View Item 

Show simple item record

Improving the Population's Health: The Affordable Care Act and the Importance of Integration

dc.contributor.authorHardcastle, Lorian E.en_US
dc.contributor.authorRecord, Katherine L.en_US
dc.contributor.authorJacobson, Peter D.en_US
dc.contributor.authorGostin, Lawrence O.en_US
dc.date.accessioned2013-02-12T19:00:30Z
dc.date.available2013-02-12T19:00:30Z
dc.date.issued2011-09en_US
dc.identifier.citationHardcastle, Lorian E.; Record, Katherine L.; Jacobson, Peter D.; Gostin, Lawrence O. (2011). "Improving the Population's Health: The Affordable Care Act and the Importance of Integration." The Journal of Law, Medicine & Ethics 39(3). <http://hdl.handle.net/2027.42/96273>en_US
dc.identifier.issn1073-1105en_US
dc.identifier.issn1748-720Xen_US
dc.identifier.urihttps://hdl.handle.net/2027.42/96273
dc.publisherWiley Periodicals, Inc.en_US
dc.publisherBlackwell Publishing Ltden_US
dc.titleImproving the Population's Health: The Affordable Care Act and the Importance of Integrationen_US
dc.typeArticleen_US
dc.rights.robotsIndexNoFollowen_US
dc.subject.hlbsecondlevelLaw and Legal Studiesen_US
dc.subject.hlbsecondlevelMedicine (General)
dc.subject.hlbtoplevelGovernment, Politics and Lawen_US
dc.subject.hlbtoplevelHealth Sciences
dc.description.peerreviewedPeer Revieweden_US
dc.contributor.affiliationumProfessor of Health Law and Policy and Director for the Center for Law, Ethics and Health at the University of Michigan School of Public Health.en_US
dc.contributor.affiliationotherLinda D. and Timothy J. O'Neill Professor of Global Health Law and Faculty Director of the O'Neill Institute for National and Global Health Law at Georgetown University Law Center; the Director of the World Health Organization Collaborating Center on Public Health Law & Human Rights; a Professor of Public Health at the Johns Hopkins Bloomberg School of Public Health; and a Visiting Professor at the Faculties of Law and Medical Sciences at the University of Oxford.en_US
dc.contributor.affiliationotherFellows at the O'Neill Institute for National and Global Health at Georgetown University Law Center.en_US
dc.identifier.pmid21871030en_US
dc.description.bitstreamurlhttp://deepblue.lib.umich.edu/bitstream/2027.42/96273/1/j.1748-720X.2011.00602.x.pdf
dc.identifier.doi10.1111/j.1748-720X.2011.00602.xen_US
dc.identifier.sourceThe Journal of Law, Medicine & Ethicsen_US
dc.identifier.citedreferenceThe Commission and Center will produce a National Care Workforce Assessment. ACA § 5103, 124 Stat. at 603–06.en_US
dc.identifier.citedreferenceFor example, see Institute of Medicine, Who Will Keep the Public Healthy?: Educating Public Health Professionals for the 21st Century, 2002, at 51; Association of Schools of Public Health, Creating a Culture of Wellness: Building Health Care Reform on Prevention and Public Health, 2009, at 2, available at < http://www.asph.org/UserFiles/Prevention‐and‐Public‐Health‐Strategies‐for‐HC‐Reform‐asph‐policy‐paper2009.pdf > (last visited June 22, 2011).en_US
dc.identifier.citedreferenceWith respect to financial incentives, see, e.g., T. Gosden, L. Pedersen, and D. Torgerson, “ How Should We Pay Doctors? A Systematic Review of Salary Payments and Their Effect on Doctor Behaviour,” QJM: An International Journal of Medicine 92, no. 1 ( 1999 ): 47 – 55 (concluding that salaries are associated with more preventive care and longer physician consultations). For a critique of medical education's focus on the biomedical model, see, e.g., D. Muller, Y. Meah, J. Griffith, A. Palermo, A. Kaufman, K. L. Smith, and S. Lieberman, “The Role of Social and Community Service in Medical Education: The Next 100 Years,” Academic Medicine 85, no. 2 (2010): 302–309, at 304, where the authors argue that “[t]he current focus in medical education on a biomedical model and organ‐specific interventions, rather than on the characteristics of the family unit, the community, and the social and physical environment that contribute to health and disease, is inadequate.” With respect to the public's preoccupation with, and thus demand for, health care services, see Hemenway, supra note 37.en_US
