Carlin, who has been a professor in the SPH since 1991, will take over as division head in May 2010. He will work with other SPH leaders to solidify the division's ranking as one of the top biostatistics units in the nation. In addition to continuing the high level of research productivity among the division's faculty members, he will work to grow the division's student body and educational programs, as well as its focus on collaborative, translational research.

"As head of the Division of Biostatistics, I'm looking forward to working with colleagues across the University of Minnesota Academic Health Center," said Carlin. "More and more, it's critical for biostatisticians to collaborate with colleagues across the health sciences. Our division has a good track record of this sort of collaboration in the broader areas of clinical trials and environmental health, as well as the study of complex chronic conditions such as cancer, heart and lung disease, and HIV/AIDS."

John R. Finnegan, PhD, dean of the School of Public Health and assistant vice president for public health, is pleased to have Carlin join school leadership.

"Dr. Carlin's energy and critical thinking will be an asset to his division and to the entire school," said Finnegan. "I'm looking forward to working with him in this next stage of his career and in this next chapter of division leadership."

Carlin takes over for School of Public Health professor John Connett, PhD, who, after serving as head of the division for nine years, is stepping down to devote more time to his own research interests, which focus on clinical trials and lung health.

Carlin's Background

Carlin's research interests include statistical applications in AIDS research, clinical trial monitoring, joint longitudinal and survival modeling, and spatial and spatio-temporal disease mapping. He also conducts geographical analysis by analyzing public health data that are geographically indexed. He is an expert in Bayes and empirical Bayes methodology, as well as Markov chain Monte Carlo (MCMC) methods for their implementation.

Carlin has a PhD and MS in statistics from the University of Connecticut and a BS in mathematics and actuarial science from the University of Nebraska. He is a member of the University of Minnesota Masonic Cancer Center, and currently serves as editor-in-chief of Bayesian Analysis, the official journal of the International Society for Bayesian Analysis. He has authored numerous papers in peer-reviewed journals as well as textbooks on Bayesian methods and hierarchical modeling for spatial data.

In 2003, Carlin was named Mayo Professor in Public Health, the highest faculty honor at the University of Minnesota School of Public Health. He has received the Mortimer Spiegelman Award from the American Schools of Public Heath Association. He is also the 2008 recipient of the University of Minnesota School of Public Health Leonard M. Schuman Award for Excellence in Teaching.

That's according to research by a team of University of Minnesota health policy researchers, led by Associate Professor Lynn Blewett.

Blewett's team examined the rates of uninsurance among U.S. health care workers by health care industry subtype and work force category, using 2004-2006 National Health Interview Survey data.

They found that overall 11 percent of the U.S. health care work force is uninsured. Furthermore, ambulatory care workers were 3.1 times as likely as hospital workers to be uninsured and residential care workers were 4.3 times as likely to be uninsured.

The findings raise concerns about safety and quality of health care in different settings, the researchers said. They add that previous research shows that uninsurance leads to delays in seeking care, fewer prevention visits, and poorer health status.

Other University of Minnesota researchers on the team were Chiu-Fang, Pamela Johnson, and Andy Ward.

More about the study

Health Care Reform

• Following Our Lead
• Improving Access
• Rural Health Care
• CBO Lowers Boom

As of this writing the fate of U.S. health care reform is still in play and forty-six million Americans remain uninsured. What we know for sure is that a national reform effort will never reach its full potential without making the fundamental connection between health care and public health.

For decades, public health professionals have worked to prevent illness, raise quality of care, reduce costs, and expand health care access--all the issues that figure so prominently in the health care debate.

Minnesota has long put these public health concepts front and center and that emphasis helped shape 2008 landmark legislation that brought sweeping reform to the state.

Investing in Disease Prevention

In addition to the health-improvement grants, the state--with input from SPH experts--is developing rules for "health care homes," clinical settings that coordinate the care for people with chronic or complex conditions. Certified health care homes will be eligible to receive "care coordination payments" from both public and private payers.

