As more and more states begin targeting insurance reform, the costs and problems they face become increasing evident. Still, the current system of health-insurance coverage in the U.S. has been "crumbling for 30 years," says Bradford Kirkmann-Liff, a professor in the School of Health Management and Policy at the W. P. Carey School of Business. In part two of Knowledge@W. P. Carey's coverage of state health care initiatives, Kirkman-Liff joins his colleague, Marjorie Baldwin, director of the health-management school, in offering ideas on reforms that could protect the 45-million Americans without health insurance safety nets.

If interest in the movie "Sicko" is any indication, insurance woes are moving to the forefront of public concerns. Will we soon see real reform that gives the 45-million Americans with no insurance coverage a safety net? Probably not, according to W. P. Carey School health care experts Marjorie Baldwin and Bradford Kirkman-Liff.

Today's health care leaders are constantly challenged with the seemingly incompatible goals of improving patient care while developing strategies to reign in skyrocketing costs. Among the many cost-reduction ideas batted around the industry, one of the most promising — yet often overlooked — areas is supply management. Recent research by Professor Eugene S. Schneller of the School of Health Management and Policy at the W. P. Carey School, examined the PPI purchasing and standardization efforts of 25 major U.S. hospitals.

Since their first appearance some 20 years ago, "hospitalists" — doctors who manage patient care during a hospital stay — have assumed an increasingly complex role in the healthcare system. Conversely, the attempt by the AMA to address a nursing shortage by the creation of a bedside care worker called the "registered care technician" was a short-lived and unsuccessful experiment. Professor Eugene Schneller of the School of Health Management and Policy at the W. P. Carey School, examined the successful hospitalist movement and the failed RCT implementation in a chapter for the recently-published "Managing Change in the Public Services."

Peter Drucker, sometimes called the father of modern management, once commented that health care organizations are the most difficult to manage of all organizations. For example, American health care is defined by legislative mandate yet implemented in the private sector. Further complicating the system is the fact that the majority of physicians who deliver hospital care are independent contractors and not employees of the hospitals. Indeed, clinicians at all levels need management skills, not only to navigate Medicaid and Medicare regulations, but also to build and operate new programs. The W. P. Carey School's David Patton, professor of practice in the School of Health Management and Policy, is teaching a series of courses designed to introduce these skills to physicians, nursing executives and others who run this complex system.