Keane, Christopher
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
Duration: 3 years (2003-2008)
Total Award: $350,300
Project Description: The proposed research will
examine 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 will further examine
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.
This research will aid development of
strategies for improving access to health services among 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 independently conduct high quality research that will
leverage improvements in access to health services. A related career goal is to advance
theoretical understanding of transformations of public health and medical
systems, and how these changes affect access to services by vulnerable
populations.
Progress to Date: Dr. Keane has begun to publish findings on charity
care and safety-net services and to translate these into decisionmaking
guidelines. Using data on hundreds of local healthcare areas, Dr. Keane has
identified typical problems in coordinating provision of charity and safety-net
services to the vulnerable. Based on his
early findings, he is modeling decisionmaking using cognitive decision-trees
and evolutionary game theory. Dr. Keane
has developed a framework to help healthcare decisionmakers solve problems in
delivering and coordinating services to the uninsured and other vulnerable
groups. He has published early findings.
Future Plans: Dr. Keane is preparing additional
publications, developing a R01 to apply his model to specific disease
management problems, and developing
guides for healthcare decisionmakers.
Highlights and Specific
Accomplishments: Dr. Keane is
developing 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 minority populations.
- 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.
- A 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.
K-Generated Publications:
- Keane C. 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.
AHRQ Research Portfolios: Socio-economics of Health
Care; Training.
AHRQ Goals: Efficiency
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