Closing the Loophole: A Case Study of Organizing for More Equitable and Affordable Access to Health Care in San Francisco

This paper presents in-depth case study of a successful hybrid political and community organizing campaign to ensure equitable access to health care through the perspective of a grassroots San Francisco community-based organization, the Chinese Progressive Association (CPA), which has been organizing low-income Chinese immigrants for over four decades. First, it outlines the Health Care Security Ordinance (HCSO), which, since its passage in 2006, has established a near-universal health care access program, helping to make health care accessible and affordable to individuals living and working in San Francisco. Then it presents the campaign to save the HCSO, focusing on CPA’s participation in the HCSO coalition. Finally, it discusses health care as it relates to the San Francisco’s affordability crisis and the political economic context in which it is taking place. Despite the limitations inherent in small case studies like this one, it nevertheless provides a valuable opportunity to better understand how one politically progressive city attempted to address the problem of grossly inequitable health care access through the lens of community organizing, advocacy, and coalition building. San Francisco, like many major American cities today, is being confronted with rapid gentrification and growing economic inequality—the backdrop to the HCSO. Through innovative experiments in social responsibility like the HCSO, however, the city has made leaps in health care access. It concludes with lessons learned from local organizing and advocacy to save the HCSO as these may inform other local efforts to promote health care for all.     

Stewardship of public assets under nonprofit conversion models: New York's Empire Blue Cross Blue Shield case study

This research describes a case study of the Empire Blue Cross Blue Shield conversion under way in New York. In January 2002, legislation approved the conversion and the disposition of $1 billion in assets: 95 percent for health care salaries and expenses and 5 percent for a foundation to promote health care for the poor. New York's approach is controversial. According to Greene and Sommerfield (2002), the New York Times considers it the largest fiscal gimmick in New York's history, and Consumers Union is challenging it in the courts, asserting the plan is illegal. This article describes New York's approach to nonprofit conversion, proposing that more research on conversions is needed and that case study research illustrating the way different states approach the issue has the potential to bring together researchers, practitioners, and policymakers in an important debate that will advance public policymaking that furthers the public good. Subsequently, on June 20, 2005, New York State's highest court dismissed the Consumers Union lawsuit, affirming the actions of the New York State legislature and bringing to an end nearly three years of state‐level litigation.     

Interactive Health Communication Technologies in the Public Health Sector: Positive Perceptions Still Outpace Actual Utilization

ABSTRACT

Effective population-based and patient-centered public health care is highly dependent on timely and reliable health-related information. The continuous growth and availability of health-related information brought about by the emergence of a new digital communications environment offers a range of opportunities that facilitate access to useful health information for the public health sector–for providers as well as patients. Such advancements, however, can only be realized if public health professionals are knowledgeable about existing sources of online health information, have the ability to successfully judge the reliability of online health information, and are able to acquire the information in a timely and efficient manner. This research follows on the heels of a survey of public health professionals in New York State that concluded that limited access and knowledge negatively impacted utilization of interactive health communication technologies. In this study, a survey was administered to providers at a large county health department located in central Michigan. Results indicate that perceptions regarding the advantages of online health information still far outweigh actual utilization. Barriers to actual utilization include lack of easy access to computers with high-speed connections, trusted and timely online information, training and staff development issues, and organizational policies concerning computer access and usage.     

The Affordable Care Act: Implications for African Americans Living with HIV

This article reviews the Patient Protection and Affordable Care Act (ACA), 2010. It highlights the implications of the ACA for African Americans living with HIV/AIDS. This law is a practical step toward decreasing disproportionate chronic disease in vulnerable communities. Proper implementation of provisions will help the United States catch up to other industrialized nations with well-established public health care programs. Included is a concise table referencing notable provisions that support increased access to treatment, health education, and quality of care for clients. Social workers can use this information to ensure that clients benefit from this legislation.     

Mental Health Care for American Indians in Prison

Abstract

Based on an earlier finding that as many Native Americans in upstate New York received mental health care in prison as outside of prison during a 10-month period, this study was designed to investigate if prisons had become an alternative treatment option for Native Americans with a mental illness in New York State. The study was not able to answer this question due to the limited number of cases and to outside constraints. However, it is possible from the results to provide a picture of mental health needs and attitudes among Native American inmates which is surprising and instructive for those who provide psychiatric care to American Indians, either within or outside of prison walls. A noteworthy finding was the importance placed by these inmates on the use of culturally appropriate ceremonies to assist in their rehabilitation. Low rates of serious mental illness among the American Indian sample highlight the need for further study in this area.     

