Rick Mayes

ADHD and the Rise in Stimulant Use Among Children

&NA; Attention‐deficit/hyperactivity disorder (ADHD) holds the distinction of being the most extensively studied pediatric mental disorder and one of the most controversial, in part because it is also the most commonly diagnosed mental disorder among minors. Currently, almost 8% of youth aged 4 to 17 years have a diagnosis of ADHD, and approximately 4.5% both have the diagnosis and are using a stimulant (methylphenidate or amphetamine) as treatment for the disorder. Yet a diagnosis of ADHD is not simply a private medical finding; it carries with it a host of policy ramifications. The enduring controversy over ADHD in the public arena therefore reflects the discomfort over what happens when science is translated into policies and rules that govern how children will be treated medically, educationally, and legally. This article (1) summarizes the existing knowledge of ADHD, (2) provides the relevant history and trends, (3) explains the controversy, (4) discusses what is and is not unique about ADHD and stimulant pharmacotherapy, (5) outlines future directions of research, and (6) concludes with a brief analysis of how two North Carolina counties have established community protocols that have improved the screening, treatment, and societal consensus over ADHD and stimulants.

Suffer the restless children: the evolution of ADHD and paediatric stimulant use, 1900-80

This article traces the historical evolution of Attention Deficit/Hyperactivity Disorder (ADHD) and the controversial use of stimulants as a treatment for children diagnosed with the disorder in North America.While the children in question have exhibited similar behaviour over the last century, the diagnostic labels used to identify them have changed due largely to cultural, medical and scientific changes and discoveries. For decades, childrens treatment with psychotropic drugs was sufficiently controversial that pharmaceutical companies would not finance research in the area. The only substantial source of research funding for paediatric psychopharmacology in the USA from the 1950s to the 1970s was the National Institute of Mental Health (NIMH). In 1970, the first in a long-running series of controversies erupted over childrens treatment with stimulants.

Moving (realistically) from volume-based to value-based health care payment in the USA: starting with Medicare payment policy

Employers and policy-makersintheUSAaredesperatetoslowtherateatwhich healthexpendituresgrow. Changing how most health care providers are reimbursed will be necessary to achieve this. Although both politically and practically daunting, massive restructuring or replacement of fee-for-service (FFS) reimbursement is what is most required. As the dominant reimbursement model in the USA, FFS payment to individual providers strongly encourages and financially rewards the quantity of care provided, regardless of its quality or necessity. Providing high quality, lower cost care with fewer complications and hospital re-admissions can even financial penalize providers. Unfortunately, physicians and other health providers respond rationally to existing financial incentives (translation: they do what they get paid to do and generally try to, or have to, minimize those activities and services for which they are not paid). Altering this reality and fostering the expansion of exemplary delivery models-such as the Mayo Clinic or Geisinger Health System-requires change in how providers behave. And changing behavior often starts with adjusting how providers are paid. Medicare is the programme and payer most capable of using payment reform to catalyze delivery system reform.

Universal coverage : the elusive quest for national health insurance

Universal health coverage has become the Mount Everest of public policy in the United States: the most daunting challenge on the political landscape. But, despite numerous attempts, all efforts to achieve universal health care have failed. In Universal Coverage, Rick Mayes examines the peculiar and persistent lack of universal health coverage in America, its economic and political origins dating back to the 1930s, and the current consequences of this significant problem. Accessible, cleverly argued, and provocative. Mayes provides fresh answers to the enduring question of why the U.S. lacks national health insurance. ---Jonathan Oberlander, University of North Carolina, Chapel Hill, Author of The Political Life of Medicare Aaron Wildavsky said good policy studies should use policy as a window on politics. Mayes does it brilliantly. --- Deborah Stone, Dartmouth College A readable and accessible account that is informed by previous scholarship yet backed up by telling details from historical archives. --- Jacob Hacker, Yale University This book makes a genuine contribution to the literatures on political institutions and interest groups. --- Kevin Esterling, University of California, Riverside Mayes is highly knowledgeable about health policy and his writing is clear and spirited. --- Martha Derthick, University of Virginia Rick Mayes is an Assistant Professor of Public Policy in the University of Richmonds Department of Political Science and a Faculty Research Fellow at the University of California, Berkeleys Petris Center on Healthcare Markets and Consumer Welfare.

