42 CFR 457.915 - Fraud detection and investigation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... and abuse cases. (2) Methods for investigating fraud and abuse cases that— (i) Do not infringe on legal rights of persons involved; and (ii) Afford due process of law. (b) State program integrity unit... implement procedures for referring suspected fraud and abuse cases to the State program integrity unit (if...

Why the affordable care act needs a better name: 'Americare'.

PubMed

Sage, William M

2010-08-01

The culmination of a century's effort to enact universal coverage in the United States is a law with an uninspiring title, the Patient Protection and Affordable Care Act, and an even more awkward acronym, PPACA. The Obama administration has decided to call the legislation the Affordable Care Act, but the expansion of health coverage that the law sets in motion has no name, and therefore no identity. It badly needs one.

76 FR 63527 - National Energy Action Month, 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-12

... build a competitive 21st- century clean energy economy. Over the past two and a half years, my... us on track to doubling renewable energy capacity in the United States by the end of next year. At... to lead in clean energy is more intense than ever before. The United States cannot afford to fall...

It All Adds Up: Examining and Enhancing Campus Climate for Affordability at a Four-Year University

ERIC Educational Resources Information Center

McClure, Kevin R.; Ryder, Andrew J.; Mauk, Andrew J.

2017-01-01

This study examined undergraduate students' perceptions of non-academic spending in college and how they navigated these expenses. Using a mixed-methods study at a public comprehensive university in the southeastern United States, we conceptualized these perceptions as a central component of campus climate for affordability in college. Findings…

75 FR 17918 - Advisory Board to the Consumer Operated and Oriented Plan (CO-OP) Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-08

...: The Patient Protection and Affordable Care Act requires the Secretary of Health and Human Services to... program. The Patient Protection and Affordable Care Act gave the Comptroller General of the United States... described in section 1805(c)(2) of the Social Security Act. Appointments are to be made not later than three...

The Role of Business Agreements in Defining Textbook Affordability and Digital Materials: A Document Analysis

ERIC Educational Resources Information Center

Raible, John; deNoyelles, Aimee

2015-01-01

Adopting digital materials such as eTextbooks and e-coursepacks is a potential strategy to address textbook affordability in the United States. However, university business relationships with bookstore vendors implicitly structure which instructional resources are available and in what manner. In this study, a document analysis was conducted on…

7 CFR Exhibit C to Subpart L of... - Housing in Underserved Areas

Code of Federal Regulations, 2010 CFR

2010-01-01

...—Housing in Underserved Areas I. Objective A. To improve the quality of affordable housing by targeting... Arizona, California, New Mexico or Texas; 2. Is in the area of the United States within 150 miles of the border between the United States and Mexico, except that the term does not include any standard...

Atmospheric Sulfur Dioxide in the United States: Can the Standards be Justified or Afforded?

ERIC Educational Resources Information Center

Megonnell, William H.

1975-01-01

Recent reviews have concluded that there is no basis for changing the standards set by the EPA in 1971, even though the data base was insufficient then for a quantifiable, scientific definition of clean air. Examination of data shows that the United States does not have a sulfur dioxide problem. (Author/BT)

Could the United States Afford to Lose a Major Port?

DTIC Science & Technology

2013-12-13

Diving TEU Twenty-Foot Equivalent Units TRIA Terrorism Risk Insurance Act TSA Transportation Security Administration ULCC Ultra Large Crude...harbor or port. The United States Navy Office of the Supervisor of Salvage and Diving (SupSalv) directed the National Academies’ Marine Board...shipping vessels might be able to navigate around the wreck if they have a shallow enough draft. This research will investigate how long these

The State of 21st Century Learning in the K-12 World of the United States: Online and Blended Learning Opportunities for American Elementary and Secondary Students

ERIC Educational Resources Information Center

Greene, Kimberly; Hale, William

2017-01-01

This paper is an examination of the current state of blended and online learning throughout the K-12 world in the United States. The analysis is predicated upon the potential of electronically-mediated learning (e-learning) to effectively prepare students for the demands of 21st century citizenship through the affordances of such learning…

A Burgeoning Crisis? A Nationwide Assessment of the Geography of Water Affordability in the United States

PubMed Central

Mack, Elizabeth A.; Wrase, Sarah

2017-01-01

While basic access to clean water is critical, another important issue is the affordability of water access for people around the globe. Prior international work has highlighted that a large proportion of consumers could not afford water if priced at full cost recovery levels. Given growing concern about affordability issues due to rising water rates, and a comparative lack of work on affordability in the developed world, as compared to the developing world, more work is needed in developed countries to understand the extent of this issue in terms of the number of households and persons impacted. To address this need, this paper assesses potential affordability issues for households in the United States using the U.S. EPA’s 4.5% affordability criteria for combined water and wastewater services. Analytical results from this paper highlight high-risk and at-risk households for water poverty or unaffordable water services. Many of these households are clustered in pockets of water poverty within counties, which is a concern for individual utility providers servicing a large proportion of customers with a financial inability to pay for water services. Results also highlight that while water rates remain comparatively affordable for many U.S. households, this trend will not continue in the future. If water rates rise at projected amounts over the next five years, conservative projections estimate that the percentage of U.S. households who will find water bills unaffordable could triple from 11.9% to 35.6%. This is a concern due to the cascading economic impacts associated with widespread affordability issues; these issues mean that utility providers could have fewer customers over which to spread the large fixed costs of water service. Unaffordable water bills also impact customers for whom water services are affordable via higher water rates to recover the costs of services that go unpaid by lower income households. PMID:28076374

A Burgeoning Crisis? A Nationwide Assessment of the Geography of Water Affordability in the United States.

PubMed

Mack, Elizabeth A; Wrase, Sarah

2017-01-01

While basic access to clean water is critical, another important issue is the affordability of water access for people around the globe. Prior international work has highlighted that a large proportion of consumers could not afford water if priced at full cost recovery levels. Given growing concern about affordability issues due to rising water rates, and a comparative lack of work on affordability in the developed world, as compared to the developing world, more work is needed in developed countries to understand the extent of this issue in terms of the number of households and persons impacted. To address this need, this paper assesses potential affordability issues for households in the United States using the U.S. EPA's 4.5% affordability criteria for combined water and wastewater services. Analytical results from this paper highlight high-risk and at-risk households for water poverty or unaffordable water services. Many of these households are clustered in pockets of water poverty within counties, which is a concern for individual utility providers servicing a large proportion of customers with a financial inability to pay for water services. Results also highlight that while water rates remain comparatively affordable for many U.S. households, this trend will not continue in the future. If water rates rise at projected amounts over the next five years, conservative projections estimate that the percentage of U.S. households who will find water bills unaffordable could triple from 11.9% to 35.6%. This is a concern due to the cascading economic impacts associated with widespread affordability issues; these issues mean that utility providers could have fewer customers over which to spread the large fixed costs of water service. Unaffordable water bills also impact customers for whom water services are affordable via higher water rates to recover the costs of services that go unpaid by lower income households.

Can the United States afford a lunar base

NASA Technical Reports Server (NTRS)

Keaton, Paul W.

1988-01-01

Establishing a lunar base will require steady funding for a decade or two. The question addressed is whether such a large space project is affordable at this time. The relevant facts and methodology are presented so that the reader may formulate independent answers. It is shown that a permanent lunar base can be financed without increasing NASA's historical budgetary trend.

Impact of the Affordable Care Act on stem cell transplantation.

PubMed

Farnia, Stephanie; Gedan, Alicia; Boo, Michael

2014-03-01

The Patient Protection and Affordable Care Act, signed into law in 2010, will have a wide-reaching impact on the health care system in the United States when it is fully implemented in 2014. Patients will see increased access to care coupled with new insurance coverage protections as well as a minimum set of benefits mandated in each state known as essential health benefits. Providers are likely to see new forms of payment reform, particularly in the Medicare program, and narrower commercial provider networks. In addition, the composition of the health insurance market will broaden with the introduction of health insurance exchanges and expanded Medicaid populations in many states. Furthermore, the Patient Protection and Affordable Care Act calls for quality initiatives such as comparative effectiveness research to increase effective, appropriate and high-value care. This paper will review the main provisions of the Patient Protection and Affordable Care Act with specific attention to their impact on the field of Stem Cell Transplantation.

A National Information Network: Changing Our Lives in the 21st Century. 1992 Annual Review of the Institute for Information Studies.

ERIC Educational Resources Information Center

Aspen Inst., Queenstown, MD.

In a workshop held by the National Research Council through their Board on Telecommunications and Computer Applications, the participants determined that the earlier vision of affordable telephone service for all, already fundamentally achieved in the United States, can be extended to a new national policy of affordable information for all. This…

Improving the Quality of Child Care. Hearing of the Committee on Labor and Human Resources on Examining Proposals To Improve the Quality of Child Care in the United States, Including the Proposed Creating Improved Delivery of Child Care: Affordable, Reliable, and Educational Act of 1997. United States Senate, One Hundred Fifth Congress. First Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Committee on Labor and Human Resources.

These hearings transcripts present testimony on proposals to improve the quality of child care in the United States. Both oral and submitted written statements are included. Contributors are: Representative Peter Deutsch (Florida); Senator James M. Jeffords, committee chairman; Senator Mike Enzi (Wyoming); Senator Edward M. Kennedy…

12 CFR Appendix to Part 745 - Examples of Insurance Coverage Afforded Accounts in Credit Unions Insured by the National Credit...

Code of Federal Regulations, 2010 CFR

2010-01-01

...: (1) The creation of which has been expressly authorized by state statute, (2) to which some functions... unit or any principal department of such unit: (1) The creation of which has been expressly authorized... interest of a co-owner in all accounts held under any form of joint ownership valid under state law...

Promoting Prevention Through the Affordable Care Act: Workplace Wellness

PubMed Central

Roffenbender, Jason S.; Goetzel, Ron Z.; Millard, Francois; Wildenhaus, Kevin; DeSantis, Charles; Novelli, William

2012-01-01

Public health in the United States can be improved by building workplace “cultures of health” that support healthy lifestyles. The Affordable Care Act (ACA), which includes the Prevention and Public Health Fund, will support a new focus on prevention and wellness, offering opportunities to strengthen the public’s health through workplace wellness initiatives. This article describes the opportunity the ACA provides to improve worker wellness. PMID:23237245

Tracking Students through Life: A Critical Structural Analysis of Academic Tracking of Mexican Immigrant Students in the United States and Korean Immigrant Students in Japan

ERIC Educational Resources Information Center

Wagner, Kathryn; Dymes, Laurie; Wiggan, Greg

2017-01-01

Students in the United States and Japan from high and middle socioeconomic (SES) backgrounds are afforded greater academic opportunities due to the systemic presence of hegemony in public schools (Darvin and Norton in "J Lang Identity Educ" 13(2):111-117, 2014). Minority and immigrant students, the majority coming from low SES, are more…

Refugee Resettlement Patterns and State-Level Health Care Insurance Access in the United States.

PubMed

Agrawal, Pooja; Venkatesh, Arjun Krishna

2016-04-01

We sought to evaluate the relationship between state-level implementation of the Patient Protection and Affordable Care Act (ACA) and resettlement patterns among refugees. We linked federal refugee resettlement data to ACA expansion data and found that refugee resettlement rates are not significantly different according to state-level insurance expansion or cost. Forty percent of refugees have resettled to states without Medicaid expansion. The wide state-level variability in implementation of the ACA should be considered by federal agencies seeking to optimize access to health insurance coverage among refugees who have resettled to the United States.

The Patient Protection and Affordable Care Act: A Primer for Hand Surgeons

PubMed Central

Adkinson, Joshua M.; Chung, Kevin C.

2014-01-01

The Affordable Care Act is the largest and most comprehensive overhaul of the United States healthcare industry since the inception of the Medicare and Medicaid. Contained within the 10 Titles are a multitude of provisions that will change how hand surgeons practice medicine and how they are reimbursed. It is imperative that surgeons are equipped with the knowledge of how this law will affect all physician practices and hospitals. PMID:25066853

Affordable Heavy Lift Capability: 2000-2004

NASA Technical Reports Server (NTRS)

2004-01-01

This custom bibliography from the NASA Scientific and Technical Information Program lists a sampling of records found in the NASA Aeronautics and Space Database. The scope of this topic includes technologies to allow robust, affordable access of cargo, particularly to low-Earth orbit. This area of focus is one of the enabling technologies as defined by NASA s Report of the President s Commission on Implementation of United States Space Exploration Policy, published in June 2004.

Space Wei QI: The Launch of Shenzhou V

DTIC Science & Technology

2004-01-01

the anticipated plans to reinvigorate the U.S. manned space exploration program. What the United States plans to do is important, but in the context of...announcing unilateral plans and forcing China into a pace it likely cannot afford. Or the United States can initiate an incremental program of space... planning for the fu- ture. As the only country of sufficient size and resources to become potentially a peer competitor, and the largest remaining communist

Prescription drug accessibility and affordability in the United States and abroad.

PubMed

Morgan, Steve; Kennedy, Jae

2010-06-01

This issue brief contrasts prescription drug access, affordability, and costs in the United States with six other high-income countries, drawing from Commonwealth Fund survey data of patient experiences as well as international spending and pricing data. The analysis reveals that Americans, particularly the relatively young and healthy, are more likely to use prescription drugs than are residents of Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom, but they also experience more financial barriers in accessing medications and spend more out-of-pocket for prescriptions. In the U.S., there are also larger income-related inequities in pharmaceutical use. Despite access barriers and disparities, spending per person in the U.S. is far higher, likely the result of paying higher prices for similar medications and using a more expensive mix of drugs. The authors say that value-based benefit designs, reference pricing, and group purchasing could reduce financial barriers and keep down pharmaceutical spending.

In New Survey Of Eleven Countries, US Adults Still Struggle With Access To And Affordability Of Health Care.

PubMed

Osborn, Robin; Squires, David; Doty, Michelle M; Sarnak, Dana O; Schneider, Eric C

2016-12-01

Surveys of patients' experiences with health care services can reveal how well a country's health system is meeting the needs of its population. Using data from a 2016 survey conducted in eleven countries-Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States-we found that US adults reported poor health and well-being and were the most likely to experience material hardship. The United States trailed other countries in making health care affordable and ranked poorly on providing timely access to medical care (except specialist care). In all countries, shortfalls in patient engagement and chronic care management were reported, and at least one in five adults experienced a care coordination problem. Problems were often particularly acute for low-income adults. Overall, the Netherlands performed at the top of the eleven-country range on most measures of access, engagement, and coordination. Project HOPE—The People-to-People Health Foundation, Inc.

22 CFR 62.25 - Secondary school students.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Secondary school students. 62.25 Section 62.25 Foreign Relations DEPARTMENT OF STATE PUBLIC DIPLOMACY AND EXCHANGES EXCHANGE VISITOR PROGRAM Specific... afforded the opportunity for up to one year of study in a United States accredited public or private...

"It's Like We Are Legally, Illegal": Latino/a Youth Emphasize Barriers to Higher Education Using Photovoice

ERIC Educational Resources Information Center

Sahay, Kashika Mohan; Thatcher, Kari; Núñez, Cruz; Lightfoot, Alexandra

2016-01-01

For a subset of undocumented immigrant youth who came to the United States (US), the Deferred Action for Childhood Arrivals (DACA) executive action presents opportunities for advancement. In becoming, "DACA"-mented, youth are afforded certain privileges. However differential implementation of DACA on a state-by-state basis has important…

Refugee Resettlement Patterns and State-Level Health Care Insurance Access in the United States

PubMed Central

Venkatesh, Arjun Krishna

2016-01-01

We sought to evaluate the relationship between state-level implementation of the Patient Protection and Affordable Care Act (ACA) and resettlement patterns among refugees. We linked federal refugee resettlement data to ACA expansion data and found that refugee resettlement rates are not significantly different according to state-level insurance expansion or cost. Forty percent of refugees have resettled to states without Medicaid expansion. The wide state-level variability in implementation of the ACA should be considered by federal agencies seeking to optimize access to health insurance coverage among refugees who have resettled to the United States. PMID:26890186

Surface transportation vulnerability assessment : general distribution version

DOT National Transportation Integrated Search

2001-10-25

The United States possesses an effective and efficient surface transportation infrastructure that : promotes both the well-being of its citizens as well as important economic and national security : goals. The level of security afforded this infrastr...

Assessing the engineering performance of affordable net-zero energy housing

NASA Astrophysics Data System (ADS)

Wallpe, Jordan P.

The purpose of this research was to evaluate affordable technologies that are capable of providing attractive, cost-effective energy savings to the housing industry. The research did so by investigating the 2011 Solar Decathlon competition, with additional insight from the Purdue INhome. Insight from the Purdue INhome verified the importance of using a three step design process to design a net-zero energy building. In addition, energy consumption values of the INhome were used to compare and contrast different systems used in other houses. Evaluation of unbiased competition contests gave a better understanding of how a house can realistically reach net-zero. Upon comparison, off-the-shelf engineering systems such as super-efficient HVAC units, heat pump hot water heaters, and properly designed photovoltaic arrays can affordably enable a house to become net-zero. These important and applicable technologies realized from the Solar Decathlon will reduce the 22 percent of all energy consumed through the residential sector in the United States. In conclusion, affordable net-zero energy buildings can be built today with commitment from design professionals, manufacturers, and home owners.

Closing the Communal Gap: The Importance of Communal Affordances in Science Career Motivation.

PubMed

Brown, Elizabeth R; Thoman, Dustin B; Smith, Jessi L; Diekman, Amanda B

2015-12-01

To remain competitive in the global economy, the United States (and other countries) is trying to broaden participation in science, technology, engineering, and mathematics (STEM) by graduating an additional 1 million people in STEM fields by 2018. Although communion (working with, helping, and caring for others) is a basic human need, STEM careers are often (mis)perceived as being uncommunal. Across three naturalistic studies we found greater support for the communal affordance hypothesis, that perceiving STEM careers as affording greater communion is associated with greater STEM career interest, than two alternative hypotheses derived from goal congruity theory. Importantly, these findings held regardless of major (Study 1), college enrollment (Study 2), and gender (Studies 1-3). For undergraduate research assistants, mid-semester beliefs that STEM affords communion predicted end of the semester STEM motivation (Study 3). Our data highlight the importance of educational and workplace motivational interventions targeting communal affordances beliefs about STEM.

Annual Demographic Data for Migrant Family Housing Centers: 1985 Harvest Season.

ERIC Educational Resources Information Center

California State Dept. of Housing and Community Development, Sacramento.

California, largest employer of seasonal labor in the United States, employs an average of 119,600 seasonal farmworkers per year. To ease problems of housing this seasonal workforce, the State Department of Housing and Community Development's Office of Migrant Services contracts with local government agencies to provide decent/affordable housing…

Annual Demographic Data for Migrant Family Housing Centers: 1986 Harvest Season.

ERIC Educational Resources Information Center

California State Dept. of Housing and Community Development, Sacramento.

California, largest employer of seasonal labor in the United States, employs an average of 119,600 seasonal farmworkers per year. Since 1966 the State Department of Housing and Community Development's Office of Migrant Services has contracted with local government agencies to provide decent/affordable housing for approximately 50,220 families…

LD/ESL Assessments. NetNews. Volume 6, Number 2

ERIC Educational Resources Information Center

LDA of Minnesota, 2006

2006-01-01

The population of most Minnesota communities has dramatically changed over the past ten years. The Minnesota State Demographic Center reports the Twin Cities area has the largest Hmong, Somali, and Liberian communities in the United States. In some communities where both jobs and affordable housing are available, the percentage of English as a…

Realization of the international human right to health in an economically integrated North America.

PubMed

Kinney, Eleanor D

2009-01-01

With the North American Free Trade Agreement (NAFTA), the health care sectors of the United States, Canada, and Mexico are becoming more economically integrated. NAFTA poses major challenges to the realization of the international human right. These include: (1) Cross Border Trade in Medical Products, (2) Cross Border Trade in Medical Services, and the attendant investment protections, (3) Portability and Comparability of Health Insurance Coverage, and (4) Protection of Public Health Insurance Programs. The United States, Mexico, and Canada all provide public health insurance programs either to the entire population as in Canada or to vulnerable groups as in the United States. In none of these countries have private, for-profit providers and insurers been able to provide universal and affordable health coverage and care in a truly free market. Private insurers and for-profit providers should not profit from the care of the healthy and wealthy in ways that compromise the public programs that serve the poor and seriously ill. Nor should they be allowed to use NAFTA processes to compromise public programs. Policy makers must consider implications of NAFTA and move toward assuring access to affordable health care for all people on the North American continent.

Shelter from the Storm: Roles, responsibilities, and challenges in United States housing policy governance.

PubMed

Willison, Charley

2017-11-01

Housing is a critical social determinant of health. Housing policy not only affects health by improving housing quality, affordability, and insecurity; housing policy affects health upstream through the politics that shape housing policy design, implementation, and management. These politics, or governance strategies, determine the successes or failures of housing policy programs. This paper is an overview of challenges in housing policy governance in the United States. I examine the important relationship between housing and health, and emphasize why studying housing policy governance matters. I then present three cases of housing governance challenges in the United States, from each pathway by which housing affects health - housing quality, affordability, and insecurity. Each case corresponds to an arm of the TAPIC framework for evaluating governance (Krieger and Higgins) [1], to assess mechanisms of housing governance in each case. While housing governance has come a long way over the past century, political decentralization and the expansion of the submerged state have increased the number of political actors and policy conflict in many areas. This creates inherent challenges for improving accountability, transparency, and policy capacity. In many instances, too, reduced government accountability and transparency increases the risk of harm to the public and lessens governmental integrity. Copyright © 2017 The Author. Published by Elsevier B.V. All rights reserved.

The patient protection and Affordable Care Act: a primer for hand surgeons.

PubMed

Adkinson, Joshua M; Chung, Kevin C

2014-08-01

The Affordable Care Act is the largest and most comprehensive overhaul of the United States health care industry since the inception of the Medicare and Medicaid. Contained within the 10 titles are a multitude of provisions that will change how hand surgeons practice medicine and how they are reimbursed. It is imperative that surgeons are equipped with the knowledge of how this law will affect all physician practices and hospitals. Copyright © 2014 Elsevier Inc. All rights reserved.

Constitutional Rights of Children. Prepared for the Subcommittee on the Constitution of the Committee on the Judiciary, United States Senate, by the American Law Division, Congressional Research Service of the Library of Congress.

ERIC Educational Resources Information Center

Library of Congress, Washington, DC. Congressional Research Service.

This paper reviews the rights of children as defined by the Constitution of the United States and summarizes a series of Supreme Court decisions which have defined the protections afforded to children by the Constitution. A short historical overview of the legal status of children is provided as background for the report. It is suggested that the…

Hydropower Vision: Full Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

None, None

Hydropower has provided clean, affordable, reliable, and renewable electricity in the United States for more than a century. Building on hydropower’s historical significance, and to inform the continued technical evolution, energy market value, and environmental performance of the industry, the U.S. Department of Energy’s (DOE’s) Wind and Water Power Technologies Office has led a first-of-its-kind comprehensive analysis focused on a set of potential pathways for the environmentally sustainable expansion of hydropower (hydropower generation and pumped storage) in the United States.

Building Technologies Office FY 2017 Budget At-A-Glance

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

2016-03-01

Buildings and homes use more than 73% of the electrical energy consumed in the United States. They also consume 40% of the nation’s total energy, with an annual energy bill of $430 billion. These energy bills can be cost effectively reduced by 20%–50% or more through various energy-efficient technologies and techniques. The Building Technologies Office (BTO) will continue to develop and demonstrate advanced building efficiency technologies and practices to make buildings in the United States more efficient, affordable, and comfortable.

12 CFR 1807.400 - Affordable housing-general.

Code of Federal Regulations, 2011 CFR

2011-01-01

... percent of Eligible Project Costs are attributable to housing units that meet the affordability... Project Costs must be attributable to housing units that meet the affordability qualifications set forth...

EPA RESPONSE TO THE NARSTO EMISSION INVENTORY ASSESSMENT

EPA Science Inventory

NARSTO conducted an assessment of emission inventory programs and recommended actions to enhance the accuracy, quality, timeliness, and affordability of emission inventories across Canada, Mexico and the United States. This briefing provides the EPA response to the NARSTO report...

Affordable and Sustainable Energy in the Borough of Woking in the United Kingdom

ERIC Educational Resources Information Center

Thorp, John P.; Curran, Lara

2009-01-01

Woking Borough Council in the United Kingdom has long been committed to protecting the environment, a goal explicitly stated as one of the borough's top three priorities. Woking is also known for its pioneering approach in operating an extensive networked electricity and district heating system based on co- and trigeneration, as well as what is…

Joining the Conversation: Twitter as a Tool for Student Political Engagement

ERIC Educational Resources Information Center

Journell, Wayne; Ayers, Cheryl A.; Beeson, Melissa Walker

2013-01-01

This article describes possibilities afforded by using social media, specifically Twitter, as a way to encourage students to join political conversations across the United States and around the world. In this study, we describe a project in which students used Twitter to share commentary about the state of the 2012 presidential election. The…

The United States mobile satellite service

NASA Astrophysics Data System (ADS)

Kiesling, J. D.

1986-09-01

The proposed U.S. mobile satellite service provides services to America's nonurban land mass where terrestrial mobile systems find little application. Based on state of the art satellite technology, and use of omnidirectional, steered, and fixed antennas, a broad range of services at affordable prices will be available, including land mobile, service to intra coastal waterways, and aviation.

Placement of Religion in the Social Studies Curriculum. Committee Report.

ERIC Educational Resources Information Center

North Carolina State Dept. of Public Instruction, Raleigh.

This document is the report of a committee charged with two tasks: (1) to examine the state recommended sequence of study and the recommended textbooks for purposes of determining whether or not North Carolina's students were afforded adequate opportunities to study the roles of religion in shaping the human heritage in the United States and the…

Geographic information system for pigweed distribution in the US Southeast

USDA-ARS?s Scientific Manuscript database

In the southeastern United States, pigweeds have become troublesome weeds in agricultural systems. To implement management strategies to control them, agriculturalists need information on areas affected by pigweeds. Geographic information systems (GIS) afford users the ability to evaluate agricult...

BACTERIA, BEACHES AND SWIMMABLE WATERS: INTRODUCING VIRTUAL BEACH

EPA Science Inventory

Safe beaches meet water quality standards and are valued for their aesthetics and the recreational opportunities that they afford. In the United States recreational water quality assessments and beach closure decisions are presently based on samples of enterococci or Escherichia ...

United States Health Care Reform Progress to Date and Next Steps

PubMed Central

Obama, Barack

2016-01-01

IMPORTANCE The Affordable Care Act is the most important health care legislation enacted in the United States since the creation of Medicare and Medicaid in 1965. The law implemented comprehensive reforms designed to improve the accessibility, affordability, and quality of health care. OBJECTIVES To review the factors influencing the decision to pursue health reform, summarize evidence on the effects of the law to date, recommend actions that could improve the health care system, and identify general lessons for public policy from the Affordable Care Act. EVIDENCE Analysis of publicly available data, data obtained from government agencies, and published research findings. The period examined extends from 1963 to early 2016. FINDINGS The Affordable Care Act has made significant progress toward solving long-standing challenges facing the US health care system related to access, affordability, and quality of care. Since the Affordable Care Act became law, the uninsured rate has declined by 43%, from 16.0% in 2010 to 9.1% in 2015, primarily because of the law’s reforms. Research has documented accompanying improvements in access to care (for example, an estimated reduction in the share of nonelderly adults unable to afford care of 5.5 percentage points), financial security (for example, an estimated reduction in debts sent to collection of $600–$1000 per person gaining Medicaid coverage), and health (for example, an estimated reduction in the share of nonelderly adults reporting fair or poor health of 3.4 percentage points). The law has also begun the process of transforming health care payment systems, with an estimated 30% of traditional Medicare payments now flowing through alternative payment models like bundled payments or accountable care organizations. These and related reforms have contributed to a sustained period of slow growth in per-enrollee health care spending and improvements in health care quality. Despite this progress, major opportunities to improve the health care system remain. CONCLUSIONS AND RELEVANCE Policy makers should build on progress made by the Affordable Care Act by continuing to implement the Health Insurance Marketplaces and delivery system reform, increasing federal financial assistance for Marketplace enrollees, introducing a public plan option in areas lacking individual market competition, and taking actions to reduce prescription drug costs. Although partisanship and special interest opposition remain, experience with the Affordable Care Act demonstrates that positive change is achievable on some of the nation’s most complex challenges. PMID:27400401

United States Health Care Reform: Progress to Date and Next Steps.

PubMed

Obama, Barack

2016-08-02

The Affordable Care Act is the most important health care legislation enacted in the United States since the creation of Medicare and Medicaid in 1965. The law implemented comprehensive reforms designed to improve the accessibility, affordability, and quality of health care. To review the factors influencing the decision to pursue health reform, summarize evidence on the effects of the law to date, recommend actions that could improve the health care system, and identify general lessons for public policy from the Affordable Care Act. Analysis of publicly available data, data obtained from government agencies, and published research findings. The period examined extends from 1963 to early 2016. The Affordable Care Act has made significant progress toward solving long-standing challenges facing the US health care system related to access, affordability, and quality of care. Since the Affordable Care Act became law, the uninsured rate has declined by 43%, from 16.0% in 2010 to 9.1% in 2015, primarily because of the law's reforms. Research has documented accompanying improvements in access to care (for example, an estimated reduction in the share of nonelderly adults unable to afford care of 5.5 percentage points), financial security (for example, an estimated reduction in debts sent to collection of $600-$1000 per person gaining Medicaid coverage), and health (for example, an estimated reduction in the share of nonelderly adults reporting fair or poor health of 3.4 percentage points). The law has also begun the process of transforming health care payment systems, with an estimated 30% of traditional Medicare payments now flowing through alternative payment models like bundled payments or accountable care organizations. These and related reforms have contributed to a sustained period of slow growth in per-enrollee health care spending and improvements in health care quality. Despite this progress, major opportunities to improve the health care system remain. Policy makers should build on progress made by the Affordable Care Act by continuing to implement the Health Insurance Marketplaces and delivery system reform, increasing federal financial assistance for Marketplace enrollees, introducing a public plan option in areas lacking individual market competition, and taking actions to reduce prescription drug costs. Although partisanship and special interest opposition remain, experience with the Affordable Care Act demonstrates that positive change is achievable on some of the nation's most complex challenges.

The development of the U.S. Health Care System and the contemporary role of the public health department.

PubMed

Grott, Catherine J

2006-01-01

The absence of national health care reform and the growing number of uninsured individuals in the United States have prompted states to develop plans to provide medical care for the low income and the indigent. Many local health departments are not only responsible for the core public health functions; but they are increasingly called upon to provide person health care services for those who cannot afford it. This article chronicles the development of the health care system in the United States and describes the contemporary role of the local public health department.

Antimicrobial and antiinsectan phenolic metabolites of dalea searlsiae

USDA-ARS?s Scientific Manuscript database

Continued interest in the chemistry of Dalea spp. (Fabaceae) has led to investigation of Dalea searlsiae, a plant native to areas of the western United States. Methanol extractions of D. searlsiae roots, and subsequent chromatographic fractionation, afforded the new prenylated and geranylated flavan...

Closing the Communal Gap: The Importance of Communal Affordances in Science Career Motivation

PubMed Central

Brown, Elizabeth R.; Thoman, Dustin B.; Smith, Jessi L.; Diekman, Amanda B.

2015-01-01

To remain competitive in the global economy, the United States (and other countries) is trying to broaden participation in science, technology, engineering, and mathematics (STEM) by graduating an additional 1 million people in STEM fields by 2018. Although communion (working with, helping, and caring for others) is a basic human need, STEM careers are often (mis)perceived as being uncommunal. Across three naturalistic studies we found greater support for the communal affordance hypothesis, that perceiving STEM careers as affording greater communion is associated with greater STEM career interest, than two alternative hypotheses derived from goal congruity theory. Importantly, these findings held regardless of major (Study 1), college enrollment (Study 2), and gender (Studies 1–3). For undergraduate research assistants, mid-semester beliefs that STEM affords communion predicted end of the semester STEM motivation (Study 3). Our data highlight the importance of educational and workplace motivational interventions targeting communal affordances beliefs about STEM. PMID:26806983

12 CFR 1282.19 - Affordability-Rent level definitions-tenant income is not known.

Code of Federal Regulations, 2010 CFR

2010-01-01

... very low-, low-, or moderate-income families where the income of the family in the dwelling unit is not known to the Enterprise, the affordability of the unit is determined based on unit size as follows: (a) For moderate-income, maximum affordable rents to count as housing for moderate-income families shall...

If Higher Education Is a Right, and Distance Education Is the Answer, Then Who Will Pay?

ERIC Educational Resources Information Center

Meyer, Katrina A.

2010-01-01

If higher education is a right, and distance education is the avenue for making higher education universally available, then who shall pay? This article asks (1) can state governments in the United States afford to fund this initiative and (2) can public higher education institutions in the U.S. fund this effort through capitalizing on…

The Curious Dawn of American Public Schools. NBER Working Paper No. 13335

ERIC Educational Resources Information Center

Go, Sun; Lindert, Peter H.

2007-01-01

Three factors help to explain why school enrollments in the Northern United States were higher than those in the South and in most of Europe by 1850. One was affordability: the northern states had higher real incomes, cheaper teachers, and greater local tax support. The second was the greater autonomy of local governments. The third was the…

Rehabilitation of fire-damaged forest lands in southwestern Maine

Treesearch

A. D. Nutting; James C. Rettie; Wayne G. Banks

1949-01-01

Recognizing that it can ill afford the loss of timber productivity on the large acreage of forest land burned over by the 1947 fires, the state of Maine requested assistance of the Northeastern Forest Experiment Station of the United States Forest Service in a program of research that would aid in the rehabilitation of the burned-over forest land.

Secondary Migration and Relocation Among African Refugee Families in the United States

PubMed Central

Weine, Stevan Merrill; Hoffman, Yael; Ware, Norma; Tugenberg, Toni; Hakizimana, Leonce; Dahnweigh, Gonwo; Currie, Madeleine; Wagner, Maureen

2014-01-01

The purpose of this study was to understand the secondary migration and relocation of African refugees resettled in the United States. Secondary migration refers to moves out of state, while relocation refers to moves within state. Of 73 recently resettled refugee families from Burundi and Liberia followed for 1 year through ethnographic interviews and observations, 13 instances of secondary migration and 9 instances of relocation were identified. A family ecodevelopmental framework was applied to address: Who moved again, why, and with what consequences? How did moving again impact family risk and protective factors? How might policies, researchers, and practitioners better manage refugees moving again? Findings indicated that families undertook secondary migration principally for employment, affordable housing, family reunification, and to feel more at home. Families relocated primarily for affordable housing. Parents reported that secondary migration and relocation enhanced family stability. Youth reported disruption to both schooling and attachments with peers and community. In conclusion, secondary migration and relocation were family efforts to enhance family and community protective resources and to mitigate shortcomings in resettlement conditions. Policymakers could provide newly resettled refugees jobs, better housing and family reunification. Practitioners could devise ways to better engage and support those families who consider moving. PMID:21361922

Cultural Similarities and Differences in Perceived Affordances of Situations for Big Five Behaviors

PubMed Central

Church, A. Timothy; Katigbak, Marcia S.; del Prado, Alicia M.

2009-01-01

The perceived affordance or conduciveness of various situations for Big Five behaviors was investigated in the United States (N = 188) and the Philippines (N = 215). The basic proposition that different situations afford different trait-relevant behaviors was supported, at least in the perceptions of cultural informants. Cultural similarities exceeded differences, and in both cultures individuals perceived Big Five behaviors as expressed in if-then patterns of variation across situations. Americans and Filipinos showed some similarity in the general dimensions along which situations are construed, but meaningful differences in the construal of certain interpersonal situations were also observed. The findings contribute to efforts to integrate person and situation approaches in personality and social psychology. PMID:20401176

Condoned or condemned: the situational affordance of anger and shame in the United States and Japan.

PubMed

Boiger, Michael; Mesquita, Batja; Uchida, Yukiko; Feldman Barrett, Lisa

2013-04-01

Two studies tested the idea that the situations that people encounter frequently and the situations that they associate most strongly with an emotion differ across cultures in ways that can be understood from what a culture condones or condemns. In a questionnaire study, N = 163 students from the United States and Japan perceived situations as more frequent to the extent that they elicited condoned emotions (anger in the United States, shame in Japan), and they perceived situations as less frequent to the extent that they elicited condemned emotions (shame in the United States, anger in Japan). In a second study, N = 160 students from the United States and Japan free-sorted the same situations. For each emotion, the situations could be organized along two cross-culturally common dimensions. Those situations that touched upon central cultural concerns were perceived to elicit stronger emotions. The largest cultural differences were found for shame; smaller, yet meaningful, differences were found for anger.

A call for evidence-based medical treatment of opioid dependence in the United States and Canada.

PubMed

Nosyk, Bohdan; Anglin, M Douglas; Brissette, Suzanne; Kerr, Thomas; Marsh, David C; Schackman, Bruce R; Wood, Evan; Montaner, Julio S G

2013-08-01

Despite decades of experience treating heroin or prescription opioid dependence with methadone or buprenorphine--two forms of opioid substitution therapy--gaps remain between current practices and evidence-based standards in both Canada and the United States. This is largely because of regulatory constraints and pervasive suboptimal clinical practices. Fewer than 10 percent of all people dependent on opioids in the United States are receiving substitution treatment, although the proportion may increase with expanded health insurance coverage as a result of the Affordable Care Act. In light of the accumulated evidence, we recommend eliminating restrictions on office-based methadone prescribing in the United States; reducing financial barriers to treatment, such as varying levels of copayment in Canada and the United States; reducing reliance on less effective and potentially unsafe opioid detoxification; and evaluating and creating mechanisms to integrate emerging treatments. Taking these steps can greatly reduce the harms of opioid dependence by maximizing the individual and public health benefits of treatment.

A patient mobility framework that travels: European and United States-Mexican comparisons.

PubMed

Laugesen, Miriam J; Vargas-Bustamante, Arturo

2010-10-01

To develop a framework that parsimoniously explains divergent patient mobility in the United States and Europe. Review of studies of patient mobility; data from the 2007 Flash Eurobarometer and the 2001 California Health Interview Survey was analyzed; and we reviewed government policies and documents in the United States and Europe. Four types of patient mobility are defined: primary, complementary, duplicative, and institutionalized. Primary exit occurs when people without comprehensive insurance travel because they cannot afford to pay for health insurance or directly finance care, as in the United States and Mexico. Second, people will exit to buy complementary services not covered, or partially covered by domestic health insurance, in both the United States and Europe. Third, in Europe, patient mobility for duplicative services provides faster or better quality treatment. Finally, governments and insurers can encourage institutionalized exit through expanded delivery options and financing. Institutionalized exit is developing in Europe, but uncoordinated and geographically limited in the United States. This parsimonious framework explains patient mobility by considering domestic health system characteristics relating to cost and quality. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

Proposing an amendment to the Constitution of the United States respecting the right to decent, safe, sanitary, and affordable housing.

THOMAS, 111th Congress

Rep. Jackson, Jesse L., Jr. [D-IL-2

2009-03-03

House - 03/16/2009 Referred to the Subcommittee on the Constitution, Civil Rights, and Civil Liberties. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

The Affordable Care Act and Abortion Comparing the U.S. and Western Europe.

PubMed

McFarlane, Deborah R

2015-01-01

The 2010 Affordable Health Care Act (ACA) treats abortion differently than any other health service, precluding public funding for abortion and imposing other restrictions on American states. To determine whether the ACA's abortion restrictions are uniquely American or have counterparts in other national health systems, this study employs a cross-sectional design comparing abortion restrictions in the ACA with those in 17 Western European countries. Using a six-item scale, the intensity of abortion restrictions is compared across Western European nations. A similar scale is employed for a five-state sample of state-level abortion restrictions. Although the United States is not alone in having abortion restrictions, how abortion is proscribed in the ACA has no counterpart in Western Europe. Unlike many Western European countries, the ACA's restrictions focus on abortion funding, not the length of gestation or the health of the pregnant woman.

The Affordable Care Act’s Impacts on Access to Insurance and Health Care for Low-Income Populations

PubMed Central

Kominski, Gerald F.; Nonzee, Narissa J.; Sorensen, Andrea

2018-01-01

The Patient Protection and Affordable Care Act (ACA) expands access to health insurance in the United States, and, to date, an estimated 20 million previously uninsured individuals have gained coverage. Understanding the law’s impact on coverage, access, utilization, and health outcomes, especially among low-income populations, is critical to informing ongoing debates about its effectiveness and implementation. Early findings indicate that there have been significant reductions in the rate of uninsurance among the poor and among those who live in Medicaid expansion states. In addition, the law has been associated with increased health care access, affordability, and use of preventive and outpatient services among low-income populations, though impacts on inpatient utilization and health outcomes have been less conclusive. Although these early findings are generally consistent with past coverage expansions, continued monitoring of these domains is essential to understand the long-term impact of the law for underserved populations. PMID:27992730

77 FR 47765 - National Health Center Week, 2012

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-09

... Health Center Week, 2012 By the President of the United States of America A Proclamation For nearly half a century, health centers have helped make primary care services available and affordable for... lives. During National Health Center Week, we recognize the professionals who power our Nation's health...

Building a Thriving Nation: 21st-Century Vision and Practice to Advance Health and Equity

ERIC Educational Resources Information Center

Cohen, Larry

2016-01-01

It is a great time for prevention. As the United States explores what health in our country should look like, it is an extraordinary time to highlight the role of prevention in improving health, saving lives, and saving money. The Affordable Care Act's investment in prevention has spurred innovation by communities and states to keep people healthy…

The medical examination in United States immigration applications: the potential use of genetic testing leads to heightened privacy concerns.

PubMed

Burroughs, A Maxwell

2005-01-01

The medical examination has been an integral part of the immigration application process since the passing of the Immigration Act of 1891. Failing the medical examination can result in denial of the application. Over the years the medical examination has been expanded to include questioning about diseases that are scientifically shown to be rooted in an individual's genetic makeup. Recent advances in the fields of genomics and bioinformatics are making accurate and precise screening for these conditions a reality. Government policymakers will soon be faced with decisions regarding whether or not to sanction the use of these newly-developed genetic tests in the immigration application procedure. The terror threat currently facing the United States may ultimately bolster the argument in favor of genetic testing and/or DNA collection of applicants. However, the possibility of a government mandate requiring genetic testing raises a host of ethical issues; including the threat of eugenics and privacy concerns. Genetic testing has the ability to uncover a wealth of sensitive medical information about an individual and currently there are no medical information privacy protections afforded to immigration applicants. This article examines the potential for genetic testing in the immigration application process and the ethical issues surrounding this testing. In particular, this article explores the existing framework of privacy protections afforded to individuals living in the United States and how this and newly-erected standards like those released by the Health and Human Services (HHS) might apply to individuals seeking to immigrate to the United States.

Parenting and the workplace: the construction of parenting protections in United States law.

PubMed

Eichner, Maxine

2008-08-04

In this paper, I discuss the shortcomings of the legal protections that exist for pregnancy, breastfeeding, and parenting for United States' workers. The two main sources of protection for pregnancy and parenting in United States employment law are the Pregnancy Discrimination Act (PDA) and the Family and Medical Leave Act (FMLA). Both, I argue, contain inadequate protections for the needs of pregnant women and breastfeeding mothers, as well as their infants. I consider what it is about the way these statutes conceptualize the needs of pregnant women, mothers, and their babies, that prevents more robust protection of their needs. I then compare the minimal protection afforded American women and families with more progressive policies in other countries to highlight the possibilities that arise when the state affirmatively supports working parents and their children.

Expanding Access

ERIC Educational Resources Information Center

Roach, Ronald

2007-01-01

There is no question that the United States lags behind most industrialized nations in consumer access to broadband Internet service. For many policy makers and activists, this shortfall marks the latest phase in the struggle to overcome the digital divide. To remedy this lack of broadband affordability and availability, one start-up firm--with…

Can We Pay for Current Education Reform?

ERIC Educational Resources Information Center

Odden, Allan

2012-01-01

For more than 30 years, the United States has been engaged in education reform efforts designed to dramatically boost student performance and close achievement gaps linked to poverty and ethnicity. Can schools afford those education ambitions? Most educators have their doubts. The author believes educators can improve student learning even when…

American Institutional Review Boards: Safeguards or Censorship?

ERIC Educational Resources Information Center

Hottenstein, Kristi N.

2018-01-01

The United States is a world leader in biomedical clinical research. America's existing human subject research regulations structure affords sizable protections for the ethical treatment of research volunteers. Early initiatives such as the Belmont Report were specific to federally funded research. Over the past several decades guidelines such as…

Cytotoxicity of ethanolic extracts of Artemisia annua to Molt-4 human leukemia cells

USDA-ARS?s Scientific Manuscript database

Cancer is the second cause of death in the United States, and current treatment is expensive and kills also healthy cells. Affordable alternatives that kill only cancer cells are needed. Artemisinin, extracted from the Artemisia annua, has potent anticancer activity and low toxicity to normal cell...

School Construction: Fixing Facilities

ERIC Educational Resources Information Center

Kennedy, Mike

2012-01-01

About two decades ago, a consensus began to take root among educators and policymakers that school systems in the United States could no longer afford to ignore the inadequate building conditions that made teaching and learning difficult in many classrooms. Since then, billions of dollars have been spent, and thousands of modern classrooms have…

Astronaut Catherine G. Coleman aboard KC-135 aircraft

NASA Image and Video Library

1994-05-28

S94-35542 (June 1994) --- Astronaut Catherine G. Coleman, mission specialist, gets a preview of next year?s United States Microgravity Laboratory (USML-2) mission aboard the Space Shuttle Columbia. The weightless experience was afforded by a special parabolic pattern flown by NASA?s KC-135 ?zero gravity? aircraft.

78 FR 49357 - National Health Center Week, 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-14

... America A Proclamation Community health centers play a critical role in providing affordable, high-quality... people living in the United States depends on their services. They are an important source of jobs in... extend our thanks to the women and men who operate America's health centers. NOW, THEREFORE, I, BARACK...

The NASA Space Launch System Program Systems Engineering Approach for Affordability

NASA Technical Reports Server (NTRS)

Hutt, John J.; Whitehead, Josh; Hanson, John

2017-01-01

The National Aeronautics and Space Administration is currently developing the Space Launch System to provide the United States with a capability to launch large Payloads into Low Earth orbit and deep space. One of the development tenets of the SLS Program is affordability. One initiative to enhance affordability is the SLS approach to requirements definition, verification and system certification. The key aspects of this initiative include: 1) Minimizing the number of requirements, 2) Elimination of explicit verification requirements, 3) Use of certified models of subsystem capability in lieu of requirements when appropriate and 4) Certification of capability beyond minimum required capability. Implementation of each aspect is described and compared to a "typical" systems engineering implementation, including a discussion of relative risk. Examples of each implementation within the SLS Program are provided.

Diabetes and the Affordable Care Act

PubMed Central

Schade, David S.

2014-01-01

Abstract The Affordable Care Act—“Obamacare”—is the most important federal medical legislation to be enacted since Medicare. Although the goal of the Affordable Care Act is to improve healthcare coverage, access, and quality for all Americans, people with diabetes are especially poised to benefit from the comprehensive reforms included in the act. Signed into law in 2010, this massive legislation will slowly be enacted over the next 10 years. In the making for at least a decade, it will affect every person in the United States, either directly or indirectly. In this review, we discuss the major changes in healthcare that will take place in the next several years, including (1) who needs to purchase insurance on the Web-based exchange, (2) the cost to individuals and the rebates that they may expect, (3) the rules and regulations for purchasing insurance, (4) the characteristics of the different “metallic” insurance plans that are available, and (5) the states that have agreed to participate. With both tables and figures, we have tried to make the Affordable Care Act both understandable and appreciated. The goal of this comprehensive review is to highlight aspects of the Affordable Care Act that are of importance to practitioners who care for people with diabetes by discussing both the positive and the potentially negative aspects of the program as they relate to diabetes care. PMID:24927108

Overview of Non-nuclear Testing of the Safe, Affordable 30-kW Fission Engine, Including End-to-End Demonstrator Testing

NASA Technical Reports Server (NTRS)

VanDyke, M. K.; Martin, J. J.; Houts, M. G.

2003-01-01

Successful development of space fission systems will require an extensive program of affordable and realistic testing. In addition to tests related to design/development of the fission system, realistic testing of the actual flight unit must also be performed. At the power levels under consideration (3-300 kW electric power), almost all technical issues are thermal or stress related and will not be strongly affected by the radiation environment. These issues can be resolved more thoroughly, less expensively, and in a more timely fashing with nonnuclear testing, provided it is prototypic of the system in question. This approach was used for the safe, affordable fission engine test article development program and accomplished viz cooperative efforts with Department of Energy labs, industry, universiites, and other NASA centers. This Technical Memorandum covers the analysis, testing, and data reduction of a 30-kW simulated reactor as well as an end-to-end demonstrator, including a power conversion system and an electric propulsion engine, the first of its kind in the United States.

Patents, pills and politics: the Australia-United States Free Trade Agreement and the Pharmaceutical Benefits Scheme.

PubMed

Harvey, Ken

2004-11-08

There is tension between the need of the pharmaceutical innovator for intellectual property protection and the need of society for equitable and affordable access to innovative drugs. The recent Australia-United States Free Trade Agreement provides a nice illustration of this interplay between patents, pills and politics. This article provides a brief history of patent law as applied to pharmaceuticals, describes how the Pharmaceutical Benefits Scheme got caught up in AUSFTA negotiations, analyses the clauses that are likely to impact upon the PBS and describes the political process that reviewed and ultimately amended the AUSFTA.

Academic Health Centers and Care of Undocumented Immigrants in the United States: Servant Leaders or Uncourageous Followers?

PubMed Central

Aguilar-Gaxiola, Sergio

2014-01-01

Public dialogue and debate about the health care overhaul in the United States is centered on one contentious question: Is there a moral obligation to ensure that all people (including undocumented immigrants) within its borders have access to affordable health care? For academic health centers (AHCs), which often provide safety-net care to the uninsured, this question has moral and social implications. An estimated 11 million undocumented immigrants living in the United States (80% of whom are Latino) are uninsured and currently prohibited from purchasing exchange coverage under the Patient Protection and Affordable Care Act, even at full cost. The authors attempt to dispel the many misconceptions and distorted assumptions surrounding the use of health services by this vulnerable population. The authors also suggest that AHCs need to recalibrate their mission to focus on social accountability as well as the ethical and humanistic practice of medicine for all people, recognizing the significance of inclusion over exclusion in making progress on population health and health care. AHCs play a crucial role, both in educational policy and as a safety-net provider, in reducing health disparities that negatively impact vulnerable populations. Better health for all is possible through better alignment, collaboration, and partnering with other AHCs and safety-net providers. Through servant leadership, AHCs can be the leaders that this change imperative demands. PMID:24556781

Academic health centers and care of undocumented immigrants in the United States: servant leaders or uncourageous followers?

PubMed

Acosta, David A; Aguilar-Gaxiola, Sergio

2014-04-01

Public dialogue and debate about the health care overhaul in the United States is centered on one contentious question: Is there a moral obligation to ensure that all people (including undocumented immigrants) within its borders have access to affordable health care? For academic health centers (AHCs), which often provide safety-net care to the uninsured, this question has moral and social implications. An estimated 11 million undocumented immigrants living in the United States (80% of whom are Latino) are uninsured and currently prohibited from purchasing exchange coverage under the Patient Protection and Affordable Care Act, even at full cost. The authors attempt to dispel the many misconceptions and distorted assumptions surrounding the use of health services by this vulnerable population. The authors also suggest that AHCs need to recalibrate their mission to focus on social accountability as well as the ethical and humanistic practice of medicine for all people, recognizing the significance of inclusion over exclusion in making progress on population health and health care. AHCs play a crucial role, both in educational policy and as a safety-net provider, in reducing health disparities that negatively impact vulnerable populations. Better health for all is possible through better alignment, collaboration, and partnering with other AHCs and safety-net providers. Through servant leadership, AHCs can be the leaders that this change imperative demands.

A Policy Analysis of Missouri Community College Residence Hall Discipline Policies with an Analysis of Changes in the State Fair Community College Residence Hall Policy

ERIC Educational Resources Information Center

Gilgour, Joseph G.

2012-01-01

Community colleges in the United States have long been known as institutions of equal opportunity and affordable education. One facet of student life appearing at more and more community colleges is the addition of residence halls. Still, the number of community colleges with on-campus living is relatively small, and for the campuses with…

Speedup for quantum optimal control from automatic differentiation based on graphics processing units

NASA Astrophysics Data System (ADS)

Leung, Nelson; Abdelhafez, Mohamed; Koch, Jens; Schuster, David

2017-04-01

We implement a quantum optimal control algorithm based on automatic differentiation and harness the acceleration afforded by graphics processing units (GPUs). Automatic differentiation allows us to specify advanced optimization criteria and incorporate them in the optimization process with ease. We show that the use of GPUs can speedup calculations by more than an order of magnitude. Our strategy facilitates efficient numerical simulations on affordable desktop computers and exploration of a host of optimization constraints and system parameters relevant to real-life experiments. We demonstrate optimization of quantum evolution based on fine-grained evaluation of performance at each intermediate time step, thus enabling more intricate control on the evolution path, suppression of departures from the truncated model subspace, as well as minimization of the physical time needed to perform high-fidelity state preparation and unitary gates.

Catholic Institutions of Higher Education and K-12 Schools Partnering for Social Justice: A Call for Scholarship

ERIC Educational Resources Information Center

Whipp, Joan L.; Scanlan, Martin

2009-01-01

Schooling for social justice involves fostering teaching and learning communities that are inclusive of students across multiple dimensions of diversity. The United States Conference of Catholic Bishops (2005) directs Catholic educators toward social justice schooling by making schools accessible, affordable, and available. In recent decades,…

The Urban Food Hubs Solution: Building Capacity in Urban Communities

ERIC Educational Resources Information Center

O'Hara, Sabine

2017-01-01

Access to affordable fresh food is an ongoing challenge for underserved urban neighborhoods across the United States. Several are designated food deserts with no access to a full-service grocery store within a one-mile radius. The Urban Food Hubs of the College of Agriculture, Urban Sustainability, and Environmental Sciences (CAUSES) of the…

Quantitative microbial risk assessment for spray irrigation of dairy manure based on an empirical fate and transport model

USDA-ARS?s Scientific Manuscript database

Background: Spray irrigation for land-applying livestock manure is increasing in the United States as farms become larger and economies of scale make manure irrigation affordable. However, human health risks from exposure to zoonotic pathogens aerosolized during manure irrigation are not well-unders...

The Impact of Human Capital and Selected Job Rewards on Community College Faculty Job Satisfaction

ERIC Educational Resources Information Center

Lyons, Frankie W.; Akroyd, Duane

2014-01-01

Community colleges accommodate nearly half of all United States college students. Increased reliance upon community colleges is driven by the current economic downturn, rising costs of higher education, and changing expectations for today's workforce requiring advanced skill sets. Community colleges offer more affordable options for broader…

75 FR 32079 - Lesbian, Gay, Bisexual, and Transgender Pride Month, 2010

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-07

..., Gay, Bisexual, and Transgender Pride Month, 2010 By the President of the United States of America A... equality on behalf of the lesbian, gay, bisexual, and transgender (LGBT) community. This month, as we.... That is why we must give committed gay couples the same rights and responsibilities afforded to any...

24 CFR 1000.2 - What are the guiding principles in the implementation of NAHASDA?

Code of Federal Regulations, 2013 CFR

2013-04-01

... Nation: (i) By using Federal resources to aid families and individuals seeking affordable homes in safe... marketplace and allow families to prosper without government involvement in their day-to-day activities. (2... an essential element in the special role of the United States in helping Indian tribes and their...

