Investigator Awards In Health Policy Research 53 Bay State Road
Boston University Health Policy Institute
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Investigators And Their Projects » Awards by Year:
Section Info
This section contains information about all of the projects and researchers that have been funded through the Investigator Awards program since the first grants were made in 1993. The indexes in this section can be used to identify investigators by name, area of expertise, or year of award. Throughout the site, you will find that each investigator’s name links to details including contact and project information.
»List Projects awarded in
Projects Awarded in 1993:
Investigator names link to complete details.
Richard G. Frank, Ph.D.
Thomas G. McGuire, Ph.D.		Integrating Mental Health and Substance Abuse Treatment Services into Health Care
Award Year: 1993

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This project develops a strategy to fully integrate mental health and substance abuse (MH/SA) services into the medical care system. An alternative to the current complex and fragmented mix of public/private sector services and financing for seriously mentally ill persons and substance abusers will be outlined. The costs of full integration as well as the political, social, and clinical developments that provide the basis for mainstreaming MH/SA care are addressed. The project considers how full integration radically reshapes the existing institutions paying for and providing MH/SA care. The complex technical and political-economic issues that arise with full integration are studied in a concrete fashion through a series of six case studies of states. A state-level simulation model is developed, illuminating the effects of full integration on the affected parties.
Annetine C. Gelijns, J.D., LL.M., Ph.D.Medical Technology in an Era of Limits
Award Year: 1993

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Dr. Gelijns provides insight into the forces that drive the rate and direction of technological change in medicine. She also examines which policy mechanisms have the most potential to encourage continued medical innovation and contain health care costs. The study focuses on: the basic mechanisms underlying medical research and development (R&D) and diffusion; conditions governing the supply and demand for new technologies; and the examination of supply-side considerations to gain a better understanding of the role played by medical technology in contributing to rising health care costs. Using cross-national comparisons, this project considers several of the most important areas of innovation in medicine. It focuses on the analysis of specific clinical conditions and the contexts from which technologies emerge. Alternative technological solutions, underlying patterns of medical specialization, and competition among medical specialists are also addressed.
Lawrence R. Jacobs, Ph.D.Democracy, Leadership and Health Care
Award Year: 1993

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Dr. Jacobs develops a theoretical framework for conceptualizing the relationship between national policymakers and public opinion in relation to the debate over health care reform. He investigates the relationship between public opinion, media coverage, and the decisions of Congress and the Clinton administration. Questions about what type of opinion-policy relationship should exist in a democracy are addressed, including whether policy leaders, in designing current health policy, are responding to public opinion or directing it. The project also explores: mass media coverage of health care; media's influence on the issues that people identify as important; the policy directions they favor; and the accuracy of the media's interpretations of public opinion polls. Extensive analysis of polling data, President Clinton's policy statements, Congressional records, media coverage, and interviews with key policymakers is undertaken. Robert Y. Shapiro, Associate Professor of Political Science at Columbia University, collaborates.
Michael L. Millenson, A.B.Measuring Medicine: A Critical Assessment of the Application of Medical Quality Research to Patient Care
Award Year: 1993

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This project examines the medical-quality management and measurement movement and evaluates current state-of-the-art language, understandable to employers, policymakers, and the lay public. It presents a common framework bringing medical-quality issues into the mainstream of the debate over the future of America's health care system. A literature search, field observations of those at the cutting edge of quality measurement and management efforts, and extensive interviews with experts are used. A conceptual framework is developed for combining pieces of the medical-quality puzzle including: health status questionnaires for ambulatory care; computerized monitoring of intensive care; and process standardization of routine inpatient care. The overall focus is on how this knowledge can change patients' lives.
Thomas R. Oliver, Ph.D., M.H.A.Public Entrepreneurship and Health Policy Innovation
Award Year: 1993

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Dr. Oliver conducts a systematic analysis of innovative leadership in health policy. He examines the characteristics, activities, and functions of public entrepreneurs individual leaders who help establish new goals, procedures, organizations, or programs in the public sector. He develops: 1) a conceptual foundation for analyzing public entrepreneurship and its contribution to health policy innovation; and 2) exemplary case studies of innovations from various areas of health policy and levels of government. The study distinguishes entrepreneurs from other participants in policy innovation and clarifies the cognition, motivations, resources, and strategies of entrepreneurs. An embedded, multiple-case research design is intended to test and generate theoretical propositions about public entrepreneurship and the process of innovation. This applied social science research provides a better understanding of individuals who think creatively about problems in health care and public health, and how they pursue change through public policy.
James C. Robinson, Ph.D.An Institutional Economics of Health Care System Integration
Award Year: 1993

