The conditions in which people are born, grow, live, work, and age that affect their health.
This briefing examined the challenges of aligning or combining public funding sources to achieve better health outcomes, how analysts can prove value in such ventures, and the role of health care professionals in caring for patients who have both medical and non-medical needs.
Evidence is growing that housing, a social determinant of health, is an important factor in the health status of various populations. According to the Department of Housing and Urban Development (HUD), more than 610,000 people experience homelessness in the U.S., and over 250,000 individuals within that population have a severe mental illness or a chronic substance use disorder. A new Alliance toolkit, “The Connection between Health and Housing: The Evidence and Policy Landscape,” provides a detailed look into federal, state and local initiatives, as well as cost implications for health and housing programs.
This briefing, the first in a three-part series exploring the intersection of health and social policy, focused on Medicaid and housing policy. What does evidence say about the relationship between stable housing and health outcomes for various populations? What financial impact can housing have on Medicaid costs, and what potential role can Medicaid play regarding housing policy? What funding sources are state and local officials currently leveraging to provide housing resources? Are there barriers to innovative health and housing approaches?
This briefing explored innovations and challenges in delivering health care to a growing population of inmates, and also the prospect of health care in the correctional setting as a key to improving population health. This is an expensive group because of the large number of people with mental illness, addiction disorders, conditions associated with aging and Hepatitis C. Indeed, corrections spending is the second fastest-growing state expenditure, behind Medicaid, according to the Pew Charitable Trusts.
Approximately 8 million children with low to moderate incomes are covered under the Children’s Health Insurance Program (CHIP) and 39 million children are covered under Medicaid. (Most children who have coverage have private coverage). The number of uninsured children has decreased by half since the enactment of CHIP in 1997; however, with a new coverage landscape and CHIP funding set to expire in October 2015, questions arise about the current state and future of children’s health care coverage.
With a continued focus on the need to control the high and rising cost of care, Congress is looking for low cost, high yield policy solutions. Chronic illnesses are among the biggest drivers of growing health care costs, and a drain on worker productivity in our nation. For example, researchers note that per person health care spending for obese adults is 56 percent higher than for normal-weight adults. Diabetes and other chronic illnesses can be prevented or greatly delayed with solutions beyond or outside of medical care. Many fall into the category of health-related behaviors, such as whether we smoke, get exercise, eat a healthy diet– factors that are newly falling into the spheres of public health or population health.
Where we live, learn, work and play can have an enormous influence on our health and well being. Yet millions of working men and women and their families face almost insurmountable barriers to better health on a daily basis. Many of these hurdles can’t be cleared simply by choosing a healthy path. For example, many inner city and rural families have virtually no access to healthful foods. Many neighborhoods are unsafe for walking, let alone exercise. Children who do not receive high-quality services and education run a higher risk of becoming less healthy adults.
If you think that all poor Americans can get health coverage through Medicaid, think again. Except in a few states with federal waivers, adults must not only meet income and asset requirements, but must fit into a category of persons for which coverage is available.
By 2050, the U.S. Latino population, already the nation’s largest minority group, will triple in size and will account for most of the population growth in the U.S. over the next four decades. Hispanics will make up almost three out of every 10 people in the U.S. by 2050. This growth will have important implications for health care in the U.S., and for national health reform.
With a substantial body of evidence showing that racial and ethnic minorities receive poorer quality care than others, state and federal policy makers are looking for ways to reduce disparities. Some states have begun to experiment with strategies for reducing health disparities.
A growing body of evidence shows disparities in quality of care among Medicare beneficiaries of different racial and ethnic backgrounds. These disparities are particularly noteworthy in Medicare, which provides nearly universal access to care to the elderly without regard to race or ethnicity.
Disparities in health care have been well documented: Nonwhites have higher rates of infant mortality, death from heart disease, incidence of diabetes and HIV/AIDS and are less likely to receive appropriate immunization than are whites. A recent study in the Journal of Racial and Ethnic Disparities indicates that between 1991 and 2000, five times as many lives could have been saved by ending health disparities than were saved by innovations in health technology over the same period.
Toward A High Performance Health System: Public-Private Efforts to Make Health Care Safer and More Effective
The U.S. health care system is the most expensive in the world. Yet it is clear that by many measures, Americans are not receiving commensurate value for the health care dollars they spend. Is it possible to simultaneously improve health coverage and quality, while generating savings for health care consumers, employers, government and health care providers? What are the characteristics of a high performance health system? What realistic steps does the private sector need to take, contrasted with government bodies, to move the U.S. toward such a system? What policy changes would be most helpful to the most vulnerable populations – the uninsured, and those facing disparities in care or coverage due to income, race/ethnicity, health or age?
