Health Policy Commons^™

Patient Experiences With Family Planning In Community Health Centers, Susan F. Wood, Tishra Beeson, Debora Goetz Goldberg, Holly Mead, Peter Shin, Aliyah Abdul-Wakil, Anna Rui, Bhakti Sahgal, Maya Shimony, Hallie Stevens, Sara Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Women of childbearing age represent one of the single largest groups of community health center patients, and family planning plays a critical role in the health, economic, and social circumstances of women, their children, and families. Family planning is a required service at all health centers, and the major expansion of health centers under the Affordable Care Act means that for low-income women of reproductive age this service should be increasingly available. The Quality Family Planning (QFP) Guidelines, jointly developed by the Centers for Disease Control and Prevention (CDC) and the Office of Population Affairs (OPA) and released in 2014, …

The State Of Accreditation Readiness In Georgia: A Case Study, Angela Peden, Gulzar H. Shah, Russell B. Toal, Dayna S. Alexander, Alesha Wright, Ashton Anderson, Nandi A. Marshall, Scott Uhlich, Jeffery A. Jones

Health Policy and Management Faculty Publications

Background: Georgia’s public health districts first began exploring the idea of national public health accreditation in 2008 when Cobb & Douglas Public Health included accreditation in their strategic plan. In May 2015, Cobb & Douglas Public Health was the first Georgia public health district to achieve national accreditation status. This article discusses the current state of accreditation readiness in Georgia and explores strengths and barriers to accreditation.

Methods: This study utilized a case study approach in order to examine PHAB accreditation efforts in Georgia within a reallife context. Data came from three sources: nine Accreditation Readiness Assessments, a PHAB Pre-Application …

Disparities In Hospital Services Utilization Among Patients With Mental Health Issues: A Statewide Example Examining Insurance Status And Race Factors From 1999-2010, Viann N. Nguyen-Feng, Hind A. Beydoun, Michael K. Mcshane, James D. Blando

Community & Environmental Health Faculty Publications

There exist many disconnects between the mental and general health care sectors. However, a goal of the Affordable Care Act (ACA) of 2010 is to change this by improving insurance access and the intersection of mental and general health care. As insurance status intersects with race, the present study examines how race, insurance status, and hospital mental health services utilization differ across groups within the state of New Jersey. The present study aims to determine trends in hospital mental health care utilization by insurance status and race from 1999 to 2010. The rate of self-pay for mental health disorders in …

Public Health, Universal Health Coverage, And Sustainable Development Goals: Can They Coexist?, Harald Schmidt, Lawrence O. Gostin, Ezekiel Emanuel

Georgetown Law Faculty Publications and Other Works

In her 2012 reconfirmation speech as WHO Director-General, Dr. Margaret Chan asserted: "universal coverage is the single most powerful concept that public health has to offer. It is our ticket to greater efficiency and better quality. It is our savior from the crushing weight of chronic noncommunicable diseases that now engulf the globe ". The UN General Assembly is currently considering proposals for Sustainable Development Goals (SDGs), succeeding the Millennium Development Goals. SDGs, focusing on health, specifically includes universal health coverage (UHC) among its targets. Unquestionably, UHC is timely and fundamentally important. However, its promotion also entails substantial risks. A …

Assessing The Education And Training Needs Of Nebraska's Public Health Workforce, Brandon L. Grimm, Patrik Johansson, Preethy Nayar, Bettye A. Apenteng, Samuel T. Opoku, Anh Nguyen

Health Policy and Management Faculty Publications

Introduction: In 2012, the Great Plains Public Health Training Center (Grant #UB6HP22821) conducted an online survey of state and local health departments and the American Indian (tribal clinics, tribal health departments, and urban Indian clinic) public health workforce across three professional levels. The objectives of the needs assessment were to determine the competency levels of the state’s public health workforce, assess gaps in public health competencies, identify public health training interests, needs, and preferences, and to determine the barriers and motivators to participate in public health training.

