Medicine and Health Sciences Commons^™

Healthcare Reform Hangs In The Balance, Lawrence O. Gostin

O'Neill Institute Papers

In this timely new briefing, Professor Lawrence O. Gostin, University Professor and Faculty Director, O’Neill Institute for National and Global Health Law, Georgetown University writes:

Prior to Tuesday’s arguments, I believed that the Supreme Court would uphold the health insurance purchase mandate by a comfortable margin. But now I believe that health care reform hangs in the balance. Here are the key arguments on which the future of President Obama’s health care reform depends: a greater freedom, cost-shifting, the health care market, acts versus omissions, limiting principles, the population-base approach, and what is necessary and proper. If the Court strikes …

Why The Affordable Care Act's Individual Purchase Mandate Is Both Constitutional And Indispensable To The Public Welfare, Lawrence O. Gostin

O'Neill Institute Papers

Integral to the Affordable Care Act's (ACA’s) conceptual design is the individual purchase mandate, which requires most individuals to pay an annual tax penalty if they do not have health insurance by 2014. Despite the vociferous opposition, the mandate is the most “market-friendly” financing device because it relies on the private sector. Ironically, less market-oriented reforms such as a single-payer system clearly would have been constitutional.

It is common sense for everyone to purchase health insurance and thus gain security against the potentially catastrophic costs of treating a serious illness or injury. However, Congress’ method of ensuring that everyone has …

Role Of Community Health Centers In Providing Services To Low-Income Women, Peter Shin, Jessica Sharac

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Because of their location and ability to serve populations with complex health and social needs, CHCs reduce disparities in access to care and generate significant costsavings. This brief examines the role CHCs play in mitigating disparities for one population subgroup, low-income women of childbearing age (defined as age 15-44), and the challenges that they will need to overcome to build upon their success in delivering care to vulnerable populations. Key findings include:

• CHCs serve approximately one in five (21.5%) low-income women of childbearing age nationally.
• The number of women of child-bearing age receiving health center services at CHCs increased by …

Community Health Centers: The Challenge Of Growing To Meet The Need For Primary Care In Medically Underserved Communities, Peter Shin, Sara J. Rosenbaum, Julia Paradise

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

No abstract provided.

Estimating Medical Cost Offsets Attributable To Public Health Spending, Glen P. Mays

Health Management and Policy Presentations

Uncertainty about the magnitude and timing of economic returns associated with spending on public health services has contributed to policy debates about the optimal role of the federal government in financing these services.

Estimating Medical Cost Offsets Attributable To Public Health Spending, Glen Mays

Glen Mays

Uncertainty about the magnitude and timing of economic returns associated with spending on public health services has contributed to policy debates about the optimal role of the federal government in financing these services.

Should Marijuana Be Decriminalized? [An Annotated Bibliography], Christina M. Costa

Undergraduate Research Award

No abstract provided.

Public Health Spending, Preventable Outcomes, And Medical Cost Offsets: Questions For Health Reform, Glen P. Mays

Health Management and Policy Presentations

Uncertainty continues to surround the health and economic effects that can be expected from increased federal spending on public health and prevention strategies. Recent research provides some insight into the question of whether spending on public health strategies can offset the need for future spending on medical care.

Public Health Spending, Preventable Outcomes, And Medical Cost Offsets: Questions For Health Reform, Glen Mays

Glen Mays

Uncertainty continues to surround the health and economic effects that can be expected from increased federal spending on public health and prevention strategies. Recent research provides some insight into the question of whether spending on public health strategies can offset the need for future spending on medical care.

Increasing Consumer Involvement In Medicaid Nursing Facility Reimbursement: Lessons From New York And Minnesota, Edward Alan Miller, Cynthia Rudder

Gerontology Institute Publications

Medicaid is the major purchaser of nursing home care in the United States. States design their methods of reimbursing nursing homes to achieve desired policy objectives related to facility cost and quality, access to care, payment equity, service capacity, and budgetary control. The incorporation of multiple, sometimes conflicting incentives into state reimbursement systems has resulted in enormously complex and demanding methodologies that inhibit consumer participation in state rating setting decisions. In turn, the lack of consumer involvement has the potential to result in the adoption of reimbursement systems that favor industry and government interests at the expense of issues important …

Overview Of The National Longitudinal Survey Of Public Health Systems, Glen Mays

Glen Mays

Since 1998, researchers have followed a nationally representative cohort of U.S. communities to examine the types of public health activities performed within the community, the range of organizations contributing to each activity, and the perceived effectiveness of each activity in addressing community needs. This information, obtained through a validated survey of local public health officials, provides an in-depth view of the structure and function of local public health delivery systems and how these systems evolve over time. Originally conducted with support from the U.S. Centers for Disease Control and Prevention, the National Longitudinal Survey of Public Health Systems (NLSPHS) was …

National Longitudinal Survey Of Public Health Systems Instrument, Glen Mays

Glen Mays

No abstract provided.

