Helen A Halpin - Academia.edu (original) (raw)

Papers by Helen A Halpin

PsycEXTRA Dataset, 2009

MMWR 117 TABLE 3. Association between lifetime history of intimate partner violence* victimizatio... more MMWR 117 TABLE 3. Association between lifetime history of intimate partner violence* victimization and selected health conditions and risk behaviors among adults aged >18 years, by sex-Behavioral Risk Factor Surveillance System, United States, 2005 Health condition/ Women Men Risk behavior AOR † (95% CI §) AOR (95% CI) Health condition Diabetes ¶ 1.1 (0.9-1.3) 1.1 (0.9-1.4) Current use of disability equipment** 1.5 † † (1.3-1.8) 1.5 † † (1.2-1.9) Arthritis ¶ § § 1.7 † † (1.6-1.9) 1.4 † † (1.2-1.6) Current asthma ¶ 1.6 † † (1.4-1.8) 1.4 † † (1.2-1.8) Current activity limitations ¶ ¶ 2.1 † † (1.9-2.3) 1.8 † † (1.6-2.1) Stroke ¶ 1.8 † † (1.4-2.2) 1.4 † † (1.0-2.0) High blood cholesterol ¶ 1.3 † † (1.1-1.4) 1.1 (1.0-1.3) High blood pressure ¶ 1.1 (1.0-1.2) 1.1 (1.0-1.3) Heart attack ¶ 1.4 † † (1.1-1.7) 1.2 (0.9-1.6) Heart disease ¶ 1.7 † † (1.4-2.1) 1.2 (0.9-1.6) Risk behavior Risk factors for human immunodeficiency virus (HIV) or sexually transmitted diseases (STDs)*** 3.1 † † (2.4-4.0) 2.6 † † (2.0-3.6) Current smoking 2.3 † † (2.1-2.6) 1.9 † † (1.7-2.2) Current heavy or binge drinking † † † 1.7 † † (1.5-2.0) 1.7 † † (1.5-1.9) Current body mass index § § § >25 1.1 (1.0-1.2) 1.0 (0.9-1.2) * Includes threatened, attempted, or completed physical violence or unwanted sex by a current or former intimate partner. † Adjusted odds ratio. All models are adjusted for age, race/ethnicity, annual household income, and education level. § Confidence interval. ¶ Told by a doctor, nurse, or other health-care professional that they had the health condition. Refers to lifetime occurrence unless indicated as current. ** Use of disability equipment, such as a cane, wheelchair, or special bed. † † Statistically significant (p<0.05) by Wald chi-square test. § § Includes arthritis, rheumatoid arthritis, gout, lupus, and fibromyalgia. ¶ ¶ Activity limitations because of physical, mental, or emotional problems. *** Respondents were considered to have risk factors for HIV infection or STDs if, during the preceding year, they had used intravenous drugs, had been treated for an STD, had given or received money or drugs in exchange for sex, or had participated in anal sex without a condom. † † † More than two drinks per day on average for men, more than one drink per day on average for women, or five or more drinks on one occasion during the preceding 30 days for men and women. § § § Weight (kg) / height (m 2).

American Journal of Public Health, Dec 1, 2002

American Journal of Public Health, Sep 1, 2001

Tobacco Control, Sep 1, 1992

The United States health care system is a unique and uncoordinated combination of private and pub... more The United States health care system is a unique and uncoordinated combination of private and public programmes involving em ployers, government, insurance companies, and individual consumers. Although spending on health care comprised 12 % of the US gross domestic product in 1990, it is estimated that 35-7 million Americans are uninsured, three quarters of whom are fulltime workers and their dependents.1 Also, it is estimated that as many as 40 million people have partial but inadequate health insurance.

Annual Symposium on Computer Application in Medical Care, Nov 7, 1984

Abstract Accurate and timely information regarding the costs and benefits of automated medical in... more Abstract Accurate and timely information regarding the costs and benefits of automated medical information systems (MIS) is important to decision makers in the TRIMIS Program Office, DoD, as well as to administrators in civilian hospitals and clinics. A methodology for conducting an economic analysis of an MIS is described. Included are methods for identifying and estimating system benefits and system costs, calculating the incremental lifecycle net benefit or cost, and testing the sensitivity of the results of the analysis to changes in benefit and economic assumptions.