With New Orleans largely evacuated and hundreds of thousands of people separated from their regular health care providers, how will Hurricane Katrina’s evacuees attend to their health and health care needs?
“Cash and Counseling” is a way of allowing individuals receiving personal assistance services through Medicaid to have more control over the services they get and who provides them. The program provides an individualized allowance that beneficiaries can use to hire a personal care assistant of their choice – often a family caregiver – or purchase items that help them live independently, such as chair lifts.
The 2004 election featured debates on major health issues including costs, access, and affordable prescription drugs. These issues will likely be subjects of continued focus during the upcoming Congress.
The Olmstead Decision Five Years Later: How Has It Affected Health Services and the Civil Rights of Individuals with Disabilities?
For decades, it was routine in the U.S. to house individuals with disabilities in institutions. Those with mental illnesses, for instance, were placed in “insane asylums,” as they were once called. The U.S. Supreme Court took a firm step toward ending this practice five years ago. In the Olmstead v. L.C. decision, the court found that institutional isolation of individuals with disabilities was, under certain circumstances, a violation of the Americans with Disabilities Act.
Low-income Medicare beneficiaries are a vulnerable population because of their disproportionately high medical and long-term care needs. Among low-income beneficiaries are nearly seven million individuals who are considered “dual-eligibles,” with coverage from both Medicare and Medicaid. They represent around one in six Medicare beneficiaries and one in seven Medicaid beneficiaries.
National polls and opinion surveys consistently show that health care is an important issue for voters. In a June 2003 survey by Harris Interactive, health care ranked third after economy/jobs and war/defense as an issue needing government action. A Gallup poll in September 2003 found that 85 percent of respondents considered presidential candidates’ positions on health care issues to be either extremely important or very important in influencing their votes.
Having health insurance, more than any other factor, determines how soon a person will get needed health care and whether that care will be the best available. Unfortunately, minorities have much lower rates of insurance coverage compared with whites. African Americans, for example, are almost twice as likely as whites to be uninsured. Hispanics/Latinos are almost three times as likely to lack coverage.
But even when coverage is equal, disparities in care persist. Minorities tend to receive lower quality care than non-minorities, have less access to specialty care, and experience more difficulties when communicating with health care providers.
What can be done to narrow the disparity gap? What measures are being taken to improve minorities’ access to health services and their quality? How do we raise awareness in the provider community about these disparities? How do we improve communication between minority patients and non-minority providers? How do we increase the number of minority health providers?
To help address these and related questions, the Alliance for Health Reform sponsored an October 10, 2003 briefing with support from the Robert Wood Johnson Foundation. Panelists were: Risa Lavizzo-Mourey, president of the Robert Wood Johnson Foundation; Carolyn Clancy, director of the Agency for Healthcare Research and Quality; and Reed Tuckson, a senior vice president at UnitedHealth Group and an Alliance board member. Ed Howard of the Alliance moderated the discussion.
At the briefing, a new Alliance publication was released entitled Closing the Gap: Racial and Ethnic Disparities in Health Care. The brief was written by Brian Smedley, co-author of Unequal Treatment,a report by the Institute of Medicine on disparities in care with recommended solutions.
The number of uninsured Americans is one important measure of how serious a problem the lack of health coverage is. But counting the uninsured is harder than it sounds. While Census Bureau estimates of the uninsured are the most widely quoted (41.3 million in 2001), Americans who lack health insurance are a constantly changing group. They may lose coverage when they are laid off, shift employers, no longer qualify for public insurance programs or go through divorce or the death of a covered spouse. Then many regain it.
Numerous comparisons have been made between the rates of spending growth in Medicare and private health insurance. Many believe that private sector innovations present opportunities for constraining Medicare costs. Nonetheless, recent research looking at the past 30 years concludes that Medicare spending growth has been similar to the private sector, and at times even slower. Figures from the Centers for Medicare and Medicaid Services show Medicare cost growth was lower than that of private insurance in 2000 and 2001. Some of the difference may be attributed to the fact that private insurance, unlike Medicare, usually covers outpatient prescription drugs, one of the fastest-growing segments of health care. Moreover, some analysts say that Medicare’s relative success in controlling costs has been at the expense of quality and access.
The conditions in which people are born, grow, live, work, and age that affect their health.