Positive Action For Hiv In Schools In Kenya, Francis Obare, Harriet Birungi, Monica Wanjiru, Sheila Bayley, John Kiunjuri, Mary Omondi, Rob Burnet, Bridget Deacon

Reproductive Health

The objective of this study was to test the feasibility of using comic books, role models, and edutainment to communicate HIV and AIDS messages to in-school young people in Kenya, with a view to improving their knowledge about the epidemic, enhancing communication about it, and promoting positive attitudes and behavior among them. The study was implemented by the Population Council in eight secondary schools in Nairobi, as part of the APHIA II Operations Research Project in collaboration with the AIDS Control Unit in the Ministry of Education, Well Told Story, and the National AIDS/STI Control Programme. The study found that …

Study Guide For United In Anger: A History Of Act Up, Matt Brim

Open Educational Resources

The United in Anger Study Guide facilitates classroom and activist engagement with Jim Hubbard’s 2012 documentary, United in Anger: A History of ACT UP. The Study Guide contains discussion sections, projects and exercises, and resources for further research about the activism of the New York chapter of ACT UP (AIDS Coalition to Unleash Power). The Study Guide is a free, interactive, multimedia resource for understanding the legacy of ACT UP, the film’s role in preserving that legacy, and its meaning for viewers' lives.

The Emergence And Potential Impact Of Medicine 2.0 In The Healthcare Industry, Terra Stump, Sarah Zilch, Alberto Coustasse

Management Faculty Research

Medicine 2.0 has emerged within healthcare information technology to enable more defined relationships among providers and patients. Physicians, hospitals, and patients are using Medicine 2.0 through social networking to maintain their foothold in the evolution of medical technologies. The authors’ purpose was to determine potential improvements that Medicine 2.0 has on communication and collaboration of healthcare information. Research has shown that Medicine 2.0 has integrated into the healthcare industry and is enabling an increase in communication in healthcare matters. The provider-patient relationship is improving through the use of Medicine 2.0 and has positively impacted society so far.

Evaluation Of A Culturally Adapted Training In Indigenous Mental Health And Wellbeing For The Alcohol And Other Drug Workforce, Racheal Hinton, Tricia Nagel

Aboriginal Policy Research Consortium International (APRCi)

Indigenous Australians have high rates of mental illness comorbid with substance misuse. The complex needs of this client group create challenges for the alcohol and other drug (AOD) workforce. This paper describes the outcomes of an Indigenous-specific “Yarning about Mental Health” training for the AOD workforce to strengthen knowledge and skills in mental health approaches and in their engagement with Indigenous clients. The training provides culturally adapted strategies and tools for understanding mental health, promoting wellbeing, and delivering brief interventions in the substance misuse setting. A nonexperimental evaluation which incorporated pre-post questionnaires was conducted with workshop participants attending one of …

Growing Up Our Way : The First Year Of Life In Remote Aboriginal Australia, Sue Kruske, Suzanne Belton, Molly Wardaguga, Conceptual Narjic

Aboriginal Policy Research Consortium International (APRCi)

In this study, we attempted to explore the experiences and beliefs of Aboriginal families as they cared for their children in the first year of life. We collected family stories concerning child rearing, development, behavior, health, and wellbeing between each infant’s birth and first birthday. We found significant differences in parenting behaviors and childrearing practices between Aboriginal groups and mainstream Australians. Aboriginal parents perceived their children to be autonomous individuals with responsibilities toward a large family group. The children were active agents in determining their own needs, highly prized, and included in all aspects of community life. Concurrent with poverty, …

Do Indigenous Australians Age Prematurely? The Implications Of Life Expectancy And Health Conditions Of Older Indigenous People For Health And Aged Care Policy, Philippa R. Cotter, John R. Condon, Tony Barnes, Ian P.S. Anderson, Leonard R. Smith, Teresa Cunningham

Aboriginal Policy Research Consortium International (APRCi)

Objective. To assess whether Indigenous Australians age prematurely compared with other Australians, as implied by Australian Government aged care policy, which uses age 50 years and over for population-based planning for Indigenous people compared with 70 years for non-indigenous people.