24 CFR 1000.2 - What are the guiding principles in the implementation of NAHASDA?

Code of Federal Regulations, 2012 CFR

2012-04-01

... Nation: (i) By using Federal resources to aid families and individuals seeking affordable homes in safe... marketplace and allow families to prosper without government involvement in their day-to-day activities. (2... an essential element in the special role of the United States in helping Indian tribes and their...

24 CFR 1000.2 - What are the guiding principles in the implementation of NAHASDA?

Code of Federal Regulations, 2014 CFR

2014-04-01

... Nation: (i) By using Federal resources to aid families and individuals seeking affordable homes in safe... marketplace and allow families to prosper without government involvement in their day-to-day activities. (2... an essential element in the special role of the United States in helping Indian tribes and their...

A Matter of Scale: Multi-Scale Ethnographic Research on Education in the United States

ERIC Educational Resources Information Center

Eisenhart, Margaret

2017-01-01

In recent years, cultural anthropologists conducting educational ethnographies in the US have pursued some new methodological approaches. These new approaches can be attributed to advances in cultural theory, evolving norms of research practice, and the affordances of new technologies. In this article, I review three such approaches under the…

Farming for restoration: Building bridges for native seeds

Treesearch

Sabine Tishew; Berta Youtie; Anita Kirmer; Nancy Shaw

2011-01-01

In both Europe and the United States, a shortage of native plant material frequently precludes successful restoration. Native plant materials are needed to restore ecosystem functioning and services, provide for in situ conservation of biodiversity (e.g., Hobbs and Cramer 2008), maintain genetic diversity (Bischoff et al. 2010), and afford resistance to invasive...

American Nightmare: A Decade of Homelessness in the United States.

ERIC Educational Resources Information Center

National Coalition for the Homeless, Washington, DC.

A 1989 national survey of the dimensions of homelessness found that at least three million Americans are homeless and that the shortage of affordable housing was cited as the chief cause. Information was gathered from a telephone survey of emergency shelter providers, housing advocacy organizations, and local governments in 26 communities, ranging…

Public School Choice in the District of Columbia: A Descriptive Analysis. Brief 13

ERIC Educational Resources Information Center

Ozek, Umut

2011-01-01

Increasing parental choice has been a leading theme of recent education policy intended to enhance the academic achievement of low-performing students in the United States. These policies aim to "level the playing field" in access to high-quality education for disadvantaged students who cannot otherwise afford higher-quality schooling…

Rethinking Online Education: The Impact of Synchronous Telecommunication Interactions on Student Success

ERIC Educational Resources Information Center

Hibbard, Joshua A.

2013-01-01

Higher education leaders in the 21st century are faced with challenges of affordability, accessibility, and increased demand for postsecondary education. The recent growth of online educational programs in the United States provides institutions with potential solutions to these challenges; yet, persistence rates continue to lag behind traditional…

32 CFR 700.939 - Granting of asylum and temporary refuge.

Code of Federal Regulations, 2010 CFR

2010-07-01

... of the Secretary of the Navy or higher authority. Persons seeking political asylum should be afforded... for political asylum in the United States will not be received on board, but will be advised to apply... voice communications will be used where possible, but must be confirmed as soon as possible with an...

CR digital mammography: an affordable entry.

PubMed

Fischer, Cathy

2006-01-01

CR full-field digital mammography (FFDM) has been used extensively in other countries, and it was one of the 4 digital mammography technologies employed in the Digital Mammographic Imaging Screening Trial. Affordability and easy integration with pre-existing mammography systems makes CR FFDM an attractive way to secure the advantages of filmless mammography imaging. CR mammography is true digital mammography--it is merely a different way of acquiring the image. The FDA has recently approved the first CR FFDM system for sale in the United States. At Gundersen Lutheran Health System (La Crosse, Wisconsin), CR FFDM is the most practical technology for realizing the potential everyday clinical benefits of filmless mammography imaging.

Affordability of Meteorology Graduate Programs in the United States and Canada.

NASA Astrophysics Data System (ADS)

Gilmore, Matthew S.; Toracinta, E. Richard

1998-06-01

The authors surveyed 55 university departments in the United States and Canada that grant doctor of philosophy and/or master of science degrees in meteorology or the atmospheric sciences. Two-thirds of university departments responded. Survey topics included graduate student income (stipends and health insurance benefits) and mandatory costs (tuition, fees, and health insurance costs) incurred for fall 1996.Results show that most graduate students do have funding but only one-quarter of departments indicate that health insurance benefits are provided to graduate assistants. The largest mandatory cost is typically housing, which was estimated (except for Canadian schools) with 1996 Fair Market Rent data from the U.S. Department of Housing and Urban Development. For schools not providing it, the second largest cost is typically health insurance. The smallest costs are typically tuition (waived for graduate assistants in most cases) and fees.The difference between income and mandatory costs over a nine-month period gives an "effective income." Evidence was found associating greater effective income with larger departments and with locations where housing costs are larger. No significant evidence was found to associate differences in effective income with city size or geographic region. The broad range in effective income between the departments suggests that some graduate programs may be much more affordable than others.This information can aid university departments in planning budgets that keep them competitive with one another. This paper will also help prospective graduate students by raising awareness about important issues of graduate program affordability.

Got Coal? Teaching about the Most Dangerous Rock in America

ERIC Educational Resources Information Center

Bigelow, Bill

2011-01-01

In 30 years of teaching, the author never taught explicitly about coal. Coal appeared in his social studies curriculum solely as a labor issue, and coal was mostly invisible in his history classes. The world cannot afford this kind of curricular invisibility today. Forty percent of the main greenhouse gas produced in the United States, carbon…

American Woman 1990-91: A Status Report. Third Edition.

ERIC Educational Resources Information Center

Rix, Sara E., Ed.

This volume provides an overview of how U.S. women and their families are faring. The contents include statistical information and articles on women's issues and documents the progress for and by women. The topics covered include: (1) African American families in the United States; (2) women and affordable housing; (3) child care; (4) gender…

32 CFR Appendix E to Part 68 - Addendum for Education Services Between [Name of Educational Institution] and the U.S. Navy

Code of Federal Regulations, 2014 CFR

2014-07-01

... DoD installation facility, including office space, classrooms, laboratories, or other features, that... readiness center, armory, unit, etc.), or recruiting center (leased space inside a shopping mall or office... afforded the opportunity to complete their high school education through a state-funded or Service...

Partnering with Carryouts: Implementation of a Food Environment Intervention Targeting Youth Obesity

ERIC Educational Resources Information Center

Perepezko, K.; Tingey, L.; Sato, P.; Rastatter, S.; Ruggiero, C.; Gittelsohn, J.

2018-01-01

Youth obesity is a major public health problem in the United States, especially among urban-based, minority youth. The B'More Healthy Communities for Kids (BHCK) trial worked at multiple levels of the food environment, including carryouts, to increase access to and demand for healthy, affordable foods. The objective of this article is to describe…

THE CHARACTERIZATION AND IMPLEMENTATION OF AN ENHANCED ACTIVATED ALUMINA FOR THE REMOVAL OF DISSOLVED ARSENIC AT THE POINT OF ENTRY

EPA Science Inventory

Technical Challenge: Nearly 5.5% of the water systems in the United States are expected to exceed the new 10 ppb arsenic maximum contaminant level. Many of these systems are in small communities that require an affordable means of meeting these arsenic standards. ...

Harnessing the Tax Code to Promote College Affordability: Options for Reform

ERIC Educational Resources Information Center

Valenti, Joe; Bergeron, David; Baylor, Elizabeth

2014-01-01

The United States tax code is full of provisions designed to encourage or reward specific behaviors, such as owning a home or saving for retirement. Tax benefits for higher education are no exception: Contributions to some college savings accounts grow tax-free, college tuition is often tax deductible, and some student-loan borrowers are able to…

Affordable Health Benefits for Part-Time School Employees

ERIC Educational Resources Information Center

Dickhart, Russ

2005-01-01

According to the U.S. Census Bureau, about 45 million Americans do not have health insurance. What's surprising is the majority of those individuals are actually employed. Part-time workers make up a full 15 percent of the uninsured population and school systems have a share of that group. Every day in the United States, approximately 10 percent…

Whose Lives Are These, Anyway? (A Comment on the Recently Issued Report on the Homeless and Emergency Shelters by the Department of Housing and Urban Development.).

ERIC Educational Resources Information Center

Hopper, Kim

1984-01-01

Criticizes a recent government report for using faulty statistical methodology and thus grossly underestimating the numbers of homeless people in the United States. Also notes the report's failure to recognize the scarcity of affordable housing as a cause of homelessness. (GC)

Minding the Missions: Mission Sets for the 21st Century Military Reserve

DTIC Science & Technology

2018-04-20

REPORT TYPE 3. DATES COVERED (From - To) 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 5d. PROJECT NUMBER...effort leaves the United States with a less effective reserve force. In an era of fiscal austerity, the Department of Defense cannot afford to purchase

MINDING THE MISSIONS: MISSION SETS FOR THE 21ST CENTURY MILITARY RESERVE

DTIC Science & Technology

2018-04-20

REPORT TYPE 3. DATES COVERED (From - To) 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 5d. PROJECT NUMBER...effort leaves the United States with a less effective reserve force. In an era of fiscal austerity, the Department of Defense cannot afford to purchase

The Economic Impact of Community College Capacity Development in Developing Countries: A Longitudinal Analysis

ERIC Educational Resources Information Center

Tyndorf, Darryl M., Jr.; Glass, Chris R.

2017-01-01

Developing countries have significantly expanded efforts to import more flexible short-cycle institutions based on the United States community college model. The U.S. community college model addresses human capital needs of the labor market in developing countries by increasing access to an affordable education. However, there is limited research…

Use and misuse of antimicrobial drugs in poultry and livestock: Mechanisms of antimicrobial resistance

USDA-ARS?s Scientific Manuscript database

Food safety begins on the farm with management practices that contribute to an abundant, safe, and affordable food supply. To attain this goal, antimicrobials have been used in all stages of food animal production in the United States and elsewhere around the world at one time or another. Among fo...

Affordability, accountability, and accessibility in health care reform: implications for cardiovascular and pulmonary rehabilitation.

PubMed

King, Marjorie L

2013-01-01

Because health care costs in the United States have been growing disproportionately compared to inflation for many years, without a clear connection to improved quality or increased access to care, employers and payers have begun to test new models of health care delivery and payment. These models are linked to the concepts of affordability, accountability, and accessibility and incorporate the premise that there must be shared responsibility for improving meaningful patient outcomes, with attention to the coordination of team-based and patient-centered care, and value for services purchased. This article explores emerging health care delivery and payment models, including expanded access to care related to the Affordable Care Act of 2010, patient-centered medical homes and neighborhoods, accountable and coordinated care organizations, and value-based purchasing and insurance design, with an emphasis on implications for cardiovascular and pulmonary rehabilitation programs and the American Association of Cardiovascular and Pulmonary Rehabilitation.

77 FR 54602 - Notice of Intent To Conduct Affirmatively Furthering Fair Housing Demonstration in Baltimore, MD...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-05

... available in mixed-income, integrated communities. In addition, HUD will require that this new affordable... fair housing marketing plan satisfactory to HUD for both the market-rate units and the units that will... (a satisfactory affirmative fair housing marketing plan must include marketing of affordable units to...

Design and Evaluation of a Net Zero Energy Low-Income Residential Housing Development in Lafayette, Colorado

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dean, J.; VanGeet, O.; Simkus, S.

This report outlines the lessons learned and sub-metered energy performance of an ultra low energy single family ranch home and duplex unit, called the Paradigm Pilot Project and presents the final design recommendations for a 153-unit net zero energy residential development called the Josephine Commons Project. Affordable housing development authorities throughout the United States continually struggle to find the most cost-effective pathway to provide quality, durable, and sustainable housing. The challenge for these authorities is to achieve the mission of delivering affordable housing at the lowest cost per square foot in environments that may be rural, urban, suburban, or withinmore » a designated redevelopment district. With the challenges the U.S. faces regarding energy, the environmental impacts of consumer use of fossil fuels and the increased focus on reducing greenhouse gas emissions, housing authorities are pursuing the goal of constructing affordable, energy efficient and sustainable housing at the lowest life-cycle cost of ownership. This report outlines the lessons learned and sub-metered energy performance of an ultra-low-energy single family ranch home and duplex unit, called the Paradigm Pilot Project and presents the final design recommendations for a 153-unit net zero energy residential development called the Josephine Commons Project. In addition to describing the results of the performance monitoring from the pilot project, this paper describes the recommended design process of (1) setting performance goals for energy efficiency and renewable energy on a life-cycle cost basis, (2) using an integrated, whole building design approach, and (3) incorporating systems-built housing, a green jobs training program, and renewable energy technologies into a replicable high performance, low-income housing project development model.« less

Policy Dilemmas in Latino Health Care and Implementation of the Affordable Care Act

PubMed Central

Ortega, Alexander N.; Rodriguez, Hector P.; Bustamante, Arturo Vargas

2016-01-01

The changing Latino demographic in the United States presents a number of challenges to health care policy makers, clinicians, organizations, and other stakeholders. Studies have demonstrated that Latinos tend to have worse patterns of access to, and utilization of, health care than other ethnic and racial groups. The implementation of the Affordable Care Act (ACA) of 2010 may ameliorate some of these disparities. However, even with the ACA, it is expected that Latinos will continue to have problems accessing and using high-quality health care, especially in states that are not expanding Medicaid eligibility as provided by the ACA. We identify four current policy dilemmas relevant to Latinos’ health and ACA implementation: (a) the need to extend coverage to the undocumented; (b) the growth of Latino populations in states with limited insurance expansion; (c) demands on public and private systems of care; and (d) the need to increase the number of Latino physicians while increasing the direct patient-care responsibilities of nonphysician Latino health care workers. PMID:25581154

Rationing health care: its impact and implications for hematology-oncology.

PubMed Central

Duffy, T. P.

1992-01-01

Rationing of health care in the United States currently exists via the covert mechanism of restricting significant segments of medical care for many of those who cannot afford it. Provision of universal health care would necessitate explicit rationing of certain interventions and technologies, even though an individual could afford them. The British and Canadian experiences provide lessons from which America can profit, and the Oregon health plan is an experiment in this direction. The progressive "graying" of America has raised the question of the need for intergenerational charity as a form of rationing. The implications of these rationing plans would result in a major restructuring of the practice of hematology-oncology. PMID:1519379

Can Low-income Americans Afford to Satisfy MyPyramid Fruit and Vegetable Guidelines?

ERIC Educational Resources Information Center

Stewart, Hayden; Hyman, Jeffrey; Frazao, Elizabeth; Buzby, Jean C.; Carlson, Andrea

2011-01-01

Objective: To estimate the costs of satisfying MyPyramid fruit and vegetable guidelines, with a focus on whether low-income households can bear these costs. Design: Descriptive analysis of the 2008 National Consumer Panel with information on the food purchases of 64,440 households across the contiguous United States was used to analyze the cost of…

United States’ Strategy and Strategic Partnerships - Understanding Others’ Perspective

DTIC Science & Technology

2011-03-16

context that this paper seeks to delineate the way forward, based on a strategic approach that cultivates meaningful partnerships and fosters...delineate the way forward, based on a strategic approach that cultivates meaningful partnerships and fosters unrestrained cooperation among all...region.3 Such awareness would afford adoption of a regional approach that mitigates acrimony and cultivates unrestrained cooperation; amongst the

War and Education in the United States: Racial Ideology and Inequality in Three Historical Episodes

ERIC Educational Resources Information Center

Rury, John L.; Darby, Derrick

2016-01-01

This paper examines the impact of war on African-American education. This question is considered in three different periods: the eras of the American Revolution, the Civil War and the Second World War. Large-scale conflict, such as these instances of total war, can afford historical moments when oppressed groups are able take steps to improve…

Credit Recovery in a Virtual School: Affordances of Online Learning for the At-Risk Student

ERIC Educational Resources Information Center

Oliver, Kevin; Kellogg, Shaun

2015-01-01

This paper summarizes evaluation findings about a high school credit recovery (CR) program as solicited by a statesponsored virtual school in the United States. Student and teacher surveys explained why CR students failed previous instances of face-to-face courses and defined how the online CR model helped these learners overcome both internal…

Pyrogenic carbon emission from a large wildfire in Oregon, United States.

Treesearch

J. Campbell; D. Donato; D. Azuma; B. Law

2007-01-01

We used a ground-based approach to compute the pyrogenic carbon emissions from the Biscuit Fire, an exceptionally large wildfire, which in 2002 burned over 200,000 ha of mixed conifer forest in southwestern Oregon. A combination of federal inventory data and supplementary ground measurements afforded the estimation of preburn densities for 25 separate carbon pools at...

Reforming Social Studies Education in the United States.

ERIC Educational Resources Information Center

Senesh, Lawrence

The efforts to reform the U.S. educational system should focus on the goal of creating a Learning Society. A Learning Society is based upon the commitment to a set of values and to a system of education that affords all members of the community the opportunity to stretch their minds to full capacity from early childhood through adulthood. This…

Housing Resources and Programs for Single Student Parents at Community and Technical Colleges. Fact Sheet #C396

ERIC Educational Resources Information Center

Thorman, Abby; Otto, Jessica; Gunn-Wright, Rhiana

2012-01-01

Parents with dependent children now make up almost one in four students pursuing higher education in the United States (Miller, Gault, and Thorman 2011). Single parents face particular challenges pursuing higher education, including securing safe and affordable housing. Single mothers often must spend over half of their income on housing expenses,…

The ICER Value Framework: Integrating Cost Effectiveness and Affordability in the Assessment of Health Care Value.

PubMed

Pearson, Steven D

2018-03-01

What should be the relationship between the concepts of cost effectiveness and affordability in value assessments for health care interventions? This question has received greater attention in recent years given increasing financial pressures on health systems, leading to different views on how assessment reports and decision-making processes can provide the best structure for considering both elements. In the United States, the advent of explicit value frameworks to guide drug assessments has also focused attention on this issue, driven in part by the prominent inclusion of affordability within the value framework used to guide reports from the Institute for Clinical and Economic Review. After providing a formal definition of affordability for health care systems, this article argues that, even after using empirical estimates of true health system opportunity cost, cost-effectiveness thresholds cannot by themselves be set in a way that subsumes questions about short-term affordability. The article then presents an analysis of different approaches to integrating cost effectiveness and budget impact assessments within information to guide decision making. The evolution and experience with the Institute for Clinical and Economic Review value framework are highlighted, providing lessons learned and guiding principles for future efforts to bring measures of affordability within the scope of value assessment. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Strategic foresight, leadership, and the future of rural healthcare staffing in the United States.

PubMed

Reimers-Hild, Connie

2018-05-01

This article uses a strategic foresight tool, megatrends, to examine forces influencing long-term healthcare staffing in the rural United States. Two megatrends-exponential advances in science and technology and the continued evolution of the decentralized global marketplace-will influence and ultimately help shape the future of rural healthcare. Successful health ecosystems of the future will need to be customer-driven, more affordable, and tech-savvy. Successful evolution in an era of continuous change will require a blend of intentional engagement with stakeholders, strategic foresight, and future-focused leadership. More research is needed to fully understand not only the challenges of rural healthcare but also the emerging opportunities.

Strategic foresight, leadership, and the future of rural healthcare staffing in the United States

PubMed Central

Reimers-Hild, Connie

2018-01-01

ABSTRACT This article uses a strategic foresight tool, megatrends, to examine forces influencing long-term healthcare staffing in the rural United States. Two megatrends—exponential advances in science and technology and the continued evolution of the decentralized global marketplace—will influence and ultimately help shape the future of rural healthcare. Successful health ecosystems of the future will need to be customer-driven, more affordable, and tech-savvy. Successful evolution in an era of continuous change will require a blend of intentional engagement with stakeholders, strategic foresight, and future-focused leadership. More research is needed to fully understand not only the challenges of rural healthcare but also the emerging opportunities. PMID:29642092

The Patient Protection and Affordable Care Act, public health, and the elusive target of human rights.

PubMed

Gable, Lance

2011-01-01

The Patient Protection and Affordable Care Act (ACA) sets in motion a wide range of programs that substantially affected the health system in the United States and signify a moderate but important regulatory shift in the role of the federal government in public health. This article briefly addresses two interesting policy paradoxes about the ACA. First, while the legislation primarily addresses health care financing and insurance and establishes only a few initiatives directly targeting public health, the ACA nevertheless has the potential to produce extensive public health benefits across the United States population by improving access to health care and services and reducing cost. Essentially, the ACA does not take the explicit form of a public health law but instead strives to advance public health indirectly through its effects. Second, while the ACA does not establish a right to health - or even a right to health insurance - in the United States, it does set in motion a number of significant structural and normative changes to United States law that comport with the attainment of the right to health. Most significantly, key provisions of the bill are designed to improve availability, accessibility, acceptability, and quality of conditions necessary for health, and to prompt the government to respect, protect, and fulfill these conditions. These developments mean that, to a degree, the United States essentially has undertaken the same types of legal and policy steps that a country would be required to take to uphold the right to health without actually recognizing the right to health in any formal or legally binding way. Despite these dual paradoxes and the upside potential for public health improvements resulting from the ACA, the public health impact of the law remains uncertain and will be decided by numerous subsequent regulatory and implementation decisions. The ACA authorizes multiple federal agencies to engage in rulemaking, a process that will largely dictate the systemic and health impacts that will become its legacy. This reality opens up ample opportunity to bolster public health aspects and interpretations of the law, and to simultaneously augment the corresponding components of the right to health. © 2011 American Society of Law, Medicine & Ethics, Inc.

Overview of the Common Core State Standard initiative and educational reform movement from the vantage of speech-language pathologists.

PubMed

Staskowski, Maureen

2012-05-01

Educational reform is sweeping the country. The adoption and the implementation of the Common Core State Standards in almost every state are meant to transform education. It is intended to update the way schools educate, the way students learn, and to ultimately prepare the nation's next generation for the global workplace. This article will describe the Common Core State Standard initiative and the underlying concerns about the quality of education in the United States as well as the opportunities this reform initiative affords speech-language pathologists. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The effects of competition on premiums: using United Healthcare's 2015 entry into Affordable Care Act's marketplaces as an instrumental variable.

PubMed

Agirdas, Cagdas; Krebs, Robert J; Yano, Masato

2018-01-08

One goal of the Affordable Care Act is to increase insurance coverage by improving competition and lowering premiums. To facilitate this goal, the federal government enacted online marketplaces in the 395 rating areas spanning 34 states that chose not to establish their own state-run marketplaces. Few multivariate regression studies analyzing the effects of competition on premiums suffer from endogeneity, due to simultaneity and omitted variable biases. However, United Healthcare's decision to enter these marketplaces in 2015 provides the researcher with an opportunity to address this endogeneity problem. Exploiting the variation caused by United Healthcare's entry decision as an instrument for competition, we study the impact of competition on premiums during the first 2 years of these marketplaces. Combining panel data from five different sources and controlling for 12 variables, we find that one more insurer in a rating area leads to a 6.97% reduction in the second-lowest-priced silver plan premium, which is larger than the estimated effects in existing literature. Furthermore, we run a threshold analysis and find that competition's effects on premiums become statistically insignificant if there are four or more insurers in a rating area. These findings are robust to alternative measures of premiums, inclusion of a non-linear term in the regression models and a county-level analysis.

On the Outskirts of National Health Reform: A Comparative Assessment of Health Insurance and Access to Care in Puerto Rico and the United States.

PubMed

Portela, Maria; Sommers, Benjamin D

2015-09-01

Puerto Rico is the United States' largest territory, home to nearly 4 million American citizens, yet it has remained largely on the outskirts of US health policy, including the Affordable Care Act (ACA). We analyzed national survey data from 2011 to 2012 and found that despite its far poorer population, Puerto Rico outperforms the mainland United States on several measures of health care coverage and access to care. While the ACA significantly increases federal resources in Puerto Rico, ongoing federal restrictions on Medicaid funding and premium tax credits in Puerto Rico pose substantial health policy challenges in the territory. Puerto Rico is the United States' largest territory, home to nearly 4 million American citizens. Yet it has remained largely on the outskirts of US health policy, including the Affordable Care Act (ACA). This article presents an overview of Puerto Rico's health care system and a comparative analysis of coverage and access to care in Puerto Rico and the mainland United States. We analyzed 2011-2012 data from the Behavioral Risk Factor Surveillance System, and 2012 data from the American Community Survey and its counterpart, the Puerto Rico Community Survey. Among adults 18 and older, we examined health insurance coverage; access measures, such as having a usual source of care and cost-related delays in care; self-reported health; and the receipt of recommended preventive services, such as cancer screening and glucose testing. We used multivariate regression models to compare Puerto Rico and the mainland United States, adjusted for age, income, race/ethnicity, and other demographic variables. Uninsured rates were significantly lower in Puerto Rico (unadjusted 7.4% versus 15.0%, adjusted difference: -12.0%, p < 0.001). Medicaid was far more common in Puerto Rico. Puerto Rican residents were more likely than those in the mainland United States to have a usual source of care and to have had a checkup within the past year, and fewer experienced cost-related delays in care. Screening rates for diabetes, mammograms, and Pap smears were comparable or better in Puerto Rico, while colonoscopy rates were lower. Self-reported health was slightly worse, but obesity and smoking rates were lower. Despite its far poorer population, Puerto Rico outperforms the mainland United States on several measures of coverage and access. Congressional policies capping federal Medicaid funds to the territory, however, have contributed to major budgetary challenges. While the ACA has significantly increased federal resources in Puerto Rico, ongoing restrictions on Medicaid funding and premium tax credits are posing substantial health policy challenges in the territory. © 2015 Milbank Memorial Fund.

77 FR 72581 - Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-05

... least two multi-State plans (MSPs) on each of the Affordable Insurance Exchanges (Exchanges). Under the... issuers to offer at least two multi-State plans (MSPs) on each of the Exchanges in the 50 States and the... Patient Protection and Affordable Care Act; Establishment of the Multi- State Plan Program for the...

Considering the total cost of electricity from sunlight and the alternatives

DOE PAGES

none,

2015-04-15

Photovoltaic (PV) electricity generation has grown to about 17 GW in the United States, corresponding to one tenth of the global capacity. Most deployment in the country has happened during the last 6 years. Reflecting back, in early 2008 this author and his collaborators James Mason and Ken Zweibel, published in Scientific American and in Energy Policy a Solar Grand Plan demonstrating the feasibility of renewable energy in providing 69% of the United States electricity demand by 2050, while reducing CO2 emissions by 60% from 2005 levels; the PV contribution to this plan was assessed to be 250 GW bymore » 2030 and 2900 GW by 2050 [1]. The DOE's more detailed SunShot vision study, released in 2012, showed the possibility of having 300 GW of PV installed in the United States by 2030, and 630 GW by 2050. Assessing the sustainability of such rapid growth of photovoltaics necessitates undertaking a careful analysis because PV markets largely are enabled by its promise to produce reliable electricity with minimum environmental burdens. Measurable aspects of sustainability include cost, resource availability, and environmental impact. The question of cost concerns the affordability of solar energy compared to other energy sources throughout the world. Environmental impacts include local-, regional-, and global-effects, as well as the usage of land and water, which must be considered in a comparable context over a long time, multigenerational horizon. As a result, the availability of material resources matters to current and future-generations under the constraint of affordability.« less

The carbohydrate-fat problem: can we construct a healthy diet based on dietary guidelines?

PubMed

Drewnowski, Adam

2015-05-01

The inclusion of nutrition economics in dietary guidance would help ensure that the Dietary Guidelines for Americans benefit equally all segments of the US population. The present review outlines some novel metrics of food affordability that assess nutrient density of foods and beverages in relation to cost. Socioeconomic disparities in diet quality in the United States are readily apparent. In general, groups of lower socioeconomic status consume cheaper, lower-quality diets and suffer from higher rates of noncommunicable diseases. Nutrient profiling models, initially developed to assess the nutrient density of foods, can be turned into econometric models that assess both calories and nutrients per reference amount and per unit cost. These novel metrics have been used to identify individual foods that were affordable, palatable, culturally acceptable, and nutrient rich. Not all nutrient-rich foods were expensive. In dietary surveys, both local and national, some high-quality diets were associated with relatively low cost. Those population subgroups that successfully adopted dietary guidelines at an unexpectedly low monetary cost were identified as "positive deviants." Constructing a healthy diet based on dietary guidelines can be done, provided that nutrient density of foods, their affordability, as well as taste and social norms are all taken into account. © 2015 American Society for Nutrition.

Student Veterans' College Experiences: Demographic Comparisons, Differences in Academic Experiences, and On-Campus Service Utilization

ERIC Educational Resources Information Center

Cate, Chris Andrew

2011-01-01

Background: The GI Bill has given United States military veterans the opportunity to afford and enroll in colleges and universities for nearly seventy years. In the Fall of 2009, the Post-9/11 GI Bill started helping a new generation of student veterans pay for their post-secondary education and earn degrees and certificates. The Post-9/11 GI Bill…

CHIP Utilization in South Texas: A Prospective Longitudinal Study of the Children's Health Insurance Program. JSRI Research Report No. 33

ERIC Educational Resources Information Center

Millard, Ann V.; Mier, Nelda; Gabriel, Olga; Flores, Soledad

2004-01-01

The Children's Health Insurance Program (CHIP) began as a federal stopgap measure to assist families whose incomes were too high to qualify for Medicaid, but too low to make health insurance for their children affordable. In 2002, efforts were launched around the United States to recruit eligible children into the program. This pilot study…

Connecting Housing, Transportation & Education to Expand Opportunity: Living, Learning & Moving Together. National Policy Convening Summary

ERIC Educational Resources Information Center

Vincent, Jeff

2015-01-01

In many parts of the United States it is difficult for families, particularly low- or moderate-income families, to be able to afford a suitable home in a transit rich neighborhood with good schools. Neighborhoods with all three elements are exceedingly rare. As a result, people often have to sacrifice one of three elements to make their lives…

Commentary: irrational exuberance for the aging in place of vulnerable low-income older homeowners.

PubMed

Golant, Stephen M

2008-01-01

This commentary argues that one-size-fits-all aging in place solutions will often not be in the best interests of low-income and frail older homeowners in the United States. This contrarian view runs counter to the reported preferences of this group, various private-sector activities, and U.S. public policies that are increasingly funding home and community-based care. The particular focus is on low-income elderly homeowners living in the oldest housing stock in the country who have demographic characteristics putting them at greater risk of having both unmet care and housing needs, which in turn have spillover effects on their neighborhoods. These vulnerable homeowners would be better served if they relocated to more affordable, easier to maintain, and better designed smaller owned units or rental properties or to planned affordable seniors' rental housing complexes that can offer both light and heavy care. Such residential moves are often not feasible, however, because of the shortage of these housing arrangements.

Closing Kynect and Restructuring Medicaid Threaten Kentucky's Health and Economy.

PubMed

Wright, Charles B; Vanderford, Nathan L

2017-08-01

Following passage of the Patient Protection and Affordable Care Act (ACA) in the United States, the Kentucky Health Benefit Exchange, Kynect, began operating in Kentucky in October 2013. Kentucky expanded Medicaid eligibility in January 2014. Together, Kynect and Medicaid expansion provided access to affordable health care coverage to hundreds of thousands of individuals in Kentucky. However, following the Kentucky gubernatorial election in 2015, the newly inaugurated governor moved to dismantle Kynect and restructure the Medicaid expansion, jeopardizing public health gains and the state economy. As the first state to announce both the closure and restructuring of a state health insurance marketplace and Medicaid expansion, Kentucky may serve as a test case for the rest of the nation for reversal of ACA-related health policies. This article describes Kynect and the Kentucky Medicaid expansion and examines the potential short-term and long-term impacts that may occur following changes in state health policy. Furthermore, this article will offer potential strategies to ameliorate the expected negative impacts of disruption of both Kynect and the Medicaid expansion, such as the creation of a new state insurance marketplace under a new governor, the implementation of a private option, and increasing the state minimum wage for workers. Copyright © 2017 by Duke University Press.

Silver bullet or trojan horse? The effects of inclusionary zoning on local housing markets in the United States.

PubMed

Schuetz, Jenny; Meltzer, Rachel; Been, Vicki

2011-01-01

Many local governments are adopting inclusionary zoning (IZ) as a means of producing affordable housing without direct public subsidies. In this paper, panel data on IZ in the San Francisco metropolitan area and suburban Boston are used to analyse how much affordable housing the programmes produce and how IZ affects the prices and production of market-rate housing. The amount of affordable housing produced under IZ has been modest and depends primarily on how long IZ has been in place. Results from suburban Boston suggest that IZ has contributed to increased housing prices and lower rates of production during periods of regional house price appreciation. In the San Francisco area, IZ also appears to increase housing prices in times of regional price appreciation, but to decrease prices during cooler regional markets. There is no evidence of a statistically significant effect of IZ on new housing development in the Bay Area.

The role of individual differences on perceptions of wearable fitness device trust, usability, and motivational impact.

PubMed

Rupp, Michael A; Michaelis, Jessica R; McConnell, Daniel S; Smither, Janan A

2018-07-01

Lack of physical activity is a severe health concern in the United States with fewer than half of all Americans meeting the recommended weekly physical activity guidelines. Although wearable fitness devices can be effective in motivating people to be active, consumers are abandoning this technology soon after purchase. We examined the impact of several user (i.e. personality, age, computer self-efficacy, physical activity level) and device characteristics (trust, usability, and motivational affordances) on the behavioral intentions to use a wearable fitness device. Novice users completed a brief interaction with a fitness device similar to a first purchase experience before completing questionnaires about their interaction. We found computer self-efficacy, physical activity level, as well as personality traits indirectly increased the desire to use a fitness device and influenced the saliency of perceived motivational affordances. Additionally, trust, usability, and perceived motivational affordances were associated with increased intentions to use fitness devices. Copyright © 2018 Elsevier Ltd. All rights reserved.

Disparities and access to healthy food in the United States: A review of food deserts literature.

PubMed

Walker, Renee E; Keane, Christopher R; Burke, Jessica G

2010-09-01

Increasingly, studies are focusing on the role the local food environment plays in residents' ability to purchase affordable, healthy and nutritious foods. In a food desert, an area devoid of a supermarket, access to healthy food is limited. We conducted a systematic review of studies that focused on food access and food desert research in the United States. The 31 studies identified utilized 9 measures to assess food access. Results from these studies can be summarized primarily into four major statements. Findings from other countries offer insight into ways, in which future research, policy development and program implementation in the U.S. may continue to be explored. Copyright 2010 Elsevier Ltd. All rights reserved.

The evolution of comprehensive haemophilia care in the United States: perspectives from the frontline.

PubMed

Aledort, L M

2016-09-01

The establishment of dedicated comprehensive treatment centres more than a half century ago transformed the management of haemophilia in the United States. Formerly, a disease associated with crippling disability and premature death, today, persons with haemophilia who are treated appropriately from infancy and do not develop inhibitors can expect a normal life expectancy and relatively few bleeding episodes. The evolution of the comprehensive haemophilia care, while chastened by the viral epidemics of the 1980s, has been marked by ongoing advances, including prophylaxis, immune tolerance induction, new drugs and gene therapy research. Current challenges include sustaining the comprehensive care model despite decreased funding and expanding the delivery and affordability of comprehensive haemophilia care. © 2016 John Wiley & Sons Ltd.

The Cost of Saving Electricity Through Energy Efficiency Programs Funded by Utility Customers: 2009–2015

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hoffman, Ian M.; Goldman, Charles A.; Murphy, Sean

The average cost to utilities to save a kilowatt-hour (kWh) in the United States is 2.5 cents, according to the most comprehensive assessment to date of the cost performance of energy efficiency programs funded by electricity customers. These costs are similar to those documented earlier. Cost-effective efficiency programs help ensure electricity system reliability at the most affordable cost as part of utility planning and implementation activities for resource adequacy. Building on prior studies, Berkeley Lab analyzed the cost performance of 8,790 electricity efficiency programs between 2009 and 2015 for 116 investor-owned utilities and other program administrators in 41 states. Themore » Berkeley Lab database includes programs representing about three-quarters of total spending on electricity efficiency programs in the United States.« less

Identification and Measurement of U.S. Interests Abroad: A Quantitative Analysis of U. S. Stakes at the Sub-Theater Level and Their Relative Vulnerability to Local Conflicts

DTIC Science & Technology

1974-11-01

net gains from United States imports from a particular area can be approximated by the difference between what we currently pay and what we would...have to pay if the imports were to be bought from the next-best sources."** (Emphasis In the original.) *Department of State, Press Releases...afford to pay the prevailing price for military equipment and services. One would expect therefore that assistance recipients, on the one hand

Evangelical Protestants and the ACA: An Opening for Community-Based Primary Care?

PubMed

Franz, Berkeley; Skinner, Daniel

2016-07-01

Evangelical Protestants make up the largest religious subgroup in the United States, and previous research has shown that Evangelical churches are disproportionately active in community engagement and efforts toward social change. Although Evangelical Protestant perspectives have been considered with regard to persistent socioeconomic stratification and racial discrimination, less focus has been given to how churches interpret poor health outcomes within the United States. In particular, this research addresses how enduring health disparities are understood within the larger discussion of healthcare reform. Due to the similarity of approaches favored by participants in this study and community-based philosophy, a suggestion is made for future health policy dialogue. Although Evangelical Protestants have been most likely to reject all aspects of the Affordable Care Act, in many ways the findings of this study suggest the potential for successful future health policy collaboration. In particular, community-based primary care might appeal to Evangelicals and health professionals in the ongoing effort to improve population health and the quality of healthcare in the United States.

Catholic social teaching: Precepts for healthcare reform

PubMed Central

Condit, Donald P.

2016-01-01

The Patient Protection and Affordable Health Care Act of 2010 accelerated bureaucratic appropriation of health care in the United States. Persuaded by laudable intentions of expanded access to care for millions of uninsured Americans, healthcare cost control, and improved medical quality, supporters are now confronted by the unintended consequences of greater government control of health care. The four primary principles of Catholic social teaching guide a best response to our neighbor's healthcare needs. The presence of these principles in the founding documents of the United States facilitates advocacy the public square. Lay summary: Catholic social teaching presents a Magisterial gift to each generation to help build a just society. The four principles, Human Dignity, Common Good, Solidarity, and Subsidiarity, can guide reform of a healthcare system in crisis. These precepts, clearly present in the United States founding documents, and persuasive in the public square, serve as a foundation upon which to improve the medical care of the sick and injured. PMID:28392586

Plasticity, political economy, and physical growth status of Guatemala Maya children living in the United States.

PubMed

Bogin, B; Loucky, J

1997-01-01

Migration of Maya refugees to the United States since the late 1970s affords the opportunity to study the consequences of life in a new environment on the growth of Maya children. The children of this study live in Indiantown, Florida, and Los Angeles, California. Maya children between 4 and 14 years old (n = 240) were measured for height, weight, fatness, and muscularity. Overall, compared with reference data for the United States, the Maya children are, on average, healthy and well nourished. They are taller and heavier and carry more fat and muscle mass than Maya children living in a village in Guatemala. However, they are shorter, on average, than children of black, Mexican-American, and white ethnicity living in Indiantown. Children of Maya immigrants born in the United States tend to be taller than immigrant children born in Guatemala or Mexico. Families that invest economic and social resources in their children have taller children. More economic successful families have taller children. Migration theory and political economy theory from the social sciences are combined with plasticity theory and life history theory (parental investment) from biology to interpret these data.

Establishment trial of an oak-pine/soybean-corn-wheat alley-cropping system in the upper coastal plain of North Carolina

Treesearch

H.D. Stevenson; D.J. Robison; F.W. Cubbage; J.P. Mueller; M.G. Burton; M.H. Gocke

2013-01-01

Alley cropping may prove useful in the Southeast United States, providing multiple products and income streams, as well as affording sustainable land use alternatives to conventional farming. An alley-cropping system may be a good alternative in agriculture because of the benefits provided by trees to crops and soils, as well as the income generated from wood products...

Report to the Congress on the Strategic Defense Initiative, 1989

DTIC Science & Technology

1989-03-13

veterinarians for its ability to cleanse harmful viruses from bovine semen so it can be used for artificial insemination . This process is also being...pointing out major advances in small, lightweight and affordable components for defensive interceptors; sensor developments for satellites and ground- based...test satellites . The United States view is that the number of designated ABM test satellites in orbit simultaneously shall not exceed a number well

Signaling the End of Deterrence Afforded by Dual Capable Aircraft

DTIC Science & Technology

2017-04-06

INTRODUCTION For more than 60 years, the Unites States and Europe relied on fighter aircraft capable of executing conventional and nuclear strike...missions. Known as dual-capable aircraft (DCA), these fighters were an integral part of the US extended nuclear deterrence strategy in Asia and Europe...force structure, sustainment and modernization by the US and Allied nations allowed tactical nuclear forces to atrophy. Starting in 2010, the US and

Fixing America's College Attainment Problems: It's about More than Affordability. Critical Considerations for Any New Federal-State Partnership

ERIC Educational Resources Information Center

Santos, Jose Luis; Haycock, Kati

2016-01-01

In response to mounting concerns about the cost of college, lawmakers have proposed major new partnerships between the federal government and states to tackle college affordability. The Education Trust maintains that any new federal-state proposal aimed at making college more affordable must also simultaneously address completion problems by…

Onchocerciasis control in Nigeria: will households be able to afford community-directed treatment with ivermectin?

PubMed

Onwujekwe, O; Shu, E; Onwuameze, O; Ndum, C; Okonkwo, P

2001-12-21

To determine the level of affordability of community-directed treatment with ivermectin (CDTI) to households living in two onchocerciasis endemic Nigerian communities namely Toro in the north and Nike in the south. The proportion of the cost of treating people with ivermectin will deplete in average monthly/projected annual household expenditure on food and health care, and on average monthly and projected annual household income were respectively calculated and used to determine the level of affordability of CDTI. Questionnaires administered to heads of households or their representatives were used to collect information on the household expenditures and income. The suggested unit CDTI cost of $0.20 was used. However, as a test of sensitivity, we also used the unit cost of $0.056 which some community based distributors are charging per treatment. Using $0.20 as the unit treatment cost, this will consume less than 0.05% of average annual household income in both communities. It will equally deplete 0.05% of combined annual household expenditures on food and health care in both communities. However, using $0.056 as the unit treatment cost, then 0.02% of average annual household expenditure on health care, 0.01% average annual expenditure on combined health care and food, and 0.01% of average annual household income will be depleted. The households living in both communities may be able to afford CDTI schemes. However, the final decision on levels of affordability lies with the households. They will decide whether they can afford to trade-off some household income for ivermectin distribution.

The Role of Government in Physician Reimbursement.

PubMed

Woerheide, James; Lake, Tim; Rich, Eugene C

2016-01-01

Governments around the world exert a substantial degree of influence over physician reimbursement, but the structure and level of that influence varies greatly. This article defines and analyzes the role of government in physician reimbursement both internationally and in the United States. We create a typology for government involvement in physician reimbursement that divides intervention into either direct control or indirect control. Within those broad categories, we describe more specific forms of involvement including rate setting, operating as a public payer, employing physicians directly, providing a source of market discipline, regulating private insurance, and convening private participants in the market. We apply our framework to the modern healthcare systems of Germany, Sweden, Canada, and the United States, highlighting some of the implications of differences between the systems. Our central finding is that in contrast to other example healthcare systems, the United States system features a complex interplay of federal and state government influence, both direct and indirect, into physician reimbursement. We conclude the article by examining the ways in which recent legislation including the Affordable Care Act and the Medicare Access and CHIP Reauthorization Act would likely change the role of government in physician reimbursement in the United States. Copyright © 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

Cancer insurance policies in Japan and the United States.

PubMed Central

Bennett, C L; Weinberg, P D; Lieberman, J J

1998-01-01

Cancer care in the United States often results in financial hardship for patients and their families. Standard health insurance covers most medical costs, but nonmedical costs (such as lost wages, deductibles, copayments, and travel to and from caregivers) are paid out of pocket. Over the course of treatment, these costs can become substantial. Insurance companies have addressed the burden of these out-of-pocket costs by offering supplemental cancer insurance policies that, upon diagnosis of cancer, pay cash benefits for items that usually require out-of-pocket expenditures and are distinct from reimbursements made by traditional health insurance. Limitations associated with managed care have fostered increased consumer awareness and interest in the United States for cancer insurance and its ability to defray treatment expenditures that usually require out-of-pocket payments. Marketing campaigns are becoming more aggressive, and the number of cancer insurance policies sold has been steadily rising. While cancer insurance is only recently gaining popularity in the United States, it has been a successful product in Japan for over twenty years. In Japan, approximately one-quarter of the population own cancer insurance, and ten-year retention rates are estimated at 75%. As a result, individuals are afforded good access to nonmedical cancer services. Understanding the factors that led to the success of cancer insurance in Japan may assist policymakers in evaluating cancer insurance policies as they become more prevalent in the United States. PMID:9448483

Cancer insurance policies in Japan and the United States.

PubMed

Bennett, C L; Weinberg, P D; Lieberman, J J

1998-01-01

Cancer care in the United States often results in financial hardship for patients and their families. Standard health insurance covers most medical costs, but nonmedical costs (such as lost wages, deductibles, copayments, and travel to and from caregivers) are paid out of pocket. Over the course of treatment, these costs can become substantial. Insurance companies have addressed the burden of these out-of-pocket costs by offering supplemental cancer insurance policies that, upon diagnosis of cancer, pay cash benefits for items that usually require out-of-pocket expenditures and are distinct from reimbursements made by traditional health insurance. Limitations associated with managed care have fostered increased consumer awareness and interest in the United States for cancer insurance and its ability to defray treatment expenditures that usually require out-of-pocket payments. Marketing campaigns are becoming more aggressive, and the number of cancer insurance policies sold has been steadily rising. While cancer insurance is only recently gaining popularity in the United States, it has been a successful product in Japan for over twenty years. In Japan, approximately one-quarter of the population own cancer insurance, and ten-year retention rates are estimated at 75%. As a result, individuals are afforded good access to nonmedical cancer services. Understanding the factors that led to the success of cancer insurance in Japan may assist policymakers in evaluating cancer insurance policies as they become more prevalent in the United States.

Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States.

PubMed

Courtemanche, Charles; Marton, James; Ukert, Benjamin; Yelowitz, Aaron; Zapata, Daniela

2017-01-01

The Affordable Care Act (ACA) aimed to achieve nearly universal health insurance coverage in the United States through a combination of insurance market reforms, mandates, subsidies, health insurance exchanges, and Medicaid expansions, most of which took effect in 2014. This paper estimates the causal effects of the ACA on health insurance coverage in 2014 using data from the American Community Survey. We utilize difference-in-difference-in-differences models that exploit cross-sectional variation in the intensity of treatment arising from state participation in the Medicaid expansion and local area pre-ACA uninsured rates. This strategy allows us to identify the effects of the ACA in both Medicaid expansion and non-expansion states. Our preferred specification suggests that, at the average pre-treatment uninsured rate, the full ACA increased the proportion of residents with insurance by 5.9 percentage points compared to 2.8 percentage points in states that did not expand Medicaid. Private insurance expansions from the ACA were due to increases in both employer-provided and non-group coverage. The coverage gains from the full ACA were largest for those without a college degree, non-whites, young adults, unmarried individuals, and those without children in the home. We find no evidence that the Medicaid expansion crowded out private coverage.

Whistleblowing in the pharmaceutical industry in the United States, England, Canada, and Australia.

PubMed

Boumil, Sylvester James; Nariani, Ashiyana; Boumil, Marcia M; Berman, Harris A

2010-04-01

Fraud and abuse in the spending of public monies plague governments around the world. In the United States the False Claims Act encourages whistleblowing by private individuals to expose evidence of fraud. They are rewarded for their efforts with monetary compensation and protection from retaliation. Such is not the case in Canada, England, and Australia. Although some recent legislation has increased the protections afforded to whistleblowers, they are still likely to be viewed more as disloyal employees than courageous public servants, and there is little incentive to risk their jobs and reputation. Qui tam laws provide a police force of thousands in the effort to reduce rampant fraud, waste, and abuse, and would be an asset in any health-care system where pubic health policy requires conservation of resources.

Let's Get Real About Health Care Reform.

PubMed

Karpf, Michael

2017-09-01

In light of the ongoing debate about health care policy in the United States, including efforts to repeal and replace the Affordable Care Act, it will be critically important for the academic community to engage in the dialogue. Developing a viable approach to health care reform requires an understanding of the interaction and interdependence between choice, cost, and coverage in a competitive and functional market-based system. Some institutions have implemented models that indicate the feasibility of providing high-quality, efficient patient care while working within fixed budgets. The academic community must stay engaged in these conversations because of its moral commitment to equitable access to health care for all. Academic medical centers will also have to define and protect their roles in an evolving health care delivery system in the United States.

Improving Quality and Child Outcomes in Early Childhood Education by Redefining the Role Afforded to Teachers in Professional Development: A Continuous Quality Improvement Learning Collaborative among Public Preschools in Chile

ERIC Educational Resources Information Center

Arbour, MaryCatherine; Yoshikawa, Hirokazu; Atwood, Sid; Duran Mellado, Francis Romina; Godoy Ossa, Felipe; Trevino Villareal, Ernesto; Snow, Catherine E.

2016-01-01

Based on evidence derived from studies conducted mostly in the United States, many low- and middle-income countries are investing in early childhood education (ECE), with high expectations that it will improve academic outcomes, increase human capital, promote economic growth and reduce economic inequality. In Chile, there has been a great…

History of Significant Vehicle and Fuel Introductions in the United States

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shirk, Matthew; Alleman, Teresa; Melendez, Margo

This is one of a series of reports produced as a result of the Co-Optimization of Fuels & Engines (Co-Optima) project, a Department of Energy (DOE)-sponsored multi-agency project initiated to accelerate the introduction of affordable, scalable, and sustainable biofuels and high-efficiency, low-emission vehicle engines. The simultaneous fuels and vehicles research and development is designed to deliver maximum energy savings, emissions reduction, and on-road performance.

The Effectiveness of a Cohort Model as a Predictor of Grade Point Average and Graduation Status of Pre-Health Sciences Students in a Public Community College

ERIC Educational Resources Information Center

Brandon, Elvis Nash

2017-01-01

There is a college completion crisis in the United States. In today's competitive job market, health sciences students cannot afford to fail in their educational attainment. The purpose of this study was to determine if participation in the cohort model is a predictor of the success of public community college pre-health sciences students.…

A Qualitative Study of Affordability: Virginia and San Antonio Class Programs

DTIC Science & Technology

2014-06-01

that actual costs and operational tempos resemble original assumptions is the most uncertain aspect of sustainment costs. Operators must respond to a...SSN 774 through SSN 787; this represents 47% of the total inventory, a typical variation for ships from the acquisition standard of 10%. Even... Goldberg , M., … MacKinnon, M. (1994). The U.S. submarine production base (MR-456-OSD). Santa Monica, CA: RAND. Blickstein, I. United States. Department

What should health insurance cover? A comparison of Israeli and US approaches to benefit design under national health reform.

PubMed

Nissanholtz Gannot, Rachel; Chinitz, David P; Rosenbaum, Sara

2018-04-01

What health insurance should cover and pay for represents one of the most complex questions in national health policy. Israel shares with the US reliance on a regulated insurance market and we compare the approaches of the two countries regarding determining health benefits. Based on review and analysis of literature, laws and policy in the United States and Israel. The Israeli experience consists of selection of a starting point for defining coverage; calculating the expected cost of covered benefits; and creating a mechanism for updating covered benefits within a defined budget. In implementing the Affordable Care Act, the US rejected a comprehensive and detailed approach to essential health benefits. Instead, federal regulators established broadly worded minimum standards that can be supplemented through more stringent state laws and insurer discretion. Notwithstanding differences between the two systems, the elements of the Israeli approach to coverage, which has stood the test of time, may provide a basis for the United States as it renews its health reform debate and considers delegating decisions about coverage to the states. Israel can learn to emulate the more forceful regulation of supplemental and private insurance that characterizes health policy in the United States.

Dialysis for undocumented immigrants in the United States.

PubMed

Rodriguez, Rudolph A

2015-01-01

The United States offers near-universal coverage for treatment of ESRD. Undocumented immigrants with ESRD are the only subset of patients not covered under a national strategy. There are 2 divergent dialysis treatment strategies offered to undocumented immigrants in the United States, emergent dialysis and chronic outpatient dialysis. Emergent dialysis, offering dialysis only when urgent indications exist, is the treatment strategy in certain states. Differing interpretations of Emergency Medicaid statute by the courts and state and federal government have resulted in the geographic disparity in treatment strategies for undocumented immigrants with ESRD. The Patient Protection and Affordable Care Act of 2010 ignored the health care of undocumented immigrants and will not provide relief to undocumented patients with catastrophic illness like ESRD, cancer, or traumatic brain injuries. The difficult patient and provider decisions are explored in this review. The Renal Physicians Association Position Statement on uncompensated renal-related care for noncitizens is an excellent starting point for a framework to address this ethical dilemma. The practice of "emergent dialysis" will hopefully be found unacceptable in the future because of the fact that it is not cost effective, ethical, or humane. Published by Elsevier Inc.

Patient Protection and Affordable Care Act; establishment of the multi-state plan program for the Affordable Insurance Exchanges.

PubMed

2013-03-11

The U.S. Office of Personnel Management (OPM) is issuing a final regulation establishing the Multi-State Plan Program (MSPP) pursuant to the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. Through contracts with OPM, health insurance issuers will offer at least two multi-State plans (MSPs) on each of the Affordable Insurance Exchanges (Exchanges). One of the issuers must be non-profit. Under the law, an MSPP issuer may phase in the States in which it offers coverage over 4 years, but it must offer MSPs on Exchanges in all States and the District of Columbia by the fourth year in which the MSPP issuer participates in the MSPP. This rule aims to balance adhering to the statutory goals of MSPP while aligning its standards to those applying to qualified health plans to promote a level playing field across health plans.

Specialty Care Access in the Safety Net-the Role of Public Hospitals and Health Systems.

PubMed

Makaroun, Lena K; Bowman, Chelsea; Duan, Kevin; Handley, Nathan; Wheeler, Daniel J; Pierluissi, Edgar; Chen, Alice Hm

2017-01-01

Access to specialty care in the United States safety net, already strained, is fac-ing increasing pressure with an influx of patients following the passage of the Affordable Care Act (ACA). We surveyed 18 public hospitals and health systems across the country to describe the current state of specialty care delivery in safety-net systems. We elicited information regarding challenges, provider models, metrics of access and productivity, and strategies for improving access. Based on our findings, we propose a framework for assessing and improving specialty care access with a focus on population health planning.

To require the Secretary of the Interior to assemble a team of technical, policy, and financial experts to address the energy needs of the insular areas of the United States and the Freely Associated States through the development of energy action plans aimed at promoting access to affordable, reliable energy, including increasing use of indigenous clean-energy resources, and for other purposes.

THOMAS, 113th Congress

Rep. Christensen, Donna M. [D-VI-At Large

2014-12-08

Senate - 12/12/2014 Received in the Senate. (All Actions) Notes: For further action, see H.R.83, which became Public Law 113-235 on 12/16/2014. Tracker: This bill has the status Passed HouseHere are the steps for Status of Legislation:

The trials of Hanna Porn: the campaign to abolish midwifery in Massachusetts.

PubMed

Declercq, E R

1994-06-01

The case of Hanna Porn affords an opportunity to examine how the laws that led to the abolition of midwifery in Massachusetts evolved and were applied to the midwife whose case set the state legal precedent. Mrs Porn served primarily a Finnish-Swedish clientele of wives of laborers. The outcomes of the births she attended appear to have been positive, and she maintained a neonatal mortality rate of less than half that of local physicians. She also repeatedly defied court orders to stop practicing. Her case exemplifies the efforts that occurred nationally to abolish midwifery in the United States.

Constraining National Health Care Expenditures. Achieving Quality Care at an Affordable Cost.

