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Welfare Reform, Substance Use and Mental Health

STUDY This study provides an overview of some of the substance abuse and mental health problems faced by welfare recipients before welfare reform. The authors (Rukmalie Jayakody, Sheldon Danzinger and Harold Pollack) used data from the 1994 and 1995 National Household Surveys of Drug Abuse (NHSDA) to determine the relationship between substance abuse, psychiatric disorders and welfare receipt among single mothers.  

SIGNIFICANT FINDINGS Nineteen percent of the welfare recipients surveyed had at least one of four psychiatric disorders (depression, general anxiety disorders, agoraphobia or panic attack) during the previous year. Twenty-one percent had used at least one illegal drug. Only 5 percent of welfare recipients reported using cocaine and crack cocaine.

 THE BOTTOM LINE This is the first study to relay data on the extent of substance abuse and mental health problems among single mothers in the welfare population. NHSDA is the only national survey that contains information on substance abuse and mental health in the welfare population.

CAVEATS The authors of this report caution against using the findings of this survey to make broad policy decisions (e.g., mandatory drug testing of all welfare recipients).

FIND THIS STUDY This study was published in the August 2000 edition of the Journal of Health Politics, Policy and Law. 

State and Local Initiatives to Enhance Health Coverage for the Working Uninsured

STUDY Authors Sharon Silow-Carroll, Stephanie E. Anthony and Jack A. Meyer of the Economic and Social Research Institute looked at the different strategies states and localities are using to make health insurance coverage more accessible and affordable to the working uninsured. Initiatives were illustrated in 11 states-Arizona, Iowa, Kansas, Massachusetts, Minnesota, New Mexico, New York, Oregon, Vermont, Washington, and Wisconsin. In each of these programs the report outlines the target population, number of participants, eligibility criteria, type and amount of subsidy, and a contact person. In addition to the state programs described, the report examines eight local initiatives under way in Boston, Massachusetts; Denver, Colorado; Lansing, Michigan; Marion County (Indianapolis), Indiana; Muskegon, Michigan; New York, New York; San Diego, California; and Wayne County, Michigan.

THE BOTTOM LINE The report provides a good overview of what states and localities are doing to combat the number of working uninsured. The tables included in the report provide a basis for comparing different programs. Additionally, the state sketches provide further detailed explanations of the selected programs.

CAVEATS The study did not examine all the state and local initiatives and therefore is not a comprehensive study. Researchers examined programs that cover the working uninsured in these 19 states and localities in an effort to highlight those they felt were the most innovative.

FIND THIS STUDY State and Local Initiatives to Enhance Health Coverage for the Working Uninsured was published in October 2000 by The Commonwealth Fund. It can be found at http://www.cmwf.org/programs/insurance/silow-carroll_initiatives_424.pdf.

RELATED STUDIES Expanding Health Coverage to Working Families: State Options, published in June 2000 by the National Conference of State Legislatures, can be ordered by calling (303) 364-7700.

Report to Congress: Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes

STUDY The Health Care Financing Agency (HCFA) studied the relationship between staffing levels and quality of care in nursing homes to justify establishing minimum staff-to-patient ratios. HCFA employed three different research strategies in this report: a literature review of prior research, quantitative analysis of the effects of nurse staffing on quality of care, and time motion studies to determine the time it takes to complete basic care services. This report was produced under the first phase of a two-part study. The second study (phase two) will focus upon the effects that minimum staffing regulations would have on the nursing home industry.

SIGNIFICANT FINDINGS This report found a strong association between staffing levels and quality of care. Statistical analysis showed a significant decrease in the quality of care in facilities that provide less than 12 minutes of registered nurse care, less than 45 minutes of licensed staff care, and less than two hours of nursing aide care per resident per day. Almost half of all nursing homes in this study fall below these standards. Additionally, HCFA found that quality of care significantly increased in facilities that provided more than one hour of licensed and registered nurse care.

THE BOTTOM LINE This is the first study that shows a clear relationship between staffing levels and quality of care. HCFA will use the findings of this report and the phase two report to create mandatory minimum staffing levels for nursing homes that receive Medicaid and Medicare funds.

CAVEATS This study does not include any specific recommendations. Phase two of this project will examine the costs and benefits of minimum staffing ratios and will include data from more states.

FIND THIS STUDY This study is available online at http://www.hcfa.gov/medicaid/reports/rp700hmp.htm.

Rural Health Policy: Where Do We Go From Here?

Understanding the Changing Rural Health System Landscape in Washington State

STUDY This report identifies many of the challenges faced by rural health care systems and some of the policy options that are being considered and implemented in rural communities in Washington. Rural communities have greater shortages of health care professionals, higher rates of uninsured, and fewer health plan options than urban communities. Cuts in federal funding and changes in private health insurance payment levels have placed considerable financial pressures on rural health care providers. This report provides a detailed description of several policy options and identifies the local, state and federal roles and the benefits of and the barriers to those policies.

SIGNIFICANT FINDINGS Several rural communities in Washington are considering long-term strategies to create health systems that deliver services that are both accessible and high in quality. One strategy involves creating a single administrative entity to coordinate insurance coverage and public funding for low-income populations. Another option involves coordinating health care services through primary care providers and a single, provider-owned, community-supported insurance plan that centralizes administrative functions. Some short-term options include expanding rural training in health professional education programs, increasing funding to expand coverage in public health insurance programs, and increasing payment levels for rural providers by public programs.

THE BOTTOM LINE Historically, rural health policies have addressed the specific failings of rural health systems. The authors argue that a broader approach is needed that recognizes the interdependencies that exist both within rural health care systems and between those systems and the communities they serve. Successful rural health programs involve coordination of efforts between all levels of government, health care providers and health insurance plans. Policymakers who are seeking solutions to these problems should try not only to obtain more funding, practitioners and services, but also to assess and maximize the existing funds and assets within their community.

FIND THIS STUDY This study can be found on the University of Washington's Health Policy Analysis Program's Web site at http://depts.washington.edu/hpap/Rural_Health/rural_health.html.

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