Methods. Cross-sectional analysis of aged care assessment, hospital and health survey data comparing Indigenous and non-indigenous age-specific prevalence of health conditions. Analysis of life tables for Indigenous and non-indigenous populations comparing life expectancy at different ages.

Results. At age 63 for women and age 65 for men, Indigenous people had the same life expectancy as non-indigenous people at age 70. …

Using First Nations Children's Perceptions Of Food And Activity To Inform An Obesity Prevention Strategy, Ashlee-Ann E. Pigford, Noreen D. Willows, Nicholas L. Holt, Amanda S. Newton, Geoff D.C. Ball

Aboriginal Policy Research Consortium International (APRCi)

No abstract provided.

Incentivizing Providers To Improve Maternal, Newborn And Child Health Services In Bangladesh: Pay-For-Performance Model Refinement And Advocacy (P4p Mra) Final Report, Md. Noorunnabi Talukder, Ubaidur Rob, Laila Rahman, A.K.M. Zafar Ullah Khan, Riad Mahmud, Azizul Alim, Ismat Ara Hena, Farhana Akter, Anup Kumar Dey

Reproductive Health

An operations research project by the Directorate General of Health Services (DGHS) of the Ministry of Health and Family Welfare, Government of Bangladesh tested the feasibility of a pay-for-performance (P4P) approach, which offered financial incentives to reward service providers for meeting and exceeding specified performance targets for maternal, newborn, and child health services. In response to the encouraging findings, the DGHS implemented a follow-up project, with technical assistance from Population Council and UNICEF, to utilize the experiences and findings of the P4P OR project. Despite it short duration, implementation of the revised P4P scheme induced improvements in service volume and …

Providers' Attitudes And Practices Regarding Emergency Contraception In India: Key Findings, M.E. Khan, Isha Bhatnagar, Deepthi S. Varma, Anvita Dixit

Reproductive Health

This policy brief reports key findings of a study in India that explored providers’ knowledge of how emergency contraception (ECP) works and its safety and effectiveness, their perceptions of the frequency of repeat use, their provision of ECP, and their attitudes toward women who seek it. Many of the findings of this study are encouraging. Most providers believed that ECP is an effective and safe method to prevent pregnancy and that it cannot induce abortion, and half supported the over-the-counter provision of ECP. Nevertheless, the study revealed many biases and gaps in knowledge. Recommendations include a number of ways to …

Increasing Access To Family Planning And Reproductive Health Services Through Community Work: A Case Study Of A Dual Cadre Model In India, Jaleel Ahmad, Isha Bhatnagar, M.E. Khan

Reproductive Health

Before the introduction of Accredited Social Health Activists (ASHAs) in India, mid-level auxiliary nurse midwives (ANMs) were responsible for community health education and services such as antenatal care, delivery, IUCD insertion, and sterilization referrals. The Population Council studied how community extension work and some primary care responsibilities have been shifted to ASHAs, who are tasked with identifying pregnant women; facilitating ANC check-ups; motivating women for institutional deliveries during ANC checkups; and organizing child immunization. Establishing dual worker cadres in India by shifting community extension tasks from ANMs to local ASHAs has been well conceived. Task shifting has allowed ANMs, as …

Providers' And Key Opinion Leaders' Attitudes And Practices Regarding Emergency Contraception In Senegal: Key Findings, Babacar Mane, Martha Brady, Saumya Ramarao, Fatou Bintou Mbow

Reproductive Health

This study examines providers’ and key opinion leaders’ knowledge, attitudes, and practices regarding the emergency contraceptive pill (ECP) in Senegal, and synthesizes the findings to suggest program and policy recommendations. Analysis of providers’ opinions and beliefs reveals that although many providers believe ECP is a safe product, persistent negative views remain. KOLs and providers recognize the importance of ECP for preventing unintended pregnancy and are supportive of the integration of ECP into national guidelines. They note, however, the need to improve accessibility and quality of provision. Given the magnitude of sexual violence and abuse, considerable interest exists in devising strategies …

