Julie Leask and colleagues in Australia published a paper, “Communicating with parents about vaccination: a framework for health professionals,” in BMC Pediatrics in 2012 that recently came to attention and is worth revisiting if you have not seen it or simply need a refresher.
Based on a review of the literature, the researchers describe five groups of parents related to attitudes about vaccination and the relative proportion of parents in each category:
In addition to describing each of these groups, the authors discussed the importance of building a relationship with parents, providing appropriate information and tailoring discussions to the needs of the individual patient or family. Goals and strategies for each group were also discussed and sample dialogues provided.
The article is available for free access courtesy of BioMed Central.
Editor’s note: David Rubin, MD, MSCE and Kathleen Noonan, JD, the co-directors of the PolicyLab at The Children's Hospital of Philadelphia presented Grand Rounds for CHOP staff in January 2014. PolicyLab is a center of emphasis at CHOP focused on health services and health policy research with a mission of “evidence to action.” This article is based on notes taken during the Grand Rounds presentation.
As we begin 2014, several critical components of the Affordable Care Act (ACA) will go into effect raising questions about which changes are taking place and how the landscape of healthcare will change over time. In 2010, when the ACA passed, approximately 50 million people in the United States were uninsured. Most of these people were adults; in fact, at the time of passage, about 90 percent of children had medical coverage, but only about 78 percent of adults did. Further, a large group of uninsured adults were between the ages of 18 and 35 years of age.
According to the Congressional Budget Office, the costs associated with the uninsured were about $43 billion in unreimbursed healthcare charges. In addition, the healthcare industry spent approximately $90 billion dollars in administrative costs associated with underwriting who was eligible for coverage. By 2010, healthcare costs represented about 16 percent of our gross domestic product (GDP) and were increasing.
A main goal of the ACA was to increase coverage thereby decreasing the costs associated with the uninsured, allowing for redirection of funds being spent by insurers and slowing the rate of increase to the GDP.
As written, the ACA would have allowed 32 of the 50 million uninsured persons to enter the insurance marketplace. This would have been accomplished by the implementation of individual mandates, abolition of pre-existing conditions policies, addition of employer penalties for non-coverage of employees and expansion of Medicaid. Two of these have been challenged legally – individual mandates and expansion of Medicaid:
The result of the difference between ACA as written and as implemented after the Supreme Court decision is unintended coverage gaps:
Like any new legislation, implementation of the ACA will not be without hurdles, and modifications to the law are likely. The ACA is, nonetheless, unprecedented in its intention to close the health insurance coverage gap in the United States. Further, the law makes it imperative that healthcare providers focus on providing high-quality, affordable care in a standardized, evidence-based environment. Finally, the law expands the importance of prevention and overall population health and requires providers to plan and provide care through this lens.
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