Health Services Research Commons^™

The Effect Of The Affordable Care Act Medicaid Expansion On The Risk Of Hospital Closure And Adolescent Hpv Immunization In Rural Counties, Juliette Des Rosiers

Scripps Senior Theses

From 2005 to 2025, over 200 rural hospitals shut their doors, often citing increased operational costs, staffing shortages, low patient volume, regulatory barriers, financial challenges exacerbated by the COVID-19 pandemic, and uncompensated care as common contributors to the closures. Rural patients are often referred by their primary care physician to a hospital for regular immunizations, since smaller clinics have less capacity to provide immunizations due to a shortage of pediatricians and limited vaccine stock. A crucial vaccine that is not required by schools and underutilized in rural areas is that against human papillomavirus (HPV), a virus that infects cutaneous and …

Diabetes And Hypertension Frequencies And Trends In The Health Districts Of Sololá, Alejandro Cerón, Sophie Perfetto, Ana Textor, Sidona Alemayehu, Emilia Alvear Escobar, Adele Beard, Sarah Berson, Rachel Bryant, Jennifer Calzontzi, Rylee Castro, Eva Cress Palencia, Jake Czarnecki, Jordyn Epstein, Nikki Harris, Patience Hinojos, Max Hippisley, Erin House, Jackson Hullett, Nathan Johnson, Amelie King, Saule Lankelyte, Juan Loya, Ashley Mackenzie, Ilana Mighdoll, Molly Morrill, Maria De Jesus Ramos Jimenez, Lilly Teklemedhin, Joseph Trujillo, Lauren Verachtert, Nathan Verachtert, Violet Vreeland, Alex Welch, Jada Wright

Anthropology: Undergraduate Student Scholarship

This report was prepared by the students, Graduate Teaching Assistants, and instructor of “The Social Determination of Health” class taught in the fall of 2025 at the University of Denver. The report was prepared for Dr. Luis Pablo Méndez, of the Vice Ministry of Health Regulation, Surveillance and Control, of the Ministry of Public Health and Social Assistance of Guatemala. The work used the following guiding question: How can available data about service production can be used to inform the planning process for the implementation of the Global Hearts Initiative’s HEARTS technical package in the Distrito de Redes Integradas de …

A Quantitative Exploration Of Risk And Protective Factors Affecting The Mental Health Of Chitimacha Tribal Youth, Daphnie Vilcan-Tanner

LSU New Orleans Theses and Dissertations

This study examines the relationships between demographics, risk factors, and protective factors with mental distress among Chitimacha Tribal adolescents aged 12 to 18. Using a Positive Youth Development framework, the research aimed to identify the prevalence of mental distress, trauma, discrimination, and protective factors, as well as their collective and individual impacts on mental health. Data were collected through online surveys completed by 73 participants residing on or near the Chitimacha Tribal Reservation. Descriptive statistics and multiple linear regression analyses were conducted to analyze the data. Results revealed that while trauma and discrimination collectively predicted mental distress, family and community …

Post-Release Health Insurance Utilization Among Ex-Prisoners: A Scoping Review, Icha Khaerunnisa, Megah Andriany, Luky Dwiantoro

Kesmas

The lack of health insurance coverage after prison release significantly reduces access to essential healthcare services, hindering the continuity of care during community reintegration. The evidence on studies of health insurance use following prison release is limited. This scoping review aimed to summarize research on health insurance utilization after release from prison. Literature searches were conducted across databases including ScienceDirect, PubMed, and Scopus. Relevant articles were selected through a two-stage screening process. Data were extracted from the included studies and presented in tabular and descriptive formats. The keywords used were "health insurance AND post-release" and "inmates OR prisoners." This scoping …

African Swine Fever In Indonesia: Insights From Southeast Asia’S Policy Response Through The One Health Approach, Niken Salindri, Wachyu Sulistiadi

Journal of Indonesian Health Policy and Administration

African Swine Fever (ASF) seriously threatens pig production systems, food security, and rural livelihoods across Southeast Asia. This study employs an analysis of secondary national data from Indonesia using a quantitative descriptive analysis approach, complemented by regional policy responses to ASF from 2019 to 2024. To contextualize regional findings, this study also integrates official statistics from Statistics Indonesia (BPS) covering provincial pork production trends (2021–2023), the number of ASF-affected pigs per province (2020–2024), and per capita pork consumption by district. Quantitative data show that ASF outbreaks have been disproportionately concentrated in specific provinces such as East Nusa Tenggara and North …

Overview Of A Hospital Management Information System Using The Hot-Fit Method In Medan Hospitals In 2025, Grace Putri Laia, Hotmarina Lumban Gaol, Jev Boris

Journal of Indonesian Health Policy and Administration

Hospital Management Information System (SIMRS/HMIS) is crucial in ensuring efficiency and quality in hospital services by integrating clinical and administrative functions. This study aims to evaluate the implementation of HMIS at Medan Adventist Hospital in 2025 using the Human-Organization-Technology Fit (HOT-Fit) framework. A descriptive design with total sampling was employed, involving 70 respondents comprising medical records staff, inpatient and outpatient registration staff, and ward officers. Data were collected through a structured questionnaire adapted from a validated instrument (validity 0.690–0.900; reliability 0.841–0.911) and analyzed using descriptive statistics. The results showed a high level of implementation in all HOT-Fit domains: system use …