Methods: The assessment was developed using the Council on Linkages Between Academia and …

Middle East Respiratory Syndrome: A Global Health Challenge, Lawrence O. Gostin, Daniel Lucey

Georgetown Law Faculty Publications and Other Works

Beginning in May 2015, Middle-East respiratory syndrome (MERS) experienced its first publicly reported “super-spreading” event in South Korea. By mid-June, more than 120 cases and 11 deaths in South Korea had been linked to a businessman returning from travel to Bahrain, United Arab Emirates, the Kingdom of Saudi Arabia and Qatar. Globally more than 1200 had been infected of whom more than 450 died—a high fatality rate of 37%.

What are the most effective legal, social, and public health responses to MERS and other emerging diseases? First, the World Health Organization’s International Health Regulations (IHR) did not effectively guide the …

Using Network Analysis To Understand Public Health Delivery Systems & Community Health Initiatives, Glen P. Mays

Health Management and Policy Presentations

The increasingly connected world of health care delivery relies on an expanding frontier of multi-stakeholder structures and processes, from interdisciplinary patient-centered care teams, to virtual accountable care organizations (ACOs), to complex community-level interventions. This session highlights recent advances in applying social network analysis (SNA) methods to study the implementation and impact of these types of innovations. This methods workshop examines the benefits and limits of novel SNA applications based on the expanding availability of large, linkable electronic clinical and administrative data sources with dependent data structures. This paper profiles examples of using SNA principles and methods to study the implementation …

Learning From Network Analysis: Care Transitions, Market Competition, & Community Interventions, Glen P. Mays

Health Management and Policy Presentations

The increasingly connected world of health care delivery relies on an expanding frontier of multi-stakeholder structures and processes, from interdisciplinary patient-centered care teams, to virtual accountable care organizations (ACOs), to complex community-level interventions. This methods workshop highlights recent advances in applying social network analysis (SNA) methods to study the implementation and impact of these types of innovations. This session will examine the benefits and limits of novel SNA applications based on the expanding availability of large, linkable electronic clinical and administrative data sources with dependent data structures.

Learning From Delivery System Behavior, Dynamics & Interactions To Advance A Culture Of Health, Glen P. Mays

Health Management and Policy Presentations

A new "Systems for Action" national research program flows directly from the Robert Wood Johnson Foundation's Culture of Health action framework. This program will build evidence on how best to align the delivery and financing systems for medical care, public health, and community services & supports so as to promote wellbeing and resiliency, realize efficiencies in resource use, and reduce inequities in health.

Changes In Public Health System Capital And Long-Run Health And Economic Outcomes: 1998 To 2014, Glen P. Mays, Cezar B. Mamaril

Health Management and Policy Presentations

Research Objective: The Affordable Care Act created new resources and incentives for hospitals, insurers, public health agencies, and others to contribute to disease prevention and health promotion activities, potentially changing the structure of public health delivery systems and expanding the implementation of strategies that improve population health. This study uses data from the 1998-2014 National Longitudinal Survey of Public Health Systems to examine: (1) the extent and nature of change in inter-organizational contributions to public health activities, which we use as indicators of public health “system capital”; and (2) the effects of these changes on preventable mortality and resource use. …

The National Health Security Preparedness Index: National Advisory Committee Meeting, Glen P. Mays, Michael Childress, Anna Goodman Hoover, Chris Bollinger

Health Management and Policy Presentations

This meeting of the National Advisory Committee for the National Health Security Preparedness Index program discussed strategies for improving the theoretical framework, measures, and analytic methodologies used in assessing and comparing preparedness levels across U.S. states and the nation as a whole.

