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Institution: University of Pittsburgh
Grant Title: Effects of Managed Care
Growth on Charity Care: The Changing Role of Health Departments and Physicians
Grant Number: K08 HS13075
Total Award: $350,300
Project Description: This research examined several mechanisms through which increases in managed care may have affected provision of care for the uninsured by local health departments (LHDs) and physicians. It also investigated the extent to which increases in managed care have:
- Diverted Medicaid revenues away from LHDs, reducing their
cross-subsidization and provision of care for the uninsured.
- Decreased the
Medicaid revenue and overall revenue of physicians, leading to a decrease in
their provision of charity care.
- Decreased physicians' autonomy (indicated
by decreased ownership, decreased clinical freedom and increase size of
practice), leading to decreased charity care.
- Increased discontinuation
and privatization of LHD services resulting in a decrease in LHD's ability to
assure access of the uninsured.
Career Goals: Dr. Keane is Assistant Professor in the Department of Behavioral and Community Health Sciences at the University of Pittsburgh, Graduate School of Public Health. He plans to continue conducting high quality research that will leverage improvements in access to health services. A related career path relates to the advancement of the theoretical understanding of transformations of public health and medical systems, and how these changes affect access to services by vulnerable populations.
Progress to Date: This grant has been completed. Dr. Keane found people mirror health choices in interesting ways. Many people trust others to reciprocate gifts of food vouchers. Many reciprocate these gifts and take a loss to do so. Fairer persons are more likely to choose health food. Put together, these findings help us model and simulate how healthy and unhealthy choices might spread.
Highlights and Specific Accomplishments:
Dr. Keane developed the
following guides for decisionmakers:
- Guidebook to aid local health department directors
determine which health services and functions to discontinue, contract out,
continue, or initiate.
- Guidebook to aid physicians' decisions about when to
provide charity care, meaning free care to the uninsured, vulnerable, and poor
- Workbook showing how healthcare decisionmakers often
rely on ideological metaphors, such as the belief that rigid, paternalistic
bureaucracies ought to be transformed into flexible, consumer-driven
partnerships and teams.
- Workbook to help healthcare decisionmakers
understand how physicians, hospital administrators, insurers, employers,
patients and other "stakeholders" use different relationship metaphors not only
in everyday communication but also as cognitive schema to evaluate healthcare
plans and negotiate decisions.
Keane, C. 2005. The effects of managerial beliefs on service privatization
and discontinuation in local health departments. Health Care Management Review 2005. 30(1):52-61.
Keane C, Marx J, Ricci E. Local health departments' mission
to the uninsured in the age of managed care: Results of a national survey.
Journal of Public Health Policy 2003. 24(2):130-49.
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