Public Health Commons^™

The Continuing Decline In Medicaid Coverage, Leighton Ku, Brian K. Bruen

Health Policy and Management Faculty Publications

No abstract provided.

A Comparison Study Of Food Facility Inspection Scores And Consumer Complaints, Debora Kim Leuer

Theses Digitization Project

No abstract provided.

Cognitively Impaired Elderly Individuals And Durable Powers Of Attorney For Healthcare, Nicole Rae Newman

Theses Digitization Project

No abstract provided.

Classification Of Participants Into Two Health Resource Utilization Groups By The Health Enrollment Assessment Review (Hear) Survey, Jody W. Donehoo

Health Services Research Dissertations

The study examined the ability of the Health Enrollment Assessment Review (HEAR) survey instrument to classify participants into one of two groups according to utilization of health resources anticipated in the following year. Developed by the U.S. Air Force, the HEAR survey is used worldwide by the Department of Defense for enrollees in TRICARE Prime, the military's adaptation of the HMO model of managed care. Individual HEAR reports are prepared for survey participants and their primary care providers in TRICARE Prime. Although it is currently administered worldwide to a majority of the 8.4 million health care beneficiaries of the Department …

Benchmarking Financial Operations Using The Premier Operations Outlook Database, Margaret M. Thompson

Community & Environmental Health Theses & Dissertations

Acute-care hospitals have come under increased pressure to reduce costs while increasing the quality of providing care. Historically, increasing costs of providing care has had the greatest impact on the reduction of operating margins necessary to expand capital and for repayment of debt. Facilities can benchmark internal historical data to identify areas where costs have increased and are able to explain the factors that contribute to the increases. One of the challenges facing hospitals in their efforts to reduce operating costs is how, what, and where, do they obtain comparative data to benchmark the cost of operating medical facility to …

Centred Voices : A Study Of The Lived Experience Of Women's Health Centre Coordinators, Jodie L. Moyle

Theses: Doctorates and Masters

The purpose of this phenomenological study is to explore and describe the lived experience of women's health centre coordinators. In addition to the intrinsic value of telling these women's stories, this research provides data which can he used to strengthen the economic, political, organisational and social position of women’s health centres and the women who work in them. Four women managers from regional urban women's health centres in Australia were interviewed about their subjective experiences with respect to their current working roles. Interviews were audio taped, transcribed and coded to produce themes and to preserve anonymity. Data was analysed using …

Retooling Tax Subsidies For Health Coverage: Old Ideas, New Politics, Karl Polzer

National Health Policy Forum

This paper describes the tax treatment of health coverage and health care spending and explores the potential impact of recent tax reform proposals. The paper summarizes the criticisms of the current system and analyzes various alternatives including capping the open-ended tax exclusion of health benefits provided by employers and unions, eliminating the exclusion, and establishing a tax credit.

Physician Organizations Assuming Risk: Market And Policy Implications, Sandra Foote, Lisa Sprague

National Health Policy Forum

This issue brief looks at capitation contracting between physician groups and health plans and ways in which financial risk and functional responsibilities may be apportioned. It traces the evolution of capitation contracting in California and the legislative and regulatory issues that have arisen.

Site Visit To Southern California — Plans And Providers: Risk, Accountability, And Staying Power, Lisa Sprague

National Health Policy Forum

This site visit was the second of two focused on managed care operations and market dynamics in California, a state notable for high HMO market penetration and intense competition. In southern California, large physician groups and independent practice associations were highly visible and influential. They had assumed significant financial risk and care management responsibility for patients in HMO plans. The result was a distinctly different model of managed care than existed in other regions of the country. The visit included meetings with leaders from physician organizations and managed care organizations in San Diego and Orange counties, as well as an …

Site Visit To Utah And Nevada — Essential Community Health Services On The Frontier, Karen Matherlee, Michael Anzick

National Health Policy Forum

From the opening dinner to the closing summary, this site visit explored the delivery and financing of essential community services for vulnerable populations in the frontier West. A sequel to the Forum's March 30-31, 1998, urban-centered site visit to Philadelphia, Providing Community-Based Primary Care: Nursing Centers, CHCs, and Other Initiatives, the visit spanned 493 miles. It included overview presentations, bus briefings, facility tours, telehealth demonstrations, panel discussions, and wrap-up reviews. Topics included the Utah health marketplace, the demands of emergency preparedness, the development of a patchwork of services along a continuum ranging from preventive care to tertiary referrals and follow-up, …

The State Children's Health Insurance Program: How Much Latitude Do The States Really Have?, Richard Hegner