dc.identifier.citedreferenceFor example, nurses are generally reimbursed by salary, while many physicians continue to be paid on a fee‐for‐service basis. The former is associated with longer patient consultations and the provision of more preventive services (Gosden et al., id.).en_US
dc.identifier.citedreferenceV. H. Barkauskas, P. Schaffer, J. G. Sebastian, J. M. Pohl, R. Benkert, J. Nagelkerk, M. Stanhope, S. C. Vonderheid, and C. L. Tanner, “ Clients Served and Services Provided by Academic Nurse‐Managed Centers,” Journal of Professional Nursing 22, no. 6 ( 2006 ): 331 – 338, at 335.en_US
dc.identifier.citedreferenceSee Beitsch et al., supra note 52.en_US
dc.identifier.citedreferenceD. H. Stone, “Public Health in the Undergraduate Medical Curriculum: Can We Achieve Integration?” Journal of Evaluation in Clinical Practice 6, no. 1 ( 2000 ): 9 – 14, at 11.en_US
dc.identifier.citedreferenceId..en_US
dc.identifier.citedreferenceSee U.S. Department of Health and Human Services, supra note 44.en_US
dc.identifier.citedreferenceAmerican Recovery and Reinvestment Act of 2009, Pub. L. No. 111–5, § 4101(a), 123 Stat. 115, 467–72 ( 2009 ).en_US
dc.identifier.citedreferenceFor a concise analysis of mandatory and discretionary “meaningful use” of electronic health records, see D. Blumenthal and M. Tavenner, “ The ‘Meaningful Use’ Regulation for Electronic Health Records,” New England Journal of Medicine 363, no. 5 ( 2010 ): 501 – 504.en_US
dc.identifier.citedreferenceId., at 501.en_US
dc.identifier.citedreferenceS. Hoffman and A. Podgurski, “ Improving Health Care Outcomes through Personalized Comparisons of Treatment Effectiveness Based on Electronic Health Records,” Journal of Law, Medicine & Ethics 39, no. 3 ( 2011 ): 425 – 436.en_US
dc.identifier.citedreferenceFor example, see B. Robinson, “ Health IT Key to National Health Security Plan,” Government Health IT, 2010, available at < http://www.govhealthit.com/newsitem.aspx?tid=74&nid=74316 > (last visited May 17, 2011) (noting that the Department of Health and Human Services' Biennial Implementation Plan for national security necessitates real time access to all electronic health records in the event of a national emergency).en_US
dc.identifier.citedreferenceFor a general discussion of HiAP, see T. Stahl, M. Wismar, E. Ollia, E. Lahtinen, and K. Leppp, Health in All Policies: Prospects and Potentials, Finland Ministry of Social Affairs and Health and the European Observatory on Health Systems and Policies, 2006.en_US
dc.identifier.citedreferenceW. E. Parmet, Populations, Public Health, and the Law ( Washington, D.C.: Georgetown University Press, 2009 ): at 2 (introducing her theory of “population‐based legal analysis,” according to which, the “law must acknowledge the critical importance of populations”).en_US
dc.identifier.citedreferenceSee L. S. Elinder, “ Obesity, Hunger, and Agriculture: The Damaging Role of Subsidies,” BMJ 331, no. 7528 ( 2005 ): 1333 – 1336.en_US
dc.identifier.citedreferenceJ. Steinhauer, “ Farm Subsidies Become Target Amid Spending Cuts,” New York Times, May 7, 2011, at A13.en_US
dc.identifier.citedreferenceSee W. C. Perdue, L. A. Stone, and L. O. Gostin, “ The Built Environment and Its Relationship to the Public's Health: The Legal Framework,” American Journal of Public Health 93, no. 9 ( 2003 ): 1390 – 1394, at 1393 (stating ways in which the built environment is adversely affected by laws and suggesting that the public attempt to influence legislatures).en_US
