Health Services Administration Commons^™

Preparing For The Future: An Evaluation Of Alternative Methods For Estimating The Needed Capacity Of Nursing Home Beds In Kentucky, Michelle D. Woods

MPA/MPP/MPFM Capstone Projects

Due to the aging of the generation known as “Baby Boomers”, the nation is expected to witness extraordinary growth in the total population ages 65 and over. Population projections provided by the United States Bureau of the Census suggest that this segment of the population will double in size to 72 million by the year 2030. In order to prepare for the anticipated increase elderly Americans, policy officials have been analyzing the potential effects on the nation’s long-term care system. Although Baby Boomers can expect to live longer than their predecessors, as they age, it is predicted that this generation …

Girls' Perception Of Physical Environmental Factors And Transportation: Reliability And Association With Physical Activity And Active Transport To School, Kelly R. Evenson, Amanda Birnbaum, Ariane L. Bedimo-Rung, James Sallis, Carolyn C. Voorhees, Kimberly Ring, John P. Elder

Department of Public Health Scholarship and Creative Works

Background

Preliminary evidence suggests that the physical environment and transportation are associated with youth physical activity levels. Only a few studies have examined the association of physical environmental factors on walking and bicycling to school. Therefore, the purpose of this study was (1) to examine the test-retest reliability of a survey designed for youth to assess perceptions of physical environmental factors (e.g. safety, aesthetics, facilities near the home) and transportation, and (2) to describe the associations of these perceptions with both physical activity and active transport to school.

Methods

Test and retest surveys, administered a median of 12 days later, …

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 …

Designing Employer-Sponsored Mental Health Benefits, Rachel Sethi, Joanne Jee, Lisa Chimento, D. Richard Mauery

Health Policy and Management Faculty Publications

No abstract provided.

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 …

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.

Managed Mental Health Care: Findings From The Literature, 1990–2005, D. Richard Mauery, Lissette Vaquerano, Rachel Sethi, Joanne Jee, Lisa Chimento

Health Policy and Management Faculty Publications

No abstract provided.

Evaluating Awareness Of Community Health And Human Services By The Hispanic Population In Lexington, Kentucky, Pilar Corbellini

MPA/MPP/MPFM Capstone Projects

Over the past 10 years, Hispanics, predominately Mexicans, have become a notable component of immigration in Kentucky. At the same time, the city of Lexington has striven to increase and stimulate community efforts to help and support people in need. Over 2000 non-profit organizations exist in the city and surrounding areas that unite community support to assist people seeking help.

Among non-profit agencies, particularly the United Way of the Bluegrass, there is a perceived idea that people in need and seeking help are overwhelmed with information about available community human and health services. Notwithstanding this perception, a different reality seems …

The Effects Of Copayments On The Use Of Medical Services And Prescription Drugs In Utah's Medicaid Program, Leighton Ku, Elaine Deschamps, Judi Hilman

Health Policy and Management Faculty Publications

In recent years, a number of states have increased cost-sharing for low-income Medicaid beneficiaries as one approach to Medicaid cost-containment. While copayments have been most commonly applied to prescription drugs, they also have been assessed for other services, such as physician visits, hospital admission, or outpatient clinic use.

Prior research has found that when low-income patients are required to pay more for health care services or for prescription drugs, they use fewer services or medications.[2] In some cases, their health could deteriorate, with the result that they may subsequently require more expensive emergency room or inpatient hospital care. While …

Medicaid Prescription Drug Spending And Use, Brian Bruen, Arunabh Ghosh

Health Policy and Management Issue Briefs

No abstract provided.

2001 Michigan Hospital Cqi/Tqm Study, Colleen L. Croxall

Wayne State University Dissertations

In recent years, there has been significant interest in the application of total quality management/continuous quality improvement (TQM/CQI) within health care organizations. The health care industry, in its quest to improve outcomes with fewer resources, began to look at CQI/TQM as a possible solution. To date, the most comprehensive and enthusiastic response to efforts to improve quality while containing or lowering costs is reflected in hospitals' commitment to continuous quality improvement/total quality management (CQI/TQM). The health care industry, particularly hospitals, has embraced the concepts of CQI/TQM with the belief that adoption will lead to an improvement in both the quality …

Reasonable Modification Or Fundamental Alteration? Recent Developments In Ada Caselaw And Implications For Behavioral Health Policy, Sara J. Rosenbaum, Joel B. Teitelbaum, D. Richard Mauery, Alexandra M. Stewart

Center for Integrated Behavioral Health Policy

No abstract provided.

Message Deleted? Resolving Physician-Patient E-Mail Through Contract Law, Michael Mccann

Law Faculty Scholarship

This article examines the impact of e-mail on the physician-patient relationship, and how contract law can resolve the uncertainties incumbent in this nascent form of communication. Significantly, courts have yet to indicate when the physician-patient relationship begins by e-mail, or to what extent e-mail affects the duties of the relationship. Instead of waiting for judicial guidance, physicians and patients can employ specialized contracts to clarify the role that e-mail plays in their relationship. As a result, more physicians and patients will regard e-mail correspondence as a valuable means of communication, and a tool for improving the quality of health care …

Seniors Count Follow-Up Study, Nina M. Silverstein, Heather Connors, May Jawad

Gerontology Institute Publications

Seniors Count is an ongoing outreach initiative under the direction of Boston Mayor Thomas M. Menino with the leadership and support of Joyce Williams, Boston's Commissioner on Affairs of the Elderly. The program's purpose is to "identify and reach out to those members of the city's elderly population who live in private housing arrangements and help provide them with the information and services they [may] need" (Boston Commission on Affairs of the Elderly, 2002). Since the program's inception in 1999, it has reached over 5,500 community-dwelling elders in the City of Boston (Boston Commission on Affairs of the Elderly, 2002). …

Erisa Health Plans: Key Structural Variations And Their Effect On Liability, Phyllis Borzi

Health Policy and Management Faculty Publications

No abstract provided.

