Health Policy Commons^™

Non-Urgent Use Of Emergency Departments By Rural And Urban Adults, Erika Ziller Phd, Carly Milkowski, Zachariah Croll, Yvonne Jonk Phd

Access / Insurance

This study, conducted by researchers at the Maine Rural Health Research Center, provides updated information and addresses gaps in knowledge about rural non-urgent ED use. Understanding the rates of non-urgent ED use among rural adults and the factors associated with this use can inform policy and practice efforts to reduce unnecessary and inappropriate use of EDs in rural communities.

Hospital emergency departments (EDs) serve a vital role in the US health care system, providing lifesaving, around-the-clock care to patients in acute health situations. However, use of the ED for non-urgent care is costly and reflects a suboptimal care setting, with …

Identifying Rural Health Clinics Within The Transformed Medicaid Statistical Information System (T-Msis) Analytic Files, Katherine Ahrens Mph, Phd, Zachariah Croll, Yvonne Jonk Phd, John Gale Ms, Heidi O'Connor Ms

Rural Health Clinics

Researchers at the Maine Rural Health Research Center describe a methodology for identifying Rural Health Clinic encounters within the Medicaid claims data using Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files.

Background: There is limited information on the extent to which Rural Health Clinics (RHC) provide pediatric and pregnancy-related services to individuals enrolled in state Medicaid/CHIP programs. In part this is because methods to identify RHC encounters within Medicaid claims data are outdated.

Methods: We used a 100% sample of the 2018 Medicaid Demographic and Eligibility and Other Services Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files for 20 states …

Reshaping Healthcare: A Bibliometric Analysis Of Lessons Learned In Post-Covid-19 Health Policy, Azliyana Azizan, Khairul Hafezad Abdullah, Sri Ratna Rahayu, Nadia Safirah Rusli, Nornajehah Tarmidzi

Kesmas

The COVID-19 pandemic has profoundly impacted health policy globally, leading to heightened concern and urgency. However, previous studies have been hampered by limited resources and insufficient discussions on the long-term implications for health policies following multiple COVID-19 waves. Thus, this study examined the evolution of international studies on post-COVID-19 health policy. A comprehensive analysis used well-known literature databases Scopus and Web of Science to explore parameters including publication growth, participating countries, areas of interest, and keyword analysis of topics such as"COVID-19" and "Health Policy." The United States emerged as an active participant, focusing on "Computer science." Key themes included "COVID-19 …

The Pink Tax: A Comparative Case Study Between Tennessee And Washington State, Megha Chitturi

Baker Scholar Projects

The imposition of an additional luxury tax on menstrual health products, otherwise referred to as the “Pink Tax” or the “Tampon Tax”, is present in some states while absent in others. The decision to repeal such a tax is one that has proven to be critical, as it removes the connotation that such products are of “luxury” and make them more accessible to menstruators throughout the state. As of 2023, twenty-three states have eliminated the tax. The state of Washington falls under that parameter while Tennessee does not. The purpose of this undergraduate honors thesis is to explore the potential …

The Development Of Health System Resiliency: How Kenya's Experience With Malaria Impacted Its Reaction To The Covid-19 Pandemic, Zoe A. Ward

Baker Scholar Projects

Public health scholars have recently focused on health system resiliency to explain how previous experiences dealing with public health crises impact the healthcare sector, public behavior, and policy response to novel crises. However, it is unclear how resiliency develops. This study contributes by testing whether a health system’s experience with a health emergency and significant interventions impacts the response to a novel crisis. This research asks, “How has Kenya’s experience with malaria impacted its response to COVID-19?” Using the United States Agency for International Development (USAID) Malaria Indicator Survey (MIS), I develop a malaria adherence score to measure county-level compliance …

Ballad Health: Understanding Appalachia’S Regional Healthcare Monopoly, Meredith A. Bailey

Baker Scholar Projects

The Ballad Health merger of 2018, which combined the now 21 hospitals in the region under one organization, has impacted the healthcare landscape in Northeast Tennessee and Southwest Virginia. Historically, Appalachia has had to persevere through primary physician shortages, a lack of specialty care, geographic obstacles to accessing healthcare, challenges related to substance abuse, and much more. Since the merger of Mountain States Health Alliance and Wellmont Health System, little research has been done to assess the perceived impact the aggregation of providers has had on the population it serves. This study utilizes an online survey to better understand the …

