Health Policy Commons^™

Women’S Health Disparities And Midwifery Care: Spotlight On Vermont, Dorothy Hiersteiner

Publications from the Center for Women in Politics and Public Policy

In Vermont, racial and ethnic dispariti es in low birth weight and preterm birth rates exist alongside racial and ethnic disparities in health insurance coverage and use of preventative care. As of 2005, the percentage of racial and ethnic minorities in Vermont was approximately 3.3%, compared to 25% for the nation as a whole. In 2005, 3.4% of the Vermont population was foreign born.

U.S. Participation In International Health Treaties, Commitments, Partnerships And Other Agreements, Jennifer Kates, Rebecca L. Katz

Health Policy and Management Faculty Publications

The U.S. government's role in global health is long-standing and multifaceted. While primarily involving directly funding and operating programs in low- and middle-income countries, it also includes participation in international treaties, commitments, partnerships, and other multilateral agreements that address or encompass health. Such agreements serve numerous purposes including establishing political and legal commitments, formalizing international relationships, and coordinating roles and responsibilities in an increasingly complex and globalized and interconnected world. The role of the U.S. in international agreements has gained new attention in the Obama Administration, which has stated an intention to reinvigorate multilateral engagement and international partnerships on health …

Multivariate Fractional Regression Estimation Of Econometric Share Models, John Mullahy

John Mullahy

This paper describes and applies econometric strategies for estimating regression models of economic share data outcomes where the shares may take boundary values (zero and one) with nontrivial probability. The main focus of the paper is on the conditional mean structures of such data. The paper proposes an extension of the fractional regression methodology proposed by Papke and Wooldridge, 1996, 2008, in univariate cross-sectional and panel contexts. The paper discusses the stochastic aspects of share definition and measurement, and summarizes important features of the existing literature on econometric strategies for share model estimation. The paper then goes on to discuss …

Mission Creep And The Compromising Of Strategic Direction In United Kingdom Police Services. An Exploratory Study Of The Evidence., Gordon Marnoch, Gavin Boyd, John Topping

Gordon Marnoch

This paper examines key problems facing United Kingdom police leaders face in meeting the service expectations of government and the public in a period of austerity. A central problem relates to the extent to which the police leader’s opportunity to pursue strategic actions appropriate to changing circumstances, has been compromised by ‘mission creep’. The empirical evidence presented here is based on a study of one large English police service supplemented by interviews conducted with senior officers in this and other police services. The paper concludes that mission creep and path dependency are inter-linked.

The Consequences Of Incremental Reform And Institutional Dynamics On The Effectiveness Of Performance Management In United Kingdom Police Services., Gordon Marnoch, Karl Mcvicker, Ruth Fee

Gordon Marnoch

The paper argues that while performance management practices are much in evidence in contemporary police services, the perceptions and views of police officers and civilian staff discussed in this paper should give us pause in concluding that there has been a straightforward triumph of managerialist rationality over operational tradition in the use of policing resources. Evidence is drawn from an extensive study of police officers and civilian staff and their self-reported engagement with performance management systems in three large United Kingdom police services.

Envisioning Nevada’S Future: Goals & Strategies For Advancing Our Quality Of Life, Nevada Vision Stakeholder Group, Moody’S Analytics

Brookings Mountain West Publications

Nevada’s severe downturn has brought to light many of the long-term challenges facing the state. Not only is its economy subject to painful swings, but Nevada’s primary drivers— consumer services (primarily gaming, hospitality and housing) and resource extraction—will provide less support than they have in past business cycles. Less economic vitality will make it harder to offer Nevadans the quality of life they expect.

The importance of the economy to quality of life is equally clear—quality of life is a hollow promise without a healthy and supportive economy. Similarly, a proper fiscal structure—both in terms of spending and revenues—is critical …

Aligning Forces For Quality: Improving Language Services Performance Measures, Marsha Regenstein

Health Policy and Management Faculty Publications

This portion of the Language Services Performance Measures guide provides a brief overview of the information contained within each section of the manual. It is intended for use as a quick reference to assist in the implementation of the Language Services performance measures. The sections of the manual are interrelated and have been designed to be used together.

Women’S Health Disparities And Midwifery Care: Spotlight On Rhode Island, Dorothy Hiersteiner

Publications from the Center for Women in Politics and Public Policy

Rhode Islanders face unique health disparities based on race, ethnicity and location. Just over six percent (6.3%) of the Rhode Island population is living in Primary Care Health Professional Shortage Areas (HPSAs), according to 2008 data. Native American and African American/black communities face particular health disparities, specifically in the areas of reproductive and infant health. In 2008, 79% of the Rhode Island population was non-Hispanic white, while 5% was African-American/black, 11% was Hispanic and 5% had other racial/ethnic backgrounds. In 2005, 12.4% of the total Rhode Island population was foreign born.

