John W. Seavey

Assuring access to rural health services: The case for revitalizing small rural hospitals

Many small rural hospitals play a critical role in assuring access to basic health care services, and it is in the public interest for these hospitals to receive the necessary support to revitalize their capabilities, especially with the growing challenges of rural acquired immune deficiency syndrome (AIDS), rural drug problems, an aging population, and a growing number of uninsured and underinsured rural residents.

The Impact of Socioeconomic Factors on Asthma Hospitalization Rates by Rural Classification

Asthma hospitalization rates have increased in the past decade. Research has shown that there are multiple correlates for this increase but that driving causal factors may differ for asthma hospitalization rates in rural and non-rural settings. Here we examine the socioeconomic correlates to asthma hospitalization rates in Maine for both rural and non-rural populations to examine the similarity and differences in causal factors. Findings indicate a clear SES gradient relative to asthma hospitalization rates; as population measured SES decreased, asthma hospitalization rates increased. The associated causal factors were found to differ in rural and non-rural areas. In non-rural areas, the presence of insurance was associated with increases in the asthma hospitalization rates while in rural areas, income, occupation and the percentage of non-English language speaking persons were associated with lower asthma hospitalization rates. Public policy should focus on targeted prevention strategies at the community level, especially in rural areas where cultural competency and socioeconomic factors are increasingly important.

Book Review: Pills, Power, and Policy: The Struggle for Drug Reform in Cold War America and its Consequences, the Safety-Net Health Care System: Health Care at the Margins, Communities and Health Care: The Rochester, New York, Experiment

Communities and Health Care: The Rochester, New York, Experiment. By Sarah F. Liebschutz. Rochester, N.Y.: University of Rochester Press. 2011. 272 pp.

Book Review: Policy Challenges in Modern Health Care

75.00. This book is a case study of the Rochester, N.Y., experiment in hospital payment (the hospital experimental payment program or HEP) that ran from 1980 to 1990. The experiment was locally developed, and the author notes was largely done as a way to avoid a perceived threat of regulation by external forces, the state and/or federal governments. The irony is that HEPs existence depended on waivers from those same sources. As a case study, it provides rich details that describe the evolution of hospital payments and the evolution of the insurance industry during that period. It is useful to revisit those times. The larger, swirling historical initiatives are not far from the books narrative. As a single case study, it suffers from the usual problem of uniqueness. The author fully acknowledges the rare attributes of the time--that is, the composition of the Rochester business community, its community leadership, and the composition of the health care institutions and the local structure of insurance. For example, the dominance of the Eastman Kodak Company and its focus on community in the 1970s created a climate in which its perspective on communitywide initiatives forced others to come together. As its dominance subsided and its interests became less community oriented, so did the pressures for communitywide solutions. There is an interesting section on Kodaks decision in 2002 to forgo community rating and to self-insure--the opposite of what HEP and Kodak had been advocating, but what companies in other parts of the country had been doing in their self-interest for 20 years. There is considerable detail about individual hospitals, community leaders, businesses, and health care organizations. HEP went through four different funding phases (the fourth actually did not really materialize). In each of these phases, organizations changed names and functions, much like a Russian novel. While the book is useful in documenting the details, an outsider may quickly become lost. There never is an explanation for the need for multiple name changes over 10 years. There are brief summaries at the end of each chapter, but there is not a useful table to walk you through the evolution of the various organizations and community leaders. The chapters are extensively footnoted and there appears to be an honest attempt to provide different perspectives on events. There are community heroes but no villains. There are multiple assessments of what was accomplished by Rochesters experiment. …

Efficacy of System Management or Ownership as Options for Distressed Small Rural Hospitals

This edited book is a collection of 16 essays that have been prepared by awardees of the Robert Wood Johnson Investigator Awards in Health Policy Research. Knowing this, the expectations for such a book are elevated; one anticipates an innovative discussion of policy issues and more depth analysis than normally would be received in such a collection. And that is exactly what this wonderful collection of essays delivers. The essays are uniformly fresh, current, and insightful. Given the nature of the selection process, this is not a collection that covers all critical health policy issues and there is some overlap. For example, there are no essays on Medicare pharmaceuticals, the cost of health care, or state-level health insurance reforms that certainly are major health policy issues in the United States today. However, given this caveat, the policy issues treated are important, and the authors provide current information and their own insights. Not surprisingly, a number of the essays are based upon research supported by the Robert Wood Johnson Foundation. The book does discuss a wide variety of issues. Part I provides a context for health care policy with four essays exploring the existing frameworks of politics, health reform, employer-based health insurance, and entrepreneurial health care. The book begins with an essay by James Morone that is based on his 2003 book, Hellfire Nation: The Politics of Sin in American History (New Haven: Yale University Press), and reflects on the role of morality in American public policy. In these days of social divide, it is important to remember this context for policymaking in addition to recent calls for evidence-based policy. Sherry Glied does an excellent job in covering employer-based health insurance, its history, its strengths, and its limitations. Part II is a series of five essays on population health and reducing disparities. Three essays explore inequality in health care, focusing on the importance of social economic status, race, and other causal factors; all provide excellent overviews of the issues. One of this section’s unique essays is by Kenneth Warner, who has written extensively on policies regarding tobacco. This essay, however, takes the lessons learned from the campaign against tobacco and applies them to obesity. It provides important insights on the nature of the problem, behavior modification, and social policy interventions for public health. Part III includes five essays on various aspects of the quality issue. Most of these begin with the Institute of Medicine’s 2000 report, To Err Is Human: Building a Safer Health System (L.T. Kohn, J.M. Corrigan, and M.S. Donaldson, eds. Washington, D.C.: National Academy Press). They point to some of the barriers to quality of care, for example, the need for culture change, the shortage of nursing, or the role of specialization. Lisa Iezzoni’s essay focuses on the part of Medicare not frequently discussed – the importance and need to improve coverage for Medicare beneficiaries with disabilities. This component of Medicare is overshadowed by the debate on the elderly and pharmaceutical coverage. Iezzoni’s essay combines data with individual cases in