The Government Accountability Office (GAO) reports are meticulously researched, politically objective, and often the most credible source of information on critical policy issues. This particular report at 20 pages is fairly brief by GAO standards; however, it quite effectively explains and graphically depicts the population health and health care expenditure dynamics undermining the fiscal sustainability of Medicare and Medicaid. The report provides the essential demographic and fiscal context necessary for any discussion of health care policy, as pertains to chronically ill and disabled populations.
In the Balanced Budget Act of 1997, Congress established the PACE Program (Program of All-Inclusive Care for the Elderly), which integrates Medicare and Medicaid financing in order to provide a comprehensive array of medical and community-based long-term care services for older adults who are at high risk for nursing home placement. This article provides the most recent review of the literature analyzing the outcomes of PACE and similar programs.
The transformation of the health care system from an acute care paradigm to one that embraces chronic disease management must be informed by examples of systems of care that test new innovations in the organization, financing, and delivery of care to the chronically ill and disabled. Master and Eng describe the policy history of these initiatives, and then explore the policy lessons learned from programs developed through two general policy models: the Program of All-Inclusive Care for the Elderly (PACE) and the Community Medical Alliance (CMA). Although the programs examined under PACE and CMA are oriented toward different chronic disease populations, all share similar characteristics: in particular, prepaid, risk-adjusted financing; integrated Medicare and Medicaid funding streams; a flexible array of acute and long-term benefits; and integrated delivery systems that tailors benefits and services to individual need. The “lessons learned” from the programs examined highlight both the policy challenges and opportunities entailed in a shift toward widespread health care system incorporation of a chronic disease management model.
Stuart and Weinrich examine France’s approach to the management of a highly prevalent form of chronic disease, Chronic Obstructive Pulmonary Disease (COPD), through regional community-based specialty systems. There are four reasons this article is highly suggested reading. First, COPD is the major cause of respiratory failure, itself the fourth leading cause of death in the U.S. Second, France has been rated number one in overall health care system performance by the World Health Organization despite the fact that France’s per capital cost for health care is about half that spent by the U.S. Third, France has lower age-adjusted death rates from chronic diseases and the pace of reducing preventable deaths from chronic diseases exceeds that of the U.S. by a wide margin (Nolte & McKee, 2008). Finally, the comparisons between the U.S. and France are contextualized by recent developments in U.S. health care policy toward the chronically ill and disabled. This article is targeted at a clinical audience rather than health care policy specialist, making it far less technical and cluttered with obscure policy jargon.
The Agency for Healthcare Research and Quality (AHRQ) is a sub-agency of the U.S. Department of Health and Human Services (HHS) and the lead federal agency for research on health care quality, costs, outcomes, and patient safety. A key research program undertaken in recent years is the investigation of health care disparities within the U.S. health care system, with a special focus on the population groups where disparities in health care are most prevalent or most detrimental, including African Americans, Hispanics, Native Americans, the poor, and the elderly. Since 2003, the AHRQ has published an annual series of National Healthcare Disparities Reports, highlighting the populations affected, the forms of healthcare disparities, and progress towards specific improvements. Each of these annual reports is quite comprehensive, straightforward to interpret, and replete with compelling findings and policy implications.
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