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Fall 2004 Commonwealth Fund Quarterly: A Digest of Current Work in Health Policy and Practice



Keep in Mind...
Only 56 percent of U.S. workers report they can take paid time off during the day to see doctors and just over one-half (53%) of all workers say they have any days of paid sick leave.
—From Wages, Health Benefits, and Workers' Health, Commonwealth Fund Issue Brief, October 2004.


International Survey: Patients Concerned About Their Primary Care
An effective primary care system is essential to keeping overall health costs down and helping people lead healthy, productive lives. But according to a new Fund survey (see "Primary Care and Health System Performance: Adults' Experiences in Five Countries," Health Affairs Web Exclusive, Oct. 28, 2004), serious shortfalls in the delivery of safe, timely, and patient-centered primary care are a big problem both in the United States and abroad. Read More>>

Grantee Spotlight: Simon Stevens
In 2000, the U.K.'s 50-year-old National Health Service embarked on a 10-year, multi-billion-pound plan to overhaul the system—by creating financial incentives for primary care physicians to better their care and for surgeons to reduce waiting times, as well as giving patients access to medical information and more provider choice. We asked Simon Stevens, a 1994-95 Harkness Fellow in Health Care Policy and Prime Minister Tony Blair's health policy adviser for the past seven years, about these reforms and the challenges faced by health systems on both sides of the Atlantic. Read More>>

A Workforce Divided: Half of Low-Wage Earners Lack Coverage
Most workers without access to employer-based coverage are uninsured—clear evidence that job-based health coverage is crucial to the health and economic well-being of Americans. But what if your employer does not offer coverage, or you cannot afford your share of the premium? And what if your modest income disqualifies you for public coverage? An analysis by Fund researchers finds that millions of workers find themselves in this quandary—and scrambling for ways to pay for needed health care. Read More>>

States Stretching Health Care Dollars in Imaginative Ways
Providing health insurance coverage to vulnerable populations is especially difficult at a time when rapidly rising insurance premiums and tepid labor markets are swelling the ranks of the uninsured and underinsured, and tight budgets are limiting states' discretionary spending. Despite these trying conditions, several states have managed to stretch their health care dollars by using a portion of state money to leverage private, federal, and additional state funds, a new Fund report finds. Read More>>

Efforts to Improve Health Care Safety Rate 'C+' Says Expert
The Institute of Medicine's 1999 landmark report on medical errors struck a nerve with medical professionals, the media, elected officials, and the American public. Now that five years have passed, has anything changed? In a new commentary, one of the nation's leading medical safety experts says that efforts to address the problem have so far done little to improve protections for patients. Read More>>

Docs Say Cost, Lack of Standards Are Barriers to IT Use
Innovations like electronic medical records, computerized drug order entry, and clinical decision support systems not only can improve the quality of care that patients receive, but they make the practice of medicine much more efficient. But cost concerns and lack of adequate standards are preventing many physicians from readily embracing them. Results of a new Fund survey reported in the online journal Medscape General Medicine indicate that only a quarter of the nation's physicians practice in a "high-tech office" where IT systems are in place to improve operational efficiency and clinical care. Read More>>

Private Plans Costing Medicare More
Federal payments to private health plans that insure Medicare beneficiaries will average 7.8 percent more in 2005 than costs in the traditional, fee-for-service Medicare program, a Fund-supported study finds. This amounts to an extra $546 for each of the 5 million enrollees in Medicare Advantage private plans, for a total of more than $2.72 billion. Read More>>

Medicare's Waiting Period Is Hard on Disabled
Unlike older Americans, who typically become eligible for Medicare upon turning 65, the nearly 6 million adults with severe or permanent disabilities must wait two years after receiving disability insurance benefits before their Medicare coverage takes effect. And the wait can have a devastating impact on their health and lives, according to this analysis. Read More>>

Parenting Support Can Be a Phone Call Away
Between 1998 and 2003, the number of calls to parenting help lines run by each state nearly doubled. It's clear that parents want timely access to childrearing advice, and that these toll-free lines are helping to fill a critical need. According to the Fund issue brief Dialing for Help: State Telephone Hotlines as Vital Resources for Parents of Young Children, while their value is undeniable, state parenting hotlines vary considerably in quality. Read More>>

Means Exist to Improve Care for Minority Children, Expert Says
The presence of racial disparities in health care doesn't mean there aren't remedies readily available. In fact, an arsenal of policy weapons is at our disposal to combat inequities in the health system, says Fund senior program officer Anne C. Beal, M.D. Read More>>

