Policy & Research

We believe that a broad approach is needed to improve the health of Kansans. To make sound decisions that optimize health, policymakers must understand how our health is influenced by a wide range of factors. Among these are the lifestyle choices we make, our socioeconomic status, our cultural diversity, the quality of our communities and schools and the financing, organization and effectiveness of our public health and health care systems.

KHI helps policymakers understand the linkages between these factors and the health of Kansans in several ways. We conduct research; provide policy analysis; convene conversations; and sponsor educational forums. This section highlights our recent work and our commitment to encouraging a comprehensive approach to health policy.

Featured Reports

The Growing Consequences of Inadequate Health Insurance

The Growing Consequences of Inadequate Health Insurance

0 | News Did You Know, Policy Did You Know, Health Insurance

While much attention has been devoted to uninsured Kansans, far less has been focused on the emerging problem of underinsurance. But recent research has begun to shed light on it.

Kansas County Health Rankings 2009

Kansas County Health Rankings 2009

0 | Community Health, Rankings-Indicators

This report, a first-of-its-kind for Kansas, ranks all 105 counties in the state according to the health and well-being of their citizens. And it demonstrates the extent to which factors other than health care influence our health.

Understanding the Health of Kansas Children

Understanding the Health of Kansas Children

0 | Child Health

There are many serious risks to a child’s health. Health risks are influenced by individual, family, neighborhood, school and community factors, as well as the physical environment. Effective economic, educational and health policies are also important to reduce children’s risk for illness and injury.

Kansans Not Following Nutrition Guidelines: Findings from the Kansas Health and Nutrition Survey

0 | Mar. 02, 2010 | Nutrition

A look at how well Kansans’ nutritional intake conforms to the national recommended dietary guidelines.

Scarce Resource Allocation Planning Documents for the State of Kansas

0 | Feb. 26, 2010 | Health Care Delivery

During a public health emergency, there is a need to have established plans with directions for maximizing the efficient use of available resources. KHI has drafted two reports, produced upon request from the Kansas Department of Health and Environment, that outline recommendations for developing these type of plans at the state, regional and local levels. KHI and KDHE are seeking feedback from stakeholders in reviewing and providing comments about these reports.

Testimony - Statewide Smoking Bans: A Research Perspective (2010 HB 2642)

0 | Feb. 11, 2010 | KHI Legislative Testimony, Tobacco

In testimony to the House Health and Human Services Committee, KHI summarizes the research about the impact of smoke-free policies.

When Health Insurance is Not Enough: Kansas and Underinsurance

0 | Feb. 10, 2010 | Health Insurance

A look at the factors associated with underinsurance and how certain insurance limitations impact Kansans.

Testimony - Use of the Kansas Birth Record Data for Monitoring the Health of Mothers and Infants (2010 SB 448)

0 | Feb. 09, 2010 | KHI Legislative Testimony

In testimony to the Senate Public Health and Welfare Committee, KHI discusses how birth record data can be used to monitor the health of mothers and infants in the state.

The Private Immunization Delivery System for Children in Kansas

0 | Dec. 23, 2009 | Immunizations

This update to a similar report from 2006 looks at the availability of private primary care clinics in Kansas that offer immunization services to children and identifies ways in which access to these services can be improved.

Federal Funding of Public Health Activities in Kansas

0 | Nov. 16, 2009 | Public Health Systems and Services

This report investigates how the levels of federal public health funding in Kansas compare with those in other states and identifies areas in which Kansas may have opportunities to expand funding.

Measures of Underinsurance: Kansas as an Example of State-Level Estimates

0 | Nov. 10, 2009 | Presentations, Health Insurance

This presentation describes the need for detailed, state-level data about the adequacy of health insurance plans.

The Road Toward Accreditation Through Regional Cooperation

0 | Nov. 10, 2009 | Presentations, Public Health Systems and Services

This presentation describes Kansas' work using the concept of regional cooperation to meet potential national accreditation standards for public health departments.

No Change in Kansas Uninsured Rate

0 | Sep. 18, 2009 | Child Health, Health Insurance

New data from the U.S. Census Bureau show that the percentage of Kansans without health insurance didn’t change significantly in the most recent reporting period. However, the percentage of Kansas children without coverage increased.

Promoting Changes to Improve Birth Outcomes: Kansas MLC-3 Experience

0 | Sep. 16, 2009 | Presentations, Public Health Systems and Services

This presentation describes Kansas' work in the Multi-state Learning Collaborative III. The MLC-3 project marks the second year Kansas has been involved with other states exploring potential impacts of efforts to construct national accreditation standards for public health departments.

