Political strategies of safety-net providers in response to medicaid managed care reforms

The Relationship of Financial Pressures and Community Characteristics to Closure of Private Safety Net Clinics

In order to better understand what threatens vulnerable populations' access to primary care, it is important to understand the factors associated with closing safety net clinics. This article examines how a clinic's financial position, productivity, and community characteristics are associated with its risk of closure. We examine patterns of closures among private-run primary care clinics (PCCs) in California between 2006 and 2012. We use a discrete-time proportional hazard model to assess relative hazard ratios of covariates, and a random-effect hazard model to adjust for unobserved heterogeneity among PCCs. We find that lower net income from patient care, smaller amount of government grants, and lower productivity were associated with significantly higher risk of PCC closure. We also find that federally qualified health centers and nonfederally qualified health centers generally faced the same risk factors of closure. These results underscore the critical role of financial incentives in the long-term viability of safety net clinics.

Priority setting and policy advocacy by nursing associations: a scoping review and implications using a socio-ecological whole systems lens

OBJECTIVE

We undertook an interpretative scoping review to examine organizational priority setting and policy advocacy and the factors that influence nursing associations' cross-sector public policy choices and actions.

METHOD

Evidence was drawn from research, narrative, and theoretical sources that described priority setting and policy advocacy undertaken by non-governmental, non-profit, and nursing associations. Text was extracted from selected papers, imported into NVivo 8, coded, and analyzed using a descriptive-analytical narrative method.

RESULTS

Many internal and external factors are shown to shape organizations' policy choices and actions including governance and governance structures, membership arrangements, legislative, professional, and jurisdictional mandates, perceived credibility, and external system disruptions.

CONCLUSIONS

Internal and external factors are identified in the literature as critical to how organizations succeed or fail to set achievable priorities and advance their advocacy goals. Case comparisons and longitudinal research are needed to understand nursing associations' policy choices and actions for cross-sector public policy given their complex organizational structures and dynamic professional-legal-social-economic-political-ecological environments. A socio-ecological systems perspective can inform the development of theoretical frameworks and research to understand leverage points and blockages to guide nursing associations' public policy choices and actions at varying points in time.