dc.identifier.citedreferenceJ. Corburn, “ Confronting the Challenges in Reconnecting Urban Planning and Public Health,” American Journal of Public Health 94, no. 4 ( 2004 ): 541 – 546, at 544.en_US
dc.identifier.citedreferenceWorld Health Organization, “ Health Impact Assessment,” available at < http://www.euro.who.int/en/what‐we‐do/health‐topics/environmental‐health/health‐impact‐assessment > (last visited June 22, 2011 ); R. Quigley, R. L. den Broeder, P. Furu, A. Bond, B. Cave, and R. Bos, Health Impact Assessment International Best Practice Principles, Special Publication Series No. 5, International Association for Impact Assessment, 200688. S. Bondurant, “A New Chapter in an Old Story: Medicine and Public Health,” Transactions of the American Clinical and Climatological Association 108 (1997): 1–25, at 4.en_US
dc.identifier.citedreferencePatient Protection and Affordable Care Act, Pub. L. No. 111–148, 124 Stat. 119.en_US
dc.identifier.citedreferenceS. A. Schroeder, “ We Can Do Better – Improving the Health of the American People,” New England Journal of Medicine 357, no. 12 ( 2007 ): 1221 – 1228, at 1222 (noting that inadequate health care services account for only 10 percent of risk of premature mortality).en_US
dc.identifier.citedreferenceK. Atwood, G. A. Colditz, and I. Kawachi, “ From Public Health Science to Prevention Policy: Placing Science in Its Social and Political Contexts,” American Journal of Public Health 87, no. 10 ( 1997 ): 1603 – 1606, at 1603.en_US
dc.identifier.citedreferenceFor example, see B. C. Booske, J. K. Athens, D. A. Kindig, H. Park, and P. L. Remington, Different Perspectives for Assigning Weights to Determinants of Health, University of Wisconsin Population Health Institute, County Health Rankings Working Paper, 2010, at 6 (citing studies estimating effect at 12% or 21%); Robert Wood Johnson Foundation, Beyond Health Care: New Directions to a Healthier America, Recommendations from the Commission to Build a Healthier America, 2009, at 10 (estimating the effect at 10–15%).en_US
dc.identifier.citedreferenceT. G. Rundall, “ The Integration of Public Health and Medicine,” Frontiers of Health Service Management 10, no. 4 ( 1994 ): 3 – 24, at 15.en_US
dc.identifier.citedreferenceM. W. Stanton, The High Concentration of U.S. Health Care Expenditures, Agency for Healthcare Research and Quality Research in Action 19 ( 2006 ): 1 – 9, at 6, available at < http://www.ahrq.gov/research/ria19/expendria.pdf > (last visited May 15, 2011).en_US
dc.identifier.citedreferenceW. Brouwer, J. Van Exel, P. Van Baal, and J. Polder, “ Economics and Public Health: Engaged to Be Happily Married! European Journal of Public Health 17, no. 2 ( 2006 ): 122 – 123.en_US
dc.identifier.citedreferenceL. Shi, “ Public Health, Medical Care, and Mortality Rates,” Journal of Health Care for the Poor and Underserved 6, no. 3 ( 1995 ): 307 – 321.en_US
dc.identifier.citedreferenceId., at 307. Comparison across states also shows a lack of correlation between levels of medical expenditure and health outcome measures.en_US
dc.identifier.citedreferenceSee Rundall, supra note 5, at 9.en_US
dc.identifier.citedreferenceId., at 10.en_US
dc.identifier.citedreferenceA. H. Mokdad, J. S. Marks, D. F. Stroup, and J. L. Gerberding, “ Actual Causes of Death in the United States, 2000,” JAMA 291, no. 10 ( 2004 ): 1238 – 1242, at 1238. Analyzing mortality data reported to the Centers for Disease Control, the authors found that modifiable behavior caused approximately 951,000 out of 2,400,000 total deaths in 2000.en_US
