Biomedical subjects

Marjorie Ginsburg

Publications and source records attributed to Marjorie Ginsburg.

4 recordsLinked to original sources

PubMed2006

Rearranging the deck chairs.

In their efforts to make insurance premiums more affordable, employers and health plans are promoting consumer-directed health care as a consumer-friendly alternative that will cut costs and improve quality. In my view, consumer-directed care reflects health care providers' failure to deliver value and unrealistically assumes that consumers can make sound, cost-effective medical decisions. It also evades the fundamental question of how society defines the limits and obligations of health insurance, and it could stall meaningful action to hold all stakeholders accountable for an equitable, high-quality, and affordable system.

Attitude to Health↗

PubMed2006

The coverage priorities of disabled adult Medi-Cal beneficiaries.

Medi-Cal, like other Medicaid programs around the U.S., has been pressed to cut its budget. We report the results of a project using the CHAT (Choosing Healthplans All Together) exercise, designed to ascertain the priorities of disabled adult Medi-Cal beneficiaries to inform any decisions regarding Medi-Cal benefits. Participants voiced greatest interest in maintaining a wide spectrum of benefits and access to a large pool of providers and were most willing to restrict pharmacy benefits. The resulting findings may be of value to legislators drafting Medicaid proposals that revise benefits for this vulnerable population.

Adult↗

PubMed2005

Improving end-of-life care in nursing facilities: the Community State Partnership To Improve End-of-Life Care--California.

BACKGROUND: The California Coalition for Compassionate Care formed in 1998 when activists and organizational leaders in several arenas sought to link their efforts for synergistic impact on end-of-life care and to obtain funding to sustain their forward momentum and collaboration. The Coalition focused on public engagement, professional education, and reforms in skilled nursing facilities. With skilled nursing facilities, the Coalition's work built on the efforts of the ECHO (Extreme Care, Human Options) Long Term Care Task Force, which served as a precursor to the Coalition. OBJECTIVE: The Coalition's objective was to assist committed facilities in devising processes of care that would operationalize basic end-of-life care principles in a manner specific to their particular facility. DESIGN: The Coalition recruited three-member leadership teams from nursing facilities throughout California to attend a 2-day training program, write an action plan, and receive 6 months of modest follow-up support. To assess its success, the group used posttraining evaluations, a follow-up evaluation, a focus group, and informal feedback over several years to assess the dynamics, achievements, and challenges of their efforts. RESULTS: In 2000-2002 the training reached 298 people representing 109 nursing facilities and each district office of the nursing facility surveyors. Response to the training was enthusiastic. Self-reported improvements in 27 care practices were best in the areas of pain assessment and management. Completion of nursing facilities' self-identified action plans varied widely. Participants generally perceived the commitment to improving end-of-life care as a vehicle for improving the overall care and quality management in nursing facilities. CONCLUSIONS: The specific challenges of organizational change in nursing facilities require sustained, focused leadership and hands-on guidance to overcome the inevitable barriers and setbacks. The Coalition's experience confirms that coalitions depend upon personal commitments and relationships, a focus on practical products, and a consistent infrastructure.

Advisory Committees↗

PubMedDate not supplied

(De)constructing 'basic' benefits: citizens define the limits of coverage.

Many initiatives for covering the uninsured call for "basic" health care coverage, yet few define that term. The Just Coverage project used a computer-based simulation exercise to learn how nearly 800 community members in northern California identified the inclusions and exclusions that would constitute basic coverage. Working with a limited budget, participants distinguished essential from nonessential health care needs, resisted high patient cost sharing, and tolerated tight restrictions on provider choice. They also supported practice guidelines and standards of effectiveness, and they excluded high-cost, low-value interventions. These results reinforce the importance of community input to policymakers.

Actuarial Analysis↗