American Journal of Preventive Medicine, Sep 1, 1994

Tobacco Control, 1992

, 46 states and the District of Columbia had laws regulating tobacco sales to minors, but these l... more , 46 states and the District of Columbia had laws regulating tobacco sales to minors, but these laws are rarely enforced. An enforcement review found that five states had nominal restrictions (for example, laws ban

cessation: results of a randomised controlled trial Variations in treatment benefits influence sm... more cessation: results of a randomised controlled trial Variations in treatment benefits influence smoking

HIPP F IRST D O N O H ARM : A CCOUNTABILITY AND H EALTH P LAN D ECISIONS Helen Schauffler, Ph.D.,... more HIPP F IRST D O N O H ARM : A CCOUNTABILITY AND H EALTH P LAN D ECISIONS Helen Schauffler, Ph.D., Juliette Cubanski, M.P.P., and Sara McMenamin, M.P.H. Health Insurance Policy Program Center for Health and Public Policy Studies, University of California, Berkeley POLICY ALERT February 1999 The Problem In 1997, approximately 1.75 million adult insured Cali- fornians reported that, as a result of their health plan’s decisions, they had not received the most appropri- ate medical care or what they needed; 1.6 million re- ported that there were delays in getting needed care; and nearly half a million (480,000) reported that they were denied care or treatment. Of even more concern to policy makers and consumers is our finding that a substantial proportion of Californians who experi- enced these problems reported that they resulted in serious health consequences. Policy Options y Establish a system of independent, external review of health plan decisions to prevent, to the extent possible...

HIPP M EDI -C AL : I NCREASING A CCESS AND C ONTINUITY Helen Schauffler, Ph.D., Juliette Cubanski... more HIPP M EDI -C AL : I NCREASING A CCESS AND C ONTINUITY Helen Schauffler, Ph.D., Juliette Cubanski, M.P.P, and Sara McMenamin, M.P.H. Health Insurance Policy Program Center for Health and Public Policy Studies, University of California, Berkeley POLICY ALERT April 1999 The Problem The recent implementation of the Healthy Families Program for low-income children in California has made even more visible those features of the Medi- Cal program that continue to create barriers to enroll- ment, continuity of care, access to needed care, and provision of high-quality medical care. The Evidence Children’s Access One of the major barriers to increasing enrollment of eligible children in the Medi-Cal program is the cum- bersome application process. Nearly 30% of all the chil- dren in the state who are eligible for Medi-Cal are not enrolled in the program and remain uninsured (Ex- hibit 1). (No comparable data for adults are available.) Three strategies would help to maximize coverage of Calif...

American Journal of Preventive Medicine, 1997

American Journal of Preventive Medicine, 1993

I review the history and politics of Medicare disease prevention policy and identify factors asso... more I review the history and politics of Medicare disease prevention policy and identify factors associated with the success or failure of legislative initiatives to add preventive services benefits to Medicare. Between 1965 and 1990, 453 bills for Medicare preventive services were introduced in the U.S. Congress, but not until 1980, after 350 bills had failed, was the first preventive service added to the Medicare program. Medicare currently pays for only four of the 44 preventive services recommended for the elderly by the U.S. Preventive Services Task Force {pneumococcal and hepatitis B vaccinations, Pap smears, and mammography). In addition, Congress has funded demonstration programs for the influenza vaccine and comprehensive preventive services. The preventive services added to Medicare reflect Over the last 15 years, the public health community has recognized that health promotion and disease prevention offer the greatest potential to improve the health of the American public.1 However, most efforts to build preventive services benefits into Medicare, the largest publicly financed health care program in the United States, have failed. The Medicare program, since its enactment in 1965 (Public Law [PL] 89-97), has prohibited reimbursement for preventive services (Section 1862), limiting coverage to the diagnosis and treatment of acute illness. 2 Health insurers generally have not considered preventive services "insurable," because they are not unpredictable and do not generate high costs. Congress has only recently begun to add preventive services benefits under Medicare as exceptions to Section 1862. 2 Even health maintenance organizations that have risk contracts with the Health Care Financing Administration are required to provide Medicare enrollees only with those preventive services covered under Medicare.

