Health and Medical Administration Commons^™

Creating Progam Logic Models: A Toolkit For State Flex Programs, John A. Gale Ms, Andrew F. Coburn Phd, Stephanie Loux Ms

Population Health & Health Policy

A logic modeling toolkit developed by the Flex Monitoring Team is available for use by state Medicare Rural Hospital Flexibility Programs (Flex Programs) in planning for and managing their Flex programs. The use of the Program Logic Model (PLM) Toolkit will provide states with a tool to assist in:

Planning, managing, reporting on, and assessing their Flex Program goals, activities, and accomplishments;

• Developing buy-in among key Flex Program stakeholders;
• Clarifying the underlying program assumptions;
• Identifying and defining measurable outcomes;
• Linking state-level Flex Program strategies and activities to specific and measurable outcomes; and
• Reporting program results to both internal and external …

The Criminal Justice Response To Elder Abuse In Nursing Homes: A Routine Activities Perspective, Brian K. Payne, Randy R. Gainey

Sociology & Criminal Justice Faculty Publications

Politicians and researchers have begun to pay more attention to elder abuse in recent times. Most of the research on elder abuse has focused on cases of abuse perpetrated by family members, treating the phenomenon as a social problem, but it is increasingly being conceptualized as a crime problem. The current study examines elder abuse in nursing homes from a criminological perspective. Using routine activities theory as a guide, particular attention is given to the criminal justice system's response to abusive activities committed by nursing home employees. In all, 801 cases of abuse investigated by Medicaid Fraud Control Units are …

Mental Illness And Barriers To Health Care Access, Charlene Powell

MPA/MPP/MPFM Capstone Projects

Statement of Problem

Access to health care in the United States is major concern, despite the fact that the country spends more per capita on health care than any other country. Individuals with mental illness may face greater access problems than the general population.

Research Question

• Does mental illness predict greater difficulties with access to health care?

Methodology

The 2004 National Health Interview Survey (NHIS) was used to examine the barriers to health care among individuals reporting a mental illness diagnosis. Nine questions relating to health access problems were drawn from the survey and combined into an access index. Multivariate …

Update - September 2005, Loma Linda University Center For Christian Bioethics

Update

In this issue:

-- Just Care: Rationing in a Public Health Crisis
-- Editorial
-- Graduate profiles
-- Jack W. Provonsha Lecture Series: Physician-Assisted Suicide: A Religious Perspective

Scope Of Services Offered By Critical Access Hospitals: Results Of The 2004 National Cah Survey, David Hartley Phd, Mha, Stephenie L. Loux Ms

Rural Hospitals (Flex Program)

No abstract provided.

Intuitive Decision Making And Leadership Style Among Healthcare Executives In The United States, Cherie Whiting

Dissertations

The purpose of this two-phased, sequential, exploratory, mixed-methods study was to survey a sample of Fellows in the American College of Healthcare Executives in the United States and then interview selected individuals who scored in the highly intuitive category on the intuition survey to explore how they made intuitive decisions. In the first phase, quantitative research questions addressed the relationship between leadership style and the potential to make intuitive decisions, as well as the relationship and interaction between the potential to make intuitive decisions and age, gender, and size of company. In the second phase, qualitative interviews were used to …

The Changing Face Of Rural General Practice: An Ethnographic Study Of General Practitioners And Their Spouses, Angela Durey

Theses: Doctorates and Masters

Rural general practice is general practice at its best: a comment by one GP interviewed for this study was echoed by colleagues who viewed their work in a rural setting as challenging, diverse, rewarding and satisfying. Despite reported difficulties associated with rural general practice, many GPs argued that the benefits outweigh the disadvantages. Few wanted to leave. Nonetheless, too few Australian trained GPs are willing to move from cities to work in the country. Consequently, overseas trained doctors have been recruited to fill vacancies or nurses provide health services in communities unable to attract a GP.