dc.identifier.citedreferenceId., at 1240, table 2 (finding that tobacco contributed to 435,000 deaths, poor diet and inadequate activity to 365,000, alcohol to 85,000, motor vehicle accidents to 43,000, firearms to 29,000, risky sexual behavior to 20,000, and illicit substance abuse to 17,000).en_US
dc.identifier.citedreferenceFor example, see D. E. Peterson, S. L. Zeger, P. L. Remington, and H. A. Anderson, “ The Effect of State Cigarette Tax Increases on Cigarette Sales,” American Journal of Public Health 82, no. 1 ( 1992 ): 94 – 96.en_US
dc.identifier.citedreferenceSee generally Booske et al., supra note 4, at 4, noting that a comprehensive literature review reveals that social and environmental circumstances account for 28% of health outcomes, whereas health care accounts for only 14%.en_US
dc.identifier.citedreferenceS. Srinivasan, L. R. O'Fallon, and A. Dearry, “ Creating Healthy Communities, Healthy Homes, Healthy People: Initiating a Research Agenda on the Built Environment and Public Health,” American Journal of Public Health 93, no. 9 ( 2003 ): 1446 – 1450, at 1446. See also F. Khan, “Combating Obesity through the Built Environment: Is There a Clear Path to Success?” Journal of Law, Medicine & Ethics 39, no. 3 (2011): 387–393.en_US
dc.identifier.citedreferenceL. O. Gostin, J. I. Boufford, and R. M. Martinez, “ The Future of the Public's Health: Vision, Values, and Strategies,” Health Affairs 23, no. 4 ( 2004 ): 96 – 107, at 107 note 29 (citing studies relating to the built environment); Centers for Disease Control and Prevention, “Ten Great Public Health Achievements – United States, 1900–1999,” Morbidity and Mortality Weekly Report 48, no. 12 (1999): 241–248, at 241, available at < http://www.cdc.gov/mmwr/PDF/wk/mm4812.pdf > (last visited June 22, 2011) (noting that 25 years of a 30‐year increase in average lifespan was attributable to public health measures).en_US
dc.identifier.citedreferenceIn 2000, exposure to microbial or toxic agents resulted in 130,000 deaths. See Mokdad et al., supra note 12, at 1240 table 2.en_US
dc.identifier.citedreferenceFor a more detailed discussion of the importance of public health, see L. O. Gostin, P. D. Jacobson, K. L. Record, and L. E. Hardcastle, “ Restoring Health to Health Reform: Integrating Medicine and Public Health to Advance the Population's Well‐Being,” University of Pennsylvania Law Review 159 ( 2011 ): 101 – 147.en_US
dc.identifier.citedreferenceA. M. Brandt and M. Gardner, “ Antagonism and Accommodation: Interpreting the Relationship between Public Health and Medicine in the United States during the 20th Century,” American Journal of Public Health 90, no. 5 ( 2000 ): 707 – 715, at 708.en_US
dc.identifier.citedreferenceR. Axelsson and S. B. Axelsson, “ Integration and Collaboration in Public Health: A Conceptual Framework,” International Journal of Health Planning and Management 21, no. 1 ( 2006 ): 75 – 88, at 78.en_US
dc.identifier.citedreferenceSee Brandt and Gardner, supra note 20, at 708.en_US
dc.identifier.citedreferenceR. F. Kushner, “ Barriers to Providing Nutrition Counseling by Physicians: A Survey of Primary Care Practitioners,” Preventive Medicine 24, no. 6 ( 1995 ): 546 – 552, at 551 (finding that low reimbursement rates incentivize physicians to spend five or fewer minutes discussing the importance of nutrition with patients).en_US
dc.identifier.citedreferenceHospital Survey and Construction Act, ch. 958, 60 Stat. 1040 ( 1946 ).en_US
dc.identifier.citedreferenceJ. M. McGinnis, “ Can Public Health and Medicine Partner in the Public Interest Health Affairs 25, no. 4 ( 2006 ): 1044 – 1052, at 1048.en_US
dc.identifier.citedreferenceJ. Gruber, “ A Win‐Win Approach to Financing Health Care Reform,” New England Journal of Medicine 361, no. 1 ( 2009 ): 4 – 5, at 4.en_US
