So far I have attempted to provide a broad framework within which to consider the importance of managerial and organisational integration. Inevitably in so doing I have found it necessary to raise wider educational and training issues which influence not only conceptual skills but also attitude. Indeed I have, on occasion, moved my argument or perspective to even wider considerations; issues pertaining to national culture. Culture, education policy or structure, industrial organisation, all interact in subtle and perhaps devious forms. Thus a cultural framework which is “overly status or class conscious” reflects this in its educational system. Most likely it is more predisposed to segment its secondary and tertiary education systems according to similar principles. It may well encourage separation of the university and technical college or polytechnic system to a degree that is industrially and commercially counterproductive — and integratively devisive. Such an educational system will no doubt require “preselection and filtering” which relies upon early, too early, subject specialisation; it may, subsequently, influence adversely the need for individuals and subgroups to communicate more intimately and to organise themselves more closely. In fact it may ensure the continuance of barriers, hierarchies, and polarised attitudes of class, structure and function all the way across and through commerce and industry.

A National Survey

Health services research conducted over the past 25 years makes a compelling case that having health insurance or using more medical care would improve the health of the uninsured. The literature's broad range of conditions, populations, and methods makes it difficult to derive a precise quantitative estimate of the effect of having health insurance on the uninsured's health. Some mortality studies imply that a 4% to 5% reduction in the uninsured's mortality is a lower bound; other studies suggest that the reductions could be as high as 20% to 25%. Although all of the studies reviewed suffer from methodological flaws of varying degrees, there is substantial qualitative consistency across studies of different medical conditions conducted at different times and using different data sets and statistical methods. Corroborating process studies find that the uninsured receive fewer preventive and diagnostic services, tend to be more severely ill when diagnosed, and receive less therapeutic care. Other literature suggests that improving health status from fair or poor to very good or excellent would increase both work effort and annual earnings by approximately 15% to 20%.

Sicker and poorer--the consequences of being uninsured: a review of the research on the relationship between health insurance, medical care use, health, work, and income.

This paper identifies family characteristics associated with use of autism-related services. A telephone or in-person survey was completed during 2003–2005 by 383 North Carolina families with a child 11 years old or younger with ASD. Access to care is limited for racial and ethnic minority families, with low parental education, living in nonmetropolitan areas, and not following a major treatment approach. Service use is more likely when parents have higher stress. Families use a broad array of services; the mix varies with child ASD diagnosis and age group. Disparities in service use associated with race, residence and education point to the need to develop policy, practice and family-level interventions that can address barriers to services for children with ASD.

Access to care for autism-related services.

The Affordable Care Act (ACA) aimed to achieve nearly universal health insurance coverage in the United States through a combination of insurance market reforms, mandates, subsidies, health insurance exchanges, and Medicaid expansions, most of which took effect in 2014. This paper estimates the causal effects of the ACA on health insurance coverage in 2014 using data from the American Community Survey. We utilize difference-in-difference-in-differences models that exploit cross-sectional variation in the intensity of treatment arising from state participation in the Medicaid expansion and local area pre-ACA uninsured rates. This strategy allows us to identify the effects of the ACA in both Medicaid expansion and non-expansion states. Our preferred specification suggests that, at the average pre-treatment uninsured rate, the full ACA increased the proportion of residents with insurance by 5.9 percentage points compared to 2.8 percentage points in states that did not expand Medicaid. Private insurance expansions from the ACA were due to increases in both employer-provided and non-group coverage. The coverage gains from the full ACA were largest for those without a college degree, non-whites, young adults, unmarried individuals, and those without children in the home. We find no evidence that the Medicaid expansion crowded out private coverage.

