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Health Care Access and Quality

Selected Research, Commentary and Congressional Testimony

Innovation in Health Care Means More Than Something New — Oct. 9, 2009

patient in exam room with doctor

If comparative effectiveness reviews lead to better decisions about how to allocate limited resources they might improve the health of the population. But the most likely outcome is that we will have more information but no system capable of using that information well, writes Elizabeth McGlynn.

Major Health Care Challenges Persist for D.C. Children Despite High Rates of Insurance Coverage — Oct. 8, 2009

a boy getting a medical checkup

Despite high rates of health insurance coverage among children in the District of Columbia, their access to health care is inadequate and poses a significant health problem—particularly for those who are publicly insured.

Electronic Health Records Linked to Improved Quality in Primary Care Practices — Oct. 5, 2009

Electronic Medical Records

Routine use of electronic health records may improve the quality of care provided in community-based primary care practices more than other common strategies intended to raise the quality of medical care.

The H1N1 Pandemic: Lessons Learned from the Cities Readiness Initiative — Sep. 14, 2009

pedestrians in city street

In this Congressional Briefing researchers Christopher Nelson and Edward Chan discuss their evaluation of the Cities Readiness Initiative, a program designed to help the nation's largest metropolitan areas prepare the delivery of medications and other medical supplies during public health emergencies.

Finally, Presidential Support for the Individual Mandate — Sep. 9, 2009

U.S. President Obama addresses Congress on health care, photo courtesy of whitehouse.gov/Souza

RAND's latest analysis of options for reducing the number of uninsured shows that among all the options included in the House tri-committee bill, the Senate HELP bill, and the proposal released by Senator Max Baucus, the individual mandate would have the greatest impact, writes Elizabeth McGlynn.

Q-DART: Innovative Solutions to Target Gaps in Health Care Quality and Health Outcomes — Aug. 24, 2009

GIS map image

The Q-DART project uses innovative approaches to highlight gaps in quality of care and health outcomes in diverse populations in order to help health plans, public health organizations, and others concerned about improving the care that people receive allocate scarce resources more wisely.

Medicare Prescription Benefit Program Has Exceeded Expectations — Aug. 24, 2009

elderly hands hold prescription bottle and pill

The program created to provide Medicare recipients with prescription drug benefits exceeded expectations during its first two years, extending pharmacy coverage to most seniors while reducing their overall spending on drugs.

Certain Health Reform Policy Options Would Significantly Reduce Number of Uninsured Americans — Aug. 24, 2009

child gets examined by doctor

A mandate requiring individuals to obtain health insurance — an option in various current legislative proposals — would increase the number of Americans with coverage by 9 million to 34 million, while a mandate requiring employers to offer insurance would boost the figure by 1.8 million to 3.4 million.

Co-Ops: A Very Tall Order — Aug. 19, 2009

doctors meeting

Cooperatives are a very tall order: a new type of organization, never before tested on a large scale, meant to fix the apparently intractable problems of high and rising costs, barriers to access and poor quality care, writes Elizabeth McGlynn.

Rapid Growth in Health Care Costs Hurts Economic Performance of U.S. Industries — Jul. 23, 2009

rising costs

The rapid growth in U.S. health care costs is now clearly linked with poorer economic performance. Researchers examined 38 industries from 1987 through 2005 and found industries with a larger percentage of workers receiving employer-sponsored health insurance had higher job losses and lower output.

Alabama's Challenge: Better Prepared Workforce — Jul. 14, 2009

worker at Alabama Mercedes plant, photo courtesy of www.ado.alabama.gov

Alabama has made significant economic progress in recent decades, attracting car manufacturers and new industrial development. The state now has an opportunity to address some systemic challenges in education, health care, and workforce development to be competitive in a global economy, writes Melissa Flournoy.

The Reliability of Provider Profiling: A Tutorial — Jul. 3, 2009

two doctors and a surgeon

Although hospitals and managed care facilities have used performance measurement for some time, the focus on doctor profiling by purchasers and health plans is relatively new, bringing to the fore the limitations of available physician data and proving the need for reliability measures in physician profiling.

Strategies and Models for Promoting Adolescent Vaccination for Low-Income Populations — Jun. 15, 2009

African American teenage boy leans on wall

Since 2005, three new vaccines for teenagers have been licensed in the U.S. Although the majority of 13-17-year-olds have received recommended vaccines, rates remain below 2010 targets, and the coverage rates for low-income adolescents and minority youth are likely to be lower.

California Parolees Have a High Need for Health Services, but Accessing Services Is a Challenge — Jun. 11, 2009

man reading book in prison

Inmates released from California prisons have a high need for drug treatment, health care and mental health services, but they face barriers to accessing such aid because many return to communities where health care services are severely strained.

