| |
Office of the |
Assistant Secretary for Planning & Evaluation |
|
|
|
|
Office of Health Policy |
This compendium summarizes health policy research activities currently in progress that are sponsored by the Office of Health Policy (HP) of the Office of the Assistant Secretary for Planning and Evaluation (ASPE) within the U.S. Department of Health and Human Services (HHS). Research within HP informs the HHS policy development process by producing information on the organization, financing, and delivery of health services within the United States. To accomplish this goal, HP conducts research in areas of major interest to HHS, including:
This website will be updated periodically as new projects are awarded in Fiscal Year 1999.
In addition, you may link to our listing of completed research.
HP - Office of Health Policy, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services
For more information, contact:
Christy Schmidt, Deputy to the Deputy Assistant Secretary, Office of Health Policy, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Room 442E, 200 Independence Ave., S.W., Room 442E, Washington, D.C. 20201, (202) 690-6870, (202) 401-7321 (Fax) cschmidt@osaspe.dhhs.gov
If you have any problems with this website, please email Roxanne Gibson. or postal mail: 200 Independence Avenue, S.W., 442E, Washington, D.C. 20201
Creating A Multistate Database for Dual Eligibles
Effect of Welfare Reform on Immigrants
Children's Health Insurance Program (CHIP) –Early Implementing States
Children's Health Insurance Patterns
Children's Health Insurance Program Baseline Estimates and Eligibility Rules
Child Health Insurance Program State Methodology Workshop
Indicators for Tracking Academic Health Centers
Changes in Technology and Health Delivery Systems
Effects of Welfare Reform on the Health Status of Immigrants
Actuarial Research Corporation (ARC) Contract:
Enhancement of the Area Resource file of the Bureau of Health Professions/HRSA
The Optimal Timing of Liver Transplantation
Evaluation of the Projects for Assistance in Transition from Homelessness (PATH) Program
Access and Financing Obstacles to Use of New Psychotropic Medications
Clustering/Co-Occurrence of Youth Risky Behaviors
Evaluation of Prescription Drug Consumer Information
Developing An HIV Resource Utilization Data Coordinating Center
An Inventory of Federal HIV-Related Databases
Developing a Framework for Domestic Infectious Diseases Surveillance
Construction of an Integrated Measure of the Burden of Disease
There has been growing interest in the service utilization and expenditure patterns of individuals enrolled in both Medicare and Medicaid (i.e., dual eligibles). In order to provide important data on these populations, two ASPE offices (HP and DALTCP) collaborate with HCFA(now known as CMS) to fund a project that will link Medicare and Medicaid data in 10-12 states. This is an effort to develop a uniform database that can be utilized by both States and the Federal Government to improve the efficiency and effectiveness of both acute and long-term care services provided to these populations. More specifically, the project strengthens the ability of HHS and States to develop effective risk-adjusted payment methods for dual eligibles, and further understanding of how interactions between the Medicare and Medicaid programs affect the access, costs and quality of services received by dually eligible beneficiaries.
Contractor: Mathematica Policy Research (MPR)
Report Availability: Interim reports will be available beginning in Fall 1999
This cooperative agreement, awarded to the Urban Institute in September 1997, evaluates the economic and health status of immigrants and the effect of the immigrant restrictions of the welfare reform statute on the health of immigrant families and the organizations that serve them. The investigators conduct in-depth interviews with immigrant families and community providers in New York City and Los Angeles. This research profiles the status of immigrants with regard to health, employment, and participation in public programs, and draws comparisons between categories of immigrants and with non-immigrants. It also explores adaptation by individuals, organizations and communities to the benefits restrictions instituted by welfare reform. The grantee works with the University of California at Los Angeles and builds upon the UI's National Survey of American Families for sampling and survey design.
Grantee: Urban Institute
Report Availability: September, 2000
As part of ASPE's research agenda on examining managed care impacts on individuals under 65 with disabilities, two offices within ASPE (HP and DALTCP) work with HCFA(now known as CMS) to modify two of the existing 1115 waiver evaluation contracts to incorporate a special analysis on SSI disabled in two waiver states, Oregon and Tennessee. The ASPE disability evaluation component is similar to the core HCFA(now known as CMS) evaluation in its examination of impacts on utilization, costs, providers, and beneficiary satisfaction and outcome measures, but the ASPE-funded components focus on the disabled beneficiary population. ASPE funding is supporting specific analyses of utilization and expenditures for care by major types of disability (mentally retarded, physically disabled, mentally ill) and, where possible, links to state data bases that provide periodic measurement of disabled individuals in both states. ASPE is also funding surveys of disabled beneficiaries (including children in Oregon), a survey (Oregon) and focus groups (Tennessee) with providers, a detailed longitudinal case-study of disabled individuals in Tennessee, and detailed case-studies of implementation in both states.