DTIC Science & Technology

1985-09-30

Medicaid (federal/state) 10.8 Other state/local government programs 5.1 Other federal programs 5.4 Philanthropy and industrial in-plant 1.2 .- Source: U.S...expenditures. Projections of future outlays and income for the Medicare Trust Fund indicate serious financing problems by the . mid to late 1990’s. The...7.1 0 France 6.4 7.9 23 West Germany 6.4 9.2 44 Italy 6 .1a 6.4 5 Netherlands 6.3 8.2 30 Sweden 7.4 9.8 32 Switzerland n/a 6.9 United Kingdom 4.3 5.2

Developing an agenda for research about policies to improve access to healthy foods in rural communities: a concept mapping study

PubMed Central

2014-01-01

Background Policies that improve access to healthy, affordable foods may improve population health and reduce health disparities. In the United States most food access policy research focuses on urban communities even though residents of rural communities face disproportionately higher risk for nutrition-related chronic diseases compared to residents of urban communities. The purpose of this study was to (1) identify the factors associated with access to healthy, affordable food in rural communities in the United States; and (2) prioritize a meaningful and feasible rural food policy research agenda. Methods This study was conducted by the Rural Food Access Workgroup (RFAWG), a workgroup facilitated by the Nutrition and Obesity Policy Research and Evaluation Network. A national sample of academic and non-academic researchers, public health and cooperative extension practitioners, and other experts who focus on rural food access and economic development was invited to complete a concept mapping process that included brainstorming the factors that are associated with rural food access, sorting and organizing the factors into similar domains, and rating the importance of policies and research to address these factors. As a last step, RFAWG members convened to interpret the data and establish research recommendations. Results Seventy-five participants in the brainstorming exercise represented the following sectors: non-extension research (n = 27), non-extension program administration (n = 18), “other” (n = 14), policy advocacy (n = 10), and cooperative extension service (n = 6). The brainstorming exercise generated 90 distinct statements about factors associated with rural food access in the United States; these were sorted into 5 clusters. Go Zones were established for the factors that were rated highly as both a priority policy target and a priority for research. The highest ranked policy and research priorities include strategies designed to build economic viability in rural communities, improve access to federal food and nutrition assistance programs, improve food retail systems, and increase the personal food production capacity of rural residents. Respondents also prioritized the development of valid and reliable research methodologies to measure variables associated with rural food access. Conclusions This collaborative, trans-disciplinary, participatory process, created a map to guide and prioritize research about polices to improve healthy, affordable food access in rural communities. PMID:24919425

Developing an agenda for research about policies to improve access to healthy foods in rural communities: a concept mapping study.

PubMed

Johnson, Donna B; Quinn, Emilee; Sitaker, Marilyn; Ammerman, Alice; Byker, Carmen; Dean, Wesley; Fleischhacker, Sheila; Kolodinsky, Jane; Pinard, Courtney; Pitts, Stephanie B Jilcott; Sharkey, Joseph

2014-06-12

Policies that improve access to healthy, affordable foods may improve population health and reduce health disparities. In the United States most food access policy research focuses on urban communities even though residents of rural communities face disproportionately higher risk for nutrition-related chronic diseases compared to residents of urban communities. The purpose of this study was to (1) identify the factors associated with access to healthy, affordable food in rural communities in the United States; and (2) prioritize a meaningful and feasible rural food policy research agenda. This study was conducted by the Rural Food Access Workgroup (RFAWG), a workgroup facilitated by the Nutrition and Obesity Policy Research and Evaluation Network. A national sample of academic and non-academic researchers, public health and cooperative extension practitioners, and other experts who focus on rural food access and economic development was invited to complete a concept mapping process that included brainstorming the factors that are associated with rural food access, sorting and organizing the factors into similar domains, and rating the importance of policies and research to address these factors. As a last step, RFAWG members convened to interpret the data and establish research recommendations. Seventy-five participants in the brainstorming exercise represented the following sectors: non-extension research (n = 27), non-extension program administration (n = 18), "other" (n = 14), policy advocacy (n = 10), and cooperative extension service (n = 6). The brainstorming exercise generated 90 distinct statements about factors associated with rural food access in the United States; these were sorted into 5 clusters. Go Zones were established for the factors that were rated highly as both a priority policy target and a priority for research. The highest ranked policy and research priorities include strategies designed to build economic viability in rural communities, improve access to federal food and nutrition assistance programs, improve food retail systems, and increase the personal food production capacity of rural residents. Respondents also prioritized the development of valid and reliable research methodologies to measure variables associated with rural food access. This collaborative, trans-disciplinary, participatory process, created a map to guide and prioritize research about polices to improve healthy, affordable food access in rural communities.

Going off the dole: a prudential and ethical critique of the healthfare state.

PubMed

Spicker, S F

1993-06-01

The present 'healthfare' state in the United States is neither practically nor morally justified. The nation currently fails to provide adequate access to health care for tens of millions of uninsured citizens. To suggest that the United States' half-million physicians should provide their care as charity is an inadequate solution. The transfer of assets from the 'haves' to the 'have-nots' through taxation in a 'healthfare state' undermines human compassion, and fails to respect minimal moral requirements. However, alternative strategies are possible. During the next 20 years health care could come to be financed on the basis of sound quasi-libertarian moral and prudential principles. In the interim deliberate political action is required to achieve novel health policy, available and affordable job and career training, and universal employment. It is possible to achieve universal access to adequate health care while sustaining individual choice, and at the same time to reduce or virtually eliminate taxpayer-subsidized health care. This approach would, in time, eliminate the healthfare state and eventually encourage and even require citizens to go off the healthfare dole.

Twitter Sentiment Predicts Affordable Care Act Marketplace Enrollment

PubMed Central

Sap, Maarten; Schwartz, Andrew; Town, Robert; Baker, Tom; Ungar, Lyle; Merchant, Raina M

2015-01-01

Background Traditional metrics of the impact of the Affordable Care Act (ACA) and health insurance marketplaces in the United States include public opinion polls and marketplace enrollment, which are published with a lag of weeks to months. In this rapidly changing environment, a real-time barometer of public opinion with a mechanism to identify emerging issues would be valuable. Objective We sought to evaluate Twitter’s role as a real-time barometer of public sentiment on the ACA and to determine if Twitter sentiment (the positivity or negativity of tweets) could be predictive of state-level marketplace enrollment. Methods We retrospectively collected 977,303 ACA-related tweets in March 2014 and then tested a correlation of Twitter sentiment with marketplace enrollment by state. Results A 0.10 increase in the sentiment score was associated with an 8.7% increase in enrollment at the state level (95% CI 1.32-16.13; P=.02), a correlation that remained significant when adjusting for state Medicaid expansion (P=.02) or use of a state-based marketplace (P=.03). Conclusions This correlation indicates Twitter’s potential as a real-time monitoring strategy for future marketplace enrollment periods; marketplaces could systematically track Twitter sentiment to more rapidly identify enrollment changes and potentially emerging issues. As a repository of free and accessible consumer-generated opinions, this study reveals a novel role for Twitter in the health policy landscape. PMID:25707038

The United States Leads Other Nations In Differences By Income In Perceptions Of Health And Health Care.

PubMed

Hero, Joachim O; Zaslavsky, Alan M; Blendon, Robert J

2017-06-01

We examined income gaps in the period 2011-13 in self-assessments of personal health and health care across thirty-two middle- and high-income countries. While high-income respondents were generally more positive about their health and health care in most countries, the gap between them and low-income respondents was much bigger in some than in others. The United States has among the largest income-related differences in each of the measures we studied, which assessed both respondents' past experiences and their confidence about accessing needed health care in the future. Relatively low levels of moral discomfort over income-based health care disparities despite broad awareness of unmet need indicate more public tolerance for health care inequalities in the United States than elsewhere. Nonetheless, over half of Americans felt that income-based health care inequalities are unfair, and these respondents were significantly more likely than their compatriots to support major health system reform-differences that reflect the country's political divisions. Given the many provisions in the Affordable Care Act that seek to reduce disparities, any replacement would also require attention to disparities or risk taking a step backward in an area where the United States is in sore need of improvement. Project HOPE—The People-to-People Health Foundation, Inc.

Relative Affordability of Health Insurance Premiums under CHIP Expansion Programs and the ACA.

PubMed

Gresenz, Carole Roan; Laugesen, Miriam J; Yesus, Ambeshie; Escarce, José J

2011-10-01

Affordability is integral to the success of health care reforms aimed at ensuring universal access to health insurance coverage, and affordability determinations have major policy and practical consequences. This article describes factors that influenced the determination of affordability benchmarks and premium-contribution requirements for Children's Health Insurance Program (CHIP) expansions in three states that sought to universalize access to coverage for youth. It also compares subsidy levels developed in these states to the premium subsidy schedule under the Affordable Care Act (ACA) for health insurance plans purchased through an exchange. We find sizeable variability in premium-contribution requirements for children's coverage as a percentage of family income across the three states and in the progressivity and regressivity of the premium-contribution schedules developed. These findings underscore the ambiguity and subjectivity of affordability standards. Further, our analyses suggest that while the ACA increases the affordability of family coverage for families with incomes below 400 percent of the federal poverty level, the evolution of CHIP over the next five to ten years will continue to have significant implications for low-income families.

The Fluidic Metaphor: A View into the Nature and Future of War

DTIC Science & Technology

2008-01-01

United States Marine Corps School of Advanced Warfighting Marine Corps University 2076 South Street Marine Corps Combat Command Development ...internal environment.14 It is this definition and concept of war that serves as the basis for development of the fluidic metaphor. Side 1 Side 2 D I M...some technological or doctrinal development has given one side a distinct if not decisive advantage in the next war. The advantage afforded by an RMA

Wind Power Technologies FY 2017 Budget At-A-Glance

DOE Office of Scientific and Technical Information (OSTI.GOV)

None, None

2016-03-01

The Wind Program accelerates U.S. deployment of clean, affordable, and reliable domestic wind power through research, development, and demonstration activities. These advanced technology investments directly contribute to the goals for the United States to generate 80% of the nation’s electricity from clean, carbon-free energy sources by 2035; reduce carbon emissions 26%-28% below 2005 levels by 2025; and reduce carbon emissions 80% by 2050 by reducing costs and increasing performance of wind energy systems.

Financial Crisis; Department of Defense Spending: How to Control Fraud, Waste, and Abuse in the Military

DTIC Science & Technology

2012-04-25

problem that continues to cost billions of dollars in losses at a time when the United States Military and Federal Government can least afford it. It...to look like. The federal budget has become the leading issue affecting every Government Agency. The military’s budget is decreasing by more than...discuss the cost savings measures and initiatives currently being debated in Washington, and offer, for debate, several new recommendations that have

The problem of choice: From the voluntary way to Affordable Care Act health insurance exchanges.

PubMed

Mulligan, Jessica

2017-05-01

This article takes a genealogical and ethnographic approach to the problem of choice, arguing that what choice means has been reworked several times since health insurance first figured prominently in national debates about health reform. Whereas voluntary choice of doctor and hospital used to be framed as an American right, contemporary choice rhetoric includes consumer choice of insurance plan. Understanding who has deployed choice rhetoric and to what ends helps explain how offering choices has become the common sense justification for defending and preserving the exclusionary health care system in the United States. Four case studies derived from 180 enrollment observations at the Rhode Island health insurance exchange conducted from March 2014-January 2017 and interviews with enrollees show how choice is experienced in this latest iteration of health reform. The Affordable Care Act (ACA) of 2010 created new pathways to insurance coverage in the United States. Insurance exchanges were supposed to unleash the power of consumer decision-making through marketplaces where health plans compete on quality, coverage, and price. Consumers, however, contended with confusing insurance terminology and difficult to navigate websites. The ethnography shows that consumers experienced choice as confusing and overwhelming and did not feel "in charge" of their decisions. Instead, unstable employment, changes in income, existing health needs, and bureaucratic barriers shaped their "choices." Copyright © 2017 Elsevier Ltd. All rights reserved.

The Affordable Care Act, Accountable Care Organizations, and Mental Health Care for Older Adults: Implications and Opportunities.

PubMed

Bartels, Stephen J; Gill, Lydia; Naslund, John A

2015-01-01

The Patient Protection and Affordable Care Act (ACA) represents the most significant legislative change in the United States health care system in nearly half a century. Key elements of the ACA include reforms aimed at addressing high-cost, complex, vulnerable patient populations. Older adults with mental health disorders are a rapidly growing segment of the population and are among the most challenging subgroups within health care, and they account for a disproportionate amount of costs. What does the ACA mean for geriatric mental health? We address this question by highlighting opportunities for reaching older adults with mental health disorders by leveraging the diverse elements of the ACA. We describe nine relevant initiatives: (1) accountable care organizations, (2) patient-centered medical homes, (3) Medicaid-financed specialty health homes, (4) hospital readmission and health care transitions initiatives, (5) Medicare annual wellness visit, (6) quality standards and associated incentives, (7) support for health information technology and telehealth, (8) Independence at Home and 1915(i) State Plan Home and Community-Based Services program, and (9) Medicare-Medicaid Coordination Office, Center for Medicare and Medicaid Innovation, and the Patient-Centered Outcomes Research Institute. We also consider potential challenges to full implementation of the ACA and discuss novel solutions for advancing geriatric mental health in the context of projected workforce shortages and the opportunities afforded by the ACA.

The Affordable Care Act, Accountable Care Organizations, and Mental Health Care for Older Adults: Implications and Opportunities

PubMed Central

Bartels, Stephen J.; Gill, Lydia; Naslund, John A.

2015-01-01

Abstract The Patient Protection and Affordable Care Act (ACA) represents the most significant legislative change in the United States health care system in nearly half a century. Key elements of the ACA include reforms aimed at addressing high-cost, complex, vulnerable patient populations. Older adults with mental health disorders are a rapidly growing segment of the population and are among the most challenging subgroups within health care, and they account for a disproportionate amount of costs. What does the ACA mean for geriatric mental health? We address this question by highlighting opportunities for reaching older adults with mental health disorders by leveraging the diverse elements of the ACA. We describe nine relevant initiatives: (1) accountable care organizations, (2) patient-centered medical homes, (3) Medicaid-financed specialty health homes, (4) hospital readmission and health care transitions initiatives, (5) Medicare annual wellness visit, (6) quality standards and associated incentives, (7) support for health information technology and telehealth, (8) Independence at Home and 1915(i) State Plan Home and Community-Based Services program, and (9) Medicare-Medicaid Coordination Office, Center for Medicare and Medicaid Innovation, and the Patient-Centered Outcomes Research Institute. We also consider potential challenges to full implementation of the ACA and discuss novel solutions for advancing geriatric mental health in the context of projected workforce shortages and the opportunities afforded by the ACA. PMID:25811340

The Affordable Care Act: new opportunities for cardiac rehabilitation in the workplace?

PubMed

Pinkstaff, Sherry O; Arena, Ross; Myers, Jonathan; Kaminsky, Leonard; Briggs, Paige; Forman, Daniel E; Patel, Mahesh J; Cahalin, Lawrence P

2014-08-01

Many people affected by cardiovascular disease (CVD) are working age. Employers bear a large percentage of the costs associated with CVD. Employers pay 80 times more in diagnosis and treatment than in prevention, although there is evidence that 50% to 70% of all diseases are associated with preventable health risks. As a result, the worksite is an appealing location to deliver health care.Cardiac rehabilitation has developed a track record of delivering improved outcomes for patients with CVD. Partnerships between cardiac rehabilitation providers and worksite health programs have the potential to improve referral and participation rates of employees with CVD. The current era of health reform in the United States that has been stimulated by the Affordable Care Act provides an ideal opportunity to reconsider worksite health programs as an essential partner in the health care team.

Perylene bisimide hydrogels and lyotropic liquid crystals with temperature-responsive color change.

PubMed

Görl, Daniel; Soberats, Bartolome; Herbst, Stefanie; Stepanenko, Vladimir; Würthner, Frank

2016-11-01

The self-assembly of perylene bisimide (PBI) dyes bearing oligo ethylene glycol (OEG) units in water affords responsive functional nanostructures characterized by their lower critical solution temperature (LCST). Tuning of the LCST is realized by a supramolecular approach that relies on two structurally closely related PBI-OEG molecules. The two PBIs socially co-assemble in water and the resulting nanostructures exhibit a single LCST in between the transition temperatures of the aggregates formed by single components. This permits to precisely tune the transition from a hydrogel to a lyotropic liquid crystal state at temperatures between 26 and 51 °C by adjusting the molar fraction of the two PBIs. Owing to concomitant changes in PBI-PBI interactions this phase transition affords a pronounced color change with "fluorescence-on" response that can be utilized as a smart temperature sensory system.

International examples of undocumented immigration and the affordable care act.

PubMed

Stutz, Matthew; Baig, Arshiya

2014-08-01

As it stands there is no viable health care option for undocumented immigrants of low socioeconomic status. Even more worrisome is that Affordable Care Act simply does not address this issue with any direct plan. The US is in a very influential time period in terms of undocumented immigration and its relationship with health care. The purpose of this paper is to examine international examples of undocumented immigrant health care and their implications for the United States' undocumented immigrant health care. This study found that physicians in the US must work to prevent the initiation of policies which exclude undocumented immigrants from accessing health care. Exclusionary policies implemented in European nations have had disastrous effects on physicians and patients. This paper examines the implications which similar policies would have if implemented in the US.

Treatment for Substance Use Disorder: Opportunities and Challenges under the Affordable Care Act

PubMed Central

Tai, Betty; Volkow, Nora D.

2016-01-01

Addiction is a chronic brain disease with consequences that remain problematic years after discontinuation of use. Despite this, treatment models focus on acute interventions and are carved out from the main health care system. The Patient Protection and Affordable Care Act (2010) brings the opportunity to change the way substance use disorder (SUD) is treated in the United States. The treatment of SUD must adapt to a chronic care model offered in an integrated care system that screens for at-risk patients and includes services needed to prevent relapses. The partnering of the health care system with substance abuse treatment programs could dramatically expand the benefits of prevention and treatment of SUD. Expanding roles of health information technology and nonphysician workforces, such as social workers, are essential to the success of a chronic care model. PMID:23731411

Advancing Understanding of Affordability in Washington State: An Interactive Model Exploring Student Higher Education Financing

ERIC Educational Resources Information Center

Fridley, James L.; Sharpe, Rachelle E.

2016-01-01

Higher education affordability is a complex concept that reflects resources available from multiple parties, the remaining cost of education, and the ability of students and families to pay the balance. States play a key role in determining the affordability of higher education for students attending public institutions. Yet decisions are made…

Affordance Realization in Climbing: Learning and Transfer.

PubMed

Seifert, Ludovic; Orth, Dominic; Mantel, Bruno; Boulanger, Jérémie; Hérault, Romain; Dicks, Matt

2018-01-01

The aim of this study was to investigate how the affordances of an indoor climbing wall changed for intermediate climbers following a period of practice during which hold orientation was manipulated within a learning and transfer protocol. The learning protocol consisted of four sessions, in which eight climbers randomly ascended three different routes of fixed absolute difficulty (5c on the French scale), as fluently as possible. All three routes were 10.3 m in height and composed of 20 hand-holds at the same locations on an artificial climbing wall; only hold orientations were altered: (i) a horizontal-edge route (H) was designed to afford horizontal hold grasping, (ii) a vertical-edge route (V) afforded vertical hold grasping, and (iii), a double-edge route (D) was designed to afford both horizontal and vertical hold grasping. Five inertial measurement units (IMU) (3D accelerometer, 3D gyroscope, 3D magnetometer) were attached to the hip, feet and forearms to analyze the vertical acceleration and direction (3D unitary vector) of each limb and hip in ambient space during the entire ascent. Segmentation and classification processes supported detection of movement and stationary phases for each IMU. Depending on whether limbs and/or hip were moving, a decision tree distinguished four states of behavior: stationary (absence of limb and hip motion), hold exploration (absence of hip motion but at least one limb in motion), hip movement (hip in motion but absence of limb motion) and global motion (hip in motion and at least one limb in motion). Results showed that with practice, the learners decreased the relative duration of hold exploration, suggesting that they improved affordance perception of hold grasp-ability. The number of performatory movements also decreased as performance increased during learning sessions, confirming that participants' climbing efficacy improved as a function of practice. Last, the results were more marked for the H route, while the D route led to longer relative stationary duration and a shorter relative duration of performatory states. Together, these findings emphasized the benefit of manipulating task constraints to promote safe exploration during learning, which is particularly relevant in extreme sports involving climbing tasks.

Healthcare: affordable quality coverage for all.

PubMed

Lee, Keat Jin

2009-06-01

The quality of medical care available in the United States is the best in the world. However, today's American healthcare delivery system is unacceptable. It is too expensive, disjointed, and wasteful. The amount spent on healthcare in the United States is sufficient to meet everyone's needs; the reason it does not is that the money is misspent. Healthcare makes up 16 percent of the gross domestic product, or $2.3 trillion, yet 46 million people are uninsured, the majority of people are underinsured, and even those with insurance suffer significant hassles in receiving healthcare. Medical errors occur at alarming rates. The lack of quality measures to define best practices leads to a wide variation of practices and costs. Fragmented healthcare leads to errors. The goal of this paper is to explore a set of 20 comprehensive steps to begin reform of healthcare in this country.

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

Frost-protected shallow foundations (FPSFs) offer a proven technology designed to substantially lower construction costs in colder climates, enhancing housing affordability for families in many parts of the United States. This document provides step-by-step procedures to assist building professionals in designing and laying a slab- on-grade FPSF. FPSFs save money over conventional designs by requiring less excavation to construct a frost-proof foundation. It is specially insulated along its perimeter to raise the temperature of the surrounding ground and decrease frost penetration, thus allowing for the construction of a substantially shallower foundation. The FPSF is considered standard practice for homes in Scandinavia,more » where 40 years of field testing has proven it to be economical to construct, durable, and energy efficient. HUD strongly encourages wide spread adoption of FPSF technology in the United States and its incorporation into major model building codes.« less

Patient Protection and Affordable Care Act; establishment of the Multi-State Plan Program for the Affordable Insurance Exchanges. Final rule.

PubMed

2014-02-24

The U.S. Office of Personnel Management (OPM) is issuing a final rule implementing modifications to the Multi-State Plan (MSP) Program based on the experience of the Program to date. OPM established the MSP Program pursuant to the Affordable Care Act. This rule clarifies the approach used to enforce the applicable standards of the Affordable Care Act with respect to health insurance issuers that contract with OPM to offer MSP options; amends MSP standards related to coverage area, benefits, and certain contracting provisions under section 1334 of the Affordable Care Act; and makes non-substantive technical changes.

24 CFR 92.254 - Qualification as affordable housing: Homeownership.

Code of Federal Regulations, 2010 CFR

2010-04-01

... revitalization strategy under § 91.215(e)(2) of its consolidated plan or Empowerment Zone or Enterprise Community... owner-occupied unit would not be subject to the income targeting or affordability provisions of § 92.254...

How can states provide affordable pharmaceuticals to the underserved?

PubMed

Zara, Jane

2006-11-01

Advocates of drug price restrictions in the U.S. argue that pharmaceutical companies operate in an unregulated market, free to charge whatever price the market will bear. The pharmaceutical industry insists that these large profits are justified for investments toward discovering new life saving medicines. As innovation wanes, marketing costs soar, and drug profits rise, public interest advocates and state leaders are challenging this justification. This article examines current problems associated with the ability to procure affordable medicines, and examines mounting tensions between the federal government and the states, particularly regarding the states' ability to negotiate lower prices with drug manufacturers in light of the recent Medicare changes. It provides a brief survey of efforts underway to secure affordable pharmaceuticals for state's residents, addressing the history and feasibility of using compulsory licensing for producing affordable life-saving drugs with respect to public health, constitutional, eminent domain, and anti-trust issues.

An Examination of the United States Navy’s Ability to Conduct Operational Fires

DTIC Science & Technology

1992-05-12

34 18 Thus, the Allied command determined that this attempt was AFFORDABLE or that they had the ability "to manage or bear [the] cost without serious...enhance the situation, but the enormous cost of this project and the time required to generate this data still places a solution years in the future...approach the accuracy enjoyed by more sophisticated overhead imagery systems at a fraction of the cost . The Navy started RPV operations after losing

New Legislation Threatens the Teaching of Evolution

NASA Astrophysics Data System (ADS)

Landau, Elizabeth

2008-05-01

A new twist on an old legislative tactic may help open the door for the discussion of creationism and intelligent design in science classrooms across the United States. While previous attempts have been made to pass legislation regarding the teaching of evolution, new state legislation is being introduced with the purpose of affording ``rights'' and ``protection'' to teachers or students ``concerning their positions on views regarding biological and chemical evolution,'' according to the text from several bills. The proposed legislation would lessen the authority of written science curricula and potentially would allow legal protection for teachers or students to discuss nonscientific views of evolution in science classrooms.

6-Aminopenicillanic acid revisited: A combined solid state NMR and in silico refinement

NASA Astrophysics Data System (ADS)

Aguiar, Daniel Lima Marques de; San Gil, Rosane Aguiar da Silva; Alencastro, Ricardo Bicca de; Souza, Eugenio Furtado de; Borré, Leandro Bandeira; Vaiss, Viviane da Silva; Leitão, Alexandre Amaral

2016-09-01

13C/15N (experimental and ab initio) solid-state NMR was used to achieve an affordable way to improve hydrogen refinement of 6-aminopenicillanic acid (6-APA) structure. The lattice effect on the isotropic chemical shifts was probed by using two different magnetic shielding calculations: isolated molecules and periodic crystal structure. The electron density difference maps of optimized and non-optimized structures were calculated in order to investigate the interactions inside the 6-APA unit cell. The 13C and 15N chemical shifts assignments were unambiguously stablished. In addition, some of the literature 13C resonances ambiguities could be properly solved.

The trials of Hanna Porn: the campaign to abolish midwifery in Massachusetts.

PubMed Central

Declercq, E R

1994-01-01

The case of Hanna Porn affords an opportunity to examine how the laws that led to the abolition of midwifery in Massachusetts evolved and were applied to the midwife whose case set the state legal precedent. Mrs Porn served primarily a Finnish-Swedish clientele of wives of laborers. The outcomes of the births she attended appear to have been positive, and she maintained a neonatal mortality rate of less than half that of local physicians. She also repeatedly defied court orders to stop practicing. Her case exemplifies the efforts that occurred nationally to abolish midwifery in the United States. PMID:8203670

House Poor in Los Angeles: Examining Patterns of Housing-Induced Poverty by Race, Nativity, and Legal Status*

PubMed Central

McConnell, Eileen Diaz

2013-01-01

Housing affordability in the United States is generally operationalized using the ratio approach, with those allocating more than thirty percent of income to shelter costs considered to have housing affordability challenges. Alternative standards have been developed that focus on residual income, whether income remaining after housing expenditures is sufficient to meet non-housing needs. This study employs Los Angeles Family and Neighborhood Survey data to consider racial/ethnic, nativity and legal status differences in one residual income standard. Logistic regression analyses of housing-induced poverty focus on whether there are differences among five distinct groups: U.S.born Latinos, Non-Hispanic Whites, and African Americans, authorized Latino immigrants, and unauthorized Latino immigrants. Results suggest that: 1) Latino natives are significantly more likely to be in housing-induced poverty than African Americans and Latino immigrants, and 2) unauthorized Latino immigrants are not more likely to experience the outcome than other groups. The present work extends previous research. First, the results provide additional evidence of the value of operationalizing housing affordability using a residual income standard. Alternatives to the ratio approach deserve more empirical attention from a wider range of scholars and policymakers interested in housing affordability. Second, housing scholarship to date generally differentiates among Latinos by ethnicity, nativity, and citizenship. The present study contributes to emerging research investigating heterogeneity among Latinos by nativity and legal status. PMID:23585711

Employer-Sponsored Health Insurance Coverage Limitations: Results from the Childhood Cancer Survivor Study

PubMed Central

Kirchhoff, Anne C.; Kuhlthau, Karen; Pajolek, Hannah; Leisenring, Wendy; Armstrong, Greg T.; Robison, Leslie L.; Park, Elyse R.

2013-01-01

Purpose The Affordable Care Act (ACA) will expand health insurance options for cancer survivors in the United States. It is unclear how this legislation will affect their access to employer-sponsored health insurance (ESI). We describe the health insurance experiences for survivors of childhood cancer with and without ESI. Methods We conducted a series of qualitative interviews with 32 adult survivors from the Childhood Cancer Survivor Study to assess their employment-related concerns and decisions regarding health insurance coverage. Interviews were performed from August to December 2009 and were recorded, transcribed, and content analyzed using NVivo 8. Results Uninsured survivors described ongoing employment limitations, such as being employed at part-time capacity, which affected their access to ESI coverage. These survivors acknowledged they could not afford insurance without employer support. Survivors on ESI had previously been denied health insurance due to their pre-existing health conditions until they obtained coverage through an employer. Survivors feared losing their ESI coverage, which created a disincentive to making career transitions. Others reported worries about insurance rescission if their cancer history was discovered. Survivors on ESI reported financial barriers in their ability to pay for health care. Conclusions Childhood cancer survivors face barriers to obtaining employer-sponsored health insurance. While Affordable Care Act provisions may mitigate insurance barriers for cancer survivors, many will still face cost barriers to affording health care without employer support. PMID:22717916

Recovering fraudulent claims for Australian federal expenditure on pharmaceuticals and medical devices.

PubMed

Faunce, Thomas; Urbas, Gregor; Skillen, Lesley; Smith, Marc

2010-12-01

The Australian Federal Government expends increasingly large amounts of money on pharmaceuticals and medical devices. It is likely, given government experience in other jurisdictions, that a significant proportion of this expenditure is paid as a result of fraudulent claims presented by corporations. In the United States, legislation such as the False Claims Act 1986 (US), the Fraud Enforcement and Recovery Act 2009 (US), the Stark (Physician Self-Referral) Statute 1995 (US), the Anti-Kickback Statute 1972 (US), the Food, Drug and Cosmetic Act 1938 (US), the Social Security Act 1965 (US), and the Patient Protection and Affordable Care Act 2010 (US) has created systematic processes allowing the United States Federal Government to recover billions of dollars in fraudulently made claims in the health and procurement areas. The crucial component involves the creation of financial incentives for information about fraud to be revealed from within the corporate sector to the appropriate state officials. This article explores the opportunities for creating a similar system in Australia in the health care setting.

Language revitalization in Native North America--issues of intellectual property rights and intellectual sovereignty.

PubMed

Tatsch, Sheri

2004-01-01

Language revitalization, oral tradition and epistemology are expressions of Native peoples intellectual sovereignty, and thus the foundation for indigenous intellectual property rights. As the people of California move towards language and cultural revitalization the question arises: What constitutes or constructs the definitions of intellectual property and how can appropriation of indigenous knowledge be protected? Looking at the issues faced by the California's indigenous populace and by implication, other indigenous peoples in the United States, this essay examines how protection may be afforded under the United Nations definition of 'heritage'. Given that the holding safe of a 'culture' or 'heritage' is inclusive of language, and thus has been determined to be a human right.

Plastic surgery practice models and research aims under the Patient Protection and Affordable Care Act.

PubMed

Giladi, Aviram M; Yuan, Frank; Chung, Kevin C

2015-02-01

As the health care landscape in the United States changes under the Affordable Care Act, providers are set to face numerous new challenges. Although concerns about practice sustainability with declining reimbursement have dominated the dialogue, there are more pressing changes to the health care funding mechanism as a whole that must be addressed. Plastic surgeons, involved in various practice models each with different relationships to hospitals, referring physicians, and payers, must understand these reimbursement changes to dictate adequate compensation in the future. In this article, the authors discuss bundle payments and accountable care organizations, and how plastic surgeons might best engage in these new system designs. In addition, the authors review the value of a focused and driven health-services research agenda in plastic surgery, and the importance of this research in supporting long-term financial stability for the specialty.

Solidarity as a national health care strategy.

PubMed

West-Oram, Peter

2018-05-02

The Trump Administration's recent attempts to repeal the Affordable Care Act have reignited long-running debates surrounding the nature of justice in health care provision, the extent of our obligations to others, and the most effective ways of funding and delivering quality health care. In this article, I respond to arguments that individualist systems of health care provision deliver higher-quality health care and promote liberty more effectively than the cooperative, solidaristic approaches that characterize health care provision in most wealthy countries apart from the United States. I argue that these claims are mistaken and suggest one way of rejecting the implied criticisms of solidaristic practices in health care provision they represent. This defence of solidarity is phrased in terms of the advantages solidaristic approaches to health care provision have over individualist alternatives in promoting certain important personal liberties, and delivering high-quality, affordable health care. © 2018 John Wiley & Sons Ltd.

The Patient Protection and Affordable Care Act of 2010: impact on otolaryngology practice and research.

PubMed

Sun, Gordon H; Davis, Matthew M

2012-05-01

The Patient Protection and Affordable Care Act (PPACA) was signed into law by President Barack Obama on March 23, 2010. Since its passage, the PPACA has led to increased health insurance coverage for millions more Americans, and it includes provisions leading to new avenues for clinical and health services research funding. The legislation also favors development of the primary care specialties and general surgery, increased training of midlevel health care providers, and medical training and service in underserved areas of the United States. However, the PPACA does not effectively engage otolaryngologists in quality improvement, despite modifications to the Physician Quality Reporting System. The legislation also levies a tax on cosmetic procedures, affecting both clinicians and patients. This article reviews the sections of the PPACA that are most pertinent to otolaryngologists and explains how these components of the bill will affect otolaryngologic practice and research over the coming decade.

Plastic Surgery Practice Models and Research Aims Under the Patient Protection and Affordable Care Act

PubMed Central

Giladi, Aviram M.; Yuan, Frank; Chung, Kevin C.

2014-01-01

As the healthcare landscape in the United States changes under the Affordable Care Act (ACA), providers are set to face numerous new challenges. Although concerns about practice sustainability with declining reimbursement have dominated the dialogue, there are more pressing changes to the healthcare funding mechanism as a whole that must be addressed. Plastic surgeons, involved in various practice models each with different relationships to hospitals, referring physicians, and payers, must understand these reimbursement changes in order to dictate adequate compensation in the future. Here we discuss bundle payments and Accountable Care Organizations (ACOs), and how plastic surgeons might best engage in these new system designs. In addition, we review the value of a focused and driven health-services research agenda in plastic surgery, and the importance of this research in supporting long-term financial stability for the specialty. PMID:25626805

Paying for Cures: Perspectives on Solutions to the "Affordability Issue".

PubMed

Schaffer, Sarah Karlsberg; Messner, Donna; Mestre-Ferrandiz, Jorge; Tambor, Ellen; Towse, Adrian

2018-03-01

Curative therapies and other medicines considered "game-changing" in terms of health gain can be accompanied by high demand and high list prices that pose budget challenges to public and private payers and health systems-the so-called affordability issue. These challenges are exacerbated when longer term effectiveness, and thus value for money, is uncertain, but they can arise even when treatments are proven to be highly cost-effective at the time of launch. This commentary reviews innovative payment solutions proposed in the literature to address the affordability issue, including the use of credit markets and of staged payments linked to patient outcomes, and draws on discussions with payers in the United States and Europe on the feasibility or desirability of operationalizing any of the alternative financing and payment strategies that appear in the literature. This included a small number of semistructured interviews. We conclude that there is a mismatch between the enthusiasm in the academic literature for developing new approaches and the scepticism of payers that they can work or are necessary. For the foreseeable future, affordability pressures will continue to be handled by aggressive price bargaining, high co-pays (in systems in which this is possible), and restricting access to subgroups of patients. Of the mechanisms we explored, outcomes-based payments were of most interest to payers, but the costs associated with operating such schemes, together with implementation challenges, did not make them an attractive option for managing affordability. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Evolution of US Health Care Reform.

PubMed

Manchikanti, Laxmaiah; Helm Ii, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A

2017-03-01

Major health policy creation or changes, including governmental and private policies affecting health care delivery are based on health care reform(s). Health care reform has been a global issue over the years and the United States has seen proposals for multiple reforms over the years. A successful, health care proposal in the United States with involvement of the federal government was the short-lived establishment of the first system of national medical care in the South. In the 20th century, the United States was influenced by progressivism leading to the initiation of efforts to achieve universal coverage, supported by a Republican presidential candidate, Theodore Roosevelt. In 1933, Franklin D. Roosevelt, a Democrat, included a publicly funded health care program while drafting provisions to Social Security legislation, which was eliminated from the final legislation. Subsequently, multiple proposals were introduced, starting in 1949 with President Harry S Truman who proposed universal health care; the proposal by Lyndon B. Johnson with Social Security Act in 1965 which created Medicare and Medicaid; proposals by Ted Kennedy and President Richard Nixon that promoted variations of universal health care. presidential candidate Jimmy Carter also proposed universal health care. This was followed by an effort by President Bill Clinton and headed by first lady Hillary Clinton in 1993, but was not enacted into law. Finally, the election of President Barack Obama and control of both houses of Congress by the Democrats led to the passage of the Affordable Care Act (ACA), often referred to as "ObamaCare" was signed into law in March 2010. Since then, the ACA, or Obamacare, has become a centerpiece of political campaigning. The Republicans now control the presidency and both houses of Congress and are attempting to repeal and replace the ACA. Key words: Health care reform, Affordable Care Act (ACA), Obamacare, Medicare, Medicaid, American Health Care Act.

Urban Green Space and the Pursuit of Health Equity in Parts of the United States.

PubMed

Jennings, Viniece; Baptiste, April Karen; Osborne Jelks, Na'Taki; Skeete, Renée

2017-11-22

Research has demonstrated that inequitable access to green space can relate to health disparities or inequalities. This commentary aims to shift the dialogue to initiatives that have integrated green spaces in projects that may promote health equity in the United States. Specifically, we connect this topic to factors such as community revitalization, affordable housing, neighborhood walkability, food security, job creation, and youth engagement. We provide a synopsis of locations and initiatives in different phases of development along with characteristics to support effectiveness and strategies to overcome challenges. The projects cover locations such as Atlanta (GA), Los Angeles (CA), the District of Columbia (Washington D.C.), South Bronx (NY), and Utica (NY). Such insight can develop our understanding of green space projects that support health equity and inform the dialogue on this topic in ways that advance research and advocacy.

Urban Green Space and the Pursuit of Health Equity in Parts of the United States

PubMed Central

Jennings, Viniece; Baptiste, April Karen; Osborne Jelks, Na’Taki; Skeete, Renée

2017-01-01

Research has demonstrated that inequitable access to green space can relate to health disparities or inequalities. This commentary aims to shift the dialogue to initiatives that have integrated green spaces in projects that may promote health equity in the United States. Specifically, we connect this topic to factors such as community revitalization, affordable housing, neighborhood walkability, food security, job creation, and youth engagement. We provide a synopsis of locations and initiatives in different phases of development along with characteristics to support effectiveness and strategies to overcome challenges. The projects cover locations such as Atlanta (GA), Los Angeles (CA), the District of Columbia (Washington D.C.), South Bronx (NY), and Utica (NY). Such insight can develop our understanding of green space projects that support health equity and inform the dialogue on this topic in ways that advance research and advocacy. PMID:29165367

Affordances and Limitations of Immersive Participatory Augmented Reality Simulations for Teaching and Learning

NASA Astrophysics Data System (ADS)

Dunleavy, Matt; Dede, Chris; Mitchell, Rebecca

2009-02-01

The purpose of this study was to document how teachers and students describe and comprehend the ways in which participating in an augmented reality (AR) simulation aids or hinders teaching and learning. Like the multi-user virtual environment (MUVE) interface that underlies Internet games, AR is a good medium for immersive collaborative simulation, but has different strengths and limitations than MUVEs. Within a design-based research project, the researchers conducted multiple qualitative case studies across two middle schools (6th and 7th grade) and one high school (10th grade) in the northeastern United States to document the affordances and limitations of AR simulations from the student and teacher perspective. The researchers collected data through formal and informal interviews, direct observations, web site posts, and site documents. Teachers and students reported that the technology-mediated narrative and the interactive, situated, collaborative problem solving affordances of the AR simulation were highly engaging, especially among students who had previously presented behavioral and academic challenges for the teachers. However, while the AR simulation provided potentially transformative added value, it simultaneously presented unique technological, managerial, and cognitive challenges to teaching and learning.

Guidebook of the Western United States: Part A - The Northern Pacific Route, With a Side Trip to Yellowstone Park

USGS Publications Warehouse

Campbell, Marius R.; ,

1915-01-01

The United States of America comprise an area so vast in extent and so diverse in natural features as well as in characters due to human agency that the American citizen who knows thoroughly his own country must have traveled widely and observed wisely. To 'know America first' is a patriotic obligation, but to meet this obligation the railroad traveler needs to have his eyes directed toward the more important or essential things within his field of vision and then to have much that he sees explained by what is unseen in the swift passage of the train. Indeed, many things that attract his attention are inexplicable except as the story of the past is available to enable him to interpret the present. Herein lie the value and the charm of history, whether human or geologic. The present stimulus given to travel in the home country will encourage many thousands of Americans to study geography at first hand. To make this study most profitable the traveler needs a handbook that will answer the questions that come to his mind so readily along the way. Furthermore, the aim of such a guide should be to stimulate the eye in the selection of the essentials in the scene that so rapidly unfolds itself in the crossing of the continent. In recognition of the opportunity afforded in 1915 to render service of this kind to an unusually large number of American citizens, as well as to visitors from other countries, the United States Geological Survey has prepared a series of guidebooks covering four of the older railroad routes west of the Mississippi. These books are educational in purpose, but the method adopted is to entertain the traveler by making more interesting what he sees from the car window. The plan of the series is to present authoritative information that may enable the reader to realize adequately the scenic and material resources of the region he is traversing, to comprehend correctly the basis of its development, and above all to appreciate keenly the real value of the country he looks out upon, not as so many square miles of territory represented on the map in a railroad folder by meaningless spaces, but rather as land - real estate, if you please - varying widely in present appearance because differing largely in its history, and characterized by even greater variation in values because possessing diversified natural resources. One region may be such as to afford a livelihood for only a pastoral people; another may present opportunity for intensive agriculture; still another may contain hidden stores of mineral wealth that may attract large industrial development; and, taken together, these varied resources afford the promise of long-continued prosperity for this or that State. Items of interest in civic development or references to significant epochs in the record of discovery and settlement may be interspersed with explanations of mountain and valley or statements of geologic history. In a broad way the story of the West is a unit, and every chapter should be told in order to meet fully the needs of the tourist who aims to understand all that he sees. To such a traveler-reader this series of guidebooks is addressed. To this interpretation of our own country the United States Geological Survey brings the accumulated data of decades of pioneering investigation, and the present contribution is only one type of return to the public which has supported this scientific work under the Federal Government.

Routine HIV screening in North Carolina in the era of the Affordable Care Act: update on laws, reimbursement, and tests.

PubMed

White, Becky L; Carter, Yvonne L; Records, Katherine; Martin, Ian B K

2013-11-01

Eighteen percent of the 1.2 million human immunodeficiency virus (HIV)-infected individuals in the United States are undiagnosed, with North Carolina accounting for the eighth largest number of new HIV diagnoses in 2011. In an effort to identify more HIV-infected individuals by reducing physician barriers to HIV testing, the Centers for Disease Control and Prevention have expanded their HIV screening recommendations to adolescents and adults without HIV risk factors or behaviors, eliminated federal requirements for pretest counseling, and modified the informed consent process. In 2010, the Office of National AIDS (acquired immunodeficiency syndrome) Policy released the first-ever national HIV/AIDS strategy, with the goal of reducing new infections, increasing access to care, improving HIV outcomes, and reducing HIV racial/ethnic disparities. In 2013, the US Preventive Services Task Force released A-level recommendations recommending nonrisk-based HIV screening for adults and adolescents that are consistent with the recommendations of the Centers for Disease Control and Prevention. In concert with these federal recommendations, the majority of states have modified their consent and counseling requirements. The implementation of the Patient Protection and Affordable Care Act will add requirements and incentives for federal (Medicare), state (Medicaid), and private (insurance) payers to reimburse physicians and patients for nonrisk-based HIV screening.

Racial Differences in Awareness of the Affordable Care Act and Application Assistance Among Low-Income Adults in Three Southern States

PubMed Central

Garcia Mosqueira, Adrian; Hua, Lynn M.; Sommers, Benjamin D.

2015-01-01

The Affordable Care Act (ACA) expanded Medicaid eligibility to adults with incomes under 138% of the federal poverty level, leading to substantial reductions in uninsured rates among low-income adults. Despite large gains in coverage, studies suggest that Latinos may be less likely than other racial/ethnic groups to apply and enroll in health insurance, and they remain the group with the highest uninsured rate in the United States. We explore two potential factors related to racial/ethnic differences in ACA enrollment—awareness of the law and receipt of application assistance such as navigator services. Using a survey of nearly 3000 low-income U.S. citizens (aged 19-64) in 3 states in late 2014, we find that Latinos had significantly lower levels of awareness of the ACA relative to other groups, even after adjusting for demographic covariates. Higher education was the strongest positive predictor of ACA awareness. In contrast, Latinos were much more likely to receive assistance from navigators or social workers when applying, relative to other racial/ethnic groups. Taken together, these results highlight the importance of ACA outreach efforts to increase awareness among low-income and less educated populations, two groups that are overrepresented in the Latino population, to close existing disparities in coverage. PMID:26453675

Covering bariatric surgery has minimal effect on insurance premium costs within the Affordable Care Act.

PubMed

English, Wayne; Williams, Brandon; Scott, John; Morton, John

2016-06-01

Currently, of the 51 state health exchanges operating under the Affordable Care Act, only 23 include benchmark plans that cover bariatric surgery coverage. Bariatric surgery coverage is not considered an essential health benefit in 28 state exchanges, and this lack of coverage has a discriminatory and detrimental impact on millions of Americans participating in state exchanges that do not provide bariatric surgery coverage. We examined 3 state exchanges in which a portion of their plans provided coverage for bariatric surgery to determine if bariatric surgery coverage is correlated with premium costs. State health exchanges; United States. Data from the 2015 state exchange plans were analyzed using information from the Centers for Medicare & Medicaid Services' Individual Market Landscape file and Benefits and Cost Sharing public use files. Only 3 states (Oklahoma, Oregon, and Virginia) in the analysis have 1 or more rating regions in which a portion of the plans cover bariatric surgery. In Oklahoma and Oregon, the average monthly premiums for all bronze, silver, and gold coverage levels are higher for plans covering bariatric surgery. Only 1 of these states included platinum plans that cover bariatric surgery. The average difference in premiums was between $1 to $45 higher in Oklahoma, and $18 to $32 higher in Oregon. Conversely, in Virginia, the average monthly premiums are between $2 and $21 lower for each level for plans covering bariatric surgery. Monthly premiums for plans covering versus not covering bariatric surgery ranged from 6% lower to 15% higher in the same geographic rating region. Across all 3 states in the sample, the average monthly premiums do not differ consistently on the basis of whether the state exchange plans cover bariatric surgery. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Mono- and Dinuclear Manganese Carbonyls Supported by 1,8-Disubstituted (L = Py, SMe, SH) Anthracene Ligand Scaffolds.

PubMed

Manes, Taylor A; Rose, Michael J

2016-06-06

Presented herein is a synthetic scheme to generate symmetric and asymmetric ligands based on a 1,8-disubstituted anthracene scaffold. The metal-binding scaffolds were prepared by aryl chloride activation of 1,8-dichloroanthracene using Suzuki-type couplings facilitated by [Pd(dba)2] as a Pd source; the choice of cocatalyst (XPhos or SPhos) yielded symmetrically or asymmetrically substituted scaffolds (respectively): namely, Anth-SMe2 (3), Anth-N2 (4), and Anth-NSMe (6). The ligands exhibit a nonplanar geometry in the solid state (X-ray), owing to steric hindrance between the anthracene scaffold and the coupled aryl units. To determine the flexibility and binding characteristics of the anthracene-based ligands, the symmetric scaffolds were complexed with [Mn(CO)5Br] to afford the mononuclear species [(Anth-SMe2)Mn(CO)3Br] (8) and [(Anth-N2)Mn(CO)3Br] (9), in which the donor moieties chelate the Mn center in a cis fashion. The asymmetric ligand Anth-NSMe (6) binds preferentially through the py moieties, affording the bis-ligated complex [(Anth-NSMe)2Mn(CO)3Br] (10), wherein the thioether-S donors remain unbound. Alternatively, deprotection of the thioether in 6 affords the free thiol ligand Anth-NSH (7), which more readily binds the Mn center. Complexation of 7 ultimately affords the mixed-valence Mn(I)/Mn(II) dimer of formula [(Anth-NS)3Mn2(CO)3] (11), which exhibits a fac-{Mn(CO)3} unit supported by a triad of bridging thiolates, which are in turn ligated to a supporting Mn(II) center (EPR: |D| = 0.053 cm(-1), E/|D| = 0.3, Aiso = -150 MHz). All of the metal complexes have been characterized by single-crystal X-ray diffraction, IR spectroscopy and NMR/EPR measurements-all of which demonstrate that the meta-linked, anthracene-based ligand scaffold is a viable approach for the coordination of metal carbonyls.

Fostering Health: The Affordable Care Act, Medicaid, and Youth Transitioning from Foster Care. Policy Brief

ERIC Educational Resources Information Center

Wilson-Simmons, Renée; Dworsky, Amy; Tongue, Denzel; Hulbutta, Marikate

2016-01-01

The Affordable Care Act includes language that requires states to provide Medicaid coverage to youth who were in foster care in their state before aging out of the child welfare system. However, most states have interpreted the law differently for youth who move to their state after aging out, determining that automatic Medicaid coverage is an…

Balancing adequacy and affordability?: Essential Health Benefits under the Affordable Care Act.

PubMed

Haeder, Simon F

2014-12-01

The Essential Health Benefits provisions under the Affordable Care Act require that eligible plans provide coverage for certain broadly defined service categories, limit consumer cost-sharing, and meet certain actuarial value requirements. Although the Department of Health and Human Services (HHS) was tasked with the regulatory development of these EHB under the ACA, the department quickly devolved this task to the states. Not surprisingly, states fully exploited the leeway provided by HHS, and state decision processes and outcomes differed widely. However, none of the states took advantage of the opportunity to restructure fundamentally their health insurance markets, and only a very limited number of states actually included sophisticated policy expertise in their decisionmaking processes. As a result, and despite a major expansion of coverage, the status quo ex ante in state insurance markets was largely perpetuated. Decisionmaking for the 2016 revisions should be transparent, included a wide variety of stakeholders and policy experts, and focus on balancing adequacy and affordability. However, the 2016 revisions provide an opportunity to address these previous shortcomings. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Interpretive policy analysis: Marshallese COFA migrants and the Affordable Care Act.

PubMed

McElfish, Pearl Anna; Purvis, Rachel S; Maskarinec, Gregory G; Bing, Williamina Ioanna; Jacob, Christopher J; Ritok-Lakien, Mandy; Rubon-Chutaro, Jellesen; Lang, Sharlynn; Mamis, Sammie; Riklon, Sheldon

2016-06-11

Since the enactment of the Affordable Care Act (ACA), the rate of uninsured in the United States has declined significantly. However, not all legal residents have benefited equally. As part of a community-based participatory research (CBPR) partnership with the Marshallese community, an interpretative policy analysis research project was conducted to document Marshallese Compact of Free Association (COFA) migrants' understanding and experiences regarding the ACA and related health policies. This article is structured to allow the voice of Marshallese COFA migrants to explain their understanding and interpretation of the ACA and related polices on their health in their own words. Qualitative data was collected from 48 participants in five focus groups conducted at the local community center and three individual interviews for those unable to attend the focus groups. Marshallese community co-investigators participated throughout the research and writing process to ensure that cultural context and nuances in meaning were accurately captured and presented. Community co-investigators assisted with the development of the semi-structured interview guide, facilitated focus groups, and participated in qualitative data analysis. Content analysis revealed six consistent themes across all focus groups and individual interviews that include: understanding, experiences, effect on health, relational/historical lenses, economic contribution, and pleas. Working with Marshallese community co-investigators, we selected quotations that most represented the participants' collective experiences. The Marshallese view the ACA and their lack of coverage as part of the broader relationship between the Republic of the Marshall Islands (RMI) and the United States. The Marshallese state that they have honored the COFA relationship, and they believe the United States is failing to meet its obligations of care and support outlined in the COFA. While the ACA and Medicaid Expansion have reduced the national uninsured rate, Marshallese COFA migrants have not benefited equally from this policy. The lack of healthcare coverage for the Marshallese COFA migrants exacerbates the health disparities this underserved population faces. This article is an important contribution to researchers because it presents the Marshallese's interpretation of the policy, which will help inform policy makers that are working to improve Marshallese COFA migrant health.

Predictors of Rural Health Clinics Managers' Willingness to Join Accountable Care Organizations.

PubMed

T H Wan, Thomas; Masri, Maysoun Dimachkie; Ortiz, Judith

2014-01-01

The implementation of the Patient Protection and Affordable Care Act has facilitated the development of an innovative and integrated delivery care system, Accountable Care Organizations (ACOs). It is timely, to identify how health care managers in rural health clinics are responding to the ACO model. This research examines RHC managers' perceived benefits and barriers for implementing ACOs from an organizational ecology perspective. A survey was conducted in Spring of 2012 covering the present RHC network working infrastructures - 1) Organizational social network; 2) organizational care delivery structure; 3) ACO knowledge, perceived benefits, and perceived barriers; 4) quality and disease management programs; and 5) health information technology (HIT) infrastructure. One thousand one hundred sixty clinics were surveyed in the United States. They cover eight southeastern states (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee) and California. A total of ninety-one responses were received. RHC managers' personal perceptions on ACO's benefits and knowledge level explained the most variance in their willingness to join ACOs. Individual perceptions appear to be more influential than organizational and context factors in the predictive analysis. The study is primarily focused in the Southeastern region of the U.S. The generalizability is limited to this region. The predictors of rural health clinics' participation in ACOs are germane to guide the development of organizational strategies for enhancing the general knowledge about the innovativeness of delivering coordinated care and containing health care costs inspired by the Affordable Care Act. Rural health clinics are lagged behind the growth curve of ACO adoption. The diffusion of new knowledge about pros and cons of ACO is essential to reinforce the health care reform in the United States.

Predictors of Rural Health Clinics Managers' Willingness to Join Accountable Care Organizations

PubMed Central

T.H.Wan, Thomas; Masri, Maysoun Dimachkie; Ortiz, Judith

2014-01-01

Purpose The implementation of the Patient Protection and Affordable Care Act has facilitated the development of an innovative and integrated delivery care system, Accountable Care Organizations (ACOs). It is timely, to identify how health care managers in rural health clinics are responding to the ACO model. This research examines RHC managers' perceived benefits and barriers for implementing ACOs from an organizational ecology perspective. Methodology/Approach A survey was conducted in Spring of 2012 covering the present RHC network working infrastructures – 1) Organizational social network; 2) organizational care delivery structure; 3) ACO knowledge, perceived benefits, and perceived barriers; 4) quality and disease management programs; and 5) health information technology (HIT) infrastructure. One thousand one hundred sixty clinics were surveyed in the United States. They cover eight southeastern states (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee) and California. A total of ninety-one responses were received. Findings RHC managers' personal perceptions on ACO's benefits and knowledge level explained the most variance in their willingness to join ACOs. Individual perceptions appear to be more influential than organizational and context factors in the predictive analysis. Research limitations/implications The study is primarily focused in the Southeastern region of the U.S. The generalizability is limited to this region. The predictors of rural health clinics' participation in ACOs are germane to guide the development of organizational strategies for enhancing the general knowledge about the innovativeness of delivering coordinated care and containing health care costs inspired by the Affordable Care Act. Originality/Value of Paper Rural health clinics are lagged behind the growth curve of ACO adoption. The diffusion of new knowledge about pros and cons of ACO is essential to reinforce the health care reform in the United States. PMID:25541569

Comparison of Orthodontic Medicaid Funding in the United States 2006 to 2015.