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This project results in a conceptual framework for understanding the transformation of the health care delivery system from a fragmented cottage industry to a competitive market of integrated delivery systems. Detailed case studies of the leading health care organizations in California are developed with emphasis placed on the evolving relationships between primary care physicians, specialists, and hospitals. The strengths and weaknesses of alternative methods of coordination for each type of provider and facility including unified ownership, joint ventures, complex contracting, and arms-length purchasing are evaluated. Particular attention is given to financial and non-financial incentives pioneered by integrated delivery systems to promote cost-consciousness and continuous quality improvement by physicians. The study builds on the core concepts of new institutional economics including principal-agent models and transactions cost economics and applies them to the health care sector.
Mark J. Schlesinger, Ph.D.Metaphors and Health Policy: The Influence of Public Values and Perception on Policymaking
Award Year: 1993

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Dr. Schlesinger examines ways in which perceptions and values in the form of four metaphors for health care affect public attitudes and the policymaking process. The metaphors represent four dominant ways in which people view the health care system: 1) as a societal right; 2) as a community responsibility; 3) as a professional service; and 4) as a marketable commodity. The project operates on and tests the belief that Americans formulate their goals for the health care system in terms of these four metaphors, providing the primary standards against which government health policies are judged. It further explores whether the many failures of contemporary policymaking can be traced to flaws in the ways that particular metaphors are linked to policies or to conflicts among competing metaphors. A conceptual framework for interpreting the role of these four metaphors in popular thinking and policymaking is developed through historical review of their role in shaping federal policy as well as application of the model to current health policy issues.
W. Richard Scott, Ph.D.Development and Evaluation of an Integrated Theoretical Model of Changes in the Organization of Medical Care
Award Year: 1993

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This study elaborates upon and empirically evaluates an integrated theoretical framework designed to depict and better account for changes in the organization of the U.S. medical care delivery system during the past three decades. It includes and synthesizes important developments in organization theory including contingency theory, resource dependence, population ecology, transaction costs economics, and institutional theory and illuminates fundamental changes that have occurred in medical care organizations since 1960. Major organization theories and existing empirical research on medical care organizations are evaluated. A data base on changes occurring in the medical services sector in the San Francisco Bay area from 1960 to 1995 are assembled and analyzed to support the testing of hypotheses drawn from a variety of theoretical perspectives.
Theda Skocpol, Ph.D.Health Care Reforms in the United States: Institutions, Alliances, and Policy Feedbacks
Award Year: 1993

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This project examines major episodes of actual and attempted U.S. health care reforms, dating from the 1930s to the 1990s. It analyzes changes and continuities in institutional contexts, political alliances, and policy feedbacks, i.e., the effects of earlier policies on later policymaking. It provides an intellectual framework for considering change in institutional and political contexts, within which reforms are debated and (if enacted) implemented, and analyzes their effects on subsequent political dynamics and reform. The analysis deals with the past for its own sake as well as large-scale institutional and political processes. It critically examines the strategic choices, successes, and errors of reform-minded experts. It draws clear lessons for advocates of broadening social access and controlling health care costs to use in strategic political choices during the 1990s and early 2000s.
Carol S. Weisman, Ph.D.Toward a Women’s Health Policy: Exploring Gender Issues in U.S. Health Care
Award Year: 1993

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Dr. Weisman critically examines contemporary issues in women's health care in the U.S., enabling policymakers and providers to improve services within the context of health care reform. She examines and reformulates conceptions of equity and appropriateness regarding women's health care; considers the evidence for gender inequities that place women at a disadvantage in the health care system (financial and non-financial access, utilization patterns, treatment outcomes); and examines the evidence that women do not receive appropriate health care (definitions of primary care, recommended guidelines, satisfaction). She specifies the implications for health services research, design and management of health services, and formulation of a comprehensive women's health policy within the context of health care reform. Previous research and data are critically reviewed and synthesized, while selected new analyses are applied to formulate policy-relevant recommendations.