Research by Author & Topic

Publications by Barbara A. Ormond on Health and Health Care

Nurses are health care's backbone, spending the most time with patients, and working with teams of caregivers in institutions and serving as advanced practice nurses in primary care settings. Short-term shortages wax and wane, but concerns about a shortage are more serious now because the next decade may see more older nurses retiring than new ones entering the workforce. Education needs to be augmented and improved, but no precise estimation method can show how many nurses society "should" produce. Policy should focus more on nurses' scopes of practice and aligning how they are treated and paid with the value they add to patient care.

DC fares better than the nation as a whole in the share of its population that is uninsured. Lower rates of employer-sponsored coverage are more than offset by higher rates of public coverage. The District's relatively generous Medicaid eligibility standards, and the DC HealthCare Alliance, a locally funded coverage program, contribute to the high share of publicly insured residents. Although all low-income individuals are eligible for either Medicaid or the Alliance, some 66,000 residents remain uninsured. These are among the findings of this data brief on insurance status in DC by age, employment, income, family status, and health status.

The ongoing debate in California over two competing 2007 proposals for universal health coverage highlights both the strengths and weaknesses of the current insurance system in the District of Columbia as a platform for coverage expansion. The District's advantages include its relatively small uninsured population and existing mechanisms for administering a public coverage program tied to income. But its fiscal base is relatively small compared with California's, its largely unregulated insurance market could lead to severe adverse selection problems for new programs, and it is at much greater risk for border-crossing by both individuals and businesses in response to reform.

This needs assessment, conducted for District of Columbia Department of Health (DC-DOH), presents findings from a literature review, analyses of Medicaid enrollment and hospital discharge data, interviews with key informants, a survey of school nurses, and findings from focus groups with young adults with epilepsy and caretakers of young adults with epilepsy in DC. It suggests changes within the health services delivery system for children and youth with epilepsy related to the following goals identified by DC-DOH: early detection, diagnosis, and treatment; improved access to medical homes; reduced stigma; reduced language and cultural barriers; and sustained systems change.

The uninsurance rate in the District is lower than the national average, but an unacceptably high number of residents remain uncovered. To help assess ways to improve coverage, the DC Department of Health convened the Health Care Coverage Advisory Panel under the District's State Planning Grant (SPG). This final report of the Panel, staffed by the authors, makes eight recommendations, including better outreach and enrollment in Medicaid and other existing public programs, allowing uninsured residents to buy in to such programs, better information on private options, and ongoing monitoring of coverage accomplishments and prevailing insurance market conditions.

This testimony described DC populations lacking health coverage and issues that expansion proposals need to address. The biggest gaps in coverage lie within the District's generous Medicaid and Alliance programs. All residents with family incomes up to 200% of the Federal Poverty Level are eligible but many are not enrolled. Another, smaller group of uninsureds have incomes of 200-400% of FPL, but subsidizing them to buy coverage requires addressing potential crowd out among 80,000 similar-income already insured residents. Expansion also needs to address the potential for adverse selection as costs for the uninsured range widely by age and health status.

In this report we examine how ten states (Alabama, California, Colorado, Florida, Massachusetts, Michigan, New Jersey, New York, Texas, and Washington) from around the nation have responded to their budget crises in fiscal year 2004. While states vary in the depth of the budget pressures they faced, all were required to make difficult choices among spending reductions, tax increases, or other revenue measures. In general, we found states with few exceptions to be unwilling to engage in significant increases in personal or corporate income taxes or sales taxes. However, other revenue measures, e.g., cigarette and alcohol taxes, were adopted more broadly. States did continue the pattern of recent years of drawing on reserves or rainy day funds, transferring monies from dedicated trust funds and shifting spending or taxes across time periods to address current shortfalls.

In this report we examine how Alabama responded to its budget crisis in fiscal year 2004. While states vary in the depth of the budget pressures they faced, all were required to make difficult choices among spending reductions, tax increases, or other revenue measures.

In this report we examine how Florida responded to its budget crisis in fiscal year 2004. While states vary in the depth of the budget pressures they faced, all were required to make difficult choices among spending reductions, tax increases, or other revenue measures.

The National Neighborhood Indicators Partnership (NNIP) is a collaborative effort to use local information in community building and policymaking. The task of building local data systems is given to a local intermediary in each of the 19 NNIP partnership cities. The partners obtain data from a variety of agencies, geocode it to the neighborhood level, and make it available to users. In the first seven years of the NNIP, the partners have learned several important lessons. First, data at the local (neighborhood) level are essential for developing public policy. Second, advances in technology over the past decade have made it possible to maintain these detailed local databases at relatively low cost. Third, there are a variety of types of local organizations that can effectively serve as the local partner, from academia to government, community foundations, or other community-based nonprofits. Fourth, as with most endeavors, good leadership is critical to successfully building the bridges across multiple agencies. Finally, a major lesson from the NNIP experience is that providing data is only the first step. Data must be used in ways that are visible, useful, and responsive to the community if the project is to retain local support and enthusiasm. (Journal of Public Health Management and Practice 9(3), 2003.)