PubMed

Minick, Gerald; Tilliss, Terri; Shellhart, W Craig; Newman, Sheldon M; Carey, Clifton M; Horne, Andrew; Whitt, Susan; Oesterle, Larry J

2017-01-01

Orthodontic treatment is reimbursed by Medicaid based on orthodontic and financial need with qualifiers determined by individual states. Changes in Medicaid-funded orthodontic treatment following the "Great Recession" in 2007 and the enactment of the Affordable Care Act in 2010 were compared for the 50 United States and the District of Columbia to better understand disparities in access to care. The results from this 2015 survey were compared to data gathered in 2006 (1). Medicaid officials were contacted by email, telephone, or postal mail regarding the age limit for treatment, practitioner type who can determine eligibility and provide treatment, records required for case review, and rate and frequency of reimbursement. When not attained by direct contact, the information was gleaned from online websites, provider manuals, and state orthodontists. Information gathered from 50 states and the District of Columbia documents that Medicaid program characteristics and expenditures continue to vary by state. Expenditures and reimbursement rates have decreased since 2006 and vary widely by geographic region. Some states have tightened restrictions on qualifiers and increased submission requirements by providers. The variation and lack of uniformity that still exists among Medicaid orthodontic programs in different states creates disparities in orthodontic care for US citizens. Barriers to care for Medicaid-funded orthodontic treatment have increased since 2006.

UnitedHealth Group

Cancer.gov

UnitedHealth Group provides accessible and affordable services, improved quality of care, coordinated health care efforts, and a supportive environment for shared decision making between patients and their physicians.

High Working Memory Load Increases Intracortical Inhibition in Primary Motor Cortex and Diminishes the Motor Affordance Effect.

PubMed

Freeman, Scott M; Itthipuripat, Sirawaj; Aron, Adam R

2016-05-18

Motor affordances occur when the visual properties of an object elicit behaviorally relevant motor representations. Typically, motor affordances only produce subtle effects on response time or on motor activity indexed by neuroimaging/neuroelectrophysiology, but sometimes they can trigger action itself. This is apparent in "utilization behavior," where individuals with frontal cortex damage inappropriately grasp affording objects. This raises the possibility that, in healthy-functioning individuals, frontal cortex helps ensure that irrelevant affordance provocations remain below the threshold for actual movement. In Experiment 1, we tested this "frontal control" hypothesis by "loading" the frontal cortex with an effortful working memory (WM) task (which ostensibly consumes frontal resources) and examined whether this increased EEG measures of motor affordances to irrelevant affording objects. Under low WM load, there were typical motor affordance signatures: an event-related desynchronization in the mu frequency and an increased P300 amplitude for affording (vs nonaffording) objects over centroparietal electrodes. Contrary to our prediction, however, these affordance measures were diminished under high WM load. In Experiment 2, we tested competing mechanisms responsible for the diminished affordance in Experiment 1. We used paired-pulse transcranial magnetic stimulation over primary motor cortex to measure long-interval cortical inhibition. We found greater long-interval cortical inhibition for high versus low load both before and after the affording object, suggesting that a tonic inhibition state in primary motor cortex could prevent the affordance from provoking the motor system. Overall, our results suggest that a high WM load "sets" the motor system into a suppressed state that mitigates motor affordances. Is an irrelevant motor affordance more likely to be triggered when you are under low or high cognitive load? We examined this using physiological measures of the motor affordance while working memory load was varied. We observed a typical motor affordance signature when working memory load was low; however, it was abolished when load was high. Further, there was increased intracortical inhibition in primary motor cortex under high working memory load. This suggests that being in a state of high cognitive load "sets" the motor system to be imperturbable to distracting motor influences. This makes a novel link between working memory load and the balance of excitatory/inhibitory activity in the motor cortex and potentially has implications for disorders of impulsivity. Copyright © 2016 the authors 0270-6474/16/365544-12$15.00/0.

Hospital Contracts: Important Issues for Medical Groups.

PubMed

Rosolio, Charles E

2016-01-01

Relationships with hospitals and outpatient medical facilities have always been an important part of the business model for private medical practices. As healthcare delivery to patients has evolved in the United States (much of it driven by the new government mandates, regulations, and the Affordable Care Act), the delivery of such services is becoming more and more centered on the hospital or institutional setting, thus making contractual relationships with hospitals even more important for medical practices. As a natural outgrowth of this relationship, attention to hospital contracts is becoming more important.

A medical tourism primer for U.S. physicians.

PubMed

Carabello, Laura

2008-01-01

As healthcare in the United States has been changing rapidly over the past few decades, so has the manner in which healthcare has been provided, billed, and paid for. There is an increasing need for Americans to reach beyond domestic borders to the international community for certain medical procedures, treatment, and care at more affordable costs. This impacts not only consumers and their physicians, but also employers, benefit plan payors, administrators, and other industry stakeholders-including America's hospitals. This article provides a framework for discussion points for physician-patient communications regarding medical tourism.

To restore the financial solvency and improve the governance of the United States Postal Service in order to ensure the efficient and affordable nationwide delivery of mail, and for other purposes.

THOMAS, 113th Congress

Rep. Meadows, Mark [R-NC-11

2018-06-12

House - 06/12/2018 Referred to the Committee on Oversight and Government Reform, and in addition to the Committees on Energy and Commerce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within... (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

78 FR 13405 - Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-27

...This final rule implements provisions related to fair health insurance premiums, guaranteed availability, guaranteed renewability, single risk pools, and catastrophic plans, consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The final rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers and group health plans that are non-federal governmental plans. This final rule also amends the standards for health insurance issuers and states regarding reporting, utilization, and collection of data under the federal rate review program, and revises the timeline for states to propose state- specific thresholds for review and approval by the Centers for Medicare & Medicaid Services (CMS).

Patient Protection and Affordable Care Act; health insurance market rules. Final rule.

PubMed

2013-02-27

This final rule implements provisions related to fair health insurance premiums, guaranteed availability, guaranteed renewability, single risk pools, and catastrophic plans, consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The final rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers and group health plans that are non-federal governmental plans. This final rule also amends the standards for health insurance issuers and states regarding reporting, utilization, and collection of data under the federal rate review program, and revises the timeline for states to propose state-specific thresholds for review and approval by the Centers for Medicare & Medicaid Services (CMS).

Itemized Charges & Student Aid: Enhancing the Capacity of States to Understand Affordability for All Students. Policy Perspectives

ERIC Educational Resources Information Center

Holcombe, Lee

2016-01-01

The Educational Policy Institute released a new report today about the ability of state and national databases to meet the policy needs related to higher education affordability. Written by EPI Senior Research Associate Lee Holcombe, the report finds that although states are establishing ambitious higher education participation and success targets…

Federal employees health program experiences lack of competition in some areas, raising cost concerns for exchange plans.

PubMed

McBride, Timothy D; Barker, Abigail R; Pollack, Lisa M; Kemper, Leah M; Mueller, Keith J

2012-06-01

The Affordable Care Act calls for creation of health insurance exchanges designed to provide private health insurance plan choices. The Federal Employees Health Benefits Program is a national model that to some extent resembles the planned exchanges. Both offer plans at the state level but are also overseen by the federal government. We examined the availability of plans and enrollment levels in the Federal Employees Health Benefits Program throughout the United States in 2010. We found that although plans were widely available, enrollment was concentrated in plans owned by just a few organizations, typically Blue Cross/Blue Shield plans. Enrollment was more concentrated in rural areas, which may reflect historical patterns of enrollment or lack of provider networks. Average biweekly premiums for an individual were lowest ($58.48) in counties where competition was extremely high, rising to $65.13 where competition was extremely low. To make certain that coverage sold through exchanges is affordable, policy makers may need to pay attention to areas where there is little plan competition and take steps through risk-adjustment policies or other measures to narrow differences in premiums and out-of-pocket expenses for consumers.

Multistate Health Plans: Agents for Competition or Consolidation?

PubMed

Moffit, Robert E; Meredith, Neil R

2015-01-01

We discuss and evaluate the Multi-State Plan (MSP) Program, a provision of the Affordable Care Act that has not been the subject of much debate as yet. The MSP Program provides the Office of Personnel Management with new authority to negotiate and implement multistate insurance plans on all health insurance exchanges within the United States. We raise the concern that the MSP Program may lead to further consolidation of the health insurance industry despite the program's stated goal of increasing competition by means of health insurance exchanges. The MSP Program arguably gives a competitive advantage to large insurers, which already dominate health insurance markets. We also contend that the MSP Program's failure to produce increased competition may motivate a new effort for a public health insurance option. © The Author(s) 2015.

The Association between State Policy Environments and Self-Rated Health Disparities for Sexual Minorities in the United States.

PubMed

Gonzales, Gilbert; Ehrenfeld, Jesse M

2018-06-01

A large body of research has documented disparities in health and access to care for lesbian, gay, and bisexual (LGB) people in the United States. Less research has examined how the level of legal protection afforded to LGB people (the state policy environment) affects health disparities for sexual minorities. This study used data on 14,687 sexual minority adults and 490,071 heterosexual adults from the 2014⁻2016 Behavioral Risk Factor Surveillance System to document differences in health. Unadjusted state-specific prevalence estimates and multivariable logistic regression models were used to compare poor/fair self-rated health by gender, sexual minority status, and state policy environments (comprehensive versus limited protections for LGB people). We found disparities in self-rated health between sexual minority adults and heterosexual adults in most states. On average, sexual minority men in states with limited protections and sexual minority women in states with either comprehensive or limited protections were more likely to report poor/fair self-rated health compared to their heterosexual counterparts. This study adds new findings on the association between state policy environments and self-rated health for sexual minorities and suggests differences in this relationship by gender. The associations and impacts of state-specific policies affecting LGB populations may vary by gender, as well as other intersectional identities.

Feasibility of the Participatory Experience Survey and the Setting Affordances Survey for use in evaluation of programmes serving youth with intellectual and developmental disabilities.

PubMed

Liljenquist, K; Coster, W; Kramer, J; Rossetti, Z

2017-07-01

Participation by youth with disabilities in recreational activities has been shown to promote the development of important skills needed for transition to adulthood. The Participatory Experience Survey (PES) and the Setting Affordances Survey (SAS) were developed for use by recreational programmes serving youth with significant intellectual and developmental disabilities (SIDD) to assess participant experiences and ensure that participants are afforded optimal opportunities to develop these skills. This paper presents a feasibility evaluation to determine the appropriateness of the PES and the SAS for use in a programme evaluation context. The PES and the SAS were used to evaluate a programme serving youth with SIDD in the greater northwest region of the United States. Three recreational activities were evaluated: an art project, trip to a zoo and a track practice. Programme volunteers used the SAS to assess opportunities and affordances offered within each activity. The PES was then given to 10 young people in each activity to capture their experiences. It was hypothesized that each setting would afford different experiences and developmental opportunities because of the differing nature of the activities. The PES and SAS were found to be feasible for conducting a programme evaluation. All three settings offered varying types of experiences and affordances. Notably, as measured by the SAS, opportunity for skill development was greater in more structured activities; the zoo had the fewest opportunities for skill development and the art project had the most skill development opportunities. Youth answered 'no' most often to 'asking for help' and 'helping a kid', suggesting changes to offer more opportunities to develop these skills would be beneficial in all three activities. These new instruments offer programmes a means to more fully include young people with disabilities during programme evaluations, leading to better-structured, more supportive programmes. © 2016 John Wiley & Sons Ltd.

Changes in health insurance for US children and their parents: comparing 2003 to 2008.

PubMed

Angier, Heather; DeVoe, Jennifer E; Tillotson, Carrie; Wallace, Lorraine

2013-01-01

Recent policy changes have affected access to health insurance for families in the United States. Private health insurance premiums have increased, and state Medicaid programs have cut back coverage for adults. Concurrently, the Children's Health Insurance Program has made public insurance available to more children. We aimed to better understand how child and parent health insurance coverage patterns may have changed as a result of these policies. We analyzed data from the nationally representative Medical Expenditure Panel Survey, comparing cohorts from 2003 and 2008. We assessed cross-sectional and full-year coverage patterns for child/parent pairs, stratified by income. We conducted chi-square tests to assess significant differences in coverage over time. Middle-income child/parent pairs had the most significant changes in their coverage patterns. For example, those with full-year health insurance coverage significantly decreased from 85.4% in 2003 to 80.6% in 2008. There was also an increase in uninsured middle-income child/parent pairs for the full year (5.6% in 2003 to 8.3% in 2008) and an increase in pairs who had a gap in coverage (9.7% in 2003 to 13.0% in 2008). The percentage of middle-income child/parent pairs who were lacking insurance, for part or all of the year, has risen, suggesting that these families may be caught between affording private coverage and being eligible for public coverage. Unless private coverage becomes more affordable, insurance instability among middle-income families may persist despite the passage of the Patient Protection and Affordable Care Act.

Undocumented students pursuing medical education: The implications of deferred action for childhood arrivals (DACA).

PubMed

Balderas-Medina Anaya, Yohualli; del Rosario, Mithi; Doyle, Lawrence Hy; Hayes-Bautista, David E

2014-12-01

There are about 1.8 million young immigrants in the United States who came or were brought to the country without documentation before the age of 16. These youth have been raised and educated in the United States and have aspirations and educational achievements similar to those of their native-born peers. However, their undocumented status has hindered their pursuit of higher education, especially in medical and other graduate health sciences. Under a new discretionary policy, Deferred Action for Childhood Arrivals (DACA), many of these young immigrants are eligible to receive permission to reside and work in the United States. DACA defers deportation of eligible, undocumented youth and grants lawful presence in the United States, work permits, Social Security numbers, and, in most states, driver's licenses. These privileges have diminished the barriers undocumented students traditionally have faced in obtaining higher education, specifically in pursuing medicine. With the advent of DACA, students are slowly matriculating into U.S. medical schools and residencies. However, this applicant pool remains largely untapped. In the face of a physician shortage and the implementation of the Affordable Care Act, an increase in matriculation of qualified undocumented students would be greatly beneficial. This Perspective is intended to begin discussion within the academic medicine community of the implications of DACA in reducing barriers for the selection and matriculation of undocumented medical students and residents. Moreover, this Perspective is a call to peers in the medical community to support undocumented students seeking access to medical school, residency, and other health professions.

Radon abate: Who should pay

DOE Office of Scientific and Technical Information (OSTI.GOV)

Henderson, Z.P.

Radon is blamed for thousands of deaths from lung cancer annually. This radioactive gas most often seeps into buildings through structural defects. The cost of protecting tenants and homeowners from the health risks of radon adds to the cost of housing, particularly for those who can least afford it. Tenants and people whose homes need repair are at higher risk for radon exposure than are people living in well-constructed and well-maintained homes. Renters are at particular risk, says Joseph Laquatra, associate professor of design and environmental analysis, because they are powerless to implement radon mitigation. Moreover, they could be hurtmore » financially if landlords were forced to upgrade buildings in an attempt to reduce radon levels. [open quotes]A balance has to be struck,[close quotes] Laquatra says, [open quotes]between making rental units safer and not reducing the availability of affordable housing for people with low incomes.[close quotes] In a study of housing in central and western New York State, Laquatra and Peter Chi, professor of consumer economics and housing, found that up to 66 percent of rental units had excessive radon levels, versus 41 percent of owner-occupied homes costing less than $40,000 and 36 percent of homes worth more than $40,000.« less

16 CFR 1061.8 - Information on the heightened degree of protection afforded.

Code of Federal Regulations, 2010 CFR

2010-01-01

... protection afforded. 1061.8 Section 1061.8 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL APPLICATIONS FOR EXEMPTION FROM PREEMPTION § 1061.8 Information on the heightened degree of protection afforded... State or local requirement provides a significantly higher degree of protection from the risk of injury...

The Influence of Affordability in Strategic Enrollment Management

ERIC Educational Resources Information Center

Pugh, Susan L.; Thompson, Roger J.

2008-01-01

In state houses around the country, one of the common higher education themes is affordability. As tuition costs have increased at rates exceeding that of inflation, students and families have pressed their legislative representatives to examine these increases. Affordability is a term used by various constituent groups, and its definition varies…

Companion Guides for Lesson Planning: A Planning Template and the Lesson Plan Pro Forma

ERIC Educational Resources Information Center

Pang, May

2016-01-01

Jason Anderson's proposal, in "ELT Journal" (2015), for an affordance-based approach to lesson planning raises important issues in teacher education. However, his arguments against the role of planned outcomes in favour of an affordance-based focus using learning opportunities as units of planning fail to acknowledge the complexities…

Direct Perception of Action-Scaled Affordances: The Shrinking Gap Problem

ERIC Educational Resources Information Center

Fajen, Brett R.; Matthis, Jonathan S.

2011-01-01

The aim of this study was to investigate the perception of possibilities for action (i.e., affordances) that depend on one's movement capabilities, and more specifically, the passability of a shrinking gap between converging obstacles. We introduce a new optical invariant that specifies in intrinsic units the minimum locomotor speed needed to…

Vision health disparities in the United States by race/ethnicity, education, and economic status: findings from two nationally representative surveys.

PubMed

Zhang, Xinzhi; Cotch, Mary Frances; Ryskulova, Asel; Primo, Susan A; Nair, Parvathy; Chou, Chiu-Fang; Geiss, Linda S; Barker, Lawrence E; Elliott, Amanda F; Crews, John E; Saaddine, Jinan B

2012-12-01

To assess vision health disparities in the United States by race/ethnicity, education, and economic status. Cross-sectional, nationally representative samples. We used national survey data from the National Health and Nutrition Examination Survey (NHANES) and the National Health Interview Survey (NHIS). Main outcome measures included, from NHANES, age-related eye diseases (ie, age-related macular degeneration [AMD], cataract, diabetic retinopathy [DR], glaucoma) and from NHIS, eye care use (ie, eye doctor visits and cannot afford eyeglasses when needed) among those with self-reported visual impairment. The estimates were age- and sex-standardized to the 2000 US Census population. Linear trends in the estimates were assessed by weighted least squares regression. Non-Hispanic whites had a higher prevalence of AMD and cataract surgery than non-Hispanic blacks, but a lower prevalence of DR and glaucoma (all P < .001 in NHANES 2005-2008). From 1999 to 2008, individuals with less education (ie, high school) and lower income (poverty income ratio [PIR] <1.00 vs ≥ 4.00) were consistently less likely to have had an eye care visit in the past 12 months compared with their counterparts (all P < .05). During this period, inability to afford needed eyeglasses increased among non-Hispanic whites and Hispanics (trend P = .004 and P = .007; respectively), those with high school education (trend P = .036), and those with PIR 1.00-1.99 (trend P < .001). Observed vision health disparities suggest a need for educational and innovative interventions among socioeconomically disadvantaged groups. Published by Elsevier Inc.

Proximal and distal determinants of access to health care among Hispanics in El Paso County, Texas.

PubMed

Law, Jon; VanDerslice, James

2011-04-01

In the United States, having health insurance is an important determinant of health care access and individual health outcomes. Nationwide, a significant proportion of the population does not have health insurance. Hispanics, in particular, are less likely than non-Hispanics to have insurance. A framework was established to examine the relationships between the determinants of insurance coverage and health care affordability in El Paso County, Texas. Data from the 2005 Behavioral Risk Factor Surveillance System were used to examine the relationships described by this framework. The sample included 653 adults, of those 477 self-identified as Hispanic or Latino. In El Paso County, almost half of adult Hispanics lack any type of health insurance coverage, three times the rate of non-Hispanics. Among Hispanics, the lack of health insurance was strongly associated with reduced affordability of health care. Employment status, income, and age were found to have significant associations with insurance coverage and health care affordability. Sex and education level were relevant, yet distal determinants of these outcomes. Ongoing conversations about health care reform should take into account the patterns of coverage within the Hispanic population. Knowing how economic and social factors affect coverage is necessary to inform policy that can effectively alleviate disparities experienced by Hispanics.

Evaluation of a model community-wide bed bug management program in affordable housing.

PubMed

Cooper, Richard A; Wang, Changlu; Singh, Narinderpal

2016-01-01

Low-income apartment communities in the United States are suffering from disproportionally high bed bug, Cimex lectularius L., infestations owing to lack of effective monitoring and treatment. Studies examining the effectiveness of integrated pest management (IPM) for the control of bed bugs in affordable housing have been limited to small subsets of bed-bug-infested apartments, rather than at the apartment community level. We developed, implemented and evaluated a complex-wide IPM program for bed bugs in an affordable housing community. Proactive inspections and biweekly treatments using a combination of non-chemical and chemical methods until bed bugs were not detected for three biweekly monitoring visits were key elements of the IPM program. A total of 55 bed-bug-infested apartments were identified during the initial inspection. Property management was unaware of 71% of these infestations. Over the next 12 months, 14 additional infested apartments were identified. The IPM program resulted in a 98% reduction in bed bug counts among treated apartments and reduced infestation rates from 15 to 2.2% after 12 months. Adopting a complex-wide bed bug IPM program, incorporating proactive monitoring, and biweekly treatments of infested apartments utilizing non-chemical and chemical methods can successfully reduce infestation rates to very low levels. © 2015 Society of Chemical Industry.

Delivering High-Quality and Affordable Care Throughout the Cancer Care Continuum

PubMed Central

Shih, Ya-Chen Tina; Ganz, Patricia A.; Aberle, Denise; Abernethy, Amy; Bekelman, Justin; Brawley, Otis; Goodwin, James S.; Hu, Jim C.; Schrag, Deborah; Temel, Jennifer S.; Schnipper, Lowell

2013-01-01

The national cost of cancer care is projected to reach $173 billion by 2020, increasing from $125 billion in 2010. This steep upward cost trajectory has placed enormous an financial burden on patients, their families, and society as a whole and raised major concern about the ability of the health care system to provide and sustain high-quality cancer care. To better understand the cost drivers of cancer care and explore approaches that will mitigate the problem, the National Cancer Policy Forum of the Institute of Medicine held a workshop entitled “Delivering Affordable Cancer Care in the 21st Century” in October 2012. Workshop participants included bioethicists, health economists, primary care physicians, and medical, surgical, and radiation oncologists, from both academic and community settings. All speakers expressed a sense of urgency about the affordability of cancer care resulting from the future demographic trend as well as the high cost of emerging cancer therapies and rapid diffusion of new technologies in the absence to evidence indicating improved outcomes for patients. This article is our summary of presentations at the workshop that highlighted the overuse and underuse of screening, treatments, and technologies throughout the cancer care continuum in oncology practice in the United States. PMID:24127450

Implementing the Affordable Care Act: State Action to Establish SHOP Marketplaces.

PubMed

Dash, Sarah J; Lucia, Kevin W; Thomas, Amy

2014-03-01

The Affordable Care Act seeks to help small employers offer coverage by reforming the small-group market and establishing Small Business Health Options Program (SHOP) marketplaces. Seventeen states and the District of Columbia chose to operate their own SHOP marketplaces in 2014, with the federal government operating the SHOP marketplace in 33 states. This brief examines state decisions to enhance the value of SHOP marketplaces for small employers and finds that most have set predictable participation and eligibility requirements and will offer a competitive choice of insurers and plans. States also are seeking to facilitate small employers' shopping experience through online tools and access to personalized assistance. While not all SHOP marketplaces are yet functioning as intended, their establishment offers an opportunity to identify successful strategies for improving the affordability and accessibility of coverage for small employers.

Cultural Markov blankets? Mind the other minds gap!. Comment on "Answering Schrödinger's question: A free-energy formulation" by Maxwell James Désormeau Ramstead et al.

NASA Astrophysics Data System (ADS)

Veissière, Samuel

2018-03-01

Ramstead et al. have pulled an impressive feat. By combining recent developments in evolutionary systems theory (EST), machine learning, and theoretical biology, they seek to apply the free-energy principle (FEP) to tackle one of the most intractable questions in the physics of life: why and how do living systems resist the second law of thermodynamics and maintain themselves in a state of bounded organization? The authors expand on a formal model of neuronal self-organization to articulate a meta-theory of perception, action, and biobehaviour that they extend from the human brain and mind to body and society. They call this model "variational neuroethology" [1]. The basic idea is simple and elegant: living systems self-organize optimally by resisting internal entropy; that is, by minimizing free-energy. The model draws on, and significantly expands on Bayesian predictive-processing (PP) theories of cognition, according to which the brain generates statistical predictions of the environment based on prior learning, and guides behaviour by working optimally to minimise prediction errors. In the neuroethology account, free energy is understood as "a function of probabilistic beliefs" encoded in an organism's internal states about external states of the world. The model thus rejoins 'enactivist' and 'affordances' accounts in phenomenology and ecological psychology, in which 'reality' for a living organism is understood as perspective-dependent, and constructed from an agent's prior dispositions ("probabilistic beliefs" in Bayesian terms). In ecological terms, an organism operates in a niche within what its dispositions in relation to features of the environment 'afford'. Ramstead et al. borrow the concept of Markov Blanket from mathematics to describe the processing of internal states and beliefs through which an organism perceives its environment. In machine learning, a Markov Blank is a learning algorithm consisting of a network of nested 'parent' and 'children' nodes for hierarchical information processing. Ramstead et al. take up this model to describe the perceptive 'veil' through which human sensory states are coupled to affordances of the broader environment. Building on the recently formulated cultural affordances paradigm, the authors extend their model to a meta-theory of the human niche, in which "cultural ensembles minimise free energy by enculturing their members so that they share common sets of precision-weighting priors". Ramstead et al. propose to enrich the cultural affordances account by bringing in the hierarchical mechanistic mind (HMM) model, which assumes the free-energy principle as a general mechanism underpinning cognitive function on evolutionary, developmental, and real-time scales. They concede, however, that ways of further integrating the HMM with cultural affordances remain an open question. As a cognitive anthropologist and co-author of the first Cultural Affordances article [2], I am happy to provide the outline of an answer. For humans, affordances are mediated through recursive loops between natural features of the environment and human conventions. A chair, for example, affords sitting for bipedal agents. This is 'natural' enough. But for humans, chairs afford sitting and not-sitting in myriad context and status-specific ways. A throne affords not-sitting for all but the monarch. In the absence of the monarch, it may afford transgressive sitting for the most daring. How do these conventional affordances come to hold with such precision? In the original model, we defined culture as collectively patterned and mutually reinforced behaviour mediated by largely implicit expectations about what one expects others to also expect - and to expect of one by extension. Environmental cues may act as triggers of affordances, but joint meta-expectations do all the mediating work. Meaning and affordances in the environment of the Homo Sapiens niche, are mostly (if not exclusively) picked up through the 'veil' of what one expects others to expect. The Markov Blanket in the human niche (the cultural Markov Blanket), thus, serves as a buffer to exploit statistical regularities in human psychology at least as much, if not more than in external states of the world. Human internal states about external states, in other words, are mediated by expectations about other humans' internal states. The nestedness of these inferences should be primarily conceptualized at the level of recursive mindreading - or inferences about other humans' internal states (about both internal and external states), dispositions, anticipations, and propositional attitudes. In order to function optimally and minimise cognitive energy in any given context, I have to know that you [the context-relevant other, actual or generalized] know that I know that you know that I know, etc. how to behave in that context. Navigating social life and cultural affordances requires the smooth acquisition, processing, and constant updating of infinitely recursive inferences about many specific, generalized, and hypothetical other minds. It might be useful to specify, thus, that the cultural Markov Blanket is one that mediates world-agent perception and action through the veil of Other Minds.

The Patient Protection and Affordable Care Act: The Impact on Urologic Cancer Care

PubMed Central

Keegan, Kirk A.; Penson, David F.

2012-01-01

In March 2010, the Patient Protection and Affordable Care Act as well as its amendments were signed into law. This sweeping legislation was aimed at controlling spiraling healthcare costs and redressing significant disparities in healthcare access and quality. Cancer diagnoses and their treatments constitute a large component of rising healthcare expenditures and, not surprisingly, the legislation will have a significant influence on cancer care in the United States. Because genitourinary malignancies represent an impressive 25% of all cancer diagnoses per year, this legislation could have a profound impact on urologic oncology. To this end, we will present key components of this landmark legislation, including the proposed expansion to Medicaid coverage, the projected role of Accountable Care Organizations, the expected creation of quality reporting systems, the formation of an independent Patient-Centered Outcomes Research Institute, and enhanced regulation on physician-owned practices. We will specifically address the anticipated effect of these changes on urological cancer care. Briefly, the legal ramifications and current barriers to the statutes will be examined. PMID:22819697

Combined Regional Investments Could Substantially Enhance Health System Performance And Be Financially Affordable.

PubMed

Homer, Jack; Milstein, Bobby; Hirsch, Gary B; Fisher, Elliott S

2016-08-01

Leaders across the United States face a difficult challenge choosing among possible approaches to transform health system performance in their regions. The ReThink Health Dynamics Model simulates how alternative scenarios could unfold through 2040. This article compares the likely consequences if four interventions were enacted in layered combinations in a prototypical midsize US city. We estimated the effects of efforts to deliver higher-value care; reinvest savings and expand global payment; enable healthier behaviors; and expand socioeconomic opportunities. Results suggest that there may be an effective and affordable way to unlock much greater health and economic potential, ultimately reducing severe illness by 20 percent, lowering health care costs by 14 percent, and improving economic productivity by 9 percent. This would require combined investments in clinical and population-level initiatives, coupled with financial agreements that reduce incentives for costly care and reinvest a share of the savings to ensure adequate long-term financing. Project HOPE—The People-to-People Health Foundation, Inc.

Partnerships for affordable and equitable disaster insurance

NASA Astrophysics Data System (ADS)

Mysiak, J.; Pérez-Blanco, C. D.

2015-08-01

Extreme events are becoming more frequent and intense, inflating the economic damages and social hardship set-off by natural catastrophes. Amidst budgetary cuts, there is a growing concern on societies' ability to design solvent disaster recovery strategies, while addressing equity and affordability concerns. The participation of private sector along with public one through Public-Private Partnerships (PPPs) has gained on importance as a means to address these seemingly conflicting objectives through the provision of (catastrophic) natural hazard insurance. This is the case of many OECD countries, notably some EU Member States such as the United Kingdom and Spain. The EU legislator has adapted to this new scenario and recently produced major reforms in the legislation and regulation that govern the framework in which PPPs for (catastrophic) natural hazard insurance develop. This paper has a dual objective: (1) review the complex legal background that rules the provision of insurance against natural catastrophes in the EU after these major reforms, (2) assess the implications of the reforms and offer concise Policy Guiding Principles.

Enforcing Enrollment in Health Insurance Exchanges: Evidence From the Netherlands, Switzerland, and Germany.

PubMed

van Ginneken, Ewout; Rice, Thomas

2015-08-01

Experience from the Netherlands, Switzerland, and Germany suggests that there may be a looming problem concerning uninsured individuals and defaulters that could derail coverage projection numbers in the United States under the Affordable Care Act. In those countries, the young, people with migrant backgrounds, and those with lower incomes-precisely the groups the Affordable Care Act is seeking to cover-are overrepresented in the numbers of the uninsured and defaulters, frequently because of difficulty in paying for their premiums. In these three countries, penalties or suspension of coverage alone has not led everyone to purchase coverage or prevented some from defaulting. Help in addressing the vulnerable position of the uninsured may be needed. Examples include using a multifaceted approach in which public authorities help with debt restructuring, freeing some funds in the exchanges to help vulnerable groups, and compensating insurers for their outstanding payments if they follow an agreed protocol instead of canceling coverage. © The Author(s) 2015.

Challenges and Opportunities for Integrating Preventive Substance-Use-Care Services in Primary Care through the Affordable Care Act

PubMed Central

Ghitza, Udi E.; Tai, Betty

2014-01-01

Undertreated or untreated substance use disorders (SUD) remain a pervasive, medically-harmful public health problem in the United States, particularly in medically underserved and low-income populations lacking access to appropriate treatment. The need for greater access to SUD treatment was expressed as policy in the Final Rule on standards related to essential health benefits, required to be covered through the 2010 Affordable Care Act (ACA) health insurance exchanges. SUD treatment services have been included as an essential health benefit, in a manner that complies with the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. Consequently, with the ACA, a vast expansion of SUD-care services in primary care is looming. This commentary discusses challenges and opportunities under the ACA for equipping health care professionals with appropriate workforce training, infrastructure, and resources to support and guide science-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) for SUD in primary care. PMID:24583486

The Affordable Care Act: a case study for understanding and applying complexity concepts to health care reform.

PubMed

Larkin, D Justin; Swanson, R Chad; Fuller, Spencer; Cortese, Denis A

2016-02-01

The current health system in the United States is the result of a history of patchwork policy decisions and cultural assumptions that have led to persistent contradictions in practice, gaps in coverage, unsustainable costs, and inconsistent outcomes. In working toward a more efficient health system, understanding and applying complexity science concepts will allow for policy that better promotes desired outcomes and minimizes the effects of unintended consequences. This paper will consider three applied complexity science concepts in the context of the Patient Protection and Affordable Care Act (PPACA): developing a shared vision around reimbursement for value, creating an environment for emergence through simple rules, and embracing transformational leadership at all levels. Transforming the US health system, or any other health system, will be neither easy nor quick. Applying complexity concepts to health reform efforts, however, will facilitate long-term change in all levels, leading to health systems that are more effective, efficient, and equitable. © 2014 John Wiley & Sons, Ltd.

The relationship of state Medicaid coverage to Medicaid acceptance among substance abuse providers in the United States.

PubMed

Andrews, Christina M

2014-10-01

The Affordable Care Act will dramatically increase the number of Americans with Medicaid coverage for substance abuse treatment (SAT). Currently, few SAT providers accept Medicaid, and consequently, there is concern that newly-eligible Medicaid enrollees will have difficulty finding SAT providers willing to serve them. However, little is known about why few SAT providers accept Medicaid. In response, this study examines how features of state Medicaid coverage for SAT, including benefits, eligibility, and oversight, are associated with Medicaid acceptance among SAT providers. Medicaid acceptance was positively associated with the number of SAT services covered, and the number of optional categorical expansions implemented by the state. Requirements for physician involvement were associated with lower odds of acceptance. The results suggest that more generous Medicaid coverage may encourage SAT providers to accept Medicaid, but regulatory policies may inhibit their ability to do so.

Integrating Phosphorus Movement with Soil and Water Loss in the Daily Erosion Project

NASA Astrophysics Data System (ADS)

Sklenar, Tim; Perez-Bidegain, Mario; Cruse, Richard; Gelder, Brian; Herzmann, Daryl

2016-04-01

The Daily Erosion Project (DEP) is an ongoing modelling effort which is now in its second generation. DEP provides comprehensive and dynamic estimates of sediment delivery, soil erosion, and hill slope runoff for agricultural land areas across the Midwestern United States every day for Hydrologic Unit Code 12 (HUC 12) size watersheds. Results are posted every morning on the Internet at dailyerosion.org. Currently DEP covers all of Iowa and portions of Kansas and Minnesota, but expansion of coverage is ongoing. The integration of highly resolute spatial and temporal climate data, soil properties, crop rotation and residue management data affords the opportunity to test the effects of using multiple conservation practices on the transport and fate of water borne nutrients, especially phosphorus, on the Midwestern United States agricultural landscapes. Understanding the interaction of different environmental and land management practices on phosphorus movement will allow data from the DEP to guide conservation efforts as expansion continues into surrounding Midwestern states. The presentation will provide an overview of the DEP technology, including how input data are derived and used to make daily erosion estimates on over 200,000 flowpaths in the modelling area, as well as a discussion of the ongoing phosphorus transport modelling efforts and plans for future expansion (both land area and model functionality).

Meeting of the Central and Eastern U.S. (CEUS) Earthquake Hazards Program October 28–29, 2009

USGS Publications Warehouse

Tuttle, Martitia; Boyd, Oliver; McCallister, Natasha

2013-01-01

On October 28th and 29th, 2009, the U.S. Geological Survey Earthquake Hazards Program held a meeting of Central and Eastern United States investigators and interested parties in Memphis, Tennessee. The purpose of the meeting was to bring together the Central and Eastern United States earthquake-hazards community to present and discuss recent research results, to promote communication and collaboration, to garner input regarding future research priorities, to inform the community about research opportunities afforded by the 2010–2012 arrival of EarthScope/USArray in the central United States, and to discuss plans for the upcoming bicentennial of the 1811–1812 New Madrid earthquakes. The two-day meeting included several keynote speakers, oral and poster presentations by attendees, and breakout sessions. The meeting is summarized in this report and can be subdivided into four primary sections: (1) summaries of breakout discussion groups; (2) list of meeting participants; (3) submitted abstracts; and (4) slide presentations. The abstracts and slides are included “as submitted” by the meeting participants and have not been subject to any formal peer review process; information contained in these sections reflects the opinions of the presenter at the time of the meeting and does not constitute endorsement by the U.S. Geological Survey.

Consumer-driven health care: answer to global competition or threat to social justice?

PubMed

Owen, Carol L

2009-10-01

Health planning in the United States is rapidly approaching a fork in the policy road, with one direction leading the nation toward a universal plan with strong government involvement and the other direction strengthening existing market-based reforms and preserving a commercial health insurance industry. "Consumer-driven health care," a slogan that captures a range of market-based approaches to preserving patient choice and increasing cost savings, is most commonly implemented in the form of individual health savings accounts. These accounts are offered to employees as a means of increasing the cost sharing ofpersonal health care expenses. The author provides an overview of health insurance history and discusses some implications of abandoning earlier practices of risk pooling health care expenses across a wider community. Access and affordability issues connected with the adoption of a consumer-driven health care system in the United States are addressed. Parallels are drawn between the expansion of community-based insurance in the United States following World War II and social work's historic commitment to social justice and economic inclusion. Suggestions are made for social workers'involvement in health policy discourse and activism during this critical time ofnational reflection on universal versus market-based reforms for the U.S. health care system.

Views of the United States healthcare system: Findings from documentary analysis of an interprofessional education course.

PubMed

Bultas, Margaret W; Ruebling, Irma; Breitbach, Anthony; Carlson, Judy

2016-11-01

As the healthcare system of the United States becomes more complex, collaboration among health professionals is becoming an essential aspect in improving the health of individuals and populations. An interprofessional education course entitled "Health Care System and Health Promotion" was developed to allow health profession students to work and learn together about issues related to healthcare delivery, health promotion, and the effect of policy issues on key stakeholders in the system. A qualitative document analysis research design was used to evaluate the effect of this interprofessional course on students' views of the current healthcare system of the United States. Fifty-nine student articles were analysed using document analysis. Health professions represented in the sample included occupational therapy, physical therapy, athletic training, nursing, and radiation therapy, nuclear medicine technology, and magnetic resonance imaging. Eight themes were identified including: increased personal awareness, the need for a system change, concern for access, affordability of healthcare, vision for future practice role, need for quality care, the value of interprofessional collaboration (IPC), and the importance of disease prevention. The results of the study suggest that healthcare education can benefit from the integration of Interprofessional Education (IPE) courses into their curriculum especially when teaching content common to all healthcare professions such as healthcare systems and health promotion.

Laparoscopic telesurgery between the United States and Singapore.

PubMed

Lee, B R; Png, D J; Liew, L; Fabrizio, M; Li, M K; Jarrett, J W; Kavoussi, L R

2000-09-01

Telemedicine is the use of electronic digital signals to transfer information from one site to another. With the advent of a telepresence operative system and development of remote robotic arms to hold and manoeuvre the laparoscope, telemedicine is finding its role in surgery, especially laparoscopic surgery. CLINICAL FEATURES AND TREATMENT: We report two successful cases of laparoscopic surgery--radical nephrectomy and varicocelectomy for a 3-cm renal tumour and for bilateral varicoceles causing pain, where a less experienced laparoscopic surgeon in Singapore was telementored by an experienced laparoscopic surgeon located remotely in the United States. Both patients recovered uneventfully and returned home on postoperative day 4 and on the day of surgery, respectively. This study demonstrates that telementored laparoscopic systems are feasible and safe, between countries halfway across the world. As the Internet expands in utility and the cost of higher bandwidth telecommunication lines decreases, even to remote countries, telementoring systems will become more affordable and may potentially pave the way for advanced surgical and laparoscopic applications and training for the future.

An approach for mapping large-area impervious surfaces: Synergistic use of Landsat-7 ETM+ and high spatial resolution imagery

USGS Publications Warehouse

Yang, Limin; Huang, Chengquan; Homer, Collin G.; Wylie, Bruce K.; Coan, Michael

2003-01-01

A wide range of urban ecosystem studies, including urban hydrology, urban climate, land use planning, and resource management, require current and accurate geospatial data of urban impervious surfaces. We developed an approach to quantify urban impervious surfaces as a continuous variable by using multisensor and multisource datasets. Subpixel percent impervious surfaces at 30-m resolution were mapped using a regression tree model. The utility, practicality, and affordability of the proposed method for large-area imperviousness mapping were tested over three spatial scales (Sioux Falls, South Dakota, Richmond, Virginia, and the Chesapeake Bay areas of the United States). Average error of predicted versus actual percent impervious surface ranged from 8.8 to 11.4%, with correlation coefficients from 0.82 to 0.91. The approach is being implemented to map impervious surfaces for the entire United States as one of the major components of the circa 2000 national land cover database.

More people than ever before are receiving behavioral health care in the United States, but gaps and challenges remain.

PubMed

Mechanic, David

2014-08-01

The high prevalence of mental illness and substance abuse disorders and their significant impact on disability, mortality, and other chronic diseases have encouraged new initiatives in mental health policy including important provisions of the Affordable Care Act and changes in Medicaid. This article examines the development and status of the behavioral health services system, gaps in access to and quality of care, and the challenges to implementing aspirations for improved behavioral and related medical services. Although many more people than ever before are receiving behavioral health services in the United States-predominantly pharmaceutical treatments-care is poorly allocated and rarely meets evidence-based standards, particularly in the primary care sector. Ideologies, finances, and pharmaceutical marketing have shaped the provision of services more than treatment advances or guidance from a growing evidence base. Among the many challenges to overcome are organizational and financial realignments and improved training of primary care physicians and the behavioral health workforce. Project HOPE—The People-to-People Health Foundation, Inc.

Regulating self-selection into private health insurance in Chile and the United States.

PubMed

Vargas Bustamante, Arturo; Méndez, Claudio A

2016-07-01

In the 1980s, Chile adopted a mixed (public and private) model for health insurance coverage similar to the one recently outlined by the Affordable Care Act in the United States (US). In such a system, a mix of public and private health plans offer nearly universal coverage using a combined approach of managed competition and subsidies for low-income individuals. This paper uses a "most different" case study design to compare policies implemented in Chile and the US to address self-selection into private insurance. We argue that the implementation of a mixed health insurance system in Chile without the appropriate regulations was complex, and it generated a series of inequities and perverse incentives. The comparison of Chile and the US healthcare reforms examines the different approaches that both countries have used to manage economic competition, address health insurance self-selection and promote solidarity. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Head and neck surgical subspecialty training in Africa: Sustainable models to improve cancer care in developing countries.

PubMed

Fagan, Johannes J; Zafereo, Mark; Aswani, Joyce; Netterville, James L; Koch, Wayne

2017-03-01

Cancer poses a health crisis in the developing world where surgery is the mainstay of treatment for head and neck cancers. However, a shortage of surgeons with appropriate skills exists. How do we train head and neck surgeons in developing countries and avoid a brain drain? The ideal model provides appropriate affordable training leading to establishment of head and neck cancer centers that teach and train others. Different head and neck surgery training models are presented based on the personal experiences of the authors. Surgical exposure of head and neck fellows in Cape Town and (potentially) in Nairobi is benchmarked against programs in the United States. Surgical exposure in Cape Town is equivalent to that in the United States, but more appropriate to a developing world setting. Training can be achieved in a number of ways, which may be complimentary. Fellowship training is possible in developing countries. © 2016 Wiley Periodicals, Inc. Head Neck 39: 605-611, 2017. © 2016 Wiley Periodicals, Inc.

International behavioral responses to a health hazard: AIDS.

PubMed

Earickson, R J

1990-01-01

This paper expands on Jonathan Mann's third wave of the AIDS pandemic: the epidemic of economic, social, political, and cultural reaction and response to the HIV infection and to AIDS. This worldwide epidemic is a major economic challenge, especially in Third World countries, which can ill afford additional health care costs. AIDS is also a harbinger of political and cultural conflicts between and among nations, states, institutions, and people everywhere. It may ultimately transform law as radically as it has health care practices. In terms of management, it is possible to approach AIDS much as we do natural and technological hazards. The biology and epidemiology of AIDS require a coordinated attack, involving research on vaccines and drugs, modification of human behavior and education of populations to arrest the disease. All of these require money, of which the United States was the major contributor before the Reagan years. Funding to the United Nations and WHO has since languished, jeopardizing the AIDS efforts of those two organizations.

Food and families' socioeconomic status.

PubMed

Kinsey, J D

1994-09-01

This paper explores the relationship between food expenditures and consumption patterns and families' socioeconomic status in the United States. Three themes follow through the paper. One is that as income rises over time and across socioeconomic groups, a smaller percent of that income is spent of food. Simultaneously, a larger percent of the food dollar buys services and food preparation moves farther away from the home. Second, characteristics of people like age and ethnicity contribute to diversity in food consumption but labor force participation by women has led the trend in away-from-home-food preparation. New scientific information and technology have changed attitudes about nutrition and food safety and their linkages to health. Finally, the continuous introduction of affordable new foods into the diet and culture of families in all socioeconomic groups has been a quiet evolution. Trying to differentiate socioeconomic groups in the United States by their food and nutritional status is almost a nonstory except for fascinating intragroup diversities that change rapidly in the postmodern society.

24 CFR 81.17 - Affordability-Income level definitions-family size and income known (owner-occupied units, actual...

Code of Federal Regulations, 2010 CFR

2010-04-01

... definitions-family size and income known (owner-occupied units, actual tenants, and prospective tenants). 81...—Income level definitions—family size and income known (owner-occupied units, actual tenants, and...-income families, where the unit is owner-occupied or, for rental housing, family size and income...

Affordable Care Act Impact on Medicaid Coverage of Smoking-Cessation Treatments.

PubMed

McMenamin, Sara B; Yoeun, Sara W; Halpin, Helen A

2018-04-01

Four sections of the Affordable Care Act address the expansion of Medicaid coverage for recommended smoking-cessation treatments for: (1) pregnant women (Section 4107), (2) all enrollees through a financial incentive (1% Federal Medical Assistance Percentage increase) to offer comprehensive coverage (Section 4106), (3) all enrollees through Medicaid formulary requirements (Section 2502), and (4) Medicaid expansion enrollees (Section 2001). The purpose of this study is to document changes in Medicaid coverage for smoking-cessation treatments since the passage of the Affordable Care Act and to assess how implementation has differentially affected Medicaid coverage policies for: pregnant women, enrollees in traditional Medicaid, and Medicaid expansion enrollees. From January through June 2017, data were collected and analyzed from 51 Medicaid programs (50 states plus the District of Columbia) through a web-based survey and review of benefits documents to assess coverage policies for smoking-cessation treatments. Forty-seven Medicaid programs have increased coverage for smoking-cessation treatments post-implementation of the Affordable Care Act by adopting one or more of the four smoking-cessation treatment provisions. Coverage for pregnant women increased in 37 states, coverage for newly eligible expansion enrollees increased in 32 states, and 15 states added coverage and/or removed copayments in order to apply for a 1% increase in the Federal Medical Assistance Percentage. Coverage for all recommended pharmacotherapy and group and individual counseling increased from seven states in 2009 to 28 states in 2017. The Affordable Care Act was successful in improving and expanding state Medicaid coverage of effective smoking-cessation treatments. Many programs are not fully compliant with the law, and additional guidance and clarification from the Centers for Medicare and Medicaid Services may be needed. Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Does Question Wording Predict Support for the Affordable Care Act? An Analysis of Polling During the Implementation Period, 2010-2016.

PubMed

Holl, Kristen; Niederdeppe, Jeff; Schuldt, Jonathon P

2018-07-01

The Patient Protection and Affordable Care Act (ACA) continues to be the subject of fierce political debate in the United States. Drawing on issue framing theory, together with research on wording effects in survey responding, we tested how common differences in the wording of ACA surveys relate to apparent public support for the law. We report on a content analysis of N = 376 U.S. national opinion surveys fielded during a more than six-year period, beginning 23 March 2010 (when President Obama signed the bill into law) and ending 8 November 2016 (Election Day), and use ordinary least squares (OLS) regression models to predict public support for the law as a function of variation in question wording. We coded questions gauging general sentiment toward the law for differences in issue labeling (e.g., Obamacare, Affordable Care Act), whether or not they referenced particular political entities (e.g., President Obama, Congress) or segments of the public (e.g., You, Your Family), various opinion metrics (e.g., Support, Favor), and different response options (e.g., Repeal, Expand) which we used to model aggregate levels of support. The results revealed several key differences in question wording-for example, generic references to the Healthcare Law were employed much more frequently than Obamacare or Affordable Care Act-a number of which reliably predicted aggregate levels of public support. The discussion considers possible explanations for these patterns and reiterates the value of attending to questionnaire design features when interpreting survey data about politically contentious health policy issues.

Availability and affordability of new medicines in Latin American countries where pivotal clinical trials were conducted.

PubMed

Homedes, Núria; Ugalde, Antonio

2015-10-01

To assess whether new pharmaceutical products approved by the United States Food and Drug Administration (FDA) in 2011 and 2012 were registered, commercialized and sold at affordable prices in the Latin American countries where they were tested. We obtained a list of new molecular entities (new pharmaceutical products) approved by the FDA in 2011 and 2012. FDA medical reviews indicated the countries where pivotal clinical trials had been conducted. The registration status of the products was obtained from pharmaceutical registers; pharmaceutical companies confirmed their availability in national markets and local pricing observatories provided the price of medicines in retail pharmacies. Affordability was assessed as the cost of a course of treatment as a proportion of monthly income. Information on safety and efficacy was gathered from independent drug bulletins. Of an expected 114 registrations, if the 33 products had been registered in all the countries where tested, only 68 (60%) were completed. Eight products were registered and commercialized in all countries but 10 had not been registered in any of the countries. With one exception, products for which we obtained pricing information ( n  = 18) cost more than the monthly minimum wage in all countries and 12 products cost at least five times the monthly minimum wage. Many pharmaceutical products tested in Latin America are unavailable and/or unaffordable to most of the population. Ethical review committees should consider the local affordability and therapeutic relevance of new products as additional criteria for the approval of clinical trials. Finally, clinical trials have opportunity costs that need to be assessed.

Total quality management in American industry.

PubMed

Widtfeldt, A K; Widtfeldt, J R

1992-07-01

The definition of total quality management is conformance to customer requirements and specifications, fitness for use, buyer satisfaction, and value at an affordable price. The three individuals who have developed the total quality management concepts in the United States are W.E. Deming, J.M. Juran, and Philip Crosby. The universal principles of total quality management are (a) a customer focus, (b) management commitment, (c) training, (d) process capability and control, and (e) measurement through quality improvement tools. Results from the National Demonstration Project on Quality Improvement in Health Care showed the principles of total quality management could be applied to healthcare.

The economics of health insurance.

PubMed

Jha, Saurabh; Baker, Tom

2012-12-01

Insurance plays an important role in the United States, most importantly in but not limited to medical care. The authors introduce basic economic concepts that make medical care and health insurance different from other goods and services traded in the market. They emphasize that competitive pricing in the marketplace for insurance leads, quite rationally, to risk classification, market segmentation, and market failure. The article serves as a springboard for understanding the basis of the reforms that regulate the health insurance market in the Patient Protection and Affordable Care Act. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

NOTES UPON AN EPIDEMIC OF FOWL CHOLERA AND UPON THE COMPARATIVE PRODUCTION OF ACID BY ALLIED BACTERIA

PubMed Central

Higgins, Charles H.

1898-01-01

(a). The bacillus isolated by me from the outbreak of choleraic diarrhœa corresponds closely in all essential particulars with that of European chicken cholera. (b). It differs, consequently, from that isolated from previous outbreaks of choleraic diarrhœa in the United States. (c). A study of the acid production by this and allied bacilli would seem to show that the amount of acid produced by so variable a microbe varies greatly and is incapable of affording a further means of distinguishing between allied forms. PMID:19866887

Case management.

PubMed

Woodward, Judy; Rice, Eve

2015-03-01

Health care in the United States is changing rapidly under pressure from both political and professional stakeholders, and one area on the front line of required change is the discipline of case management. Historically, case management has worked to defragment the health care delivery system for clients and increase access to health care. Case management will have an expanded role resulting from Affordable Care Act initiatives to improve health care. This article includes definitions of case management, current issues related to case management, case management standards of practice, and a case study of the management of pediatric chronic disease. Copyright © 2015 Elsevier Inc. All rights reserved.

Managing the Delivery of Health Care: What Can Health Care Learn From the Business Community?

PubMed

Sharan, Alok D; Millhouse, Paul W; West, Michael E; Schroeder, Gregory D; Vaccaro, Alexander R

2015-08-01

The passage of the Patient Protection and Affordable Care Act in March 2010 has resulted in dramatic changes to the delivery of health care in the United States toward a value-based system. While this is a significant change from the previous model, it presents an opportunity for high-quality health care providers to improve patient outcomes while also increasing revenue. However, those that lack a clear strategy to effectively implement change and communicate the increased value to the patients likely will suffer, regardless of how successful or prestigious they seem today.

Integrating Health and Mental Health Services: A Past and Future History.

PubMed

Druss, Benjamin G; Goldman, Howard H

2018-04-25

The authors trace the modern history, current landscape, and future prospects for integration between mental health and general medical care in the United States. Research and new treatment models developed in the 1980s and early 1990s helped inform federal legislation, including the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act, which in turn are creating new opportunities to further integrate services. Future efforts should build on this foundation to develop clinical, service-level, and public health approaches that more fully integrate mental, medical, substance use, and social services.

Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Office of Personnel Management relating to the treatment of Members of Congress and congressional staff under section 1312 of the Patient Protection and Affordable Care Act.

THOMAS, 113th Congress

Rep. McCaul, Michael T. [R-TX-10

2013-09-16

House - 09/16/2013 Referred to the Committee on House Administration, and in addition to the Committee on Oversight and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of... (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Investigating cigarette affordability in 60 cities using the cigarette price‐daily income ratio

PubMed Central

Kan, Ming‐yue

2007-01-01

Objective To investigate cigarette affordability in 60 cities. Methods Affordability of cigarettes is defined as the ratio of the price of one pack of cigarettes to daily income (cigarette price‐daily income ratio: CPDIR). Daily income data were calculated using the mean of the seven occupations with the lowest daily wage, as listed in the 2006 Union Bank of Switzerland survey; cigarette prices in 2006 were sourced from the Economist Intelligence Unit. Results Cigarette affordability in most of the surveyed cities remains high. There is a tendency for cities with high income economies to have a high level of cigarette affordability. Most of the cities in Western Europe and South and North America have high cigarette affordability, whereas 66.7% of their counterparts in Eastern Europe have medium cigarette affordability. In Asia, all cities with high cigarette affordability belong to the group of upper middle to high income economies, except for the Philippines. In Africa, Johannesburg and Nairobi have high and medium levels of cigarette affordability, respectively. Conclusion Cigarette affordability for most of the sampled cities, especially those in high income economies, is high. There is room for increasing cigarette prices via tax increases. There is a risk that the increase in cigarette prices in newly emerging economies lags behind the high speed of economic growth being experiencing. Tax increases should be given high priority. PMID:18048622

The high throughput biomedicine unit at the institute for molecular medicine Finland: high throughput screening meets precision medicine.