An FY97 contract modification to the Oregon evaluation provides additional funds to examine the impact of managed care on dual eligibles (individuals enrolled in both Medicare and Medicaid) within that state.
Contractors: Center for Health Economics Research--Oregon Mathematica Policy Research - 5 State Study
Report Availability: Final Reports Available in September, 1999
This study is a set of case studies that will examine issues related to outreach, crowd-out and data and evaluation in six states whose CHIP plans were among the first to be approved. The six States are Oregon, Alabama, New York, Colorado, Massachusetts and Ohio. Besides representing different parts of the country, these States also cover the three types of arrangement allowed under CHIP: Medicaid expansions, new CHIP programs and combination approaches.
Contractor: American Institutes for Research
Report Availability: Spring 1999
This contract is intended to study the dynamics of insurance coverage among children using the Census Bureau's Survey of Income and Program Participation (SIPP), the largest longitudinal database available. In addition to studying the pattern of coverage for children over time, this study will particularly focus on measuring Medicaid eligibility and counting the number of children eligible for Medicaid but not enrolled. This study will take advantage of SIPP's ability to determine if there are different demographic characteristics associated with those who remained uninsured for different lengths of time.
Contractor: Mathematica Policy Research
Report Availability: Summer 1999
This project will establish the necessary analytic groundwork for future evaluation of the CHIP program. This project will build on the contractor's previous SIPP analysis of children's health insurance enrollment patterns by analyzing the trigger events that lead to Medicaid/CHIP eligibility and the trigger events that lead to a lose of coverage. In addition, this project will use a newly developed statistical technique to produce improved CPS-based state-by-state estimates of the uninsured. These state-by-state estimates may be used to fulfil the statutory requirement to establish a state-specific baseline of the number of uninsured children. The project will also test the use of HCFA(now known as CMS) administrative enrollment data (which, starting in 1999, all states must begin submitting electronically) to track monthly enrollment patterns in CHIP and Medicaid. In addition, this task order will help ASPE and the research community analyze CHIP program parameters and eligibility rules in great detail through work on a complete fifty state database of state CHIP plans and a smaller, focused database of income deeming and disregard procedures.
Contractor: Mathematica Policy Research
Report Availability: Fall 1999
One area of intense interest in Congress, in the Federal Government and in the States in the development of the CHIP legislation and in its implementation is the issue of crowd out, the substitution of this new form of subsidized insurance for insurance coverage already available, particularly employer-sponsored insurance. There is a concern that families will choose to drop employer-sponsored insurance for CHIP coverage which may have fewer out of pocket costs and offer more generous benefits. Alternatively, employers may choose not to offer dependent coverage if a government-subsidized insurance program is available. CHIP legislation requires States to describe the measures they will take to address crowd out. States are being asked to monitor their crowd out experience and to take corrective action as needed.
The Committee on National Statistics of the National Academy of Sciences will bring together the research community, officials operating or evaluating CHIP insurance expansions and others concerned with the issue of crowd out to explore methods of evaluating crowd out at the State level. This workshop will have a practical focus and be geared to state-level program managers and evaluators. It will result in a document for use by the States and others.
Contractor: Funds transferred to the National Science Foundation and awarded to the Committee on National Statistics, National Academy of Sciences
Report Availability: Summer 1999
The nation's health care provider safety net consists of hospitals; primary care facilities; specialized service providers such as family planning clinics, HIV services providers, and community mental health centers, and drug and alcohol treatment clinics; and individual practitioners. These providers operate under both public and private auspices. As a group they are diverse, with varied funding sources which include Medicaid and Medicare patient revenues and other payments, Federal grant support from multiple sources, other grants, state and local public funding, a limited amount of private third party insurance, patient fees (often sliding scale), and private philanthropy. Federal policy affects these providers in a myriad of ways.
Products from this project will include a series of working papers, a workshop summary and a final "framework" document. The project is intended to result in new ways of organizing the Department's thinking around safety net providers. In particular, we hope to have a structure which helps us consider how Federal grant programs, payment policies and other Federal policies affect these providers as they interact among each other at the community level. We also hope to have a better sense of the data needed to inform Federal policies as they affect these providers, what is now available and significant gaps. We would also learn what additional research is needed and have a better sense of where we in ASPE should devote future efforts. The framework should also be useful to other Department components as they plan their own studies around these providers.
