Health and Health Services Access Among Adults With Disabilities Who Receive Federal Housing Assistance

Using newly available U.S. Department of Housing and Urban Development (HUD) administrative data linked with National Health Interview Survey data, this study estimates the prevalence of disability among HUD-assisted adults and examines health disparities for this population. The linked data suggest a much higher prevalence of disability among HUD-assisted adults than previously suggested by HUD administrative data. Controlling for individual characteristics and HUD program type, assisted-housing residents who have disabilities experienced higher rates of self-reported fair or poor health, asthma, diabetes, hypertension, obesity, and cigarette smoking. Adults with disabilities had more frequent use of emergency rooms and increased concerns with affording the necessary health care. HUD-assisted adult residents with disabilities were more likely than residents without disabilities to be connected to the health-care system, having higher rates of insurance coverage and more frequent contact with specialists, general doctors, and mental health-care providers. Policy implications are discussed.     

HEALTH-CARE REFORM UNDER PRESIDENT CLINTON: ISSUES,IDEAS AND IMPLICATIONS

Abstract: President Clinton's proposals to reform health-care in the United States have stimulated unprecedented levels of discussion amongst stakeholders, commentators, policy analysts and the media. It seems obvious that there is a need to reform a system that consumes 14% of gross domestic product, yields only OECD-average morbidity and mortality rates and fails to provide coverage to millions of people. Nevertheless, forces against change are marshalling considerable resources in opposition to Clinton's proposals, and now that the November 1994 mid-term elections have routed the democrats in both the House of Representatives and the Senate, the belief is that his reforms will never be adopted in their original format. Some of the issues and ideas emanating from the American debate parallel trends in Australian health-care. Elements in transition include the switch from an input-to an outcomes-orientation, improving the quality of care, focusing on the customer and securing greater value-for-money. Unlike America, Australia has a limit on national health-care spending and this poses different challenges. However, the American debate is of vital interest to Australia. Australian and American hospitals are increasingly in competition to export services to South-East Asia. Of particular importance to Australia are: the extremely public nature of the American debate, which should be emulated, the fact that explicit rationing is now clearly on the international health-care agenda, the need to reconceptualise western culture's preoccupation with immortality, the need to alter economic incentives to health-care providers and the shift to outcomes measurement and effectiveness. Despite the comparatively healthy state of the Australian system, complacency should not be allowed to set in. Lessons for Australia from America are numerous, and it behoves us to monitor closely developments, trends and options arising from the Clinton-inspired debate.     

Medicaid in the 1990s: Trends, Innovations, and the Future of the "PAC-Man" of State Budgets

Rapidly escalating health-care inflation and congressionallymandated expansions have led to large increases in spendingfor Medicaid, the federal-state program of health care for thepoor. These increases came at a time when state budgets werealready under recession-induced stresses. In addition, 1991brought new pressures for Medicaid spending from the courtsand closer federal scrutiny and control over revenues used forthe program's state "match." Yet the Medicaid picture is farfrom bleak. Diversity, innovation, and an emerging stale policyrole also characterize the program in ways that epitomize thestrengths and weaknesses of the American intergovernmental system.     

Medicaid Section 1115 Waivers: Shifting Health Care Reform to the States

This article focuses on recent developments in state Medicaidprograms and the role ojSection 1115 waivers in this process.The evidence presented here demonstrates quite clearly thatthe states are using Section 1115 waivers to experiment witha broad range of innovative health-care service delivery, reimbursement,and eligibility concepts. This has allowed the states to reconfiguretheir Medicaid systems. More important, perhaps, the use ofSection 1115 waivers has also increased the role ofof the statesin the American health-care policy process.     

The Influence of Federal Regional Offices on State Medicaid Maternal and Child Health-Care Services

This article focuses on the influence of federal regional administrativeoffices on maternal and child health-care services in stateMedicaid programs. The empirical results demonstrate that regionaladministrative offices affect the adoption of state policy choices.More traditional economic and political variables seem to havelittle direct impact These findings provide important insightsinto the role of federal regional offices in state Medicaidmaternal and child health-care services. They emphasize theneed for further empirical research on the exact processes bywhich regional administrative offices exert their impact onthe American policy process.     

Our quest to be perfect

You don't have to be wrinkled or rich to go under the knife. New techniques are luring more and younger patients, while doctors hurry to set up shop. But there are risks as well as options in cosmetic surgery's new age.     

