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Physicians’ willingness to change how care is delivered is a key component of the ability of accountable care organizations (ACOs) to transform patient care. Yet physicians participating in Medicare ACOs are only moderately convinced that ACOs are an effective model for delivering cost-effective care.

Using data from a 1996/1997 survey of undocumented Latino immigrants in four sites, we examine reasons for coming to the United States, use of health care services, and participation in government programs. We find that undocumented Latinos come to this country primarily for jobs. Their ambulatory health care use is low compared with that of all Latinos and all persons nationally, and their rates of hospitalization are comparable except for hospitalization for childbirth. Almost half of married undocumented Latinos have a child who is a U.S. citizen. Excluding undocumented immigrants from receiving government-funded health care services is unlikely to reduce the level of immigration and likely to affect the well-being of children who are U.S. citizens living in immigrant households.

Major increases in the resources devoted to the collection of health-related data and advances in survey methodology may be offset by more nonresponse and coverage bias resulting from privacy concerns, technological changes, and an increasingly complex health care environment. Hence, it is unclear whether policymakers today are basing their decisions on data that are of higher or even the same quality as those collected twenty-five years ago. We offer several recommendations for improving data quality, including changes related to Office of Management and Budget review, broad reexamination of the federal health survey portfolio, and greater investment in survey methods research. [PUBLICATION ABSTRACT]

We conducted a survey to learn about Americans' familiarity with specific technologies, their sources of information, and their trust in those sources. Our findings indicate a high degree of familiarity with common devices and procedures as well as a high level of interest in better understanding them. Americans are broadly supportive of new technology, but there was not blanket acceptance of all technologies. Family and friends are the main source of information on specific technologies, but a personal physician is identified as the most trusted source when Americans consider potential risks and benefits of using a new technology. [PUBLICATION ABSTRACT]

Objective: To assess local health department (LHD) capacity to serve diverse populations. Design: Data on 2300 LHDs (National Association of County and City Health Officials 2005 National Profile of LHDs) was linked with 2000 census data to make population profiles that characterized the degree of diversity present in jurisdictions. The LHDs with the most diverse populations were surveyed, and their actions to assess and adjust to the needs of culturally and linguistically diverse populations were examined. Setting: The researchers administered a questionnaire to LHDs by mail. Participants: For the population profiles, 2300 LHDs were included. Nearly 300 LHDs serving jurisdictions across the United States completed the survey. Main Outcome Measures: In the population profiles, diversity was measured through poverty rates, race/ethnicity, linguistic isolation, languages spoken, and immigration. The survey assessed the utilization of approaches for meeting needs of diverse subgroups, including administrative approaches, interpreter services and materials, special programs and partnerships, and workforce training. Results: For each diversity measure, the top decile of LHDs served jurisdictions with at least 20.3% of population in poverty, 3.4% recent immigrants, 43.5% nonwhite population, 4.5% linguistically isolated households, and 32 languages spoken. The vast majority of LHDs collect data on clients to identify needs, but less than 30% have conducted needs assessments. Most also have some form of interpreter services and translated materials, but only one-third do readability testing. The LHDs whose service area populations were the most diverse had a greater number of strategies in place to meet the needs of culturally and linguistically diverse populations, while smaller jurisdictions had fewer. Conclusions: Many LHDs have strategies in place to serve culturally and linguistically diverse clients, but implementation is uneven across jurisdictions, and challenges remain.

Instead of assessing support for specific health reform initiatives, this study examines fundamental attitudes that shape views about the provision and financing of health insurance. We find strong support for equity and expansion of coverage, with few differences across sociodemographic groups, but some support for holding individuals responsible for health-related behavior. Consumers want to retain choice of plans and coverage for routine expense yet not bear additional financial burden. Compared with the rest of the United States, Californians' views exhibit more reliance on individuals and provide additional caution about the difficulty of identifying acceptable trade-offs and reaching consensus. [PUBLICATION ABSTRACT]

Health care decisionmakers face increasing pressure to use health care resources more efficiently, but the information they need to assess policy options often is unavailable or not disseminated in a useful form. Findings from stakeholder meetings and a survey of private-sector health care decisionmakers in California begin to identify high-priority issues, the perceived adequacy of current information, and preferred formats and other desired attributes of research. This is a first step in establishing a systematic approach to linking the information priorities of private-sector decisionmakers with those who fund and conduct research. [PUBLICATION ABSTRACT]

Using the 1994 Robert Wood Johnson Foundation National Access to Care Survey, we examine the likelihood of having a usual source of care, inability to obtain needed care, and number of physician visits for persons with private insurance, Medicaid coverage, and no insurance. Inability to obtain services is surprisingly consistent: For each service, Medicaid enrollees were about half as likely as uninsured persons and about twice as likely as privately insured persons were to report difficulty. For other access measures, access for those on Medicaid more closely resembles that of the privately insured than that of the uninsured.

Instead of assessing support for specific health reform initiatives, this study examines fundamental attitudes that shape views about the provision and financing of health insurance. We find strong support for equity and expansion of coverage, with few differences across sociodemographic groups, but some support for holding individuals responsible for health-related behavior. Consumers want to retain choice of plans and coverage for routine expense yet not bear additional financial burden. Compared with the rest of the United States, Californians' views exhibit more reliance on individuals and provide additional caution about the difficulty of identifying acceptable trade-offs and reaching consensus. Adapted from the source document.

With health care costs, and insurance premiums in particular, escalating rapidly, we may see the reintroduction of utilization management strategies associated with managed care, which seemed destined for oblivion only a short time ago. Results from a survey to assess Americans' views of managed care cost containment strategies indicate mixed support: Despite an overall lack of confidence in managed care, Americans appear to be receptive to specific managed care practices. Those designing cost containment strategies must find a balance between imposing restrictions that moderate use and hold down costs and allowing consumers to retain some control over their own health care.