Contractor: Northwestern University
Report Availability: Final Report expected Fall 1999
This project encompasses a series of activities aimed at increasing our knowledge of academic health centers' financial status and their ability to sustain the production of such public goods as uncompensated care, teaching, and research. A conference of leading experts was held in September 1998 in order to explore additional, and more consistent data sources for studying this issue. In addition, analyses comparing the performance of academic health centers to other hospitals has been extended through the use of 1997 data and a similar analysis comparing children's' hospitals to other hospitals has been conducted. Finally, we are assessing the possibility that data filed by hospitals with the SEC when they float public bonds will be complete enough to permit further analysis of the financial status and mission related activities of these hospitals.
Contractor: Center for the Study of Hospital Finance and Management, Johns Hopkins University
Report Availability: Summer 1999
With the Institute of Medicine, this project is studying trends in medical technology and changes in the health delivery system, including a historical review of major changes and assessments of the future from the research community. This will include information on what we can expect technology to achieve and the uses for which the medical community will recommend this technology. This information can then be used to reexamine assumptions about changes in demographics, disability, and life expectancy.
Contractor: The Lewin Group
Report Availability: Summer 1999
This cooperative agreement, awarded to the Urban Institute in September, 1997, will evaluate the economic and health status of immigrants and the effect of the immigrant restrictions of the welfare reform statute on the health of immigrant families and the organizations that serve them. The investigators will conduct in-depth interviews with immigrant families and community providers in New York City and Los Angeles. This research will profile the status of immigrants with regard to health, employment, and participation in public programs, and draw comparisons between categories of immigrants and with non-immigrants. It will also explore adaptation by individuals, organizations and communities to the benefits restrictions instituted by welfare reform. The grantee will work with the University of California at Los Angeles and will build upon the UI's National Survey of American Families for sampling and survey design.
Grantee: The Urban Institute
Report Availability: October, 2000
This is a multi-year contract to provide analytic and cost estimates for Administration and Congressional proposals in health care. The analytical tools provided under the contract are important to ASPE in assessing potential reforms of health insurance, Medicare, and Medicaid.
Contractor: Actuarial Research Corporation
Report Availability: Not Applicable
The Area Resource File (ARF) is a compilation of data maintained by the Bureau of Health Professions (BHPr) of the Health Resources and Services Administration (HRSA) and made available to external users. The basic objective of the proposed project is to increase the flexibility of the data base to permit it (a) to support data at a level of resolution finer than the County, the present structure, and (b) to increase the ease of use of the file through its segmentation into topical areas with linkages through relational data base mechanisms.
The specific tasks to be carried out by the contractor will include: (1) To segment the County-level ARF into components addressing specific contents such as (a) demographic and socioeconomic characteristics of the populations, (b) their patterns of utilization of health care resources, (c) the detailed distributions of health care providers (physicians and other personnel), (d) detailed distributions of other health care resources. (2) To create a relational base structure linking the files through County and year identifiers. (3) To create "wizards" to assist users in the querying of the data bases and the extraction of material relevant to specific projects. (4) Based on the creation of the relational structure, to assemble data already available at levels below the County (ZIP code, census tract) into files that may be associated with the County-level data through the County and year identifiers.
Collaborating Agency: Bureau of Health Professions
Report Availability: Not Applicable
This is a three-year grant (FY98 is Year 3) sponsored by the Agency for Health Care Policy Research (AHCPR). This study will use large scale decision-analytic models which employ Markov processes to conduct simulations, and to combine it with previous work to estimate survival, quality of life and costs in liver transplantation. The characteristic of this work that distinguishes it from other work in the field is its focus not on the transplant recipient but on the patient with end-stage liver disease (ESLD) who is a candidate for liver transplantation. Decision-analytic techniques will be used to characterize the choices and the probabilistic events associated with the care of the patient with ESLD. The inputs into the model will require the quantitative description of the "natural" history of ESLD patients with and without transplantation in the form of expected survival, quality of life, and resource use, adjusted for clinical characteristics (i.e. severity of illness). The result of the analyses should be the identification of criteria (patient characteristics as a function of the evolution of the severity of disease over time) that will permit the selection of recipients and the timing of the transplant so as to optimize the balance of quality-adjusted life-years to resource use in the population with ESLD.