2004-05 Minority Health Policy Fellows Selected
In July, the eighth class of Commonwealth Fund/Harvard University Fellows in Minority Health Policy will begin their work toward master's degrees in public health or public administration. The one-year fellowships, established in 1995, prepare minority physicians for leadership positions in the fields of minority health and public policy. Read More>>

President's Forum: Health Care at the Crossroads
The end of any election is a natural time to reflect on the issues that marked the campaign and look ahead to the direction a new administration is likely to take. In her new column for the Commonwealth Fund Quarterly, Fund president Karen Davis offers her thoughts on the prospects for health care reform over the next four years. Davis says that although the administration has proposed a number of initiatives to address the public concerns about the health system, policy proposals to date may not be sufficiently ambitious to meet the many challenges we face. Read More>>

Recent and Forthcoming Commonwealth Fund Publications, Fall 2004

Fund Reports
L. Achman and M. Gold, Are the 2004 Payment Increases Helping to Stem Medicare Advantage's Benefit Erosion? December 2004

M. Bailit and M. B. Dyer, Beyond Bankable Dollars: Establishing a Business Case for Improving Health Care, August 2004

C. L. Barry, Trends in Mental Health Care, November 2004

B. Biles, L. H. Nicholas, and B. S. Cooper, The Cost of Privatization: Extra Payments to Medicare Advantage Plans–2005 Update, December 2004

M. Booth, T. Brown, and M. Richmond-Crum, Dialing for Help: State Telephone Hotlines as Vital Resources for Parents of Young Children, November 2004

B. Brown, M. Weitzman et al., Early Child Development in Social Context: A Chartbook, September 2004

S. R. Collins, K. Davis, M. M. Doty et al., Wages, Health Benefits, and Workers' Health, October 2004

J. Cubanski, Continuing Policy Issues in Medicare Prescription Drug Coverage, November 2004

J. Cubanski, Is Incremental Change Working? Or Is It Time to Reconsider Universal Coverage? November 2004

P. S. Keenan, What's Driving Health Care Costs? November 2004

P. S. Keenan and J. Kline, Paying for Performance, November 2004

S. E. Palsbo, T. Kroll, and M. McNeil, Addressing Chronic Conditions Through Community Partnerships: A Formative Evaluation of Taking on Diabetes, September 2004

Y. Roubideaux, A Review of the Quality of Health Care for American Indians and Alaska Natives, September 2004

E. L. Schor and C. Elfenbein, A Need for Faculty Development in Developmental and Behavioral Pediatrics, November 2004

S. Silow-Carroll and T. Alteras, Stretching State Health Care Dollars During Difficult Economic Times, October 2004

G. K. SteelFisher, Addressing Unequal Treatment: Disparities in Health Care, November 2004

E. Strumpf, The Obesity Epidemic in the United States: Causes and Extent, Risks and Solutions, November 2004

B. Williams, A. Dulio, H. Claypool et al., Waiting for Medicare: Experiences of Uninsured People with Disabilities in the Two-Year Waiting Period for Medicare, October 2004

Journal Articles and Other Publications
A.-M. J. Audet, M. M. Doty, J. Peugh et al., "Information Technologies: When Will They Make It Into Physicians' Black Bags?" Medscape General Medicine (December 7, 2004)

A. C. Beal, "Policies to Reduce Racial and Ethnic Disparities in Child Health and Health Care," Health Affairs 23 (September/October 2004): 171–79

R. A. Berenson, "Medicare Disadvantaged and the Search for the Elusive 'Level Playing Field,'" Health Affairs Web Exclusive (December 15, 2004): W4-572–W4-585

B. Biles, G. Dallek, and L. H. Nicholas, "Medicare Advantage: Déjà Vu All Over Again?" Health Affairs Web Exclusive (December 15, 2004): W4-586–W4-597

J. Blanchard and N. Lurie, "R-E-S-P-E-C-T: Patient Reports of Disrespect in the Health Care Setting and Its Impact on Care," Journal of Family Practice 53 (September 2004): 721

C. Schoen, R. Osborn, P. T. Huynh et al., "Primary Care and Health System Performance: Adults' Experiences in Five Countries," Health Affairs Web Exclusive (October 28, 2004): W4-487–W4-503

R. M. Wachter, "The End of the Beginning: Patient Safety Five Years After To Err Is Human," Health Affairs Web Exclusive (November 30, 2004): W4-534–W4-545

Publication Details



Fall 2004 Commonwealth Fund Quarterly: A Digest of Current Work in Health Policy and Practice, Volume 10, Issue 3.