National Health Policy Forum

The State Children's Health Insurance Program (CHIP) — a major program to cover low-income, uninsured children — was passed as part of the Balanced Budget Act of 1997. Its passage was part of a trend of a shifting balance of power between the federal and state governments, particularly in the policy areas of health and social welfare. This issue brief explores the degree of freedom afforded the states by CHIP, the factors guiding state decision making and planning, and the factors influencing the states' various decisions about CHIP. It also discusses state options in four basic areas: participation or nonparticipation …

Protecting The Confidentiality Of Health Information, Nora Super

National Health Policy Forum

This issue brief focuses on the legislation aimed at protecting the confidentiality of health information. It provides an overview of legislation being considered in 1998 and focuses on three key issues: controlling access to health information, conducting research, and preempting state laws.

Communicating To Beneficiaries About Medicare+Choice: Opportunities And Pitfalls, Nora Super

National Health Policy Forum

This issue brief explores the opportunities and potential pitfalls in communicating to beneficiaries about Medicare+Choice. This issue brief also looks at the difficulties inherent in communicating complex information to a diverse group of older individuals as well as at communications and programmatic challenges related to information overload, marketing concerns, lack of uniform standards, lack of infrastructure, and the vulnerability of various subpopulations.

Medicare Coverage And Technology Diffusion: Past, Present, And Future, Robin J. Strongin

National Health Policy Forum

This issue brief provides an overview of the Medicare coverage process. Coverage involves deciding whether or not to pay for a particular service or product. This brief examines Medicare's coverage determination process, which includes technology assessment, payment determination, and the demand for evidence. Options for improving the coverage determination process are reviewed.

Measurement Of Hospital Performance: Environmental And Organizational Factors Associated With Cost, Debra Kay Dierksmeier Anderson

Health Services Research Dissertations

As U.S. health care expenditures top the $1 trillion mark, there is increased interest in measuring the performance of health care providers. For bottom line oriented payors such as government and business, the focus is on measuring cost. As hospitals account for over one-third of health care expenses, hospital cost per admission is a common measure of performance.

Many environmental and organizational factors come into play in determining hospital cost per admission. This research examines several of these factors, using Raymond Zammuto's model of organizational effectiveness assessment. Using Zammuto's framework, this research looks at the relationship of social, physical, and …

Erisa Health Plan Denials: Exploring Models For External Review, Karl Polzer

National Health Policy Forum

This paper outlines the current process under the Employee Retirement Income and Security Act (ERISA) by which plan participants can appeal a claim denial as well as changes to the claims procedure requirements being considered by the Department of Labor. It describes state legislative activity in this area and summarizes research describing practices currently in place among managed health care organization. The paper also describes two existing models for external review of managed care plan decisions, one used by the Medicare program and another by the state of Florida.

Nursing Home Ownership And Public Policy: An Historical Analysis, K. R. Kaffenberger

Graduate Doctoral Dissertations

In the early days of the United States, care of the disabled elderly outside the home meant the public almshouse. By the 1920s, private, nonprofit homes for the aged were prevalent. More recently, private, for-profit facilities have grown to dominate the field.

For-profit ownership has been controversial. Underlying the controversy is the concern that quality might be lowered in order to enhance profit.

This study asks why most nursing homes are privately owned and why most privately owned nursing homes are operated for profit. It does so with reference to The Nonprofit Economy, in which Burton Weisbrod describes a …

Site Visit To New Jersey — State And County Experiences With Welfare Reform And Access To Health Care, Michael Anzick, Richard Hegner

National Health Policy Forum

This site visit was the second in a series to examine what is occurring at the state and local level with respect to welfare reform, Medicaid, public health, and safety net and other supportive services. During this visit, policymaker discovered how state officials, directors, and front-line staff at urban and suburban county welfare offices are working with clients to move them off the welfare rolls into jobs and providing the support services necessary for job retention; heard from clients about how programmatic changes are affecting them and their families; learned how the role of safety net health care and temporary …

How Do Hmos Achieve Savings? The Effectiveness Of One Organization's Strategies., Ann B. Flood, Allen M. Fremont, K Jin, David M. Bott

Dartmouth Scholarship

To examine how a group practice used organizational strategies rather than provider-level incentives to achieve savings for health maintenance organization (HMO) compared to fee-for-service (FFS) patients. A large group practice with a group model HMO also treating FFS patients. Data sources were all patient encounter records, demographic files, and clinic records covering 3.5 years (1986-1989). The clinic's procedures to record services and charges were identical for FFS and HMO patients. All FFS and HMO patients under age 65 who received any outpatient services during approximately 100,000 episodes of the seven study illnesses were eligible.

