Medicine and Health Sciences Commons^™

Got Junk? The Federal Role In Regulating “Competitive” Foods, Eileen Salinsky

National Health Policy Forum

A wide variety of food and beverage items are available in schools in addition to the school meals provided through the National School Lunch Program and School Breakfast Program. A long-standing source of controversy, the need for stronger federal restrictions on foods that compete with school meals is again under debate. This issue brief examines the availability and consumption of competitive foods, explores the regulation of these foods at the federal level, considers trends in state and local restrictions, and summarizes perceived barriers to improving the nutritional quality of competitive food options.

No Free Lunch? Current Challenges Facing The National School Lunch And School Breakfast Programs, Eileen Salinsky

National Health Policy Forum

This background paper describes important characteristics of the National School Lunch Program and the School Breakfast Program, reviews U.S. Department of Agriculture rules regarding the nutritional content of school meals, and examines compliance with current nutrition standards. It also considers the dietary status and obesity risk of meal program participants, discusses proposed improvements to nutritional standards and meal requirements, and highlights key legislative issues.

The Role Of Ombudsmen In Assuring Quality For Residents Of Long-Term Care Facilities: Straining To Make Ends Meet, Carol O'Shaughnessy

National Health Policy Forum

Assuring quality of care for residents in long-term care facilities has been a serious and continuing concern of policymakers for decades. The Older Americans Act’s long-term care ombudsman program is a consumer advocacy model intended to improve quality of care by helping the 2.5 million residents of almost 67,000 nursing and other residential care facilities resolve complaints about their care and protect their rights. Despite broad recognition of its value in assisting residents and its efforts to complement federal and state oversight of long-term care facilities, some observers are concerned about the program’s ability to meet its legislative mandates. Limited …

Quantitative And Qualitative Findings And Implications Of An Intercultural Sensitivity Assessment Among Employees At A Large Health System, Jarret R. Patton Md, Jay Baglia Phd, Lynn M. Deitrick Rn, Phd, Anthony Nerino Ma, Eric J. Gertner Md, Mph, Judith Sabino Mph, Mary Kay Grim Bs, Debbie Salas-Lopez Md, Mph

Department of Pediatrics

Tuesday, November 10, 2009: 2:45 PM Jarret R. Patton, MD , Department of Pediatrics, Lehigh Valley Health Network, Allentown, PA Jay Baglia, PhD , Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA Lynn M. Deitrick, RN, PhD , Department of Community Health, Health Studies and Education, Lehigh Valley Health Network, Allentown, PA Anthony Nerino, MA , Department of Community Health, Health Studies and Education, Lehigh Valley Health Network, Allentown, PA Eric J. Gertner, MD, MPH , Department of Medicine, Lehigh Valley Health Network, Allentown, PA Judith N. Sabino, MPH , Cultural Awareness, Lehigh Valley Health Network, Allentown, PA …

A Community Benefit Reporting Toolkit For Critical Access Hospitals, John A. Gale Ms, Melanie Race Ms

Rural Hospitals (Flex Program)

No abstract provided.

Caring For The Country: Physician Retention At Cortland Regional Medical Center, Jennifer E. Truck

MPA Capstone Projects 2006 - 2015

Americans living in rural areas of the United States have historically suffered from a lack of adequate health care. As the focus of this study, the Cortland County area of central upstate New York State is a rural community of 74,000 that has been served for the last 118 years by Cortland Regional Medical Center (CRMC). CRMC is the federally designated "sole community hospital" which means that there are no other hospitals within 45 minutes of the medical center ("Department of Health and Human Services," 2009). Its HSPA designation indicates that on average, each primary care physician must allocate services …

National Health Accounts: Lessons For Pakistan, Muhammad Ashar Malik

Community Health Sciences

No abstract provided.

Revitalisation, Rigour And Relevance: The Citizen-Client And Planning In The Health Services., Vivienne Byers

Conference Papers

Whereas, in many OECD countries strategic planning in health care has been in evidence since the 1970s, in Ireland the emergence of strategic management processes in health care planning didn’t occur until the 1990s.

This paper reports on part of a comparative study of health services planning in Ireland and in Canada. How can the strategic management of the Irish health services in the form of service planning be implemented? The focus of this paper is the identification of two key stumbling blocks to success in this endeavour. These include the limitations of the control mechanism, the legislation, underpinning service …

Strategic Change In The Irish Health Services: Comparative Case Studies In Planning, Vivienne Byers

Conference Papers

This paper reports on a study of the implementation of service planning in the Irish health services in the context of significant organisational change. One of the central mechanisms of the Strategic Management Initiative (SMI) is the devolution of accountability and responsibility from the centre to executive agencies. Service planning in the Irish health care sector is seen as part of this strategic planning ethos.

