Pauline Vaillancourt Rosenau

Introduction The Strengths and Weaknesses of Public-Private Policy Partnerships

In theory, public-private partnerships in many policy sectors are expected to create synergistic dynamics that draw on the strengths and weaknesses of each partner. Evidence from the articles in this issue suggests that this is not always the case. Partnering may, at least in the short term, decrease costs, if cost and efficiency are defined narrowly and externalities are discounted. Despite this advantage, public-private policy partnerships have substantial problems. They do not exhibit superior performance in the criteria of equity, access, and democracy. Rather than reduce regulation, public-private policy partnerships appear to increase it. Regarding accountability, public partners are the providers of last resort, although this could change if private partners gain more experience and partnering moves beyond minimalist forms to more fully developed policy partnerships. In short, public-private policy partnerships are imperfect and in need of refinement and reform. Several articles in this issue provide suggestions for such modifications. Specific recommendations are offered as well.In theory, public-private partnerships in many policy sectors are expected to create synergistic dynamics that draw on the strengths and weaknesses of each partner. Evidence from the articles in this issue suggests that this is not always the case. Partnering may, at least in the short term, decrease costs, if cost and efficiency are defined narrowly and externalities are discounted. Despite this advantage, public-private policy partnerships have substantial problems. They do not exhibit superior performance in the criteria of equity, access, and democracy. Rather than reduce regulation, public-private policy partnerships appear to increase it. Regarding accountability, public partners are the providers of last resort, although this could change if private partners gain more experience and partnering moves beyond minimalist forms to more fully developed policy partnerships. In short, public-private policy partnerships are imperfect and in need of refinement and reform. Several articles in this issue provi...

Two Decades of Research Comparing For-Profit and Nonprofit Health Provider Performance in the United States

This article reports on a systematic review of data-based, peer-reviewed scientific assessments of performance differences between private for-profit and private nonprofit U.S. health care providers published since 1980. Copyright (c) 2003 by the Southwestern Social Science Association.

An Experiment with Regulated Competition and Individual Mandates for Universal Health Care: The New Dutch Health Insurance System

The 2006 Enthoven-inspired Dutch health insurance reform, based on regulated competition with a mandate for individuals to purchase insurance, will interest U.S. policy makers who seek universal coverage. This ongoing experiment includes guaranteed issue, price competition for a standardized basic benefits package, community rating, sliding-scale income-based subsidies for patients, and risk equalization for insurers. Our assessment of the first two years is based on Dutch Central Bank statistics, national opinion polls, consumer surveys, and qualitative interviews with policy makers. The first lesson for the United States is that the new Dutch health insurance model may not control costs. To date, consumer premiums are increasing, and insurance companies report large losses on the basic policies. Second, regulated competition is unlikely to make voters/citizens happy; public satisfaction is not high, and perceived quality is down. Third, consumers may not behave as economic models predict, remaining responsive to price incentives. Finally, policy makers should not underestimate the opposition from health care providers who define their profession as more than simply a job. If regulated competition with individual mandates performs poorly in auspicious circumstances such as the Netherlands, how will this model fare in the United States, where access, quality, and cost challenges are even greater? Might the assumptions of economic theory not apply in the health sector?

Demand-Driven Care and Hospital Choice. Dutch Health Policy Toward Demand-Driven Care: Results from a Survey into Hospital Choice

In the Netherlands, current policy opinion emphasizes demand-driven health care. Central to this model is the view, advocated by some Dutch health policy makers, that patients should be encouraged to be aware of and make use of health quality and health outcomes information in making personal health care provider choices. The success of the new health care system in the Netherlands is premised on this being the case. After a literature review and description of the new Dutch health care system, the adequacy of this demand-driven health policy is tested. The data from a July 2005, self-administered questionnaire survey of 409 patients (response rate of 94%) as to how they choose a hospital are presented. Results indicate that most patients did not choose by actively employing available quality and outcome information. They were, rather, referred by their general practitioner. Hospital choice is highly related to the importance a patient attaches to his or her physician’s opinion about a hospital. Some patients indicated that their hospital choice was affected by the reputation of the hospital, by the distance they lived from the hospital, etc. but physician’s advice was, by far, the most important factor. Policy consequences are important; the assumptions underlying the demand-driven model of patient health provider choice are inadequate to explain the pattern of observed responses. An alternative, more adequate model is required, one that takes into account the patient’s confidence in physician referral and advice.

Ownership, financing, and management strategies of the ten largest for-profit nursing home chains in the United States.

This study examined the ownership, financing, and management strategies of the 10 largest for-profit nursing home chains in the United States, including the four largest chains purchased by private equity corporations. Descriptive data were collected from Internet searches, company reports, and other sources for the decade 1998–2008. Since 1998, the largest chains have made many changes in their ownership and structure, and some have converted from publicly traded companies to private ownership. This study shows the increasing complexity of corporate nursing home ownership and the lack of public information about ownership and financial status. The chains have used strategies to maximize shareholder and investor value that include increasing Medicare revenues, occupancy rates, and company diversification, establishing multiple layers of corporate ownership, developing real estate investment trusts, and creating limited liability companies. These strategies enhance shareholder and investor profits, reduce corporate taxes, and reduce liability risk. There is a need for greater transparency in ownership and financial reporting and for more government oversight of the largest for-profit chains, including those owned by private equity companies.