dc.identifier.citedreferenceM. Breton, J. F. Levesque, R. Pineault, L. Lamothe, and L. J. Denis, “ Integrating Public Health into Local Healthcare Governance in Quebec: Challenges in Combining Population and Organization Perspectives,” Healthcare Policy 4, no. 3 ( 2009 ): 159 – 178, at 169.en_US
dc.identifier.citedreferenceS. J. Leischow and B. Milstein, “ Systems Thinking and Modeling for Public Health Practice,” American Journal of Public Health 96, no. 3 ( 2006 ): 403 – 405, at 404.en_US
dc.identifier.citedreferenceId., at 404.en_US
dc.identifier.citedreferenceSee Rundall, supra note 5, at 15.en_US
dc.identifier.citedreferenceR. G. Brooks, L. M. Beitsch, P. Street, and A. Chukmaitov, “ Aligning Public Health Financing with Essential Public Health Service Functions and National Public Health Performance Standards,” Journal of Public Health Management Practice 15, no. 4 ( 2009 ): 299 – 306; C. Atchison, M. A. Barry, N. Kanarek, and K. Gebbie, “The Quest for an Accurate Accounting of Public Health Expenditures,” Journal of Public Health Management Practice 6, no. 5 (2000): 93–102.en_US
dc.identifier.citedreferenceId. (Brooks et al.), at 299.en_US
dc.identifier.citedreferenceM. St‐Pierre, D. Reinharz, and J. B. Gauthier, “ Organizing the Public Health‐Clinical Health Interface: Theoretical Bases,” Medicine, Health Care and Philosophy 9, no. 1 ( 2006 ): 97 – 106, at 99.en_US
dc.identifier.citedreferenceFor example, see D. B. Abrams, C. T. Orleans, R. S. Niaura, M. G. Goldstein, J. O. Prochaska, and W. Velicer, “ Integrating Individual and Public Health Perspectives for Treatment of Tobacco Dependence Under Managed Care: A Combined Stepped‐Care and Matching Model,” Annals of Behavioral Medicine 18, no. 4 ( 1996 ): 290 – 304.en_US
dc.identifier.citedreferenceSee Brandt and Gardner, supra note 20, at 712.en_US
dc.identifier.citedreferenceSee St‐Pierre et al., supra note 33, at 99.en_US
dc.identifier.citedreferenceD. Hemenway, “ Why We Don't Spend Enough on Public Health,” New England Journal of Medicine 362, no. 18 ( 2010 ): 1657 – 1658, at 1657.en_US
dc.identifier.citedreferenceFor example, see R. A. Cherry, “ Repeal of the Pennsylvania Motorcycle Helmet Law: Reflections on the Ethical and Political Dynamics of Public Health Reform,” BMC Public Health 10 ( 2010 ): 202 – 205.en_US
dc.identifier.citedreferenceSee A. L. Sensenig, “ Refining Estimates of Public Health Spending as Measured in National Health Expenditures Accounts: The United States Experience,” Journal of Public Health Management 13, no. 2 ( 2007 ): 103 – 14, at 108 table 1.1 (reporting that public health represented three percent of total health expenditures in 2004).en_US
dc.identifier.citedreferenceFor example, see J. Levi, R. St. Laurent, L. M. Segal, and S. Vinter, Shortchanging America's Health: A State‐by‐State Look at How Public Health Dollars Are Spent and Key Health Facts, 2010, at 1, available at < http://healthyamericans.org/assets/files/shortchanging09.pdf > (last visited June 22, 2011) (finding that federal public health spending has not changed in the last five years and state governments have recently cut spending).en_US
dc.identifier.citedreferenceThe Clinical Preventive Services Task Force (under the Agency for Healthcare Research and Quality) is charged with developing recommendations regarding the efficacy of clinical preventive services. ACA § 4003(a), 124 Stat. 119, 541 – 42.en_US
dc.identifier.citedreferenceThe Department of Health and Human Services' Advisory Group on Prevention, Health Promotion, and Integrative and Public Health will advise the National Prevention, Promotion, and Public Health Council, chaired by the Surgeon General. The Council is in the process of developing a National Prevention Strategy and will issue recommendations to Congress by 2011. Id. § 4001, 124 Stat. at 538–41.en_US