Media and politics in French political science

Abstract. The study of the relationship between media and politics has long been marginal in French political science. The take–off of research has been stimulated by the impact of the Presidential election under the Fifth republic and by the increasing role of television and spin–doctors in this new electoral context. If French studies on political communication converge with international research, they are also characterised by strong peculiarities. The material of case–studies is not campaign–centred, but gives room to various TV programmes, to a wide range of media uses by French politicians. The contribution of historians, the influence of a literary tradition of 'textual' analysis of political speech are important. The publishing of books on this topic also reveals a surprisingly intense participation from spin– doctors, journalists and even politicians. Three main 'schools' are contributing to the dynamics of French research. Linked to the tradition of semiological and literary studies the first one focuses on the study of political discourse in the media. Merging the legacy of English–speaking studies and the French tradition of electoral studies a second one develops an analysis of the campaigning process and of its effects. More recently, a new generation of researchers has widened the object of research to the complex network of relations between politicians, journalists and consultant. Linking successfully the most recent developments or international research and the peculiarities of academic tradition, research on political communication appears as one of the most dynamic areas of French political science.     

The Clinton solution

Twelve days before Bill Clinton was to address Congress and the nation, the leaked disclosure of his plan for health-care reform ignited the debate about the issue that will define his presidency. Newsweek assesses the president's plan--and looks at what it will mean for you.     

New occupations,old demands: The public regulation of paraprofessionals

Like doctors, lawyers, and architects before them, many new paraprofessionals occupations are rapidly being defined and regulated, raising the time-worn questions regarding the virtues of free labor markets versus those of regulated labor markets. The trend to regulation is growing rapidly as the paraprofessionals increase in number. The new regulation may improve the quality of services that paraprofessionals provide. But the costs threaten to exceed the benefits. There are less costly ways to deal with the problems that have given rise to the demands for regulation. The success of these demands is due in part to inadequate consideration of their implications.     

A very risky business. Medical professionals are demanding more effective AIDS protection for themselves.

Physicians, nurses and other health-care workers have always been willing to risk exposure to infectious diseases; it goes with the territory. But AIDS is in a grim category all by itself--a contagious illness that, so far, is almost always fatal. Today many health professionals no longer feel safe on the job--and they're demanding better protection for themselves.     

Doctors and AIDS

Just a year ago most authorities considered the chances of patients contracting AIDS from doctors and other healthcare workers a virtual impossibility. But last week a Florida woman who got AIDS from her dentist lay near death, and two Minneapolis physicians admitted they had treated hundreds of patients since being diagnosed with the virus. Although doctors are at far greater risk than patients, the Minneapolis cases renewed the debate over the right of sides to know each other's HIV status.     

Interpersonal metaphor revisited: identification,categorization, and syndrome

Grammatical metaphor (ideational metaphor and interpersonal metaphor as sub-categories) “leads to an expansion of the meaning potential: by creating new patterns of structural realization, it opens up new systemic domains of meaning”. Ideational metaphor has been extensively studied in terms of identification, categorization, and application. Interpersonal metaphor, though being readily applicable to interaction-oriented disciplines, has not been studied in depth and many issues remain to be tackled. One significant issue is how to identify interpersonal metaphor, metaphors of mood in particular. With instances from the CORP corpus built out of successful reply posts by doctors and nurses on the health forum of doctorslounge.com, we propose two principles (Context-first Principle and AS IF Principle) that can be used to identify both metaphors of mood and metaphors of modality. Categories of interpersonal metaphor and the metaphoric syndrome can thus be described in a consistent way.     

The State of American Federalism, 2005: Federalism Resurfaces in the Political Debate

After several years during which federalism was rarely a prominentor explicit issue in political debates, it was in several waysthrust into the public consciousness in 2005. It was not thatthe president or Congress ceased sacrificing state and localinterests to substantive policy goals, as shown by the costlyREAL ID Act, stringent new federal requirements in the TemporaryAid to Needy Families reauthorization, and congressional interventionin the Terri Schiavo case. However, Hurricane Katrina, and particularlythe delayed and ineffective intergovernmental response, generatedsubstantial debate about the appropriate federal role in disasterrelief. In addition, state and local governmental oppositionto the No Child Left Behind Act intensified and generated significantattention during the year, particularly as a result of a Utahstatute asserting the precedence of state over federal law anda Connecticut lawsuit against the act. Meanwhile, state governmentscontinued to address a number of policy problems that federalofficials were unable or unwilling to confront, especially regardingenvironmental, health-care, and labor issues. Finally, althoughthe Supreme Court in 2005 continued its recent (2003–2004)trend of pulling back somewhat from its late-1990s Congress-curbingdecisions, federalism issues figured quite prominently in thesenate confirmation hearings for Chief Justice John Robertsand Justice Samuel Alito.     