Concurrent Sexual Partnerships Do Not Explain The Hiv Epidemics In Africa: A Systematic Review Of The Evidence, Larry Sawers, Eileen Stillwaggon

Economics Faculty Publications

The notion that concurrent sexual partnerships are especially common in sub-Saharan Africa and explain the region’s high HIV prevalence is accepted by many as conventional wisdom. In this paper, we evaluate the quantitative and qualitative evidence offered by the principal proponents of the concurrency hypothesis and analyze the mathematical model they use to establish the plausibility of the hypothesis.

We find that research seeking to establish a statistical correlation between concurrency and HIV prevalence either finds no correlation or has important limitations. Furthermore, in order to simulate rapid spread of HIV, mathematical models require unrealistic assumptions about frequency of sexual …

Kinerja Penyuluhan Keluarga Berencana Di Indonesia: Pedoman Pengujian Efektivitas Kinerja Pada Era Desentralisasi, Ukik Kusuma Kurniawan, Hadi Pratomo, Adang Bachtiar

Kesmas

Keberhasilan program KB mengendalikan tingkat kelahiran di Indonesia selama lebih dari tiga dekade tidak terlepas dari peran petugas Penyuluh Keluarga Berencana (PKB). Di Rwanda, keaktifan penyuluhan oleh PKB dapat meningkatkan prevalensi kesertaan akseptor hingga 29%. Sejak tahun 2004, pascakebijakan desentralisasi di Indonesia, jumlah PKB menurun drastis hingga menyisakan dua pertiga dari jumlah awal sekitar 3.500 petugas. Dampak perubahan tersebut tercermin pada angka fertilitas total (TFR) Indonesia berdasarkan data SDKI 2007 yang bertahan sama dengan data SDKI 2002-2003 (2,6 anak per wanita). Hal tersebut dikhawatirkan dapat semakin meningkat apabila kinerja program KB termasuk kinerja petugas PKB tidak mendapat perhatian. Peningkatan TFR …

Pelayanan Rumah Sakit Bagi Masyarakat Miskin (Studi Kasus Di Enam Wilayah Indonesia), Tri Rini Puji Lestari

Kesmas

Pelayanan kepada pasien miskin yang diberikan secara berbeda masih sering terjadi. Penelitian ini bertujuan mendapatkan informasi tentang pelayanan kesehatan yang diberikan oleh rumah sakit kepada masyarakat miskin di enam wilayah Indonesia. Penelitian menggunakan pendekatan kualitatif dengan subjek penelitiannya adalah masyarakat miskin yang sedang dan/atau pernah mendapatkan pelayanan kesehatan di rumah sakit di enam wilayah Indonesia. Hasil penelitian memperlihatkan bahwa pasien miskin di rumah sakit pemerintah maupun rumah sakit swasta, umumnya memiliki tingkat kepuasan yang kurang memadai, di antaranya pada pelayanan administrasi yang dinilai rumit, berbelit, kurang informasi, petugas yang kurang ramah, tidak diberikan resep obat generik, dan pelayanan yang memakan …

Community Health Centers: Opportunities And Challenges Of Health Reform, Sara J. Rosenbaum, Peter Shin, Emily Jones, Jennifer Tolbert

Health Policy and Management Faculty Publications

Community Health Centers: Opportunities and Challenges of Health Reform describes the provisions of the new health reform law that affect community health centers, including increased funding designed to expand the number of health centers, health insurance expansions that will significantly reduce the number of health center patients without insurance, and strategies aimed at increasing the primary care workforce. The brief also discusses some of the opportunities and challenges for the health centers, such as the task of recruiting and retaining qualified health professionals, the need to establish networks and referral arrangements and the renewed focus on prevention and public health …

Drive Alive: Teen Seat Belt Survey Program, Katie M. Burkett, Steve Davidson, Carol Cotton, James Barlament, Laurel Loftin, James H. Stephens, Martin Dunbar, Ryan Butterfield

Health Policy and Management Faculty Publications

Objective: To increase teen seat belt use among drivers at a rural high school by implementing the Drive Alive Pilot Program (DAPP), a theory-driven intervention built on highway safety best practices.