Using a NIATx based local learning collaborative for performance improvement

Local governments play an important role in improving substance abuse and mental health services. The structure of the local learning collaborative requires careful attention to old relationships and challenges local governmental leaders to help move participants from a competitive to collaborative environment. This study describes one county's experience applying the NIATx process improvement model via a local learning collaborative. Local substance abuse and mental health agencies participated in two local learning collaboratives designed to improve client retention in substance abuse treatment and client access to mental health services. Results of changes implemented at the provider level on access and retention are outlined. The process of implementing evidence-based practices by using the Plan-Do-Study-Act rapid-cycle change is a powerful combination for change at the local level. Key lessons include: creating a clear plan and shared vision, recognizing that one size does not fit all, using data can help fuel participant engagement, a long collaborative may benefit from breaking it into smaller segments, and paying providers to offset costs of participation enhances their engagement. The experience gained in Onondaga County, New York, offers insights that serve as a foundation for using the local learning collaborative in other community-based organizations.     

Children and Society Policy Review: Health Policy Affecting Children and Young People

The Health and Social Care Act comes into force in April 2013. It changes the organisation of the health service and accelerates the integration of health and social care. New relationships between primary and secondary healthcare will develop and the culture of clinical and cost effectiveness will expand into social care; work on children in public care is in the vanguard of this change. However, this is not an organisational change designed for children and there are considerable anxieties about how it will impact on the delivery of health care. The issues for children in public care need to stay high on the national agenda and in local fora.     

‘Children in Need’: Using Geographical Information Systems to Inform Strategic Planning for Social Service Provision

SUMMARY: Recent legislation, requires local authorities to provide services such as day care for children in need. New computer techniques for geo-spatial analysis—Geographical Information Systems—ore now muck used by local authorities in planning environmental and engineering services. This article explores the extent to which these techniques can be applied to social data and, in particular, whether they are useful for strategic planning of day care and other social service provision.     

Meeting immigrant health challenges: An integrated model in New York City

New York City has traditionally been the portal to America for millions of foreign‐born immigrants. Current immigration echoes this past. Each year, tens of thousands of immigrants and migrants enter New York City. These individuals and families come from diverse cultures and health care systems which continue to impact on their health care needs. How can New York's health care system provide culturally sensitive and epidemiologically informed health services to these immigrants? In 1990, with a grant from the Aaron Diamond Foundation, an interdisciplinary group of professionals established the New York Task Force on Immigrant Health. This paper will describe the work of this unique multi‐disciplinary organisation as it seeks to address issues of health status and service delivery to immigrant populations. The paper will discuss specific issues and strategies with respect to a) the development of data bases, b) ethnographic investigations, c) cross‐cultural and structural barriers to care, d) the creation and analysis of models to integrate traditional and Western bio‐technical health care, and e) the informing and transforming of public policy and programs to result in more linguistically appropriate, culturally sensitive and effective health and social services. The successes of the New York Task Force on Immigrant Health, in a relatively brief period of time, provide both a model and a stimulus for other localities and nation‐states interested in preventing illness and improving the health status of their diverse populations.     

纽约城市转型与绿色发展对北京的启示

纽约城市转型表现为由制造业到服务业再到高端知识型服务业和绿色发展的城市演变轨迹,其特征主要表现为重视创新驱动、高端服务业集群、人才教育培养、城市功能融合、城市绿化建设等。借鉴纽约城市转型经验,北京应加强城市功能的均衡化疏解、基本公共服务均等化,加强产业多中心集聚和分散布局,大力发展教育、医疗、卫生、文化休闲等服务业,完善公共交通系统,加快绿色产业、绿色技术创新和城市绿化建设,促进城市转型与绿色发展。     

Who Gets What From Government? Distributional Consequences of Child‐Care Assistance Policies

Given the fragmented structure of child‐care assistance in the United States, it has been difficult to obtain accurate estimates of which families are assisted, through which mechanisms, and at what level. Making use of survey data from New York City, we analyze the distribution of several forms of public child‐care assistance. Results suggest that about 40% of all families with young children receive some form of child‐care assistance. Considering all forms of assistance, the distribution of child‐care help is targeted in both expected and some unexpected ways. Implications of these results are discussed in the context of U.S. child‐care policies governing access and benefit levels.     