The Road To Universal Health Coverage In Massachusetts: A Story In Three Parts, John E. Mcdonough

New England Journal of Public Policy

In 1988, the Massachusetts Legislature passed a new law, a “play or pay” employer mandate, requiring all employers with six or more workers to provide health insurance coverage for their employees. A few years later, with Medicaid identified as a “Budget Buster,” the Weld administration sought deregulation as the way to cut costs and expand access by establishing MassHealth, which dropped the employer mandate and expanded Medicaid, and eventually distinguished Massachusetts as the state with the greatest percent of covered citizens. But MassHealth enrollment has declined as premium costs have risen, and the Uncompensated Care Pool is once again faced …

When The Safety Net Fails: An Analysis Of Alternative Long-Term Care Services In Kentucky, Suzanne Dale

MPA/MPP/MPFM Capstone Projects

The Problem

In early 2003, the Kentucky Cabinet for Health Services, faced with a $450 million Medicaid shortfall, implemented several cost-cutting measures to the Medicaid program. The most visible measure included new stricter medical eligibility requirements for long-term care programs. As a result of these new requirements, approximately 2,813 elderly and disabled Kentuckians were denied services in Kentucky’s Aged/Disabled Home and Community-Based Waiver Program, a Medicaid program that provides long-term care services in people’s homes and in community-settings. The Cabinet for Health Services claimed that those who lost home and community-based Medicaid services could receive care through alternative state programs. …

Identifying Compliance Issues In The Community Health Care Clinic Environment, Faye K. Beery

Graduate Theses

This study explored the high number of failed appointments and follow-up appointments at a community health care children’s clinic. A thirty-seven item questionnaire was randomly given to 112 participants seeking health care at the clinic on a random basis. Based on literature reviews, five hypothesis were generated to examine reasons for failing to keep appointments for children: 1. Communication difficulties between healthcare personnel and parents regarding patient comprehension of instructions and bottle directions were anticipated. 2. Patient/physician/clinic relationships were expected to influence patient compliance. The need for more reminder calls for appointments was anticipated to be a factor in patient …

Expanding Self-Direction In Services For The Aged And People With Disabilities, Ruth A. Burgess

Theses, Dissertations and Capstones

Medicaid-funded long-term care services are traditionally delivered in nursing homes. States may apply for waivers which allow them to provide home and community based services with Medicaid funds. Because these services are by definition an alternative to nursing home care, waiver services are generally based upon a medical model which emphasizes medical deficits and tends to restrict consumers’ movements to inside the home. Recent developments such as the Olmstead Decision and federal New Freedom Initiatives have caused states to recognize that consumers desire and have a legal right to be part of a community rather than institutionalized or homebound. These …

The Medicaid Buy-In Program: Lessons Learned From Nine "Early Implementer" States, Donna Folkemer, Allen Jensen, Robert Silverstein, Tara Straw

Center for Health Policy Research

For many individual Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) recipients, the risk of losing Medicaid coverage linked to their cash benefits is a powerful work disincentive. Eliminating barriers to health care and creating incentives to work can greatly improve financial independence and well being. To support this goal, Congress included a Medicaid Buy-In option in the Balanced Budget Act of 1997 and enacted the Ticket to Work and Work Incentives Improvement Act (TWWIIA) in 1999. These laws authorized states to create Medicaid Buy-In programs to extend Medicaid coverage to persons with disabilities who go to work. …

Policy Frameworks For Designing Medicaid Buy-In Programs And Related State Work Incentive Initiatives, Allen Jensen, Robert Silverstein, Donna Folkemer, Tara Straw

Center for Health Policy Research

This report provides policy frameworks to assist stakeholders (such as Medicaid directors, state legislators, and cross-disability coalitions) design and implement Medicaid Buy-In programs and related work incentive initiatives to enhance the level of economic self-sufficiency of persons with significant disabilities. Of particular focus of the paper are the design decisions affecting enrollment, costs, and a state's fiscal exposure.

The policy frameworks describe the interrelationships between federal and state cash assistance programs (particularly SSDI, SSI, and state SSI supplementation programs) and health entitlements (particularly the Medicaid program). The policy frameworks are derived from the experiences of the nine early implementation states …

Trends. The Privileged Status Of The Physical In Health Ideology: The Security Consequences Of Aids, Ibpp Editor

International Bulletin of Political Psychology

The author discusses the importance of recognizing both physical and psychological factors of the AIDS (Acquired Immune Deficiency Syndrome) pandemic on security.

