Journal of Health Politics Policy & Law

Journal of Health Politics, Policy and Law
Volume 29, Number 1, February 2004


    Troyer, Jennifer L.
    Thompson, Herbert G.
  • The Impact of Litigation on Nursing Home Quality
    [Access article in HTML] [Access article in PDF]
    Subject Headings:
    • Nursing homes -- Law and legislation -- United States.
    • Nursing homes -- United States -- Quality control.
      Government reports indicate that regulations have been ineffective in improving quality of care in many nursing homes. Some analysts feel that litigation against nursing homes may be the result of quality problems that are monitored during the inspection process, some contend litigation merely causes quality problems by diverting financial resources away from patient care, and some argue that litigation is duplicating the efforts of the inspection process. Given that the relationship between litigation and inspection-oriented measures of quality is not clear, this article explores the relationship empirically. When a significant relationship is found, the empirical results suggest that litigation is associated with a decline in inspection-oriented measured quality in the nursing home facing the legal claim. In contrast, litigation against a chain has a very different relationship to firm-level quality, where firms within a chain that is being sued have higher levels of inspection-oriented quality. Our results suggest that legal claims may result from quality problems that go unmeasured during the inspection process. However, more research in this area is warranted.
    Harrington, Charlene.
    Mullan, Joseph T.
    Carrillo, Helen.
  • State Nursing Home Enforcement Systems
    [Access article in HTML] [Access article in PDF]
    Subject Headings:
    • Nursing homes -- Law and legislation -- United States -- States.
    • Nursing homes -- United States -- States -- Quality control.
      This study presents interview and statistical data from a telephone and fax survey of state agency officials and statistical data from the Centers for Medicare & Medicaid Services' Online Survey Certification and Reporting (OSCAR) system. State survey activities for nursing facilities were reviewed and the number and types of intermediate sanctions issued by states in l999 were reported, along with barriers to the use of such sanctions. Using five selected enforcement measures to create a summary score, states were classified by quartiles based on the stringency of their nursing facility enforcement activities. Controlling for the number of complaints as a proxy for quality, the predictors of a summary of state enforcement actions were: percentage of population at age eighty-five and above, Democratic governors, higher percentages of chain facilities, and lower facility occupancy rates. Regional differences in enforcement patterns also were shown. Many federal policies and resource constraints were identified as barriers to effective regulation. The findings identified nursing facility survey and enforcement issues that need to be addressed by policy makers.
    Page, Stephen.
  • How Physicians' Organizations Compete: Protectionism and Efficiency
    [Access article in HTML] [Access article in PDF]
    Subject Headings:
    • Collective bargaining -- Physicians -- United States.
    • Managed care plans (Medical care) -- United States.
    • Medical care -- United States -- Cost control.
    • Medical care -- United States -- Quality control.
      This article develops a framework that distinguishes four types of competitive strategies that physicians' organizations can adopt in their interactions with health plans. Two types of strategies protect physicians' incomes and autonomy from incursion and control by insurers; the other two enhance the efficiency of health care markets by controlling costs and embedding physicians' caregiving in a community of professionals. The mix of strategies that each organization adopts at any given time depends on the market conditions and regulatory policies it faces, as well as its organizational capacity. The article reviews recent developments in the field that indicate that today's markets and regulations create neither the pressures nor the capacity for physicians' organizations to adopt strategies that enhance efficiency. The managed care backlash has led to a relaxation of pressures to control costs, and the lack of a business case for quality has discouraged embedded caregiving. These developments instead have encouraged and enabled physicians' organizations to adopt strategies that protect their members from the bargaining power and micromanagement of health plans. The article therefore proposes changes in purchasing and regulatory policies to alter the pressures and improve the capacity of physicians' organizations to pursue efficiency and eschew protectionism.
    Blewett, Lynn.
    Brown, Margaret E.
    Call, Kathleen Thiede.
    Davern, Michael.
  • Monitoring the Uninsured: A State Policy Perspective
    [Access article in HTML] [Access article in PDF]
    Subject Headings:
    • Medically uninsured persons -- Government policy -- United States -- States.
      Because states have primary responsibility for the implementation of public health insurance programs, states need timely, good quality data to evaluate programs, monitor trends in the number and characteristics of the uninsured, and better understand the dynamics of health insurance coverage. This article provides a synthesis of the data sources available to states for monitoring rates of health insurance coverage. Information was collected through a comprehensive review of state and national health surveys and in-depth interviews with state analysts in all fifty states. Our findings suggest that national surveys do not meet states' needs for data, and in response, states have initiated their own household surveys. We provide information on thirty-six household surveys that are used to estimate state levels of health insurance coverage. We recommend that national and state efforts be better coordinated to facilitate efficient use of resources to achieve good state-level date.


    Barnard, David, 1948-
  • Death Is That Man Taking Names: Intersections of American Medicine, Law, and Culture (review)
    [Access article in HTML] [Access article in PDF]
    Subject Headings:
    • Burt, Robert, 1939- Death is that man taking names: intersections of American medicine, law, and culture.
    • Death.
    Silberberg, Mina.
  • Managing to Care: Case Management and Service System Reform (review)
    [Access article in HTML] [Access article in PDF]
    Subject Headings:
    • Dill, Ann E. P., 1948- Managing to care: case management and service system reform.
    • Social case work -- Management.
    Morton, Christine H., 1961-
  • Baby's First Picture: Ultrasound and the Politics of Fetal Subjects (review)
    [Access article in HTML] [Access article in PDF]
    Subject Headings:
    • Mitchell, Lisa Meryn. Baby's first picture: ultrasound and the politics of fetal subjects.
    • Fetus -- Ultrasonic imaging -- Social aspects.

Books Received

News and Notes

News from Affiliated Organizations


[Project MUSE] [Search Page] [Journals] [Journal Directory] [Top]