Category Archives: Public policy
Annik Sorhaindo, MSc, is a senior program researcher with the Population Council’s Reproductive Health Program in Mexico. A 1997 alumna of the Robert Wood Johnson Foundation-funded Project L/EARN initiative, she conducts research to provide evidence that helps inform government policy. This post reports on her work.
Fifty-five percent of all pregnancies in Mexico are unplanned.
That dramatic statistic, from a report by the Guttmacher Institute, can be mapped to the limited access women have to contraception.
“Many women can’t readily obtain contraceptive methods,” says Annik Sorhaindo. As part of a five-organization alliance working to improve reproductive health in the world’s 11th most populous country, the council directs research and analysis for the effort.
“My work focuses on answering research questions: Which occurrences in daily life impact women’s decisions about contraception? What are the impediments to preventing teen pregnancy? What are the challenges to using contraception post-abortion?”
Sorhaindo is quick to note that the council stays above the political fray. “We do the research and interpret the results, and the advocacy organizations address the politics,” she says.
One of the key recommendations in the landmark Institute of Medicine report on the future of nursing is to advance access to primary care by reducing barriers to practice for nurses. Implementation of this recommendation is now one step closer, thanks to a provision in President Obama’s budget proposal for fiscal year 2015, which was released this month.
Obama’s budget includes a provision that would extend an increase in Medicaid payments for primary care providers for one year at a cost of about $5.4 billion, according to an article in USA Today. The extension would, for the first time, apply to nurse practitioners (NPs) and physician assistants (PAs).
The Institute of Medicine recommended fixing this Medicaid “glitch” in its report on the future of nursing. The report is the foundation for the Future of Nursing: Campaign for Action, a national effort backed by the Robert Wood Johnson Foundation (RWJF) and AARP that is working to transform health care through nursing.
Obama’s budget proposal also calls for nearly $4 billion over six years to grow the National Health Services Corps (NHSC) from 8,900 primary care providers to at least 15,000 providers annually, starting in 2015, according to an analysis by the Campaign. Ten percent of the funding would be reserved for NPs and PAs.
An interview with Renee Hsia, MD, a Robert Wood Johnson Foundation Physician Faculty Scholars program alumna and associate professor of emergency medicine at the University of California, San Francisco. She is the co-author of “Emergency Care: Then, Now and Next,” published in the December 2013 issue of Health Affairs, which focused on the future of emergency medicine. The interview is part of a series of posts featuring RWJF Scholars who authored articles in the issue.
Human Capital Blog: Other than the obvious changes in technology, how are emergency departments (EDs) different today than they were 50 years ago?
Renee Hsia: We’ve had a dramatic transition since the 1950s, in terms of what emergency departments do, and the patient outcomes we expect. We mention in the article, for example, that years ago many emergency departments used funeral hearses to transport patients to the ED. Now transport is usually in vehicles with all sorts of life-saving equipment on board. That’s one reason the mortality rate is a lot lower now than it was then; death is much rarer in the emergency room today.
Another dramatic transition has been the rise of the specialist in emergency medicine. It used to be more common to have physicians trained in other specialties taking turns in the emergency room. You still see that in some rural areas, but it’s far less common. There’s been a gradual movement toward the understanding that we need people who are masters in the acute presentation of illness.
We’ve also seen the beginnings of a system transition, with a growing focus on regionalization. We have to account for the reality that not all community EDs and hospitals are equipped with the same technology as tertiary hospitals, such as a cardiac catheterization lab, for example. We need to be sure that we can get patients “the right care in the right place at the right time,” and that requires close coordination within the larger health care system.
HCB: You discuss the relationship between ED crowding and changes in primary care practice. Could you tell us about that?
The Robert Wood Johnson Foundation (RWJF) Investigator Awards in Health Policy Research program has selected projects and Investigators as a result of its 2013 application process. The program provides funding to highly qualified individuals undertaking broad studies of the most challenging health, health care, and health policy issues facing the country. Grants of up to $335,000 are awarded to investigators from a wide range of disciplines.
Eleven individuals have been selected to join the program. Their eight projects address race, ethnicity, and class in pharmaceutical marketing; mood and behavior disorders in children and adolescents; ethical and policy issues raised by living donor transplantation; resilience and recovery from disasters; and more. Grants to their institutions will be awarded on a rolling basis throughout 2014.
An interview with Sara Rosenbaum, JD, the Hirsh Professor in the School of Public Health and Health Services at the George Washington University, in Washington, DC, and a Robert Wood Johnson Foundation (RWJF) Investigator Awards in Health Policy Research recipient. She is the author of “The Enduring Role of the Emergency Medical Treatment and Active Labor Act,” published in the December 2013 issue of Health Affairs, which focused on the future of emergency medicine. The interview is part of a series of posts featuring RWJF Scholars who authored articles in the issue.
Human Capital Blog: Your article discusses the past, present, and future of the Emergency Medical Treatment and Active Labor Act (EMTALA), adopted in 1986. Could you tell us a little about what moved Congress and the President to create the law, and what its purpose was?
Sara Rosenbaum: The law had several roots. To begin, it was the outgrowth of a good deal of law that came before it, embracing the notion that hospitals should provide emergency care, even without the expectation of payment. So that idea wasn’t unique to EMTALA, but by the early 1970s the expectation that hospitals would provide the community benefit of emergency services had revved up, partly because states had adopted that expectation under their own common law and statutes. So EMTALA was the culmination of a lot of legal precedent. But what prompted passage of the law in 1986 was two things: First, a substantial number of news stories about patient-dumping, particularly in California; and second, on the heels of Medicare payment reform a few years earlier, there was a lot of concern that hospitals would start discharging Medicare patients in an unstable state – sicker and quicker, as the saying went.