Project Update: The Underinsured in Kansas

0 | Aug. 31, 2009 | Health Insurance

The goal of this initiative is to help policymakers better understand what it means to be underinsured and to determine the extent to which inadequate coverage is a problem in Kansas.

Early Learning in Kansas: The Impact of Kindergarten on Academic and Social Learning

0 | Aug. 28, 2009 | Child Health

A new assessment shows that children who attend full-day kindergarten make more progress during the school year than those in half-day kindergarten.

Infant mortality in Kansas: We can do better

0 | Jul. 17, 2009 | Presentations

Kansas has the 18th highest infant mortality rate in the nation, with more than 300 infant deaths in 2008. The rate is higher than in many developing countries, including Cuba and Croatia.

Evaluation of the Maximizing Office Based Immunizations in Kansas Program

0 | May. 11, 2009 | Presentations

Maximizing Office Based Immunizations in Kansas (MOBI-KS) is an educational program designed to improve immunization rates at physician offices. KHI evaluated the program to assess its effectiveness and to identify processes that can be improved.

More research from

Measurement Framework: Evaluating Efficiency Across Patient-Focused Episodes of Care

March 5, 2010

This consensus report lays the groundwork for a measurement framework that evaluates efficiency, and ultimately value, across patient-focused episodes of care. This framework will help key stakeholders move toward a high-performing healthcare system that is patient-centered, focused on quality, mindful of costs, and vigilant against waste.

The Massachusetts Child Psychiatry Access Project: Supporting Mental Health Treatment in Primary Care

March 3, 2010

Massachusetts has successfully demonstrated the Massachusetts Child Psychiatry Access Project, a program that provides timely telephonic psychiatric and clinical guidance to primary care providers treating children with mental health problems. This study looks into the development and implementation of the project.

Improving Asthma Outcomes in Minority Children: A Randomized, Controlled Trial of Parent Mentors

Feb. 26, 2010

This article looks an experimental program in Milwaukee that uses trained parent mentors to help other parents care for their young child's asthma.

Medicare Savings Programs: Analyzing Options for Expanding Eligibility

Feb. 25, 2010

Medicare savings programs are designed to provide financial assistance to Medicare beneficiaries whose income and assets are too high to allow them to qualify for full Medicaid coverage. This article examines policy changes that would expand eligibility by either relaxing resource requirements or increasing the income limit.

Hospital Cost of Care, Quality of Care, and Readmission Rates: Penny-Wise and Pound-Foolish

Feb. 22, 2010

A study of Medicare beneficiaries admitted to U.S. hospitals with congestive heart failure or pneumonia showed no definitive connection between the cost and quality of care, or between cost and death rates.

New York Times Examines Millennium Villages In Africa

March 9, 2010

The New York Times examines development and health improvements in Sauri, Kenya, which was the first Millennium Village in Africa, a project conceived by economist Jeffrey Sachs, which aims "to show that tightly focused, technology-based and relatively straightforward programs on a number of fronts simultaneously – health care, education, job training – could rapidly lift people out of poverty."

Haitian President To Meet With Obama As Long-Term Rebuilding Plans Take Shape

March 8, 2010

Haitian President Rene Preval is expected to meet with President Barack Obama Wednesday in the U.S. to ask for "billions of dollars to rebuild" Haiti, Agence France-Presse reports. The White House said that Obama will emphasize that the U.S. is a "friend and partner" to Haiti and discuss ways the international community could aid Haiti (Burleigh, 3/7).

Recent Releases In Global Health

Feb. 26, 2010

Also In Global Health News: Maize Loss In Zimbabwe; Preterm, Stillbirth Research; Public Health Insurance In Kenya

Feb. 24, 2010

WHO AFRO Delegation Travels To U.S. To Discuss Health Care Collaboration

Feb. 24, 2010

Luis Gomes Sambo, the WHO's regional director for Africa, "is in the U.S. this week" for meetings with senior health officials and development agency representatives to discuss collaborating on health, the New Times/allAfrica.com reports.