This study in examining the function and implementation of the service plan in the Irish health care system drew comparisons with the Canadian experience. A multiple case study design was utilised. Key research questions were …

Introduction Of A Qualitative Perinatal Audit At Muhimbili National Hospital, Dar Es Salaam, Tanzania, Hussein Kidanto, Ingrid Mogren, Jos Van Roosmalen, Angela N. Thomas, Lennarth Nystrom, Gunilla Lindmark

Faculty of Health Sciences, East Africa

Background Perinatal death is a devastating experience for the mother and of concern in clinical practice. Regular perinatal audit may identify suboptimal care related to perinatal deaths and thus appropriate measures for its reduction. The aim of this study was to perform a qualitative perinatal audit of intrapartum and early neonatal deaths and propose means of reducing the perinatal mortality rate (PMR).

Methods From 1st August, 2007 to 31st December, 2007 we conducted an audit of perinatal deaths (n = 133) with birth weight 1500 g or more at Muhimbili National Hospital (MNH). The audit was done by three obstetricians, …

Coverage And Payment For Prescription Drugs Under Medicare Part B: A Complex Patchwork, Amanda Cassidy

National Health Policy Forum

As part of the diverse discussions around health care reform, many have looked to refining Medicare payment systems as a way to give health care practitioners and providers greater incentives to deliver care more efficiently, and thus slow health care spending growth. Understanding how Medicare currently pays for Part B services, including drugs covered under Part B, is essential to understanding the potential impact of these types of reforms. Most items and services covered under Part B, including most Part B drugs, are paid individually, which means practitioners and providers generally receive more payments for providing more services. Some reform …

Stimulus Bill Implementation: Expanding Meaningful Use Of Health It, Rob Cunningham

National Health Policy Forum

The American Recovery and Reinvestment Act authorizes an estimated $38 billion in incentives and supports for health information technology (IT) from 2009 to 2019. After years of sluggish health IT adoption, this crisis-driven investment of public funds creates a unique opportunity for rapid diffusion of a technology that is widely expected to improve care, save money, and facilitate transformation of the troubled U.S. health system. Achieving maximal effect from the stimulus funds is nevertheless a difficult challenge. The Recovery Act strengthens the federal government’s leadership role in promoting health IT. But successful adoption and utilization across the health system will …

Issues For Dsm-V: The Role Of Culture In Psychiatric Diagnosis, Renato D. Alarcón, Anne E. Becker, Roberto Lewis-Fernández, Robert C. Like, Prakash Desai, Edward Foulks, Junius Gonzales, Helena Hansen, Alex Kopelowicz, Francis G. Lu, María A. Oquendo, Annelle Primm

Publications from Provost Junius J. Gonzales

No abstract provided.

Complex Adaptive Systems As A Model For Evaluating Organisational Change Caused By The Introduction Of Health Information Systems, Kieren Diment Mr, Ping Yu, K. Garrety

Faculty of Informatics - Papers (Archive)

This paper documents the preliminary development of a framework for evaluating organisational change processes during the implementation of an electronic nursing documentation system in residential aged care facilities. It starts with a brief outline of organisational change processes. This is followed by a more detailed exposition of the principles underlying complex adaptive systems (CAS) theory, where we explain how mathematical concepts can be used to illuminate qualitative research approaches. Finally we present some preliminary findings on the facilitators and barriers for the introduction of the electronic documentation system, explained with reference to the CAS theory, based on analysis of interviews …

The Medicare Drug Benefit: Update On The Low-Income Subsidy, Mary Ellen Stahlman

National Health Policy Forum

The Medicare drug benefit (Medicare "Part D"), provides federal subsidies to pay premiums and cost sharing for low-income beneficiaries—almost 10 million in 2009. Yet there are several policy issues concerning these low-income beneficiaries under Part D. First, over 2 million individuals who may qualify for the subsidies have not enrolled. Second, in some states, low-income beneficiaries have little choice of plans (while non-low-income beneficiaries have dozens of choices), unless they pay out-of-pocket for premium amounts above what the subsidy covers. And third, millions of those who have enrolled in the benefit face the prospect each year of switching drug plans …