Dual Diagnoses: The Challenge Of Serving People With Concurrent Mental Illness And Substance Abuse Problems, Richard Hegner

National Health Policy Forum

This paper describes the prevalence of comorbid mental disorders in the population and discusses what is known about causality and relapse. The relationship between dual diagnosis and homelessness and crime is also discussed. The paper also explores options for improving treatment among the dually diagnosed.

Increasing The Federal Cigarette Tax: A Means Of Reducing Consumption?, Lauren Tran, Richard Hegner

National Health Policy Forum

This issue brief probes the economic issues associated with tobacco and cigarettes. It examines the possible effectiveness of a tax increase as a strategy to reduce cigarette consumption, especially among young people, and the likely ramifications of a tax increase for the tobacco industry.

Restructuring The Va Health Care System: Safety Net, Training, And Other Considerations, Barbara Skydell

National Health Policy Forum

This paper provides an historical overview of the modern Veterans Administration (VA) healthcare system and describes the multiple missions of the VA — patient care, health professions education, research, and medical preparedness. The VA's reform plan, which addresses issues related to decentralization, management and oversight, resource allocation, eligibility reform, and primary/ambulatory care, is also described and discussed. Challenges facing the VA as it transitions to a greater focus on prevention, primary care, and care management are also addressed.

The Federal Employees Health Benefits Program: What Lessons Can It Offer Policymakers?, Karl Polzer

National Health Policy Forum

This paper provides an historical overview of the Federal Employees Health Benefits (FEHB) program and its marketplace dynamics. It also reviews key program features and issues, including payments to health plans, strategies used to mitigate the opportunities for risk selection, and costs.

Interprofessional Working And Continuing Medical Education., Linda Headrick, Peter Wilcock, Paul Batalden

Dartmouth Scholarship

No abstract provided.

Site Visit To Philadelphia — Providing Community-Based Primary Care: Nursing Centers, Chcs, And Other Initiatives, Karen Matherlee

National Health Policy Forum

This site visit provided federal congressional and agency health staff opportunities to visit facilities and engage in discussions on essential community health services. Focused on community-based primary care in a managed care environment, it featured delivery and financing concerns relating to nursing centers, community health centers, public-mission hospitals, and homeless services. In examining the impact of managed care in a rapidly changing health marketplace, it explored the implementation of the Medicaid HealthChoices program in the city as well as access to and delivery of care to persons with neither public nor private insurance. It also looked at the role of …

Site Visit To Northern California — Risk, Accountability, And Staying Power In Next-Generation Managed Care, Lisa Sprague, Sandra Foote

National Health Policy Forum

This three-day site visit looked at private health insurance and delivery of care in a market notable for high managed care penetration, relatively low premium costs, and sophisticated provider groups. Federal congressional and regulatory staff heard from health insurance purchasers (both public and private), health plans, hospital systems, and physician groups about the changing relationships and accountabilities in this market and the ways various organizations were positioning themselves to survive the turmoil and emerge the stronger for it. Participants also heard from two county health programs about how competition and realignment in the private market were impacting safety-net services for …

Health Care Quality: From Data To Accountability, Mary Darby

National Health Policy Forum

This paper discussed the evolution of quality measurement and reporting activities as well as efforts to develop accountability for delivering high-quality care. It examined (a) initiatives in the professional arena, such as accreditation and performance measurement by independent accrediting bodies; (b) activities of market proponents, who have preferred to concentrate on making data available to purchasers and consumers that would enable them to choose high- quality plans and providers; and (c) attempts by the public sector to secure quality through regulation and oversight. An exploration of the successes, limitations, overlaps, and gaps in quality assurance initiatives, the paper was published …

Improving Patient Satisfaction With A Major Healthcare Organization, Mary Carolyn Tornero

Theses Digitization Project

No abstract provided.

Indicators Of Leadership Characteristics Of Health Care Administrators: Executive Tenure, Behavioral Attributes, And Self-Professed Values, Kenneth Dale Kassinger

Theses Digitization Project

No abstract provided.

Evaluation De La Prise En Charge De La Maternité Sans Risque Et De La Survie De L'Enfant Au Niveau Communautaire De Bazéga, Direction De La Santé Et De La Famille (Dsf), University Of Ouagadougou Demographic Research Unit (Uerd), Mwangaza, Population Council

Reproductive Health

No abstract provided.