Inclusión Cultural En Fonasa: Parto Aymara Como Un Estudio De Caso, Madison Singleton

Independent Study Project (ISP) Collection

Los primeros años de la década de 2000s sirven como un período legal transformador en Chile, debido al auge de los grupos de representación indígena y la introducción de la ley 20.584 que asegura un modelo de interculturalidad en los servicios de salud. El objetivo de esta investigación es comprender los factores que impactaron en la priorización de la inclusión cultural en el sistema público de salud (FONASA), utilizando el parto aymara en Arica como un estudio de caso. Esta investigación toma forma en un diseño de investigación cualitativa y exploratoria utilizando 5 entrevistas y 5 observaciones, así como las …

Socioecological Factors Linked With Pharmaceutical Incentive-Driven Prescribing In Pakistan, Muhammad Naveed Noor, Afifah Rahman-Shepherd, Amna Rehana Siddiqui, Wafa Aftab, Sadia Shakoor, Rumina Hasan, Mishal Khan

Department of Pathology and Laboratory Medicine

Pharmaceutical marketing through financial incentivisation to general practitioners (GPs) is a poorly studied health system problem in Pakistan. Pharmaceutical incentivisation is seen to be distorting GPs prescribing behaviour that can compromise the health and well-being of patients. We draw on a conceptual framework outlined in the ecological system theory to identify multiple factors linked with pharmaceutical incentivisation to GPs in Pakistan. We conducted qualitative interviews with 28 policy actors to seek their views on the health system dynamics, how they sustain pharmaceutical incentivisation and their effect on the quality of care. Our analysis revealed four interlinked factors operating at different …

Impact Of A Multifaceted Intervention On Physicians' Knowledge, Attitudes And Practices In Relation To Pharmaceutical Incentivisation: Protocol For A Randomised Control Trial, Muhammad Naveed Noor, Mishal Khan, Afifah Rahman-Shepherd, Amna Rehana Siddiqui, Sabeen Sharif Khan, Iqbal Azam, Sadia Shakoor, Rumina Hasan

Department of Pathology and Laboratory Medicine

Introduction: In settings where the private sector constitutes a larger part of the health system, profit-gathering can take primacy over patients' well-being. In their interactions with pharmaceutical companies, private general practitioners (GPs) can experience the conflict of interest (COI), a situation whereby the impartiality of GPs' professional decision making may be influenced by secondary interests such as financial gains from prescribing specific pharmaceutical brands.
Methods and analysis: This study is a randomised controlled trial to assess the impact of a multifaceted intervention on GPs' medical practice. The study sample consists of 419 registered GPs who own/work in private clinics and …

Narrative Synthesis Systematic Review Of Pakistani Women's Health Outcomes From Primary Care Interventions, Sara Rizvi Jafree, Qaisar Khalid Mahmood, Sohail Mujahid, Muhammad Asim, Jane Barlow

Community Health Sciences

Objective: Women living in Pakistan have complex health problems including infectious and non-communicable diseases, accident and injuries, and mental health problems. While a majority of these women rely on primary healthcare services for all of their healthcare needs, there has to date been no overview of the extent of their effectiveness. The objective of this review was to (1) synthesise the available evidence regarding the effectiveness of primary care based interventions aimed at improving women's mental and physical health and (2) identify the factors that promote effectiveness for women's health outcomes.
Methods: Five academic databases were searched, including PubMed, BMC …

Maximising Access To Timely Trauma Care Across Population Of Karachi And Its Districts: A Geospatial Approach To Develop A Trauma Care Network, Muhammad Nabeel Ashraf, Mohammad Salman Khalil, Ahwaz Akhtar, Lubna Samad, Asad Latif

Department of Anaesthesia

Objectives: To develop and propose a cost-effective trauma care network for Karachi, Pakistan, by calculating maximum timely trauma care (TTC) coverage achieved with the addition of potential designated private and public level 1 and level 2 trauma centres (TCs).
Setting: A lower middle-income country metropolis, Karachi is Pakistan's largest city with a population of 16 million and a total of 56 hospitals as per government registry data.
Participants: 41 potential TCs selected using a two-level, contextually-relevant TC designation criteria adapted from various international guidelines.
Primary and secondary outcome measures: Maximum TTC coverage achievable with the addition of potential TCs. Proposed …

La Política Cultural Del Aborto: Las Percepciones Y El Manejo Del Aborto En Arica, Chile, Eva Strelitz-Block

