Research by Author & Topic

Publications by Bradford Gray on Health and Health Care

Bradford Gray traces HMOs movement from the periphery to the center of the American health care system and from depiction as policy solution to policy problem. The paper describes where HMOs came from, how they became important, and how they came to act in ways that generated the managed care backlash of the 1990s. He shows that the problems of the HMO movement came partly from compromises in the original HMO Act of 1973 as well as later policy decisions regarding sources of capital, the ERISA exemption from state regulation, and the Internal Revenue Service's hostility toward nonprofits. (History and Health Policy in the United States edited by Rosemary A. Stevens, Charles E. Rosenberg, and Lawton R. Burns, Rutgers University Press, 2006.)

This Health Affairs web exclusive, co-authored by Bradford Gray and Yale's Mark Schlesinger, comprehensively reviews the empirical evidence bearing on criticisms that nonprofits fail to distinguish themselves from their for-profit counterparts and do not reliably provide community benefits commensurate with their tax subsidies. They conclude that the evidence shows these criticisms to be either wrong or incomplete. To address the challenges facing the nonprofit sector in American health care, the authors propose reformulating ownership-related policies to define both the appropriate forms of community benefit and the appropriate mix of ownership in terms of local markets and communities. (Health Affairs Web Exclusive, 25, no. 4 (2006): 287-303)

Managing children's care in Medicaid is difficult if they experience inadequate tenures in health plans. Case studies of five states found that children's tenures in health plans was two to four months shorter than their (often short) tenures in Medicaid itself. Major reasons for the discrepancy were retroactive enrollment practices in Medicaid and delays in enrollees' selection of a health plan. Frequent and burdensome Medicaid recertification processes exacerbate the problem, frequently resulting in breaks in enrollment in Medicaid and the need to reenroll in health plans. The value of managed care for children in Medicaid is undermined as a consequence. (Journal of Health Care for the Poor and Underserved. 2005; 16:444-452)

Declining legitimacy of the nonprofit sector in American society can be traced to a limited public understanding of nonprofit enterprise. This study explores the nature and correlates of ownership-related expectations in medical care. Data from a new national survey document that more Americans believe that ownership affects medical care. However, about a third of the public does not understand ownership; those who do not have decidedly less favorable attitudes toward nonprofits. Expectations for nonprofits are more positive among those who feel vulnerable to bad outcomes in medical care, but are substantially more negative among minority groups. (Nonprofits and Voluntary Sector Quarterly 33(4): 673–710.)

Policymakers, advocates, and scholars frequently make claims about how the American public sees ownership affecting the delivery of medical care. In the paper, we provide a comprehensive assessment of how Americans think about nonprofit and for-profit ownership. We summarize findings from surveys fielded between 1985 and 2000 and supplement them with findings from a new survey. Most Americans believe that ownership matters for multiple aspects of medical care; they expect nonprofit hospitals and health plans to be more trustworthy, fair, and humane but lower in quality. People who are better informed about ownership have more positive expectations about nonprofits' performance. (Health Affairs 23(6): 181–91.)