State Eligibility Rules Under Separate State Schip Programs--Implications For Children's Access To Health Care, Sara Rosenbaum, Anne Rossier Markus

Health Policy and Management Issue Briefs

This Policy Brief is the fourth in a series of reports1 issued by the George Washington University Center for Health Services Research and Policy that examine the design of separately-administered State Children’s Health Insurance Programs (SCHIP) that is, programs that operate directly under the authority of the federal SCHIP statute rather than expansions of state Medicaid programs.2 These Policy Briefs also consider the implications of states’ design choices for children’s access to health care.

School-Based Health Centers And Managed Care Arrangements: A Review Of State Models And Implementation Issues, Jennel Harvey, Lissette Vaquerano, Lea Nolan, Colleen Sonosky

Health Policy and Management Faculty Publications

No abstract provided.

The Impact Of The State Children's Health Insurance Program (Schip) On Community Health Centers, Lea Nolan, Jennel Harvey, Karen Jones, Lissette Vaquerano, Ann Zuvekas

Health Policy and Management Faculty Publications

Nearly 12 million children in the United States do not have health insurance, and therefore often lack access to health care. In response, Congress enacted the State Children’s Health Insurance Program (SCHIP) in August 1997, the largest expansion of health insurance coverage since the inception of the Medicare and Medicaid programs. The SCHIP provides states with federal matching funds for children’s insurance either by expanding the existing Medicaid program, by creating a separate state program, or a combination of both.

The George Washington University’s Center for Health Services Research and Policy (CHSRP) was funded by the Health Resources and Services …

Welfare Reform Reauthorization In 2002:What Are The Issues For Tribal Communities And Indian Families?, Kathleen A. Maloy

Health Policy and Management Issue Briefs

American Indian tribes have new options under the 1996 Welfare Reform legislation that created Temporary Assistance for Needy Families (TANF), a block grant enacted to replace the Aid to Families with Dependent Children (AFDC). TANF, which expires in September of this year, provides cash assistance to poor families with children, including poor American Indian Families, and gives tribes the option to design and administer their own family assistance programs following approval of the plan by the Department of Health and Human Services. As Congress considers TANF reauthorization, three new publications prepared for the Kaiser Family Foundation provide insight into the …

Access To Pediatric Services Under Medicaid Managed Care In The District Of Columbia, Karen Shaw, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

No abstract provided.

State Benefit Design Choices Under Schip - Implications For Pediatric Health Care, Sara J. Rosenbaum, Anne Rossier Markus, Colleen Sonosky, Lee Repasch

Health Policy and Management Issue Briefs

This policy brief1 is the second in a series of reports focusing on the design of state SCHIP programs as they near full implementation. It examines the extent to which state agencies adopt conventional insurance norms or adhere to special principles of Medicaid coverage design for children in designing separately administered (or freestanding) SCHIP programs. The issue of coverage design is particularly relevant for children with low prevalence conditions and special health care needs. Increasingly, conventional insurance uses standardized coverage norms to limit coverage and treatment. These standardized norms take the form of across-the-board treatments and exclusions, limited definitions of …

State Schip Design And The Right To Coverage, Sara J. Rosenbaum, Barbara Smith

Health Policy and Management Issue Briefs

No abstract provided.

Beyond Stigma: What Barriers Actually Affect The Decisions Of Low-Income Families To Enroll In Medicaid?, Jennifer P. Stuber, Kathleen A. Maloy, Sara Rosenbaum, Karen C. Jones

Health Policy and Management Issue Briefs

No abstract provided.

An Analysis Of Implementation Issues Relating To Chip Cost-Sharing Provisions For Certain Targeted Low Income Children, Sara J. Rosenbaum, Anne Rossier Markus, Dylan Roby

Health Policy and Management Issue Briefs

This analysis, prepared for the Health Care Financing Administration and the Health Resources and Services Administration, examines issues that arise under laws designed to avert excessive cost-sharing in the case of low income families whose children participate in the State Children’s Health Insurance Program (CHIP). High cost-sharing has been shown to significantly affect children’s participation in insurance programs, as well as their utilization of health services. As a result, the Federal CHIP legislation, while permitting cost-sharing under certain circumstances, also places limitations on the total amount of cost-sharing to which families can be exposed for services covered by State CHIP …

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

Health Policy and Management Faculty Publications

No abstract provided.

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

Theses Digitization Project

No abstract provided.

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 …

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 …

The Effects Of Organizational Culture On Quality Of Life For Older Veterans, Michelle Diane Stone

Dissertations

The organizational culture in a Veteran's Administration Medical Center (VAMC) was described using triangulated methods which included both secondary quantitative survey data, and internal documentary data sources. The initial survey data collected, from staff and elder veterans revealed an overall positive perception from both samples regarding the quality of life for elder veterans living on extended care wards. The study investigated the extent to which the VAMC's organizational culture affected these perceptions of quality of life.

Documentary data were collected from a variety of VAMC sources regarding behaviors, ideologies, leadership trends, mechanisms of control, and the formal organizational structure. A …

Medicare Supplemental Insurance: Today's Crisis, Health Care For All, Gerontology Institute, University Of Massachusetts Boston

Gerontology Institute Publications

The purpose of health insurance is to spread risk. The system works under the assumption that, at any given point in time, only a percentage of the people in a given group will be sick. Regardless of health status, all members of the group will be paying premiums in order to cover the cost of care for those who need it.

As a group, however, seniors represent a high-risk population. They are more likely than younger people to need health care services and tend to require longer hospital stays. Yet, while their expenses are greater, their financial resources are generally …