Independent Study Project (ISP) Collection

Chile has a long history of restricting access to legal abortion. Until 2017, when the government passed the law N° 21.030 decriminalizing abortion on three grounds, abortion was completely illegal. However, despite this movement towards decriminalization, legal abortion access is still very limited and highly restricted. In this criminalized, highly stigmatized environment, self-managed abortion has emerged as a way to transform the landscape of abortion. This qualitative, exploratory study seeks to explore perceptions of abortion and practices of abortion management both within and outside of the official healthcare system among women and people with the capacity to become pregnant and …

The 2025 Michigan State Oral Health Plan, Ellen Sugrue Hyman Jd

The Journal of the Michigan Dental Association

This feature article explores the 2025 Michigan State Oral Health Plan (SOHP), a comprehensive initiative developed by the Michigan Oral Health Coalition (MOHC) and a statewide coalition, including the Michigan Dental Association (MDA). With a focus on enhancing oral health for all Michigan residents, the SOHP prioritizes addressing economic and racial disparities. The plan, guided by three key goals—Increasing Awareness and Education, Dental-Health Integration, and Access and Infrastructure—aims to improve oral health outcomes. The article discusses the plan's development process, key findings highlighting existing disparities, workforce challenges, and the strategic implementation of the SOHP through collaborative efforts and workgroups.

Healthcare Transformation In Saudi Arabia: An Overview Since The Launch Of Vision 2030, Ahmed Ali Alasiri, Viqaruddin Mohammed

University Administration Publications

Saudi Arabia’s Vision 2030 has taken a centre stage in the development of its healthcare sector through privatization adopting Public Private Partnerships (PPPs). The objective of this study is to provide an overview of healthcare transformation in Saudi Arabia since the launch of the ambitious Vision 2030, identifying issues those need to be addressed and steps taken towards provision of health systems transformation. Literature review was based on extensive review of published and unpublished articles, where different search engines and databases searched using the key words: ‘Saudi Healthcare’, ‘Healthcare transformation’, ‘Saudi vision: 2030’, ‘Public-Private Partnerships’ and ‘Privatization’, in addition to …

Perceptions Of The Healthcare System Among Stakeholders, Michael D. Markee, Christine Ascencio, Laura Brugger, Renee Jonas, Hisako Matsuo

Patient Experience Journal

The U.S. healthcare system is rife with complexities and is consistently a source of political debate. One’s interaction with the system may directly impact the understanding of the system. The objective of this research is to examine the perceptions of the United States healthcare system from the viewpoint of healthcare providers, insurers, and consumers. Using a grounded theory approach, theoretical sampling was used to explore similarities and differences between the three groups of actors in the healthcare system. Data were collected through interviews with thirty-one participants using a semi-structured interview schedule. Themes of cost, access, and inefficiency emerged from the …

The Influence Of The Urban Food Environment On Diet, Nutrition And Health Outcomes In Low-Income And Middle-Income Countries: A Systematic Review, Susannah Westbury, Iman Ghosh, Helen Margaret Jones, Daniel Mensah, Folake Samuel, Ana Irache, Nida Azhar, Lena Al-Khudairy, Romaina Iqbal, Oyinlola Oyebode

Community Health Sciences

Introduction: Diet and nutrition are leading causes of global morbidity and mortality. Our study aimed to identify and synthesise evidence on the association between food environment characteristics and diet, nutrition and health outcomes in low-income and middle-income countries (LMICs), relevant to urban settings, to support development and implementation of appropriate interventions.
Methods: We conducted a comprehensive search of 9 databases from 1 January 2000 to 16 September 2020 with no language restrictions. We included original peer-reviewed observational studies, intervention studies or natural experiments conducted in at least one urban LMIC setting and reporting a quantitative association between a characteristic of …

Measuring The Impact Of The Affordable Care Act Medicaid Expansion On Access To Primary Care Using An Interrupted Time Series Approach, Elizabeth A. Brown, Brandi M. White, Walter J. Jones, Mulugeta Gebregziabher, Kit N. Simpson

Health and Clinical Sciences Faculty Publications

BACKGROUND: The Patient Protection and Affordable Care Act of 2010, commonly referred to as the Affordable Care Act (ACA), was created to increase access to primary care, improve quality of care, and decrease healthcare costs. A key provision in the law that mandated expansion of state Medicaid programme changed when states were given the option to voluntarily expand Medicaid. Our study sought to measure the impact of ACA Medicaid expansion on preventable hospitalization (PH) rates, a measure of access to primary care.