Methods: The first component of the program was 20 observational teen seat belt surveys conducted by volunteer students in a high school parking lot over a 38-month period before and after the month-long intervention. The survey results were published in the newspaper. The second component was the use of incentives, such as gift cards, to promote teen seat belt use. The third component involved disincentives, such as increased police …

Buying Health Care, The Individual Mandate, And The Constitution, Sara J. Rosenbaum, Jonathan Gruber

Health Policy and Management Faculty Publications

Three separate cases raising constitutional challenges to the Affordable Care Act (ACA) are now under way, and together they present issues of great legal complexity. Yet although difficult legal questions must be resolved, a pivotal issue is whose version of events will serve as the judicial analytic filter. For reasons related to the very basis of Congress's constitutional power to enact health care reform, the fight is over whether the individual mandate to purchase health insurance (or pay a tax) is about regulating individuals' economic conduct or regulating their noneconomic status. Depending on which characterization of the facts prevails, the …

From Energy Sector Inquiry To Recent Antitrust Decisions In European Energy Markets: Competition Law As A Means To Implement Energy Sector Regulation In Eu, Michael Diathesopoulos

Michael Diathesopoulos

This paper presents the conceptual path followed by European Union, European Commission and European Competition Network, after the Energy Sector Inquiry (2007) towards the realisation of the objective of an Energy Internal Market, fully functional and open to competition. Firstly, we examine the findings of Sector Inquiry and then we describe how the Third Energy Package - that followed - tried to address the issues highlighted by the Inquiry and how Third Energy Package introduces a promising but complex system, in order to develop sector rules. Following the above, we proceed to a brief but close examination of 10 recent …

Coverage Of Obesity Treatment: A State-By-State Analysis Of Medicaid And State Insurance Laws, Jennifer S. Lee, Jennifer L.O. Sheer, Nancy Lopez, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Objectives. We determined whether state Medicaid programs cover recommended treatments for adult and pediatric obesity and to what extent states regulate the treatment and coverage of obesity by private insurers.

Methods. We conducted a state-by-state document review of Medicaid manuals and private insurance laws and regulations.

Results. Eight state Medicaid programs appear to cover all recommended obesity treatment modalities for adults. Only 10 states appear to reimburse for obesity-related treatment in children. In the small-group insurance market, 35 states expressly allow obesity to be used for rate adjustments, while 10 states do so in the individual market. Two states expressly …

Socioeconomic Indicators That Matter For Population Health, Paula M. Lantz, Andrew Pritchard

Health Policy and Management Faculty Publications

Increasing research and policy attention is being given to how the socioeconomic environment influences health. This article discusses potential indicators or metrics regarding the socioeconomic environment that could play a role in an incentive-based system for population health. Given the state of the research regarding the influence of socioeconomic contextual variables on health outcomes, the state of data and metrics for these variables at the local level, and the potential for program and policy intervention, we recommend a set of metrics related to the socioeconomic composition of a community (including poverty, unemployment, and public assistance rates); educational attainment and achievement; …

Mother Earth "Speaks": Change Yourself, Change The World, Use The Archetypal Energy "Harmony" As A Guide, Carroy U. Ferguson

Carroy U "Cuf" Ferguson, Ph.D.

In relation to the Cosmos, we all, as human beings, live on this tiny planet we call Earth, a planet that supports and sustains life, as we know it. There are many different kinds of people, plants, and animals functioning in harmony with soil, air, and water--all linked to one another in a complex web of life to form one Earth community. Unfortunately, we often take this miracle and ecosystem of life for granted. When, however, we take the ecosystem of life too much for granted, Mother Earth "speaks," reflecting imbalances and dis-harmonies. When Mother Earth "speaks," her message is …

Strengthening Primary Care To Bend The Cost Curve: The Expansion Of Community Health Centers Through Health Reform, Leighton C. Ku, Patrick Richard, Avi Dor, Ellen Tan, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

The recent enactment of health reform sets into motion important changes that will expand health insurance coverage, increase funding for community health centers and alter the way that health centers are paid. These reforms will have a major impact on two major challenges of health reform: bolstering the capacity of the nation's primary care system and reducing the long term growth in health care costs.

Our analyses examine the impact of the new health reform law on the number of patients who will receive primary care services at community health centers and the effect of the service expansions on overall …

Mengenal Rancang Bangun Program Keluarga Harapan Kesehatan, Budi Hidayat

Kesmas

Pemerintah Indonesia sedang melakukan uji coba program bantuan tunai bersyarat (BTB), yakni Program Keluarga Harapan (PKH). Program ini memberikan bantuan tunai kepada rumah tangga miskin dengan mensyaratkan mereka melakukan investasi sumber daya manusia. Pelaksanaan BTB di berbagai negara selalu diikuti upaya sistematis untuk mengukur efektivitas dan memahami dampak yang lebih luas dari program pada perilaku rumah tangga. Artikel ini menyajikan bukti nyata bahwa BTB telah meningkatkan kehidupan penduduk miskin. BTB dipuji sebagai cara untuk mengurangi kesenjangan terutama di sejumlah negara Amerika Latin; membantu rumah tangga keluar dari lingkaran setan kemiskinan yang ditularkan dari satu generasi ke generasi berikutnya; meningkatkan status …