Cost Estimation In Public Health Services & Systems Research, Glen P. Mays

Health Management and Policy Presentations

Considerable uncertainty persists about the resources required to implement public health programs and policies, and about the factors that drive variation in resource needs and utilization across community and institutional settings. This paper reviews several alternative approaches to cost estimation that we have used in the field of public health services & systems research (PHSSR). This review was prepared for an expert panel meeting convened as part of a study commissioned by the U.S. Assistant Secretary for Planning and Evaluation (ASPE) to estimate the costs associated with public health emergency preparedness capabilities.

How Will Texas’ Affordable Care Act Implementation Decisions Affect The Population? A Closer Look, Sara J. Rosenbaum, Sara Rothenberg, Sara Ely

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

The Affordable Care Act (ACA) gives states two key choices: Whether to expand Medicaid to cover poor uninsured adults; and whether to establish a state Exchange. No population stands to gain more from these choices than residents of Texas, who experience the nation’s highest uninsured rate. National estimates show that by not expanding Medicaid, the state has foregone coverage for 1.5 million people. County‐level estimates show that in 249 out of 254 counties, the proportion of uninsured adults exceeds 20 percent of the total adult county population. In 31 counties, the proportion of low income uninsured adults exceeds 60 percent …

Medical Education Departments: A Study Of Four Medical Schools In Sub-Saharan Africa, Elsie Kiguli-Malwadde, Zohray Talib, Hannah Wohltjen, Susan C. Connors, Jonathan Gandari, Sekelani S. Benda, Lauren A. Maggio, Susan C. Van Schalkwyk

Health Policy and Management Faculty Publications

Background

Many African countries are investing in medical education to address significant health care workforce shortages and ultimately improve health care. Increasingly, training institutions are establishing medical education departments as part of this investment. This article describes the status of four such departments at sub-Saharan African medical schools supported by the Medical Education Partnership Initiative (MEPI). This article will provide information about the role of these institutional structures in fostering the development of medical education within the African context and highlight factors that enable or constrain their establishment and sustainability.

Methods

In-depth interviews were conducted with the heads or directors …

Still “Saving Babies”? The Impact Of Child Medicaid Expansions On High School Completion Rates, Lincoln H. Groves

Center for Policy Research

Precipitated by the legislative decision to decouple child Medicaid benefits from welfare receipt, the number of young children qualifying for public health insurance grew markedly throughout the 1980s and early 1990s. From a baseline of roughly 15% in the average state at the beginning of the decade, the rate increased to more than 40% of all young children in the United States by the time all federal mandates were fully enacted in 1992. This paper extends the academic literature examining early childhood investments and longer-term human capital measures by exploring whether public health insurance expansions to low-income children led to …

Cultural Beliefs And Understandings Of Cervical Cancer Among Mexican Immigrant Women In Southeast Georgia, John S. Luque, Yelena N. Tarasenko, Jonathan N. Maupin, Moya L. Alfonso, Lisa C. Watson, Claudia Reyes-Garcia, Daron G. Ferris

Health Policy and Management Faculty Publications

Rural Mexican immigrant women in the U.S. are infrequently screened and experience health disparities from cervical cancer. We explored cancer-related cultural beliefs in this population. We administered a cross-sectional survey to 39 Mexican immigrant women due for screening. We conducted univariate and bivariate analyses of participants’ characteristics, Pap test history, cancer-related knowledge and beliefs, and cultural consensus analysis about causes of cervical cancer and barriers to screening. For all the cultural consensus tasks, there was consensus (Eigenratios >3:1) among survey participants. Comparing the rankings of risk factor clusters, clusters related to sexual behaviors were ranked more severely than clusters related …

Moving The Needle: How Transparency Could Lower Costs And Improve Quality In United States Hospitals, Anna "Nina" Russell

Harvey M. Applebaum ’59 Award

This thesis shows the limitations of price and quality information for improving the value of healthcare delivery in the United States. First, in four survey experiments to determine the impact of information on decision-making, consumers were more likely to choose the lower cost or higher quality option when relevant information was presented in straightforward ways with a minimized risk of information overload (n = 224, t = -3.7065, p = 0.0002). Second, hospitals on the U.S. News Best Hospital list between 2008 and 2011 were shown to be significantly more likely to be found in wealthy, highly populated areas, while …