PubMed

Pietiainen, Vilja; Saarela, Jani; von Schantz, Carina; Turunen, Laura; Ostling, Paivi; Wennerberg, Krister

2014-05-01

The High Throughput Biomedicine (HTB) unit at the Institute for Molecular Medicine Finland FIMM was established in 2010 to serve as a national and international academic screening unit providing access to state of the art instrumentation for chemical and RNAi-based high throughput screening. The initial focus of the unit was multiwell plate based chemical screening and high content microarray-based siRNA screening. However, over the first four years of operation, the unit has moved to a more flexible service platform where both chemical and siRNA screening is performed at different scales primarily in multiwell plate-based assays with a wide range of readout possibilities with a focus on ultraminiaturization to allow for affordable screening for the academic users. In addition to high throughput screening, the equipment of the unit is also used to support miniaturized, multiplexed and high throughput applications for other types of research such as genomics, sequencing and biobanking operations. Importantly, with the translational research goals at FIMM, an increasing part of the operations at the HTB unit is being focused on high throughput systems biological platforms for functional profiling of patient cells in personalized and precision medicine projects.

Does medicaid coverage matter?: A qualitative multi-state study of abortion affordability for low-income women.

PubMed

Dennis, Amanda; Manski, Ruth; Blanchard, Kelly

2014-11-01

Medicaid is designed to ensure low-income populations can afford health care. However, not all health services are covered by the program. Most state Medicaid programs restrict abortion coverage, though a small number of state programs offer such coverage. Little is known about how low-income women are affected by differing Medicaid coverage policies regarding abortion. We conducted in depth interviews with 98 low-income women who had abortions. We found that women's impressions about abortion costs and the availability of Medicaid coverage are generally accurate and that women rely predominantly on abortion facilities for confirmatory cost and coverage information. Additionally, when abortion is out of financial reach, women and the people in their lives experience numerous emotional and financial harms. Policies that aim to ensure abortion is affordable largely prevent these harms, though the availability of Medicaid coverage does not always guarantee access to affordable care. Findings can help advance evidence-based policies

Therapeutic Affordances of Online Support Group Use in Women With Endometriosis

PubMed Central

2016-01-01

Background The Internet has provided women living with endometriosis new opportunities to seek support online. Online support groups may provide a range of therapeutic affordances that may benefit these women. Objective To examine the presence of therapeutic affordances as perceived by women who use endometriosis online support groups. Methods Sixty-nine women (aged 19-50 years, mean 34.2 years; 65.2% (45/69) United Kingdom, 21.7% (15/69) United States) participated in a Web-based interview exploring online support group use. Participants had been using online support groups for an average of 2 years and 4 months (range = 1 month to 14 years, 9 months). Responses were analyzed using inductive thematic analysis. Results The analysis revealed 4 therapeutic affordances related to online support group use: (1) “connection,” that is, the ability to connect in order to support each other, exchange advice, and to try to overcome feelings of loneliness; (2) “exploration,” that is, the ability to look for information, learn, and bolster their knowledge; (3) “narration,” that is, the ability to share their experiences, as well as read about the experiences of others; and (4) “self-presentation,” that is, the ability to manage how they present themselves online. The associated outcomes of use were predominantly positive, such as reassurance and improved coping. However, a number of negative aspects were revealed including the following: concerns about the accuracy of information, arguments between members, overreliance on the group, becoming upset by negative experiences or good news items, and confidentiality of personal information. Conclusions Our findings support the previously proposed SCENA (Self-presentation, Connection, Exploration, Narration, and Adaptation) model and reveal a range of positive aspects that may benefit members, particularly in relation to reassurance and coping. However, negative aspects need to be addressed to maximize the potential benefit of support groups. Some of these can be addressed relatively easily through making privacy policies clearer, including health professionals to moderate content, and structuring forums to encourage the sharing of positive stories. PMID:27160641

Challenges facing the United States of America in implementing universal coverage.

PubMed

Rice, Thomas; Unruh, Lynn Y; Rosenau, Pauline; Barnes, Andrew J; Saltman, Richard B; van Ginneken, Ewout

2014-12-01

In 2010, immediately before the United States of America (USA) implemented key features of the Affordable Care Act (ACA), 18% of its residents younger than 65 years lacked health insurance. In the USA, gaps in health coverage and unhealthy lifestyles contribute to outcomes that often compare unfavourably with those observed in other high-income countries. By March 2014, the ACA had substantially changed health coverage in the USA but most of its main features--health insurance exchanges, Medicaid expansion, development of accountable care organizations and further oversight of insurance companies--remain works in progress. The ACA did not introduce the stringent spending controls found in many European health systems. It also explicitly prohibits the creation of institutes--for the assessment of the cost-effectiveness of pharmaceuticals, health services and technologies--comparable to the National Institute for Health and Care Excellence in the United Kingdom of Great Britain and Northern Ireland, the Haute Autorité de Santé in France or the Pharmaceutical Benefits Advisory Committee in Australia. The ACA was--and remains--weakened by a lack of cross-party political consensus. The ACA's performance and its resulting acceptability to the general public will be critical to the Act's future.

Analytical Tools for Affordability Analysis

DTIC Science & Technology

2015-05-01

function (Womer)  Unit cost as a function of learning and rate  Learning with forgetting (Benkard)  Learning depreciates over time  Discretionary...Analytical Tools for Affordability Analysis David Tate Cost Analysis and Research Division Institute for Defense Analyses Report Documentation...ES) Institute for Defense Analyses, Cost Analysis and Research Division,4850 Mark Center Drive,Alexandria,VA,22311-1882 8. PERFORMING ORGANIZATION

76 FR 56767 - Request for Information Regarding State Flexibility To Establish a Basic Health Program Under the...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-14

... essential health benefits described in section 1302(b) of the Affordable Care Act to eligible individuals in... Affordable Care Act; (2) covers at least the essential health benefits described in section 1302(b) of the Affordable Care Act; and (3) in the case of a plan that provides health insurance coverage offered by a...

The Origination Clause, the Affordable Care Act, and Indirect Constitutional Violations.

PubMed

Dysart, Tessa L

2015-01-01

"All bills for raising revenue shall originate in the House of Representatives; but the Senate may propose or concur with amendments as on other Bills." U.S. Const. art. I, § 7, cl. 1 (Origination Clause). "As we have often noted, '[c]onstitutional rights would be of little value if they could be . . . indirectly denied.'" United States Term Limits, Inc. v. Thornton, 514 U.S. 779, 829 (1995) The Supreme Court's opinion in National Federation of Independent Business v. Sebelius, upholding the constitutionality of the Patient Protection and Affordable Care Act (ACA) as a permissible exercise of Congress's taxing power rekindled an old question about the constitutionality of the Act: Was the Act unconstitutional under the Origination Clause? The bill that became the ACA, H.R. 3590, originated in the House as the Service Members Home Ownership Tax Act of 2009. It was gutted by the Senate and replaced with the ACA before being passed and sent back to the House for final passage. The Supreme Court has heard very few cases on the Origination Clause, and Origination Clause challenges have met with little success. Most of these cases have developed over the questions of whether the bill is actually a revenue-raising bill that is constitutionally required to be originate in the House, and, if so, whether the Senate amendments were appropriate. But United States Term Limits v. Thornton provides another angle under which to examine the constitutionality of the ACA: an indirect violation of a constitutional prohibition. In this Article, I will provide an overview of the ACA's passage and analyze it through the lenses of traditional Origination Clause arguments and the Term Limits approach.

Vision Health Disparities in the United States by Race/Ethnicity, Education, and Economic Status: Findings from Two Nationally Representative Surveys

PubMed Central

Zhang, Xinzhi; Cotch, Mary Frances; Ryskulova, Asel; Primo, Susan A.; Nair, Parvathy; Chou, Chiu-Fang; Geiss, Linda S.; Barker, Lawrence; Elliott, Amanda F.; Crews, John E.; Saaddine, Jinan B.

2014-01-01

Purpose To assess vision health disparities in the United States by race/ethnicity, education, and economic status. Design Cross-sectional, nationally representative samples Methods We used national survey data from the National Health and Nutrition Examination Survey (NHANES) and the National Health Interview Survey (NHIS). Main outcome measures included, from NHANES, age-related eye diseases (i.e., age-related macular degeneration [AMD], cataract, diabetic retinopathy [DR], glaucoma) and from NHIS, eye care use (i.e., eye doctor visits and cannot afford eyeglasses when needed) among those with self-reported visual impairment. The estimates were age- and sex-standardized to the 2000 US census population. Linear trends in the estimates were assessed by weighted least squares regression. Results Non-Hispanic whites had a higher prevalence of AMD and cataract surgery than non-Hispanic blacks, but a lower prevalence of DR and glaucoma (all P < 0.001 in NHANES 2005–2008). From 1999 to 2008, individuals with less education (i.e., < high school vs. > high school) and lower income (poverty income ratio [PIR] < 1.00 vs. ≥4.00) were consistently less likely to have had an eye care visit in the past 12 months compared with their counterparts (all P < 0.05). During this period, inability to afford needed eyeglasses increased among non-Hispanic whites and Hispanics (trend P = 0.004 and P = 0.007; respectively), those with high school education (trend P = 0.036), and those with PIR 1.00–1.99 (trend P < 0.001). Conclusions Observed vision health disparities suggest a need for educational and innovative interventions among socioeconomically disadvantaged groups. PMID:23158224

California Multifamily Affordable Solar Housing Program: benefitting both owners and tenants

EPA Pesticide Factsheets

California’s Multifamily Affordable Solar Housing (MASH) program has brought solar energy to thousands of multifamily building owners and tenants across the state. Discover lessons learned through this case study.

Medical Care in a Free Clinic: A Comprehensive Evaluation of Patient Experience, Incentives, and Barriers to Optimal Medical Care with Consideration of a Facility Fee.

PubMed

Birs, Antoinette; Liu, Xinwei; Nash, Bee; Sullivan, Sara; Garris, Stephanie; Hardy, Marvin; Lee, Michael; Simms-Cendan, Judith; Pasarica, Magdalena

2016-02-19

Free and charitable clinics are important contributors to the health of the United States population. Recently, funding for these clinics has been declining, and it is, therefore, useful to identify what qualities patients value the most in clinics in an effort to allocate funding wisely. In order to identify targets and incentives for improvement of patients' health, we performed a comprehensive analysis of patients' experience at a free clinic by analyzing a patient survey (N=94). The survey also assessed patient opinions of a small facility fee, which could be used to offset the decrease in funds. Interestingly, our patients believed it is appropriate to be charged a facility fee (78%) because it increases involvement in their care (r = 0.69, p < 0.001) and self-respect (r = 0.66, p < 0.001). Incentives to medical care include continuity of care, faith-based care, having a patient medical provider partnership, and charging a facility fee. Barriers include affordable housing, transportation, medication, and accessible information. In order to improve medical care in the uninsured population, our study suggested that we need to: 1) offer continuity of medical care; 2) offer affordable preventive health screenings; 3) support affordable transportation, housing, and medications; and 4) consider including a facility fee.

Economic grand rounds: financing first-episode psychosis services in the United States.

PubMed

Goldman, Howard H; Karakus, Mustafa; Frey, William; Beronio, Kirsten

2013-06-01

Adequate financing is essential to implementing services for individuals experiencing a first episode of a psychotic illness. Recovery After an Initial Schizophrenia Episode (RAISE), a project sponsored by the National Institute of Mental Health, is providing a practical test of the implementation and effectiveness of first-episode services in real-world settings. This column describes approaches to financing early intervention services that are being used at five of 18 U.S. sites participating in a clinical trial of a team-based, multielement RAISE intervention. The authors also describe new options for financing that will become available as the Affordable Care Act (ACA) is implemented more fully. The ACA will rationalize coverage of first-episode services, but the all-important Medicaid provisions will also require individual state action to implement services optimally.

Effect of the Economic Recession on Primary Care Access for the Homeless.

PubMed

White, Brandi M; Jones, Walter J; Moran, William P; Simpson, Kit N

2016-01-01

Primary care access (PCA) for the homeless can prove challenging, especially during periods of economic distress. In the United States, the most recent recession may have presented additional barriers to accessing care. Limited safety-net resources traditionally used by the homeless may have also been used by the non-homeless, resulting in delays in seeking treatment for the homeless. Using hospitalizations for ambulatory care sensitivity (ACS) conditions as a proxy measure for PCA, this study investigated the recession's impact on PCA for the homeless and non-homeless in four states. The State Inpatient Databases were used to identify ACS admissions. Findings from this study indicate the recession was a barrier to PCA for homeless people who were uninsured. Ensuring that economically-disadvantaged populations have the ability to obtain insurance coverage is crucial to facilitating PCA. With targeted outreach efforts, the Affordable Care Act provides an opportunity for expanding coverage to the homeless.

Fair pricing law prompts most California hospitals to adopt policies to protect uninsured patients from high charges.

PubMed

Melnick, Glenn; Fonkych, Katya

2013-06-01

Millions of uninsured Americans rely on hospital emergency departments (EDs) for medical care. Throughout the United States, uninsured patients treated in or admitted to the hospital through the ED receive hospital bills based on what hospitals call "billed charges." These charges are much higher than those paid by insured patients. In 2006 California approved "fair pricing" legislation to protect uninsured patients from having to pay full billed charges. We found that by 2011 most California hospitals had responded to the law by adopting financial assistance policies to make care more affordable for the state's 6.8 million uninsured people. Ninety-seven percent of California hospitals reported that they offered free care to uninsured patients with incomes at or below 100 percent of the federal poverty level. California's approach offers a promising policy option to other states seeking to protect the uninsured from receiving bills based on full billed charges.

A new performance measurement system for maternal and child health in the United States.

PubMed

Kogan, Michael D; Dykton, Christopher; Hirai, Ashley H; Strickland, Bonnie B; Bethell, Christina D; Naqvi, Iran; Cano, Carlos E; Downing-Futrell, Sheri L; Lu, Michael C

2015-05-01

The Title V Maternal and Child Health (MCH) Block Grant is the linchpin for US MCH services. The first national performance measures (NPMs) for MCH were instituted in 1997. Changing trends in MCH risk factors, outcomes, health services, data sources, and advances in scientific knowledge, in conjunction with budgetary constraints led the Maternal and Child Health Bureau (MCHB) to design a new performance measurement system. A workgroup was formed to develop a new system. The following guiding principles were used: (1) Afford States more flexibility and reduce the overall reporting burden; (2) Improve accountability to better document Title V's impact; (3) Develop NPMs that encompass measures in: maternal and women's health, perinatal health, child health, children with special health care needs, adolescent health, and cross-cutting areas. A three-tiered performance measurement system was proposed with national outcome measures (NOMs), NPMs and evidence-based/informed strategy measures (ESMs). NOMs are the ultimate goals that MCHB and States are attempting to achieve. NPMs are measures, generally associated with processes or programs, shown to affect NOMs. ESMs are evidence-based or informed measures that each State Title V program develops to affect the NPMs. There are 15 NPMs from which States select eight, with at least one from each population area. MCHB will provide the data for the NOMs and NPMs, when possible. The new performance measurement system increases the flexibility and reduces the reporting burden for States by allowing them to choose 8 NPMs to target, and increases accountability by having States develop actionable ESMs. The new national performance measure framework for maternal and child health will allow States more flexibility to address their areas of greatest need, reduce their data reporting burden by having the Maternal and Child Health Bureau provide data for the National Outcome and Performance Measures, yet afford States the opportunity to develop measurable strategies to address their selected performance measures.

Mandatory insurance coverage and hospital productivity in Massachusetts: bending the curve?

PubMed

Thompson, Mark A; Huerta, Timothy R; Ford, Eric W

2012-01-01

The aim of this study was to examine whether universal insurance coverage mandates lead to a more productive use of hospital resources. The American Hospital Association's Annual Survey and the Centers for Medicare and Medicaid Services' case mix index for fiscal years 2005 through 2008 were used. A Malmquist approach was used to assess hospitals' productivity in the United States and Massachusetts over the sample period. Propensity score matching is used to "simulate" a randomized control group of hospitals from other markets to compare with Massachusetts. Comparisons are then made to examine if productivity differences are due to universal health insurance coverage mandate. In the early stages, Massachusetts' coverage mandates lead to a significant drop in hospitals' productivity relative to comparable facilities in other states. In 2008, Massachusetts functioned 3.53% below its 2005 level, whereas facilities across the United States have seen a 4.06% increase over the same period. If the individual mandate is implemented nationwide, the Massachusetts' experience indicates that a near-term decrease in overall hospital productivity will occur. As such, current cost estimates of the Patient Protection and Affordable Care Act's impact on overall health spending are potentially understated.

Reliability and Maintainability Engineering - A Major Driver for Safety and Affordability

NASA Technical Reports Server (NTRS)

Safie, Fayssal M.

2011-01-01

The United States National Aeronautics and Space Administration (NASA) is in the midst of an effort to design and build a safe and affordable heavy lift vehicle to go to the moon and beyond. To achieve that, NASA is seeking more innovative and efficient approaches to reduce cost while maintaining an acceptable level of safety and mission success. One area that has the potential to contribute significantly to achieving NASA safety and affordability goals is Reliability and Maintainability (R&M) engineering. Inadequate reliability or failure of critical safety items may directly jeopardize the safety of the user(s) and result in a loss of life. Inadequate reliability of equipment may directly jeopardize mission success. Systems designed to be more reliable (fewer failures) and maintainable (fewer resources needed) can lower the total life cycle cost. The Department of Defense (DOD) and industry experience has shown that optimized and adequate levels of R&M are critical for achieving a high level of safety and mission success, and low sustainment cost. Also, lessons learned from the Space Shuttle program clearly demonstrated the importance of R&M engineering in designing and operating safe and affordable launch systems. The Challenger and Columbia accidents are examples of the severe impact of design unreliability and process induced failures on system safety and mission success. These accidents demonstrated the criticality of reliability engineering in understanding component failure mechanisms and integrated system failures across the system elements interfaces. Experience from the shuttle program also shows that insufficient Reliability, Maintainability, and Supportability (RMS) engineering analyses upfront in the design phase can significantly increase the sustainment cost and, thereby, the total life cycle cost. Emphasis on RMS during the design phase is critical for identifying the design features and characteristics needed for time efficient processing, improved operational availability, and optimized maintenance and logistic support infrastructure. This paper discusses the role of R&M in a program acquisition phase and the potential impact of R&M on safety, mission success, operational availability, and affordability. This includes discussion of the R&M elements that need to be addressed and the R&M analyses that need to be performed in order to support a safe and affordable system design. The paper also provides some lessons learned from the Space Shuttle program on the impact of R&M on safety and affordability.

Considering disparities: How do nurse practitioner regulatory policies, access to care, and health outcomes vary across four states?

PubMed

Sonenberg, Andréa; Knepper, Hillary J

Health disparities persist among morbidity and mortality rates in the United States. Contributing significantly to these disparities are the ability to pay for health care (largely, access to health insurance) and access to, and capacity of, the primary care health workforce. This article examines key determinants of health (DOH) including demographics, public and regulatory policies, health workforce capacity, and primary health outcomes of four states of the United States. The context of this study is the potential association among health care disparities and myriad DOH, among them, the restrictive nurse practitioner (NP) scope of practice (SOP) regulatory environment, which are documented to influence access to care and health outcomes. This descriptive study explores current NP SOP regulations, access to primary care, and health outcomes of key chronic disease indicators-diabetes, hypertension, and obesity in Alabama, Colorado, Mississippi, and Utah. These states represent both the greatest disparity in chronic disease health outcomes (obesity, diabetes, and hypertension) and the greatest difference in modernization of their NP SOP laws. The Affordable Care Act has greatly expanded access to health care. However, it is estimated that 23 million Americans, 7% of its total population, will remain uninsured by 2019. Restrictive and inconsistent NP SOP policies may continue to contribute to health workforce capacity and population health disparities across the country, with particular concern for primary care indicators. The study findings bring into question whether states with more restrictive NP SOP regulations impact access to primary care, which may in turn influence population health outcomes. These findings suggest the need for further research. NPs are essential for meeting the increasing demands of primary care in the United States, and quality-of-care indicator research supports their use. Copyright © 2016 Elsevier Inc. All rights reserved.

Affordance of Participation Rights for Children in Home-Based Education and Care: An Interactive Process Model of Participation--2007

ERIC Educational Resources Information Center

Layland, Judy

2010-01-01

Recent models relating to the affordance of children's participation rights, based on articles 12 and 13 of the United Nations Convention on the Rights Of the Child (1989), have focused on the role of and strategies used by the adults working with children ("Children and Society" 10, 2001: 107-117; "Children and Society" 20,…

Cooperative Extension as a Framework for Health Extension: The Michigan State University Model.

PubMed

Dwyer, Jeffrey W; Contreras, Dawn; Eschbach, Cheryl L; Tiret, Holly; Newkirk, Cathy; Carter, Erin; Cronk, Linda

2017-10-01

The Affordable Care Act charged the Agency for Healthcare Research and Quality to create the Primary Care Extension Program, but did not fund this effort. The idea to work through health extension agents to support health care delivery systems was based on the nationally known Cooperative Extension System (CES). Instead of creating new infrastructure in health care, the CES is an ideal vehicle for increasing health-related research and primary care delivery. The CES, a long-standing component of the land-grant university system, features a sustained infrastructure for providing education to communities. The Michigan State University (MSU) Model of Health Extension offers another means of developing a National Primary Care Extension Program that is replicable in part because of the presence of the CES throughout the United States. A partnership between the MSU College of Human Medicine and MSU Extension formed in 2014, emphasizing the promotion and support of human health research. The MSU Model of Health Extension includes the following strategies: building partnerships, preparing MSU Extension educators for participation in research, increasing primary care patient referrals and enrollment in health programs, and exploring innovative funding. Since the formation of the MSU Model of Health Extension, researchers and extension professionals have made 200+ connections, and grants have afforded savings in salary costs. The MSU College of Human Medicine and MSU Extension partnership can serve as a model to promote health partnerships nationwide between CES services within land-grant universities and academic health centers or community-based medical schools.

Harnessing Private-Sector Innovation to Improve Health Insurance Exchanges

PubMed Central

Gresenz, Carole Roan; Hoch, Emily; Eibner, Christine; Rudin, Robert S.; Mattke, Soeren

2016-01-01

Abstract Overhauling the individual health insurance market—including through the creation of health insurance exchanges—was a key component of the Patient Protection and Affordable Care Act's multidimensional approach to addressing the long-standing problem of the uninsured in the United States. Despite succeeding in enrolling millions of Americans, the exchanges still face several challenges, including poor consumer experience, high operational and development costs, and incomplete market penetration. In light of these challenges, analysts considered a different model for the exchanges—privately facilitated exchanges—which could address these challenges and deepen the Affordable Care Act's impact. In this model, the government retains control over sovereign exchange functions but allows the private sector to assume responsibility for more-peripheral exchange functions, such as developing and sustaining exchange websites. Although private-sector entities have already undertaken exchange-related functions on a limited basis, privately facilitated exchanges could conceivably relieve the government of its responsibility for front-end website operations and consumer decision-support functions entirely. A shift to privately facilitated exchanges could improve the consumer experience, increase enrollment, and lower costs for state and federal governments. A move to such a model requires, nonetheless, managing its risks, such as reduced consumer protection, increased consumer confusion, and the possible lack of a viable revenue base for privately facilitated exchanges, especially in less populous states. On net, the benefits are large enough and the risks sufficiently manageable to seriously consider such a shift. This paper provides background information and more detail on the analysts' assessment. PMID:28083414

Harnessing Private-Sector Innovation to Improve Health Insurance Exchanges.

PubMed

Gresenz, Carole Roan; Hoch, Emily; Eibner, Christine; Rudin, Robert S; Mattke, Soeren

2016-05-09

Overhauling the individual health insurance market-including through the creation of health insurance exchanges-was a key component of the Patient Protection and Affordable Care Act's multidimensional approach to addressing the long-standing problem of the uninsured in the United States. Despite succeeding in enrolling millions of Americans, the exchanges still face several challenges, including poor consumer experience, high operational and development costs, and incomplete market penetration. In light of these challenges, analysts considered a different model for the exchanges-privately facilitated exchanges-which could address these challenges and deepen the Affordable Care Act's impact. In this model, the government retains control over sovereign exchange functions but allows the private sector to assume responsibility for more-peripheral exchange functions, such as developing and sustaining exchange websites. Although private-sector entities have already undertaken exchange-related functions on a limited basis, privately facilitated exchanges could conceivably relieve the government of its responsibility for front-end website operations and consumer decision-support functions entirely. A shift to privately facilitated exchanges could improve the consumer experience, increase enrollment, and lower costs for state and federal governments. A move to such a model requires, nonetheless, managing its risks, such as reduced consumer protection, increased consumer confusion, and the possible lack of a viable revenue base for privately facilitated exchanges, especially in less populous states. On net, the benefits are large enough and the risks sufficiently manageable to seriously consider such a shift. This paper provides background information and more detail on the analysts' assessment.

Committee Opinion No. 574: Marriage equality for same-sex couples.

PubMed

2013-09-01

Same-sex couples encounter barriers to health care that include concerns about confidentiality and disclosure, stigma and discriminatory attitudes and treatment, limited access to health care and health insurance, and often a limited understanding of their health risks. Same-sex couples and their families are adversely affected by the lack of legal recognition of their relationships, a problem with major implications for the health of same-sex couples and their families. Tangible harm has come from the lack of financial and health care protections granted to legal spouses, and children are harmed by the lack of protections afforded to families in which partners are married. However, the recent Supreme Court ruling, The United States v Windsor, which afforded equal treatment for legally married same-sex couples will provide many important health and financial benefits. Evidence suggests that marriage confers health benefits to individuals and families, yet a sizable proportion of individuals do not experience these health benefits because of their sexual orientation. Additional data suggest that same-sex couples who live in states with bans on same-sex unions experience adverse health outcomes. Civil marriage is currently available to same-sex couples in only thirteen states and the District of Columbia and honored by one state. The American College of Obstetricians and Gynecologists endorses marriage equality for same-sex couples and equal treatment for these couples and their families and applauds the Supreme Court's decision as an important step in improving access to benefits received by legally married same-sex couples. However, additional efforts are necessary to ensure that same-sex couples in every state can receive these same benefits.

Trends and affordability of cigarette prices: ample room for tax increases and related health gains

PubMed Central

Guindon, G; Tobin, S; Yach, D

2002-01-01

Objectives: To compare cigarette price data from more than 80 countries using varying methods, examine trends in prices and affordability during the 1990s, and explore various policy implications pertaining to tobacco prices. Design: March 2001 cigarette price data from the Economist Intelligence Unit are used to compare cigarette prices across countries. To facilitate comparison and to assess affordability, prices are presented in US dollars, purchasing power parity (PPP) units using the Big Mac index as an indicator of PPP and in terms of minutes of labour required to purchase a pack of cigarettes. Annual real percentage changes in cigarette prices between 1990 and 2000 and annual changes in the minutes of labour required to buy cigarettes between 1991 and 2000 are also calculated to examine trends. Results: Cigarette prices tend to be higher in wealthier countries and in countries that have strong tobacco control programmes. On the other hand, minutes of labour required to purchase cigarettes vary vastly between countries. Trends between 1990 and 2000 in real prices and minutes of labour indicate, with some exceptions, that cigarettes have become more expensive in most developed countries but more affordable in many developing countries. However, in the UK, despite recent increases in price, cigarettes are still more affordable than they were in the 1960s. Conclusions: The results suggest that there is ample room to increase tobacco prices through taxation. In too many countries, cigarette prices have failed to keep up with increases in the general price level of goods and services, rendering them more affordable in 2000 than they were at the beginning of the decade. Opportunities to increase government revenue and improve health through reduced consumption brought about by higher prices have been overlooked in many countries. PMID:11891366

Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation.

PubMed

Rees, M A; Dunn, T B; Kuhr, C S; Marsh, C L; Rogers, J; Rees, S E; Cicero, A; Reece, L J; Roth, A E; Ekwenna, O; Fumo, D E; Krawiec, K D; Kopke, J E; Jain, S; Tan, M; Paloyo, S R

2017-03-01

Organ shortage is the major limitation to kidney transplantation in the developed world. Conversely, millions of patients in the developing world with end-stage renal disease die because they cannot afford renal replacement therapy-even when willing living kidney donors exist. This juxtaposition between countries with funds but no available kidneys and those with available kidneys but no funds prompts us to propose an exchange program using each nation's unique assets. Our proposal leverages the cost savings achieved through earlier transplantation over dialysis to fund the cost of kidney exchange between developed-world patient-donor pairs with immunological barriers and developing-world patient-donor pairs with financial barriers. By making developed-world health care available to impoverished patients in the developing world, we replace unethical transplant tourism with global kidney exchange-a modality equally benefitting rich and poor. We report the 1-year experience of an initial Filipino pair, whose recipient was transplanted in the United states with an American donor's kidney at no cost to him. The Filipino donor donated to an American in the United States through a kidney exchange chain. Follow-up care and medications in the Philippines were supported by funds from the United States. We show that the logistical obstacles in this approach, although considerable, are surmountable. © 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.

Patient Protection and Affordable Care Act; standards related to reinsurance, risk corridors, and risk adjustment. Final rule.

PubMed

2012-03-23

This final rule implements standards for States related to reinsurance and risk adjustment, and for health insurance issuers related to reinsurance, risk corridors, and risk adjustment consistent with title I of the Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. These programs will mitigate the impact of potential adverse selection and stabilize premiums in the individual and small group markets as insurance reforms and the Affordable Insurance Exchanges ("Exchanges") are implemented, starting in 2014. The transitional State-based reinsurance program serves to reduce uncertainty by sharing risk in the individual market through making payments for high claims costs for enrollees. The temporary Federally administered risk corridors program serves to protect against uncertainty in rate setting by qualified health plans sharing risk in losses and gains with the Federal government. The permanent State-based risk adjustment program provides payments to health insurance issuers that disproportionately attract high-risk populations (such as individuals with chronic conditions).

Student Flow Analysis: CSU Student Progress toward Graduation. Report to the California State University as Part of the "Making Opportunity Affordable" Planning Year

ERIC Educational Resources Information Center

Institute for Higher Education Leadership & Policy, 2009

2009-01-01

The CSU (California State University) Chancellor's Office received a grant from the Lumina Foundation to engage in a year of planning activities to increase productivity within the CSU system. The grant is part of the Making Opportunity Affordable (MOA) initiative of the Lumina Foundation that is aimed at improving higher education productivity…

Availability and affordability of new medicines in Latin American countries where pivotal clinical trials were conducted

PubMed Central

Ugalde, Antonio

2015-01-01

Abstract Objective To assess whether new pharmaceutical products approved by the United States Food and Drug Administration (FDA) in 2011 and 2012 were registered, commercialized and sold at affordable prices in the Latin American countries where they were tested. Methods We obtained a list of new molecular entities (new pharmaceutical products) approved by the FDA in 2011 and 2012. FDA medical reviews indicated the countries where pivotal clinical trials had been conducted. The registration status of the products was obtained from pharmaceutical registers; pharmaceutical companies confirmed their availability in national markets and local pricing observatories provided the price of medicines in retail pharmacies. Affordability was assessed as the cost of a course of treatment as a proportion of monthly income. Information on safety and efficacy was gathered from independent drug bulletins. Findings Of an expected 114 registrations, if the 33 products had been registered in all the countries where tested, only 68 (60%) were completed. Eight products were registered and commercialized in all countries but 10 had not been registered in any of the countries. With one exception, products for which we obtained pricing information (n = 18) cost more than the monthly minimum wage in all countries and 12 products cost at least five times the monthly minimum wage. Conclusion Many pharmaceutical products tested in Latin America are unavailable and/or unaffordable to most of the population. Ethical review committees should consider the local affordability and therapeutic relevance of new products as additional criteria for the approval of clinical trials. Finally, clinical trials have opportunity costs that need to be assessed. PMID:26600609

Healthcare reform in the United States and China: pharmaceutical market implications.

PubMed

Daemmrich, Arthur; Mohanty, Ansuman

2014-01-01

The United States and China are broadening health insurance coverage and increasing spending on pharmaceuticals, in contrast to other major economies that are reducing health spending and implementing a variety of drug price controls. This article analyzes the implications of health system reforms in the United States and China for national pharmaceutical markets. It follows a historical institutionalist approach that identifies path dependency in the design and operation of national health systems. On that basis, we estimate prescription sales for 2015 and 2020, analyze the sustainability of free-market pricing for drugs in the two countries, and assess future competitive dynamics in the pharmaceutical sector. The institutional trajectories of health system reform and insurance coverage were studied for the United States and China. Next, data were collected from government, industry, and analyst reports on total healthcare spending and prescription drug expenditure by insurance status (in the United States) and by site of care (in China). Simple quantitative models were developed to estimate future drug spending based on insurance coverage, treatment locations, and health spending as a percentage of GDP. Both countries will see rising total pharmaceutical spending and will be the two largest country markets for prescription drugs through at least 2020. In dollar terms, the U.S. pharmaceutical market will be over $440 billion in 2015 and $700 billion in 2020; China's prescription market will be over $155 billion in 2015 and grow further to $260 billion in 2020. In both countries, generics will increase their share of all prescriptions, but economic and structural incentives for new drug invention and brand-name prescribing by physicians will keep the share of patented drug sales high compared to countries with more direct government control over the pharmaceutical market. Expanding private insurance contributes to spending on branded drugs, since insurers compete for market share rather than cost savings. Health system reforms presently being enacted in the United States and China align to historical institutional trajectories in each country, but leave unresolved a core tension between incentives for new drug invention and universal access to affordable medicines.

The Impact of the Affordable Care Act on Funding for Newborn Screening Services.

PubMed

Costich, Julia F; Durst, Andrea L

2016-01-01

The Affordable Care Act requires most health plans to cover the federal Recommended Uniform Screening Panel of newborn screening (NBS) tests with no cost sharing. However, state NBS programs vary widely in both the number of mandated tests and their funding mechanisms, including a combination of state laboratory fees, third-party billing, and other federal and state funding. We assessed the potential impact of the Affordable Care Act coverage mandate on states' NBS funding. We performed an extensive review of the refereed literature, federal and state agency reports, relevant organizations' websites, and applicable state laws and regulations; interviewed 28 state and federal officials from August to December 2014; and then assessed the interview findings manually. Although a majority of states had well-established systems for including laboratory-based NBS tests in bundled charges for newborn care, billing practices for critical congenital heart disease and newborn hearing tests were less uniform. Most commonly, birthing facilities either prepaid the costs of laboratory-based tests when acquiring the filter paper kits, or the facilities paid for the tests when the kits were submitted. Some states had separate arrangements for billing Medicaid, and smaller facilities sometimes contracted with hearing test vendors that billed families separately. Although the Affordable Care Act coverage mandate may offset some state NBS funding for the screenings themselves, federal support is still required to assure access to the full range of NBS program services. Limiting reimbursement to the costs of screening tests alone would undermine the common practice of using screening charges to fund follow-up services counseling, and medical food or formula, particularly for low-income families.

The U.S. Health Care Crisis Five Years After Passage of the Affordable Care Act: A Data Snapshot.

PubMed

Hellander, Ida

2015-01-01

Despite passage of the Affordable Care Act in 2010, the U.S. health care crisis continues. While coverage has been expanded, the reform will leave 27 million people uninsured in 2024, according to the Congressional Budget Office. Much of the new coverage is of low actuarial value with high cost-sharing requirements, creating barriers to access. Choice of physician is restricted to narrow networks of providers. Recent measures of uninsurance, underinsurance, access to care, and health care costs are given. Changes in Medicare, particularly privatization and the rise of specialty drug tiers that limit access to medically necessary medications, are reviewed. Data on a new wave of consolidation among hospitals, medical groups, insurers, and drug companies are presented. The rise of ultra-high-price drugs, such as Solvadi, is raising pharmaceutical costs, particularly in Medicaid, the program for low-income Americans. International health comparisons continue to show the United States performing poorly in relation to other countries. Recent polling data are presented, showing support for more fundamental reform. © The Author(s) 2015.

Perylene bisimide hydrogels and lyotropic liquid crystals with temperature-responsive color change† †Electronic supplementary information (ESI) available: Detailed procedures and results for all reported experiments, along with synthetic details for PBI 1. See DOI: 10.1039/c6sc02249a Click here for additional data file.

PubMed Central

Görl, Daniel; Soberats, Bartolome; Herbst, Stefanie; Stepanenko, Vladimir

2016-01-01

The self-assembly of perylene bisimide (PBI) dyes bearing oligo ethylene glycol (OEG) units in water affords responsive functional nanostructures characterized by their lower critical solution temperature (LCST). Tuning of the LCST is realized by a supramolecular approach that relies on two structurally closely related PBI–OEG molecules. The two PBIs socially co-assemble in water and the resulting nanostructures exhibit a single LCST in between the transition temperatures of the aggregates formed by single components. This permits to precisely tune the transition from a hydrogel to a lyotropic liquid crystal state at temperatures between 26 and 51 °C by adjusting the molar fraction of the two PBIs. Owing to concomitant changes in PBI–PBI interactions this phase transition affords a pronounced color change with “fluorescence-on” response that can be utilized as a smart temperature sensory system. PMID:28451124

Critical Anthropology of Global Health "takes a stand" statement: a critical medical anthropological approach to the U.S.'s Affordable Care Act.

PubMed

Horton, Sarah; Abadía, Cesar; Mulligan, Jessica; Thompson, Jennifer Jo

2014-03-01

The Affordable Care Act (ACA) of 2010--the U.S.'s first major health care reform in over half a century-has sparked new debates in the United States about individual responsibility, the collective good, and the social contract. Although the ACA aims to reduce the number of the uninsured through the simultaneous expansion of the private insurance industry and government-funded Medicaid, critics charge it merely expands rather than reforms the existing fragmented and costly employer-based health care system. Focusing in particular on the ACA's individual mandate and its planned Medicaid expansion, this statement charts a course for ethnographic contributions to the on-the-ground impact of the ACA while showcasing ways critical medical anthropologists can join the debate. We conclude with ways that anthropologists may use critiques of the ACA as a platform from which to denaturalize assumptions of "cost" and "profit" that underpin the global spread of market-based medicine more broadly. © 2014 by the American Anthropological Association.

Applying Expectancy Theory to residency training: proposing opportunities to understand resident motivation and enhance residency training

PubMed Central

Shweiki, Ehyal; Martin, Niels D; Beekley, Alec C; Jenoff, Jay S; Koenig, George J; Kaulback, Kris R; Lindenbaum, Gary A; Patel, Pankaj H; Rosen, Matthew M; Weinstein, Michael S; Zubair, Muhammad H; Cohen, Murray J

2015-01-01

Medical resident education in the United States has been a matter of national priority for decades, exemplified initially through the Liaison Committee for Graduate Medical Education and then superseded by the Accreditation Council for Graduate Medical Education. A recent Special Report in the New England Journal of Medicine, however, has described resident educational programs to date as prescriptive, noting an absence of innovation in education. Current aims of contemporary medical resident education are thus being directed at ensuring quality in learning as well as in patient care. Achievement and work-motivation theories attempt to explain people’s choice, performance, and persistence in tasks. Expectancy Theory as one such theory was reviewed in detail, appearing particularly applicable to surgical residency training. Correlations between Expectancy Theory as a work-motivation theory and residency education were explored. Understanding achievement and work-motivation theories affords an opportunity to gain insight into resident motivation in training. The application of Expectancy Theory in particular provides an innovative perspective into residency education. Afforded are opportunities to promote the development of programmatic methods facilitating surgical resident motivation in education. PMID:25995656

Applying Expectancy Theory to residency training: proposing opportunities to understand resident motivation and enhance residency training.

PubMed

Shweiki, Ehyal; Martin, Niels D; Beekley, Alec C; Jenoff, Jay S; Koenig, George J; Kaulback, Kris R; Lindenbaum, Gary A; Patel, Pankaj H; Rosen, Matthew M; Weinstein, Michael S; Zubair, Muhammad H; Cohen, Murray J

2015-01-01

Medical resident education in the United States has been a matter of national priority for decades, exemplified initially through the Liaison Committee for Graduate Medical Education and then superseded by the Accreditation Council for Graduate Medical Education. A recent Special Report in the New England Journal of Medicine, however, has described resident educational programs to date as prescriptive, noting an absence of innovation in education. Current aims of contemporary medical resident education are thus being directed at ensuring quality in learning as well as in patient care. Achievement and work-motivation theories attempt to explain people's choice, performance, and persistence in tasks. Expectancy Theory as one such theory was reviewed in detail, appearing particularly applicable to surgical residency training. Correlations between Expectancy Theory as a work-motivation theory and residency education were explored. Understanding achievement and work-motivation theories affords an opportunity to gain insight into resident motivation in training. The application of Expectancy Theory in particular provides an innovative perspective into residency education. Afforded are opportunities to promote the development of programmatic methods facilitating surgical resident motivation in education.

Nuclear Thermal Propulsion

NASA Technical Reports Server (NTRS)

Mitchell, Sonny; Houts, Michael G.; Kim, Tony

2015-01-01

Development efforts in the United States for nuclear thermal propulsion (NTP) systems began with Project Rover (1955-1973) which completed 22 high-power rocket reactor tests. Results indicated that an NTP system with a high thrust-to-weight ratio and a specific impulse greater than 900 s would be feasible. John F. Kennedy, in his historic special address to Congress on the importance of Space on May 25, 1961, said, "First, I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the Moon and returning him safely to the Earth..." This was accomplished. He also said, "Secondly ... accelerate development of the Rover nuclear rocket. This gives promise of someday providing a means for even more exciting and ambitious exploration of space... to the very end of the solar system itself." The current NTP project focuses on demonstrating the affordability and viability of a fully integrated NTP system with emphasis on fuel fabrication and testing and an affordable development and qualification strategy. The goal is to enable NTP to be considered a mainstream option for supporting human Mars and other missions beyond Earth orbit.

Humans and robots: hand in grip.

PubMed

Hubbard, G Scott

2005-01-01

As we move boldly forward into the 21st century, there has rarely been a more exciting time in which to contemplate the future of space exploration. The President of the United States has made a new and ambitious commitment to exploration of the solar system and beyond. Robotic partners will play a vital role in ensuring that the Vision is truly "sustainable and affordable". Relevant science and technology will be discussed with particular emphasis on expertise from NASA Ames Research Center of which the author is Director. The likely evolution of the balance between human explorers and robotic explorers will be addressed. c2005 Published by Elsevier Ltd.

Increasing Receipt of Women's Preventive Services

PubMed Central

Fox, Jared

2015-01-01

Abstract The receipt of clinical preventive services is important for health promotion and prevention of illness, death, and disability for women in the United States. Today, the Affordable Care Act makes a variety of evidence-based preventive services available with no out-of-pocket cost to women with certain health insurance plans. Nevertheless, available service receipt data suggest receipt of the services for all American adults remains suboptimal. This article seeks to raise awareness about the critical gaps in the delivery of preventive services to women and highlight opportunities for women, primary care providers, and public health professionals to increase receipt of clinical preventive services among women. PMID:26447836

Legal consciousness and LGBT research: the role of the law in the everyday lives of LGBT individuals.

PubMed

Knauer, Nancy J

2012-01-01

The law occupies a prominent place in the everyday lives of lesbian, gay, bisexual, and transgender (LGBT) individuals, and the continuing regulation and policing of sexuality and gender weighs heavily on many people who identify as LGBT. Despite remarkable progress in the area of LGBT civil rights, LGBT individuals in the United States still lack formal equality and are denied many of the protections that are afforded other historically disadvantaged groups. These legal disabilities represent an ongoing source of minority stress and can produce a correspondingly high degree of legal consciousness within the LGBT community.

Costs of novel tuberculosis diagnostics--will countries be able to afford it?

PubMed

Pantoja, Andrea; Kik, Sandra V; Denkinger, Claudia M

2015-04-01

Four priority target product profiles for the development of diagnostic tests for tuberculosis were identified: 1) Rapid sputum-based (RSP), 2) non-sputum Biomarker-based (BMT), 3) triage test followed by confirmatory test (TT), and 4) drug-susceptibility testing (DST). We assessed the cost of the new tests in suitable strategies and of the conventional diagnosis of tuberculosis as per World Health Organization guidelines, in 36 high tuberculosis and MDR burden countries. Costs were then compared to the available funding for tuberculosis at country level. Costs of diagnosing tuberculosis using RSP ranged US$93-187 million/year; if RSP unit cost is of US$2-4 it would be lower/similar cost than conventional strategy with sputum smear microscopy (US$ 119 million/year). Using BMT (with unit cost of US$2-4) would cost US$70-121 million/year and be lower/comparable cost than conventional diagnostics. Using TT with TPP characteristics (unit cost of US$1-2) followed by Xpert would reduce diagnostic costs up to US$36 million/year. Costs of using different novel DST strategies for the diagnosis of drug resistance would be higher compared with conventional diagnosis. Introducing a TT or a biomarker test with optimal characteristics would be affordable from a cost and affordability perspective at the current available funding for tuberculosis. Additional domestic or donor funding would be needed in most countries to achieve affordability for other new diagnostic tests. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Will the Australia-United States Free Trade Agreement undermine the Pharmaceutical Benefits Scheme?

PubMed

Harvey, Ken J; Faunce, Thomas A; Lokuge, Buddhima; Drahos, Peter

2004-09-06

The Australia-United States Free Trade Agreement (AUSFTA) contains major concessions to the US pharmaceutical industry that may undermine the egalitarian principles and operation of the Pharmaceutical Benefits Scheme (PBS) and substantially increase the costs of medicinal drugs to Australian consumers. AUSFTA's approach to the PBS excessively emphasises the need to reward manufacturers of "innovative" new pharmaceuticals, instead of emphasising consumers' need for equitable and affordable access to necessary medicines (the first principle of our National Medicines Policy). Several features of AUSFTA may bring pressure to bear on the Pharmaceutical Benefits Advisory Committee (PBAC) to list "innovative" drugs that the committee initially rejected because the evidence for cost-effectiveness was not compelling. Intellectual property provisions of AUSFTA are likely to delay the entry of PBS cost-reducing generic products when pharmaceutical patents expire. We support the many concerned health and consumer organisations who have asked the Senate either not to pass the enabling legislation, or to delay its passage until a fairer deal in terms of public health can be obtained.

Light Water Reactor Sustainability Program Integrated Program Plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

McCarthy, Kathryn A.; Busby, Jeremy; Hallbert, Bruce

2014-04-01

Nuclear power has safely, reliably, and economically contributed almost 20% of electrical generation in the United States over the past two decades. It remains the single largest contributor (more than 70%) of non-greenhouse-gas-emitting electric power generation in the United States. Domestic demand for electrical energy is expected to experience a 31% growth from 2009 to 2035. At the same time, most of the currently operating nuclear power plants will begin reaching the end of their initial 20-year extension to their original 40-year operating license for a total of 60 years of operation. Figure E-1 shows projected nuclear energy contribution tomore » the domestic generating capacity. If current operating nuclear power plants do not operate beyond 60 years, the total fraction of generated electrical energy from nuclear power will begin to decline—even with the expected addition of new nuclear generating capacity. The oldest commercial plants in the United States reached their 40th anniversary in 2009. The U.S. Department of Energy Office of Nuclear Energy’s Research and Development Roadmap (Nuclear Energy Roadmap) organizes its activities around four objectives that ensure nuclear energy remains a compelling and viable energy option for the United States. The four objectives are as follows: (1) develop technologies and other solutions that can improve the reliability, sustain the safety, and extend the life of the current reactors; (2) develop improvements in the affordability of new reactors to enable nuclear energy to help meet the Administration’s energy security and climate change goals; (3) develop sustainable nuclear fuel cycles; and (4) understand and minimize the risks of nuclear proliferation and terrorism. The Light Water Reactor Sustainability (LWRS) Program is the primary programmatic activity that addresses Objective 1. This document summarizes the LWRS Program’s plans.« less

Health insurance premium increases for the 5 largest school districts in the United States, 2004-2008.

PubMed

Cantillo, John R

2010-03-01

Local school districts are often one of the largest, if not the largest, employers in their respective communities. Like many large employers, school districts offer health insurance to their employees. There is a lack of information about the rate of health insurance premiums in US school districts relative to other employers. To assess the change in the costs of healthcare insurance in the 5 largest public school districts in the United States, between 2004 and 2008, as representative of large public employers in the country. Data for this study were drawn exclusively from a survey sent to the 5 largest public school districts in the United States. The survey requested responses on 3 data elements for each benefit plan offered from 2004 through 2008; these included enrollment, employee costs, and employer costs. The premium growth for the 5 largest school districts has slowed down and is consistent with other purchasers-Kaiser/Health Research & Educational Trust and the Federal Employee Health Benefit Program. The average increase in health insurance premium for the schools was 5.9% in 2008, and the average annual growth rate over the study period was 7.5%. For family coverage, these schools provide the most generous employer contribution (80.8%) compared with the employer contribution reported by other employers (73.5%) for 2008. Often the largest employers in their communities, school districts demonstrate a commitment to provide choice of benefits and affordability for employees and their families. Despite constraints typical of public employers, the 5 largest school districts in the United States have decelerated in premium growth consistent with other purchasers, albeit at a slower pace.

Health Insurance Premium Increases for the 5 Largest School Districts in the United States, 2004–2008

PubMed Central

Cantillo, John R.

2010-01-01

Background Local school districts are often one of the largest, if not the largest, employers in their respective communities. Like many large employers, school districts offer health insurance to their employees. There is a lack of information about the rate of health insurance premiums in US school districts relative to other employers. Objective To assess the change in the costs of healthcare insurance in the 5 largest public school districts in the United States, between 2004 and 2008, as representative of large public employers in the country. Methods Data for this study were drawn exclusively from a survey sent to the 5 largest public school districts in the United States. The survey requested responses on 3 data elements for each benefit plan offered from 2004 through 2008; these included enrollment, employee costs, and employer costs. Results The premium growth for the 5 largest school districts has slowed down and is consistent with other purchasers—Kaiser/Health Research & Educational Trust and the Federal Employee Health Benefit Program. The average increase in health insurance premium for the schools was 5.9% in 2008, and the average annual growth rate over the study period was 7.5%. For family coverage, these schools provide the most generous employer contribution (80.8%) compared with the employer contribution reported by other employers (73.5%) for 2008. Conclusions Often the largest employers in their communities, school districts demonstrate a commitment to provide choice of benefits and affordability for employees and their families. Despite constraints typical of public employers, the 5 largest school districts in the United States have decelerated in premium growth consistent with other purchasers, albeit at a slower pace. PMID:25126311

Establishing hospice care for prison populations: An integrative review assessing the UK and USA perspective.

PubMed

Stone, Katie; Papadopoulos, Irena; Kelly, Daniel

2012-12-01

models of care based on the hospice model have delivered effective support to dying people since their inception. Over the last 20 years this form of care has also been introduced into the prison system (mainly in the United States) to afford terminally ill inmates the right to die with dignity. the aim of this review is to examine the evidence from the United States and the United Kingdom on the promotion of palliative care in the prison sector, summarizing examples of good practice and identifying barriers for the provision of end-of-life care within the prison environment both in the USA and UK. an integrative review design was adopted using the Green et al. model incorporating theoretical and scientific lines of enquiry. literature was sourced from six electronic databases between the years 2000 and 2011; the search rendered both qualitative and quantitative papers, discussion papers, 'grey literature' and other review articles. the results highlight a number of issues surrounding the implementation of palliative care services within the prison setting and emphasize the disparity between the USA model of care (which emphasizes the in-prison hospice) and the UK model of care (which emphasizes palliative care in-reach) for dying prisoners. the provision of palliative care for the increasing prison population remains under-researched globally, with a notable lack of evidence from the United Kingdom.

Processor Units Reduce Satellite Construction Costs

NASA Technical Reports Server (NTRS)

2014-01-01

As part of the effort to build the Fast Affordable Science and Technology Satellite (FASTSAT), Marshall Space Flight Center developed a low-cost telemetry unit which is used to facilitate communication between a satellite and its receiving station. Huntsville, Alabama-based Orbital Telemetry Inc. has licensed the NASA technology and is offering to install the cost-cutting units on commercial satellites.

Patient Protection and Affordable Care Act Medicaid expansion and gains in health insurance coverage and access among cancer survivors.

PubMed

Nikpay, Sayeh S; Tebbs, Margaret G; Castellanos, Emily H

2018-04-17

The Patient Protection and Affordable Care Act extends Medicaid coverage to millions of low-income adults, including many survivors of cancer who were unable to purchase affordable health insurance coverage in the individual health insurance market. Using data from the 2011 to 2015 Behavioral Risk Factor Surveillance System, the authors compared changes in coverage and health care access measures for low-income cancer survivors in states that did and did not expand Medicaid. The study population of 17,381 individuals included adults aged 18 to 64 years, and was predominantly female, white, and unmarried. The authors found a relative reduction in the uninsured rate of 11.7 percentage points and a relative increase in the probability of having a personal physician of 5.8 percentage points. Stratifying by whether states expanded Medicaid by 2015, the authors found that relative gains in coverage and access were larger among those individuals residing in states with expanded Medicaid compared with those residing in nonexpansion states. The results of the current study suggest that the Patient Protection and Affordable Care Act Medicaid expansion has improved coverage and access for cancer survivors. Cancer 2018. © 2018 American Cancer Society. © 2018 American Cancer Society.

Availability of tobacco cessation services in substance use disorder treatment programs: Impact of state tobacco control policy.

PubMed

Abraham, Amanda J; Bagwell-Adams, Grace; Jayawardhana, Jayani

2017-08-01

Given the high prevalence of smoking among substance use disorder (SUD) patients, the specialty SUD treatment system is an important target for adoption and implementation of tobacco cessation (TC) services. While research has addressed the impact of tobacco control on individual tobacco consumption, largely overlooked in the literature is the potential impact of state tobacco control policies on availability of services for tobacco cessation. This paper examines the association between state tobacco control policy and availability of TC services in SUD treatment programs in the United States. State tobacco control and state demographic data (n=51) were merged with treatment program data from the 2012 National Survey of Substance Abuse Treatment Services (n=10.413) to examine availability of TC screening, counseling and pharmacotherapy services in SUD treatment programs using multivariate logistic regression models clustered at the state-level. Approximately 60% of SUD treatment programs offered TC screening services, 41% offered TC counseling services and 26% offered TC pharmacotherapy services. Results of multivariate logistic regression showed the odds of offering TC services were greater for SUD treatment programs located in states with higher cigarette excise taxes and greater spending on tobacco prevention and control. Findings indicate cigarette excise taxes and recommended funding levels may be effective policy tools for increasing access to TC services in SUD treatment programs. Coupled with changes to insurance coverage for TC under the Affordable Care Act, state tobacco control policy tools may further reduce tobacco use in the United States. Published by Elsevier Ltd.

From policy to practice in the Affordable Care Act: Training center for New York State's health insurance programs.

PubMed

Selwyn, Casey; Senter, Lindsay

2016-09-01

The United States currently faces the large, logistical undertaking of enrolling millions of Americans into a complex Affordable Care Act (ACA) system within a short period of time. One way states have addressed this implementation challenge is through the development of consumer assistance programs. In these programs, health care professionals-known as "Assistors"-are trained in insurance enrollment services to help consumers navigate the complex application and plan selection process, with the ultimate goal of optimizing enrollment rates. Cicatelli Associates Inc. (CAI), a non-profit capacity building organization, has served as the Statewide Training Center for New York's Health Insurance Program Initiative since 2013, before the ACA Marketplace roll-out occurred. This article presents a narrative of CAI's experiences and promising practices related to training and developing of the Assistor workforce in New York State (NYS). By the end of the second enrollment period (February 2015), NYS trained and certified over 11,000 Assistors (1); CAI trained fifteen percent of this total workforce. As a result of this intensive workforce training effort, NYS observed extremely high rates of facilitated enrollment, and overall success with the roll-out process. Through this initiative, CAI has garnered key insights for other organizations that engage in similar work, as well as state policymakers considering how to integrate and bolster the Assistor programs in their states. These lessons include: the necessity of ensuring that Assistors are armed with all technical concepts and messages; ensuring that Assistors are motivated to work through a change process; the constructive feedback process that can occur when these Assistors directly communicate issues to the state; and the transformation of public opinion that can occur when Assistors provide good customer service and can effectively promote statewide and federal ACA policies and benefits. Copyright © 2016 Elsevier Inc. All rights reserved.

