Health not Wealth: Enlarging the EMU

Economic health not wealth should be the decisive criterion when considering the prospects of the Central and East European (CEE) candidates for EU membership and the capacity of the EU to enlarge. Viewed this way the outlook is promising. The CEE countries are still very poor, compared to most of the existing EU members, but they are also much more dynamic. Growth rates are generally expected to remain around 4-5 per cent in CEE for the foreseeable future, compared to about 2-3 per cent for the EU. This still implies that full catch-up in terms of GDP per capita will take decades, rather than years, but full catch-up is not the relevant criterion if one is concerned about enlargement. Experience in the EU has shown that problems are much more likely to arise from established rich member countries with stagnant economies (Belgium in the 1980s and Germany today) than poor, but more dynamic states (such as Portugal and Ireland today). The fact that most of the so-called 'periphery' is now growing more strongly than the 'core' confirms that EU integration benefits poorer countries even more.     

Changing the Culture of Health: One Public Health Misstep at a Time

In this article, I argue that public health regulations are a necessary component of changing the culture of health in the US. After considering libertarian critiques of public health interventions, I maintain that many of the interventions critiqued are not in fact coercive. Looking forward, I do not envision an either/or between the nanny state vs. a libertarian polity. Instead, a middle ground will emerge that respects individual choice and personal responsibility while accepting that government has a legitimate interest in securing the population’s health. Better health helps people make better choices and enjoy freedom; being free from poor health status is as important to liberty as free choice.     

Centralisation versus regionalisation: Designing the Sixth National Mental Health Plan

In response to the recent Productivity Commission report into mental health, the previous Federal Government announced its intention to produce a new national agreement that lays the platform for Australia's sixth national mental health plan. It has been recommended mental health move to a more regional model of governance and planning, away from a centralised, top-down approach, partly in response to broader reforms affecting health care, and partly in direct response to consistent inquiry evidence that the mental health system remains in crisis. The past 30 years of mental health planning have been centralised. Successive national plans set a broad framework, with real decisions about mental health funding and service allocation made in the health departments of our capital cities. Will the next plan sponsor or inhibit regionality in mental health planning? This paper assesses Australia's historical approach to health planning particularly as it affected mental health and the costs arising. In learning these lessons, we propose the necessary ingredients to facilitate a regional, innovative, and effective approach to decentralised planning, for better mental health outcomes. We cannot afford to replicate the failed planning approaches of the past.     

Understanding the Relationship between Health PACs and Health Lobbying in the American States

We examine how health PAC activity in the states is connectedto lobbying. Is the political money that health interest organizationsbring to the policy process a powerful, independent means ofinfluence or is it better understood narrowly as a tactic usedto support lobbying? We examine the relationship between campaigncontributions and lobby activity and the limited work that hasbeen conducted on them and raise a number of questions aboutthe process by which they are connected. We utilize 1998 dataon state lobbying and PAC activity, allowing us to answer causalresearch questions generated from existing studies at the nationallevel. We conclude that PAC activity is best viewed as an adjunctof lobbying rather than an independent form of political activity.     

Health Insurance in Transition: The Health Insurance Portability and Accountability Act of 1996

The Health Insurance Portability and Accountability Act (HIPAA)of 1996 (PL. 104–191) brings the federal government fullyinto insurance regulation for the first time. Despite the Republicanmajority's rhetoric about state control, election-year politicstrumped federalism. HIPAA's immediate impact oncoverage maybe modest, but its ultimate significance is great because itcreates a template for more farreaching federal involvementin regulating insurance. HIPAA amends the Employee RetirementIncome Security Act (ERISA), the Public Health Service Act,and the Internal Revenue Code, creating a complicatedstructuredictated by efforts to avoid an unfunded mandate. The historyof insurance regulation and the activity surrounding the enactmentof PL. 104–191 suggest that HIPAA continues an incrementalprocess of transition between state insurance regulation andfederal oversight driven by recent and accelerating changesin the structure of the health-care marketplace.     

社会医疗保险:新农合的发展取向

新农合向社会医疗保险发展是实现城乡居民社会医疗保险一体化的重要举措,它有利于巩固和发展新农合的成果,推动医疗保障事业的发展。目前新农合与城镇居民社会医疗保险制度框架基本统一、社会救助实现了城乡居民一体化、公共卫生投入向农村倾斜、已形成比较科学的农村医疗卫生管理制度等,为新农合向社会医疗保险发展提供了可行性。但是,新农合向社会医疗保险发展还存在着农村公共卫生建设相对滞后、地(市)级统筹难度大、农民的出资水平难以提高等难点。为此,要继续为新农合添加更多的社会医疗保险的构成要素,加快农民工医疗保障城市化进程,加强法制建设,进行新的社会医疗保险制度创新。     

The Effect of Medical Marijuana Laws on the Health and Labor Supply of Older Adults: Evidence from the Health and Retirement Study

Older adults are at elevated risk of reducing labor supply due to poor health, partly because of high rates of symptoms that may be alleviated by medical marijuana. Yet, surprisingly little is known about how this group responds to medical marijuana laws (MMLs). We quantify the effects of state medical marijuana laws on the health and labor supply of adults age 51 and older, focusing on the 55 percent with one or more medical conditions with symptoms that may respond to medical marijuana. We use longitudinal data from the Health and Retirement Study to estimate event study and differences‐in‐differences regression models. Three principle findings emerge from our analysis. First, active state medical marijuana laws lead to lower pain and better self‐assessed health among older adults. Second, state medical marijuana laws lead to increases in older adult labor supply, with effects concentrated on the intensive margin. Third, the effects of MMLs are largest among older adults with a health condition that would qualify for legal medical marijuana use under current state laws. Findings highlight the role of health policy in supporting work among older adults and the importance of including older adults in assessments of state medical marijuana laws.     

The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions

The U.S. population receives suboptimal levels of preventive care and has a high prevalence of risky health behaviors. One goal of the Affordable Care Act (ACA) was to increase preventive care and improve health behaviors by expanding access to health insurance. This paper estimates how the ACA‐facilitated state‐level expansions of Medicaid in 2014 affected these outcomes. Using data from the Behavioral Risk Factor Surveillance System, and a difference‐in‐differences model that compares states that did and did not expand Medicaid, we examine the impact of the expansions on preventive care (e.g., dental visits, immunizations, mammograms, cancer screenings), risky health behaviors (e.g., smoking, heavy drinking, lack of exercise, obesity), and self‐assessed health. We find that the expansions increased insurance coverage and access to care among the targeted population of low‐income childless adults. The expansions also increased use of certain forms of preventive care, but there is no evidence that they increased ex ante moral hazard (i.e., there is no evidence that risky health behaviors increased in response to health insurance coverage). The Medicaid expansions also modestly improved self‐assessed health.     

Achieving Improved Health Outcomes for Urban Aboriginal People: Biomedical and Ethnomedical Models of Health

Urban Aboriginal people could be expected to achieve positive health outcomes owing to their close proximity to mainstream health care services. The available data indicate that this is not the case, although people generally self-report as being in 'good to excellent' health. Research indicates that Aboriginal people may not be benefiting from mainstream services owing to the emphasis placed on biomedical models of health that conflict with more culturally-based, ethnomedical models. This paper looks at achieving an interface between the two models as a means of pursuing more positive health outcomes in urban settings.     

Health policy for the elderly

also director of the human development program at his university. He is the author of The Decision-Makers: The Power Structure of Dallas; The Aging Enterprise; Long-Term Care of the Elderly,and Political Economy, Health, and Aging.     

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.