The “State” of Cervical Cancer Prevention in America – 2008

Women in Government. The “State” of Cervical Cancer Prevention in America – 2008. Washington, DC: 2008.

This report is Women In Government‘s fourth annual review of state efforts to eliminate cervical cancer. This year’s report illustrates the many ways that individuals working to fight cervical cancer have turned challenges into opportunities to advance prevention efforts and raise awareness about HPV and its link to cervical cancer. The American Cancer Society predicted that 11,150 cases of invasive cervical cancer would be diagnosed in 2007 and about 3,670 women would die from the disease-a high toll from a disease that is preventable with routine screening. However, new technologies are allowing healthcare providers and public health officials to get the upper hand. Two vaccines- Gardasil®, currently available, and CervarixTM, which is under FDA review-offer the possibility of a generation of women who will not know cervical cancer. In addition, the HPV test is providing women and doctors with much greater screening accuracy than the Pap test alone in identifying cervical changes that may lead to invasive cancer. The report provides individual profiles of state actions to address cervical cancer, a “report card” on progress and summary tables in appendices that permit easy comparison across states. Full report (pdf)

Health Policy Fellowships and Internships

Kaiser.edu maintains a continuously updated Policy Fellowships database that summarizes and links to more than 200 fellowships and internships in health policy and related fields. The database includes fellowships located across the United States that are available to undergraduates, graduate students, and professionals. Searches can be performed based on educational level, geographic location, whether the opportunity is paid or unpaid, or by keyword.

The Impacts of Health Insurance and Child Care on Job Retention and Mobility among Low-Income Mothers

Sunhwa Lee. Keeping Moms on the Job: The Impacts of Health Insurance and Child Care on Job Retention and Mobility among Low-Income Mothers. Washington, DC: Institute for Women’s Policy Research, 2007.

Building on prior research, this report examines factors related to job retention and labor market advancement among low-wage workers, and suggests effective policy strategies for improving their labor market outcomes. Using data from a national longitudinal survey, The Survey of Income and Program Participation, the report assesses the importance of various factors that facilitate or hinder job retention among low-income mothers. It also investigates what happens when they leave a job: are they moving to a better job, and if so, what helps or hinders their move to a better-paying job? Since a majority of welfare leavers and low-wage workers are women, particularly single mothers, the study pays special attention to work supports that can be important for job stability among working mothers, such as employer-provided health insurance, child care subsidies, and child care arrangements. Other major factors considered in the study are: personal/family characteristics (race/ethnicity, education, marital status, health status, presence of young children, etc.) and job characteristics (full-time status, occupation, hourly wages, union membership, etc.). Full report (pdf)

Robert Wood Johnson Foundation Investigator Awards in Health Policy Research

The Robert Wood Johnson Foundation Investigator Awards in Health Policy Research program supports highly qualified individuals to undertake broad studies of America’s most challenging policy issues in health and health care. Grants of up to $335,000 are awarded to investigators from a variety of disciplines for innovative research projects that have national policy relevance.

Applications are welcomed from investigators in the fields of anthropology, business, demography, economics, engineering, ethics, genetics, health and social policy, health services research, history, journalism, law, medicine, nursing, political science, psychology, public health, science policy, social work, sociology and others. Complete instructions on how to apply can be found in the Call for Applications (pdf).
Key Dates:

• March 26, 2008 (5 p.m. ET)-Deadline for receipt of letters of intent (by mail only).
• June 13, 2008-Applicants will be notified by mail if selected to submit a full proposal.
• July 29, 2008-Deadline for receipt of full proposals.
• December 15, 2008 -Notification of acceptance mailed.
• March 1-September 1, 2009-Acceptable start dates for projects.

Managed Care and Medical Expenditures of Medicare Beneficiaries

Michael Chernew, Philip DeCicca, Robert Town. Managed Care and Medical Expenditures of Medicare Beneficiaries. Cambridge, MA: NBER Working Paper #13747, January 2008.
This paper investigates the impact of Medicare HMO penetration on the medical care expenditures incurred by Medicare fee-for-service enrollees. We find that increasing penetration leads to reduced health care spending on fee-for-service beneficiaries. In particular, a one percentage point increase in Medicare HMO penetration reduces such spending by .9 percent. We estimate similar models for various measures of health care utilization and find penetration-induced reductions, consistent with our spending estimates. Finally, we present evidence that suggests our estimated spending reductions are driven by beneficiaries who have at least one chronic condition. Full text (pdf)

Preference Heterogeneity and Insurance Markets: Explaining a Puzzle of Insurance

David M. Cutler, Amy Finkelstein, Kathleen McGarry. Preference Heterogeneity and Insurance Markets: Explaining a Puzzle of Insurance. Cambridge, MA: NBER Working Paper #13746, January 2008.

