On Medicaid — Looking Back in New York and Ahead across the Nation: A Conversation with Deborah Bachrach | Michael Birnbaum: Journal of Health Politics, Policy and Law

Michael Birnbaum. On Medicaid — Looking Back in New York and Ahead across the Nation: A Conversation with Deborah Bachrach. Journal of Health Politics, Policy and Law 35(3): 407-422 (2010); DOI:10.1215/03616878-2010-005 [Abstract] [PDF]

Michael Birnbaum interviews Deborah Bachrach about her three-year tenure as director of the nation’s largest Medicaid program. Bachrach, who served under Governors Spitzer and Paterson, had previously spent over a decade as a partner in a New York law firm, navigating and shaping health policy for clients whose patients depended on Medicaid. Reviewing the ambitious Medicaid agenda that she helped lead, Bachrach reflects on expanding eligibility and increasing enrollment, designing and implementing payment reforms, and struggling with how best to rationalize program administration. Enactment of national health reform, finalized shortly after the interview was conducted, makes Bachrach’s experiences and insights particularly timely and relevant: Medicaid in New York is now less of an outlier and more of a model for states across the nation as they face implementation of major coverage expansions for their low-income residents.

Stewardship in Mental Health Policy: Inspiration, Influence, Institution? | Journal of Health Politics, Policy and Law

Lawrence D. Brown, Kimberley R. Isett, and Michael Hogan. Stewardship in Mental Health Policy: Inspiration, Influence, Institution? Journal of Health Politics, Policy and Law 35(3): 389-405 (2010); DOI:10.1215/03616878-2010-004 [Abstract] [PDF] [References]

The venerable but amorphous concept of stewardship has lately gained prominence in discussions of public policy and management and is sometimes offered as a “strategy” with a distinctive potential to mobilize effective public leadership in the service of broad social missions. In this article we explore how stewardship may be useful to the theory and practice of mental health policy, and, reciprocally, how examples from mental health policy may elucidate the dynamics of stewardship. After examining its key political ingredients — authority, advocacy, and analysis — we discuss the practical challenges in moving stewardship from moral inspiration to institutional reality.

The French Health Care System: Liberal Universalism | Monika Steffen: Journal of Health Politics, Policy and Law — Table of Contents (June 2010, 35 [3])

Monika Steffen. The French Health Care System: Liberal Universalism. Journal of Health Politics, Policy and Law 35(3): 353-387 (2010); DOI:10.1215/03616878-2010-003 [Abstract] [PDF] [References]

This article analyzes the reforms introduced over the last quarter century into the French health care system. A particular public-private combination, rooted in French history and institutionalized through a specific division of the policy field between private doctors and public hospitals, explains the system’s core characteristics: universal access, free choice, high quality, and a weak capacity for regulation. The dual architecture of this unique system leads to different reform strategies and outcomes in its two main parts. While the state has leverage in the hospital sector, it has failed repeatedly in attempts to regulate the ambulatory care sector. The first section of this article sets out the main characteristics and historical landmarks that continue to affect policy framing and implementation. Section 2 focuses on the evolution in financing and access, section 3 on management and governance in the (private) ambulatory care sector, and section 4 on the (mainly public) hospital sector. The conclusion compares the French model with those developed in the comparative literature and sets out the terms of the dilemma: a state-run social health insurance that lacks both the legitimacy of Bismarckian systems and the leverages of state-run systems. The French system therefore pursues contradictory policy goals, simultaneously developing universalism and liberalism, which explains both the direct state intervention and its limits.

The End of Insurance? Mexico’s Seguro Popular, 2001 – 2007 | Jason M. Lakin: Journal of Health Politics, Policy and Law

Jason M. Lakin. The End of Insurance? Mexico’s Seguro Popular, 2001 – 2007. Journal of Health Politics, Policy and Law 35(3): 313-352 (2010); DOI:10.1215/03616878-2010-002 [Abstract] [PDF] [References]

Health system reforms that introduce insurance principles into public health systems (such as national health insurance, internal markets, and separation of purchasers and providers) have been popular in the last two decades. Little is known, however, about the political complexities of transforming existing health services into health insurance systems in developing countries. Mexico’s Seguro Popular (Popular Health Insurance) program, introduced in 2003, was an attempt to do exactly this: radically alter the country’s existing health service and convert it into health insurance. Popular Health Insurance (PHI) has garnered international attention and has been held up as a model for other countries to follow. Yet little has been written about the political process that led to the reform or the difficulties of implementing it. This article fills that lacuna, offering an assessment of the reform context as well as of the process of formulating, adopting, and implementing it. It argues that, while the reform has improved Mexico’s public health service, it has thus far failed to transform that health service into a true insurance system. Limited institutional reform has also left PHI severely underfinanced. The Mexican case is a cautionary tale for reformers who want to transform extant health services into health insurance systems.