METHODS: We performed an interrupted time series analysis of quarterly hospitalization rates across eight states from 2012 to …

Government Management Capacities And The Containment Of Covid-19: A Repeated Cross-Sectional Study Across Chinese Cities, Wenchao Li, Jing Li, Junjian Yi

Research Collection School Of Economics

Objectives: Better understanding of the dynamics of the COVID-19 (2019 novel coronavirus disease) pandemic to curb its spread is now a global imperative. While travel restrictions and control measures have been shown to limit the spread of the disease, the effectiveness of the enforcement of those measures should depend on the strength of the government. Whether, and how, the government plays a role in fighting the disease, however, has not been investigated. Here, we show that government management capacities are critical to the containment of the disease. Setting: We conducted a statistical analysis based on cross-city comparisons within China. China …

Essays On Rehospitalization Under The Hospital Readmission Reduction Program, Yangyuna Yang

Theses & Dissertations

The Hospital Readmission Reduction Program (HRRP), a part of the Affordable Care Act (ACA), requires the Centers for Medicare and Medicaid Services (CMS) to penalize hospitals with excess readmissions. The following conditions/procedures with high 30-day readmission rates were included in the program: Acute Myocardial Infarction, heart failure, pneumonia, chronic obstructive pulmonary disease, total hip arthroplasty and/or total knee arthroplasty, and coronary artery bypass graft (CABG). More research needs to be done regarding the national impact of the program. In addition, the risk factors of newly targeted CABG needs to be investigated robustly. Lastly, besides evaluating the risk of readmissions before …

Global Burden Of Cardiovascular Diseases And Risk Factors, 1990-2019: Update From The Gbd 2019 Study, Gregory A. Roth, Veincent Christian F. Pepito, Gbd-Nhlbi-Jacc Global Burden Of Cardiovascular Diseases Writing Group, 608 Co-Authors

Ateneo School of Medicine and Public Health Publications

Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019.

Prevalent cases …

Health Is Political: Public Health Practitioners And Researchers Should Be Trained Accordingly, Claire Pendergrast

Population Health Research Brief Series

Policy has long been considered a core element of public health practice. The COVID-19 pandemic has made clear that public health practice and research exist within a political context that cannot be ignored.

Sex Education In The United States: Implications For Sexual Health And Health Policy, Eliana R. Johnson

The Corinthian

There is much disagreement over what constitutes effective sex education in the United States. There are several reasons why America’s sex education system is outdated and problematic. First, it often advocates only for abstinence, which leaves people unprepared and unable to protect themselves if/when they choose to have sex, leading to higher rates of unintended pregnancies, abortions, and sexually transmitted infections in the U.S. than in any other developed nation in the world. In addition, the culture of fear surrounding sex education leads to negative attitudes among young people about sex. This can not only cause sexual dysfunction and strife …

Substance Use Among Rural And Urban Youth And Young Adults, Jennifer D. Lenardson Mhs, Nathan Paluso Mph, Erika C. Ziller Phd

Mental Health / Substance Use Disorders

Rural youth and young adults have historically had higher use rates of alcohol and other substances than their urban counterparts. Recent research suggests that rates of youth and young adult alcohol and other substance use have declined over the past two decades, but we have limited knowledge of whether and how current rural and urban substance use patterns may differ. As national substance use rates decline, it is important to re-assess differences in use among rural versus urban youth and young adults. This study uses data from the National Survey of Drug Use and Health (NSDUH) to examine rural-urban differences …

Availability And Affordability Of Medicines And Cardiovascular Outcomes In 21 High-Income, Middle-Income And Low-Income Countries, Clara Kayei Chow, Tu Ngoc Nguyen, Simone Marschner, Rafael Diaz, Omar Rahman, Alvaro Avezum, Scott A. Lear, Koon Teo, Karen E. Yeates, Khawar Kazmi

Section of Cardiology

Objectives: We aimed to examine the relationship between access to medicine for cardiovascular disease (CVD) and major adverse cardiovascular events (MACEs) among people at high risk of CVD in high-income countries (HICs), upper and lower middle-income countries (UMICs, LMICs) and low-income countries (LICs) participating in the Prospective Urban Rural Epidemiology (PURE) study.
Methods: We defined high CVD risk as the presence of any of the following: hypertension, coronary artery disease, stroke, smoker, diabetes or age >55 years. Availability and affordability of blood pressure lowering drugs, antiplatelets and statins were obtained from pharmacies. Participants were categorised: group 1-all three drug types …