Health care financing review, 1992

This study evaluates the use of risk factors for chronic disease as health status adjusters for M... more This study evaluates the use of risk factors for chronic disease as health status adjusters for Medicare's capitation formula, the average adjusted per capita costs (AAPCC). Risk factor data for the surviving members of the Framingham Study cohort who were examined in 1982-83 were merged with 100 percent Medicare payment data for 1984 and 1985, matching on Social Security number and sex. Seven different AAPCC models were estimated to assess the independent contributions of risk factors and measures of prior utilization and disability in increasing the explanatory power of AAPCC. The findings suggest that inclusion of risk factors for chronic disease as health status adjusters can improve substantially the predictive accuracy of AAPCC.

Medical Care Research and Review, 1993

In summary, the managed care system we propose for preventive services is designed to limit the p... more In summary, the managed care system we propose for preventive services is designed to limit the potential for overcare under FFS payment and for undercare under capitation and comprehensive fixed fees. It bases payment on the provision of a complete set of preventive services, thus limiting the tendency of physicians to provide only the relatively high-profit services, such as screening tests, while neglecting the lower-profit services, such as counseling. It also allows primary care providers to outsource selected services to lower-cost providers, such as laboratories, health educators, and counselors, and community-based health promotion programs, thus encouraging greater efficiency. In addition, the proposed system funds both primary and high-risk preventive case management to ensure that individuals receive preventive services appropriate to their age, sex, and risk factors. Finally, the proposed system monitors the use of preventive services, relying on physician reminders to stimulate the appropriate provision of preventive care and denying payment for unauthorized care. Existing research suggests that none of the individual strategies for managed care can be expected to achieve all of the goals of managing and promoting the appropriate use of preventive services as defined by the U.S. Preventive Services Task Force (1989). To be most effective, we conclude that the strategies need to be coordinated and integrated into the current health care delivery practices of HMOs, PPOs, and point-of-service plans. In addition, the strategies require additional provider training in preventive care. With this support, the proposed model has the potential to improve quality, control costs, and increase the appropriate use of preventive care. While many of the individual components of the proposed managed care model have been evaluated for preventive services, a great deal more research is needed to evaluate the effect of combining these elements into a coordinated and comprehensive approach to managing preventive care. Research is also needed on workable ways to invite people not currently receiving medical care into the health care system to receive preventive care. To inform policy development, the impact of the proposed managed care model--both on preventive services utilization for specific screening, immunization, and counseling services, and on total health care costs and patient health status outcomes--needs to be evaluated.

JAMA, 2003

ECENT REPORTS, INCLUDING 2 by the Institute of Medicine (IOM) of the National Academy of Sciences... more ECENT REPORTS, INCLUDING 2 by the Institute of Medicine (IOM) of the National Academy of Sciences, argue that the quality of health care in the United States falls far short of biomedical knowledge and that this gap in quality is primarily a failure of organization, rather than of individual physicians. 1-7 The IOM and others have called for the implementation of organized processes to improve quality and have argued that government and large private purchasers of health care should provide physician organizations (POs) with incentives to implement such processes. 8-14 The IOM also has advocated government financial assistance to POs to improve their clinical information technology (IT), which is considered fundamental to organized attempts to improve quality of care. 2,15,16 Despite this attention and despite a growing body of research supporting the effectiveness of organized processes in improving quality of care, 17 little information is available to answer 4 fundamental questions: (1) To what extent do POs-medical groups and independent practice associations (IPAs)currently use organized processes to improve quality? 18 (2) Do POs have external incentives to improve quality? (3) What clinical IT capabilities do POs have? and (4) Are external incentives and clinical IT capabilities associated with in