San Diego: Major Providers Pursue Countywide Networks and New Patient Care Models

San Diego has long been a geographically well-defined health care market with high managed care penetration and a consolidated provider sector. In recent years, hospital systems have faced increasing cost pressures as commercial health plans have responded to employer demands for more affordable premiums. Safety-net providers expanded capacity to deal with the large Medi-Cal expansion that began in 2014, but continue to grapple with how to provide adequate care for a new enrollee population that is far sicker, with more complex medical and social service needs, than the providers' previous patient base.Key developments include:While the hospital market remained largely stable in recent years, most of the smaller hospitals have been losing volume and struggling financially.Major systems are pursuing population health strategies and increasingly using provider-sponsored health plans to take full risk for more patients.The challenges of independent practice are leading many primary care physicians to choose employment at system-affiliated groups.In the two years since Medicaid eligibility was first expanded under the ACA, San Diego's Medi-Cal managed care enrollment almost doubled to 700,000. Many Medi-Cal enrollees without a regular primary care provider sought care at hospital emergency departments, and access gaps for many kinds of specialty care and behavioral health care were even more severe.San Diego County's commitment to providing health care for low-income residents continues to be limited, although the county Health and Human Services Agency has become more active in fostering collaborations between health and other social services

Orange County: Changing Market Fuels New Models of Provider Collaboration

Since 2010, Orange County has largely recovered from the economic downturn and remains a relatively well-educated community with high rates of private insurance coverage overall. Socioeconomic variation persists in this county, with the number of low-income residents growing and a large jump in the proportion of the population that gained Medi-Cal coverage under the Affordable Care Act (ACA). Other key findings include:The region's major hospital systems are expanding ambulatory services and geographic reach.Orange County physicians are increasingly giving up independence to varying degrees and joining larger physician organizations or hospital-affiliated groups to gain shelter from mounting financial pressures and administrative burdens.Providers are collaborating on new payment arrangements, with some Orange County physician organizations and hospitals working toward assuming more risk for more patients, particularly the growing numbers in preferred-provider organizations (PPOs).The proportion of Orange County residents covered by Medi-Cal has jumped, with a greater proportional increase in Medi-Cal enrollment than other California regions studied.Safety-net provider capacity is tight; private providers are playing a significant role in serving the Medi-Cal expansion population

An Investigation into the Use of Validities and Fallacies in State of the Union Addresses as a Function of Political Popularity and Policy Issue

State of the Union addresses have always allowed presents to argue their views on policy issues. Arguments, however, even those in presidential speeches, can rely on fallacies as well as valid statements. This investigation sought to find a correlation between the validity/fallacy ratio in each speech and the president’s average approval rating over the two months prior to the address. State of the Union speeches were selected from Franklin Roosevelt to George W. Bush and the ratio of the number of lines of validities to fallacies was calculated for each speech. A high approval rating had a weak positive association with a high validity/fallacy ratio (few fallacies per validity), yet the correlation was obscured by outliers. When validity/fallacy ratios were calculated for various policy issues, the issues generally considered the most urgent had a low validity/fallacy ratio (many fallacies per validity), while the more distant issues had higher validity/fallacy ratios. The difference between the two types of issues was found to be statistically significant (p <0.05). The discrepancy is explained by the different audiences towards which the president directs each argument—fallacies to the public on urgent issues and logical arguments to Congressmen on more distant ones.College of William and Mary, Roy C. Charles Center, James Monroe Scholar Progra

Policy Implications of a National Public Opinion Survey on Abortion in Mexico

In Mexico, recent political events have drawn increased public attention to the subject of abortion. In 2000, using a national probability sample, we surveyed 3,000 Mexicans aged 15-65 about their knowledge and opinions on abortion. Forty-five per cent knew that abortion was sometimes legal in their state, and 79% felt that abortion should be legal in some circumstances. A majority of participants believed that abortion should be legal when a woman\u27s life is at risk (82%), a woman\u27s health is in danger (76%), pregnancy results from rape (64%) or there is a risk of fetal impairment (53%). Far fewer respondents supported legal abortion when a woman is a minor (21%), for economic reasons (17%), when a woman is single (11%) or because of contraceptive failure (11%). In spite of the influence of the Church, most Mexican Catholics believed the Church and legislators\u27 personal religious beliefs should not factor into abortion legislation, and most supported provision of abortions in public health services in cases when abortion is legal. To improve safe, legal abortion access in Mexico, efforts should focus on increasing public knowledge of legal abortion, decreasing the Church\u27s political influence on abortion legislation, reducing the social stigma associated with sexuality and abortion, and training health care providers to offer safe, legal abortions

Comparing the Sexual Reproductive Success of Two Exotic Trees Invading Spanish Riparian Forests vs. a Native Reference

A widely accepted hypothesis in invasion ecology is that invasive species have higher survival through the early stages of establishment than do non-invasive species. In this study we explore the hypothesis that the sexual reproductive success of the invasive trees Ailanthus altissima (Mill.) Swingle and Robinia pseudoacacia L. is higher than that of the native Fraxinus angustifolia Vahl., all three species coexisting within the riparian forests of Central Spain. We compared different stages of the early life cycle, namely seed rain, seed infestation by insects, seed removal by local fauna, seed germination under optimal conditions and seedling abundance between the two invasive trees and the native, in order to assess their sexual reproductive success. The exotic species did not differ from the native reference (all three species displaying high seed rain and undergoing seed losses up to 50% due to seed removal by the local fauna). Even if the exotic R. pseudoacacia showed a high percentage of empty and insect-parasited seeds along with a low seedling emergence and the exotic A. altissima was the species with more viable seeds and of higher germinability, no differences were found regarding these variables when comparing them with the native F. angustifolia. Unsuitable conditions might have hampered either seedling emergence and survival, as seedling abundance in the field was lower than expected in all species -especially in R. pseudoacacia-. Our results rather suggest that the sexual reproductive success was not higher in the exotic trees than in the native reference, but studies focusing on long-term recruitment would help to shed light on this issue