A socio-ecological approach for examining factors related to contraceptive use among recent Latina immigrants in an emerging Latino state.

PubMed

White, Kari; Ocampo, Michelle; Scarinci, Isabel C

2017-08-01

Using the Social Ecological Model, the individual, partner, social, and structural factors related to recent Latina immigrants' contraceptive use in an emerging immigrant community were explored. During September 2013-January 2014, door-to-door sampling was used in Birmingham, Alabama to recruit Latina immigrants who had lived in the United States (U.S.) for less than 5 years. Ten women with foreign-born children and 10 with only U.S.-born children completed in-depth interviews about their contraceptive use following migration. Women's narratives revealed interrelated barriers to using highly effective contraception after migrating to the U.S. Women had nuanced concerns about using hormonal contraception, which, when combined with other factors, led them to rely on condoms and withdrawal. Limited partner communication was a barrier to effective method use for some women, but partner attitudes that women should be responsible for contraception were less important. Weak female networks made it difficult for immigrants to learn about the U.S. health-care system, especially those with only U.S.-born children. Even once women accessed services, a full range of highly effective methods was not available or affordable. In emerging communities, integrated strategies that address immigrants' need for information and ensure access to affordable contraception would help women achieve their reproductive life goals.

Biomedical Wireless Ambulatory Crew Monitor

NASA Technical Reports Server (NTRS)

Chmiel, Alan; Humphreys, Brad

2009-01-01

A compact, ambulatory biometric data acquisition system has been developed for space and commercial terrestrial use. BioWATCH (Bio medical Wireless and Ambulatory Telemetry for Crew Health) acquires signals from biomedical sensors using acquisition modules attached to a common data and power bus. Several slots allow the user to configure the unit by inserting sensor-specific modules. The data are then sent real-time from the unit over any commercially implemented wireless network including 802.11b/g, WCDMA, 3G. This system has a distributed computing hierarchy and has a common data controller on each sensor module. This allows for the modularity of the device along with the tailored ability to control the cards using a relatively small master processor. The distributed nature of this system affords the modularity, size, and power consumption that betters the current state of the art in medical ambulatory data acquisition. A new company was created to market this technology.

Hours Lost to Planned and Unplanned Dental Visits Among US Adults.

PubMed

Kelekar, Uma; Naavaal, Shillpa

2018-01-11

Poor oral health is associated with lost hours at work or school, which may affect a person's productivity. The objective of our study was to estimate work or school hours lost to dental visits among adults aged 18 and older by the types of visits (emergency or unplanned; routine, planned, or orthodontic; or cosmetic) and to determine the factors associated with hours lost. We used the most recent Oral Health Supplement data, from the 2008 National Health Interview Survey (NHIS), to estimate the total hours lost at work or school for dental visits among adults in the United States. The associations of the hours lost in unplanned and planned dental visits with socioeconomic characteristics, oral health status, and affordability were calculated. We used χ 2 tests and logistic regression to determine associations at P < .05. An average of 320.8 million work or school hours were lost annually for dental care in the United States, of which 92.4 million hours were for emergency (unplanned) care (0.99 h/adult), 159.8 million for routine (planned) care or orthodontic care (1.71 h/adult), and 68.6 million for cosmetic care (0.73 h/adult). Adults with poor oral health were more likely to lose one or more hours in unplanned dental visits (OR = 5.60; 95% confidence interval [CI], 3.25-9.63) than those who reported very good oral health. Not being able to afford dental care was positively associated with more work hours lost in unplanned care (odds ratio [OR] = 2.56; 95% CI, 1.76-3.73). Compared with Hispanic adults, non-Hispanic white adults (OR = 2.09; 95% CI, 1.40-3.11) and non-Hispanic Asian adults and adults of other races/ethnicities (OR =1.91; 95% CI, 1.06-3.47) were more likely to lose any hours for planned care. Consistently, those with more than a high school education were more likely to lose any hours in planned care (OR = 1.39; 95% CI, 1.06-1.83) than those with a high school education or less. Dental problems result in hours lost from work and may adversely affect a person's productivity. There is disparity in lost hours at work by race/ethnicity and dental care affordability.

The impact of comparative effectiveness research on interventional pain management: evolution from Medicare Modernization Act to Patient Protection and Affordable Care Act and the Patient-Centered Outcomes Research Institute.

PubMed

Manchikanti, Laxmaiah; Falco, Frank J E; Benyamin, Ramsin M; Helm, Standiford; Parr, Allan T; Hirsch, Joshua A

2011-01-01

The Patient-Centered Outcomes Research Institute (PCORI) was established by the Affordable Care Act of 2010 to promote comparative effectiveness research (CER) to assist patients, clinicians, purchasers, and policy-makers in making informed health decisions by advancing the quality and relevance of evidence concerning the manner in which diseases, disorders, and other health conditions can effectively and appropriately be prevented, diagnosed, treated, monitored, and managed through research and evidence synthesis. The development of PCORI is vested in the Medicare Modernization Act (MMA) and the American Recovery and Reinvestment Act (ARRA). The framework of CER and PCORI describes multiple elements which are vested in all 3 regulations including stakeholder involvement, public participation, and open transparent decision-making process. Overall, PCORI is much more elaborate with significant involvement of stakeholders, transparency, public participation, and open decision-making. However, there are multiple issues concerning the operation of such agencies in the United States including the predecessor of Agency for Healthcare Research and Quality (AHRQ), the Agency for Healthcare Policy and Research (AHCPR), AHRQ Effectiveness Health Care programs, and others. The CER in the United States may be described at cross-roads or at the beginnings of a scientific era of CER and evidence-based medicine (EBM). However the United States suffers as other countries, including the United Kingdom with its National Health Services (NHS) and National Institute for Health and Clinical Excellence (NICE), with major misunderstandings of methodology, an inordinate focus on methodological assessment, lack of understanding of the study design (placebo versus active control), lack of involvement of clinicians, and misinterpretation of the evidence which continues to be disseminated. Consequently, PCORI and CER have been described as government-driven solutions without following the principles of EBM with an extensive focus on costs rather than quality. It also has been stated that the central planning which has been described for PCORI and CER, a term devised to be acceptable, will be used by third party payors to override the physician's best medical judgement and patient's best interest. Further, stakeholders in PCORI are not scientists, are not balanced, and will set an agenda with an ultimate problem of comparative effectiveness and PCORI that it is not based on medical science, but rather on political science and not even under congressional authority, leading to unprecedented negative changes to health care. Thus, PCORI is operating in an ad hoc manner that is incompatible with the principles of evidence-based practice.This manuscript describes the framework of PCORI, and the role of CER and its impact on interventional pain management.

Challenges facing the United States of America in implementing universal coverage

PubMed Central

Unruh, Lynn Y; Rosenau, Pauline; Barnes, Andrew J; Saltman, Richard B; van Ginneken, Ewout

2014-01-01

Abstract In 2010, immediately before the United States of America (USA) implemented key features of the Affordable Care Act (ACA), 18% of its residents younger than 65 years lacked health insurance. In the USA, gaps in health coverage and unhealthy lifestyles contribute to outcomes that often compare unfavourably with those observed in other high-income countries. By March 2014, the ACA had substantially changed health coverage in the USA but most of its main features – health insurance exchanges, Medicaid expansion, development of accountable care organizations and further oversight of insurance companies – remain works in progress. The ACA did not introduce the stringent spending controls found in many European health systems. It also explicitly prohibits the creation of institutes – for the assessment of the cost–effectiveness of pharmaceuticals, health services and technologies – comparable to the National Institute for Health and Care Excellence in the United Kingdom of Great Britain and Northern Ireland, the Haute Autorité de Santé in France or the Pharmaceutical Benefits Advisory Committee in Australia. The ACA was – and remains – weakened by a lack of cross-party political consensus. The ACA’s performance and its resulting acceptability to the general public will be critical to the Act’s future. PMID:25552773

New metrics of affordable nutrition: which vegetables provide most nutrients for least cost?

PubMed

Drewnowski, Adam

2013-09-01

Measuring food prices per gram, rather than per calorie, is one way to make healthful vegetables appear less expensive. However, a better measure of affordability would take the nutrient content of vegetables into account. This study, based on analyses of US Department of Agriculture datasets, aimed to identify which vegetables, including juices and soups, provided the most nutrients per unit cost. Nutrient density was measured using the Nutrient Rich Foods (NRF) index, based on nine nutrients to encourage: protein; fiber; vitamins A, C, and E; calcium; iron; magnesium; and potassium; and on three nutrients to limit: saturated fat, added sugar, and sodium. Food cost in dollars was calculated per 100 g, per 100 kcal, per serving, and per nutrient content. One-way analyses of variance with post hoc tests were used to determine statistical significance. Results showed that tomato juices and tomato soups, dark green leafy and nonleafy vegetables, and deep yellow vegetables, including sweet potatoes, had the highest NRF scores overall. Highest NRF scores per dollar were obtained for sweet potatoes, white potatoes, tomato juices and tomato soups, carrots, and broccoli. Tomato sauces, raw tomatoes, and potato chips were eaten more frequently than were many other vegetables that were both more affordable and more nutrient-rich. These new measures of affordable nutrition can help foodservice and health professionals identify those vegetables that provide the highest nutrient density per unit cost. Processed vegetables, including soups and juices, can contribute to the quality and the affordability of the diet. Copyright © 2013 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Affording shared responsibility for universal coverage: insights from California.

PubMed

Curtis, Rick; Neuschler, Ed

2009-01-01

This paper presents key insights from California's recent experience in developing a plan for universal health coverage with "shared responsibility" among individuals, employers, and governments. A major challenge was finding an acceptable balance among the goals of affordability, equity, and cost to the state. Although reform did not pass, the state's approach-particularly differences from Massachusetts regarding modest-income workers and related employer and public roles-provides important insights for federal reform.

On Medicaid and the Affordable Care Act in Connecticut

PubMed Central

Manthous, Constantine A.; Sofair, Andre N.

2014-01-01

Background: Medicaid is the federal program, administered by states, for health care for the poor. The Affordable Care Act (ACA) has added a large number of new recipients to this program. Hypothesis: Medicaid programs in some, if not many, states do not provide patients uniform access to subspecialty care guaranteed by the federal statutes. Insofar as the ACA does not address this pre-existing “sub-specialty gap” and more patients are now covered by Medicaid under the ACA, the gap is likely to increase and may contribute to disparities of health care access and outcomes. Methods: A brief description of previous studies demonstrating or suggesting a subspecialty gap in Medicaid services is accompanied by perspectives of the authors, using published literature — most notably the Denver, Colorado health care system — to propose various solutions that may be deployed to address gaps in subspecialty coverage. Results: All published studies describing the Medicaid subspecialty gap are qualitative, survey designs. There are no authoritative objective data regarding the exact prevalence of gaps for each subspecialty in each state. However, surveys of caregivers suggest that gaps were prevalent in the United States prior to initiation of the ACA. Even fewer papers have addressed solutions (in light of the paucity of data describing the magnitude of the problem), and proposed solutions remain speculative and not grounded in objective data. Conclusions: There is reason to believe that a substantial proportion of U.S. citizens — those who are guaranteed a full complement of health services through Medicaid — have difficult or no access to some subspecialty services, many of which other citizens take for granted. This problem deserves greater attention to verify its existence, quantify its magnitude, and develop solutions. PMID:25506291

On the Outskirts of National Health Reform: A Comparative Assessment of Health Insurance and Access to Care in Puerto Rico and the United States

PubMed Central

Portela, Maria; Sommers, Benjamin D

2015-01-01

Context Puerto Rico is the United States’ largest territory, home to nearly 4 million American citizens. Yet it has remained largely on the outskirts of US health policy, including the Affordable Care Act (ACA). This article presents an overview of Puerto Rico’s health care system and a comparative analysis of coverage and access to care in Puerto Rico and the mainland United States. Methods We analyzed 2011-2012 data from the Behavioral Risk Factor Surveillance System, and 2012 data from the American Community Survey and its counterpart, the Puerto Rico Community Survey. Among adults 18 and older, we examined health insurance coverage; access measures, such as having a usual source of care and cost-related delays in care; self-reported health; and the receipt of recommended preventive services, such as cancer screening and glucose testing. We used multivariate regression models to compare Puerto Rico and the mainland United States, adjusted for age, income, race/ethnicity, and other demographic variables. Findings Uninsured rates were significantly lower in Puerto Rico (unadjusted 7.4% versus 15.0%, adjusted difference: −12.0%, p < 0.001). Medicaid was far more common in Puerto Rico. Puerto Rican residents were more likely than those in the mainland United States to have a usual source of care and to have had a checkup within the past year, and fewer experienced cost-related delays in care. Screening rates for diabetes, mammograms, and Pap smears were comparable or better in Puerto Rico, while colonoscopy rates were lower. Self-reported health was slightly worse, but obesity and smoking rates were lower. Conclusions Despite its far poorer population, Puerto Rico outperforms the mainland United States on several measures of coverage and access. Congressional policies capping federal Medicaid funds to the territory, however, have contributed to major budgetary challenges. While the ACA has significantly increased federal resources in Puerto Rico, ongoing restrictions on Medicaid funding and premium tax credits are posing substantial health policy challenges in the territory. PMID:26350931

24 CFR 92.252 - Qualification as affordable housing: Rental housing.

Code of Federal Regulations, 2011 CFR

2011-04-01

... include average occupancy per unit and adjusted income assumptions. (b) Additional Rent limitations. In... provides the HOME rent limits which include average occupancy per unit and adjusted income assumptions... occupied only by households that are eligible as low-income families and must meet the following...

Projecting the Unmet Need and Costs for Contraception Services After the Affordable Care Act

PubMed Central

Steinmetz, Erika; Gavin, Lorrie; Rivera, Maria I.; Pazol, Karen; Moskosky, Susan; Weik, Tasmeen; Ku, Leighton

2016-01-01

Objectives. We estimated the number of women of reproductive age in need who would gain coverage for contraceptive services after implementation of the Affordable Care Act, the extent to which there would remain a need for publicly funded programs that provide contraceptive services, and how that need would vary on the basis of state Medicaid expansion decisions. Methods. We used nationally representative American Community Survey data (2009), to estimate the insurance status for women in Massachusetts and derived the numbers of adult women at or below 250% of the federal poverty level and adolescents in need of confidential services. We extrapolated findings to simulate the impact of the Affordable Care Act nationally and by state, adjusting for current Medicaid expansion and state Medicaid Family Planning Expansion Programs. Results. The number of low-income women at risk for unintended pregnancy is expected to decrease from 5.2 million in 2009 to 2.5 million in 2016, based on states’ current Medicaid expansion plans. Conclusions. The Affordable Care Act increases women’s insurance coverage and improves access to contraceptive services. However, for women who remain uninsured, publicly funded family planning programs may still be needed. PMID:26691128

Comparing mandated health care reforms: the Affordable Care Act, accountable care organizations, and the Medicare ESRD program.

PubMed

Watnick, Suzanne; Weiner, Daniel E; Shaffer, Rachel; Inrig, Jula; Moe, Sharon; Mehrotra, Rajnish

2012-09-01

In addition to extending health insurance coverage, the Affordable Care Act of 2010 aims to improve quality of care and contain costs. To this end, the act allowed introduction of bundled payments for a range of services, proposed the creation of accountable care organizations (ACOs), and established the Centers for Medicare and Medicaid Innovation to test new care delivery and payment models. The ACO program began April 1, 2012, along with demonstration projects for bundled payments for episodes of care in Medicaid. Yet even before many components of the Affordable Care Act are fully in place, the Medicare ESRD Program has instituted legislatively mandated changes for dialysis services that resemble many of these care delivery reform proposals. The ESRD program now operates under a fully bundled, case-mix adjusted prospective payment system and has implemented Medicare's first-ever mandatory pay-for-performance program: the ESRD Quality Incentive Program. As ACOs are developed, they may benefit from the nephrology community's experience with these relatively novel models of health care payment and delivery reform. Nephrologists are in a position to assure that the ACO development will benefit from the ESRD experience. This article reviews the new ESRD payment system and the Quality Incentive Program, comparing and contrasting them with ACOs. Better understanding of similarities and differences between the ESRD program and the ACO program will allow the nephrology community to have a more influential voice in shaping the future of health care delivery in the United States.

Who has housing affordability problems? Disparities in Housing Cost burden by Race, Nativity and Legal Status in Los Angeles

PubMed Central

McConnell, Eileen Diaz

2013-01-01

Housing costs are a substantial component of U.S. household expenditures. Those who allocate a large proportion of their income to housing often have to make difficult financial decisions with significant short-term and long-term implications for adults and children. This study employs cross-sectional data from the first wave of the Los Angeles Family and Neighborhood Survey (L.A.FANS) collected between 2000 and 2002 to examine the most common U.S. standard of housing affordability, the likelihood of spending thirty percent or more of income on shelter costs. Multivariate analyses of a low-income sample of U.S. born Latinos, Whites, African Americans, authorized Latino immigrants and unauthorized Latino immigrants focus on baseline and persistent differences in the likelihood of being cost burdened by race, nativity and legal status. Nearly half or more of each group of low-income respondents experience housing affordability problems. The results suggest that immigrants’ legal status is the primary source of disparities among those examined, with the multivariate analyses revealing large and persistent disparities for unauthorized Latino immigrants relative to most other groups. Moreover, the higher odds of housing cost burden observed for unauthorized immigrants compared with their authorized immigrant counterparts remains substantial, accounting for traditional indicators of immigrant assimilation. These results are consistent with emerging scholarship regarding the role of legal status in shaping immigrant outcomes in the United States. PMID:24077641

Comparison of USDA Forest Service and Stakeholder Motivations and Experiences in Collaborative Federal Forest Governance in the Western United States

NASA Astrophysics Data System (ADS)

Davis, Emily Jane; White, Eric M.; Cerveny, Lee K.; Seesholtz, David; Nuss, Meagan L.; Ulrich, Donald R.

2017-11-01

In the United States, over 191 million acres of land is managed by the United States Department of Agriculture Forest Service, a federal government agency. In several western U.S. states, organized collaborative groups have become a de facto governance approach to providing sustained input on management decisions on much public land. This is most extensive in Oregon, where at least 25 "forest collaboratives" currently exist. This affords excellent opportunities for studies of many common themes in collaborative governance, including trust, shared values, and perceptions of success. We undertook a statewide survey of participants in Oregon forest collaboratives to examine differences in motivations, perceptions of success, and satisfaction among Forest Service participants ("agency participants"), who made up 31% of the sample, and other respondents ("non-agency") who represent nonfederal agencies, interest groups, citizens, and non-governmental groups. We found that agency participants differed from non-agency participants. They typically had higher annual incomes, and were primarily motivated to participate to build trust. However, a majority of all respondents were similar in not indicating any other social or economic motivations as their primary reason for collaborating. A majority also reported satisfaction with their collaborative—despite not ranking collaborative performance on a number of specific potential outcomes highly. Together, this suggests that collaboration in Oregon is currently perceived as successful despite not achieving many specific outcomes. Yet there were significant differences in socioeconomic status and motivation that could affect the ability of agency and nonagency participants to develop and achieve mutually-desired goals.

Comparison of USDA Forest Service and Stakeholder Motivations and Experiences in Collaborative Federal Forest Governance in the Western United States.

PubMed

Davis, Emily Jane; White, Eric M; Cerveny, Lee K; Seesholtz, David; Nuss, Meagan L; Ulrich, Donald R

2017-11-01

In the United States, over 191 million acres of land is managed by the United States Department of Agriculture Forest Service, a federal government agency. In several western U.S. states, organized collaborative groups have become a de facto governance approach to providing sustained input on management decisions on much public land. This is most extensive in Oregon, where at least 25 "forest collaboratives" currently exist. This affords excellent opportunities for studies of many common themes in collaborative governance, including trust, shared values, and perceptions of success. We undertook a statewide survey of participants in Oregon forest collaboratives to examine differences in motivations, perceptions of success, and satisfaction among Forest Service participants ("agency participants"), who made up 31% of the sample, and other respondents ("non-agency") who represent nonfederal agencies, interest groups, citizens, and non-governmental groups. We found that agency participants differed from non-agency participants. They typically had higher annual incomes, and were primarily motivated to participate to build trust. However, a majority of all respondents were similar in not indicating any other social or economic motivations as their primary reason for collaborating. A majority also reported satisfaction with their collaborative-despite not ranking collaborative performance on a number of specific potential outcomes highly. Together, this suggests that collaboration in Oregon is currently perceived as successful despite not achieving many specific outcomes. Yet there were significant differences in socioeconomic status and motivation that could affect the ability of agency and nonagency participants to develop and achieve mutually-desired goals.

Behind the scenes of the Patient Protection and Affordable Care Act: the making of a health care co-op.

PubMed

Giaimo, Susan

2013-06-01

A primary goal of the Patient Protection and Affordable Care Act (PPACA) is to reduce the number of uninsured by making health insurance more affordable for small businesses and individuals. Toward that end, the PPACA encourages the creation of nonprofit, member-owned health insurance cooperatives to operate inside each state exchange. Co-ops face significant challenges in entering mature insurance markets, but they also possess unique characteristics that may help them survive and thrive. Using Common Ground Healthcare Cooperative in Wisconsin as a case study, this article traces the origins of co-ops in health care reform at national and state levels and analyzes the political and technical challenges and opportunities facing these organizations.

Cooperative Extension as a Framework for Health Extension: The Michigan State University Model

PubMed Central

Dwyer, Jeffrey W.; Contreras, Dawn; Tiret, Holly; Newkirk, Cathy; Carter, Erin; Cronk, Linda

2017-01-01

Problem The Affordable Care Act charged the Agency for Healthcare Research and Quality to create the Primary Care Extension Program, but did not fund this effort. The idea to work through health extension agents to support health care delivery systems was based on the nationally known Cooperative Extension System (CES). Instead of creating new infrastructure in health care, the CES is an ideal vehicle for increasing health-related research and primary care delivery. Approach The CES, a long-standing component of the land-grant university system, features a sustained infrastructure for providing education to communities. The Michigan State University (MSU) Model of Health Extension offers another means of developing a National Primary Care Extension Program that is replicable in part because of the presence of the CES throughout the United States. A partnership between the MSU College of Human Medicine and MSU Extension formed in 2014, emphasizing the promotion and support of human health research. The MSU Model of Health Extension includes the following strategies: building partnerships, preparing MSU Extension educators for participation in research, increasing primary care patient referrals and enrollment in health programs, and exploring innovative funding. Outcomes Since the formation of the MSU Model of Health Extension, researchers and extension professionals have made 200+ connections, and grants have afforded savings in salary costs. Next Steps The MSU College of Human Medicine and MSU Extension partnership can serve as a model to promote health partnerships nationwide between CES services within land-grant universities and academic health centers or community-based medical schools. PMID:28353501

Finding Your "Element" in the High School/Unit District Superintendency

ERIC Educational Resources Information Center

Hubbard, Bradford D.

2016-01-01

This research study examined the conditions and features that have worked in concert to afford a select group of high school/unit district superintendents to become highly successful. Many studies have critically looked at leadership, educational leadership, and the superintendency, however, this one utilizes a non-educational theoretical…

HIA 2016 DOE Zero Energy Ready Home Case Study: United Way of Long Island, United Veterans, Beacon House, Deer Park, NY

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pacific Northwest National Laboratory

Case study of a DOE 2016 Housing Innovation Award winning affordable home in the mixed-humid climate that met the DOE Zero Energy Ready Home criteria and achieved a HERS 32 without PV or HERS 9 with PV.

Assessing the impact of the Australia-United States Free Trade Agreement on Australian and global medicines policy

PubMed Central

Faunce, Thomas; Doran, Evan; Henry, David; Drahos, Peter; Searles, Andrew; Pekarsky, Brita; Neville, Warwick

2005-01-01

On 1 January 2005, a controversial trade agreement entered into force between Australia and the United States. Though heralded by the parties as facilitating the removal of barriers to free trade (in ways not achievable in multilateral fora), it also contained many trade-restricting intellectual property provisions and others uniquely related to altering pharmaceutical regulation and public health policy in Australia. The latter appear to have particularly focused on the world-respected process of federal government reimbursement after expert cost-effectiveness evaluation, popularly known as the Pharmaceutical Benefits Scheme ('PBS'). It remains uncertain what sort of impacts – if any – the Australia-United States Free Trade Agreement ('AUSFTA') will have on PBS processes such as reference pricing and their important role in facilitating equitable and affordable access to essential medicines. This is now the field of inquiry for a major three year Australian Research Council ('ARC')-funded study bringing together a team of senior researchers in regulatory theory from the Australian National University and pharmacoeconomics from the University of Newcastle. The project proposes to monitor, assess and analyse the real and potential impacts of the AUSFTA in this area, providing Australian policy-makers with continuing expertise and options. To the extent that the AUSFTA medicines provisions may represent an important precedent in a global strategy by industry on cost-effectiveness evaluation of pharmaceuticals, the study will also be of great interest to policy makers in other jurisdictions. PMID:16209703

The International Space Station: A Pathway to the Future

NASA Technical Reports Server (NTRS)

Kitmacher, Gary H.; Gerstenmaier, William H.; Bartoe, John-David F.; Mustachio, Nicholas

2004-01-01

Nearly six years after the launch of the first International Space Station element, and four years after its initial occupation, the United States and our 16 international partners have made great strides in operating this impressive Earth orbiting research facility. This past year we have done so in the face of the adversity of operating without the benefit of the Space Shuttle. In his January 14, 2004, speech announcing a new vision for America's space program, President Bush affirmed the United States' commitment to completing construction of the International Space Station by 2010. The President also stated that we would focus our future research aboard the Station on the longterm effects of space travel on human biology. This research will help enable human crews to venture through the vast voids of space for months at a time. In addition, ISS affords a unique opportunity to serve as an engineering test bed for hardware and operations critical to the exploration tasks. NASA looks forward to working with our partners on International Space Station research that will help open up new pathways for future exploration and discovery beyond low Earth orbit. This paper provides an overview of the International Space Station Program focusing on a review of the events of the past year, as well as plans for next year and the future.

No right to food and nutrition in the SDGs: mistake or success?

PubMed Central

Vivero Pol, Jose Luis; Schuftan, Claudio

2016-01-01

Although the recently approved Sustainable Development Goals (SDGs) explicitly mention access to water, health and education as universally guaranteed human rights, access to affordable and sufficient food is not given such recognition. The SDGs road map assumes that market mechanisms will suffice to secure nutritious and safe food for all. We question how and why the right to food has disappeared from such an international agreement and we will provide insights on the likely causes of this and the options to make good on such a regrettable omission. Analysis of political stances of relevant western stakeholders, such as the United States (US) and the European Union (EU), is also included. PMID:28588925

A Guide to the Economics of Hepatitis C Virus Cure in 2017.

PubMed

Linas, Benjamin P; Nolen, Shayla

2018-06-01

This commentary reviews the core principals of cost-effectiveness and applies them to the rapidly evolving context of hepatitis C virus treatment in the United States. The article provides a foundation of evidence that hepatitis C virus treatment provides good economic value, even though it is expensive, and even when treating people who inject drugs who are at high risk for hepatitis C virus reinfection. The price of medications has decreased, but the high price continues to limit access to care. This wedge between cost effectiveness and affordability stands front and center as one of the leading obstacles to elimination. Copyright © 2018 Elsevier Inc. All rights reserved.

Development of a Green Roof Environmental Monitoring and Meteorological Network in New York City

PubMed Central

Gaffin, Stuart R.; Khanbilvardi, Reza; Rosenzweig, Cynthia

2009-01-01

Green roofs (with plant cover) are gaining attention in the United States as a versatile new environmental mitigation technology. Interest in data on the environmental performance of these systems is growing, particularly with respect to urban heat island mitigation and stormwater runoff control. We are deploying research stations on a diverse array of green roofs within the New York City area, affording a new opportunity to monitor urban environmental conditions at small scales. We show some green roof systems being monitored, describe the sensor selection employed to study energy balance, and show samples of selected data. These roofs should be superior to other urban rooftops as sites for meteorological stations. PMID:22574037

Development of a green roof environmental monitoring and meteorological network in new york city.

PubMed

Gaffin, Stuart R; Khanbilvardi, Reza; Rosenzweig, Cynthia

2009-01-01

Green roofs (with plant cover) are gaining attention in the United States as a versatile new environmental mitigation technology. Interest in data on the environmental performance of these systems is growing, particularly with respect to urban heat island mitigation and stormwater runoff control. We are deploying research stations on a diverse array of green roofs within the New York City area, affording a new opportunity to monitor urban environmental conditions at small scales. We show some green roof systems being monitored, describe the sensor selection employed to study energy balance, and show samples of selected data. These roofs should be superior to other urban rooftops as sites for meteorological stations.

The Case of Nuclear Propulsion

NASA Technical Reports Server (NTRS)

Koroteev, Anatoly S.; Ponomarev-Stepnoi, Nicolai N.; Smetannikov, Vladimir P.; Gafarov, Albert A.; Houts, Mike; VanDyke, Melissa; Godfroy, Tom; Martin, James; Bragg-Sitton, Shannon; Dickens, Ricky

2003-01-01

Fission technology can enable rapid, affordable access to any point in the solar system. If fission propulsion systems are to be developed to their full potential; however, near-term customers must be identified and initial fission systems successfully developed, launched, and utilized. Successful utilization will simultaneously develop the infrastructure and experience necessary for developing even higher power and performance systems. To be successful, development programs must devise strategies for rapidly converting paper reactor concepts into actual flight hardware. One approach to accomplishing this is to design highly testable systems, and to structure the program to contain frequent, significant hardware milestones. This paper discusses ongoing efforts in Russia and the United States aimed at enabling near-term utilization of space fission systems.

Society for the advancement of material and process engineering. 41st International SAMPE symposium and exhibition, Volume 41, Books 1 and 2

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

This document contains reports which were presented at the 41st International Society For The Advancement of Material and Process Engineering Symposium and Exhibition. Topics include: structural integrity of aging aircraft; composite materials development; affordable composites and processes; corrosion characterization of aging aircraft; adhesive advances; composite design; dual use materials and processing; repair of aircraft structures; adhesive inspection; materials systems for infrastructure; fire safety; composite impact/energy absorption; advanced materials for space; seismic retrofit; high temperature resins; preform technology; thermoplastics; alternative energy and transportation; manufacturing; and durability. Individual reports have been processed separately for the United States Department of Energy databases.

Trends and affordability of cigarette prices: ample room for tax increases and related health gains.

PubMed

Guindon, G E; Tobin, S; Yach, D

2002-03-01

Increasing the price of tobacco products is arguably the most effective method of curbing the prevalence and consumption of tobacco products. Price increases would reduce the global burden of disease brought about by tobacco consumption. To compare cigarette price data from more than 80 countries using varying methods, examine trends in prices and affordability during the 1990s, and explore various policy implications pertaining to tobacco prices. March 2001 cigarette price data from the Economist Intelligence Unit are used to compare cigarette prices across countries. To facilitate comparison and to assess affordability, prices are presented in US dollars, purchasing power parity (PPP) units using the Big Mac index as an indicator of PPP and in terms of minutes of labour required to purchase a pack of cigarettes. Annual real percentage changes in cigarette prices between 1990 and 2000 and annual changes in the minutes of labour required to buy cigarettes between 1991 and 2000 are also calculated to examine trends. Cigarette prices tend to be higher in wealthier countries and in countries that have strong tobacco control programmes. On the other hand, minutes of labour required to purchase cigarettes vary vastly between countries. Trends between 1990 and 2000 in real prices and minutes of labour indicate, with some exceptions, that cigarettes have become more expensive in most developed countries but more affordable in many developing countries. However, in the UK, despite recent increases in price, cigarettes are still more affordable than they were in the 1960s. The results suggest that there is ample room to increase tobacco prices through taxation. In too many countries, cigarette prices have failed to keep up with increases in the general price level of goods and services, rendering them more affordable in 2000 than they were at the beginning of the decade. Opportunities to increase government revenue and improve health through reduced consumption brought about by higher prices have been overlooked in many countries.

Patient Protection and Affordable Care Act; annual eligibility redeterminations for exchange participation and insurance affordability programs; health insurance issuer standards under the Affordable Care Act, including standards related to exchanges. Final rule.

PubMed

2014-09-05

This final rule specifies additional options for annual eligibility redeterminations and renewal and re-enrollment notice requirements for qualified health plans offered through the Exchange, beginning with annual redeterminations for coverage for benefit year 2015. This final rule provides additional flexibility for Exchanges, including the ability to propose unique approaches that meet the specific needs of their state, while streamlining the consumer experience.

Implementing health care reform in the United States: intergovernmental politics and the dilemmas of institutional design.

PubMed

Béland, Daniel; Rocco, Philip; Waddan, Alex

2014-05-01

The Affordable Care Act (ACA) was enacted, and continues to operate, under conditions of political polarization. In this article, we argue that the law's intergovernmental structure has amplified political conflict over its implementation by distributing governing authority to political actors at both levels of the American federal system. We review the ways in which the law's demands for institutional coordination between federal and state governments (and especially the role it preserves for governors and state legislatures) have created difficulties for rolling out health-insurance exchanges and expanding the Medicaid program. By way of contrast, we show how the institutional design of the ACA's regulatory reforms of the insurance market, which diminish the reform's political salience, has allowed for considerably less friction during the implementation process. This article thus highlights the implications of multi-level institutional designs for the post-enactment politics of major reforms. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Toward Affordability: Policy Recommendations for Virginia Higher Education

ERIC Educational Resources Information Center

State Council of Higher Education for Virginia, 2009

2009-01-01

In its 2007-13 strategic plan, Advancing Virginia: Access, Alignment, Investment, the State Council highlighted 12 strategic higher education initiatives that it believed were necessary to ensure Virginia's future. Key among these goals was improvement of the affordability of a college education in the Commonwealth. Recent events have reinforced…

Measures of Student Success with Textbook Transformations: The Affordable Learning Georgia Initiative

ERIC Educational Resources Information Center

Croteau, Emily

2017-01-01

In 2014, the state of Georgia's budget supported a University System of Georgia (USG) initiative: Affordable Learning Georgia (ALG). The initiative was implemented via Textbook Transformation Grants, which provided grants to USG faculty, libraries and librarians, and institutions to "transform their use of textbooks and other learning…

42 CFR 457.348 - Determinations of Children's Health Insurance Program eligibility by other insurance...

Code of Federal Regulations, 2012 CFR

2012-10-01

... insurance affordability program. (b) Provision of CHIP for individuals found eligible for CHIP by another insurance affordability program. If a State accepts final determinations of CHIP eligibility made by another... electronic account containing the determination of CHIP eligibility; and (2) Comply with the provisions of...

42 CFR 457.348 - Determinations of Children's Health Insurance Program eligibility by other insurance...

Code of Federal Regulations, 2014 CFR

2014-10-01

... insurance affordability program. (b) Provision of CHIP for individuals found eligible for CHIP by another insurance affordability program. If a State accepts final determinations of CHIP eligibility made by another... electronic account containing the determination of CHIP eligibility; and (2) Comply with the provisions of...

42 CFR 457.348 - Determinations of Children's Health Insurance Program eligibility by other insurance...

Code of Federal Regulations, 2013 CFR

2013-10-01

... insurance affordability program. (b) Provision of CHIP for individuals found eligible for CHIP by another insurance affordability program. If a State accepts final determinations of CHIP eligibility made by another... electronic account containing the determination of CHIP eligibility; and (2) Comply with the provisions of...

78 FR 20581 - Patient Protection and Affordable Care Act; Exchange Functions: Standards for Navigators and Non...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-05

... Protection and Affordable Care Act; Exchange Functions: Standards for Navigators and Non-Navigator Assistance..., training and certification, and meaningful access standards applicable to Navigators and non-Navigator assistance personnel in Federally- facilitated Exchanges, including State Partnership Exchanges, and to non...

Uninsured Primary Care Visit Disparities Under the Affordable Care Act

PubMed Central

Angier, Heather; Hoopes, Megan; Marino, Miguel; Huguet, Nathalie; Jacobs, Elizabeth A.; Heintzman, John; Holderness, Heather; Hood, Carlyn M.; DeVoe, Jennifer E.

2017-01-01

PURPOSE Health insurance coverage affects a patient’s ability to access optimal care, the percentage of insured patients on a clinic’s panel has an impact on the clinic’s ability to provide needed health care services, and there are racial and ethnic disparities in coverage in the United States. Thus, we aimed to assess changes in insurance coverage at community health center (CHC) visits after the Patient Protection and Affordable Care Act (ACA) Medicaid expansion by race and ethnicity. METHODS We undertook a retrospective, observational study of visit payment type for CHC patients aged 19 to 64 years. We used electronic health record data from 10 states that expanded Medicaid and 6 states that did not, 359 CHCs, and 870,319 patients with more than 4 million visits. Our analyses included difference-in-difference (DD) and difference-in-difference-in-difference (DDD) estimates via generalized estimating equation models. The primary outcome was health insurance type at each visit (Medicaid-insured, uninsured, or privately insured). RESULTS After the ACA was implemented, uninsured visit rates decreased for all racial and ethnic groups. Hispanic patients experienced the greatest increases in Medicaid-insured visit rates after ACA implementation in expansion states (rate ratio [RR] = 1.77; 95% CI, 1.56–2.02) and the largest gains in privately insured visit rates in nonexpansion states (RR = 3.63; 95% CI, 2.73–4.83). In expansion states, non-Hispanic white patients had twice the magnitude of decrease in uninsured visits compared with Hispanic patients (DD = 2.03; 95% CI, 1.53–2.70), and this relative change was more than 2 times greater in expansion states compared with nonexpansion states (DDD = 2.06; 95% CI, 1.52–2.78). CONCLUSION The lower rates of uninsured visits for all racial and ethnic groups after ACA implementation suggest progress in expanding coverage to CHC patients; this progress, however, was not uniform when comparing expansion with nonexpansion states and among all racial and ethnic minority subgroups. These findings suggest the need for continued and more equitable insurance expansion efforts to eliminate health insurance disparities. PMID:28893813

The state of American health care: November 2016 to November 2020, a look forward.

PubMed

Marmor, Theodore; Gusmano, Michael K

2018-01-01

The election of Donald Trump, coupled with the retention of Republican majorities in the US House of Representatives and Senate, raises questions about future of the Patient Protection and Affordable Care Act, the structure and funding of the country's public health insurance programs - Medicare, Medicaid and the Child Health Insurance Program - and the direction of health policy in the United States, more generally. Political scientists are not renowned for their capacity to predict the future and many of those who forecast election results have received criticism in recent weeks for failing to predict the Trump victory. While the future is uncertain, it is possible for social scientists to offer a 'conditional causal analysis' about the future. This essay is an effort to think about the likely shape of American health care between now and the next US presidential election.

The effect of culture on perspective taking.

PubMed

Wu, Shali; Keysar, Boaz

2007-07-01

People consider the mental states of other people to understand their actions. We evaluated whether such perspective taking is culture dependent. People in collectivistic cultures (e.g., China) are said to have interdependent selves, whereas people in individualistic cultures (e.g., the United States) are said to have independent selves. To evaluate the effect of culture, we asked Chinese and American pairs to play a communication game that required perspective taking. Eye-gaze measures demonstrated that the Chinese participants were more tuned into their partner's perspective than were the American participants. Moreover, Americans often completely failed to take the perspective of their partner, whereas Chinese almost never did. We conclude that cultural patterns of interdependence focus attention on the other, causing Chinese to be better perspective takers than Americans. Although members of both cultures are able to distinguish between their perspective and another person's perspective, cultural patterns afford Chinese the effective use of this ability to interpret other people's actions.

Who Are the Remaining Uninsured and Why Haven’t They Signed Up for Coverage?

PubMed

Collins, Sara R; Gunja, Munira Z; Doty, Michelle M; Beutel, Sophie

2016-08-01

The number of uninsured people in the United States has declined by an estimated 20 million since the Affordable Care Act went into effect in 2010. Yet, an estimated 24 million people still lack health insurance. Goal: To examine the characteristics of the remaining uninsured adults and their reasons for not enrolling in marketplace plans or Medicaid. Methods: Analysis of the Commonwealth Fund ACA Tracking Survey, February--April 2016. Key findings and conclusions: There have been notable shifts in the demographic composition of the uninsured since the law's major coverage expansions went into effect in 2014. Latinos have become a growing share of the uninsured, rising from 29 percent in 2013 to 40 percent in 2016. Whites have become a declining share, falling from half the uninsured in 2013 to 41 percent in 2016. The uninsured are very poor: 39 percent of uninsured adults have incomes below the federal poverty level, twice the rate of their overall representation in the adult population. Of uninsured adults who are aware of the marketplaces or who have tried to enroll for coverage, the majority point to affordability concerns as a reason for not signing up.

An affordable wearable video system for emergency response training

NASA Astrophysics Data System (ADS)

King-Smith, Deen; Mikkilineni, Aravind; Ebert, David; Collins, Timothy; Delp, Edward J.

2009-02-01

Many emergency response units are currently faced with restrictive budgets that prohibit their use of advanced technology-based training solutions. Our work focuses on creating an affordable, mobile, state-of-the-art emergency response training solution through the integration of low-cost, commercially available products. The system we have developed consists of tracking, audio, and video capability, coupled with other sensors that can all be viewed through a unified visualization system. In this paper we focus on the video sub-system which helps provide real time tracking and video feeds from the training environment through a system of wearable and stationary cameras. These two camera systems interface with a management system that handles storage and indexing of the video during and after training exercises. The wearable systems enable the command center to have live video and tracking information for each trainee in the exercise. The stationary camera systems provide a fixed point of reference for viewing action during the exercise and consist of a small Linux based portable computer and mountable camera. The video management system consists of a server and database which work in tandem with a visualization application to provide real-time and after action review capability to the training system.

Studies on the π-π stacking features of imidazole units present in a series of 5-amino-1-alkylimidazole-4-carboxamides

NASA Astrophysics Data System (ADS)

Ray, Sibdas; Das, Aniruddha

2015-06-01

Reaction of 2-ethoxymethyleneamino-2-cyanoacetamide with primary alkyl amines in acetonitrile solvent affords 1-substituted-5-aminoimidazole-4-carboxamides. Single crystal X-ray diffraction studies of these imidazole compounds show that there are both anti-parallel and syn-parallel π-π stackings between two imidazole units in parallel-displaced (PD) conformations and the distance between two π-π stacked imidazole units depends mainly on the anti/ syn-parallel nature and to some extent on the alkyl group attached to N-1 of imidazole; molecules with anti-parallel PD-stacking arrangements of the imidazole units have got vertical π-π stacking distance short enough to impart stabilization whereas the imidazole unit having syn-parallel stacking arrangement have got much larger π-π stacking distances. DFT studies on a pair of anti-parallel imidazole units of such an AICA lead to curves for 'π-π stacking stabilization energy vs. π-π stacking distance' which have got similarity with the 'Morse potential energy diagram for a diatomic molecule' and this affords to find out a minimum π-π stacking distance corresponding to the maximum stacking stabilization energy between the pair of imidazole units. On the other hand, a DFT calculation based curve for 'π-π stacking stabilization energy vs. π-π stacking distance' of a pair of syn-parallel imidazole units is shown to have an exponential nature.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kong, Bo

China’s energy insecurity largely originates from its constrained availability, questionable reliability, and uncertain affordability of its oil supplies. The country’s fast industrialization and urbanization, together with demand for infrastructure and increasing popularity of automobiles, requires a lot of energy, but it consumes energy both intensively and inefficiently, threatening the environmental well-being of China and its neighbors. China’s risk aversion and poor energy policy making system further magnifies its perceptions of the low availability, reliability and affordability of oil imports, which further compounds its sense of energy insecurity. Distrustful of the market, and suspicious of other major energy players in themore » international market, the Chinese leadership relies on the state-centered approach, or economic nationalism, rather than a market approach to enhance its energy security. However, the country lacks not only an energy policy making system that can make and implement sound energy policies but also an energy market that relies on market prices to allocate energy resources efficiently. As a result of this domestic failure, China has pushed its national flagship companies to undertake a global scavenger hunt for energy while muddling along a messy road of energy reform at home. Setbacks in acquiring new sources of oil have validated the Chinese leadership’s belief that the international oil market is not free and China’s access to international oil is not guaranteed through the market. China’s problems in the international energy market are also perceived as evidence of attempts to prevent China from exerting international influence. China’s leadership is convinced that China should focus on areas where western capital is not heavily concentrated or where western influences are weak. With the recent revaluation of Chinese currency and growing economy, China has both the wherewithal and appetite to acquire more oil assets abroad. Both China and the United States stand at a critical juncture of history where China’s rise depends on reliable energy supplies which it increasingly imports from abroad and where the growing wealth of the United States is increasingly dependent upon China’s success. If China does not have energy security it’s 1.3 billion fuel-starved people will prevent the rest of the world from achieving energy security.« less

24 CFR 1000.136 - What insurance requirements apply to housing units assisted with NAHASDA grants?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false What insurance requirements apply... ACTIVITIES Affordable Housing Activities § 1000.136 What insurance requirements apply to housing units assisted with NAHASDA grants? (a) The recipient shall provide adequate insurance either by purchasing...

Preserving Neighborhood Opportunity: Where Federal Housing Subsidies Expire.

PubMed

Lens, Michael C; Reina, Vincent

2016-01-01

Rent burdens are increasing in U.S. metropolitan areas while subsidies on privately owned, publicly subsidized rental units are expiring. As a result, some of the few remaining affordable units in opportunity neighborhoods are at risk of being converted to market rate. Policy makers face a decision about whether to devote their efforts and scarce resources toward developing new affordable housing, recapitalizing existing subsidized housing, and/or preserving properties with expiring subsidies. There are several reasons to preserve these subsidies, one being that properties may be located in neighborhoods with greater opportunity. In this article, we use several sources of data at the census tract level to learn how subsidy expirations affect neighborhood opportunity for low-income households. Our analysis presents several key findings. First, we find that units that left the project-based Section 8 program were - on average - in lower opportunity neighborhoods, but these neighborhoods were improving. In addition, properties due to expiry from the Section 8 program between 2011 and 2020 are in higher opportunity neighborhoods than any other subsidy program. On the contrary, new Low-Income Housing Tax Credit (LIHTC) units were developed in tracts similar to those where LIHTC units are currently active, which tend to be lower opportunity neighborhoods.

Legal and Regulatory Barriers to Reverse Innovation.

PubMed

Rowthorn, Virginia; Plum, Alexander J; Zervos, John

Reverse innovation, or the importation of new, affordable, and efficacious models to high-income countries from the developing world, has emerged as a way to improve the health care system in the United States. Reverse innovation has been identified as a key emerging trend in global health systems in part because low-resourced settings are particularly good laboratories for low-cost/high-impact innovations that are developed out of necessity. A difficult question receiving scant attention is that of legal and regulatory barriers. The objective of this paper is to understand and elucidate the legal barriers faced by innovators bringing health interventions to the United States. Semistructured qualitative interviews were conducted with 9 key informants who have directly participated in the introduction of global health care approaches to the United States health system. A purposive sampling scheme was employed to identify participants. Phone interviews were conducted over one week in July 2016 with each participant and lasted an average of 35 minutes each. Purely legal barriers included questions surrounding tort liability, standard of care, and concerns around patient-administered self-care. Regulatory burdens included issues of international medical licensure, reimbursement, and task shifting and scope of work challenges among nonprofessionals (e.g. community health workers). Finally, perceived (i.e. not realized or experienced) legal and regulatory barriers to innovative modalities served as disincentives to bringing products or services developed outside of the United States to the United States market. Conflicting interests within the health care system, safety concerns, and little value placed on low-cost interventions inhibit innovation. Legal and regulatory barriers rank among, and contribute to, an anti-innovation atmosphere in healthcare for domestic and reverse innovators alike. Reverse innovation should be fostered through the thoughtful development of legal and regulatory standards that encourage the introduction and scalable adoption of successful health care innovations developed outside of the US, particularly innovations that support public health goals and do not have the benefit of a large corporate sponsor to facilitate introduction to the market. Copyright © 2016 Icahn School of Medicine at Mount Sinai. Published by Elsevier Inc. All rights reserved.

Eliminating health disparities in unintended pregnancy with long-acting reversible contraception (LARC).

PubMed

Parks, Caitlin; Peipert, Jeffrey F

2016-06-01

Significant public health disparities exist surrounding teen and unplanned pregnancy in the United States. Women of color and those with lower education and socioeconomic status are at much greater risk of unplanned pregnancy and the resulting adverse outcomes. Unplanned pregnancies reduce educational and career opportunities and may contribute to socioeconomic deprivation and widening income disparities. Long-acting reversible contraception (LARC), including intrauterine devices and implants, offer the opportunity to change the default from drifting into parenthood to planned conception. LARC methods are forgettable; once placed, they offer highly effective, long-term pregnancy prevention. Increasing evidence in the medical literature demonstrates the population benefits of use of these methods. However, barriers to more widespread use of LARC methods persist and include educational, access, and cost barriers. With increasing insurance coverage under the Affordable Care Act and more widespread, no-cost coverage of methods, more and more women are choosing intrauterine devices and the contraceptive implant. Increasing the use of highly effective contraceptive methods may provide one solution to the persistent problem of the health disparities of unplanned and teen pregnancies in the United States and improve women's and children's health. Copyright © 2016 Elsevier Inc. All rights reserved.

A current and historical perspective on disparities in US childhood pneumococcal conjugate vaccine adherence and in rates of invasive pneumococcal disease: Considerations for the routinely-recommended, pediatric PCV dosing schedule in the United States

PubMed Central

McLaughlin, John M; Utt, Eric A; Hill, Nina M; Welch, Verna L; Power, Edward; Sylvester, Gregg C

2016-01-01

Previous research has suggested that reducing the US 4-dose PCV13 schedule to a 3-dose schedule may provide cost savings, despite more childhood pneumococcal disease. The study also stressed that dose reduction should be coupled with improved PCV adherence, however, US PCV uptake has leveled-off since 2008. An estimated 24–36% of US children aged 5–19 months are already receiving a reduced PCV schedule (i.e., missing ≥1 dose). This raises a practical concern that, under a reduced, 3-dose schedule, a similar proportion of children may receive ≤2 doses. It is also unknown if a reduced, 3-dose PCV schedule in the United States will afford the same disease protection as 3-dose schedules used elsewhere, given lower US PCV adherence. Finally, more assurance is needed that, under a reduced schedule, racial, socioeconomic, and geographic disparities in PCV adherence will not correspond with disproportionately higher rates of pneumococcal disease among poor or minority children. PMID:26376039

Moving National Breastfeeding Policies into Practice: A Plea to Integrate Lactation Education and Training into Nutrition and Dietetics Programs in the United States.

PubMed

Theurich, Melissa Ann; McCool, Megan Elizabeth

2016-08-01

In 2011, the Surgeon General's Call to Action to Support Breastfeeding called on all health professional organizations, medical schools, and credentialing boards to establish and incorporate minimum lactation education and training requirements into their credentialing, licensing, and certification processes and to include breastfeeding education in undergraduate and graduate education and training programs. Given the commonalities between the fields of nutrition and breastfeeding, it has been proposed that nutrition professionals are an underutilized resource in the field of lactation management. Considering the lack of breastfeeding knowledge and skills among health professionals, nutrition professionals should be afforded opportunities to learn lactation management during their studies. The United States Breastfeeding Committee published Core Competencies in Breastfeeding Care and Services for All Health Professionals in 2010. However, professional nutrition and lactation credentialing boards should cooperate to integrate mandatory minimum standards of lactation education for nutrition professionals. Undergraduate and graduate programs in nutrition and dietetics should incorporate lactation content into their core curricula to comply with such standards. In addition, dietetics programs should offer optional clinical lactation experiences for students who aspire to become an International Board Certified Lactation Consultant. © The Author(s) 2016.

The third wave--medical tourism in the 21st century.

PubMed

Pafford, Bennett

2009-08-01

The high number of uninsured or underinsured Americans and the spiraling cost of healthcare in the United States has spurred growth in patients traveling abroad for affordable healthcare, which has become known as medical tourism. It is projected to become a $21 billion a year industry by 2011. Overseas prices for most procedures, including airfare, are often half the cost of those performed in the United States; some procedures are 80% less. International facilities in India, Thailand, and elsewhere are obtaining Joint Commission International (JCI) accreditation and aggressively marketing to Western customers and insurance agencies and advertising high quality standards and personalized service. The acceptance of medial tourism is growing, with a recent poll showing more than 40% of US healthcare consumers willing to travel abroad for care. Insurance companies have begun to integrate foreign care into their coverage, offering discounts to patients agreeing to overseas travel. Physician groups have been slow to respond, even though estimates are that medical tourism may represent $162 billion in lost spending in America by 2012. Some experts think the continued US healthcare cost crisis will drive an increase in medical tourism and international competition, significantly impacting domestic physicians and hospitals.

The First Amendment and scientific freedom in the era of bioterrorism.

PubMed

Anton, Brian P

2004-01-01

The events of 9/11 have raised awareness that certain scientific research in the public domain may aid terrorists in their quest to develop biological weapons, and there is a legitimate cause for concern in rare cases. Proposed executive branch responses are consistent in their approach to the problem: restrain the offending research by restricting public access to it in some form or another. This paper examines some of the history of the United States (U.S.) government's restrictions on scientific communication and the protection that the First Amendment affords scientists against such restrictions. It focuses in particular on biological science, which has in recent years come under increased scrutiny due to fears of "bioterrorism." It concludes that science needs to be vigilant against government encroachment, but also needs to become the first line of defense in preventing dissemination of potentially dangerous research data. Should the exercise of prior restraint against biological research become necessary, the guidelines developed at the 2002 Monterey workshop provide a useful framework for determining what biological research might cause "direct, immediate, and irreparable" harm to national security under the New York Times Co. v. United States precedent.

Sexual tourism: implications for travelers and the destination culture.

PubMed

Marrazzo, Jeanne M

2005-03-01

Health care providers in a variety of settings need to improve their ability--along with the capabilities of supporting laboratories, surveillance systems, and services for sex partner management--to diagnose and treat STI. Whether the travel health care sector, as such, is willing to take on the additional burden of STI-related screening and risk reduction counseling has been raised by some authors. Currently, the burden of providing formalized STI care falls on the public sector; however, in the United States, most STI are actually diagnosed in the offices of private physicians. Given that the United States has the highest STI rates of any industrialized country, the undeniable synergy between STI and HIV acquisition, the failure of many American providers to screen for C trachomatis despite clear guidelines, the global resurgence of syphilis and extension of resistant N gonorrhoeae and of HIV, and the risk behaviors consistently reported by travelers, it is hard to argue against travel specialists' joining the daunting battle against these recalcitrant infections and their often devastating consequences. Most of the relevant diagnostic tests are relatively affordable, and patient-centered risk-reduction counseling, once mastered, can be brief and easily integrated into the overall conversation about protecting oneself during travel.

What it will take to achieve the as-yet-unfulfilled promises of health information technology.

PubMed

Kellermann, Arthur L; Jones, Spencer S

2013-01-01

A team of RAND Corporation researchers projected in 2005 that rapid adoption of health information technology (IT) could save the United States more than $81 billion annually. Seven years later the empirical data on the technology's impact on health care efficiency and safety are mixed, and annual health care expenditures in the United States have grown by $800 billion. In our view, the disappointing performance of health IT to date can be largely attributed to several factors: sluggish adoption of health IT systems, coupled with the choice of systems that are neither interoperable nor easy to use; and the failure of health care providers and institutions to reengineer care processes to reap the full benefits of health IT. We believe that the original promise of health IT can be met if the systems are redesigned to address these flaws by creating more-standardized systems that are easier to use, are truly interoperable, and afford patients more access to and control over their health data. Providers must do their part by reengineering care processes to take full advantage of efficiencies offered by health IT, in the context of redesigned payment models that favor value over volume.