Limiting Work Hours for Medical Residents Could Cost Hospitals $1.6 Billion Annually — May 20, 2009

tired doctor sits against hospital wall

New recommendations to limit the fatigue and workload of medical residents could cost the nation's teaching hospitals about $1.6 billion annually. These measures' effectiveness at preventing medical errors and patient harm is unknown and would not mitigate their high net costs to the hosptials.

Limiting Treatment to Those Who Need It — Apr. 29, 2009

MRI machine

The ever-increasing share of U.S. national output going to health care is the source of much hand-wringing by policy makers. They worry that we cannot afford to spend so much, and that our national output will suffer as a result. They have it backwards, writes Dana P. Goldman.

Higher Co-Payments Discourage Patients with Newly Diagnosed Chronic Illnesses from Starting Drug Treatment — Apr. 28, 2009

woman hands credit card to pharmacist

Patients newly diagnosed with hypertension, diabetes or high cholesterol are significantly more likely to delay initiating recommended drug treatment if they face higher co-payments for medications.

Pay-For-Performance for Medical Groups Stimulates Changes in Practice — Mar. 10, 2009

doctor doing paperwork

A large group of California physicians given financial incentives to improve the quality of medical care have begun to embrace an array of changes important to advancing quality.

Report Quantifies Level of Disadvantage Faced by Boys and Men of Color in California — Feb. 5, 2009

two men of color

The first multi-dimensional effort to quantify the disparities faced by African-American and Latino boys and men in California across a broad spectrum of health and social factors provides a disquieting outlook for their lives.

PREPARE for Pandemic Influenza: A Toolkit to Improve Public Health Preparedness — Dec. 22, 2008

researcher holds reconstructed 1918 Pandemic Influenza Virus inside a specimen vial, photo courtesy of CDC/Gathany

Mounting an effective emergency response to a public health threat, such as a pandemic influenza, is a common challenge of state and local public health agencies across the country. The PREPARE toolkit provides a brief tutorial on using quality improvement methods to build agency capabilities and public health emergency preparedness.

Gauging the Accuracy, Validity of the Veterans' Health Care System Forecasting Tools — Nov. 5, 2008

veteran medals on uniform

The U.S. Department of Veterans Affairs (VA) relies on the Enrollee Health Care Projection Model (EHCPM) to project the amount and cost of veterans' use of VA health care services. This study evaluates the EHCPM and assesses the risks and benefits posed by the VA's reliance on the model for budgeting and planning.

Creating Health ID Numbers Could Improve Patient Privacy — Oct. 30, 2008

hospital bracelet

As it considers ways to improve the efficiency and quality of U.S. health care, one issue that a new Congress should reconsider is the longstanding roadblock that has stalled efforts to create a system of unique patient identification numbers for every person in the United States, writes Richard Hillestad.

Creating Unique Health ID Numbers Would Facilitate Improved Health Care Quality and Efficiency — Oct. 20, 2008

stethoscope on keyboard

Creating a unique patient identification number for every person in the United States would facilitate a reduction in medical errors, simplify the use of electronic medical records, increase overall efficiency and help protect patient privacy.

Military Child Care System Should Reassess Delivery of Services to Better Meet Goals — Sep. 29, 2008

Family Child Care program, photo courtesy of Army/E. Wilson

The U.S. military should reassess its child care system to look for ways to make it better fit the needs of military families and more effectively meet recruitment, readiness and retention goals.

War's Invisible Wounds: Our Veterans Are Not Getting the Care They Need, Deserve — Sep. 28, 2008

Soldier hugging family member

Nearly 300,000 Iraq and Afghanistan service veterans who have returned home -- about one in five -- may suffer from combat-stress-related mental health problems. Our veterans ought to get the best available treatments our nation can offer, but they don't, write authors Terry Schell, Terri Tanielian and Lisa Jaycox.

Health Insurance Market Rating Practices — Sep. 23, 2008

health insurance form

In testimony presented before the Senate Finance Committee, John Bertko discusses the methods used by private health insurers in setting premium rates.

Lessons from Early Adopters of Child-Care Quality Rating and Improvement Systems — Sep. 16, 2008

Teacher helping children in daycare

Although child-care quality rating and improvement systems have widespread appeal and are being adopted in many states, there is a dearth of practical knowledge on how to develop and implement them. A review of early-adopter programs highlights lessons learned and offers recommendations.

Retail Medical Clinics Attract Patients Who Do Not Have Regular Health Care Providers — Sep. 10, 2008

Boy getting checkup at clinic

Retail medical clinics located in pharmacies and other stores typically attract insured and uninsured patients who are seeking help for a small group of easy-to-treat illnesses or preventive care and do not otherwise have a regular health care provider.

Potential Benefits and Costs of Increased Adoption of Health Information Technology — Jul. 17, 2008

shelves of paper medical records

In testimony presented before the Senate Finance Committee, Richard Hillestead discusses the need for increased HIT adoption in order to improve quality of care and to reduce long-term health system costs, as well as likely barriers to adoption that government policy can help overcome.