"At the root of [both these initiatives] is a goal to achieve better health, not just better health care," says Minnesota Health Commissioner Sanne Magnan. "We're working to prevent the chronic diseases that bring people into the health care system in the first place."

States as Leaders in Health Care Reform

In the 16 years since the Clinton administration failed to rework health care, there has been a lack of national leadership on reform. So states have moved ahead on their own. The progress Minnesota has made helps position it as a leader in national reform, says SPH associate professor Lynn Blewett.

As head of the State Health Access Data Assistance Center (SHADAC), Blewett works with states to increase access to health care, often determining whether Minnesota models can be used elsewhere.

In addition to health care homes and SHIP, Blewett cites quality payment incentives and "baskets of care" as successful Minnesota initiatives.

Using community-based data, experts have developed a set of 29 quality measures for specific services at different health care systems statewide. The measures will be used to compare quality of care and to reward the systems that meet quality benchmarks.

"Baskets of care" involves looking at common services, like asthma care for children and total knee replacement, and bundling together all the costs associated with those services into a "basket." This way, consumers will be able to compare costs across the market. "Each health care system attaches a price tag to each basket," explains Blewett. "So as a consumer, you will be able to compare apples to apples."

Blewett believes that Minnesota will continue to play a leading role in national health care reform even after initial legislation is passed this year. At that point, federal analysts will be looking for models of payment reform that improve efficiency and financial incentives that promote quality. "Minnesota will be at the top of their list," she says.

Health Care Reform

• Following Our Lead
• Improving Access
• Rural Health Care
• CBO Lowers Boom

Minnesota has some of the highest levels of insurance coverage in the country at around 93 percent. This success can be attributed to strong public programs, extensive employer-sponsored coverage, and a culture that fosters innovation and quality in care delivery.

Yet the state is home to some of the nation’s greatest health disparities, with minority populations experiencing lower coverage rates and worse health than the overall population. Other groups most likely to be uninsured include recent immigrants, young adults, and low- and middle-income families.

“Any health reform aimed at increasing access to health insurance will have an impact on reducing health disparities in Minnesota,” says SPH associate professor Kathleen Call. “While efforts to expand coverage are a step in the right direction, attention to cost and quality will also be needed.”

The survey data has, in part, led to a $9.5 million initiative to reduce health disparities among Minnesota’s populations of color and American Indians by 2010. Florida is the only other state to enact a similar legislation. Launched in 2001, the state-funded Eliminating Health Disparities Initiative demonstrates Minnesota’s “longstanding history of trying to tackle health disparities,” says Call. “We’ve already seen some success.”

Minnesota is one of nine high-coverage states singled out for federal support with the goal of insuring the state’s entire population. First-year funds of $4.6 million—with the potential for $35 million over five years—will provide preventive health care to those who are not eligible for public programs and unable to afford private insurance. “It’s that last push to get to universal coverage,” says SPH associate professor Lynn Blewett, whose team at the State Health Access Data Assistance Center (SHADAC) will help evaluate the program.

At the national level, the outlook for universal coverage is not as promising. The proposals moving through Congress would reduce the nation’s 46 million uninsured anywhere from 17 million to 36 million, depending on the bill. But any proposal is better than none; if no reforms are passed uninsured rates are estimated to hit 54 million by 2019—around 16 percent of the total population.

Plugging Away at Health Care Reform

While achieving universal coverage, introducing a public option, and truly reforming the way care is delivered do not appear to be likely in this round of legislation, some sort of bill will pass. For some experts, just moving forward is promising.

“If we can get a toe hold in the process and get a bill passed, we can work on reforming the system to make it more efficient,” says Blewett. “We can continue to push for at payment reform, cost containment, and access expansion.”

SPH assistant professor Jean Abraham agrees. She recently returned from a year in Washington where she worked on the President's Council of Economic Advisers (see sidebar). “It’s not really about getting health care reform done this year. “It’s about getting it started,” she says.

It has been a long time since health care issues have been so visible, both in Washington and across the country. “We’ve had a good national discussion,” says Blewett. “But people like me will continue to work on health care reform when it no longer makes front-page news.” 