Global Strategies And Local Implementation Of Health And Health-Related Sdgs: Lessons From Consultation In Countries Across Five Regions, Sameen Siddiqi, Wafa Aftab, Fahad Javaid Siddiqui, Luis Huicho, Roman Mogilevskii, Peter Friberg, Johanna Lindgren-Garcia, Sara Causevic, Anil Khamis, Mashal Murad Shah, Zulfiqar Ahmed Bhutta

Community Health Sciences

Evidence on early achievements, challenges and opportunities would help low-income and middle-income countries (LMICs) accelerate implementation of health and health-related sustainable development goals (HHSDGs). A series of country-specific and multicountry consultative meetings were conducted during 2018-2019 that involved 15 countries across five regions to determine the status of implementation of HHSDGs. Almost 120 representatives from health and non-health sectors participated. The assessment relied on a multidomain analytical framework drawing on existing public health policy frameworks. During the first 5 years of the sustainable development goals (SDGs) era, participating LMICs from South and Central Asia, East Africa and Latin America demonstrated …

Employed Mothers’ Satisfaction With The Breastfeeding Provisions In The Patient Protection And Affordable Care Act, Rebecca A. Penders

Graduate Doctoral Dissertations

Objective: Guided by the Conceptual Model for Nursing and Health Policy (CMNHP), the purpose of this study was to determine the extent to which employed mothers perceived satisfaction in their breastfeeding experiences after enactment of the Patient Protection and Affordable Care Act (PPACA) breastfeeding provisions. Methods: The participants (N=507) were employed mothers who returned to work after the birth of their infants and reported hourly pay. Convenience sampling was used to recruit women via La Leche USA Facebook account (LLL USA). Participants completed the Penders Breastfeeding Survey in Research Electronic Data Capture (REDCap). The survey consisted of 39-items; including five …

Shadow Standards And The Logic Of Costs: Care, Stewardship, And Data In U.S. Community Health, Margarite J. Whitten

Dissertations, Theses, and Capstone Projects

This dissertation examines the delegation of responsibility for providing health care to particular categories of marginalized populations in the United States in the absence of a uniform and universal health care system. It explores how the U.S. federal government governs patient populations at a distance by mandating that healthcare providers collect, produce, and report on patient data. Drawing from eighteen months of ethnographic research in Massachusetts clinics for the homeless and the frail elderly between 2014-2015, I argue that when marginalized patients are unable to satisfy the neoliberal ideal of self-governance to maintain their health in cost-effective ways, providers are …

Understanding The Failure Of Universal Healthcare Proposals In The U.S. And Paths Forward, Nicholas J. Telesco

Senior Honors Projects, 2020-current

Unlike most developed countries, the U.S. does not have a form of universal healthcare, where the government provides insurance for all citizens, despite attempts dating back to 1915. The Patient Protection and Affordable Care Act (ACA), passed in 2010 by President Obama, was a significant expansion of government power in healthcare policy, yet did not guarantee universal insurance. In recent years, universal healthcare proposals have gained traction as the U.S. healthcare system faces issues of low access, high cost, and mediocre quality. In this thesis, I intended to discover the factors that influenced the passage of past U.S. healthcare reforms …

The Feasibility Of Healthy Corner Stores In Saint Louis, Chancelor Thomas

Theses

We analyze the success of healthy corner store initiatives within the Saint Louis area. We use ARCGIS to map and geospatial analysis understand areas of demand within Saint Louis and food deserts to determine the level of competition between successful healthy corner stores and potential alternatives. We determine that based on the concentration of alternatives that healthy corner stores in Saint Louis are insufficient and other alternative policies should be used to address food insecurity include stricter standards for EBT retailers.

The Future Of Patient Experience: Five Thoughts On Where We Must Go From Here, Jason A. Wolf Phd, Cpxp

Patient Experience Journal

In looking to the future, we must never forget it is grounded in today and the steps that brought us to this point. Those efforts and actions that led to where we stand now set the foundation for all we can do and what we will accomplish as we look to the future. This idea of not looking too far ahead without knowing where you stand is fundamental in human nature. Far too often we have let our gaze to the future miss the people right in front of us or overlook the significance of the moment in which we …