The Leader Who Serves (Duluth, Mn), C. William Pollard

C. William Pollard Papers

Speaking to a gathering of the Benedictine Health System's leaders in Duluth, MN, Pollard applauds the Benedictine tradition's emphasis on hospitality and encourages servant leadership as model for the system going forward.

Understanding Medicaid Home And Community Services: A Primer, Gary Smith, Janet O'Keeffe, Letty Carpenter, Pamela Doty, Brian Burnwell, Robert Mollica, Loretta Williams, George Washington University, Center For Health Policy Research

Center for Health Policy Research

No abstract provided.

Effect Of The 1996 Welfare And Immigration Reform Laws On Immigrants' Ability And Willingness To Access Medicaid And Health Care Services, George Washington University, Center For Health Services Research And Policy

Center for Health Policy Research

No abstract provided.

Estimating Costs Of Post-Abortion Services. General Hospital Aurelia Valdivieso, Oaxaca, Mexico, Population Council

Reproductive Health

Health care systems around the world are facing problems providing quality care with increasingly constrained resources. While modern practices and diagnostic tests have made pregnancy a much less risky event than in the past, not all pregnancies have a favorable outcome. Spontaneous abortion occurs in 15–45% of all known pregnancies, and studies show that 25% of all obstetric/gynecology hospital admissions are for incomplete abortion. Given the high level of resources devoted to treating this condition, it is imperative to develop cost-effective methodologies to provide quality care. Unsafe abortion performed by untrained and inexperienced providers is the fourth leading cause of …

Building Web Sites That Attract Visitors, C. David Shepherd, Daniel Fell

Faculty Articles

The article discusses the use of web sites for health care service marketing. The potential benefits of Internet services for users and care providers are mentioned, but challenges in implementation are also listed. A three generation model of web site design is offered, distinguishing various levels of interactivity, customization, and perceived value. Suggestions are offered applying this model to health care service web sites and their marketing potential.

Comparing Quality Of Reproductive Health Services Before And After Clinic-Strengthening Activities: A Case Study In Rural Burkina Faso, Direction De La Santé Et De La Famille (Dsf), University Of Ouagadougou Demographic Research Unit (Uerd), Mwangaza, Population Council

Reproductive Health

Much literature has been written about improving the quality of reproductive health (RH) care at service delivery points (SDPs) because women deserve quality services, and as a means of increasing use of family planning (FP) and other RH services. There are six fundamental dimensions of quality of care: choice of methods, information given to clients, technical competence, interpersonal relations, mechanisms to encourage continuity, and an appropriate constellation of services. Improving these elements is thought to increase client satisfaction, resulting in an increase in contraceptive use and eventually fertility decline. Existing research has not convincingly demonstrated this link between quality of …

Monitoring Of Macro-Level Family Planning Quality Of Care Indicators, Meiwita B. Iskandar

Reproductive Health

The success of population development in Indonesia can be seen partly from success in reducing population growth. Population growth has declined from 2.32 percent (1971–80) to 1.98 percent (1980–90), and then to 1.66 percent (1990–95). The continued slowing of population growth is expected to bring expanded opportunities for economic development and improved quality of life. The success of family planning (FP) programs cannot be judged solely on reduction of population growth but should also be judged in terms of quality of care (QOC) and success in helping women achieve their reproductive goals. The Indonesian National Family Planning Coordinating Board (BKKBN) …

Improving Quality Of Care In Fp/Rh Of Selected Communities Of Pangasinan Province: An Intervention Study, Zelda C. Zablan, Josefina V. Cabigon, Luzviminda Muego, Marilou P. Costello, Chona R. Echavez

Reproductive Health

This intervention study was designed to improve the quality of family planning (FP) services within the Integrated Family Planning and Maternal Health Program of the Pangasinan Population and Family Planning Program in the Philippines. It addresses high unmet need and studies the feasibility of enhancing quality of services by training service providers in fixed clinics and orienting outreach workers on the method of identifying women who have unmet need for FP. Four municipalities were chosen from the 47 municipalities comprising the province of Pangasinan and randomly assigned to experimental and control groups. Four indicators were used to match the chosen …