Health-Care Workers and HIV: Policy Choice in a Federal System

In 1991, the Centers for Disease Control (CDC) announced thata health-care worker (HCW) had apparently transmitted the virusthat causes the Acquired Immune Deficiency Syndrome (AIDS) topatients while providing them routine medical treatment. Thisarticle examines the policy choices made based on this case.It begins by reviewing the federal system for making these policies.The conflicting public and professional policy recommendationsare then summarized. Next, a framework for policy choice ina federal system is outlined and federal and state choices aredescribed. The final section suggests some implications of thesechoices for American federalism.     

Reforming regulatory relationships: The impact of medical revalidation on doctors,employers, and the General Medical Council in the United Kingdom

In 2012, medical regulation in the United Kingdom was fundamentally changed by the introduction of revalidation – a process by which all licensed doctors are required to regularly demonstrate that they are up to date and fit to practice in their chosen field and are able to provide a good level of care. This paper examines the implications of revalidation on the structure, governance, and performance management of the medical profession, as well as how it has changed the relationships between the regulator, employer organizations, and the profession. We conducted semi‐structured interviews with clinical and non‐clinical staff from a range of healthcare organizations. Our research suggests that organizations have become intermediaries in the relationship between the General Medical Council and doctors, enacting regulatory processes on its behalf and extending regulatory surveillance and oversight at local level. Doctors’ autonomy has been reduced as they have become more accountable to and reliant on the organizations that employ them.     

The Impact of Welfare Reform on Medicaid

Welfare reform did not usher in comprehensive Medicaid reform,if "reform" is defined as dismantling the basic framework ordesign of the nations's health-care system for the poor. Instead,it left much of the previous Medicaid system intact. However,welfare reform has contributed to changes in the Medicaid-eligiblepopulations, greater variability and experimentation with stateMedicaid initiatives, and greater sate control over Medicaidprogram decisions. Thus, the welfare-reform movement clarifieda major trend in contemporary American politics—the increasein state discretion and flexibility in social welfare policymaking.The states are now at the center of Medicaid decisionmaking,and they are in a key position to determine the future directionof heath-care assistance for the poor in the United States.     

An Elected Upper House and Other Fallacies

All fashionable political talk is of an elected House of Lords. Doing this smart, new unthought‐out thing, says Edward Pearce, means dissolving the reliably rebellious upper house regularly rejecting bad bills from Tory and Labour governments, for a House as submissive as the Commons. Second‐line politicians will replace the difficult individual people, soldiers, doctors, academics, scientists, assorted and distinguished experts who, by lucky muddle, go there today. Far better, he says, to abolish actual titles which create a false idea of privilege, but continue drawing upon independent professional specialists. Also, Ministers should be barred from the pernicious Mandelson Effect, of making an instant Minister by life‐ennoblement, huge powers conferred without a voter in sight. An upper house called ‘The Upper House’, chosen as now for competence, will be a House of Commoners, of Independence, of Contradiction. Elected Party‐liners under guidance would be a House of Sheep.     

Exploring Identity Dynamics from a Combined Social Exchange and Social Identity Perspective

The aim of this article is to explore identity dynamics of unit and department leaders in a healthcare setting using both social identity and social exchange theories. In particular, we developed a mediational moderated model in which supervisor trust indirectly influences identification with a subordinate level (i.e., the clinical unit) through its effect on identification with a superordinate level (i.e., the organization as a whole). Furthermore, we predicted and found that this relation is moderated by organizational tenure, contract breach, and the clinical-manager's role (heads of clinical units vs. chairs of departments). We tested our hypotheses with doctors of a large public hospital in northern Italy. A total of 370 doctors completed questionnaires measuring organizational and unit identification, supervisor trust, and contract breach. Results supported our hypotheses: supervisor trust was related to unit identification through its effect on organizational identification. As expected, this relation was stronger for more tenured department chairs, and for those doctors who perceived less contract breach.     

Healthtown, U.S.A

The landscape of health care is about to change. Under the Clinton proposal every American will choose one of three basic kinds of health plan--HMO, fee-for-service or a combination. The big questions are how much you will pay and how you will choose your doctors. Lost already? Here's a tour of Healthtown, U.S.A.