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States include genetics services among their public health programs, but budget shortfalls raise the question, is genetics an essential part of public health? We used the Essential Services of Public Health consensus statement and data from state genetics plans to analyze states' public health genetics programs. Public health genetics programs fulfill(More)
Public employers provide health insurance coverage to nearly 16 percent of all U.S. workers. Their reactions to rapidly rising premiums can have an important effect on local markets for health insurance because of their size, their visibility, and their reflection of public policy. However, public employers are constrained in their responses by tight(More)
This literature review of 46 articles uses the ecological model as a framework for organizing concepts and themes related to health care transition among youth with disabilities or special health care needs (SHCN). Transition involves interactions in immediate and distal environmental systems. Important interactions in immediate environments include those(More)
OBJECTIVES Washington was the first state to require insurance companies to cover all categories of licensed providers. The purpose of this paper was to examine the effect of Washington's law on coverage decisions of major health plans. DESIGN The study uses literature and document review as well as key informant interviews. SETTINGS/LOCATION The study(More)
Despite large premium increases, employers made only modest changes to health benefits in the past two years. By increasing copayments and deductibles and changing their pharmacy benefits, employers shifted costs to those who use services. Employers recognize these changes as short-term fixes, but most have not developed strategies for the future. Although(More)
PURPOSE To analyze genetic clinic utilization in Washington State and to explore factors associated with utilization. METHODS Our analysis included data from the 9 of 15 genetic clinics that consistently reported to the Washington State Minimum Data Set between 1995 and 2004. Prenatal genetics services were excluded. We described utilization with yearly(More)
BACKGROUND Growing interest in the promise of patient-centered care has led to numerous health care innovations, including the patient-centered medical home, shared decision-making, and payment reforms. How best to vet and adopt innovations is an open question. Washington State has been a leader in health care reform and is a rich laboratory for(More)
BACKGROUND Since 1996, Washington State law has required that private health insurance cover licensed complementary and alternative medicine (CAM) providers. OBJECTIVE To evaluate how insured people used CAM providers and what role this played in healthcare utilization and expenditures. STUDY DESIGN Cross-sectional analysis of insurance enrollees from(More)
BACKGROUND Patient-centered innovation is spreading at the federal and state levels. A conceptual framework can help frame real-world examples and extract systematic learning from an array of innovative applications currently underway. The statutory, economic, and political environment in Washington State offers a special contextual laboratory for observing(More)
To compare insured youth (age 15-25 years) with and without disabilities on risk of insurance loss. We conducted a cross-sectional study using data from the Survey of Income and Program Participation 2001. Descriptive statistics characterized insured youth who maintained and lost insurance for at least 3 months over a 3-year time frame. We conducted(More)