Biomedical subjects

A M Foltz

Publications and source records attributed to A M Foltz.

4 recordsLinked to original sources

PubMed1985

A statistical analysis of reasons for East-West differences in hospital use.

Although it is well known that West Coast residents spend 40% fewer days per year in the hospital than do East Coast residents, the reasons for this difference are less well understood. In this analysis of data from the 1977 National Health Interview Survey and Area Resource File, we attempted to isolate which share of the East-West difference is due to population factors and which share is due to characteristics of the health care systems. When we compared New York City hospital use with Los Angeles, population factors were slightly more important than health system characteristics. When we compared other Northeast metropolitan areas with Western metropolitan areas, health system factors were more important. In the case of the New York-Los Angeles comparison, we were able to isolate the following health system characteristics, in order of importance, as especially significant: the backlog of patients in acute care hospitals awaiting placement in long-term care facilities, the greater number of hospital beds per capita in New York City than in Los Angeles, and the larger supply of medical specialists and residents in New York City than in Los Angeles.

Adolescent↗

PubMed1978

The annual Pap test: a dubious policy success.

The annual Pap test became a recommended standard for American women without ever having been subjected to controlled trials to estimate its efficacy and effectiveness. After more than 30 years of routine use, the Pap test fails to meet most of the generally accepted criteria for a mass screening program. The policy persists, however, because the nation's ideology supports the maximum utilization of new technologies; and special interest groups have promoted the test as the major weapon in the "War on Cancer." With some exceptions, this is a questionable allocation of public and private health resources.

American Cancer Society↗

PubMed1975

State response to federal policy: children, EPSDT, and the Medicaid Muddle.

The implementation in Connecticut of Early and Periodic Screening, Diagnosis and Treatment (EPSDT), a program of comprehensive medical care for needy children, illustrates the complexities engendered by federally mandated state-administered health programs. The EPSDT amendments to Title V and Title XIX (Medicaid) were ambiguous on four major issues: administrative responsibility, costs, eligibility, and scope of services. The problems experienced by federal, regional, state, and local administrators in resolving these issues illustrate the weaknesses inherent in federal-state relations, and the contrasting roles health and welfare agencies under Medicaid have played in the development of health policy. Connecticut may represent maximum limits to state performance in carrying out EPSDT because it is a rich state, ranking high in medical resources and in the provision of Medicaid services. During the first year of implementation of EPSDT, the program had little impact: less than 5 percent of eligible children were served. State policies, which contravened federal policy, precluded effective resolution of the legislative ambiguities; no new services were added, the organization of health services remained unchanged and fragmented; and the State Health Department played only a limited role.

Child Health Services↗

PubMed1975

The development of ambiguous federal policy: early and periodic screening, diagnosis, and treatment (EPSDT).

This paper examines why Congress's first major program for comprehensive health care to needy children took five years to begin even partial operation. An examination of the 1967 program's legislative history reveals that Congress paid little attention to EPSDT's implications: it was left ambiguous whether health (Title V) or welfare (Title XIX) would administer; costs were never clearly stated; eligibility and scope of services to be provided were left vague. Despite pressure from welfare rights interest groups, these ambiguities delayed the preparation of regulation and guidelines which never did succeed in resolving the question of overlapping jurisdiction and costs. In addition, many states' resistance to paying for the program further held up implementation. The paper concluded that: (1) Congress's and HEW's unwillingness to face up to the real costs of health programs threatens long-term public and state support for such programs; (2) division of responsibility between health and welfare lessens the impact of a program; (3) grant-in-aid programs give states the power to distort the intent of federal health policies; and (4) where states fail to implement such policies, initiatives may pass to consumer advocacy groups.

Child↗