Health Policy

Climate Change and Human Health in Cities

Climate Change and Human Health in Cities
in Urban Climate Change Research Network (UCCRN), First UCCRN Assessment Report on Climate Change in Cities (ARC3), edited by C. Rosenzweig, W. D. Solecki, S. A. Hammer, and S. Mehrotra. New York, NY: Cambridge University Press, 2011, forthcoming, pp. 183-217

M. Barata (Rio de Janeiro), E. Ligeti (Toronto), Coordinating Lead Authors and G. De Simone (Rio de Janeiro), T. Dickinson (Toronto), D. Jack (New York City), J. Penney (Toronto), M. Rahman (Dhaka), and R. Zimmerman (New York City.)
04/01/2011

Massachusetts Links Pay for Performance to the Reduction of Racial and Ethnic Disparities

Massachusetts Links Pay for Performance to the Reduction of Racial and Ethnic Disparities
Health Affairs. 30(6):1165-1175.

Blustein, Jan, Joel Weissman, Andrew M Ryan, Tim Doran and Romana Hasnain-Wynia.
04/01/2011

The Institute of Medicaid has identified equity as a key dimension of quality. Recently, Massachusetts’ Medicaid program (MassHealth) took the unusual step of linking pay-for-performance (P4P) to the reduction of racial/ethnic disparities for hospital care.  We report on early experience with the program, describing the challenges of implementing an ambitious program in a short time frame, with limited resources.  Our findings raise questions about whether P4P as currently constituted is a suitable tool for addressing disparities in hospital care.

Health and Social Service Expenditures: Associations with Health Outcomes

Health and Social Service Expenditures: Associations with Health Outcomes
BMJ - Quality and Safety. Mar 29 epub, In Press.

Elizabeth Bradley, Benjamin Elkins, Jeph Herrin and Brian Elbel.
03/29/2011

Objective To examine variations in health service expenditures and social services expenditures across Organisation for Economic Co-operation and Development (OECD) countries and assess their association with five population-level health outcomes.

Design A pooled, cross-sectional analysis using data from the 2009 release of the OECD Health Data 2009 Statistics and Indicators and OECD Social Expenditure Database.

Setting OECD countries (n=30) from 1995 to 2005.

Main outcomes Life expectancy at birth, infant mortality, low birth weight, maternal mortality and potential years of life lost.

Results Health services expenditures adjusted for gross domestic product (GDP) per capita were significantly associated with better health outcomes in only two of five health indicators; social services expenditures adjusted for GDP were significantly associated with better health outcomes in three of five indicators. The ratio of social expenditures to health expenditures was significantly associated with better outcomes in infant mortality, life expectancy and increased potential life years lost, after adjusting for the level of health expenditures and GDP.

Conclusion Attention to broader domains of social policy may be helpful in accomplishing improvements in health envisioned by advocates of healthcare reform.

 

Aligning Ideologies and Institutions: Reorganization in the HIV/AIDS Services Administration of New York City

Aligning Ideologies and Institutions: Reorganization in the HIV/AIDS Services Administration of New York City
Public Administration Review, 2011. Volume 71 / Issue 02 / March 2011, pp 243–252, Published online

Kimberley Isett, Michael Sparer, Sherry Glied and Lawrence Brown
03/01/2011

How effective was organizational reform implemented inside one critical New York City health agency? Specifically, we examine the extent to which the reorganization of the HIV/AIDS Services Administration (HASA) into the Medical Insurance Services Administration (MICSA) achieved three goals: (1) realizing synergies among the component MICSA programs; (2) cross-fertilizing ideas among MICSA agencies; and (3) facilitating HASA operations through the lens of organization change theory. Qualitative methods including interviews, site visits, and document analysis triangulate the effects of the reorganization. Implications for organization change literature are explored, especially highlighting where more theoretical and empirical studies are needed.