Crowded Advocacy: Framing Dynamic in the Fracking Controversy in New York

In the hydrofracturing controversy in New York advocates hotly contested notions of the problem, what should be done, by whom, and how. This controversy can be characterized as “crowded advocacy,” involving intense mobilization and counter-mobilization of advocates with competing perspectives. Extant theories about the expansion of advocacy organizations are unclear about how advocates’ interactions shape the policy arena, particularly when there is competition within and across multiple coalitions. This article contributes by asking: How do advocates’ interactive framing dynamics shape public discourse when advocacy is crowded? It assumes that advocacy in general, and framing in particular, evolves as advocates respond to each other. I find that competing “discourse coalitions” collectively influence public discourse by articulating divergent notions of (1) what constitutes credible knowledge, (2) who can speak with authority on the issues, and (3) what institutional arrangements should be activated to manage risks. The consequence is that advocates have to react to others' framing on these issues—to defend their knowledge, their credibility, and specific institutions, rather than arguing their case on the merits. The implication is that advocacy is not only the means of influence (strategy) but also creates the context of advocacy in particular ways in a crowded field.     

Change and Inertia in the New York State Medicaid Personal Care Services Program: An Institutional Case Study

This study analyzes how competing logics (belief systems) of stakeholders have influenced patterns of change and inertia in the development of the New York Medicaid Personal Care Services (PCS) program. A case-study methodology was used to collect documents, statistics, and interview data from four key stakeholder groups: state and city officials, PCS agencies, a labor union, and consumer advocates covering the period 1999 to 2005. The New York PCS program is one of the oldest, largest, and most stable programs in the United States. Its early unionization of workers resulted in relatively generous wages and benefits and made New York number one nationally in PCS spending per capita. In spite of wide support from stakeholder groups, the overall number of participants has gradually declined since 1999. A consumer-directed model of personal care developed in 1995 challenged the status quo and has grown steadily. Resistance by public officials, agency providers, and union representatives to the consumer-directed model has resulted in a small program that is often targeted toward individuals labeled “difficult to serve.” Dominant stakeholders in New York have ensured a stable personal care program that has resisted change and led to program inertia.     

Inequities in health outcomes and access to health care in South Africa: a comparison between persons with and without disabilities

Health is a fundamental human right and if health care is to be universal and equitable it should not be less accessible to some sectors of society than to others. The objective of this study was to compare health outcomes and access to health care between persons living with disabilities and their non-disabled counterparts. The research was based on secondary data analysis of wave 1 of the National Income Dynamic Survey. Results from the study indicated that people with disabilities reported a higher incidence of communicable and non-communicable diseases, lower access to medical insurance and greater use of public health care than their non-disabled counterparts. In conclusion, the findings highlight the inequities in health outcomes and access to health services for people with disabilities and emphasise the need for disability-friendly health care policies that reduce barriers to accessing health care.     

Hospital response to the legalization of abortion in New York State: an analysis of program innovation

The reorientation of hospital services in the state of New York to accommodate women's constitutional right to elective abortion was investigated. Market and resource constraints, the social orientations of the organization, and the values of physicians were examined in the effort to evaluate hospital response between 1971 and 1973. Analysis indicates that program innovation in obstetrical and gynecological services to include elective abortion was inhibited by economic factors that generally determined the feasibility of diverting finite resources to a new service and social orientations and values that determined the compatibility of elective abortions with the dominant values underlying hospital operations. The reform of New York abortion statutes and the subsequent ruling by the Supreme Court reiterating the right of women to terminate pregnancy failed to standardize the delivery of health care so that individual rights to service could be obtained everywhere in the state. The social changes ultimately realized through legislative and judicial action were essentially conditional upon the responsiveness of local health care providers. Legal action that failed to specifically address the administrative role of hospitals in social change qualified local access and could not be completely effective in legitimizing the redefinition of abortion in society.     

Regulation of US Charitable Solicitations Since 1954

A major shift in the climate for the solicitation of charitable donations in the United States occurred in the second half of the twentieth century. Starting with legislation passed by the Legislatures of New York and Massachusetts in 1954 and eventually including 40 largely similar laws in force today, state governments grew to playing a predominant part in the regulation of appeals for public support for charitable activities. State regulators, voluntary oversight and advocacy groups, accounting standards-setting bodies, and the data-collection activities of the Internal Revenue Service all influenced the development of the body of regulations which now shape the process of seeking support for nonprofits?? work. This article summarizes the effect of earlier innovations in the field of fundraising and then examines the interplay of public and private actors in the course of the creation of the present regulatory climate.     