HCB: What are the law’s key components?
Rosenbaum: The one everybody knows best is the screening component: If somebody comes to an emergency department and requests an examination, hospitals must examine the patient to determine if there's an emergency medical condition. And if they find one, they must provide stabilization treatment. Or, if the patient has an emergency condition that the hospital is unable to stabilize, it can seek the cooperation of another hospital with more specialized capabilities, and transfer the patient. And then that second hospital has a separate obligation; it can’t just say “no.”
HCB: What’s your sense of how the law operates in the daily life of a hospital?
Kentucky Gov. Steve Beshear signed legislation last week that lifts a key limitation on advanced practice registered nurses (APRNs) and increases consumer access to health care.
The new law “allows more flexibility for nurse practitioners to provide accessible health care to Kentuckians,” Beshear said. “Nurse practitioners are a critical part of helping more Kentuckians get the medical care they need quickly and efficiently, and I am proud of the bipartisan effort to serve Kentucky’s health needs.”
In the past, APRNs were only allowed to prescribe medication with a physician’s written consent. The new law removes that requirement for APRNs who have four or more years of experience prescribing medication under a collaborative agreement with a physician or as an independent practitioner in another state, according to the Future of Nursing: Campaign for Action.
Federal health care workforce and research programs will receive modest funding boosts in this fiscal year under a new omnibus spending bill cleared in January by Congress, according to a summary released by the American Association of Colleges of Nursing (AACN). The programs affect nursing and other health professions.
Under the Consolidated Appropriations Act of 2014, signed into law on Jan. 17, two health care workforce agencies are slated for increases in fiscal year 2014.
The Health Resources and Services Administration will receive $6.3 billion, an 8 percent increase over the last fiscal year, and the Bureau of Health Professions will get $469.2 million, a 7 percent increase, according to AACN. Nursing workforce development programs under Title VIII of the Public Health Service Act will get $223.8 million in fiscal year 2014, a 3 percent increase.
Sheryl Magzamen, PhD, MPH, is an assistant professor in the College of Veterinary Medicine and Biomedical Sciences at Colorado State University and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2007-2009). She recently published two studies exploring the link between early childhood lead exposure and behavioral and academic outcomes in Environmental Research and the Annals of Epidemiology. She discusses both below.
Human Capital Blog: What are the main findings of your study on childhood lead exposure and discipline?
Sheryl Magzamen: We found that children who had moderate but elevated exposure lead in early childhood were more than two times as likely as unexposed children to be suspended from school, and that’s controlling for race, socioeconomic status, and other covariates. We’re particularly concerned about this because of what it means for barriers to school success and achievement due to behavioral issues.
We are also concerned about the fact that there‘s a strong possibility, based on animal models, that neurological effects of lead exposure predispose children to an array of disruptive or anti-social behavior in schools. The environmental exposures that children have prior to going to school have been largely ignored in debates about quality public education.
This is part of a series introducing programs in the Robert Wood Johnson Foundation (RWJF) Human Capital Portfolio.
The RWJF Health Policy Fellows program will celebrate its 40th anniversary this year. The program supports exceptional midcareer health professionals and behavioral and social scientists to actively participate in health policy processes at the federal level and gain exclusive, hands-on policy experience. Heralded as the “nation’s most prestigious fellowship at the nexus of health science, policy, and politics,” the Health Policy Fellows program provides health professionals the opportunity to work on Capitol Hill and in the Executive Branch, gaining front-line experience in federal health policy-making and an insider’s perspective on our country’s political process.
Founded in 1973, the program is supported by the Robert Wood Johnson Foundation (RWJF) and sponsored by the Institute of Medicine within the National Academies of Science.
Health Policy Fellows have become some of the nation’s most influential leaders in the health care field. As professors, deans, and presidents at major academic institutions, directors of voluntary health organizations and health professional societies, leaders in state and federal government, and experts at think tank and advocacy organizations, the Fellows are transforming the nation’s health care policy and practice.
Margaret Wainwright Henbest, RN, MSN, CPNP, is executive director of the Idaho Alliance of Leaders in Nursing and co-lead of the Idaho Nursing Action Coalition. She served in the Idaho state Legislature from 1996-2008.
I stumbled into politics in the midst of my nursing career. After serving as a nurse practitioner (NP) for two years in California and Oregon, I moved to Idaho in 1986. But it wasn’t until after the move that I discovered that I could not practice in my new home state unless a physician recommended me to the Idaho Board of Medicine (IBM) for licensure. That was not the only barrier to practice: To get my license, I had to interview with the IBM and win its approval.
I took a faculty position instead. But I soon met NPs all across the state who were seeking a change to this restrictive licensing requirement. I somehow wound up as the spokesperson for our eventual legislative effort, which was defeated after its first Senate hearing in the early 1990s.
That experience taught me that if something needs to be done, if a law needs to be changed, no one is going to do it for you; you have to do it yourself. Since I had a part-time job, I had the time to get active in local nursing organizations, and one thing led to another. I was approached to run for office and, after deliberating with family and friends, decided to make the leap. I won by seven votes in 1996. Every vote counts!
When I arrived at the state Capitol, I found that my perspective as a nurse was extremely valuable, especially during health care debates. I recognized prior to running that nurses were educationally and intellectually prepared for public office, and that we had little if any self-serving agenda in health care reform debates. We had a legitimate altruistic interest in patient and community health. This was readily apparent to policy-makers and the public.