Business Plan For Sleep Center, Mohammed Al Ghamdi

Boise State Graduate Student Projects

A sleep disorder is a medical disorder of the sleep patterns of a person, and it is serious enough to affect normal physical, mental, and emotional function. Most sleep disorders can be diagnosed in a sleep center through the use of a common test known as the polysomnogram. The wide need of sleep medicine and the severe shortage of centers and technologists impact our understanding of sleep disorders, especially in the Kingdom of Saudi Arabia. Currently, several health service organizations have started to focus on the need to study the function of sleep, to understand and develop better treatments for …

Opportunities For Comparative Research In Public Health Pbrns : A Baseline Analysis Of Local Practice Settings, Glen P. Mays, Sharla A. Smith, Elaine B. Wootten, Sylvia J. Porchia

Health Management and Policy Presentations

This analysis describes the organizational and operational characteristics of local public health agencies participating in an initial cohort of five (5) public health PBRNs in the U.S. We examine variation in practice settings within and between PBRNs; compare practice settings to state and national norms; and identify opportunities for comparative research that can be conducted through PBRNs.

A Health Insurance Exchange: Prototypes And Design Issues, Mark Merlis

National Health Policy Forum

Many reform proposals call for the creation of one or more health insurance exchanges, intermediaries that can help individuals or small employers navigate the insurance market. An exchange might be public or private, national, or local. It might serve simply as a clearinghouse for plan information or could play an active role in setting benefit packages, choosing high-quality plans, and negotiating premium rates. This paper begins with a summary of recent experience with insurance exchanges and similar systems. It then reviews basic issues in the design of an exchange.

Underwriting In The Non-Group Health Insurance Market: The Fundamentals, Kathryn Linehan

National Health Policy Forum

Non-group health insurance is coverage that individuals purchase on their own rather than as part of a group. Most states currently permit non-group insurers to underwrite, a process whereby an insurer assesses the health and other characteristics of individuals to determine their likely utilization of health services or risk; insurers then use this assessment to determine whether they will offer coverage and the premium they will charge. Policymakers have identified underwriting and related practices in non-group markets as a target for reform to enable broader access for the currently uninsured. This publication reviews the characteristics of non-group markets and insurers' …

Resilience And Renaissance: Efforts To Rebuild A Healthier New Orleans, Michele J. Orza, Jessamyn Taylor

National Health Policy Forum

The National Health Policy Forum sponsored a site visit to New Orleans, Louisiana, in May 2009 to explore the city's health challenges, which are similar to those faced by other cities but were all greatly exacerbated by Hurricane Katrina and its aftermath. The agenda focused on three themes: primary care and behavioral health services availability and access, public health preparedness, and rebuilding healthier communities. It examined how these themes and others intersect in two distinct communities within New Orleans: the Holy Cross community surrounding the Lower Ninth Ward Center for Sustainable Engagement and Development and the community surrounding the Mary …

The Psychology Of Money: Beyond Behavioral Finance, Cicily Maton, William Martin

Publications – Dreihaus College of Business

Behavioral finance has attracted the attention of both academics and practitioners. This article explores the roots of behavioral finance, psychology, and showns how these principles are actually used in practice.

The Children's Health Insurance Program (Chip): The Fundamentals, Jennifer Ryan

National Health Policy Forum

This background paper provides a brief overview of the fundamental elements of the Children’s Health Insurance Program (CHIP). CHIP, which served more than 7 million children in federal fiscal year 2008, is a jointly funded federal-state partnership that was originally enacted in 1997 as a complement to the Medicaid program. CHIP is designed to provide health insurance coverage for children in families who earn too much to qualify for Medicaid but cannot afford to purchase private insurance coverage. The program was reauthorized in the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009, which included several changes and additions to …

Show Me The Money: The Implications Of Schedule H, Eileen Salinsky

National Health Policy Forum

Responding to policymakers' concerns, the Internal Revenue Service (IRS) implemented significant new hospital community benefit reporting under Schedule H of its revised Form 990, the return used by tax-exempt organizations. This issue brief considers the policy implications of the quantitative and qualitative information that hospitals are now mandated to report through Schedule H, including the costs associated with charity care, bad debt, and the unreimbursed costs of Medicaid and Medicare. The paper examines unresolved issues related to the new reporting requirements, such as controversies regarding the scope of Schedule H, and considers the potential for these reports to influence IRS …

Schedule H: New Community Benefit Reporting Requirements For Hospitals, Eileen Salinsky

National Health Policy Forum

In recent years, some policymakers have questioned whether not-for-profit hospitals benefit the communities they serve at a level commensurate with the tax exemptions they receive as charitable organizations. This background paper reviews the new community benefit reporting requirements hospitals will face in 2009 under Schedule H of the Internal Revenue Service's revised Form 990 (the return used by organizations exempt from federal income tax). The paper provides a descriptive summary of the quantitative and qualitative information to be reported on Schedule H, such as charity care, bad debt, and the unreimbursed costs of Medicaid and Medicare.