Child and Adolescent Fast Food Choice and the Influence of Calorie Labeling

Child and Adolescent Fast Food Choice and the Influence of Calorie Labeling
International Journal of Obesity

Elbel, B., Gyamfi, J. & Kersh, R.
02/01/2011

Objective:Obesity is an enormous public health problem and children have been particularly highlighted for intervention. Of notable concern is the fast-food consumption of children. However, we know very little about how children or their parents make fast-food choices, including how they respond to mandatory calorie labeling. We examined children's and adolescents' fast-food choice and the influence of calorie labels in low-income communities in New York City (NYC) and in a comparison city (Newark, NJ).
Design:Natural experiment: Survey and receipt data were collected from low-income areas in NYC, and Newark, NJ (as a comparison city), before and after mandatory labeling began in NYC. Study restaurants included four of the largest chains located in NYC and Newark: McDonald's, Burger King, Wendy's and Kentucky Fried Chicken.Subjects:A total of 349 children and adolescents aged 1-17 years who visited the restaurants with their parents (69%) or alone (31%) before or after labeling was introduced. In total, 90% were from racial or ethnic minority groups.
Results:We found no statistically significant differences in calories purchased before and after labeling; many adolescents reported noticing calorie labels after their introduction (57% in NYC) and a few considered the information when ordering (9%). Approximately 35% of adolescents ate fast food six or more times per week and 72% of adolescents reported that taste was the most important factor in their meal selection. Adolescents in our sample reported that parents have some influence on their meal selection.
Conclusions:Adolescents in low-income communities notice calorie information at similar rates as adults, although they report being slightly less responsive to it than adults. We did not find evidence that labeling influenced adolescent food choice or parental food choices for children in this population.

The Effect of the MassHealth Hospital Pay-for-Performance Program on Quality

The Effect of the MassHealth Hospital Pay-for-Performance Program on Quality
Health Services Research. 2011:46(3);712-728

Ryan, Andrew M and Jan Blustein.
01/06/2011

Objective. To test the effect of Massachusetts Medicaid's (MassHealth) hospital-based pay-for-performance (P4P) program, implemented in 2008, on quality of care for pneumonia and surgical infection prevention (SIP). Data. Hospital Compare process of care quality data from 2004 to 2009 for acute care hospitals in Massachusetts (N=62) and other states (N=3,676) and American Hospital Association data on hospital characteristics from 2005. Study Design. Panel data models with hospital fixed effects and hospital-specific trends are estimated to test the effect of P4P on composite quality for pneumonia and SIP. This base model is extended to control for the completeness of measure reporting. Further sensitivity checks include estimation with propensity-score matched control hospitals, excluding hospitals in other P4P programs, varying the time period during which the program was assumed to have an effect, and testing the program effect across hospital characteristics. Principal Findings. Estimates from our preferred specification, including hospital fixed effects, trends, and the control for measure completeness, indicate small and nonsignificant program effects for pneumonia (-0.67 percentage points, p>.10) and SIP (-0.12 percentage points, p>.10). Sensitivity checks indicate a similar pattern of findings across specifications. Conclusions. Despite offering substantial financial incentives, the MassHealth P4P program did not improve quality in the first years of implementation.

The Evolving Private Psychiatric Inpatient Market

The Evolving Private Psychiatric Inpatient Market
The Journal of Behavioral Health Services & Research, 2011. Volume 38 / Issue 01 / January 2011, pp 122-131, Published online

Erica Hutchins, Richard Frank and Sherry Glied
01/01/2011

The private psychiatric hospital market has exhibited great volatility over time. From 1976 to 1992, the number of hospitals more than doubled, while in the decade following, the number of facilities dropped by half. Recently, however, the industry has begun to grow again. The evolution of this market reflects the response of a private industry with access to capital markets to changes in both the supply of substitutes and the demand for services. Most recently, the limited supply of facilities and expanded demand for psychiatric services have spurred renewed growth. The two leading firms today, Universal Health Services, Inc., which rode the market crest and downturn since the 1980s, and Psychiatric Solutions, Inc., a newer entrant, have employed different strategies to take advantage of these opportunities. The rapid responsiveness of the private psychiatric hospital market, as exemplified by these two firms, presents significant potential for shaping future mental health policy.

Economics of children's environmental health

Economics of children's environmental health
Mt Sinai J Med. 2011 Jan-Feb;78(1):98-106

Trasande L
01/01/2011

Economic analyses are increasingly appearing in the children's environmental-health literature. In this review, an illustrative selection of articles that represent cost analyses, cost-effectiveness analyses, and cost-benefit analyses is analyzed for the relative merits of each approach. Cost analyses remain the dominant approach due to lack of available data. Cost-effectiveness and cost-benefit analyses in this area face challenges presented by estimation of costs of environmental interventions, whose costs are likely to decrease with further technological innovation. Benefits are also more difficult to quantify economically and can only be partially alleviated through willingness-to-pay approaches. Nevertheless, economic analyses in children's environmental health are highly informative and important informants to public-health and policy practice. Further attention and training in their appropriate use are needed.

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