Ethical Dilemmas Faced By Independent Practitioners As A Result Of Managed Care, Caren Renee Debernardo

All-Inclusive List of Electronic Theses and Dissertations

This study surveyed licensed psychologists in private practice regarding their perceptions of ethical issues associated with managed care. Surveys addressing ethical issues were mailed to 1,000 members of the American Psychological Association's (APA) Division oflndependent Practice (Division 42). Forty-two percent of the surveys were returned. The responses were summarized using descriptive statistics and analyzed to compare opinions of psychologists as a function of theoretical orientation, geographical location, specialty, population of location area, years in practice, and level of state and national organizational involvement. The results of the study identified a number of ethical concerns including compromised confidentiality, inadequate diagnosis and …

The Leader Who Serves (Scottsdale, Az), C. William Pollard

C. William Pollard Papers

In this address to the Baptist Healthcare Association (Scottsdale, AZ), Pollard applauds religious healthcare institutions for their commitment to the physical and spiritual welfare of the human person. With this holistic approach, they refuse to submit to the logic of simple economic efficiency and thus serve as a prime example of servant leadership.

Health Care Marketing And The Internet, C. David Shepherd, Daniel Fell

Faculty Articles

This article presents research on the growing number of health care providers using the Internet as a health care marketing tool in the U.S. The author notes that the Internet is changing the way consumers seek healthcare related information as well as the way it can be provided to them. The results of the study suggest that consumers will increasingly rely on sources like the Internet for information, that health information will be a commodity on the Internet, that the Internet will help build relationships between providers and consumers and that marketers will be expected to develop and manage Internet-related …

Performance And Accountability In Human Services: Ownership And Responsibility Of Professionals, Anna-Marie Madison

New England Journal of Public Policy

The recent frenzy of grant makers and government agencies in requiring impact evaluations of all grant recipients has created consternation among human service providers. To ensure their agencies' survival and worker job security, the leaders are faced with meeting the demands offunder-driven programming. Agencies seeking funding must comply with funder-defined needs and accountability criteria rather than their public missions. This article describes the use of mission-based performance evaluation rather than funder compliance to demonstrate accountability for mission accomplishment.

Improving Workforce Conditions In Private Human Service Agencies: A Partnership Between A Union And Human Service Providers, James Green

New England Journal of Public Policy

In 1995 the Service Employees International Union Local 509 and four Massachusetts human service providers signed an unusual agreement to forge a partnership in which employers would remain neutral while the union approached its workers with an offer to advocate in the state legislature for greater funding for private human service employees and to promote cooperative relations with their employers. This study examines the context of the agreement and the pressures on public employee unions and small human service providers whose workforce copes with low wages, high turnover, meager benefits, and poor public image as well as the give-and-take between …

Labor's Response To Hospital And Workplace Transformation, Enid Eckstein

New England Journal of Public Policy

The health care industry and the nation's hospitals are in the throes of revolutionary change. The shift to managed care resulted in fundamental changes in the delivery of care and the structure of health care, For the past ten years, hospitals have actively been merging and creating large-scale integrated delivery systems. Employers, eager to expand market share and reduce costs, are engaged in radical reorganization of the hospital and the structure of work from which no group is immune. Physicians, nurses, technicians, and housekeepers are all affected by these changes. Hospitals are reducing their personnel, shifting work outside the hospital, …

Congress Crafts Child Health Insurance Program, George Washington University Medical Center, Center For Health Policy Research

Center for Health Policy Research

No abstract provided.

Integrating Indian Health Programs Into Medicaid Managed Care Systems, Part 2, Sara J. Rosenbaum, Ann Zuvekas

Center for Health Policy Research

The Indian Health Service (IHS), recognizing that state Medicaid programs are rapidly purchasing managed care plans for their beneficiaries and that managed care enrollment has significant implications for both Indians and Indian health facilities, convened this Roundtable to discuss options for participation in such care. The purpose of this roundtable was to identify options to increase Medicaid managed care participation by Indian health programs. These include programs operated directly by IHS, programs operated by tribes under the Indian Self-Determination Act, and urban Indian programs under Title V of the Indian Health Care Improvement Act.By design, Roundtable participants were a group …