La Souffrance Animale À Distance: Des Vétérinaires Dans L’Action Humanitaire, Frédéric Keck, Miriam Ticktin

Publications and Research

Résumé

Cet article étudie le rôle des vétérinaires dans l’humanitaire à partir de deux types de pratique : la défense des animaux contre la cruauté et la surveillance des animaux touchés par les épidémies. En suivant l’extension de l’action humanitaire aux animaux comme nouvelles figures de victimes innocentes, nous cherchons à dépasser l’approche compassionnelle de l’humanitaire pour étudier les nouvelles formes scientifiques impliquant des non-humains, comme la médecine vétérinaire légale, les neurosciences et l’immunologie. Nous soutenons finalement que ces sciences produisent de nouveaux collectifs d’humains et de non-humains.

Abstract

This article traces the role of veterinarians in humanitarian action, focusing …

Revising The International Health Regulations: Call For A 2017 Review Conference., Rebecca Katz, Scott F. Dowell

Health Policy and Management Faculty Publications

No abstract provided.

Analyzing Reproductive Policy: Patriarchal Legitimization And Women In Latin America, Shannon C. Magni

Honors Scholar Theses

This paper examines the way in which gendered violence is carried out as a way for the formal state and the Catholic Church to negotiate power. While examples of a much larger trend, three Latin American countries are discussed in detail. The first case occurred in Nicaragua, where a 9-year-old victim of rape was denied an abortion by both the state and the Church. The second case examined is the use of rape as a torture tactic by the military junta in Argentina during the Dirty War from 1976 to 1983. The final case examined is that of the forced …

Adolescent Girls, Human Rights And The Expanding Climate Emergency, Holly G. Atkinson, Judith Bruce

Publications and Research

Many adolescent girls—the poorest girls in the poorest communities—already live in an “emergency.” Humanitarian crises only amplify the call on their coping and caring capacities, while exacerbating their vulnerabilities. The frequency and intensity of emergencies, including natural disasters, conflicts, and infectious disease outbreaks such as Ebola, appear to be growing.¹ These emergencies threaten entire communities and whole countries, often with global implications. Many become virtually permanent. The authors urge key actors responding to both the threats and opportunities that climate change poses to understand adolescent girls as exceptionally at risk on the one hand, and as exceptionally resilient and …

Improving Rhode Island’S Health Care System: Lessons From The Cuban Model, Sarah R. Moffitt

Senior Honors Projects

Improving Rhode Island’s health care system: lessons from the Cuban model

Cuba is world renowned for its health care system. In regards to international health crises, Cuba is a leader in sending workers abroad and training doctors from all over the world. Within its own borders, the Cuban model provides free access to all citizens in which every individual has a primary care provider. Cuba boasts high vaccination rates, a long life expectancy, low infant mortality rate, and a population that is one of the healthiest in the western hemisphere.

The purpose of this research project is to evaluate the …

Swords Into Stethoscopes: How The U.S. Military Could Conduct Medical Diplomacy, Oliver Kendall

Political Science Honors Projects

Since the early 1960’s, Cuba and China have won international appreciation by sending doctors abroad to help where they are needed. While there was surprise in some quarters when U.S. military personnel were deployed to combat Ebola in the last months of 2014, the Department of Defense actually has a long history of medical activity. In its current form, DoD medical outreach cannot likely garner soft power in the way that the Chinese and Cuban programs can, but with a few modifications, the U.S. military could be a serious conductor of medical diplomacy that would save countless lives and benefit …

Rush To Judgment: The Sti-Treatment Trials And Hiv In Sub-Saharan Africa, Eileen Stillwaggon, Larry Sawers

Economics Faculty Publications

Introduction: The extraordinarily high incidence of HIV in sub-Saharan Africa led to the search for cofactor infections that could explain the high rates of transmission in the region. Genital inflammation and lesions caused by sexually transmitted infections (STIs) were a probable mechanism, and numerous observational studies indicated several STI cofactors. Nine out of the ten randomized controlled trials (RCTs), however, failed to demonstrate that treating STIs could lower HIV incidence. We evaluate all 10 trials to determine if their design permits the conclusion, widely believed, that STI treatment is ineffective in reducing HIV incidence.