Medicare payment policy and the controversy over hospital cost shifting.

This article examines (i) the background and debate over cost shifting; (ii) hospitals as business institutions that often shift the financial responsibility for their costs in the form of differential pricing; and (iii) how the cost-shifting debate affects and is affected by Medicare. The aim is to gain a better understanding of how changes in reimbursement by large government health insurance programmes affect hospital behaviour. The article argues that the controversy over cost shifting is becoming an increasingly important issue for hospitals in the US and their ability (or willingness) to provide uncompensated charity care. The issue has also become very important for workers and their dependants. This is because workers have shouldered the largest portion of the dramatic growth in healthcare costs that have occurred in the US in recent years, due in large part to increased cost shifting (or ’sharing of financial responsibility’) from their employers.

Chronic disease, prevention policy, and the future of public health and primary care

Globally, chronic disease and conditions such as diabetes, cardiovascular disease, depression and cancer are the leading causes of morbidity and mortality. Why, then, are public health efforts and programs aimed at preventing chronic disease so difficult to implement and maintain? Also, why is primary care—the key medical specialty for helping persons with chronic disease manage their illnesses—in decline? Public health suffers from its often being socially controversial, personally intrusive, irritating to many powerful corporate interests, and structurally designed to be largely invisible and, as a result, taken for granted. Primary care struggles from low reimbursements, relative to specialists, excessive paperwork and time demands that are unattractive to medical students. Our paper concludes with a discussion of why the need for more aggressive public health and redesigned primary care is great, will grow substantially in the near future, and yet will continue to struggle with funding and public popularity.

The ADHD Explosion: Myths, Medication, Money, and Today's Push for Performance

TheADHD “explosion” cited in the title of this book, which was written by a clinical psychologist and a health economist at the University of California, San Francisco, and Berkeley, respectively, refers to the enormous increase in diagnosis and treatment of attention-deficit hyperactivity disorder and to the American public’s acceptance—nay enthusiasm—for ADHD as a treatable disorder. The authors argue that the explosion has been fueled by cultural and classspecific anxieties about children’s academic and professional performance. But “explosion” could also refer to the corresponding flood of scientific, clinical, and promotional literature. To that flood this book is a welcome and timely addition. What makes this book timely is the adroit combination of a clinician’s review of the historical, epidemiological, and clinical literature for ADHD and an economist’s review of the larger cultural and economic context that has stimulated such literature and its avid consumption. To the authors’ credit and the reader’s benefit, each section is introduced by a clinical vignette that puts a human face on the phenomena in question. The reader also benefits from an accessible style: messages frequently lost amid technical jargon are stated in highly readable form. This is an important gift to readers because what we call ADHD attracts a diverse readership: not just parents of affected children and adults possibly affected themselves, but also a range of professionals, including physicians, psychologists, teachers, and child welfare workers. The book’s content and style are accessible to readers fromall of these groups. (A few editing lapses—for example, “draeptomania” for “drapetomania” and “unmediated” for “unmedicated”—do not detract.) A criticism may be offered, surprisingly, in terms of the authors’ determination to describe and help those caught up in a medical-cultural “explosion,” that the title, while succeeding in drawing the reader’s attention to the explosion, may play to some readers’ inclination to medicalize and decontextualize children’s challenges. The review of causes might also have included mention of hypotheses regarding the possible role of environmental toxins. But the overall contribution of the book is to provide a welcome comprehensive review of the biology, developmental psychology, and social and cultural setting of a condition that needs to be appreciated from all of these perspectives.

Public Health and Primary Care Struggling to “Win Friends and Influence People”

Why are the goals of public health and primary care less politically popular and financially supported than those of curative medicine? A major part of the answer to this question lies in the fact that humans often worry wrongly by assessing risk poorly. This reality is a significant obstacle to the adequate promotion of and investment in public health, primary care, and prevention. Also, public health’s tendency to infringe on personal privacy—as well as to call for difficult behavioral change—often sparks intense controversy and interest group opposition that discourage broader political support. Finally, in contrast to curative medicine, both the cost-benefit structure of public health (costs now, benefits later) and the way in which the profession operates make it largely invisible to and, thus, underappreciated by the general public. When curative medicine works well, most everybody notices. When public health and primary care work well, virtually nobody notices.