Grantee: University of Pittsburgh
Completion Date: September, 2000
The Office of Health Policy provided start up funding for NCHS to establish and evaluate the utility of a Research Data Center so that files which do not meet confidentiality standards for release to the public can be made available to qualified researchers in a controlled environment where confidentiality can be protected. Researchers with approved projects will be granted access to files which do not contain direct identifiers such as name or social security numbers but which contain information that could make the files identifiable if used outside a controlled environment (e.g. matching to other data sources). NCHS Research Data Center (RDC) staff will monitor data use in the RDC, develop disclosure avoidance mechanisms, and provide technical assistance to researchers in complying with the procedures necessary for gaining access to the RDC. After one year of operation, NCHS will provide ASPE with a written report evaluating the utility of the RDC for improving researcher access to data.
Contractor: Funds transferred to the National Center for Health Statistics
Report Availability: January, 2000
This project is designed to test the feasibility of obtaining state level data from the Health Interview Survey by supplementing the sample of in-person interviews from a state's primary sampling units (PSU's) with a sample of telephone interviews---hence the title dual frame. The project is purely a methodological exploration, state by state, of how large the telephone supplementary sample would have to be and what the approximate costs would be to obtain state representative HIS data. Once this project is completed, the next logical step would be to pilot test the methodology in one or more states.
Contractor: Funds transferred to the National Center for Health Statistics
Report Availability: January, 2000
This evaluation is conducted in collaboration with the Substance Abuse and Mental Health Services Administration (SAMHSA). The purpose is to assess the impact of the PATH program, a categorical grant program where states and territories receive funds to assist individuals with severe mental illness and/or addictions to move from homelessness to mainstream treatment services and housing. A legislative requirement exists to review program operations every three years, and the General Accounting Act of 1996 resulted in a transfer of authority to conduct this activity from GAO to the SAMHSA Administrator.
Contractor: Westat (Subcontractor: R.O.W. Sciences)
Report Availability: Fall 2000
This project involves a collaboration with the National Institute of Mental Health to examine both obstacles and opportunities in the use of some of the "new generation" of antidepressant (e.g., Prozac, Paxil, Zoloft, etc.) and antipsychotic (e.g., Clozaril, Risperidone, etc.) medications. While a growing body of literature is demonstrating the efficacy and long-term cost-effectiveness of many of these newer drugs, a number of obstacles exist (e.g. restrictive drug formularies, coverage policies within benefit packages, limited knowledge of prescribing [in many cases, primary care] physicians, non-compliance by patients, etc.) that prevent more widespread use of these pharmacotherapies. The project would review the literature on the cost-effectiveness of these medications, conduct key informant interviews with various stakeholders regarding current practices in this area and potential obstacles to the widespread use of these medications, and analyze data from state Medicaid formularies and several state Medicaid programs.
Contractor: The Lewin Group
Report Availability: Fall 1999
Historically, much of the research in this country examining problems among youth has tended to focus on discrete risk behaviors (e.g., alcohol use, marijuana use, early onset of sexual activity, involvement in a gang, suicide ideation and attempts, etc.), and has produced prevalence estimates of these various risk behaviors in isolation from each other. While many of these prevalence estimates among various subpopulations of youth have become fairly well established in recent years, much less is known about how these risk behaviors cluster or co-occur with one another, and how these clusterings may differ by various demographic factors (i.e., age, race, gender, socio-economic status, etc.).
The proposed task order contract would provide prevalence estimates of various configurations of risk behaviors from several recent nationally-representative surveys of adolescents sponsored by the Department, including: 1) the National Longitudinal Study on Adolescent Health (Add Health); 2) the Youth Risk Behavior Survey (YRBS); and 3) the National Survey of Adolescent Males (NSAM). The project will produce a series of data tables and research briefs regarding incidence and prevalence estimates for various clusterings/co-occurrences of risky behaviors among youth.
Contractor: The Urban Institute
Report Availability: Fall 1999
This project is being conducted primarily by FDA's Center for Drug Evaluation & Research (CDER) to conduct a survey and evaluation of the "usefulness" (or quality) of written information provided to patients with their prescription drugs. In 1997 Congress set required goals for the provision of "useful" prescription drug information to 75 percent of patients receiving new prescriptions by the year 2000 and 95 percent of such patients by the year 2006. If these goals are not achieved by a private sector voluntary effort, FDA regulatory mandates will be permitted. The objective of this project is to provide a comprehensive evaluation of the current extent of provision of useful prescription drug information as an interim "report card" of private sector progress before the final evaluation is conducted in the year 2000. This interim evaluation has a two-fold purpose. First, it will provide critical guidance information that will enable private sector information providers and pharmacists to gauge progress toward the specified goals and make any adjustment that may be necessary to facilitate goal achievement. Second, it will provide a field test of the procedures to be used for the year 2000 evaluation to ensure that they provide valid and publicly acceptable data.