Remembering Leonard Robins | Jim Morone: Journal of Health Politics, Policy and Law

Len Robins — a devoted and cheerful member of the health politics and policy community — has died. His close friend and longtime collaborator Ted Litman followed Len’s wishes and removed him from life support last fall. More at Journal of Health Politics, Policy and Law…

Impact of Enrolling in Health Insurance on Low-Income Children that Enrolled for a Medical Reason | Patricia Barreto and Moira Inkelas: Urban Institute

Patricia Barreto and Moira Inkelas. Impact of Enrolling in Health Insurance on Low-Income Children that Enrolled for a Medical Reason. Washington DC: Urban Institute, May 15, 2010.

Children enrolling for a medical reason in Healthy Kids reported a range of common conditions including allergies, anemia, asthma, cough/cold, stomach problems, and ear/eye infection as their reason for enrollment. A large portion (67%) of parents report enrolling because the child needed prescription medication the family could not afford. Enrollment was associated with improved access to health care and lower out-of-pocket costs. However, families of children enrolled for a medical reason faced persistent barriers in accessing sub-specialty care and demonstrated higher use of emergency department services compared to those not enrolled for a medical reason. More at Urban Institute.

Witch hunt: Right wing distorts CMS nominee Berwick’s comments in latest smear | Matthew Gertz: Media Matters for America

Right-wing media have launched an assault on Donald Berwick, President Obama‘s nominee to head the Centers for Medicare and Medicaid Services. Those attacks distort Berwick’s statements on the U.S. and U.K. health care systems and ignore fundamental realities about the those systems, as well as Berwick’s broad support. More at Media Matters for America.

A Transatlantic Review of the NHS at 60 | Donald Berwick: 1000 Lives Plus

Donald M. Berwick, MD, MPP, FRCP (London), FRCPS (Glasg), KBE President and CEO, Institute for Healthcare Improvement, Cambridge, MA 02138, USA. NHS Live: Wembley: 1 July 2008.

Let me begin with thanks – twice.  First, thanks for letting me work with you for almost 15 years; this has been one of the most satisfying journeys of my entire career.  My colleagues in the Institute for Healthcare Improvement feel the same.  Second, thanks for what the NHS does as an example for health care worldwide.

If you’re a cynic, you’ll want to go get a cup of tea about now.  I am going to annoy you, because I am not a cynic. I am romantic about the NHS; I love it.  All I need to do to rediscover the romance is to look at health care in my own country. More at 1000 Lives Plus…

Donald Berwick on Redistributing Wealth | YouTube

YouTube – Donald Berwick on Redistributing Wealth.

The Authoritarian Reign in American Health Care | * Kathryn A. Ballou and Kandace J. Landreneau: Policy, Politics, & Nursing Practice

Kathryn A. Ballou and Kandace J. Landreneau. The Authoritarian Reign in American Health Care. Policy, Politics, & Nursing Practice, February 2010; vol. 11: pp. 71–79 [Abstract] [Full Text (PDF)] [References]

The aim of this article is to increase understanding of the mechanisms of the continuation of elite hegemonic control of a highly valued social system—American health care. White, male physicians and administrators achieved control of the health care industry and its workers, including nurses, at the start of the 20th century. Using critical theorists’ work on authoritarianism and incorporating gender analysis, the authors describe the health care system from a critical social— psychological perspective. The authors discuss the meaning and presence of authoritarian hierarchy and gender effects in today’s health system through a critical analysis of the profession of medicine, the profession of nursing, corporate and bureaucratic health care, and patients or consumers. It is concluded that the social—psychological behavior of the American health care system has profound implications that must be taken into account in any recommendations for change. More at Policy, Politics, & Nursing Practice…