House Health Bill's High-Income Surcharge: A Reasonable Approach

July 17, 2009

Reforming the health care system to provide universal health coverage is an urgent priority. But, facing huge projected budget deficits that have the nation on an unsustainable fiscal path, the White House and Congress must enact a health reform plan that is also fully financed and that reduces the growth rate of health care costs over the long term. Policymakers have been considering two major proposals to help finance health care reform that represent sound tax policy: …

Allowing Multiple Insurance Exchanges in a Single Area Would Make It Harder To Obtain Affordable, Good-Quality Coverage

July 8, 2009

The new insurance exchanges that policymakers are contemplating as part of national health reform could greatly improve people’s access to affordable, decent-quality health insurance, reduce insurers’ ability to “cherry pick” healthy enrollees, and help reduce administrative costs within the health insurance market. But allowing multiple exchanges to participate in the same geographic area, as some have recommended, [1] would undermine these goals by …

Senate Finance Committee Faces Difficult Choices In Lowering Cost of Health Bill

July 1, 2009

The Senate Finance Committee is seeking to reduce the cost of its health reform bill to approximately $1 trillion over ten years. It faces difficult choices in doing so. Among the modifications it is considering are changes in the subsidies intended to enable low- and moderate-income families and individuals to afford insurance. Some of those changes would make it more difficult for moderate-income households — principally those between 300 percent and 400 percent …

Employer Requirement Under Consideration For Senate Finance Committee Health Bill Could Discourage Hiring of Low-Income, Minority, Disabled Workers

June 24, 2009

While an employer responsibility requirement is an essential component of health care reform, a proposal that the Senate Finance Committee and the Senate Health, Education, Labor, and Pensions Committee are considering for the forthcoming health legislation is flawed and would have serious unintended consequences, particularly for low-income and minority workers and workers with disabilities. [1] Under the new proposal, employers who do not offer their workers …

Some Media Reports Mischaracterize CBO Estimate of Senate “HELP” Health Reform Bill

June 16, 2009

The news media are widely reporting that, according to a partial and preliminary Congressional Budget Office (CBO) analysis, health reform legislation that the Senate Committee on Health, Education, Labor, and Pensions (HELP) is developing would cut the number of uninsured by only 16 million people while costing $1 trillion over ten years. That conclusion, however, is incorrect. The CBO analysis covers only a part of the HELP plan (the parts for which the Committee …

Obamas, Clinton Commemorate International Women's Day

March 9, 2010

Marking International Women's Day at the White House Monday, President Barack Obama vowed to fight for gender equality at home and abroad, Agence France-Presse reports. The president marked the event with First Lady Michelle Obama, Secretary of State Hillary Rodham Clinton and former Secretary of State Madeleine Albright, AFP reports.

Unequal Health Care, Neglect, And Sex-Selective Infanticide, Abortion Lead To Large Gender Gap In Asia, Report Finds

March 8, 2010

"Nearly 100 million women across Asia have 'disappeared' because of a huge and growing gender gap that has fatally deprived them of access to health care and food and has led to widespread abortions of female fetuses, according to a U.N. report released Monday," the Associated Press reports.

Global Fund Releases Latest Impact Data, Projections For Improving Global Health In Next Decade

March 8, 2010

By 2015, mother-to-child HIV transmission will be virtually eliminated and deaths from malaria and tuberculosis will continue to decline if health investments for the diseases are maintained or scaled up, according to an annual report published Monday by the Global Fund to Fight AIDS, Tuberculosis and Malaria, Agence France-Presse/Africasia.com reports (3/8).

Recent Releases In Global Health

March 5, 2010

Also In Global Health News: HIV In Philippines; Birth Control, Child Health In Afghanistan; Guatemala's Progress On MDGs

March 4, 2010

Editorial Board

April 1, 2010

A comparative analysis of remuneration models for pharmaceutical professional services

Nov. 30, 2009

Abstract: Objectives: Pharmacists provide a wide range of professional services to support the appropriate use of medicines by patients. This study aims to conduct an international, comparative analysis of remuneration models for pharmaceutical professional services.Methods: Information about remuneration models was derived from a literature review and a semi-structured questionnaire completed by experts.Results: Remuneration models differ in the way that pharmacists are paid for professional services beyond dispensing medicines. Also, the scope of services that are remunerated varies. The majority of countries regulate remuneration for services only when the medicine is paid for under the reimbursement scheme. Remuneration of services implies a commitment to assure their quality in some countries. Collaborative practice models have been set up where pharmacists work together with other health care professionals to deliver diagnosis-specific services or services based on the patient's use of medicines. The remuneration of services is influenced by the value of services, budgetary constraints, the payer perspective, and the attitude of physicians, pharmacists and patients.Conclusions: Professional organisations need to formulate a clear strategy for developing and gaining remuneration for pharmaceutical professional services. This implies that pharmacists not only demonstrate the value of services, but also assure their quality.

