designed to make health care more accessible and affordable for older adults. As policy intended, utilization increased over the decade as indicated by both increases in the number of panelists with health care bills and increases in the size of total bills (constant dollars). Consistent with federal policy to reduce personal costs, out-of-pocket expenditures and the proportion of total bills paid out of pocket decreased. However, the effects of these federal policy initiatives were constrained by reimbursement rules and the social location of users. For instance, even at the end of the 1970s, out-of-pocket health care expenditures across subpopulations persisted. The 1980s and early 1990s have brought increased concern over the cost of health care and renewed concern over access. Data suggest that future proposals aimed at providing universal coverage along with high out-of-pocket costs may not result in equitable programs, and are likely to have a limited impact on constraining health care costs. The LRHS data indicate that utilization increased despite continued high out-of-pocket costs for all except the lower-income groups, who may be limited in their ability to purchase increasingly costly care.
Aged↗
The gap between law and ethics in human embryonic stem cell research: overcoming the effect of U.S. federal policy on research advances and public benefit.
Key ethical issues arise in association with the conduct of stem cell research by research institutions in the United States. These ethical issues, summarized in detail, receive no adequate translation into federal laws or regulations, also described in this article. U.S. Federal policy takes a passive approach to these ethical issues, translating them simply into limitations on taxpayer funding, and foregoes scientific and ethical leadership while protecting intellectual property interests through a laissez faire approach to stem cell patents and licenses. Those patents and licenses, far from being scientifically and ethically neutral in effect, virtually prohibit commercially sponsored research that could otherwise be a realistic alternative to the federal funding gap. The lack of federal funding and related data-sharing principles, combined with the effect of U.S. patent policy, the lack of key agency guidance, and the proliferation of divergent state laws arising from the lack of Federal leadership, significantly impede ethical stem cell research in the United States, without coherently supporting any consensus ethical vision. Research institutions must themselves implement steps, described in the article, to integrate addressing ethical review with the many legal compliance issues U.S. federal and state laws create.
Ethics, Medical↗
Contradictions in federal policies put elderly at risk of health care neglect.
Federal and state efforts to control hospital costs have increased the demand for home health services, especially services for the more acutely ill patient. At the same time, recent regulatory policies on Medicare eligibility and reimbursement are limiting the ability of home health agencies to respond. Examination of New Jersey home health data and case examples illustrate the increased demand, conflict with federal policy (as experienced in claim denials and loss of waiver of liability), and effect on patients and their families.
Aged↗
Does U.S. federal policy support employment and recovery for people with psychiatric disabilities?
Evidence suggests that a high percentage of people with a psychiatric disability can recover--find meaningful work, develop positive relationships, and participate fully in their communities. Evidence also suggests that work is an essential component of recovery. However, few people with a serious psychiatric disability are actually employed and most of those who are employed work only part-time at barely minimum wages. To assess the impact of federal programs such as Social Security Disability Insurance, vocational rehabilitation, medical insurance, and psychiatric services upon employment, we conducted a qualitative study of 16 employed and 16 unemployed individuals with psychiatric disabilities. All of our participants had disabilities severe enough to qualify them for Social Security Disability benefits. They told us that current federal policies and practices encouraged employment and integration of only a few participants, in a particular stage of their recovery, and placed significant barriers in the employment path of others.
Adult↗
New executive policy; federal hospital planning.
Explore the source record for details and available documents.
Hospitals↗
State response to federal policy: children, EPSDT, and the Medicaid Muddle.
The implementation in Connecticut of Early and Periodic Screening, Diagnosis and Treatment (EPSDT), a program of comprehensive medical care for needy children, illustrates the complexities engendered by federally mandated state-administered health programs. The EPSDT amendments to Title V and Title XIX (Medicaid) were ambiguous on four major issues: administrative responsibility, costs, eligibility, and scope of services. The problems experienced by federal, regional, state, and local administrators in resolving these issues illustrate the weaknesses inherent in federal-state relations, and the contrasting roles health and welfare agencies under Medicaid have played in the development of health policy. Connecticut may represent maximum limits to state performance in carrying out EPSDT because it is a rich state, ranking high in medical resources and in the provision of Medicaid services. During the first year of implementation of EPSDT, the program had little impact: less than 5 percent of eligible children were served. State policies, which contravened federal policy, precluded effective resolution of the legislative ambiguities; no new services were added, the organization of health services remained unchanged and fragmented; and the State Health Department played only a limited role.
Child Health Services↗
Restructuring federalism: the effects of decentralized federal policy on states' responsiveness to family planning needs.
The Reagan Administration sought to decentralize many federal programs by (1) consolidating categorical grants into black grants; (2) reducing their funding; and (3) relying more upon state fiscal support. This study examines the effects of this decentralist policy upon the federal family planning program. Two periods are analyzed: (1) FY 1976-1981, the period immediately prior to the Reagan Administration and (2) FY 1982-1987, the period during the Reagan Administration. Findings show that a more decentralized program produced less responsiveness to individual state needs for family planning, and that these effects could have been predicted from the previous period.
Family Planning Policy↗
The problem of monopoly power in federal health policy.
Federal programs to regulate health care providers appear to have contradictory objectives, indicating ambivalence toward group power in American political philosophy. The conflict between monopoly-creating monopoly-destroying strategies is demonstrated through three attempts to integrate professional power into a democratic political system.
Democracy↗
The federal policy for the protection of human subjects.
Explore the source record for details and available documents.
Behavioral Research↗
AHA blasts federal policy on home health ownership.
A month after the Health Care Financing Administration implemented its new transfer payment policy, the American Hospital Association has blasted federal investigators for unfairly targeting hospital discharge planners. According to the association, recent actions by investigators suggest that the government is set to crack down on hospitals that own home health agencies, and particularly on discharge planners, who remain under suspicion for allegedly limiting patient choice in steering patients to hospital-owned agencies. The AHA's senior associate director of policy development stresses the importance of reviewing and correcting all discharge policies to make sure financial incentives aren't driving discharge decisions.
American Hospital Association↗
The development of ambiguous federal policy: early and periodic screening, diagnosis, and treatment (EPSDT).
This paper examines why Congress's first major program for comprehensive health care to needy children took five years to begin even partial operation. An examination of the 1967 program's legislative history reveals that Congress paid little attention to EPSDT's implications: it was left ambiguous whether health (Title V) or welfare (Title XIX) would administer; costs were never clearly stated; eligibility and scope of services to be provided were left vague. Despite pressure from welfare rights interest groups, these ambiguities delayed the preparation of regulation and guidelines which never did succeed in resolving the question of overlapping jurisdiction and costs. In addition, many states' resistance to paying for the program further held up implementation. The paper concluded that: (1) Congress's and HEW's unwillingness to face up to the real costs of health programs threatens long-term public and state support for such programs; (2) division of responsibility between health and welfare lessens the impact of a program; (3) grant-in-aid programs give states the power to distort the intent of federal health policies; and (4) where states fail to implement such policies, initiatives may pass to consumer advocacy groups.
Child↗
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.↗