Healthcare Reform and the Next Generation: United States Medical Student Attitudes toward the Patient Protection and Affordable Care Act

PubMed Central

Huntoon, Kristin M.; McCluney, Colin J.; Scannell, Christopher A.; Wiley, Elizabeth A.; Bruno, Richard; Andrews, Allen; Gorman, Paul

2011-01-01

Context Over one year after passage of the Patient Protection and Affordable Care Act (PPACA), legislators, healthcare experts, physicians, and the general public continue to debate the implications of the law and its repeal. The PPACA will have a significant impact on future physicians, yet medical student perspectives on the legislation have not been well documented. Objective To evaluate medical students' understanding of and attitudes toward healthcare reform and the PPACA including issues of quality, access and cost. Design, Setting, and Participants An anonymous electronic survey was sent to medical students at 10 medical schools (total of 6982 students) between October–December 2010, with 1232 students responding and a response rate of 18%. Main Outcome Measures Medical students' views and attitudes regarding the PPACA and related topics, measured with Likert scale and open response items. Results Of medical students surveyed, 94.8% agreed that the existing United States healthcare system needs to be reformed, 31.4% believed the PPACA will improve healthcare quality, while 20.9% disagreed and almost half (47.7%) were unsure if quality will be improved. Two thirds (67.6%) believed that the PPACA will increase access, 6.5% disagreed and the remaining 25.9% were unsure. With regard to containing healthcare costs, 45.4% of participants indicated that they are unsure if the provisions of the PPACA will do so. Overall, 80.1% of respondents indicated that they support the PPACA, and 78.3% also indicated that they did not feel that reform efforts had gone far enough. A majority of respondents (58.8%) opposed repeal of the PPACA, while 15.0% supported repeal, and 26.1% were undecided. Conclusion The overwhelming majority of medical students recognized healthcare reform is needed and expressed support for the PPACA but echoed concerns about whether it will address issues of quality or cost containment. PMID:21931604

The Legacy of the U. S. Public Health Services Study of Untreated Syphilis in African American Men at Tuskegee on the Affordable Care Act and Health Care Reform Fifteen Years After President Clinton’s Apology

PubMed Central

Mays, Vickie M.

2013-01-01

This special issue addresses the legacy of the United States Public Health Service Syphilis Study on health reform, particularly the Affordable Care Act (ACA). The 12 manuscripts cover the history and current practices of ethical abuses affecting American Indians, Latinos, Asian Americans and African Americans in the United States and in one case, internationally. Commentaries and essays include the voice of a daughter of one of the study participants in which we learn of the stigma and maltreatment some of the families experienced and how the study has impacted generations within the families. Consideration is given in one essay to utilizing narrative storytelling with the families to help promote healing. This article provides the reader a roadmap to the themes that emerged from the collection of articles. These themes include population versus individual consent issues, need for better government oversight in research and health care, the need for overhauling our bioethics training to develop a population level, culturally driven approach to research bioethics. The articles challenge and inform us that some of our assumptions about how the consent process best works to protect racial/ethnic minorities may be merely assumptions and not proven facts. Articles challenge the belief that low participation rates seen in biomedical studies have resulted from the legacy of the USPHS Syphilis Study rather than a confluence of factors rooted in racism, bias and negative treatment. Articles in this special issue challenge the “cultural paranoia” of mistrust and provide insights into how the distrust may serve to lengthen rather than shorten the lives of racial/ethnic minorities who have been used as guinea pigs on more than one occasion. We hope that the guidance offered on the importance of developing a new framework to bioethics can be integrated into the foundation of health care reform. PMID:23630410

The Legacy of the U. S. Public Health Services Study of Untreated Syphilis in African American Men at Tuskegee on the Affordable Care Act and Health Care Reform Fifteen Years After President Clinton's Apology.

PubMed

Mays, Vickie M

2012-11-01

This special issue addresses the legacy of the United States Public Health Service Syphilis Study on health reform, particularly the Affordable Care Act (ACA). The 12 manuscripts cover the history and current practices of ethical abuses affecting American Indians, Latinos, Asian Americans and African Americans in the United States and in one case, internationally. Commentaries and essays include the voice of a daughter of one of the study participants in which we learn of the stigma and maltreatment some of the families experienced and how the study has impacted generations within the families. Consideration is given in one essay to utilizing narrative storytelling with the families to help promote healing. This article provides the reader a roadmap to the themes that emerged from the collection of articles. These themes include population versus individual consent issues, need for better government oversight in research and health care, the need for overhauling our bioethics training to develop a population level, culturally driven approach to research bioethics. The articles challenge and inform us that some of our assumptions about how the consent process best works to protect racial/ethnic minorities may be merely assumptions and not proven facts. Articles challenge the belief that low participation rates seen in biomedical studies have resulted from the legacy of the USPHS Syphilis Study rather than a confluence of factors rooted in racism, bias and negative treatment. Articles in this special issue challenge the "cultural paranoia" of mistrust and provide insights into how the distrust may serve to lengthen rather than shorten the lives of racial/ethnic minorities who have been used as guinea pigs on more than one occasion. We hope that the guidance offered on the importance of developing a new framework to bioethics can be integrated into the foundation of health care reform.

US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity.

PubMed

Gomez, G; Stanford, F C

2018-03-01

Obesity is now the most prevalent chronic disease in the United States, which amounts to an estimated $147 billion in health care spending annually. The Affordable Care Act (ACA) enacted in 2010 included provisions for private and public health insurance plans that expanded coverage for lifestyle/behavior modification and bariatric surgery for the treatment of obesity. Pharmacotherapy, however, has not been included despite their evidence-based efficacy. We set out to investigate the coverage of Food and Drug Administration-approved medications for obesity within Medicare, Medicaid and ACA-established marketplace health insurance plans. We examined coverage for phentermine, diethylpropion, phendimetrazine, Benzphentamine, Lorcaserin, Phentermine/Topiramate (Qysmia), Liraglutide (Saxenda) and Buproprion/Naltrexone (Contrave) among Medicare, Medicaid and marketplace insurance plans in 34 states. Among 136 marketplace health insurance plans, 11% had some coverage for the specified drugs in only nine states. Medicare policy strictly excludes drug therapy for obesity. Only seven state Medicaid programs have drug coverage. Obesity requires an integrated approach to combat its public health threat. Broader coverage of pharmacotherapy can make a significant contribution to fighting this complex and chronic disease.

Guidebook of the Western United States: Part D - The Shasta Route and Coast Line

USGS Publications Warehouse

Diller, Joseph Silas; ,

1915-01-01

The United States of America comprise an area so vast in extent and so diverse in natural features as well as in characters due to human agency that the American citizen who knows thoroughly his own country must have traveled widely and observed wisely. To 'know America first' is a patriotic obligation, but to meet this obligation the railroad traveler needs to have his eyes directed toward the more important or essential things within his field of vision and then to have much that he sees explained by what is unseen in the swift passage of the train. Indeed, many things that attract his attention are inexplicable except as the story of the past is available to enable him to interpret the present. Herein lie the value and the charm of history, whether human or geologic. The present stimulus given to travel in the home country will encourage many thousands of Americans to study geography at first hand. To make this study most profitable the traveler needs a handbook that will answer the questions that come to his mind so readily along the way. Furthermore, the aim of such a guide should be to stimulate the eye in the selection of the essentials in the scene that so rapidly unfolds itself in the crossing of the continent. In recognition of the opportunity afforded in 1915 to render service of this kind to an unusually large number of American citizens as well as to visitors from other countries, the United States Geological Survey has prepared a series of guidebooks covering four of the older railroad routes west of the Mississippi. These books are educational in purpose, but the method adopted is to entertain the traveler by making more interesting what he sees from the car window. The plan of the series is to present authoritative information that may enable the reader to realize adequately the scenic and material resources of the region he is traversing, to comprehend correctly the basis of its development, and above all to appreciate keenly the real value of the country he looks out upon, not as so many square miles of territory represented on the map in a railroad folder by meaningless spaces, but rather as land - real estate, if you please - varying widely in present appearance because differing largely in its history and characterized by even greater variation in values because possessing diversified natural resources. One region may be such as to afford a livelihood for only a pastoral people; another may present opportunity for intensive agriculture; still another may contain hidden stores of mineral wealth that may attract large industrial development; and taken together these varied resources afford the promise of long-continued prosperity for this or that State. Items of interest in civic development or references to significant epochs in the record of discovery and settlement may be interspersed with explanations of mountain and valley or statements of geologic history. In a broad way, the story of the West is a unit, and every chapter should be told in order to meet fully the needs of the tourist who aims to understand all that he sees. To such a traveler-reader this series of guidebooks is addressed. To this interpretation of our own country the United States Geological Survey brings the accumulated data of decades of pioneering investigation, and the present contribution is only one type of return to the public which has supported this scientific work under the Federal Government. In preparing the description of the country traversed by the Shasta Route and Coast Line all the geographic and geologic information already published as well as other unpublished material in the possession of the Geological Survey has been utilized, but to supplement this material Mr. Diller made a field examination of the entire route in 1914. Information has been furnished by Dr. F. M. Anderson, Dr. J. C. Branner, Dr. J. Harlen Bretz, Prof. E. S. Burgess, Mr. J. S. Daggett, Mrs. L. P. Diller, Mr. Harold Hannibal, Mr. O

Guidebook of the Western United States: Part B - The Overland Route, With a Side Trip to Yellowstone Park

USGS Publications Warehouse

Lee, Willis Thomas; Stone, Ralph Walter; Gale, Hoyt Stoddard; ,

1915-01-01

The United States of America comprise an area so vast in extent and so diverse in natural features as well as in characters due to human agency that the American citizen who knows thoroughly his own country must have traveled widely and observed wisely. To 'know America first' is a patriotic obligation, but to meet this obligation the railroad traveler needs to have his eyes directed toward the more important or essential things within his field of vision and then to have much that he sees explained by what is unseen in the swift passage of the train. Indeed, many things that attract his attention are inexplicable except as the story of the past is available to enable him to interpret the present. Herein lie the value and the charm of history, whether human or geologic. The present stimulus given to travel in the home country will encourage many thousands of Americans to study geography at first hand. To make this study most profitable the traveler needs a handbook that will answer the questions that come to his mind so readily along the way. Furthermore, the aim of such a guide should be to stimulate the eye in the selection of the essentials in the scene that so rapidly unfolds itself in the crossing of the continent. In recognition of the opportunity afforded in 1915 to render service of this kind to an unusually large number of American citizens as well as to visitors from other countries, the United States Geological Survey has prepared a series of guidebooks covering four of the older railroad routes west of the Mississippi. These books are educational in purpose, but the method adopted is to entertain the traveler by making more interesting what he sees from the car window. The plan of the series is to present authoritative information that may enable the reader to realize adequately the scenic and material resources of the region he is traversing, to comprehend correctly the basis of its development, and above all to appreciate keenly the real value of the country he looks out upon, not as so many square miles of territory represented on the map in a railroad folder by meaningless spaces, but rather as land - real estate, if you please - varying widely in present appearance because differing largely in its history and characterized by even greater variation in values because possessing diversified natural resources. One region may be such as to afford a livelihood for only a pastoral people; another may present opportunity for intensive agriculture; still another may contain hidden stores of mineral wealth that may attract large industrial development; and taken together these varied resources afford the promise of long-continued prosperity for this or that State. Items of interest in civic development or references to significant epochs in the record of discovery and settlement may be interspersed with explanations of mountain and valley or statements of geologic history. In a broad way, the story of the West is a unit, and every chapter should be told in order to meet fully the needs of the tourist who aims to understand all that he sees. To such a traveler-reader this series of guidebooks is addressed. To this interpretation of our own country the United States Geological Survey brings the accumulated data of decades of pioneering investigation, and the present contribution is only one type of return to the public which has supported this scientific work under the Federal Government. In preparing the description of the country traversed by the Overland Route the geographic and geologic information already published as well as unpublished material in the possession of the Geological Survey has been utilized, but to supplement this material Messrs. Lee, Stone, and Gale made a field examination of the entire route in 1914, Mr. Lee working between Omaha and Ogden, Mr. Stone between Ogden and Yellowstone, and Mr. Gale between Ogden and San Francisco. Information has been furnished by Profs. J. C. Merriam a

Pharmacists' perspectives on the Patient Protection and Affordable Care Act.

PubMed

Khanna, Rahul; Mahabaleshwarkar, Rohan; Holmes, Erin R; Jariwala, Krutika

2015-01-01

Passed in 2010, the Patient Protection and Affordable Care Act (PPACA) resulted in significant changes to the health care system in the United States (US). Though general population surveys reveal the fractious political debate surrounding the law, insights on pharmacists' perspectives on the PPACA are lacking in the literature. The objectives of this study were to determine pharmacists' perspectives on the PPACA and determine whether pharmacists' demographic and practice-related characteristics and political beliefs influence their perspectives on the PPACA. This study was conducted using a descriptive, cross-sectional design. Study data were collected with a self-administered online questionnaire distributed to 21,769 registered pharmacists in five states. A total of 1127 completed surveys were received (5.6% response rate). Roughly 37% of pharmacists reported that they understood the major provisions of the PPACA although most (89%) respondents agreed that understanding such policies is important for practicing pharmacy. Just over half (50.6%) of respondents did not support the PPACA while 47.7% supported the legislation. Political orientation, age, gender, and race were found to be significantly related to pharmacists' perspectives on the PPACA. Respondent pharmacists' perceptions of the PPACA appear to be related to political orientation and demographic characteristics. Given that pharmacists will be impacted by the implementation of the PPACA and are so accessible to the public, additional information on health care policy and PPACA should be provided to pharmacists. Copyright © 2015 Elsevier Inc. All rights reserved.

Federal Home Visiting under the Affordable Care Act

ERIC Educational Resources Information Center

Strader, Kathleen; Counts, Jacqueline; Filene, Jill

2013-01-01

The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program is part of The Patient Protection and Affordable Care Act and provides $1.5 billion over 5 years to states, territories, and tribes with the goal of delivering evidence-based home visiting services as part of a high-quality, comprehensive early childhood system that promotes…

Higher Education Governance and Performance Based Funding as an Ecology of Games

ERIC Educational Resources Information Center

Nisar, Muhammad Azfar

2015-01-01

To address the problematic situation of higher education affordability, and literacy, President Obama has recently outlined a new strategy to make colleges more affordable for the middle class. While this strategy includes many components, "Paying for Performance" is a core components of this new strategy. In recent years, states have…

Patient Protection and Affordable Care Act; program integrity: Exchange, SHOP, and eligibility appeals. Final rule.

PubMed

2013-08-30

This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). Specifically, this final rule outlines Exchange standards with respect to eligibility appeals, agents and brokers, privacy and security, issuer direct enrollment, and the handling of consumer cases. It also sets forth standards with respect to a State's operation of the Exchange and Small Business Health Options Program (SHOP). It generally is finalizing previously proposed policies without change.

Non-Research-Related Physician-Industry Relationships of Radiologists in the United States.

PubMed

Harvey, H Benjamin; Alkasab, Tarik K; Pandharipande, Pari V; Halpern, Elkan F; Prabhakar, Anand M; Oklu, Rahmi; Rosenthal, Daniel I; Hirsch, Joshua A; Gazelle, G Scott; Brink, James A

2015-11-01

To evaluate non-research-related, physician-industry financial relationships in the United States, in 2013, as reported pursuant to the Physician Payments Sunshine Act (a provision of the Affordable Care Act). In September 2014, CMS released the first five months (August 2013 to December 2013) of data disclosing physician-industry financial relationships. The frequency and value of non-research-related transfers in radiology were calculated and compared with those for 19 other specialties. Subanalyses of the frequency and value of such transfers in radiology were performed, based on state of licensure, radiologic subspecialty, nature of payment, manufacturer identity, and drug or device involved. A total of 7.4% (2,654 of 35,768) of radiologists from the United States had reportable non-research-related financial relationship(s) with industry during the 5-month period, the second-lowest level among the medical specialties evaluated. The average value of non-research-related transfers of value to radiologists, excluding royalties and licenses, was low ($438.71; SD: $2,912.15; median: $43.85), with <4% of radiologists receiving >$10 per month. Of all categories, that of food and beverage had the most transfers of value (86.0%; 5,655 of 6,577); royalties and licensure were associated with the greatest average value ($27,072.34; SD: $67,524.92). Although high-value relationships were rare, 57.8% (26 of 45) of radiologists who received a value >$1,000 per month held leadership positions in imaging enterprises. Less than 4% of radiologists have non-research-related financial relationships with industry that are valued at >$10 per month, suggesting that meaningful, deleterious effects of such relationships on radiology practice, if present, are infrequent. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

United States of America: health system review.

PubMed

Rice, Thomas; Rosenau, Pauline; Unruh, Lynn Y; Barnes, Andrew J; Saltman, Richard B; van Ginneken, Ewout

2013-01-01

This analysis of the United States health system reviews the developments in organization and governance, health financing, health-care provision, health reforms and health system performance. The US health system has both considerable strengths and notable weaknesses. It has a large and well-trained health workforce, a wide range of high-quality medical specialists as well as secondary and tertiary institutions, a robust health sector research program and, for selected services, among the best medical outcomes in the world. But it also suffers from incomplete coverage of its citizenry, health expenditure levels per person far exceeding all other countries, poor measures on many objective and subjective measures of quality and outcomes, an unequal distribution of resources and outcomes across the country and among different population groups, and lagging efforts to introduce health information technology. It is difficult to determine the extent to which deficiencies are health-system related, though it seems that at least some of the problems are a result of poor access to care. Because of the adoption of the Affordable Care Act in 2010, the United States is facing a period of enormous potential change. Improving coverage is a central aim, envisaged through subsidies for the uninsured to purchase private insurance, expanded eligibility for Medicaid (in some states) and greater protection for insured persons. Furthermore, primary care and public health receive increased funding, and quality and expenditures are addressed through a range of measures. Whether the ACA will indeed be effective in addressing the challenges identified above can only be determined over time. World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

Affordability Challenges to Value-Based Pricing: Mass Diseases, Orphan Diseases, and Cures.

PubMed

Danzon, Patricia M

2018-03-01

To analyze how value-based pricing (VBP), which grounds the price paid for pharmaceuticals in their value, can manage "affordability" challenges, defined as drugs that meet cost-effectiveness thresholds but are "unaffordable" within the short-run budget. Three specific contexts are examined, drawing on recent experience. First, an effective new treatment for a chronic, progressive disease, such as hepatitis C, creates a budget spike that is transitory because initial prevalence is high, relative to current incidence. Second, "cures" that potentially provide lifetime benefits may claim abnormally high VBP prices, with high immediate budget impact potentially/partially offset by deferred cost savings. Third, although orphan drugs in principle target rare diseases, in aggregate they pose affordability concerns because of the growing number of orphan indications and increasingly high prices. For mass diseases, the transitory budget impact of treating the accumulated patient stock can be managed by stratified rollout that delays treatment of stable patients and prioritizes patients at high risk of deterioration. Delay spreads the budget impact and permits potential savings from launch of competing treatments. For cures, installment payments contingent on outcomes could align payment flows and appropriately shift risk to producers. This approach, however, entails high administrative and incentive costs, especially if applied across multiple payers in the United States. For orphan drugs, the available evidence on research and development trends and returns argues against the need for a higher VBP threshold to incentivize research and development in orphan drugs, given existing statutory benefits under orphan drug legislation. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Foreword: Follow-on Biologics: Implementation Challenges and Opportunities.

PubMed

Paradise, Jordan

2011-01-01

This Book of the Seton Hall Law Review presents the contributions to Follow-On Biologics: Implementation Challenges and Opportunities, a one-day roundtable event hosted by Seton Hall University School of Law in the fall of 2010. The roundtable fostered an international dialogue regarding the future of follow-on biologics in the United States resulting from the Patient Protection and Affordable Care Act of March 2010. THE BIOLOGIC PRICE COMPETITION AND INNOVATION ACT OF 2010. The March 23, 2010, enactment of the Patient Protection and Affordable Care Act (PPACA) and the companion Health Care and Education Affordability Reconciliation Act of 2010 ushered in landmark reform of the American health care system. Along with sweeping overhauls of the health care system generally, PPACA also provides a new regulatory challenge for the Food and Drug Administration (FDA). A subtitle within PPACA, the Biologics Price Competition and Innovation Act (BPCIA), bestows upon FDA broad authority to implement an abbreviated approval route to market for biological products (also known as biologics) that are "biosimilar" to an existing marketed product. The brief introduction will provide a basic comparison of biologics and conventional pharmaceutical drugs that will prove central to the FDA's development of this follow-on biologic pathway as well as specifically examine the content and scope of the BPCIA provisions and identify future challenges for the FDA. It will conclude by highlighting details of presentations during the roundtable held at the Seton Hall University School of Law and introduce the two resulting articles contained with this Book of the Seton Hall Law Review.

Undocumented and uninsured: aftereffects of the Patient Protection and Affordable Care Act.

PubMed

Agabin, Nataly; Coffin, Janis

2015-01-01

Although with the implementation of the Patient Protection and Affordable Care Act millions of previously uninsured American residents will gain access to healthcare coverage, millions more will remain uninsured due to the lack of mandatory state Medicaid expansion as well as mandates that forbid undocumented immigrants and legal residents of less than five years from purchasing insurance through the newly available market exchange. With limited options for healthcare coverage due to employment and lack of citizen status, undocumented immigrants rely heavily on funds provided by both Emergency Medicaid and Disproportionate Share Hospital programs. Through reevaluation of current funding, mandates forbidding access to market exchanges, and plans to further enable access to affordable health coverage, states have the unique opportunity to both aid their residents and relieve the financial burden on healthcare facilities and Emergency Medicaid funds.

Crossing 138: two approaches to churn under the Affordable Care Act.

PubMed

Ravel, Gabriel; DeSantis, J Angelo

2014-01-01

A predicted side effect of the Medicaid expansion and state-based Exchanges under the Affordable Care Act is churn. Churn is the shifting into and out of eligibility for insurance affordability programs due to income changes. Because the line between Medicaid and Exchange eligibility is fine -138% of the federal poverty level -millions of Americans are expected to gain and lose eligibility. Frequently, this churning undermines continuity of care, raises costs, and frustrates those affected. This article explores two proposed programs to mitigate the effects of churn: the Basic Health Program and the Bridge Program. This article evaluates both programs' ability to mitigate the effects of churn, the likely side effects to states' implementing them, and legal and practical obstacles to their implementation. It concludes that the Bridge Program is the better approach.

State and regional tools for coordinating housing and transportation.

DOT National Transportation Integrated Search

2014-01-01

Federal, state, and local governments spend billions on transportation infrastructure and affordable : housing subsidies, but rarely with complete coordination. States and regional entities are pivotal in : shaping transportation and housing systems....

Implementing the Affordable Care Act: state approaches to premium rate reforms in the individual health insurance market.

PubMed

Giovannelli, Justin; Lucia, Kevin W; Corlette, Sabrina

2014-12-01

The Affordable Care Act protects people from being charged more for insurance based on factors like medical history or gender and establishes new limits on how insurers can adjust premiums for age, tobacco use, and geography. This brief examines how states have implemented these federal reforms in their individual health insurance markets. We identify state rating standards for the first year of full implementation of reform and explore critical considerations weighed by policymakers as they determined how to adopt the law's requirements. Most states took the opportunity to customize at least some aspect of their rating standards. Interviews with state regulators reveal that many states pursued implementation strategies intended primarily to minimize market disruption and premium shock and therefore established standards as consistent as possible with existing rules or market practice. Meanwhile, some states used the transition period to strengthen consumer protections, particularly with respect to tobacco rating.

OCLC book interlibrary loan in a basic-unit hospital library: one year's experience.

PubMed

Landwirth, T K

1983-04-01

Methodist Medical Center of Illinois Medical Library, a "basic-unit" medical library (i.e., not a resource library) in the Regional Medical Library Program recently completed one year of borrowing and lending books using OCLC. Of the books successfully borrowed through OCLC, 79% were obtained from nonmedical libraries. Forming cost-sharing OCLC clusters among basic units makes OCLC an affordable alternative to borrowing books from overburdened medical resource libraries.

Black Jobs Matter: Racial Inequalities in Conditions of Employment and Subsequent Health Outcomes.

PubMed

Doede, Megan Sarah

2016-01-01

African-Americans shoulder an excessive burden of unemployment, precarious employment, and low paying jobs in the United States, which may help explain why they experience some of the worst health outcomes among U.S. citizens. This paper presents a conceptual framework describing this phenomenon. The social determinants of health as described by this framework include racism, social and public policy formation, socioeconomic status, and conditions of employment. The intermediate determinants of health, which include the ability to afford health behavior, depression and addiction, environmental exposures, and access to primary care, are informed by conditions of employment, which leads to poor health outcomes for African-Americans. This paper will explore in detail these relationships. © 2015 Wiley Periodicals, Inc.

Perspective: POTUS Trump's Executive Orders - Implications for Immigrants and Health Care.

PubMed

Talamantes, Efrain; Aguilar-Gaxiola, Sergio

2017-01-01

The United States, under new executive orders proposed by its 45th president, may quickly lose its greatness in serving Emma Lazarus' untimely portrait of immigrants and refugees as " the tired, poor and huddled masses yearning to breathe free ." After years of progress in improving health care access to underserved populations, new executive orders threaten our nation's advancements in health equity. Within this perspective, we offer examples on how these actions may result in damaging impacts on patients, families, communities and the health care workforce. We add our voices to a myriad of national leaders who are advocating for the preservation of the Affordable Care Act (ACA) and the protection of immigrants, including Deferred Action for Childhood Arrivals (DACA).

Thirty Years of Media Coverage on High Drug Prices in the United States--A Never-Ending Story or a Time for Change?

PubMed

Leopold, Christine; Chambers, James D; Wagner, Anita K

2016-01-01

In recent years drug prices have increasingly become a topic of debate for patients, providers, payers and policy makers. To place the current drug price debate into historical context, we searched the New York Times and Wall Street Journal from 1985 - 2015 and found that concerns about drug prices have commonly featured in the press over the study period with recently stronger calls for change. Price levels, types of innovations, stakeholder responses, and strategies to address high prices discussed in the media suggest that concerted efforts are required to enable affordable and high-value innovations. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Golf in the United States: an evolution of accessibility.

PubMed

Parziale, John R

2014-09-01

Golf affords physical and psychological benefits to persons who are physically challenged. Advances in adaptive technology, changes in golf course design, and rules modifications have enabled persons with neurological, musculoskeletal, and other impairments to play golf at a recreational, elite amateur, or professional level. The Americans with Disabilities Act has been cited in both federal and US Supreme Court rulings that have improved access for physically challenged golfers. Medical specialties, including physiatry, have played an important role in this process. This article reviews the history of golf's improvements in accessibility, and provides clinicians and physically challenged golfers with information that will facilitate participation in the sport. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

A longitudinal test of the Comprehensive Indoor Tanning Expectations Scale: The importance of affective beliefs in predicting indoor tanning behavior.

PubMed

Myrick, Jessica Gall; Noar, Seth M; Kelley, Dannielle; Zeitany, Alexandra E; Morales-Pico, Brenda M; Thomas, Nancy E

2017-01-01

In order to better understand drivers of dangerous indoor tanning behaviors, researchers developed the Comprehensive Indoor Tanning Expectations scale. To examine the longitudinal effectiveness of Comprehensive Indoor Tanning Expectations, we surveyed young women in the Southeastern United States at two time points ( N = 553). The scale demonstrated strong test-retest reliability. Participants who believed indoor tanning would improve their mood and afford social approval were significantly more likely to tan 6 months later, while participants who believed indoor tanning leads to psychological/physical discomfort were significantly less likely to tan 6 months later. Knowing the psychological bases for indoor tanning can inform intervention and message design.

Affordable and accurate large-scale hybrid-functional calculations on GPU-accelerated supercomputers

NASA Astrophysics Data System (ADS)

Ratcliff, Laura E.; Degomme, A.; Flores-Livas, José A.; Goedecker, Stefan; Genovese, Luigi

2018-03-01

Performing high accuracy hybrid functional calculations for condensed matter systems containing a large number of atoms is at present computationally very demanding or even out of reach if high quality basis sets are used. We present a highly optimized multiple graphics processing unit implementation of the exact exchange operator which allows one to perform fast hybrid functional density-functional theory (DFT) calculations with systematic basis sets without additional approximations for up to a thousand atoms. With this method hybrid DFT calculations of high quality become accessible on state-of-the-art supercomputers within a time-to-solution that is of the same order of magnitude as traditional semilocal-GGA functionals. The method is implemented in a portable open-source library.

National health expenditure projections, 2014-24: spending growth faster than recent trends.

PubMed

Keehan, Sean P; Cuckler, Gigi A; Sisko, Andrea M; Madison, Andrew J; Smith, Sheila D; Stone, Devin A; Poisal, John A; Wolfe, Christian J; Lizonitz, Joseph M

2015-08-01

Health spending growth in the United States is projected to average 5.8 percent for 2014-24, reflecting the Affordable Care Act's coverage expansions, faster economic growth, and population aging. Recent historically low growth rates in the use of medical goods and services, as well as medical prices, are expected to gradually increase. However, in part because of the impact of continued cost-sharing increases that are anticipated among health plans, the acceleration of these growth rates is expected to be modest. The health share of US gross domestic product is projected to rise from 17.4 percent in 2013 to 19.6 percent in 2024. Project HOPE—The People-to-People Health Foundation, Inc.

Some thoughts concerning large load-carrying vehicles

NASA Technical Reports Server (NTRS)

Spearman, M. L.

1983-01-01

Some implications relative to combat operations and force sustainability into the twenty-first century are discussed. The basic conjecture is that, sometime in the future, secure overseas basing may be denied to the United States by the Soviet Union or by unfriendly, unstable governments. In that event, the support of future battle itself, may be conducted from the continental U.S. and would introduce requirements for large, long-range, efficient, and sometimes, fast air vehicles. Some unusual design concepts and the technology requirements for such vehicles are suggested. It is concluded that, while much of the required technology is already being pursued, further advanced should be expected and sought in improved aerodynamics, propulsion, structures, and avionics with a view toward increased efficiency, utility, and affordability.

Stem-cell-derived products: an FDA update.

PubMed

Moos, Malcolm

2008-12-01

The therapeutic potential of products derived from stem cells of various types has prompted increasing research and development and public attention. Initiation of human clinical trials in the not-too-distant future is now a realistic possibility. It is, therefore, important to weigh the potential benefits against known, theoretical and totally unsuspected risks in light of current knowledge to ensure that subjects participating in these trials are afforded the most reasonable balance possible between potential risks and potential benefits. There are no apparent differences in fundamental, qualitative biological characteristics between stem-cell-derived products and other cellular therapies regulated by the United States Food and Drug Administration (FDA). Existing authorities can, therefore, be applied. Nevertheless, these products do have properties that require careful evaluation.

Analysis of mixed-layer clay mineral structures

USGS Publications Warehouse

Bradley, W.F.

1953-01-01

Among the enormously abundant natural occurrences of clay minerals, many examples are encountered in which no single specific crystallization scheme extends through a single ultimate grain. The characterization of such assemblages becomes an analysis of the distribution of matter within such grains, rather than the simple identification of mineral species. It having become established that the particular coordination complex typified by mica is a common component of many natural subcrystalline assemblages, the opportunity is afforded to analyze scattering from random associations of these complexes with other structural units. Successful analyses have been made of mixed hydration states of montmorillonite, of montmorillonite with mica, of vermiculite with mica, and of montmorillonite with chlorite, all of which are variants of the mica complex, and of halloysite with hydrated halloysite.

Seeing the forest for the trees: Networked workstations as a parallel processing computer

NASA Technical Reports Server (NTRS)

Breen, J. O.; Meleedy, D. M.

1992-01-01

Unlike traditional 'serial' processing computers in which one central processing unit performs one instruction at a time, parallel processing computers contain several processing units, thereby, performing several instructions at once. Many of today's fastest supercomputers achieve their speed by employing thousands of processing elements working in parallel. Few institutions can afford these state-of-the-art parallel processors, but many already have the makings of a modest parallel processing system. Workstations on existing high-speed networks can be harnessed as nodes in a parallel processing environment, bringing the benefits of parallel processing to many. While such a system can not rival the industry's latest machines, many common tasks can be accelerated greatly by spreading the processing burden and exploiting idle network resources. We study several aspects of this approach, from algorithms to select nodes to speed gains in specific tasks. With ever-increasing volumes of astronomical data, it becomes all the more necessary to utilize our computing resources fully.

Student Affordability Report. Daring to Be Great: The NDUS Edge

ERIC Educational Resources Information Center

North Dakota University System, 2016

2016-01-01

This 2016 student affordability report looks at the following numerical data for higher education in the state of North Dakota: (1) Tuition, Mandatory Fees, Room & Board; (2) Total Estimated Student Cost; (3) Federal Funding Sources; (4) Net Price; (5) Loan Volume and Indebtedness; and (6) Percent of Students with Aid. In 2015-16, tuition and…

The potential conflict between policy and ethics in caring for undocumented immigrants at academic health centers.

PubMed

Cacari Stone, Lisa; Steimel, Leah; Vasquez-Guzman, Estela; Kaufman, Arthur

2014-04-01

Academic health centers (AHCs) are at the forefront of delivering care to the diverse medically underserved and uninsured populations in the United States, as well as training the majority of the health care workforce, who are professionally obligated to serve all patients regardless of race or immigration status. Despite AHCs' central leadership role in these endeavors, few consolidated efforts have emerged to resolve potential conflicts between national, state, and local policies that exclude certain classifications of immigrants from receiving federal public assistance and health professionals' social missions and ethical oath to serve humanity. For instance, whereas the 2010 Patient Protection and Affordable Care Act provides a pathway to insurance coverage for more than 30 million Americans, undocumented immigrants and legally documented immigrants residing in the United States for less than five years are ineligible for Medicaid and excluded from purchasing any type of coverage through state exchanges. To inform this debate, the authors describe their experience at the University of New Mexico Hospital (UNMH) and discuss how the UNMH has responded to this challenge and overcome barriers. They offer three recommendations for aligning AHCs' social missions and professional ethics with organizational policies: (1) that AHCs determine eligibility for financial assistance based on residency rather than citizenship, (2) that models of medical education and health professions training provide students with service-learning opportunities and applied community experience, and (3) that frontline staff and health care professionals receive standardized training on eligibility policies to minimize discrimination towards immigrant patients.

Cost-Performance Parametrics for Transporting Small Packages to the Mars Vicinity

NASA Technical Reports Server (NTRS)

McCleskey, C.; Lepsch, Roger A.; Martin, J.; Popescu, M.

2015-01-01

This paper explores the costs and performance required to deliver a small-sized payload package (CubeSat-sized, for instance) to various transportation nodes en route to Mars and near-Mars destinations (such as Mars moons, Phobos and Deimos). Needed is a contemporary assessment and summary compilation of transportation metrics that factor both performance and affordability of modern and emerging delivery capabilities. The paper brings together: (a) required mass transport gear ratios in delivering payload from Earths surface to the Mars vicinity, (b) the cyclical energy required for delivery, and (c) the affordability and availability of various means of transporting material across various Earth-Moon vicinity and Near-Mars vicinity nodes relevant to Mars transportation. Examples for unit deliveries are computed and tabulated, using a CubeSat as a unit, for periodic near-Mars delivery campaign scenarios.

Government as Institutional Entrepreneur: Extending Working Life in the UK and Japan.

PubMed

Flynn, Matthew; Schröder, Heike; Higo, Masa; Yamada, Atsuhiro

2014-07-01

Through the lens of Institutional Entrepreneurship, this paper discusses how governments use the levers of power afforded through business and welfare systems to affect change in the organisational management of older workers. It does so using national stakeholder interviews in two contrasting economies: the United Kingdom and Japan. Both governments have taken a 'light-touch' approach to work and retirement. However, the highly institutionalised Japanese system affords the government greater leverage than that of the liberal UK system in changing employer practices at the workplace level.

The difficult business model for mask equipment makers and mask infrastructure development support from consortia and governments

NASA Astrophysics Data System (ADS)

Hector, Scott

2005-11-01

The extension of optical projection lithography through immersion to patterning features with half pitch <=65 nm is placing greater demands on the mask. Strong resolution enhancement techniques (RETs), such as embedded and alternating phase shift masks and complex model-based optical proximity correction, are required to compensate for diffraction and limited depth of focus (DOF). To fabricate these masks, many new or upgraded tools are required to write patterns, measure feature sizes and placement, inspect for defects, review defect printability and repair defects on these masks. Beyond the significant technical challenges, suppliers of mask fabrication equipment face the challenge of being profitable in the small market for mask equipment while encountering significant R&D expenses to bring new generations of mask fabrication equipment to market. The total available market for patterned masks is estimated to be $2.5B to $2.9B per year. The patterned mask market is about 20% of the market size for lithography equipment and materials. The total available market for mask-making equipment is estimated to be about $800M per year. The largest R&D affordability issue arises for the makers of equipment for fabricating masks where total available sales are typically less than ten units per year. SEMATECH has used discounted cash flow models to predict the affordable R&D while maintaining industry accepted internal rates of return. The results have been compared to estimates of the total R&D cost to bring a new generation of mask equipment to market for various types of tools. The analysis revealed that affordability of the required R&D is a significant problem for many suppliers of mask-making equipment. Consortia such as SEMATECH and Selete have played an important role in cost sharing selected mask equipment and material development projects. Governments in the United States, in Europe and in Japan have also helped equipment suppliers with support for R&D. This paper summarizes the challenging business model for mask equipment suppliers and highlight government support for mask equipment and materials development.

Universal Health Insurance Coverage in Massachusetts Did Not Change the Trajectory of Arthroplasty Use or Costs.

PubMed

Kurtz, Steven M; Lau, Edmund; Ong, Kevin L; Katz, Jeffrey N; Bozic, Kevin J

2016-05-01

The state of Massachusetts enacted universal health insurance in 2006. However it is unknown whether the increased access to care resulted in changes to surgical use or costs. We asked the following related research questions: compared with the United States as a whole, how did the (1) number of cases (as a percentage of the overall population, to account for changes in the overall population during the time surveyed), (2) payer mix, and (3) inpatient costs for arthroplasty change in Massachusetts after introduction of health insurance reform? We analyzed the use and cost of primary THAs and TKAs in Massachusetts using the State Inpatient Database (SID) between 2002 and 2011 compared with the Nationwide Inpatient Sample (NIS) during the same years. The SID captures 100% of inpatient procedures in Massachusetts, while the NIS is a nationally representative database of inpatient procedures for the United States. The SID and NIS are publicly available data sources from the Agency for Healthcare Research and Quality, and include information regarding procedure volumes, payer mixes, and costs. Inpatient costs were defined similarly in both databases by using hospital charges and an average cost-to-charge ratio that is unique for each hospital. The incidence of arthroplasties was calculated by dividing the procedure volume by the relevant population (either for Massachusetts or the entire country) based on public data from the United States Census bureau. The incidence of THAs and TKAs performed in Massachusetts increased steadily throughout the study period, and paralleled a similar increase in the United States as a whole. In Massachusetts, the incidence of THAs increased by 59% between 2002 and 2011, and the incidence of TKAs likewise increased by 80%. The trends for the incidence in total joint arthroplasties were similar to those for Massachusetts for the United States as a whole. The period of health insurance reform in Massachusetts was associated with a greater proportion of patients covered by Medicaid, Commonwealth Care, or Health Safety Net for THAs and TKAs. By 2011, universal health insurance in Massachusetts covered 2.45% of primary THAs and 2.77% of primary TKAs. Coverage for Medicaid in Massachusetts increased from 3.23% and 3.04% of THAs and TKAs in 2002 to 4.06% and 4.34% respectively in 2011. On average, Medicaid coverage was greater for TKAs in Massachusetts than across the United States during the study period. The introduction of health insurance reform had a minimal effect on the cost of total joint arthroplasties in Massachusetts. Although the costs of total joint arthroplasties in the United States were higher than those in Massachusetts, this difference narrowed substantially from 2002 to 2011, with the Massachusetts cost trending upward and the overall United States cost trending downward. Despite extending insurance coverage to the entire state of Massachusetts, there was little change in actual utilization trends for joint replacement. The enactment of universal health insurance coverage in Massachusetts appears to have been a nonevent insofar as the use and cost of total hip and knee surgeries is concerned in the state. Factors other than health insurance reform appear to be driving the growth in demand for arthroplasties in Massachusetts and are likely to do so as well in the United States under the Affordable Care Act of 2010.

Preserving Neighborhood Opportunity: Where Federal Housing Subsidies Expire

PubMed Central

Lens, Michael C.; Reina, Vincent

2017-01-01

Rent burdens are increasing in U.S. metropolitan areas while subsidies on privately owned, publicly subsidized rental units are expiring. As a result, some of the few remaining affordable units in opportunity neighborhoods are at risk of being converted to market rate. Policy makers face a decision about whether to devote their efforts and scarce resources toward developing new affordable housing, recapitalizing existing subsidized housing, and/or preserving properties with expiring subsidies. There are several reasons to preserve these subsidies, one being that properties may be located in neighborhoods with greater opportunity. In this article, we use several sources of data at the census tract level to learn how subsidy expirations affect neighborhood opportunity for low-income households. Our analysis presents several key findings. First, we find that units that left the project-based Section 8 program were – on average – in lower opportunity neighborhoods, but these neighborhoods were improving. In addition, properties due to expiry from the Section 8 program between 2011 and 2020 are in higher opportunity neighborhoods than any other subsidy program. On the contrary, new Low-Income Housing Tax Credit (LIHTC) units were developed in tracts similar to those where LIHTC units are currently active, which tend to be lower opportunity neighborhoods. PMID:28553063

Private Education in the Absence of a Public Option: The Cases of the United Arab Emirates and Qatar

ERIC Educational Resources Information Center

Ridge, Natasha Y.; Shami, Soha; Kippels, Susan M.

2016-01-01

In the face of rising demand for private schooling in the United Arab Emirates (UAE) and Qatar, a lack of affordable schooling options, monopolistic behavior of private education providers, and unpredictable government regulations have created a complex and unequal education sector. This research employs a mixed methods comparative approach to…

12 CFR 1282.17 - Affordability-Income level definitions-family size and income known (owner-occupied units, actual...

Code of Federal Regulations, 2010 CFR

2010-01-01

... GOALS AND MISSION Housing Goals § 1282.17 Affordability—Income level definitions—family size and income..., for rental housing, family size and income information for the dwelling unit is known to the... sizes: Number of persons in family Percentageof area median income 1 70 2 80 3 90 4 100 5 or more...

Implementing the Affordable Care Act: Promoting Competition in the Individual Marketplaces.

PubMed

Cusano, David; Lucia, Kevin

2016-02-01

A main goal of the Affordable Care Act is to provide Americans with access to affordable coverage in the individual market, achieved in part by pro­moting competition among insurers on premium price and value. One primary mechanism for meeting that goal is the establishment of new individual health insurance marketplaces where consumers can shop for, compare, and purchase plans, with subsidies if they are eligible. In this issue brief, we explore how the Affordable Care Act is influencing competition in the individual marketplaces in four states--Kansas, Nevada, Rhode Island, and Washington. Strategies include: educating consumers and providing coverage information in one place to ease decision-making; promoting competition among insurers; and ensuring a level playing field for premium rate development through the rate review process.

OCLC book interlibrary loan in a basic-unit hospital library: one year's experience.

PubMed Central

Landwirth, T K

1983-01-01

Methodist Medical Center of Illinois Medical Library, a "basic-unit" medical library (i.e., not a resource library) in the Regional Medical Library Program recently completed one year of borrowing and lending books using OCLC. Of the books successfully borrowed through OCLC, 79% were obtained from nonmedical libraries. Forming cost-sharing OCLC clusters among basic units makes OCLC an affordable alternative to borrowing books from overburdened medical resource libraries. PMID:6860829

78 FR 42823 - Patient Protection and Affordable Care Act; Exchange Functions: Standards for Navigators and Non...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-17

...This final rule addresses various requirements applicable to Navigators and non-Navigator assistance personnel in Federally- facilitated Exchanges, including State Partnership Exchanges, and to non-Navigator assistance personnel in State Exchanges that are funded through federal Exchange Establishment grants. It finalizes the requirement that Exchanges must have a certified application counselor program. It creates conflict-of-interest, training and certification, and meaningful access standards; clarifies that any licensing, certification, or other standards prescribed by a state or Exchange must not prevent application of the provisions of title I of the Affordable Care Act; adds entities with relationships to issuers of stop loss insurance to the list of entities that are ineligible to become Navigators; and clarifies that the same ineligibility criteria that apply to Navigators apply to certain non-Navigator assistance personnel. The final rule also directs that each Exchange designate organizations which will then certify their staff members and volunteers to be application counselors that assist consumers and facilitate enrollment in qualified health plans and insurance affordability programs, and provides standards for that designation.

Medicaid expansion and access to care among cancer survivors: a baseline overview.

PubMed

Tarazi, Wafa W; Bradley, Cathy J; Harless, David W; Bear, Harry D; Sabik, Lindsay M

2016-06-01

Medicaid expansion under the Affordable Care Act facilitates access to care among vulnerable populations, but 21 states have not yet expanded the program. Medicaid expansions may provide increased access to care for cancer survivors, a growing population with chronic conditions. We compare access to health care services among cancer survivors living in non-expansion states to those living in expansion states, prior to Medicaid expansion under the Affordable Care Act. We use the 2012 and 2013 Behavioral Risk Factor Surveillance System to estimate multiple logistic regression models to compare inability to see a doctor because of cost, having a personal doctor, and receiving an annual checkup in the past year between cancer survivors who lived in non-expansion states and survivors who lived in expansion states. Cancer survivors in non-expansion states had statistically significantly lower odds of having a personal doctor (adjusted odds ratio [AOR] 0.76, 95 % confidence interval [CI] 0.63-0.92, p < 0.05) and higher odds of being unable to see a doctor because of cost (AOR 1.14, 95 % CI 0.98-1.31, p < 0.10). Statistically significant differences were not found for annual checkups. Prior to the passage of the Affordable Care Act, cancer survivors living in expansion states had better access to care than survivors living in non-expansion states. Failure to expand Medicaid could potentially leave many cancer survivors with limited access to routine care. Existing disparities in access to care are likely to widen between cancer survivors in Medicaid non-expansion and expansion states.

Who Can Afford it? How Rising Costs are Making College Unaffordable for Working Families. Commission Report 08-10

ERIC Educational Resources Information Center

California Postsecondary Education Commission, 2008

2008-01-01

This white paper looks at the way that rising college costs are affecting California families. Higher education in California has historically been guided by the principle that maintaining affordability is paramount to providing access to all students who desire a postsecondary education. However, over recent decades, eroding state funding for…

Towards Development of OER Derived Custom-Built Open Textbooks: A Baseline Survey of University Teachers at the University of the South Pacific

ERIC Educational Resources Information Center

Prasad, Deepak; Usagawa, Tsuyoshi

2014-01-01

Textbook prices have soared over the years, with several studies revealing many university students are finding it difficult to afford textbooks. Fortunately, two innovations--open educational resources (OER) and open textbooks--hold the potential to increase textbook affordability. Experts, though, have stated the obvious: that students can save…

A human rights approach to the WHO Model List of Essential Medicines.

PubMed Central

Seuba, Xavier

2006-01-01

Since the first WHO Model List of Essential Medicines was adopted in 1977, it has become a popular tool among health professionals and Member States. WHO's joint effort with the United Nations Committee on Economic, Social and Cultural Rights has resulted in the inclusion of access to essential medicines in the core content of the right to health. The Committee states that the right to health contains a series of elements, such as availability, accessibility, acceptability and quality of health goods, services and programmes, which are in line with the WHO statement that essential medicines are intended to be available within the context of health systems in adequate amounts at all times, in the appropriate dosage forms, with assured quality and information, and at a price that the individual and the community can afford. The author considers another perspective by looking at the obligations to respect, protect and fulfil the right to health undertaken by the states adhering to the International Covenant of Economic, Social and Cultural Rights (ICESCR) and explores the relationship between access to medicines, the protection of intellectual property, and human rights. PMID:16710552

The Downside of Marketization: A Multilevel Analysis of Housing Tenure and Types in Reform-era Urban China

PubMed Central

Fu, Qiang; Zhu, Yushu; Ren, Qiang

2015-01-01

Based on data from the 2005 National Population Sample Survey and compiled covariates of 205 prefectures, this research adopted principal-component and multilevel-logistic analyses to study homeownership in urban China. Although the housing reform has severed the link between work units and residence, working in state sectors (government, state-owned enterprises and collective firms) remained significant in determining a household’s entitlement to reform-era housing with heavy subsidies or better qualities. While the prefecture-level index of marketization reduced local homeownership of self-built housing, affordable housing and privatized housing, its effect is moderated by cross-level interactions with income, education and working in state sectors across different types of housing. Meanwhile, the index of political and market connections promoted all types of homeownership except for self-built housing. By situating the downside of marketization within a context of urban transformation, this research not only challenges the teleological premise of the neoliberal market transition theory but calls for research on institutional dynamics and social consequences of urban transformation in China. PMID:25432608

Commentary: the importance of Medicaid expansion for criminal justice populations in the south.

PubMed

Zaller, Nickolas D; Cloud, David H; Brinkley-Rubinstein, Lauren; Martino, Sarah; Bouvier, Benjamin; Brockmann, Brad

2017-12-01

Though the full implications of a Trump presidency for ongoing health care and criminal justice reform efforts remain uncertain, whatever policy changes are made will be particularly salient for the South, which experiences the highest incarceration rates, highest uninsured rates, and worst health outcomes in the United States. The passage of the Affordable Care Act (ACA) in 2010 was a watershed event and many states have taken advantage of opportunities created by the ACA to expand healthcare coverage to their poorest residents, and to develop partnerships between health and justice systems. Yet to date, only four have taken advantage of the benefits of healthcare reform. Expanding Medicaid would provide Southern states with the opportunity to significantly impact health outcomes for criminal justice-involved individuals. In the context of an uncertain policy landscape, we suggest the use of three strategies, focusing on advancing incremental change while safeguarding existing gains, rebranding Medicaid as a local or statewide initiative, and linking Medicaid expansion to criminal justice reform, in order to implement Medicaid expansion across the South.

The downside of marketization: a multilevel analysis of housing tenure and types in reform-era urban China.

PubMed

Fu, Qiang; Zhu, Yushu; Ren, Qiang

2015-01-01

Based on data from the 2005 National Population Sample Survey and compiled covariates of 205 prefectures, this research adopted principal-component and multilevel-logistic analyses to study homeownership in urban China. Although the housing reform has severed the link between work units and residence, working in state sectors (government, state-owned enterprises and collective firms) remained significant in determining a household's entitlement to reform-era housing with heavy subsidies or better qualities. While the prefecture-level index of marketization reduced local homeownership of self-built housing, affordable housing and privatized housing, its effect is moderated by cross-level interactions with income, education and working in state sectors across different types of housing. Meanwhile, the index of political and market connections promoted all types of homeownership except for self-built housing. By situating the downside of marketization within a context of urban transformation, this research not only challenges the teleological premise of the neoliberal market transition theory but calls for research on institutional dynamics and social consequences of urban transformation in China. Copyright © 2014 Elsevier Inc. All rights reserved.

An integrated low carbon energy solution to cooking fuel, tailored to Niger state's rural population

NASA Astrophysics Data System (ADS)

Carvell, Aaron; Price-Allison, Andrew; Birch, Calum; Green, Toby; Harijan, Khanji; Maihankuri, Sheidi; Raji, Abdulganiy; Uqaili, Mohammed; Dupont, Valerie

2017-11-01

Niger State (Nigeria) was selected as a case study of renewable, affordable and user friendly clean energy provision in remote areas of developing countries. Niger state has 80% of its 4.5 million population living in rural agrarian areas with low literacy rates, there is a lack of wind thus eliminating wind as widely available potential power source. Based on the assessment of the local large insolation, the type of agricultural, biomass and husbandry resources, this study selected the design of anaerobic digestion units processing mostly animal and human waste, and whose heating and power requirement would be entirely provided by solar photovoltaic/thermal to maintain optimum efficiency of the biogas production. The designs was carried out at the scale of up to 15 household demand (community scale). Volume and therefore the production of biogas maybe increased or decreased in the design considered, and local, low cost resilient material were proposed. The proposed system was costed for a community of 24 people, demonstrating the potential for clean and renewable gas production economically.

Coal resources in environmentally-sensitive lands under federal management

USGS Publications Warehouse

Watson, William D.; Tully, John K.; Moser, Edward N.; Dee, David P.; Bryant, Karen; Schall, Richard; Allan, Harold A.

1995-01-01

This report presents estimates of coal-bearing acreage and coal tonnage in environmentally-sensitive areas. The analysis was conducted to provide data for rulemaking by the Federal Office of Surface Mining (Watson and others, 1995). The rulemaking clarifies conditions under which coal can be mined in environmentally-sensitive areas. The area of the U.S. is about 2.3 billion acres. Contained within that acreage are certain environmentally-sensitive and unique areas (including parks, forests, and various other Federal land preserves). These areas are afforded special protection under Federal and State law. Altogether these protected areas occupy about 400 million acres. This report assesses coal acreage and coal tonnage in these protected Federal land preserves. Results are presented in the form of 8 map-displays prepared using GIS methods at a national scale. Tables and charts that accompany each map provide estimates of the total acreage in Federal land preserve units that overlap or fall within coal fields, coal-bearing acreage in each unit, and coal tonnage in each unit. Summary charts, compiled from the maps, indicate that about 8% of the Nation's coal reserves are located within environmentally-sensitive Federal land preserves.

Trends in Health Insurance Coverage of Title X Family Planning Program Clients, 2005-2015.

PubMed

Decker, Emily J; Ahrens, Katherine A; Fowler, Christina I; Carter, Marion; Gavin, Loretta; Moskosky, Susan

2018-05-01

The federal Title X Family Planning Program supports the delivery of family planning services and related preventive care to 4 million individuals annually in the United States. The implementation of the 2010 Affordable Care Act's (ACA's) Medicaid expansion and provisions expanding access to health insurance, which took effect in January 2014, resulted in higher rates of health insurance coverage in the U.S. population; the ACA's impact on individuals served by the Title X program has not yet been evaluated. Using administrative data we examined changes in health insurance coverage among Title X clinic patients during 2005-2015. We found that the percentage of clients without health insurance decreased from 60% in 2005 to 48% in 2015, with the greatest annual decrease occurring between 2013 and 2014 (63% to 54%). Meanwhile, between 2005 and 2015, the percentage of clients with Medicaid or other public health insurance increased from 20% to 35% and the percentage of clients with private health insurance increased from 8% to 15%. Although clients attending Title X clinics remained uninsured at substantially higher rates compared with the national average, the increase in clients with health insurance coverage aligns with the implementation of ACA-related provisions to expand access to affordable health insurance.

The Latino Physician Shortage: How the Affordable Care Act Increases the Value of Latino Spanish-Speaking Physicians and What Efforts Can Increase Their Supply.

PubMed

Daar, David A; Alvarez-Estrada, Miguel; Alpert, Abigail E

2018-02-01

The United States Latino population is growing at a rapid pace and is set to reach nearly 30% by 2050. The demand for culturally and linguistically competent health care is increasing in lockstep with this growth; however, the supply of doctors with skills and experience suited for this care is lagging. In particular, there is a major shortage of Latino Spanish-speaking physicians, and the gap between demand and supply is widening. The implementation of the Affordable Care Act (ACA) has increased the capacity of the US healthcare system to care for the growing Latino Spanish-speaking population, through health insurance exchanges, increased funding for safety net institutions, and efforts to improve efficiency and coordination of care, particularly with Accountable Care Organizations and the Hospital Readmissions Reduction Program. With these policies in mind, the authors discuss how the value of Latino Spanish-speaking physicians to the healthcare system has increased under the environment of the ACA. In addition, the authors highlight key efforts to increase the supply of this physician population, including the implementation of the Deferred Action for Childhood Arrivals Act, premedical pipeline programs, and academic medicine and medical school education initiatives to increase Latino representation among physicians.