dc.identifier.citedreferenceSee St‐Pierre et al., supra note 33, at 97.en_US
dc.identifier.citedreferenceU.S. Department of Health and Human Services, Building Healthier Communities by Investing in Prevention, available at < http://www.healthcare.gov/news/factsheets/prevention02092011b.html > (last visited June 22, 2011 ).en_US
dc.identifier.citedreferenceThe Fund is the first guarantee of federal monies appropriated towards prevention on an annual basis. The amounts, however, are nominal: 1.5 billion dollars in the fiscal year 2014 and two billion per annum thereafter, ACA § 4002(b), 124 Stat. at 541. In contrast, estimates indicate that annual funding of $4.3 billion is necessary merely to sustain support for public health activities, while the cost of a modernized system is estimated at $18 billion annually (J. Levi, C. Juliano, and M. Richardson, “Financing Public Health: Diminished Funding for Core Needs and State‐by‐State Variation in Support,” Journal of Public Health Management & Practice 13, no. 2 [2007]: 97–102, at 100).en_US
dc.identifier.citedreferenceACA § 4201(f), 124 Stat. at 566; id. § 4002(b), 124 Stat. at 541.en_US
dc.identifier.citedreferenceShortly after President Obama signed the ACA into law, Senators Johanns and Thune introduced an amendment to divert $11 billion from the Prevention Fund into the general federal budget to compensate for lost tax revenue that would have resulted from the proposed repeal of small business tax reporting requirement. Small Business Paperwork Mandate Elimination Act, S.3578, 111th Cong. ( 2010 ).en_US
dc.identifier.citedreferenceH. K. Koh and K. G. Sebelius, “ Promoting Prevention through the Affordable Care Act,” New England Journal of Medicine 363, no. 14 ( 2010 ): 1296 – 1299, at 1297.en_US
dc.identifier.citedreferenceACA § 4108, 124 Stat. at 561–64.en_US
dc.identifier.citedreferenceACA § 4201, 124 Stat. at 564–66.en_US
dc.identifier.citedreferenceSee U.S. Department of Health and Human Services, supra note 44.en_US
dc.identifier.citedreferenceL. M. Beitsch, R. G. Brooks, J. H. Glasser, and Y. D. Coble, “ The Medicine and Public Health Initiative: Ten Years Later,” American Journal of Preventive Medicine 29, no. 2 ( 2005 ): 149 – 153, at 150.en_US
dc.identifier.citedreferenceId., at 150.en_US
dc.identifier.citedreferenceT. R. Oliver, “ The Politics of Public Health Policy,” Annual Review of Public Health 27 ( 2006 ): 195 – 233, at 195.en_US
dc.identifier.citedreferenceAlthough there is a grant program to fund the implementation of efficacious strategies, this program focuses only on implementing preventive strategies from the federal task force, not the state demonstration projects. It is also given meager funding.en_US
dc.identifier.citedreferenceQualified health plans include those participating in state‐based exchanges immediately, and all group plans by 2014. States cannot impose cost‐sharing for annual check‐ups on any Medicaid beneficiaries, and must also cover smoking cessation services free of charge for pregnant women immediately and for all beneficiaries by 2014. While states are not required to eliminate cost‐sharing for other preventive services, they will receive a one percent increase in federal medical assistance for doing so. ACA § 4107, 124 Stat. at 560–61.en_US
