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Biomedical subjects

M S Sparer

Publications and source records attributed to M S Sparer.

9 recordsLinked to original sources
PubMed1999

Nothing exceeds like success: managed care comes to Medicaid in New York City.

Nearly every state is encouraging or requiring Medicaid beneficiaries to enroll in managed care delivery systems. In New York City, Medicaid officials began with an incremental, but not insignificant, managed care initiative. Buoyed by its success, New York policy makers tried, and failed, to accelerate the transition to managed care. The legacy of that failure still plagues them. A comparison of such initiatives in other states indicates that most state officials have remembered what New York's leaders temporarily forgot, namely, that Medicaid managed care is a complex exercise that demands consultation and consensus building.

Health Care Reform↗
PubMed1997

Laboratories and the health care marketplace: the limits of state workforce policy.

Nearly every state has enacted its own effort to change both the composition and the practice patterns of America's medical workforce. At the same time, the health care marketplace is altering the nation's medical workforce, encouraging more medical students to enter primary care and fewer to become specialists. In this article, I consider various issues raised by these trends. Do the various state programs constitute an effective policy laboratory? Is the market solving problems government could not? Are the government initiatives now irrelevant? I conclude that the market is solving the problem of specialty maldistribution (too many specialists) but not the problem of geographic maldistribution (too many medically underserved communities). I also conclude that state workforce efforts have not constituted good policy laboratories and that only federal action can seriously address the geographic maldistribution problem.

Area Health Education Centers↗
PubMed1996

Medicaid managed care and the health reform debate: lessons from New York and California.

Nearly every state now encourages (or requires) its Medicaid beneficiaries to enroll in managed care. There is, however, extraordinary variation in every aspect of state managed care policy. In this article, I examine the managed care initiatives of two states, New York and California, and focus on variation in state policy-making environments and on the influence of such variation on efforts to protect the medical safety net. I conclude that California's managed care initiative is less decentralized and pluralistic than New York's, and that California has used its discretion to adopt a strategy designed in part to protect safety-net hospitals. I end with a plea for greater federal control of managed care initiatives, a policy proposal that is at odds with the current trend to increase state authority.

California↗
PubMed1993

States in a reformed health system: lessons from nursing home policy.

Most serious health system reform proposals include a prominent role for states, despite documented variation in costs, delivery systems, and health status among states. As policymakers search for an approach that will reform the health system and minimize inappropriate interstate variation, the experience of nursing home policies and politics in two states--New York and California--can offer useful lessons about underlying reasons for variation and how to ensure equitability amidst state differences. These two states are examined as case studies because they have the nation's two largest Medicaid programs yet have approached their long-term care systems very differently. The differences in their nursing home policy approaches suggest that state-based health system reform be pursued with caution, lacking further study of state variations.

California↗
PubMedDate not supplied

Devolution of power: an interim report card.

During the mid-1990s liberals hoped that states would enact health insurance expansions, while conservatives looked to the states to contain costs. This essay considers whether states are meeting these great expectations. I review state performance in four policy priorities: encouraging Medicaid clients to enroll in managed care; expanding insurance coverage for children; making insurance more available and more affordable for the small-business community; and containing long-term care costs. The review suggests that states cannot accomplish these tasks without federal help. Congress seems to be getting the message and has enacted its own child health and insurance reform legislation. This trend is overdue and welcome.

Child↗
PubMedDate not supplied

Uneasy alliances: managed care plans formed by safety-net providers.

Health care providers that have traditionally served the poor are forming their own managed care plans, often in alliance with local safety-net peers. These alliances make it easier to raise needed capital, increase the pool of likely enrollees, and enable plans to benefit from efficiencies of scale. At the same time, however, the alliances often are undermined by conflicts of interest among the different sponsors and between the sponsors and the plan. This paper suggests that these plans are most likely to do well when the state makes special efforts to help and when plans have the leadership and financial reserves to take advantage of their supportive state policies.

Conflict of Interest↗
PubMedDate not supplied

Window shopping: state health reform politics in the 1990s.

Throughout the 1990s states sought politically acceptable policies to reduce the ranks of the uninsured. Visions of comprehensive health reform and universal coverage yielded by mid-decade to more modest measures to repair private health insurance markets, and to these enactments were added several new public programs (state and federal) to expand coverage for lower-income children and, in some cases, adults. Because governments remain ill equipped to counter the power of business, insurers, and providers in conflicts fought on private turf, reform agendas have been more readily set, moved, and cleared in public-sector arenas. Although the number of uninsured rose steadily until 1999, "catalytic federalism"--the accelerating interplay between state and federal reform forces and funds--may be putting the programmatic foundations for broader coverage incrementally into place.

California↗