Standard theories of insurance, dating from Rothschild and Stiglitz (1976), stress the role of adverse selection in explaining the decision to purchase insurance. In these models, higher risk people buy full or near-full insurance, while lower risk people buy less complete coverage, if they buy at all. While this prediction appears to hold in some real world insurance markets, in many others, it is the lower risk individuals who have more insurance coverage. If the standard model is extended to allow individuals to vary in their risk tolerance as well as their risk type, this could explain why the relationship between insurance coverage and risk occurrence can be of any sign, even if the standard asymmetric information effects also exist. We present empirical evidence in five difference insurance markets in the United States that is consistent with this potential role for risk tolerance. Specifically, we show that individuals who engage in risky behavior or who do not engage in risk reducing behavior are systematically less likely to hold life insurance, acute private health insurance, annuities, long-term care insurance, and Medigap. Moreover, we show that the sign of this preference effect differs across markets, tending to induce lower risk individuals to purchase insurance in some of these markets, but higher risk individuals to purchase insurance in others. These findings suggest that preference heterogeneity may be important in explaining the differential patterns of insurance coverage in various insurance markets. Full text (pdf)

A Progress Report On State Health Access Reform

John E. McDonough, Michael Miller, and Christine Barber. A Progress Report On State Health Access Reform. Health Affairs Web Exclusive, January 29, 2008.

Enactment of ambitious health reform laws in Massachusetts and Vermont in 2006 helped instigate a wave of state legislative activities to expand coverage to uninsured people. We identify thirty-nine states that have enacted laws in at least one access category since 2006. At least thirteen states have begun processes to enact comprehensive reforms to cover at least half of their uninsured residents. Key activities involve coverage expansions for uninsured children and for uninsured adults; regulatory changes in small-group and individual insurance markets; and individual and employer mandates. The future extent and durability of this wave are uncertain.  Abstract (html)

Health Literacy Practices in Primary Care Settings: Examples from the Field

Sharon E. Barrett, Jennifer Sheen Puryear, and Kathie Westpheling. Health Literacy Practices in Primary Care Settings: Examples from the Field. New York: Commonwealth Fund, January 2008.
Low health literacy is widespread among U.S. patients, yet limited research has been done to assess the effects of health literacy practices designed to combat the problem, particularly among safety-net providers in primary care settings. This report presents findings from a 2005 study in which the Association of Clinicians for the Underserved first did an online survey of health care facilities across the country and then followed it up with visits to five selected sites for staff and patient interviews. The study identified five health literacy practices that staff considered especially valuable for their group’s patients and potentially applicable to other clinics: a team effort, beginning at the front desk; use of standardized communication tools; use of plain language, face-to-face communication, pictorials, and educational materials; clinicians partner with patients to achieve goals; and organizational commitment to create an environment where health literacy is not assumed. Full report (pdf)

Paying for quality: Understanding and assessing physician pay-for-performance initiatives

Jon B. Christianson, Sheila Leatherman, and Kim Sutherland. Paying for quality: Understanding and assessing physician pay-for-performance initiatives. Princeton, N.J. Robert Wood Johnson Foundation, Research Synthesis Report No. 13, December 2007.

To date, policy-makers have had little information on the effectiveness of P4P initiatives in shifting physician practice. They are interested in knowing to what extent and under what circumstances P4P will improve the quality of care delivered by physicians. This synthesis report reviews the available evidence on this issue, addressing five questions: 1. What explains the current widespread interest in physician P4P? 2. How are current incentive programs structured and how prevalent are they? 3. What performance measurement issues does physician P4P raise? 4. How do physicians perceive quality incentive programs? 5. What is the research evidence on the impact of P4P? Full report (pdf)

Listening to Consumers: Values-Focused Health Benefits and Education

Listening to Consumers: Values-Focused Health Benefits and Education
By Lois A. Vitt, Institute for Socio-Financial Studies (ISFS), and Ray Werntz, EBRI Fellow. EBRI Issue Brief No. 313. January 2008.

This report on how employers can provide useful information to employees in conjunction with consumer-directed health plans concludes: “Consumer values can provide essential insights into consumer thinking about health-related behaviors and financial decision-making. They also can provide a blueprint for health care businesses and policymakers working to make the U.S. health care system more responsive to consumers. Should health education initiatives prove ineffective, the “consumer-driven health movement” could well be doomed, especially if it relies upon fully educated health consumers taking self-initiated actions. The perceived ineffectiveness of education in 401(k) plans resulted in legislation to add “defaults” to these plans so that they no longer relied upon positive employee action. In the health arena, the default approach is exactly what the consumer-driven
health model seeks to move away from.”  Full report (pdf)