Discussion: Examination of the …

Assessing Changes In Safety Net Providers Since The Passage Of The Affordable Care Act, Arlesia Mathis, Julia Burke, Gulzar H. Shah

Health Policy and Management Faculty Presentations

The passage of the Affordable Care Act presented opportunities and challenges for safety net providers. Significant investments in provider capacity promised much needed expansion of services; and in 2014, the law extended coverage to millions of previously uninsured Americans. However, safety net providers are concerned that changes to financing brought about by changes in the ACA may threaten their ability to provide services to millions more who still lack insurance. This is a preliminary study of changes occurring with maternal and child health services among safety-net providers.

Use Of Facebook By Local Health Departments: Activity And Focus Areas, Rakhi Trivedi, Gulzar H. Shah

Health Policy and Management Faculty Presentations

This presentation was given at the Keeneland Conference for Public Health Systems and Services Research.

Can Electronic Health Records Systems Support New Payment Methods For Health Centers?, Peter Shin, Feygele Jacobs, Jeffrey Barnes, James B. Welsh, Lisa Perry, Scott D. Morgan

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This study assessed the feasibility and usefulness of combining electronic health record (EHR) data with federal cost report data for the purposes of: 1) quantifying the provision of enabling services; and 2) for use as the basis of community health center payment rate-setting. The study used EHR data derived from the Center for Primary Care Informatics to isolate enabling services and perform the end-to-end analysis that might be required to develop or evaluate reimbursement rates. The study revealed that data extracted from federal cost reports combined with data from the EHR fall short of providing the information required to reasonably …

Breast Cancer Among Women Living In Poverty: Better Care In Canada Than In The United States, Kevin M. Gorey, Nancy L. Richter, Isaac N. Luginaah, Caroline Hamm, Eric J. Holowaty, Guangyong Zou, Madhan K. Balagurusamy

Social Work Publications

This historical study estimated the protective effects of a universally accessible, single-payer health care system versus a multipayer system that leaves many uninsured or underinsured by comparing breast cancer care of women living in high-poverty neighborhoods in Ontario and California between 1996 and 2011. Women in Canada experienced better care, particularly as compared with women who were inadequately insured in the United States. Women in Canada were diagnosed earlier (rate ratio [RR] = 1.12) and enjoyed better access to breast conserving surgery (RR = 1.48), radiation (RR = 1.60), and hormone therapies (RR = 1.78). Women living in high-poverty Canadian …

Levels And Predictors Of Lhds' Engagement In Community Health Assessment, 2002-2013, Gulzar H. Shah, Kay Lovelace, Daniel F. Linder

Health Policy and Management Faculty Presentations

This presentation was given at the Keeneland Conference for Public Health Systems and Services Research.

Improving Police Officer Responses To Persons With Mental Illnesses: A Review Of The Literature, Portland State University. Criminology And Criminal Justice Senior Capstone

Criminology and Criminal Justice Senior Capstone Project

Addressing mental illness in the American criminal justice system is necessary in order to ensure both citizens and officers are safe. According to Centers for Disease Control and Prevention (2011), published studies show approximately 25 percent of all adults in the U.S. have a mental illness and nearly 50 percent of adults in the U.S. will develop at least one mental illness during their lifetimes. The U.S. Department of Justice’s Bureau of Justice Statistics also indicates nearly 25 percent of state prisoners and jail inmates with a mental health problem have three or more prior incarcerations (as cited in Glaze …