Drew E. Altman

Experiences of Hurricane Katrina Evacuees in Houston Shelters: Implications for Future Planning

OBJECTIVES To shed light on how the public health community can promote the recovery of Hurricane Katrina victims and protect people in future disasters, we examined the experiences of evacuees housed in Houston area shelters 2 weeks after the hurricane. METHODS A survey was conducted September 10 through 12, 2005, with 680 randomly selected respondents who were evacuated to Houston from the Gulf Coast as a result of Hurricane Katrina. Interviews were conducted in Red Cross shelters in the greater Houston area. RESULTS Many evacuees suffered physical and emotional stress during the storm and its aftermath, including going without adequate food and water. In comparison with New Orleans and Louisiana residents overall, disproportionate numbers of this group were African American, had low incomes, and had no health insurance coverage. Many had chronic health conditions and relied heavily on the New Orleans public hospital system, which was destroyed in the storm. CONCLUSIONS Our results highlight the need for better plans for emergency communication and evacuation of low-income and disabled citizens in future disasters and shed light on choices facing policymakers in planning for the long-term health care needs of vulnerable populations.

Race, Ethnicity, and the Health Care System: Public Perceptions and Experiences

To assess the public’s perceptions and attitudes about racial and ethnic differences in health care, the Kaiser Family Foundation surveyed a nationally representative sample of 3,884 whites, African Americans, and Latinos in 1999. The survey found that the majority of Americans are uninformed about health care disparities—many were unaware that blacks fare worse than whites on measures susch as infant mortality and life expectancy, and that Latinos are less likely than whites to have health insurance. Views on whether the health system treats people equally were strikingly different by race. For example, most minority Americans perceive that they get lower quality care than whites, but most whites think otherwise. Nonetheless, more minority Americans were concerned about the cost of care than racial barriers. Efforts to eliminate disparities will need to improve public awareness of the problems as well as address racial and financial barriers to care.

Health News and the American Public, 1996-2002

The Kaiser Family Foundation/Harvard School of Public Health Health News Index, a series of 39 surveys with a total of over 42,000 respondents from 1996 through 2002, measures how closely Americans follow major health stories in the news and what they understand about the issues covered in those stories. On average, four in ten adults reported following health news stories closely. The public reports paying the most attention to stories about public health, followed by health policy and disease-related stories. While knowledge about health news varies, individuals who follow health news stories closely are significantly more likely to give the correct answer to knowledge questions about those stories.

Corporate Attitudes toward Health Care Costs

WITH THE GOVERNMENT STRAINING TO MEET its health benefit obligations to the poor and the elderly, it is not surprising that some policy analysts see the development of an alliance between business and government as the only effective means to control inflation in the health sector. Most Americans receive health benefits from their employers rather than from government (Carroll and Arnett, 1979). Rising health care costs, however, affect all purchasers of health care services. Government action alone has been unable to limit the growth in these costs. An aroused business community could make the difference if it added its purchasing power to that of government in an effort to discipline the utilization and pricing of health care services. Businesses are certainly important purchasers of health care services, buying annually tens of billions of dollars worth of care on behalf of their employees. Many observers believe that firms, because of these expenditures, are a potential force for health sector reform (Council on Wage and Price Stability, 1976; Havighurst, 1978; Altman, 1978). The view they offer is that firms, especially the largest, are concerned about increases in health care costs; are seeking to improve

Liking The Pieces, Not The Package: Contradictions In Public Opinion During Health Reform

Public opinion played a prominent role during the recent health care reform debate. Critics of reform pointed to poll results as evidence that a majority of Americans opposed sweeping changes. Supporters cited polls showing that people favored many specific aspects of the legislation. A closer examination of past and present polling shows that opinion tracked with historic patterns and was relatively stable, even if the contentious public debate suggested a volatile public mood in 2009 and 2010. Going forward, the public will begin reacting to reform implementation, primarily by judging it in terms of their perceptions of and experiences with what the new law does and does not do for people. These opinions could in turn influence implementation or future legislation.

Medicare and Medicaid at 50 Years: Perspectives of Beneficiaries, Health Care Professionals and Institutions, and Policy Makers

IMPORTANCE Medicare and Medicaid are the nations 2 largest public health insurance programs, serving the elderly, those with disabilities, and mostly lower-income populations. The 2 programs are the focus of often deep partisan disagreement. Medicare and Medicaid payment policies influence the health care system and Medicare and Medicaid spending influences federal and state budgets. Debate about Medicare and Medicaid policy sometimes influences elections. OBJECTIVE To review the roles of Medicare and Medicaid in the health system and the challenges the 2 programs face from the perspectives of the general public and beneficiaries, health care professionals and health care institutions, and policy makers. EVIDENCE Analysis of publicly available data and private surveys of the public and beneficiaries. FINDINGS Together, Medicare and Medicaid serve 111 million beneficiaries and account for

Voters and Health Reform in the 2008 Presidential Election

1 trillion in total spending, generating 43% of hospital revenue and representing 39% of national health spending. The median income for Medicare beneficiaries is

Physicians' views of interventions to reduce medical errors: does evidence of effectiveness matter?

23,500 and the median income for Medicaid beneficiaries is

The politics of health care regulation: the case of the National Health Planning and Resources Development Act.

15,000. Future issues confronting both programs include whether they will remain open-ended entitlements, the degree to which the programs may be privatized, the scope of their cost-sharing structures for beneficiaries, and the roles the programs will play in payment and delivery reform. CONCLUSIONS AND RELEVANCE As the number of beneficiaries and the amount of spending for both Medicare and Medicaid increase, these programs will remain a focus of national attention and policy debate. Beneficiaries, health care professionals, health care organizations, and policy makers often have different interests in Medicare and Medicaid, complicating efforts to make changes to these large programs.

The implications of the 2000 election

Voters view health care as an important issue in the 2008 U.S. presidential election. Most voters favor major changes in our health care system. Registered voters who planned to vote for Senator Obama placed higher priority on increasing coverage for the uninsured, and Senator McCains supporters gave higher priority to health care reforms that would not raise taxes.