Mollyann Brodie

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.

Economic incentives in the choice between vaginal delivery and cesarean section

The dramatic rise in cesarean-section (C-section) rates, and their high costs and wide variation, has raised interest in understanding the factors affecting decisions to use this procedure. The economic incentives of physicians, hospitals, payers, and mothers are examined. In the economic framework, physicians must balance their short-term interests against their reputation, which is derived from efficiently providing what mothers want. Providers who encounter higher opportunity costs while attending to mothers in prolonged labor can reduce these costs by operating or by restructuring their practices. The mainly indirect evidence on financial incentives indicates that insured mothers have low marginal financial costs when they undergo C-section. Mothers with private, fee-for-service insurance have higher C-section rates than mothers who are covered by staff-model HMOs, who are uninsured, or who are publicly insured. In conclusion, research and payment reforms to reduce distortions to good practice are proposed.

Perceptions of Latinos, African Americans, and Whites on Media as a Health Information Source

This study examined the responses from over 3,400 interviews with African Americans, Latinos, and Whites from three nationally representative telephone surveys on sources of health information and the role of mass media. It focused specifically on the perceived effectiveness and relevance of general market media versus Black - and Latino - oriented media as sources of health information for racially and ethnically diverse audience segments. The study found that large majorities of Whites, African Americans, and Latinos rely heavily on the media for information about health and health care, take personal action as a result of media health coverage, and would like the media to expand its coverage of health topics. African Americans and Latinos reported more regular use of general market media outlets versus Black - or Latino - oriented media sources, although minority oriented media also figured prominently . African Americans and Latinos were more critical of general media health coverage than were Whites ...

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.

Voters and Health Reform in the 2008 Presidential 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.

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

Purpose Despite widespread public attention and numerous ongoing patient safety initiatives, physicians are skeptical of the most commonly prescribed interventions to reduce medical errors. This study examined the association between the published evidence of effectiveness of interventions to reduce medical errors and physicians’ ratings of the effectiveness of those interventions. It further assessed whether academic affiliation was associated with physicians’ ratings of effectiveness. Method The authors conducted a literature review seeking evidence of effectiveness of 13 interventions to reduce medical errors. A four-page questionnaire was sent to a random sample of 1,332 U.S. physicians in the spring of 2002. A total of 831 (62%) responded, providing ratings of the perceived effectiveness of these interventions to reduce medical errors. Results We identified published evidence of effectiveness for six of the 13 interventions. Physicians rated 34% of these and 29% of the interventions without published evidence as “very effective” (p < .01). Physicians with an academic affiliation and those in practice for more years were slightly more likely to rate interventions with published evidence as “very effective.” Conclusions Physicians’ ratings of the effectiveness of interventions to reduce medical errors are only weakly associated with published evidence of effectiveness. More evidence, better dissemination strategies for existing evidence such as inclusion in medical school curriculum or recertification examinations, and a focus on removing barriers to interventions may be needed to engage physicians in moving patient safety interventions into medical practice.

Regional variations in public opinion on the affordable care act.

One year after passage, the Patient Protection and Affordable Care Act (ACA) remains a divisive topic. Most publicly released polls on the law have focused on the views of Americans as a whole. But with much of the responsibility of implementation lying with the states, this essay explores whether opinion differs geographically. The analysis finds that views on the health reform law do differ by region, and these differences are most likely driven by the political leanings of a given area. While opinion nationally differs by age and race, this pattern does not hold when looking by region. Areas that have a larger share of uninsured and are slated to receive greater federal funding under the ACA also do not differ in their opinions. These data suggest that regional variations in attitudes about the ACA are based less on the demographic structure of a region and more on the political ideologies of residents in a given region. As implementation of the law continues, this analysis shows that national opinion data mask important regional variations in views of the ACA.

Impact of issue advertisements and the legacy of Harry and Louise.

The Health Insurance Association of America’s “Harry and Louise” ads have become part of the lore of the Clinton health care reform debate of 1993–1994. Anyone involved in the debate at the time, or a student of the debate, or involved in health care reform since, knows about the campaign and has likely deliberated with colleague, friend, or foe about the impact the ads had, or did not have, on the outcome. Harry and Louise was not the first ad to be used in a health policy debate. Interest groups have organized and launched professional advertising campaigns and grassroots efforts as far back as Harry Truman’s national health insurance proposals in the late 1940s (Starr 1982). What made Harry and Louise so special was that the ad was launched during one of the nation’s most contentious and high-profile health policy debates in recent history, bringing intense scrutiny to both it and the role of issue advertising in the health policy arena. Since the campaign we have seen a dramatic increase in the amount of dollars spent and the number of issue ads produced and aired in every election cycle, with health care being one of the primary topics of the ads (Aday 2000; Annenberg Public Policy Center 2001). Add to this our inherent interest in better understanding the links among our political institutional structure, political actors, the political debates themselves, and policy outcomes, and it becomes clear why we are driven to ask what we can learn from Harry and Louise. Critically examining the impacts of