Public involvement at the design stage of primary health research: A narrative review of case examples

Dec. 7, 2009

Abstract: Objective: To review published examples of public involvement in research design, to synthesise the contributions made by members of the public, as well as the identified barriers, tensions and facilitating strategies.Design: Systematic literature search and narrative review.Findings: Seven papers were identified covering the following topics: breast-feeding, antiretroviral and nutrition interventions; paediatric resuscitation; exercise and cognitive behavioural therapy; hormone replacement therapy and breast cancer; stroke; and parents’ experiences of having a pre-term baby. Six papers reported public involvement in the development of a clinical trial, while one reported public involvement in the development of a mixed methods study. Group meetings were the most common method of public involvement. Contributions that members of the public made to research design were: review of consent procedures and patient information sheets; outcome suggestions; review of acceptability of data collection procedures; and recommendations on the timing of potential participants into the study and the timing of follow-up. Numerous barriers, tensions and facilitating strategies were identified.Conclusions: The issues raised here should assist researchers in developing research proposals with members of the public. Substantive and methodological directions for further research on the impact of public involvement in research design are set out.

Measuring moral hazard and adverse selection by propensity scoring in the mixed health care economy of Hong Kong

Nov. 20, 2009

Abstract: Objectives: To evaluate the presence of moral hazard, adjusted for the propensity to have self-purchased insurance policies, employer-based medical benefits, and welfare-associated medical benefits in Hong Kong.Methods: Based on 2005 population survey, we used logistic regression and zero-truncated negative binomial/Poisson regressions to assess the presence of moral hazard by comparing inpatient and outpatient utilization between insured and uninsured individuals. We fitted each enabling factor specific to the type of service covered, and adjusted for predisposing socioeconomic and demographic factors. We used a propensity score approach to account for potential adverse selection.Results: Employment-based benefits coverage was associated with increased access and intensity of use for both inpatient and outpatient care, except for public hospital use. Similarly, welfare-based coverage had comparable effect sizes as employment-based schemes, except for the total number of public ambulatory episodes. Self-purchased insurance facilitated access but did not apparently induce greater demand of services among ever users. Nevertheless, there was no evidence of moral hazard in public hospital use.Conclusions: Our findings suggest that employment-based benefits coverage lead to the greatest degree of moral hazard in Hong Kong. Future studies should focus on confirming these observational findings using a randomized design.

What prevents young adolescents from smoking? Self-reported motives of 12–15-year-old non-smokers

Nov. 23, 2009

Abstract: Objectives: This study investigated the real motives of German non-smokers.Methods: In the German SToP (“Sources of Tobacco for Pupils”) Study 707 non-smoking pupils were asked to write down their motives for being non-smokers. A total of 1324 partially very elaborate free text statements (mean/range: 1.9/1–7 distinguishable motives) were evaluated in a qualitative content analysis.Results: The most important and frequently mentioned motives for not smoking were health-related arguments (78.1%). Except for cancer significant main health risks of tobacco consumption like cardio- and cerebrovascular diseases or COPD were hardly perceived. Further important reasons were an aesthetic aversion (38.6%), missing perception of a benefit (25.2%), and economic motives (20.8%). Girls and pupils from academic high schools named aesthetic motives significantly more often than boys and pupils from secondary schools respectively. A historical comparison shows that the motive “lacking benefit” reached a higher rank in our study than in the 1990s.Conclusions: When non-smokers are asked directly, extrinsic reasons (restrictions, smoking bans) do not seem to be relevant for them. Reasons concerning health, good physical shape, and beauty should be a central argument in the medical practise with young smokers.

Specialized Care Of Overweight Children In Community Health Centers [Web First]

March 2, 2010

We have developed a new approach to child obesity that supports the delivery of so-called secondary care—referral-based specialized visits—by primary care teams within community health centers. The Healthy Weight Clinic reorganizes care to provide access to a trained team consisting of a pediatric provider, nutritionist, and case manager during dedicated weight management visits. Our model improves obesity care by promoting local specialization and increasing capacity for specialized care; building multidisciplinary teams within primary care; focusing on health behavior change as a critical determinant of chronic disease outcomes; and using health information technology to promote high-quality care.