Inequitable Access to Health Services for Older Adults with Diabetes: Potential Solutions on a State Level

Diabetes is a serious global public health challenge. The cost for health services for diabetes care has increased 41% over the past 5 years. Despite escalating health expenditure, the United States continues to have higher rates of diabetes than many other developed countries. There is a need for health care reform in the United States not only in reducing health care costs but also in improving the quality of preventative care. This study presents the testing of a multilevel model investigating variables on the individual and state levels to develop a better understanding of the most important contextual pathways that can lead to providing older adults (50+) with type 2 diabetes with the recommended preventative quality care they require. The model was tested using a three-level repeated cross-sectional design with data from various existing data sources, using a national sample of 181,870 individuals aged 50 years and older. Results showed that differences in state health care systems contributed to inequitable access. Specifically, in a state where there was a higher percentage of adults 65 and older coupled with a shortage of health care professionals, the likelihood of receiving the recommended preventative quality care decreased. Also, older adults living in states with a higher percentage of people with diagnosed diabetes but with a lower-than-average annual per capita health care expenditure fared worse in receiving quality preventative care. Last, older adults in wealthy states with higher percentages of uninsured people had the lowest odds of receiving quality preventative care. Health care reform, similar to what is currently promoted by the Patient Protection and Affordable Care Act of 2010, is recommended to improve the performance of all health care systems in all states.     

Health Care and Female Survivors of Childhood Sexual Abuse: Health Professionals' Perspectives

The present study explored health professionals' experiences with adult survivors of child sexual abuse in New Zealand. Face-to-face, semistructured interviews of up to an hour took place with 13 health professionals. The participants were asked about training, screening practices, their response to disclosures, and advice to other health professionals. A model—transition to ethical practice—emerged from the data, where delivering more sensitive health care to child sexual abuse survivors sits on a continuum from lack of awareness of child sexual abuse to delivery of care where all patients are comfortable. We recommend making sensitive care for all as the standard care of practice and providing training for health professionals on how to deal with disclosures.     

Variations in Provider Capacity to Offer Accessible Health Care for People with Disabilities

Abstract

Since social workers are likely to practice in a range of health care settings, their training focusing on human behavior in the social environment could help providers develop strategies to improve access to care for people with disabilities. In this article, results from a comprehensive survey of providers about access to health care for people with a broad range of disabilities are reported. Results suggest that a minority of providers report difficulty serving people with disabilities. However, dentists and mental health/substance abuse providers are significantly less likely than other providers to report that they provide accessible services to individuals with disabilities. These providers are less likely to report having had training related to mobility impairments, providing mirrors at their facility, having an accessible door, or providing assistance with personal care needs, and are more likely to report that their building poses a barrier for people with disabilities. Social workers are well positioned to take a leadership role in working with providers and patients to improve access to health care for people with disabilities. A social work framework of understanding the individual in a social environment may be the most appropriate perspective for creating innovative strategies for addressing the complex, multidimensional needs of people with disabilities who experience limited access to care.     

Policy recommendations for rare disease centres of expertise

AimRare diseases are a serious public health concern and are a priority in the EU. This study aims to develop policy recommendations for rare disease centres of expertise (CoEs) in order to improve standards and quality of care.Subject and methodsA modified 3-round Delphi technique was used. Participants included rare diseases patients, carers, patient representatives and healthcare professionals (HCPs) from CoEs in two countries—Denmark and the UK.ResultsThe results suggest the need to make improvements within current CoE environments, access to CoEs and the need for coordination and cooperation of services within and outside CoEs. It is recommended that CoEs are not overly ‘medicalised’, while at the same time they should be established as research facilities. The importance of including patient representatives in CoE performance management was also highlighted. Raising awareness and provision of appropriate training amongst non-specialist HCPs is seen as a priority for early and correct diagnosis and ensuring high quality care. Similarly, provision of targeted information about patients’ illness and care was considered essential along with access to social assistance within CoEs.ConclusionsPolicy recommendations were developed in areas previously recognised as having gaps. Their implementation is expected to strengthen and improve current care provision for rare disease patients. In member states where national plans and strategies are being developed, it is recommended to replicate the methodological approach used in this study as it has proven to be a helpful tool in rare disease centres of expertise policy development.