HIGHLIGHTS OF STUDIES APPEARING IN THE SEPTEMBER/OCTOBER
ISSUE OF HEALTH AFFAIRS

• Access To Postacute Nursing Home Care Before And After The BBA, by Joseph Angelelli, David Gifford, Orna Intrator, Pedro Gozalo, Linda Laliberte, and Vincent Mor. Contrary to expectations, nursing home patients have not suffered from the enactment of a prospective payment system (PPS) put in place by the 1997 Balanced Budget Act (BBA). In a review of all Medicare Part A hospital and nursing facility claims for providers in Ohio, researchers found that the BBA-mandated per diem rate for Medicare patients did not lead nursing homes to deny any care to their patients, not even to the most costly patients. However, researchers say that continued monitoring of the PPS is needed because the potential for nursing facilities to deny care to seriously ill, more costly patients does exist.
  
  
• Employing Persons With Serious Mental Illness, by David Mechanic, Scott Bilder, and Donna D. McAlpine. Authors reviewed a number of national surveys and found that half of all mentally ill people are gainfully employed across a wide range of occupations. As a matter of fact, their employment profile isn't much different from that of the average worker. People with more serious mental illness are less likely to be employed and hold steady jobs but 12 % of schizophrenics work full time, some in high functioning positions. Researchers also found that educational attainment is the greatest predictor of employment for the mentally ill. For example, mentally ill people with a post college education are 43 times more likely to be employed. Authors recommend that mental health services and supports be provided to keep the mentally ill in competitive employment, and that education completion be made a priority for mentally ill patients.
  
  
• The Benefits Divide: Health Care Purchasing In Retail Versus Other Sectors, by James Maxwell, Peter Temin, and Saminaz Zaman. Retail workers pay more for coverage and are less likely to receive health care coverage from their employers or to receive coverage after retirement than employees in other Fortune 500 Companies. In the first ever comparison of health care purchasing in retail versus other sectors of the Fortune 500, authors found a nearly fivefold difference in offer rates for health care coverage. Authors conclude that reliance on high-turnover, low-wage, part-time workers makes it difficult for retail employers to provide health care coverage to a large segment of their employees. They recommend that policymakers consider business type rather than business size when creating policies to make insurance coverage more affordable. This would ensure that low-wage workers receive coverage regardless of the size of the company for which they work.

Health Affairs, published by Project HOPE, is a bimonthly, multidisciplinary journal devoted to publishing the leading edge in health policy thought and research. Copies of the journal are free to interested members of the press. Address inquiries to Jon Gardner at Health Affairs, 301-656-7401, ext. 230, or via e-mail, press@healthaffairs.org. Selected articles from the September/October issue are available free on the journal's Web site, www.healthaffairs.org.

©2002 Project HOPE–The People-to-People Health Foundation, Inc.