/pdf/early-impacts-of-the-affordable-care-act-on-health-insurance-56ggk8jc8f.pdf

Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States

https://www.nber.org/system/files/working_papers/w22213/w22213.pdf

Premium Subsidies, the Mandate, and Medicaid Expansion: Coverage Effects of the Affordable Care Act

This study examines the effects of having an uninsured parent on access to health care for low-income children. Data from the 1999 National Survey of America's Families indicates that having an uninsured parent decreases the likelihood that a child will have any medical provider visit by 6.5 percentage points, and decreases the likelihood of a well-child visit by 6.7 percentage points. Efforts to increase insurance coverage of parents, either by extending eligibility for public insurance or through other policy interventions, will have positive spillover effects on access to care for children. (Davidoff, Amy, Genevieve Kenney, and Alshadye Yemane. Fall 2003. The Effect of Parents' Insurance Coverage on Access to Care for Low-Income Children. Inquiry 40(3): 254-268.)

https://inq.sagepub.com/content/40/3/254.full.pdf

The effect of parents' insurance coverage on access to care for low-income children.

In April 2006, Massachusetts enacted a comprehensive health care reform bill that seeks to move the state to near universal insurance coverage. The bill included expanded eligibility for public coverage, subsidized insurance, market reforms, requirements for employers, and, most controversial, an individual mandate. A study of the early impacts of the state's initiative found evidence of a substantial drop in uninsurance--from 13 to 7 percent for nonelderly adults (Long 2008). Because that study relied on a simple pre-post comparison, it is possible that the estimates of the impact of health reform reflect both the changes under health reform and factors beyond health reform that changed over the same period, leading to biased estimates of the impacts of reform (Lawrence B. Mohr 1995). This paper expands on the earlier work to estimate the impacts of health reform in Massachusetts using new data and a stronger research design. Specifically, we rely on data over time for Massachusetts and other states from the Current Population Survey (CPS) to estimate difference-in-differences (DD) models (Jeffrey M. Wooldridge 2002).

Another Look at the Impacts of Health Reform in Massachusetts: Evidence Using New Data and a Stronger Model

Medicaid enrollees' access to and use of health care may be affected by the type of Medicaid managed care (MMC) program operating in their county. Using National Health Interview Survey data linked to county-level Medicaid managed care characteristics, we found that, relative to traditional fee-for-service programs, mandatory programs with both primary care case management (PCCM) and HMO options did the most to improve health care access and utilization for children. In contrast, we found potentially negative health care impacts for women in mandatory HMO programs. Mandatory PCCM programs had virtually no effects on access and use for women or children. (Health Services Research 38(2): 575?94.)

/pdf/effects-of-medicaid-managed-care-programs-on-health-services-362u39twrn.pdf

Effects of Medicaid Managed Care Programs on Health Services Access and Use

We estimated the proportion of children with special health care needs (CSHCN) eligible for Medicaid and the State Children's Health Insurance Program (SCHIP) using data from the 2000 and 2001 National Health Interview Survey (NHIS) and an algorithm to determine likely eligibility. We find that CSHCN were more likely to be eligible compared with other children (50 versus 43 percent), and that they were eligible through different program mechanisms. Relatively few faced waiting periods and premiums to participate in public programs. Participation rates were higher for CSHCN eligible through Medicaid Program rules prior to the SCHIP expansions, compared with those newly eligible after 1997. CSHCN had higher rates of participation than children without special needs (CWOSN), across all eligibility categories.

https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/HealthCareFinancingReview/downloads/04fallpg119.pdf

Public insurance eligibility and enrollment for special health care needs children.

Although the rapid increase in Medicaid managed care during the early 1990s attracted commercial plans to the program, by the late 1990s commercial plan participation in Medicaid had begun to decli...

Alshadye Yemane

Papers

The effect of parents' insurance coverage on access to care for low-income children.

Another Look at the Impacts of Health Reform in Massachusetts: Evidence Using New Data and a Stronger Model

Effects of Medicaid Managed Care Programs on Health Services Access and Use

Public insurance eligibility and enrollment for special health care needs children.

Commercial Plans in Medicaid Managed Care: Understanding Who Stays and Who Leaves