Lessons from the West Wing

Over the past year, SPH assistant professor Jean Abraham served in Washington, D.C., as one of ten senior economists on the President's Council of Economic Advisers. Working in a nonpartisan capacity under the Bush and Obama administrations, Abraham was tapped for her expertise in health economics and policy.

She was charged with examining the economic implications of different aspects of health care reform such as a public option and insurance exchange. She also studied ways to pay for health care reform through changes to Medicare and Medicaid and through other revenue streams—an exercise that taught her to round dollar amounts in billions.

Q: What surprised you about your experience in Washington?

A: I learned that politics can trump good economic policy. For example, we had some good ideas on how to change the formula the federal government uses to reimburse states for Medicaid costs as a way to reduce geographic variation and generate savings. But the political insiders rejected the idea, saying that certain senators from higher-cost states would never support it. The discussion just stopped immediately.

Q: Did you gain any insight to the White House’s role in health care reform?

Contrary to media reports, there is a lot of communication between the administration and the Hill. The criticism that President Obama didn’t put up his own plan—that was a strategic decision. But one should not assume that the administration was sitting idle. There are actually dozens of people [in the administration] working on health care reform—on issues of [economic] modeling, budgeting, and idea formulation. Much of that work is communicated to congressional staff members on a daily basis.

Q: What do you say to critics who say we can’t pay for health care reform?

Whether we can pay or not is a subjective answer. It’s all about what you think of the distribution of wealth in the United States. But the issues of cost and coverage are linked. If we expand coverage, we have to recognize that we must deal with cost. Even if we don’t expand coverage, as long as health care costs continue to outpace overall economic growth, we are going to face serious decisions about taxes, other government spending, and budget deficits.

Health Care Reform

• Following Our Lead
• Improving Access
• Rural Health Care
• CBO Lowers Boom

The fact that this country's health policy is crafted in the urban setting of Washington D.C. is both a symbolic and concrete example of how rural America can be left out of reform discussions, says SPH professor Ira Moscovice.

As director of the Upper Midwest Rural Health Research Center, Moscovice has highlighted how reform measures have failed to consider the rural health care context. For instance, proposals that seek to expand coverage have not accounted for the longstanding access issues faced by those living in rural areas. And higher government reimbursements for large, often urban-based providers who invest in robust health information technology put smaller rural-based providers at a disadvantage. Moscovice's team released a series of reports on these issues at the request of the Health Resources and Services Administration, one of the largest agencies in the U.S. Department of Health and Human Services.

"Rural heath care shouldn't be an afterthought," says Moscovice. "We want to make sure the 20 to 25 percent of Americans who live in rural settings aren't left behind."

Health Care Reform

• Following Our Lead
• Improving Access
• Rural Health Care
• CBO Lowers Boom

On July 16, Doug Elmendorf, Director of the Congressional Budget Office (CBO), said “a large-scale expansion of insurance coverage would represent a permanent increase of roughly 10 percent” to the federal budget, which is on an “unsustainable path.” With that declaration, the President’s end-of-summer deadline for signing a health care bill died.

CBO reached that conclusion after a thorough in-house analysis. But the agency also regularly consults with a cadre of non-D.C.-based economists. SPH professor Roger Feldman serves on the CBO’s Panel of Health Advisors. Recently, he’s been asked to weigh in on how malpractice reform would affect health care costs and the economic implications of a public option.

This isn’t Feldman’s first time at bat with health care reform or Washington politics--he served on the senior staff of the Council of Economic Advisors during Reagan's presidency and assisted the health reform task force for the Clinton administration. Feldman says this time around a weak economy boosts CBO’s power in the reform process. “The mood in Congress and in the country is very cautious about increasing the deficit,” he says. “CBO has much more influence in this kind of environment.”

So, what are the symptoms? We asked John Finnegan, dean of the University of Minnesota School of Public Health.

He provides background on H1N1, explains the symptoms, who is most at risk and explains when someone should seek medical care.

Listen to Finnegan on Public Health Scene (4:58)