The Child Abuse We Inflict Through Child Obesity [From The Editor-in-Chief]

March 2, 2010

Health Centers Fill Critical Gap, Enjoy Support [Entry Point]

March 2, 2010

Health Affairs founding editor John K. Iglehart writes about federally qualified community health centers and their increasingly important role as safety-net providers.

People & Places [People & Places]

March 2, 2010

National, State, And Local Disparities In Childhood Obesity [Worsening Trends, Action Agenda]

March 2, 2010

New data from the 2007 National Survey of Children’s Health show that the percentage of children ages 10–17 who are overweight (body mass index in the eighty-fifth to ninety-fourth percentiles) remained stable, while the national prevalence of obesity (BMI in the ninety-fifth percentile and higher) grew significantly, from 14.8 percent in 2003 to 16.4 percent in 2007. This increase in obesity accounted for the entire increase in the combined prevalence of overweight and obesity between 2003 and 2007 (from 30.6 percent to 31.6 percent). An estimated 10.58 million children, or nearly one in three children ages 10–17, were overweight or obese in 2007. Our findings suggest that the obesity epidemic among children may not yet have reached its plateau for some groups of children. The data also reveal persistent and highly variable disparities in childhood overweight and obesity within and among states, associated with socioeconomic status, school outcomes, neighborhoods, type of health insurance, and quality of care. This requires policy makers’ attention nationally and within states.

AIDS in America -- Forgotten but Not Gone

Feb. 10, 2010

(No abstract is available for this citation)

Five Next Steps for a New National Program for Comparative-Effectiveness Research

Feb. 17, 2010

(No abstract is available for this citation)

The FDA and Safe Use of Long-Acting Beta-Agonists in the Treatment of Asthma

Feb. 24, 2010

(No abstract is available for this citation)

Contaminated Heparin Associated with Adverse Clinical Events and Activation of the Contact System and Outbreak of Adverse Reactions Associated with Contaminated Heparin

Feb. 24, 2010

(No abstract is available for this citation)

Choosing Asthma Step-up Care

March 3, 2010

(No abstract is available for this citation)

Accessing Healthy & Affordable Food

March 9, 2010

Strategies make healthy, affordable food available in in communities across the country.

APHA's Get Ready Campaign: Set Your Clocks, Check Your Stocks

March 9, 2010

APHA's Get Ready campaign reminds everyone to check preparedness kits when changing clocks to daylight savings time on March 14, 2010.

ASTMH 59th Annual Meeting

March 9, 2010

November 3-7, 2010, Atlanta, GA

CDC Recruiting Candidates for Public Health Apprentice Program

March 9, 2010

The CDC is recruiting Public Health Apprentice Program (PHAP) candidates and identifying assignments for 50 new apprenticeships throughout the United States. Applications are due March 8, 2010.

CDC Releases County Level Report on Heart Disease Hospitalizations

March 9, 2010

A new report released by the CDC shows that heart disease hospitalization rates among Americans aged 65 years and older vary substantially depending on where they live.

Senate Delays Medicare Pay Cut Until October 1

March 10, 2010

If the House concurs and President Obama signs the measure into law, it will be the third time in 4 months that lawmakers have postponed the reduction. Medscape Medical News

Medicare Part D Has Not Improved Access to Medication Among Beneficiaries With Depression

March 10, 2010

Access to medication has not improved among Medicare beneficiaries with depressive symptoms despite efforts to do with the introduction of Medicare Part D. Medscape Medical News

Transcranial Magnetic Stimulation Reduces Pain of Migraine With Aura

March 10, 2010

Electrical field could reduce corticol spreading depression involved in migraine with aura. Medscape Medical News

Going Regional? Think Local. New Study Probes Overlap Between PCI and Non-PCI Hospitals

March 10, 2010

A Medicare analysis looking at 30-day mortality between hospitals offering PCI and those that don't hints that policy-makers looking to regionalize AMI care need to take into account what works and what doesn't at a local level. Heartwire

Components of Metabolic Syndrome Linked to Plaque Progression

March 10, 2010

A new IVUS study has found that although the metabolic syndrome is associated with accelerated plaque progression, this can be attributed to its individual component risk factors rather than the syndrome itself. Heartwire

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Did you know?

What is underinsurance?

Being underinsured means someone has inadequate health insurance coverage to address the financial expenses associated with health care services, resulting in financial strain, medical debt, or postponing needed care due to cost.