Health Politics Meets Post-Modernism: Its Meaning and Implications for Community Health Organizing

In this article, post-modern theory is described and applied to health politics with examples from community health organizing, social movements, and health promotion. Post-modernism questions conventional assumptions about concepts such as representation, participation, empowerment, community, identity, causality, accountability, responsibility, authority, and roles in community health promotion (those of expert, leader, and organizer). I compare post-modern social movements with their modern counterparts: the organizational forms, leadership styles, and substantive intellectual orientations of the two differ. I explain the social planning, community development, and social action models of community health organizing, comparing them with the priorities of post-modern social movements, and show the similarities and differences between them as to structural preferences, process, and strategies. Finally, and most importantly, I present the implicit lessons that post-modernism offers to health politics and outline the strengths and weaknesses of this approach to health politics.

United States-Mexico cross-border health insurance initiatives: Salud Migrante and Medicare in Mexico

While U.S. health care reform will most likely reduce the overall number of uninsured Mexican-Americans, it does not address challenges related to health care coverage for undocumented Mexican immigrants, who will remain uninsured under the measures of the reform; documented low-income Mexican immigrants who have not met the five-year waiting period required for Medicaid benefits; or the growing number of retired U.S. citizens living in Mexico, who lack easy access to Medicare-supported services. This article reviews two promising binational initiatives that could help address these challenges-Salud Migrante and Medicare in Mexico; discusses their prospective applications within the context of U.S. health care reform; and identifies potential challenges to their implementation (legal, political, and regulatory), as well as the possible benefits, including coverage of uninsured Mexican immigrants, and their integration into the U.S. health care system (through Salud Migrante), and access to lower-cost Medicare-supported health care for U.S. retirees in Mexico (Medicare in Mexico).

The comparative performance of for-profit and nonprofit home health care services in the US.

ABSTRACT Objective: To determine, by way of an exhaustive, systematic, and comprehensive review and summary of all scientific published studies, whether or not there are any performance differences between private for-profit and private nonprofit home health care providers. The second objective is to discover the proportion of all research on this topic that is devoted to home health care services compared to all other health services providers. Data Sources: Computerized bibliographic searches of relevant databases and published indexes and abstracts were undertaken. They included Medline (Ovid and Pubmed versions), Web of Science (Social Sciences Citation Index and Science Citation Index), ABI/Inform, and Sociological Abstracts. Follow-up searches of reference lists in each article obtained from the computerized search were then completed. Study Design: This systematic review retained for analysis all published studies that compared the performance of for-profit and nonprofit health care providers on access, quality, cost/efficiency, and/or amount of charity care, based on data collected after 1980. As a quality control measure only studies published in peer reviewed journals were included. Studies were coded according to the articles stated conclusions: for-profit superiority, nonprofit superiority, or no difference/mixed results. Principal Findings: The comparative performance of for-profit and nonprofit home health service organizations is one of the most understudied areas of health care provider services in the US today. Only 6 of the over 1030 comparisons of the two concerned home health care. No data on this topic have been collected since 1991, and no articles about it have been published in a peer-reviewed journal since 1995. Conclusion: Research on the relative performance of for-profit and nonprofit home health care services is a research priority urgently in need of attention.

Challenges facing the United States of America in implementing universal coverage

Abstract In 2010, immediately before the United States of America (USA) implemented key features of the Affordable Care Act (ACA), 18% of its residents younger than 65 years lacked health insurance. In the USA, gaps in health coverage and unhealthy lifestyles contribute to outcomes that often compare unfavourably with those observed in other high-income countries. By March 2014, the ACA had substantially changed health coverage in the USA but most of its main features – health insurance exchanges, Medicaid expansion, development of accountable care organizations and further oversight of insurance companies – remain works in progress. The ACA did not introduce the stringent spending controls found in many European health systems. It also explicitly prohibits the creation of institutes – for the assessment of the cost–effectiveness of pharmaceuticals, health services and technologies – comparable to the National Institute for Health and Care Excellence in the United Kingdom of Great Britain and Northern Ireland, the Haute Autorité de Santé in France or the Pharmaceutical Benefits Advisory Committee in Australia. The ACA was – and remains – weakened by a lack of cross-party political consensus. The ACA’s performance and its resulting acceptability to the general public will be critical to the Act’s future.

Rx-to-OTC switch movement.

The medications that are being made available upon demand are not just those that &dquo;relieve symptoms of minor, self-limiting conditions.&dquo; They include medications of substantial importance that &dquo;prevent diseases&dquo; and &dquo;manage chronic conditions&dquo; (Young 1988, 6).5 Future switches are likely to continue in this direction. For example, Shering Plough Health Care will apply to the Food and Drug Administration (FDA) to sell oral contraceptives over the counter (Angier 1993). Neither are the financial dimensions of the Rx-to-OTC switch trivial. Switched