Louisiana State University Health Science Center

How much responsibility for providing health care to the poor should be devolved from the federal government to the states? Any answer to this critical policy question requires a careful assessment of the Medicaid program. Drawing on the insights of leading scholars and top state health care officials, this volume analyzes the policy and management implications of various options for Medicaid devolution. Proponents of devolution typically express confidence that states can meet the challenges it will pose for them. But, as this book shows, the degree to which states have the capacity and commitment to use enhanced discretion to sustain or improve health care for the poor remains an open question. Their failure to attend to issues of politics, implementation, and management could lead to disappointment. Chapters focus on such topics as Medicaid financing, benefits and beneficiaries, long-term care, managed care, safety net providers, and the appropriate division of labor between the federal government and the states. The contributors are Donald Boyd, Center for the Study of the States; Lawrence D. Brown, Columbia University; James R. Fossett, Rockefeller College; Richard P. Nathan, Nelson A. Rockefeller Institute of Government, State University of New York, Albany; Michael Sparer, Columbia University; James Tallon, United Hospital Fund; and Joshua M. Weiner, the Urban Institute.

Migration from less-developed nations to the United States and Western Europe is steadily increasing, and it is unlikely that this trend will reverse. There are currently over a hundred million immigrants worldwide. And many of these immigrants are in a condition of poverty or near poverty, while many also suffer from poor health. The articles in this collection address the health conditions of international labor migrants and the availability and limitations of human and health services for them. Written by leading social scientists and health professionals from both the United States and the European Union, six of the articles focus on Europe, three on the United States, and two on psychological issues related to immigration. The contributors to this volume, representing a wide variety of disciplines (including medicine, social work, political science, sociology, anthropology, psychology, and biology), are in agreement that the health and human services offered in industrial nations are generally monocultural, and not well suited for migrants from other cultures. One article even arrives at the disquieting conclusion that the mental health services offered to immigrants not only do not respond to their needs, but rather serve to reinforce negative perceptions regarding immigrants from third-world countries. This book represents a timely and urgently needed contribution to the discourse on health services for migrants. It demonstrates that the issues and problems of immigration in the United States and Europe have many commonalities and that much can be learned from examining the experiences, successes, and failures of both. Antonio Ugalde is Professor of Sociology at the University ofTexas at Austin and Adjunct Professor at the School of Public Health, University of Texas Health Science Center at Houston.