Quantifying Health Systems' Investment In Social Determinants Of Health, By Sector, 2017-19.

The past decade has seen a growing recognition of the importance of social determinants of health for health outcomes. However, the degree to which US health systems are directly investing in community programs to address social determinants of health as opposed to screening and referral is uncertain. We searched for all public announcements of new programs involving direct financial investments in social determinants of health by US health systems from January 1, 2017, to November 30, 2019.

Improving the capability to provide integrated mental health and substance abuse services in a state system of outpatient care.

The paper reports on the capability of New York State (NYS) outpatient programs to provide integrated services for co-occurring disorders (COD). Assessments of 447 outpatient clinics, using two dual diagnosis capability indices (one used in addiction settings, the other in mental health settings), produced an overall score of 2.70, interpreted to position NYS clinics closer to "capable" (3.

Transforming the delivery of care in the post-health reform era: what role will community health workers play?

The Patient Protection and Affordable Care Act (PPACA) affords opportunities to sustain the role of community health workers (CHWs). Among myriad strategies encouraged by PPACA are prevention and care coordination, particularly for chronic diseases, chief drivers of increased health care costs. Prevention and care coordination are functions that have been performed by CHWs for decades, particularly among underserved populations.

Understanding the craft of philanthropy: do we make something that should be simple too complex?

This Perspective considers two key questions raised by John Billings: First, do philanthropies adequately evaluate their approaches to grant making when working to encourage social change? Second, could philanthropies better test ideas if they used less "merit-based" approaches to selecting grantees for demonstration projects?

The public/private partnership behind the Cash and Counseling Demonstration and Evaluation: its origins, challenges, and unresolved issues.

Objective: To discuss why and how the Cash and Counseling Demonstration came to be designed, implemented, and evaluated through a partnership between the U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (ASPE) and the Robert Wood Johnson Foundation (RWJF).

Perspectives on the recent decline in disability at older ages.

A decline has been found in the prevalence of disability among the older U.S. population during the 1980s and 1990s.

Field building: lessons from the Robert Wood Johnson Foundation's anthology series.

As editors of the Robert Wood Johnson Foundation's (RWJF's) anthology series, we have examined the entire range of the foundation's grant making since 1972. We found that the RWJF has enjoyed considerable success in building fields--from nurse practitioners to tobacco control to end-of-life care. The RWJF has done this by shaping fields as they were emerging, by adopting a wide-ranging "bear hug" approach, and by staying the course.

The Dartmouth data: moving from analysis to action.

The work of Jack Wennberg and colleagues on variations in medical practice and outcomes has clarified our understanding of the relationships between supply, costs, and quality of medical care. Variations persist, however, in spite of our knowledge of them. Progress in reducing these variations will require technical, political, and regulatory solutions to problems surrounding financial incentives and health care delivery.

Online consumer surveys as a methodology for assessing the quality of the United States health care system.

Background: Interest in monitoring the quality of health care in the United States has increased in recent years. However, the policy objectives associated with collecting this information are constrained by the limited availability of timely and relevant data at a reasonable cost. Online data-collection technologies hold the promise of gathering data directly and inexpensively from large, representative samples of patients and consumers.

What new knowledge would help policymakers better balance investments for optimal health outcomes?

Objective: Review the limitations in cross-sectoral health outcomes research and suggest a future research agenda. DATA SOURCES, STUDY DESIGN, DATA COLLECTION: Literature review and workshop discussion.

Principal Findings: The research evidence that would aid public and private policy makers in answering the question the title poses is quite limited.

Medical vulnerability in America: how does the health system respond?

This study explores the hypothesis that market change affects the medically vulnerable more than the non-medically vulnerable. Analysis of data measuring change between 1997 and 1999 indicates that access to care eroded for both groups, but no evidence emerges to suggest that the changes were systematically worse for the medically vulnerable. Paradoxically, some measures of satisfaction with actual care received improved between 1997 and 1999 for both groups of people.

Wealth patterns among elderly Americans: implications for health care affordability.

This paper estimates the ability of the elderly to pay for necessary health care services and emerging technologies. Projections from the Long Term Care Financing Model paint a promising picture of the income and assets that elders in the future will have available to support discretionary, uncovered health care and service costs. Nevertheless, policymakers should pay close attention to the finances of the "Tweeners"--people who are middle class with low levels of discretionary assets available for health and long-term care.

The ultrastructural organization of the patch matrix compartments in the human striatum.

The mammalian striatum is a heterogeneous structure characterized by striosomes and matrix. The synaptic organization of the striatum has been described previously in various mammalian species including human; however, potential ultrastructural differences in striosomal organization have not been well studied. Samples (n = 7) of striatal tissue were obtained from the Maryland Brain Collection (mean age, 37.

The 2030 problem: caring for aging baby boomers.

Objective: To assess the coming challenges of caring for large numbers of frail elderly as the Baby Boom generation ages.

Study Setting: A review of economic and demographic data as well as simulations of projected socioeconomic and demographic patterns in the year 2030 form the basis of a review of the challenges related to caring for seniors that need to be faced by society.

Study Design: A series of analyses are used to consider the challenges related to caring for elders in the year 2030: (1) measures of macroeconomic burden are developed and analyzed, (2) the literatures on trends in disability, payment approaches for long-term care, healthy aging, and cultural views of aging are analyzed and synthesized, and (3) simulations of future income and assets patterns of the Baby Boom generation are developed.

The case for more active policy attention to health promotion.

Until recently, when anthrax triggered a concern about preparedness in the public health infrastructure, U.S. health policy and health spending had been dominated by a focus on payment for medical treatment.

Changing the chronic care system to meet people's needs.

Persons who are likely to be the heaviest users of medical and supportive care services--those with chronic illnesses, disabilities, and functional limitations--are often forced to navigate a system that requires them to perform most of the coordination functions themselves and is generally not organized around their needs. In 1996 an estimated 128 million Americans had at least one of these three conditions, and 9.5 million had all three.

Predictors of homelessness among families in New York City: from shelter request to housing stability.

Objectives: This study examined predictors of entry into shelter and subsequent housing stability for a cohort of families receiving public assistance in New York City.

Methods: Interviews were conducted with 266 families as they requested shelter and with a comparison sample of 298 families selected at random from the welfare caseload. Respondents were reinterviewed 5 years later.

Factors important in the purchase of partnership long-term care insurance.

Objective: To understand the factors important in the purchase of long-term care insurance through the Robert Wood Johnson Foundation Partnership for Long-Term Care.

Data Sources: Information on the Partnership programs, telephone surveys, data on Partnership purchasers, and random sample frames.

Study Design: Logistic regression analysis is used to examine characteristics associated with the purchase of a Partnership insurance policy.