Implementation of Electronic Health Records and Entrepreneurial Strategic Orientation in Substance Use Disorder Treatment Organizations.

PubMed

Fields, Dail; Riesenmy, Kelly; Blum, Terry C; Roman, Paul M

2015-11-01

This research studied the relationships of the components of entrepreneurial strategic orientation (ESO) with implementation of electronic health records (EHRs) within organizations that treat patients with substance use disorders (SUDs). A national sample of 317 SUD treatment providers were studied in a period after the Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted (2009) and meaningful use EHR requirements were established (2010), but before implementation of the Affordable Care Act. The study sample was selected using stratified random sampling and was part of a longitudinal study of treatment providers across the United States. After we controlled for potentially confounding variables, four components of ESO had a significant relationship with EHR implementation. Levels of slack resources in an organization moderated the relationship of ESO with meaningful use of EHRs, increasing the strength of the relationship for some components but reducing the strength of others. From a policy and practice perspective, the results suggest that training and education to develop higher levels of ESO within SUD treatment organizations are likely to increase their level of meaningful use of EHRs, which in turn may enhance the integration of SUD treatment with primary medical providers, better preparing SUD treatment providers for the environmental changes of the Affordable Care Act.

Redressing the limitations of the Affordable Care Act for Mexican immigrants through bi-national health insurance: a willingness to pay study in Los Angeles.

PubMed

González Block, Miguel Angel; Vargas Bustamante, Arturo; de la Sierra, Luz Angélica; Martínez Cardoso, Aresha

2014-04-01

The 12.4 million Mexican migrants in the United States (US) face considerable barriers to access health care, with 45% of them being uninsured. The Affordable Care Act (ACA) does not address lack of insurance for some immigrants, and the excluded groups are a large proportion of the Mexican-American community. To redress this, innovative forms of health insurance coverage have to be explored. This study analyses factors associated with willingness to pay for cross-border, bi-national health insurance (BHI) among Mexican immigrants in the US. Surveys were administered to 1,335 Mexican migrants in the Mexican Consulate of Los Angeles to assess their health status, healthcare utilization, and willingness to purchase BHI. Logistic regression was used to identify predictors of willingness to pay for BHI. Having a job, not having health insurance in the US, and relatives in Mexico attending public health services were significant predictors of willingness to pay for BHI. In addition, individuals identified quality as the most important factor when considering BHI. In spite of the interest for BHI among 54% of the sampled population, our study concludes that this type of coverage is unlikely to solve access to care challenges due to ACA eligibility among different Mexican immigrant populations.

Freedom of conscience and health care in the United States of america: the conflict between public health and religious liberty in the patient protection and affordable care act.

PubMed

West-Oram, Peter

2013-09-01

The recent confirmation of the constitutionality of the Obama administration's Patient Protection and Affordable Care Act (PPACA) by the US Supreme Court has brought to the fore long-standing debates over individual liberty and religious freedom. Advocates of personal liberty are often critical, particularly in the USA, of public health measures which they deem to be overly restrictive of personal choice. In addition to the alleged restrictions of individual freedom of choice when it comes to the question of whether or not to purchase health insurance, opponents to the PPACA also argue that certain requirements of the Act violate the right to freedom of conscience by mandating support for services deemed immoral by religious groups. These issues continue the long running debate surrounding the demands of religious groups for special consideration in the realm of health care provision. In this paper I examine the requirements of the PPACA, and the impacts that religious, and other ideological, exemptions can have on public health, and argue that the exemptions provided for by the PPACA do not in fact impose unreasonable restrictions on religious freedom, but rather concede too much and in so doing endanger public health and some important individual liberties.

Health Education Specialists' Knowledge, Attitudes, and Perceptions of the Patient Protection and Affordable Care Act.

PubMed

Strong, Jessica; Hanson, Carl L; Magnusson, Brianna; Neiger, Brad

2016-03-01

The changing landscape of health care as a result of the Patient Protection and Affordable Care Act (ACA) may provide new opportunities for health education specialists (HES). The purpose of this study was to survey HES in the United States on their knowledge and attitudes of the ACA and assess their perceptions of job growth under the law. A random sample of 220 (36% response rate) certified HES completed a 53-item cross sectional survey administered online through Qualtrics. Findings were compared to public opinion on health care reform. HES are highly favorable of the law (70%) compared to the general public (23%). A total of 85% of respondents were able to list a provision of the ACA, and most (81%) thought the ACA would be successful at increasing insured Americans. Over half (64.6%) believe job opportunities will increase. Those who viewed the law favorably were significantly more likely to score better on a knowledge scale related to the ACA. HES understand publicized provisions but are uncertain about common myths and specific provisions related to Title IV, "Prevention of Chronic Disease and Improving Public Health." Directed and continuing education to HES regarding the ACA is warranted. © 2015 Society for Public Health Education.

Implementation of Electronic Health Records and Entrepreneurial Strategic Orientation in Substance Use Disorder Treatment Organizations

PubMed Central

Fields, Dail; Riesenmy, Kelly; Blum, Terry C.; Roman, Paul M.

2015-01-01

Objective: This research studied the relationships of the components of entrepreneurial strategic orientation (ESO) with implementation of electronic health records (EHRs) within organizations that treat patients with substance use disorders (SUDs). Method: A national sample of 317 SUD treatment providers were studied in a period after the Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted (2009) and meaningful use EHR requirements were established (2010), but before implementation of the Affordable Care Act. The study sample was selected using stratified random sampling and was part of a longitudinal study of treatment providers across the United States. Results: After we controlled for potentially confounding variables, four components of ESO had a significant relationship with EHR implementation. Levels of slack resources in an organization moderated the relationship of ESO with meaningful use of EHRs, increasing the strength of the relationship for some components but reducing the strength of others. Conclusions: From a policy and practice perspective, the results suggest that training and education to develop higher levels of ESO within SUD treatment organizations are likely to increase their level of meaningful use of EHRs, which in turn may enhance the integration of SUD treatment with primary medical providers, better preparing SUD treatment providers for the environmental changes of the Affordable Care Act. PMID:26562603

Influence of affordability of alcohol on educational disparities in alcohol-related mortality in Finland and Sweden: a time series analysis.

PubMed

Herttua, Kimmo; Östergren, Olof; Lundberg, Olle; Martikainen, Pekka

2017-12-01

Prices of alcohol and income tend to influence how much people buy and consume alcohol. Price and income may be combined into one measure, affordability of alcohol. Research on the association between affordability of alcohol and alcohol-related harm is scarce. Furthermore, no research exists on how this association varies across different subpopulations. We estimated the effects of affordability of alcohol on alcohol-related mortality according to gender and education in Finland and Sweden. Vector-autoregressive time series modelling was applied to the quarter-annual aggregations of alcohol-related deaths and affordability of alcohol in Finland in 1988-2007 and in Sweden in 1991-2008. Alcohol-related mortality was defined using information on both underlying and contributory causes of death. We calculated affordability of alcohol index using information on personal taxable income and prices of various types of alcohol. Among Finnish men with secondary education, an increase of 1% in the affordability of total alcohol was associated with an increase of 0.028% (95% CI 0.004 to 0.053) in alcohol-related mortality. Similar associations were also found for affordability for various types of alcohol and for beer only in the lowest education group. We found few other significant positive associations for other subpopulations in Finland or Sweden. However, reverse associations were found among secondary-educated Swedish women. Overall, the associations between affordability of alcohol and alcohol-related mortality were relatively weak. Increased affordability of total alcoholic beverages was associated with higher rates of alcohol-related mortality only among Finnish men with secondary education. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Keeping up with the Cadillacs: What Health Insurance Disparities, Moral Hazard, and the Cadillac Tax Mean to The Patient Protection and Affordable Care Act.

PubMed

Fletcher, Rebecca Adkins

2016-03-01

A major goal of The Patient Protection and Affordable Care Act is to broaden health care access through the extension of insurance coverage. However, little attention has been given to growing disparities in access to health care among the insured, as trends to reduce benefits and increase cost sharing (deductibles, co-pays) reduce affordability and access. Through a political economic perspective that critiques moral hazard, this article draws from ethnographic research with the United Steelworkers (USW) at a steel mill and the Retail, Wholesale and Department Store Union (RWDSU) at a food-processing plant in urban Central Appalachia. In so doing, this article describes difficulties of health care affordability on the eve of reform for differentially insured working families with employer-sponsored health insurance. Additionally, this article argues that the proposed Cadillac tax on high-cost health plans will increase problems with appropriate health care access and medical financial burden for many families. © 2014 by the American Anthropological Association.

Insurance-related Practices at Title X-funded Family Planning Centers under the Affordable Care Act: Survey and Interview Findings.

PubMed

Zolna, Mia R; Kavanaugh, Megan L; Hasstedt, Kinsey

Given the recent reforms in the United States health care system, including the passage and implementation of the Affordable Care Act, as well as anticipated upcoming changes to health care coverage, it is critical that publicly funded health care providers understand how to effectively work with their states' Medicaid programs and the private health insurance plans in their service areas to provide high-quality contraceptive care to the millions of women relying on services at these sites annually. We collected survey data from a nationally representative sample of 535 clinics providing family planning services that received Title X funding and conducted semistructured interviews with 23 administrators at a subsample of surveyed clinics to explore provider-reported experiences working with health plans and to identify barriers to, and practices that lead to, adequate reimbursement for services provided. Providers report that knowledgeable staff are crucial to securing contracts with both public and private insurance plan issuers, and that the contracts they secure often include coverage restrictions on methods or services clinics offer their clients. Good staff relationships with issuers are key to obtaining adequate and consistent reimbursement for all covered services. Providers are trying to understand how insurance programs in their area knit together. Regardless of how U.S. health policies and delivery systems may change in the coming years, it is imperative that publicly funded family planning centers continue to work with health plans and maximize their third-party revenue to provide services to those in need. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

76 FR 17661 - Notice of Submission of Proposed Information Collection to OMB Public/Private Partnerships for...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-30

...The proposed information collection requirement described below has been submitted to the Office of Management and Budget (OMB) for review, as required by the Paperwork Reduction Act. The Department is soliciting public comments on the subject proposal. In 1998, the HUD Reform Act allowed Mixed-Finance public and affordable housing development. Mixed-Finance is the process where public housing funds are mixed with other government and non-government financing in order to encourage the development of mixed-income housing that includes public housing units. In addition, Public Housing Authorities (PHAs) may use other sources of financing to supplement their development or rehabilitation of public housing units. The form and agreements in this Information Collection pertain to the financial closing of a Mixed-Finance housing project's development or rehabilitation. They describe the ownership of, type, size and number of, construction period and permanent financing of, the restrictions on the usage of, and HUD and Federal Government rights to, the public, affordable and market rate rental housing units that are being developed or rehabilitated.

Measuring Up 2002: The State-By-State Report Card for Higher Education.

ERIC Educational Resources Information Center

National Center for Public Policy and Higher Education, CA.

This report is the second in a series of biennial, state-by-state 50-state report cards. As in the earlier report, state higher education systems are evaluated, compared, and graded in five categories of performance: preparation, participation, affordability, completion, and benefits. All states are given an "incomplete" in the sixth category,…

Online HIV awareness and technology affordance benefits for black female collegians - maybe not: the case of stigma.

PubMed

Payton, Fay Cobb; Kvasny, Lynette

2016-11-01

We investigate the technology affordances associated with and anticipated from an online human immunodeficiency virus (HIV) prevention awareness platform, myHealthImpactNetwork, intended to reach black female college students. This population is at increased risk for HIV transmission, but is not often studied. In addition, this population regularly uses digital tools, including Web sites and social media platforms, to engage in health information seeking. We conducted 11 focus groups with 60 black female college students attending 2 universities in the United States. Focus groups were recorded, transcribed, and analyzed using content analyses. Contrary to our proposition, the participants' information needs did not align with the anticipated benefits associated with the technology affordances of the prevention awareness platform. Concerns about personal online social capital, reputation management, and stigma limited participants' willingness to engage with the HIV prevention content on the website. Although the participants use digital tools as a primary means of becoming informed about health, concerns that friends, family, and others in their social networks would assume that they were HIV infected limited their willingness to engage with myHealthImpactNetwork. Print media and conversations with health care professionals were preferred channels for obtaining HIV prevention information. Perceptions of stigma associated with HIV negatively impact health information seeking and sharing in the online social networks in which black college students engage. However, by understanding the unanticipated consequences, researchers can effectively design for cultures and subcultures infected and affected by health disparities. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Trends in smoking and obesity among US adults before, during, and after the great recession and Affordable Care Act roll-out.

PubMed

Pernenkil, Vikash; Wyatt, Taylor; Akinyemiju, Tomi

2017-09-01

This study examined trends in smoking and overweight/obesity rates among United States (US) adults ages 40years and older by race and socio-economic status (SES) across three study periods; pre-recession (2003-2005), recession (2007-2009), and post-recession/Affordable Care Act (2010-2012). Data was obtained from the Behavioral Risk Factor Surveillance System (BRFSS), and multivariable regression analysis was used to examine changes in overweight/obesity, smoking, physical activity and smoking cessation rates over the study periods. There were 2,805,957 adults included in the analysis; 65.5% of the study population was overweight/obese, and 33.3% were current smokers. Smoking prevalence increased marginally among those with lower SES (income<$10,000) from pre-recession (52.5%) to post-recession (52.9%), but declined in other socio-demographic groups. The odds of overweight/obesity increased in the post-recession (OR: 1.22, 95% CI: 1.21-1.23) and recession (OR: 1.11, 95% CI: 1.11-1.12) periods compared with pre-recession, but odds of smoking overall decreased in the post-recession (OR: 0.93, 95% CI: 0.92-0.94) and recession (OR: 0.95, 95% CI: 0.94-0.97) periods. Overweight/obesity increased over the study periods, regardless of race, SES or healthcare access, while smoking rates showed significant declines post-recession compared with pre-recession, except in low SES groups. These findings suggest that strategies focused on reducing overweight/obesity and increasing access to smoking cessation services, especially among low-income adults, are needed. Prospective studies are needed to better evaluate the influence of the economic recession and Affordable Care Act on behavioral risk factors. Copyright © 2017 Elsevier Inc. All rights reserved.

Constellation Program Life-cycle Cost Analysis Model (LCAM)

NASA Technical Reports Server (NTRS)

Prince, Andy; Rose, Heidi; Wood, James

2008-01-01

The Constellation Program (CxP) is NASA's effort to replace the Space Shuttle, return humans to the moon, and prepare for a human mission to Mars. The major elements of the Constellation Lunar sortie design reference mission architecture are shown. Unlike the Apollo Program of the 1960's, affordability is a major concern of United States policy makers and NASA management. To measure Constellation affordability, a total ownership cost life-cycle parametric cost estimating capability is required. This capability is being developed by the Constellation Systems Engineering and Integration (SE&I) Directorate, and is called the Lifecycle Cost Analysis Model (LCAM). The requirements for LCAM are based on the need to have a parametric estimating capability in order to do top-level program analysis, evaluate design alternatives, and explore options for future systems. By estimating the total cost of ownership within the context of the planned Constellation budget, LCAM can provide Program and NASA management with the cost data necessary to identify the most affordable alternatives. LCAM is also a key component of the Integrated Program Model (IPM), an SE&I developed capability that combines parametric sizing tools with cost, schedule, and risk models to perform program analysis. LCAM is used in the generation of cost estimates for system level trades and analyses. It draws upon the legacy of previous architecture level cost models, such as the Exploration Systems Mission Directorate (ESMD) Architecture Cost Model (ARCOM) developed for Simulation Based Acquisition (SBA), and ATLAS. LCAM is used to support requirements and design trade studies by calculating changes in cost relative to a baseline option cost. Estimated costs are generally low fidelity to accommodate available input data and available cost estimating relationships (CERs). LCAM is capable of interfacing with the Integrated Program Model to provide the cost estimating capability for that suite of tools.

Self-rated health, generalized trust, and the Affordable Care Act: A US panel study, 2006-2014.

PubMed

Mewes, Jan; Giordano, Giuseppe Nicola

2017-10-01

Previous research shows that generalized trust, the belief that most people can be trusted, is conducive to people's health. However, only recently have longitudinal studies suggested an additional reciprocal pathway from health back to trust. Drawing on a diverse body of literature that shows how egalitarian social policy contributes to the promotion of generalized trust, we hypothesize that this other 'reverse' pathway could be sensitive to health insurance context. Drawing on nationally representative US panel data from the General Social Survey, we examine whether the Affordable Care Act of 2010 could have had influence on the deteriorating impact of worsening self-rated health (SRH) on generalized trust. Firstly, using two-wave panel data (2008-2010, N = 1403) and employing random effects regression models, we show that a lack of health insurance coverage negatively determines generalized trust in the United States. However, this association is attenuated when additionally controlling for (perceived) income inequality. Secondly, utilizing data from two separate three-wave panel studies from the US General Social Survey (2006-10; N = 1652; 2010-2014; N = 1187), we employ fixed-effects linear regression analyses to control for unobserved heterogeneity from time-invariant factors. We demonstrate that worsening SRH was a stronger predictor for a decrease in generalized trust prior (2006-2010) to the implementation of the Affordable Care Act. Further, the negative effect of fair/poor SRH seen in the 2006-2010 data becomes attenuated in the 2010-2014 panel data. We thus find evidence for a substantial weakening of the previously established negative impact of decreasing SRH on generalized trust, coinciding with the most significant US healthcare reforms in decades. Social policy and healthcare policy implications are discussed. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

What's at Stake in U.S. Health Reform: A Guide to the Affordable Care Act and Value-Based Care.

PubMed

Rambur, Betty A

2017-05-01

The U.S. presidential election of 2016 accentuated the divided perspectives on the Patient Protection and Affordable Care Act of 2010, commonly known as Obamacare. The perspectives included a pledge from then candidate Donald J. Trump to "repeal and replace on day one"; Republican congressional leaders' more temperate suggestions in the first weeks of the Trump administration to "repair" the Affordable Care Act (ACA); and President Trump's February 5, 2017 statement-16 days after inauguration-that a Republican replacement for the ACA may not be ready until late 2017 or 2018. The swirling rhetoric, media attention, and the dizzying rate of U.S. health and payment reforms both within and outside of the ACA makes it difficult for nurses, both United States and globally, to discern which health policy issues are grounded in the ACA and which aspects reflect payer-driven "volume to value" reimbursement changes. Moreover, popular and controversial elements of the ACA-for example, the clause that prohibits insurance carriers to deny coverage to those with preexisting health conditions and the more controversial individual mandate that bears Supreme Court support as a constitutional provision-are paired in ways that might be unclear to those unfamiliar with nuances of insurance rate determination. To support nurses' capacity to maximize their impact on health policy, this overview distills the 906-page ACA into major themes and describes payment reform legislation and initiatives that are external to the ACA. Understanding the political and societal forces that affect health care policy and delivery is necessary for nurses to effectively lead and advocate for the best interests of their patients.

The Patient Protection and Affordable Care Act and Reproductive Health: Harnessing Data to Improve Care

PubMed Central

Stulberg, Debra

2013-01-01

The Patient Protection and Affordable Care Act (PPACA) has great potential to improve reproductive health through several components: expanded coverage of people of reproductive age; required coverage of many reproductive health services; and insurance exchange structures that encourage individuals and states to hold plans and providers accountable. These components can work together to improve reproductive health. But in order for this to work, consumers and states need information with which to assess plans. This review article summarizes state contracting theory and argues that states should use this structure to require health plans to collect and report meaningful data that patients, providers, plans, payers, and third-party researchers can access. Now that the Supreme Court has upheld the PPACA and states must set up health insurance exchanges, populations can benefit from improved care and outcomes through data transparency. PMID:23262767

Solar Energy Systems for Ohioan Residential Homeowners

NASA Astrophysics Data System (ADS)

Luckett, Rickey D.

Dwindling nonrenewable energy resources and rising energy costs have forced the United States to develop alternative renewable energy sources. The United States' solar energy industry has seen an upsurge in recent years, and photovoltaic holds considerable promise as a renewable energy technology. The purpose of this case study was to explore homeowner's awareness of the benefits of solar energy. Disruptive-innovation theory was used to explore marketing strategies for conveying information to homeowners about access to new solar energy products and services. Twenty residential homeowners were interviewed face-to-face to explore (a) perceived benefits of solar energy in their county in Ohio, and (b) perceptions on the rationale behind the marketing strategy of solar energy systems sold for residential use. The study findings used inductive analyses and coding interpretation to explore the participants' responses that revealed 3 themes: the existence of environmental benefits for using solar energy systems, the expensive cost of equipment associated with government incentives, and the lack of marketing information that is available for consumer use. The implications for positive social change include the potential to enable corporate leaders, small business owners, and entrepreneurs to develop marketing strategies for renewable energy systems. These strategies may promote use of solar energy systems as a clean, renewable, and affordable alternative electricity energy source for the 21st century.

Role of telehealth in renal replacement therapy education.

PubMed

Malkina, Anna; Tuot, Delphine S

2018-03-01

The prevalence of end-stage renal disease is rising in the United States, which bears high financial and public health burden. The most common modality of renal replacement therapy (RRT) in the United States is in-center hemodialysis. Many patients report lack of comprehensive and timely education about their treatment options, which may preclude them from participating in home-based dialysis therapies and kidney transplantation evaluation. While RRT education has traditionally been provided in-person, the rise of telehealth has afforded new opportunities to improve upon the status quo. For example, technology-augmented RRT education has recently been implemented into telehealth nephrology clinics, informational websites and mobile applications maintained by professional organizations, patient-driven forums on social media, and multimodality programs. The benefits of technology in RRT education are increased access for geographically isolated and/or medically frail patients, versatility of content delivery, information repetition to enhance knowledge retention, and interpersonal connection for educational content and emotional support. Challenges center around privacy and accuracy of information sharing, in addition to differential access to technology due to age and socioeconomic status. A review of available scholarly and social media resources suggests that technology-aided delivery of education about treatment options for end-stage renal disease provides an important alternative and/or supplemental resource for patients and families. © 2018 Wiley Periodicals, Inc.

Incorporating Interprofessional Evidenced-Based Sepsis Simulation Education for Certified Nursing Assistants (CNAs) and Licensed Care Providers Within Long-term Care Settings for Process and Quality Improvement.

PubMed

Mihaljevic, Susan E; Howard, Valerie M

2016-01-01

Improving resident safety and quality of care by maximizing interdisciplinary communication among long-term care providers is essential in meeting the goals of the United States' Federal Health care reform. The new Triple Aim goals focus on improved patient outcomes, increasing patient satisfaction, and decreased health care costs, thus providing consumers with quality, efficient patient-focused care. Within the United States, sepsis is the 10th leading cause of death with a 28.6% mortality rate in the elderly, increasing to 40% to 60% in septic shock. As a result of the Affordable Care Act, the Centers for Medicare & Medicaid services supported the Interventions to Reduce Acute Care Transfers 3.0 program to improve health care quality and prevent avoidable rehospitalization by improving assessment, documentation, and communication among health care providers. The Interventions to Reduce Acute Care Transfers 3.0 tools were incorporated in interprofessional sepsis simulations throughout 19 long-term care facilities to encourage the early recognition of sepsis symptoms and prompt communication of sepsis symptoms among interdisciplinary teams. As a result of this simulation training, many long-term care organizations have adopted the STOP and WATCH and SBAR tools as a venue to communicate resident condition changes.

Overcoming the Challenges in Implementing Type 2 Diabetes Mellitus Prevention Programs Can Decrease the Burden on Healthcare Costs in the United States.

PubMed

Subramanian, Kritika; Midha, Inuka; Chellapilla, Vijaya

2017-01-01

Theoretically, identifying prediabetics would reduce the diabetic burden on the American healthcare system. As we expect the prevalence rate of prediabetes to continue increasing, we wonder if there is a better way of managing prediabetics and reducing the economic cost on the healthcare system. To do so, understanding the demographics and behavioral factors of known prediabetics was important. For this purpose, responses of prediabetic/borderline diabetes patients from the most recent publicly available 2015 Behavioral Risk Factor Surveillance System (BRFSS) survey were analyzed. The findings showed that there was a correlation between household income, geographic residence in the US, and risk for developing diabetes mellitus type 2, aside from the accepted risk factors such as high BMI. In conclusion, implementation of the National Diabetes Prevention Program is a rational way of reducing the burden of DM on the healthcare system both economically and by prevalence. However, difficulties arise in ensuring patient compliance to the program and providing access to all regions and communities of the United States. Technology incorporation in the NDPP program would maintain a low-cost implementation by the healthcare system, be affordable and accessible for all participants, and decrease economic burden attributed to diabetes mellitus.

The location and scope of geographic remote sensing training in the United States

NASA Technical Reports Server (NTRS)

Hawley, A. J.

1981-01-01

Maps displaying the distribution of graduate departments of geography in the United States and enrollments in remote sensing courses in all geography departments during the past two calendar years were compiled. It was anticipated that the two distributions would show a marked similarity since remote sensing is a relatively new geographic tool requiring specialized training to use as well as equipment not normally found in most geography departments. Thus only the larger graduate departments can afford to devote time and resources to this specialty. A broad correspondence does exist between the graduate departments of geography and the courses in remote ensing. However, the correlation is far from complete and the exceptions are frequent and large enough to cast doubt upon the accuracy of the original hypothesis. Whereas many large departments do offer courses in remote sensing, many smaller colleges and universities do also. A number of possible explanations can be offered for the discrepancies: (1) course titles, (2) the liberal arts orientation of geography departments in many universities, (3) job-oriented skills which many smaller departments have emphasized, and (4) in the tight job market many new graduates of even the larger departments have had to accept position in smaller departments and colleges.

A systematic review of food deserts, 1966-2007.

PubMed

Beaulac, Julie; Kristjansson, Elizabeth; Cummins, Steven

2009-07-01

"Food deserts," areas characterized by poor access to healthy and affordable food, may contribute to social and spatial disparities in diet and diet-related health outcomes. However, the extent to which food deserts exist is debated. We review the evidence for the existence of food deserts in socioeconomically disadvantaged areas. We conducted a systematic review of primary, quantitative, observational studies, published in English or French, that used geographic or market-basket approaches in high-income countries. The literature search included electronic and hand searches and peer-reviewed and grey literature from 1966 through 2007. We also contacted key researchers to identify other studies. We analyzed the findings and quality of the studies qualitatively. Forty-nine studies in 5 countries met inclusion criteria; the amount and consistency of the evidence varied by country. These studies were a mix of geographic and market-basket approaches, but the methodologic quality of studies and completeness of reported findings were mixed. We found clear evidence for disparities in food access in the United States by income and race. Findings from other high-income countries were sparse and equivocal. This review suggests that food deserts exist in the United States, where area-level deprivation compounds individual disadvantage. Evidence for the existence of food deserts in other high-income nations is weak.

Access to Primary Care in US Counties Is Associated with Lower Obesity Rates.

PubMed

Gaglioti, Anne H; Petterson, Stephen; Bazemore, Andrew; Phillips, Robert

2016-01-01

Obesity causes substantial morbidity and mortality in the United States. Evidence shows that primary care physician (PCP) supply correlates positively with improved health, but its association with obesity in the United States as not been adequately characterized. Our purpose was to characterize the association between PCP supply in US counties and adult obesity. We performed a multivariate logistic regression analysis to examine the relationship between county-level PCP supply and individual obesity status. We controlled for individual variables, including sex, race, marital status, income, and insurance status, and county-level variables, including rurality and poverty. Higher county-level PCP supply was associated with lower adult obesity after controlling for common confounders. Individuals living in counties with the most robust PCP supply were about 20% less likely to be obese (P ≤ .01) than those living in counties with the lowest PCP supply. While the observed association between the supply of PCPs and lower rates of obesity may not be causal, the association warrants further investigation. This may have important implications for restructuring the physician workforce in the context of the current PCP shortage and implementation of the Affordable Care Act and the patient-centered medical home. © Copyright 2016 by the American Board of Family Medicine.

Breastfeeding: The Illusion of Choice.

PubMed

Dinour, Lauren M; Bai, Yeon K

2016-01-01

Breastfeeding is frequently described as a woman's decision, yet this choice is often illusionary owing to suboptimal social and structural supports. Despite passage of the Patient Protection and Affordable Care Act (2010) that requires all qualifying employers to provide mothers "reasonable" break time and a private, non-bathroom space to express breast milk, the majority of women in the United States still do not have access to both accommodations. At least three issues may be influencing this suboptimal implementation at workplaces: 1) federal law does not address lactation space functionality and accessibility, 2) federal law only protects a subset of employees, and 3) enforcement of the federal law requires women to file a complaint with the United States Department of Labor. To address each of these issues, we recommend the following modifications to current law: 1) additional requirements surrounding lactation space and functionality, 2) mandated coverage of exempt employees, and 3) requirement that employers develop company-specific lactation policies. If the goal is to give women a real choice of whether to continue breastfeeding after returning to work, we must provide the proper social and structural supports that will allow for a truly personal decision. No mother should have to choose between breastfeeding her child and earning a paycheck. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Preliminary Survey of Icing Conditions Measured During Routine Transcontinental Airline Operation

NASA Technical Reports Server (NTRS)

Perkins, Porter J.

1952-01-01

Icing data collected on routine operations by four DC-4-type aircraft equipped with NACA pressure-type icing-rate meters are presented as preliminary information obtained from a statistical icing data program sponsored by the NACA with the cooperation of many airline companies and the United States Air Force. The program is continuing on a much greater scale to provide large quantities of data from many air routes in the United States and overseas. Areas not covered by established air routes are also being included in the survey. The four aircraft which collected the data presented in this report were operated by United Air Lines over a transcontinental route from January through May, 1951. An analysis of the pressure-type icing-rate meter was satisfactory for collecting statistical data during routine operations. Data obtained on routine flight icing encounters from.these four instrumented aircraft, although insufficient for a conclusive statistical analysis, provide a greater quantity and considerably more realistic information than that obtained from random research flights. A summary of statistical data will be published when the information obtained daring the 1951-52 icing season and that to be obtained during the 1952-53 season can be analyzed and assembled. The 1951-52 data already analyzed indicate that the quantity, quality, and range of icing information being provided by this expanded program should afford a sound basis for ice-protection-system design by defining the important meteorological parameters of the icing cloud.

Influence of Medical Insurance Under the Affordable Care Act on Access to Pain Management of the Trauma Patient.

PubMed

Wiznia, Daniel H; Zaki, Theodore; Maisano, Julianna; Kim, Chang-Yeon; Halaszynski, Thomas M; Leslie, Michael P

The Affordable Care Act intended to "extend affordable coverage" and "ensure access" for vulnerable patient populations. This investigation examined whether the type of insurance (Medicaid, Medicare, Blue Cross, cash pay) carried by trauma patients influences access to pain management specialty care. Investigators phoned 443 board-certified pain specialists, securing office visits with 235 pain physicians from 8 different states. Appointments for pain management were for a patient who sustained an ankle fracture requiring surgery and experiencing difficulty weaning off opioids. Offices were phoned 4 times assessing responses to the 4 different payment methodologies. Fifty-three percent of pain specialists contacted (235 of 443) were willing to see new patients to manage pain medication. Within the 53% of positive responses, 7.2% of physicians scheduled appointments for Medicaid patients, compared with 26.8% for cash-paying patients, 39.6% for those with Medicare, and 41.3% with Blue Cross (P < 0.0001). There were no differences in appointment access between states that had expanded Medicaid eligibility for low-income adults versus states that had not expanded Medicaid eligibility. Neither Medicaid nor Medicare reimbursement levels for new patient visits correlated with ability to schedule an appointment or influenced wait times. Access to pain specialists for management of pain medication in the postoperative trauma patient proved challenging. Despite the Affordable Care Act, Medicaid patients still experienced curtailed access to pain specialists and confronted the highest incidence of barriers to receiving appointments.

The Affordable Care Act and Health Insurance Exchanges: Advocacy Efforts for Children's Oral Health.

PubMed

Orynich, C Ashley; Casamassimo, Paul S; Seale, N Sue; Litch, C Scott; Reggiardo, Paul

2015-01-01

To evaluate legislative differences in defining the Affordable Care Act's (ACA) pediatric dental benefit and the role of pediatric advocates across states with different health insurance Exchanges. Data were collected through public record investigation and confidential health policy expert interviews conducted at the state and federal level. Oral health policy change by the pediatric dental profession requires advocating for the mandatory purchase of coverage through the Exchange, tax subsidy contribution toward pediatric dental benefits, and consistent regulatory insurance standards for financial solvency, network adequacy and provider reimbursement. The pediatric dental profession is uniquely positioned to lead change in oral health policy amidst health care reform through strengthening state-level formalized networks with organized dentistry and commercial insurance carriers.

Three-Year Impacts Of The Affordable Care Act: Improved Medical Care And Health Among Low-Income Adults.

PubMed

Sommers, Benjamin D; Maylone, Bethany; Blendon, Robert J; Orav, E John; Epstein, Arnold M

2017-06-01

Major policy uncertainty continues to surround the Affordable Care Act (ACA) at both the state and federal levels. We assessed changes in health care use and self-reported health after three years of the ACA's coverage expansion, using survey data collected from low-income adults through the end of 2016 in three states: Kentucky, which expanded Medicaid; Arkansas, which expanded private insurance to low-income adults using the federal Marketplace; and Texas, which did not expand coverage. We used a difference-in-differences model with a control group and an instrumental variables model to provide individual-level estimates of the effects of gaining insurance. By the end of 2016 the uninsurance rate in the two expansion states had dropped by more than 20 percentage points relative to the nonexpansion state. For uninsured people gaining coverage, this change was associated with a 41-percentage-point increase in having a usual source of care, a $337 reduction in annual out-of-pocket spending, significant increases in preventive health visits and glucose testing, and a 23-percentage-point increase in "excellent" self-reported health. Among adults with chronic conditions, we found improvements in affordability of care, regular care for those conditions, medication adherence, and self-reported health. Project HOPE—The People-to-People Health Foundation, Inc.

Fused dithienogermolodithiophene low band gap polymers for high-performance organic solar cells without processing additives.

PubMed

Zhong, Hongliang; Li, Zhe; Deledalle, Florent; Fregoso, Elisa Collado; Shahid, Munazza; Fei, Zhuping; Nielsen, Christian B; Yaacobi-Gross, Nir; Rossbauer, Stephan; Anthopoulos, Thomas D; Durrant, James R; Heeney, Martin

2013-02-13

We report the synthesis of a novel ladder-type fused ring donor, dithienogermolodithiophene, in which two thieno[3,2-b]thiophene units are held coplanar by a bridging dialkyl germanium. Polymerization of this extended monomer with N-octylthienopyrrolodione by Stille polycondensation afforded a polymer, pDTTG-TPD, with an optical band gap of 1.75 eV combined with a high ionization potential. Bulk heterojunction solar cells based upon pDTTG-TPD:PC(71)BM blends afforded efficiencies up to 7.2% without the need for thermal annealing or processing additives.

Perspective: POTUS Trump’s Executive Orders – Implications for Immigrants and Health Care

PubMed Central

Talamantes, Efrain; Aguilar-Gaxiola, Sergio

2017-01-01

The United States, under new executive orders proposed by its 45th president, may quickly lose its greatness in serving Emma Lazarus’ untimely portrait of immigrants and refugees as “the tired, poor and huddled masses yearning to breathe free.” After years of progress in improving health care access to underserved populations, new executive orders threaten our nation’s advancements in health equity. Within this perspective, we offer examples on how these actions may result in damaging impacts on patients, families, communities and the health care workforce. We add our voices to a myriad of national leaders who are advocating for the preservation of the Affordable Care Act (ACA) and the protection of immigrants, including Deferred Action for Childhood Arrivals (DACA). PMID:28439182

When family enters the picture: the model of cultural negotiation and gendered experiences of Japanese academic sojourners in the United States.

PubMed

Sakamoto, Izumi

2006-07-01

A grounded-theory study aimed at reconceptualizing cultural adaptation processes from gender role and family/couple perspectives while critically drawing from acculturation and culture and self literatures. In-depth interviews with 34 Japanese academic sojourners (international students, scholars) and their spouses (a total of 50 interviews with select longitudinal interviews) were conducted. The author earlier developed the Model of Cultural Negotiation (2001; 2006) capturing uneven and cyclical processes of dealing with multiple cultural contexts. The current study further develops more tailored versions of this model, Family-Based (Couple-Based) Cultural Negotiation and Individual-Based Cultural Negotiation, highlighting the impacts of family/couple and gender roles, especially for female spouses. These conceptualizations afford a sophisticated understanding of the processes of culture.

The US commercial space launch program and the Department of Defense dilemma

NASA Astrophysics Data System (ADS)

Clapp, William G.

1994-08-01

A scenario by which the United States might regain its lost advantage in launching commercial satellites is developed using the Ariane space commercial launch company as a benchmark. Ariane's advantages are identified and low-cost recommendations for countering them are presented The four areas selected for analysis inidentifying an American strategy are launch vehicle: (1) payload characteristics; (2) delivery costs; (3) selection process; and (4) technology. Several of the recommendations require Department of Defense funding even though the primary beneficiary appears to be the commercial space sector. But this will ensure that the military has affordable access to space and it is part of a dual purpose strategy whereby government spending benefits both the public and private sector. There is also a brief discussion of other foreign launch vehicle competition.

Looking beyond "affordable" health care: cultural understanding and sensitivity-necessities in addressing the health care disparities of the U.S. Hispanic population.

PubMed

Askim-Lovseth, Mary K; Aldana, Adriana

2010-10-01

Health disparities are pervasive in the United States; but among Hispanics, access to health care is encumbered by poverty, lack of insurance, legal status, and racial or minority status. Research has identified certain aspects of Hispanic culture, values, and traditions contributing to the nature of the Hispanic patient-doctor relationship and the quality of the health care service. Current educational efforts by nonprofit organizations, government, health professionals, and pharmaceutical manufacturers fail to address the needs for accessible and appropriately culture-sensitive information when approaching the diverse Hispanic community. Understanding Hispanics' consumptive practices and expectations surrounding medications is critical to the success of many treatment regimens. Recommendations are presented to address this health care issue.

Traditional Sexually Transmitted Disease Prevention and Control Strategies: Tailoring for African American Communities

PubMed Central

Barrow, Roxanne Y.; Berkel, Cady; Brooks, Lesley C.; Groseclose, Samuel L.; Johnson, David B.; Valentine, Jo A.

2009-01-01

African Americans carry the largest disease burden for bacterial sexually transmitted diseases (STDs) in the United States. These infections can have a devastating impact on sexual and reproductive health if they are not diagnosed and treated. Traditionally, public health efforts to prevent and control bacterial STDs have been through surveillance, clinical services, partner management, and behavioral intervention strategies. However, the persistence of disparities in STDs indicates that these strategies are not achieving sufficient impact in African American communities. It may be that factors such as limited access, acceptability, appropriateness, and affordability of services reduce the efficacy of these strategies for African American communities. In this article we describe the STD prevention strategies and highlight the challenges and implications of these strategies in addressing disparities in African American communities. PMID:18955915

Presidential Elections and HIV-Related National Policies and Programs.

PubMed

Holtgrave, David R; Bonacci, Robert A; Valdiserri, Ronald O

2017-03-01

The November 2016 general election and subsequent voting of the Electoral College resulted in the selection of Donald Trump as President of the United States. The incoming Administration ran a campaign that indicated a desire for substantial change in health policy, including the repeal of the Affordable Care Act (ACA). President Trump has said very little directly about HIV programs and policies, but some campaign positions (such as the repeal of the ACA) would clearly and substantially impact the lives of persons living with HIV. In this editorial, we highlight important HIV-related goals to which we must recommit ourselves, and we underscore several key points about evidence-based advocacy that are important to revisit at any time (but most especially when there is a change in Administration).

National Health Accounts: A Framework For Understanding Health Care Financing.

PubMed

Waldo, Daniel

2018-03-01

Over the course of the past century, the challenges facing the United States in its consumption of health care goods and services have not changed very much. What is being consumed, who is paying for it, and how much is affordable are questions that arise in every cycle of the debate-if they ever go dormant. National Health Accounts are one tool to use in the search for answers to these questions and to the challenges behind the questions. The accounts cannot (and do not pretend to) address every aspect of the debate, but they provide an important context. In this article I briefly review the history of the health accounts and discuss their strengths and weaknesses in the context of the present debate over spending.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wierer, Jonathan J.; Tsao, Jeffrey Y.; Sizov, Dmitry S.

Solid-state lighting (SSL) is now the most efficient source of high color quality white light ever created. Nevertheless, the blue InGaN light-emitting diodes (LEDs) that are the light engine of SSL still have significant performance limitations. Foremost among these is the decrease in efficiency at high input current densities widely known as “efficiency droop.” Efficiency droop limits input power densities, contrary to the desire to produce more photons per unit LED chip area and to make SSL more affordable. Pending a solution to efficiency droop, an alternative device could be a blue laser diode (LD). LDs, operated in stimulated emission,more » can have high efficiencies at much higher input power densities than LEDs can. In this article, LEDs and LDs for future SSL are explored by comparing: their current state-of-the-art input-power-density-dependent power-conversion efficiencies; potential improvements both in their peak power-conversion efficiencies and in the input power densities at which those efficiencies peak; and their economics for practical SSL.« less

A market approach to better care at lower cost.

PubMed

Antos, Joseph

2015-11-01

The Affordable Care Act expanded health insurance coverage in the United States but did little to address the structural problems that plague the U.S. health care system. Controlling cost while maintaining or improving access to quality care requires a more fundamental reform based on market principles. Such an approach means aligning the financial incentives of patients and providers to promote smarter spending. It also requires better information and more flexible regulation to promote well-functioning competitive markets. Key elements of these reforms include setting reasonable limits on subsidies for Medicare, Medicaid, and private health insurance; modernizing the Medicare program and adopting reforms that promote competition between traditional Medicare and Medicare Advantage; allowing greater flexibility for states in running their Medicaid programs; enacting smarter regulations to protect consumers without imposing greater inefficiency on the health market; and promoting more direct consumer involvement in all phases of their health and health care. These changes will challenge academic medical centers as a new era of creativity and competition emerges in the health care market.

The Horizontal Gaze Nystagmus test: fraudulent science in the American courts.

PubMed

Booker, J L

2004-01-01

The Horizontal Gaze Nystagmus (HGN) test was conceived, developed and promulgated as a simple procedure for the determination of the blood alcohol concentration of drivers suspected of driving while intoxicated (DWI). Bypassing the usual scientific review process and touted through the good offices of the federal agency responsible for traffic safety, it was rushed into use as a law enforcement procedure, and was soon adopted and protected from scientific criticism by courts throughout the United States. In fact, research findings, training manuals and other relevant documents were often held as secrets by the state. Still, the protective certification of its practitioners and the immunity afforded by judicial notice failed to silence all the critics of this deeply flawed procedure. Responding to criticism, the sponsors of the test traveled the path documented in this paper that led from mere (if that word can ever truly apply to a matter of such gravity) carelessness in research through self-serving puffery and finally into deliberate fraud--always at the expense of the citizen accused.

Whooping cough in 2014 and beyond: an update and review.

PubMed

Hartzell, Joshua D; Blaylock, Jason M

2014-07-01

Pertussis, or whooping cough, has had a dramatic resurgence in the past several years and is the most common vaccine-preventable disease in the world. The year 2012 marked the most cases in the United States in > 50 years. Large outbreaks have occurred in multiple states, and infant deaths have drawn the attention of not only health-care providers but also the media. Although the disease is theoretically preventable by vaccination, it remains a challenge to control. New vaccination strategies have been implemented across different age groups and populations of patients, but vaccine coverage remains dismally low. Acellular vaccines, although safe, do not afford the same long-lasting immunity as the previously used whole-cell vaccine. Ultimately, improvements in the development of vaccines and in vaccination coverage will be essential to decrease the burden of pertussis on society. This article provides a review of pertussis infection and discusses advances related to the epidemiology, diagnosis, treatment, and prevention of infection, as well as continued areas of uncertainty.

The case for full practice authority.

PubMed

Holmes, Olivia; Kinsey-Weathers, Shanieka

2016-03-01

The Institute of Medicine (IOM) recommended in its 2010 report on the future of nursing that advanced practice registered nurses (APRNs) should factor prominently in providing care to the millions of Americans who access healthcare services under the Affordable Care Act (ACA). The IOM also recommended that APRNs practice to the full extent of their education and training.However, many states have laws in place that limit full practice authority for APRNs, specifically NPs, in providing basic health services such as primary care. These laws place restrictions on independent practice and Medicaid and Medicare reimbursement, which prevent nurses from “responding effectively to rapidly changing health care settings and an evolving health care system.” Less than half of the United States has adopted full practice authority licensure and practice laws (see APRN practice authority at a glance). This article discusses how the primary care needs of millions of Americans can be met by granting full practice authority to APRNs nationwide and provides evidence to support the high level of care these practitioners can provide independently.

National Health Expenditure Projections, 2015-25: Economy, Prices, And Aging Expected To Shape Spending And Enrollment.

PubMed

Keehan, Sean P; Poisal, John A; Cuckler, Gigi A; Sisko, Andrea M; Smith, Sheila D; Madison, Andrew J; Stone, Devin A; Wolfe, Christian J; Lizonitz, Joseph M

2016-08-01

Health spending growth in the United States for 2015-25 is projected to average 5.8 percent-1.3 percentage points faster than growth in the gross domestic product-and to represent 20.1 percent of the total economy by 2025. As the initial impacts associated with the Affordable Care Act's coverage expansions fade, growth in health spending is expected to be influenced by changes in economic growth, faster growth in medical prices, and population aging. Projected national health spending growth, though faster than observed in the recent history, is slower than in the two decades before the recent Great Recession, in part because of trends such as increasing cost sharing in private health insurance plans and various Medicare payment update provisions. In addition, the share of total health expenditures paid for by federal, state, and local governments is projected to increase to 47 percent by 2025. Project HOPE—The People-to-People Health Foundation, Inc.

State parity laws and access to treatment for substance use disorder in the United States: implications for federal parity legislation.

PubMed

Wen, Hefei; Cummings, Janet R; Hockenberry, Jason M; Gaydos, Laura M; Druss, Benjamin G

2013-12-01

The passage of the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act incorporated parity for substance use disorder (SUD) treatment into federal legislation. However, prior research provides us with scant evidence as to whether federal parity legislation will hold the potential for improving access to SUD treatment. To examine the effect of state-level SUD parity laws on state-aggregate SUD treatment rates and to shed light on the impact of the recent federal SUD parity legislation. We conducted a quasi-experimental study using a 2-way (state and year) fixed-effect method. We included all known specialty SUD treatment facilities in the United States and examined treatment rates from October 1, 2000, through March 31, 2008. Our main source of data was the National Survey of Substance Abuse Treatment Services, which provides facility-level information on specialty SUD treatment. State-level SUD parity laws during the study period. State-aggregate SUD treatment rates in (1) all specialty SUD treatment facilities and (2) specialty SUD treatment facilities accepting private insurance. The implementation of any SUD parity law increased the treatment rate by 9% (P < .001) in all specialty SUD treatment facilities and by 15% (P = .02) in facilities accepting private insurance. Full parity and parity only if SUD coverage is offered increased the SUD treatment rate by 13% (P = .02) and 8% (P = .04), respectively, in all facilities and by 21% (P = .03) and 10% (P = .04), respectively, in facilities accepting private insurance. We found a positive effect of the implementation of state SUD parity legislation on access to specialty SUD treatment. Furthermore, the positive association is more pronounced in states with more comprehensive parity laws. Our findings suggest that federal parity legislation holds the potential to improve access to SUD treatment.

State Parity Laws and Access to Treatment for Substance Use Disorder in the United States: Implications for Federal Parity Legislation

PubMed Central

Wen, Hefei; Cummings, Janet R.; Hockenberry, Jason M.; Gaydos, Laura M.; Druss, Benjamin G.

2014-01-01

Context The passage of the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) and the 2010 Affordable Care Act (ACA) incorporated parity for substance use disorder (SUD) into federal legislation. Yet prior research provides us with scant evidence as to whether federal parity legislation will hold the potential for improving access to SUD treatment. Objective This study examined the effect of state-level SUD parity laws on state-aggregate SUD treatment rates from 2000 to 2008, to shed light on the impact of the recent federal-level SUD parity legislation. Design A quasi-experimental study design using a two-way (state and year) fixed-effect method Setting and Participants All known specialty SUD treatment facilities in the United States Interventions State-level SUD parity laws between 2000 and 2008 Main Outcome Measures State-aggregate SUD treatment rates in: (1) all specialty SUD treatment facilities, and (2) specialty SUD treatment facilities accepting private insurance Results The implementation of any SUD parity law increased the treatment rate by 9 percent (p<0.01) in all specialty SUD treatment facilities and by 15 percent (p<0.05) in facilities accepting private insurance. Full parity and parity-if-offered (i.e., parity only if SUD coverage is offered) increased SUD treatment rate by 13 percent (p<0.05) and 8 percent (p<0.05) in all facilities, and by 21 percent (p<0.05) and 10 percent (p<0.05) in those accepting private insurance. Conclusions We found a positive effect of the implementation of state SUD parity legislation on access to specialty SUD treatment. Furthermore, the positive association was more pronounced in states with more comprehensive parity laws. Our findings suggest that federal parity legislation holds the potential to improve access to SUD treatment. PMID:24154931

48 CFR 1352.271-88 - Guarantees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... when practicable, the Government shall afford the contractor an opportunity to effect such corrections... expiration of the time frame stated in this clause, it is not subject to the time limitations stated in this...

38 CFR 18a.3 - Delegation to the Chief Medical Director.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Act of 1964, in connection with payments to State homes, with State home facilities for furnishing nursing home care, and from recognized national organizations whose representatives are afforded space and...

Meeting the Tobacco Cessation Coverage Requirement of the Patient Protection and Affordable Care Act: State Smoking Cessation Quitlines and Cost Sharing.

PubMed

Lemaire, Robin H; Bailey, Linda; Leischow, Scott J

2015-11-01

We explored whether various key stakeholders considered cost sharing with state telephone-based tobacco cessation quitlines, because including tobacco cessation services as part of the required essential health benefits is a new requirement of the Patient Protection and Affordable Care Act (ACA). We analyzed qualitative data collected from interviews conducted in April and May of 2014 with representatives of state health departments, quitline service providers, health plans, and insurance brokers in 4 US states. State health departments varied in the strategies they considered the role their state quitline would play in meeting the ACA requirements. Health plans and insurance brokers referred to state quitlines because they were perceived as effective and free, but in 3 of the 4 states, the private stakeholder groups did not consider cost sharing. If state health departments are going to initiate cost-sharing agreements with private insurance providers, then they will need to engage a broad array of stakeholders and will need to overcome the perception that state quitline services are free.

Meeting the Tobacco Cessation Coverage Requirement of the Patient Protection and Affordable Care Act: State Smoking Cessation Quitlines and Cost Sharing

PubMed Central

Bailey, Linda; Leischow, Scott J.

2015-01-01

Objectives. We explored whether various key stakeholders considered cost sharing with state telephone-based tobacco cessation quitlines, because including tobacco cessation services as part of the required essential health benefits is a new requirement of the Patient Protection and Affordable Care Act (ACA). Methods. We analyzed qualitative data collected from interviews conducted in April and May of 2014 with representatives of state health departments, quitline service providers, health plans, and insurance brokers in 4 US states. Results. State health departments varied in the strategies they considered the role their state quitline would play in meeting the ACA requirements. Health plans and insurance brokers referred to state quitlines because they were perceived as effective and free, but in 3 of the 4 states, the private stakeholder groups did not consider cost sharing. Conclusions. If state health departments are going to initiate cost-sharing agreements with private insurance providers, then they will need to engage a broad array of stakeholders and will need to overcome the perception that state quitline services are free. PMID:26447918

Putting Cocrystal Stoichiometry to Work: A Reactive Hydrogen-Bonded "Superassembly" Enables Nanoscale Enlargement of a Metal-Organic Rhomboid via a Solid-State Photocycloaddition.

PubMed

Chu, Qianli; Duncan, Andrew J E; Papaefstathiou, Giannis S; Hamilton, Tamara D; Atkinson, Manza B J; Mariappan, S V Santhana; MacGillivray, Leonard R

2018-04-11

Enlargement of a self-assembled metal-organic rhomboid is achieved via the organic solid state. The solid-state synthesis of an elongated organic ligand was achieved by a template directed [2 + 2] photodimerization in a cocrystal. Initial cocrystals obtained of resorcinol template and reactant alkene afforded a 1:2 cocrystal with the alkene in a stacked yet photostable geometry. Cocrystallization performed in the presence of excess template resulted in a 3:2 cocrystal composed of novel discrete 10-component hydrogen-bonded "superassemblies" wherein the alkenes undergo a head-to-head [2 + 2] photodimerization. Isolation and reaction of elongated photoproduct with Cu(II) ions afforded a metal-organic rhomboid of nanoscale dimensions that hosts small molecules in the solid state as guests.

Principles of Child Health Care Financing.

PubMed

Hudak, Mark L; Helm, Mark E; White, Patience H

2017-09-01

After passage of the Patient Protection and Affordable Care Act, more children and young adults have become insured and have benefited from health care coverage than at any time since the creation of the Medicaid program in 1965. From 2009 to 2015, the uninsurance rate for children younger than 19 years fell from 9.7% to 5.3%, whereas the uninsurance rate for young adults 19 to 25 years of age declined from 31.7% to 14.5%. Nonetheless, much work remains to be done. The American Academy of Pediatrics (AAP) believes that the United States can and should ensure that all children, adolescents, and young adults from birth through the age of 26 years who reside within its borders have affordable access to high-quality and comprehensive health care, regardless of their or their families' incomes. Public and private health insurance should safeguard existing benefits for children and take further steps to cover the full array of essential health care services recommended by the AAP. Each family should be able to afford the premiums, deductibles, and other cost-sharing provisions of the plan. Health plans providing these benefits should ensure, insofar as possible, that families have a choice of professionals and facilities with expertise in the care of children within a reasonable distance of their residence. Traditional and innovative payment methodologies by public and private payers should be structured to guarantee the economic viability of the pediatric medical home and of other pediatric specialty and subspecialty practices to address developing shortages in the pediatric specialty and subspecialty workforce, to promote the use of health information technology, to improve population health and the experience of care, and to encourage the delivery of evidence-based and quality health care in the medical home, as well as in other outpatient, inpatient, and home settings. All current and future health care insurance plans should incorporate the principles for child health financing outlined in this statement. Espousing the core principle to do no harm, the AAP believes that the United States must not sacrifice any of the hard-won gains for our children. Medicaid, as the largest single payer of health care for children and young adults, should remain true to its origins as an entitlement program; in other words, future fiscal or regulatory reforms of Medicaid should not reduce the eligibility and scope of benefits for children and young adults below current levels nor jeopardize children's access to care. Proposed Medicaid funding "reforms" (eg, institution of block grant, capped allotment, or per-capita capitation payments to states) will achieve their goal of securing cost savings but will inevitably compel states to reduce enrollee eligibility, trim existing benefits (such as Early and Periodic Screening, Diagnostic, and Treatment), and/or compromise children's access to necessary and timely care through cuts in payments to providers and delivery systems. In fact, the AAP advocates for increased Medicaid funding to improve access to essential care for existing enrollees, fund care for eligible but uninsured children once they enroll, and accommodate enrollment growth that will occur in states that choose to expand Medicaid eligibility. The AAP also calls for Congress to extend funding for the Children's Health Insurance Program, a plan vital to the 8.9 million children it covered in fiscal year 2016, for a minimum of 5 years. Copyright © 2017 by the American Academy of Pediatrics.