Contractor: National Association of Boards of Pharmacy
Report Availability: August, 1999
This project is conducted in collaboration with the Agency for Health Care Policy and Research (AHCPR), Health Resources and Services Administration (HRSA) and the Substance Abuse and Mental Health Services Administration (SAMHSA). The purpose of this effort is to facilitate the establishment of a HIV Resource Utilization Data Coordinating Center ("Data Center") with the capability to receive, analyze, and disseminate information about the care provided to persons with HIV disease and, in particular, the determinants of health care resource utilization by people with HIV/AIDS. This project will lay the foundation for the Data Center infrastructure and will establish procedures and protocols for assembling health services cost and utilization data from providers of HIV care across the United States. It is the first phase of a larger, longer-term project. In the envisioned second-phase project, the Data Center would engage in ongoing data receipt and analysis and would be able to provide timely information and analysis in response to policy-relevant issues in the area of HIV services utilization, care delivery, and financing. This project is being conducted under a contract with AHCPR.
Contractor: Johns Hopkins University School of Medicine
Report Availability: Not Applicable
This project will develop an inventory of existing major federally-sponsored HIV-related databases. This project will describe the relevant databases and review their potential applications for administrative, clinical research, epidemiologic, financing, policy making, or the program administration purposes. It will also identify key research questions that could be addressed by these databases and identify opportunities for cross-agency collaboration in data collection or analysis within the Department of Health and Human Services (DHHS) and between DHHS and the Department of Veterans Affairs and/or the Social Security Administration. The project will culminate in a final report that includes the annotated inventory and the relevant database assessments that point to key research issues and opportunities for interagency collaboration and cross-cutting analyses.
Contractor: George Washington University Center for Health Policy Research
Report Availability: Fall 1999
The purpose of this study is to develop an analytic framework that can be used to help create consensus on core, or minimum, capacities needed at each level of government for effective national infectious diseases surveillance. Emphasis will be placed on several areas including: defining the relative roles of each level of government, and of the public and private sectors; analyzing resource issues with particular attention to sources of funding, and to categorical versus integrated funding streams; translating surveillance activities into meaningful public health responses; evaluating surveillance activities; and identifying training needs. The study will take into account the rapidly changing environment, especially the role of local health departments, and the changing nature of infectious diseases.
The work will consist of collecting and analyzing data and information from the literature and from experts; using this information to develop an initial framework describing what is needed for effective surveillance; and establishing an expert panel which will use the framework as a tool to reach consensus on the minimum core capabilities needed at each level of government, and the relative roles of the public and private sector for more effective national infectious diseases surveillance.
Contractor: The Lewin Group
Report Availability: Spring 2000
The burden of disease in individuals and in populations is manifested in four distinct ways- (a) by morbidity (the biological events experienced), (b) by functional status, (c) by psychological perceptions of the adequacy of the care, and (d) by the utilization of resources. The essence of medical decisions on the selection of interventions and of societal decisions on the allocation of resources is the acceptance of trade-offs among these four dimensions or measures. The optimization of health care strategies hinges on an understanding of what trade-offs are currently being accepted and reassessment of their desirability. The construction of an integrated measure of the burden of disease consists of the empiric assessment of the trade-offs (calculation of relative weights accorded to the component measures). The additional step is the assessment of the effects alternative strategies for health care on the weights of the component measures and, therefore, on the integrated measure. That step is the basis of choice among the strategies.
The project is to be carried out in four steps. The first, a literature review, to identify available approaches to dealing with the problem of multivariate analysis of multiple outcomes affected by multiple inputs has been completed and a report has been submitted and accepted. The second step, the assembly of data sets on which the methodology is to be tested, the responsibility of the OASPE project monitor, is underway. The essential DoD data sets are in hand, and the data sets derived from the Medicare Beneficiary Survey are being constructed. The third step, the selection and development of methodologies based on the literature review, will begin shortly.
Contractor: The Lewin Group
Contract Period: September 1998 - September 1999, with periodic reports.
Collaborative efforts are underway with other components of the Department (HRSA, HCFA(now known as CMS). NIH) to identify and support successful efforts to increase organ donation. Specific projects will be selected late in the spring of 1999.