The Africa Regional Sexual And Gender-Based Violence Network Annual Partners Meeting: June 26-27 2012, Mombasa, Kenya—Meeting Report, Population Council

Reproductive Health

The Population Council convened an annual partners meeting of its Africa Regional Sexual and Gender-Based Violence (SGBV) Network. Over 30 participants attended the meeting whose objectives were: 1) to facilitate South-South technical exchange and information-sharing on the changing landscape of violence among partners, donors, and other experts; and 2) to reflect on the ways in which research is translating into policy and practice. This report highlights the myriad ways in which activities conducted under this Network have influenced policy, practice, and funding considerations in the region, while detailing the progress of Network partners on their projects, built around several key …

Enacting Accountability: Networked Governance, Canadian Ngos And The Fctc, Raphael Lencucha, Anita Kothari, Ronald Labonte

Anita Kothari

Accountability is a pressing challenge within the present system of international lawmaking. Scholars continue to examine the role of non-governmental organizations (NGOs) to encourage the accountability of governments during this process. The negotiation of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) provides an important context to examine accountability as it is and was inherently influenced by corporate interests and government economics, and involved extensive NGO participation. We conducted in depth interviews and document analysis to examine the role of Canadian NGO representatives in the negotiation of the FCTC. We highlight two sets of findings about Canadian …

Community Based Research-Vancouver Rent Bank, Nisha Malhotra

Nisha Malhotra

As part of UBC’s initiative to facilitate community-based learning, this course gave students the option of participating in a research project that helps a non-profit organization gain better understanding of a specific issue. Whereas most undergraduate economic curricula focus on theory or data analysis, Community-Based Research (CBR) lets students use their theoretical knowledge and analytical skills to help people in their own community

What Is A Healthy Community?, Denise Tanata Ashby, Jennifer Pharr

Lincy Institute Reports and Briefs

The health of a community is dependent not only upon the genetics of its residents, but also upon the environment within which those individuals live. A person’s health is a product of their environment. As such, a healthy community is one in which all residents have access to a quality education, safe and healthy homes, adequate employment, transportation, physical activity, and nutrition, in addition to quality health care. Unhealthy communities lead to chronic disease, such as cancers, diabetes, and heart disease. The health of our communities is critical to the growth and development of our region. To build healthy communities …

Physician Wages In States With Expanded Aprn Scope Of Practice, Patricia Pittman, Benjamin Williams

Health Policy and Management Faculty Publications

In recent years, states have looked to reforms in advanced practice nursing scope of practice (SOP) barriers as a potential means to increase access to primary care while reducing costs. Currently, 16 states and the District of Columbia permit advanced practice registered nurses to practice independently of physicians, allowing them to perform functions such as diagnosing and prescribing under their own authority within the primary care setting. Given the resistance of many physician associations to these reforms, we asked whether the economic interests of primary care physicians might be affected by reforms. Using the Bureau of Labor Statistics data on …

Assessment Of Management Information System [Mis] Of National Program For Family Planning And Primary Health Care [Lhw Program], Arshad Mahmood, Syeda Saman Naz

Reproductive Health

This assessment by the Population Council is based on a random sample of 154 Lady Health Workers (LHWs) from three provinces of Pakistan. The aim is to strengthen the routine LHW-MIS (management information system) in the districts so that it can contribute to the improvement of the district health system by providing reliable evidence. Further, based on the findings of the current assessment, the districts managers/decisionmakers should be able to continuously improve the LHW-MIS through applying a problem-solving approach. The report details recommendations for program management, including: 1) providing all necessary MIS tools to each LHW; 2) providing basic equipment …

Repositioning Community-Based Family Planning In Ghana: A Case Study Of Community-Based Health Planning And Services (Chps), Stephen Ntsua, Placide Tapsoba, Gloria Quansah Asare, Frank K. Nyonator

Reproductive Health

The Population Council conducted a diagnostic appraisal of delivering family planning services using the community-based health planning and services (CHPS model) in Ghana. This study’s results indicate that the CHPS program is well appreciated by rural communities where it is operational. However, the study identified several developments with implications for service delivery: increased community health officer (CHO) workloads and concomitant reductions in outreach services and home visits by community health visitors (CHVs) have weakened the CHO-CHV working relationship, leaving both cadres working in isolation. CHPS has significantly improved health indices but its contribution to increasing family planning is limited and …