Coordinating Care For People With Multiple Chronic Conditions: The Guided Care Model And Other Innovative Approaches, Judith D. Moore, Carol O'Shaughnessy

National Health Policy Forum

The Forum sponsored two site visits to explore the Johns Hopkins University's research and demonstration program on Guided Care, in April and August 2009. Guided Care is a patient-centered medical home model that uses an interdisciplinary approach to coordinating health care for older people with multiple chronic conditions. Guided Care nurses located in primary care practices work with Medicare patients on a long-term basis, coordinate their care among various providers, provide transitional care, and assist patients with self-management skills. Site visit participants learned about the complexities of caring for frail Medicare patients, some of whom see multiple physicians and other …

The Medicaid Drug Rebate Program, Christie Provost Peters

National Health Policy Forum

The Medicaid Drug Rebate Program helps lower Medicaid spending on outpatient prescription drugs by ensuring states receive discounts similar to those provided to private purchasers. Based on manufacturer reported pricing data, Medicaid drug rebates generate significant revenue for the states (and the federal government) that helps offset Medicaid prescription drug expenditures. This publication describes the Medicaid Drug Rebate Program and reviews how it works.

Difficult Choices In Total Compensation: Balancing Health Care Costs And Wage Increases, Jennifer Dose

Business Educator Scholarship

This article describes an experiential exercise suitable for undergraduate or master’s-level students. The goals of the exercise are for students to correctly apply health insurance concepts such as premium, deductible, co-pay, and coinsurance; to understand and explain the dilemma facing organizations in an environment of increasing health care costs and limited compensation budgets; to discern and apply the concerns of employees with varying demographic profiles to health care cost sharing; and to develop competency in calculating health care costs at the organizational level. Students receive a scenario in which they act as an employee representative and are asked to provide …

Over-Utilization Of Advanced Imaging In The Hospital Setting: An Educational Approach To Reduce Unnecessary Inpatient Studies, Guillermo Madero, J. Platnick, L. Voutsinas, R. Wetz, S. Buchbinder

Internal Medicine

By several measures, health care spending continues to rise, forcing businesses and families to cut back on operations and household expenses. In 2008, health care spending in the United States reached $2.4 trillion dollars, and is projected to reach $3.1 trillion in 2012.During the past decades, there has been a steady increase in the utilization of expensive inpatient imaging studies, with an overall increase in health care costs. In particular, advanced imaging includes CT, MRI and Nuclear Medicine, used for the diagnosis and management of hospitalized patients. The reasons for unnecessary imaging examinations include indirect financial benefit to physicians, medico-legal …

Prevention Of Mother-To-Child Transmission (Pmtct) Of Hiv In The Sub-Saharan Africa Region With A Focus On Uganda, Emily K. Franks

Senior Honors Theses

With the rise of the HIV/AIDS epidemic in the past thirty years, people of all ages, infants to elderly alike, all over the world, suffer from its adverse effects. Even an unborn baby in-utero can contract this virulent infection by means of mother-to-child transmission (MTCT) (Sweeney, 2005). Infants and children diseased in this way comprise 90% of the estimated 800,000 new cases of HIV in children seen each year, but the region hit hardest, however, is Sub-Saharan Africa, with the country of Uganda historically having the highest incident rate for a time (Stringer, E.M., et al. 2008). Therefore, the purpose …

Health Care-Associated Infections: Is There An End In Sight?, Lisa Sprague

National Health Policy Forum

Health care–associated infections (HAIs) have emerged as a significant concern in policy as well as clinical circles. An HAI is an infection acquired during treatment for another condition. Some of the HAI-causing bacteria have become drug-resistant; methicillin-resistant Staphylococcus aureus, or MRSA, is a familiar example. Tied to perhaps 100,000 deaths and $20 billion in health care costs each year, HAIs have given rise to state laws, legislative proposals at the federal level, public-private initiatives, and work at the hospital system and individual hospital level. However, much remains to be done. This issue brief reviews the prevalence of HAIs and the …