Health of Chinese and Indian Citizens Improves but Still Lags Behind Rest of World — Jul. 1, 2008

Indian doctor examines eye of patient

China and India's health systems have shown advances in boosting life expectancy and disease prevention in the past fifty years. However, those living in the two nations are still exposed to a high degree of financial risk, geographical inequities in health care access, and overall poorer health than in other countries.

An Assessment of How Tobacco Money Could Improve Washington, D.C.’s Health Care System — Jun. 25, 2008

People boating by Jefferson Memorial

This study of health care access and delivery in the nation's capital explores how an assessment of D.C. citizens' comprehensive and urgent health needs as well as the recent tobacco settlement could be used to improve local health care policy options.

The Public Option: Sorting Rhetoric from Reality — Jun. 24, 2008

illustration of silhouette figures debating over health insurance claim form, pills

President Obama and several Congressional leaders have recently expressed support for the idea of allowing citizens to buy into a public insurance program as part of any health reform legislation. The intensity of the ensuing debate has been fascinating given the lack of specifics that have been offered by either side, writes Elizabeth A. McGlynn.

The Case for Keeping Quality on the Health Reform Agenda — Jun. 3, 2008

doctor talks with patient

In testimony presented before the Senate Committee on Finance, Elizabeth McGlynn discusses the substantial gap that exists between what is known to work and what is actually provided in the U.S. health care system.

What Does Economics Tell Us About Early Childhood Policy? — May 12, 2008

Baby with father

A growing body of economic research suggests that public investment in early childhood programs may be able to lower public costs for social services by improving children's long-term welfare.

RAND Review, Spring 2008: Baby Steps — Apr. 30, 2008

baby in hospital

The Spring 2008 issue of RAND Review compares neonatal services across the United Kingdom, the United States, Canada, Australia, and Sweden, discusses water resources management, U.S. policies in Asia, and political polarization.

A Better Way to Pay for Prescriptions — Apr. 19, 2008

Prescription medicine

The pricing plans most people choose for their cell phones are simple: Pay one price and talk as much as you want. What if paying for your prescription drugs were as easy and appealing?, writes Dana P. Goldman.

One In Five Iraq and Afghanistan Veterans Suffer from PTSD or Major Depression — Apr. 17, 2008

soldiers in shadow

Nearly 20 percent of military service members who have returned from Iraq and Afghanistan — 300,000 in all — report symptoms of post traumatic stress disorder or major depression, yet only slightly more than half have sought treatment.

Health Indicators Address Quality of Care in Older Adults — Feb. 15, 2008

Elderly woman with nurse

Vulnerable elders receive on average only half of recommended care; for conditions that affect primarily the elderly, they receive appropriate care less than one-third of the time. Interventions based on ACOVE indicators can improve the care physicians provide to older adults.

The Quality of Health Care for America's Children — Feb. 4, 2008

Elizabeth McGlynn

In a policy luncheon hosted by the Promising Practices Network and the RAND Corporation, Dr. Elizabeth McGlynn presented research findings and recommendations related to the quality of pediatric health care in the United States. Video of the event is available online.

Consumers Could Buy Yearly `Drug Licenses' As New Way to Pay for Prescriptions — Jan. 21, 2008

Prescription Medicine

Changing the way consumers pay for prescription drugs so that the system more closely resembles paying for cell phones or computer software could increase drug use without altering patients' out-of-pocket spending, health plan costs or drug company profits.

Serious Gaps Exist in Health Care Quality for America's Children — Oct. 10, 2007

Boy getting check-up

Children in the United States are not receiving recommended preventive care and screening services, such as regular weight and measurement checks to ensure that they are growing properly and not at risk for obesity; nor are they receiving standard care for conditions such as asthma and diarrhea.

Enrollment in SCHIP Improves Low-Income Children's Quality of Life — Sep. 26, 2007

Girl with doctor

Children newly enrolled in a public health insurance program in California reported improvements such as doing better in school, feeling better physically, and getting along better with their peers.

Options to Improve Health Care Access and Quality for Immigrants — Sep. 11, 2007

Doctor examining young patient

Expanding opportunities for immigrants to obtain legal residency and citizenship may be the best option to offer them better access to health care. Factors that affect their access to health care include: socioeconomic background, immigration status, limited English proficiency, and more.

Effective State Children's Health Insurance Program (SCHIP) Policy — Jul. 19, 2007

People at a conference

In a policy forum hosted by the Promising Practices Network and Kansas Action for Children, top experts from around the country shared research and practice knowledge related to federal and state SCHIP policy. Video of the event is available online.

Prison Health Care — Jul. 12, 2007

Inmate and warden

California's ill and aging prison population needs improved health care – not just as a matter of compassion, but to protect the health and safety of the rest of us, writes Lois M. Davis.

Better Access to Family Leave Helps Working Parents of Chronically Ill Children — Jun. 21, 2007

Doctor examining child

Working parents are more able to care for their chronically ill children when given greater access to federal and employer-provided time off from their jobs.

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