Summaries of Independent Scientist (K) Awards

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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