Assessing the effectiveness of state policy regimes on health-care costs, access, and efficiency.

다국어 초록 (Multilingual Abstract)

During the last decade, the burden on individuals, families, and businesses of prohibitive health-care costs-and lack of access to affordable health insurance-have motivated state decision makers to prioritize health-care issues on state public policy agendas. This research sought to determine how political ideologies, state administrative structures, and health-care policies affect health-care costs, access, and efficient use of resources. The study was conducted in two phases. First, states were categorized according to their approaches to health-care policy-making (expressed as policy regimes); and second, the direction and strength of influence of policy regimes on health system costs, access, and efficiency were tested.
Although the findings related to the impact of policy regimes on health system outcomes were unpersuasive, two major conclusions can be drawn from this research. First, the policy regime typology (as operationalized in this research) does not sort the states into discrete categories. States appear to possess combinations of policy regime characteristics that reflect the history of the incremental development of government resources.
Second, the impact of policy regimes on health system outcomes (as operationalized in this research) cannot be determined. The results for cost, access and efficiency models were insignificant. When the policy regime variables were transformed into three separate measures, the results for Ideology were strong enough to indicate that, as state ideology became more Liberal, access to health insurance increased and efficiency improved.
Of the control variables, measures for the supply of hospitals and physicians were the most significant for the cost model. According to the linear regression, as the supply of physicians and hospital beds increased, Per Capita Health-Care Expenditures increased. Under the linear model for Efficiency, the variable for hospital bed supply was significant, and Efficiency decreased as the hospital bed supply increased.
When the model for cost was revised to reflect percent change in expenditures, the Competitive Hospital Market variable was significant, and Percent Change in Expenditures decreased as the percent of population living in competitive hospital markets increased. A revised model for efficiency resulted in significance for the Average Personal Income variable. As the Average Personal Income increased, Efficiency increased.