dc.identifier.citedreferenceAs of 2008, fewer than 30 percent of private sector employers offered wellness incentives to employees, even though for every dollar spent on a wellness promotion, employers save approximately five times as much on health care costs and lost productivity. See E. R. Stolzfus, Access to Wellness and Employee Assistance Programs in the United States, Bureau of Labor Statistics, 2009, at charts 2–3, available at < http://www.bls.gov/opub/cwc/cm20090416ar01p1.htm > (last visited June 22, 2011) (showing that 25 percent of all private sector workers had access to wellness programs in 2008); U.S. Department of Health and Human Services, Prevention Makes Common “Cents,” U.S. Department of Health and Human Services, 2003, at 23, available at < http://aspe.hhs.gov/health/prevention/prevention.pdf > (last visited June 22, 2011) (noting a study of nine large private employers that found their health promotion and disease management programs “with the range of benefit‐to‐cost ratios, ranging from $1.49 to $4.91 in benefits per dollar spent on the program”).en_US
dc.identifier.citedreferenceThe ACA authorizes the Department of Health and Human Services, Department of the Treasury, or the Secretary of Labor to increase the incentive valuation cap to up to 50 percent of the value of the plan. Federal wellness program grants will distribute $200 million between 2011 and 2015 to employers with fewer than a hundred employees. ACA § 10408, 124 Stat. at 977–78.en_US
dc.identifier.citedreferenceV. Navarro, “ What We Mean by Social Determinants of Health,” International Journal of Health Services 39, no. 3 ( 2009 ): 423 – 441, at 424, where the author cites evidence that in East Baltimore, a black unemployed youth has a lifespan 32 years shorter than a white corporate lawyer, and a blue‐collar worker is 2.8 times more likely than a businessman to die from a cardiovascular condition.en_US
dc.identifier.citedreferenceJ. Gruber, The Role of Consumer Copayments for Health Care: Lessons from the RAND Health Insurance Experiment and Beyond, 2006, at 6, available at < http://www.kff.org/insurance/upload/7566.pdf > (last visited June 22, 2011). Although the study found that for most people, the presence of co‐payments did not translate to adverse health effects, low‐income individuals who were also in poor health assigned to the free plan performed better on various health indicators than those in the co‐insurance plan.en_US
dc.identifier.citedreferenceId., at 6.en_US
dc.identifier.citedreferenceThis is significant not only for its monetary value, but also because the Prevention Fund was created to strengthen non‐clinical preventive activities. Allocating such a substantial portion of the Fund towards clinical providers defeats this goal in part. See generally U.S. Department of Health & Human Services, Fact Sheet: Creating Jobs and Increasing the Number of Primary Care Providers, available at < http://www.healthreform.gov/newsroom/primarycareworkforce.html > (last visited June 22, 2011).en_US
dc.identifier.citedreferenceACA § 10501, 124 Stat. at 1000–01.en_US
dc.identifier.citedreferenceACA § 5604, 124 Stat. at 679–80.en_US
dc.identifier.citedreferenceTrust for America's Health, Prevention and Public Health Fund to Jumpstart Community‐Based Prevention Programs, Press Release, 2010, available at < http://healthyamericans.org/newsroom/releases/?releaseid=215 > (last visited June 22, 2011).en_US
dc.identifier.citedreferenceACA §§ 4002, 5204, 5206, 5313, 5314, 5315.en_US
dc.owningcollnameInterdisciplinary and Peer-Reviewed


Files in this item

Name:
j.1748-720X.2011.00602.x.pdf
Size:
307.3KB
Format:
PDF
View/Open

Show simple item record

Remediation of Harmful Language

The University of Michigan Library aims to describe library materials in a way that respects the people and communities who create, use, and are represented in our collections. Report harmful or offensive language in catalog records, finding aids, or elsewhere in our collections anonymously through our metadata feedback form. More information at Remediation of Harmful Language.

Accessibility

If you are unable to use this file in its current format, please select the Contact Us link and we can modify it to make it more accessible to you.