View Research by Author - Jill A. Marsteller

Citation URL: http://www.urban.org/JillAMarsteller

Researchers studied the impact of public hospital closures or conversions in Milwaukee, Boston, Tampa, Philadelphia, and San Diego. The good news is that some localities seem to have invented a better way to deliver and finance care for the poor at an affordable price. The bad news is that it is at best a struggle to maintain funding for indigent care in the absence of a public hospital. The authors conclude that a robust local safety net needs non-local funding, and safety net policies need to be made at local and higher levels of government.

In this analysis, the authors suggest that any of the main federal patient protection proposals will substantially expand regulation of managed care. The authors conclude: the number of people receiving patient protections will increase under all the main federal bills; the practical impact of any proposed patients' rights bill will depend on state circumstances such as the proportion of people covered by managed care, the type of managed care plan, and the extent to which the state has enacted patient protection legislation; most of the federal proposals are similar to existing state laws; and enforcement provisions, including standards for appeals and the right to sue, vary widely among the federal proposals.

This article contributed to the debate over nonprofit conversions. Based on a conceptual economic framework; analysis of empirical, legal, and theoretical literature; and review of statutes, rules, and court decisions, it argued that market conditions are the most important determinant of institutional behavior and that a mix of nonprofit and for-profit institutions may best serve consumers and the public interest. (Health Services Research 1998 December; 33(5) part II: 1495-1535)

There are two Highlights for each state. The Highlights that focus on health cover Medicaid, other public insurance programs, the health care marketplace, and the role of public providers. The Highlights capture policies in place and planned in 1996 and early 1997.

Price competition seems to have increased health insurance coverage for low-income people by giving Medicaid agencies better value for their money, according to this paper. Many states have used these savings to expand eligibility for Medicaid or other public coverage. On the other hand, this new competition also threatens hospitals? traditional ability to support charity care. The most important emerging policy issue identified is how to weave a competition-era safety net for the growing share of poor Americans who lack coverage.

The state reports describe the safety net and health care programs in place for low-income people on the eve of welfare reform. The reports also analyze the particular circumstances that are shaping the state's response to the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). The state reports are based on case studies in the respective state.

Using the state as the unit of analysis, this study gauges the effects of various state policy interventions on rates of uninsurance, private coverage, and Medicaid coverage for the nonelderly population. The study controls for economic structures, population demographics, and characteristics of the health-service market. Then, using Wisconsin counties as units of analysis within a common regulatory environment, the relative importance of economic and demographic characteristics of the health-service market are tested to see if any of these factors can explain overall rates of health insurance coverage.

There are two Highlights for each state. The Highlights that focus on health cover Medicaid, other public insurance programs, the health care marketplace, and the role of public providers. The Highlights capture policies in place and planned in 1996 and early 1997.

The state reports describe the safety net and health care programs in place for low-income people on the eve of welfare reform. The reports also analyze the particular circumstances that are shaping the state's response to the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). The state reports are based on case studies in the respective state.

The spread of managed care organizations' (MCOs’) selective networks reduced patient access to services, along with provider access to paying patients, so many providers have lobbied for laws to force plans to contract with "any willing provider" and give patients "freedom of choice." In opposition are MCOs, which want full freedom to contract selectively to control prices and utilization. This article comprehensively described laws in all 51 jurisdictions, classified by relative strength, and assessed the policy implications. Most enactments are relatively weak, and all are limited in application by ERISA and the Federal HMO Act. An associative multivariate analysis also showed that states with laws also have higher HMO penetration and higher physician density, but smaller rural populations. This paper concluded that the strongest laws overly restrict the management of care, to the likely detriment of cost control. But where market power is rapidly concentrating, unrestrained selective contracting could diminish patient access to care and long-term competition. In the face of uncertainty about the impact of these laws, an intermediate approach may be better than all or nothing. States should consider mandating that plans offer point-of-service options, for a separate premium. This option guarantees patient choice of plans at the time of enrollment and of providers at the time of care, yet maintains plan ability to control core providers. (Journal of Health Politics, Policy and Law 1997 October; 22(5): 1133-1189).

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