The Effects Of Input And Characteristic Factors On Contact Rate Achievement Among Puskesmas In Indonesia, Iqbal Andri Makarim, Pujiyanto Pujiyanto

Journal of Indonesian Health Policy and Administration

The contact rate is the lowest-performing indicator in the Performance-Based Capitation Payment system initiated by BPJS Kesehatan. Analysis of the 2019 National Health Facility Research (Rifaskes) data showed that less than half of Puskesmas in Indonesia achieved the target. This cross-sectional study analyzed 5,384 Puskesmas from the 2019 Rifaskes to examine the effect of input and characteristic factors on achieving the contact rate. Independent variables included health worker ratios (doctors, nurses, midwives per 5,000 participants), completeness of essential medical equipment, communication facilities, P-Care application use, and Puskesmas characteristics. Multivariate logistic regression identified four significant factors: doctor ratio (OR=1.06; p<0.0001), midwife ratio (OR=1.01; p=0.033), completeness of essential medical equipment (OR=1.16; p=0.029), and BLUD-based financial management (OR=1.13; p=0.029). These factors explained only 2.6% of the variance (Nagelkerke R²=0.026), suggesting other unmeasured influences. Policy implications include equitable distribution of health personnel, targeted procurement of essential equipment, strengthening financial autonomy through BLUD, and optimizing P-Care data utilization to improve service accessibility and performance.

Experiences Of Elderly Living With Noncommunicable Diseases In Utilizing Health Services In Myanmar During The Covid-19 Pandemic, Nway Eint Chei, Kwanjai Amnatsatsue, Natkamol Chansatitporn, Ariya Bunngamchairat

Kesmas

The COVID-19 pandemic and armed conflicts in Myanmar have intensified the challenges in accessing and utilizing health services, particularly for noncommunicable diseases (NCDs) among older adults. This qualitative study explored the experiences of the elderly with NCDs regarding health service accessibility and utilization in secure areas with fully operational health facilities by conducting in-depth interviews with 20 eligible older adults in Myanmar; data were analyzed using content analysis. Four key themes emerged: NCD service utilization patterns; unmet needs; preferences and hesitancy toward NCD services; and disparities, barriers, and opportunities. The findings revealed widespread underutilization of NCD services due to several …

Government Health Spending And Life Expectancy: Evidence From Cities And Districts In Indonesia, Kurnia Sari, Budi Hidayat, Amal Chalik Sjaaf, Mardiati Nadjib

Kesmas

Life expectancy is widely recognized as a fundamental indicator of population health, and its improvement is often linked to government health spending, particularly in decentralized health systems. This study aimed to investigate the relationship between local government health expenditures and life expectancy in decentralized Indonesia. Data from 492 cities and districts, spanning from 2015 to 2019, were analyzed using a two-way fixed effects regression model to control for time-invariant district characteristics and common temporal shocks. The findings indicated that a 10% increase per capita in government health expenditure was associated with a 0.01% increase in life expectancy. This association was …

Associated Factors In Willingness To Shift Tobacco Expenditure Into National Health Insurance Premium Among Subsidized Members, Mugi Wahidin, Muhammad Agus Mikrajab, Rozana Ika Agustiya, Veza Azteria

Kesmas

In Indonesia, subsidized members are the largest group in the National Health Insurance program. Hence, it is essential to understand their ability to pay (ATP) based on tobacco expenditure. This study aimed to determine the ATP of subsidized members based on tobacco expenditure and factors associated with their willingness to pay (WTP). This cross-sectional study used secondary data from the National Institute of Health Research and Development. The population included all subsidized members; 19,918 were sampled for ATP, and 14,560 were WTP. The independent t-test, ANOVA, and logistic regression were performed. Results showed that ATP from tobacco expenditure ranged from …

Direct Medical Costs Of Diabetes Mellitus Treatment For Patients With Cardiovascular And Renal Complications, Rizki Fadila, Ayu Tyas Purnamasari, A.A. Istri Citra Dewiyani

Kesmas

Type 2 Diabetes Mellitus (T2DM) represents a growing global health challenge with significant clinical and economic implications, notably in Indonesia. The burden is intensified by renal and cardiovascular complications, especially among National Health Insurance beneficiaries. This retrospective study evaluated the direct medical costs of hospitalized T2DM patients with such complications at a type B hospital from 2019 to 2022. Costs were analyzed from both healthcare provider and payer perspectives, covering medical services, medical support services, pharmaceuticals, and other support services. Of the 192 patients reviewed, most were male (57.8%), aged 45–64 years (72.4%), with hospital stays of 1–5 days (90,1%) …

Contribution Of National Health Insurance Patient Revenue To Financial Performance Of Private-Profit Hospitals From 2017 To 2022, Fadlul Imansyah, Amal Chalik Sjaaf, Mardiati Nadjib, Rina Hartini

Kesmas

This study investigated the relationship between National Health Insurance (NHI) patient revenue and profit-private hospital financial performance in Indonesia. As the NHI provider, Badan Penyelenggara Jaminan Sosial (BPJS) Healthcare Security’s influence on hospital revenues has raised concerns about its impact on financial sustainability. This study used financial performance indicators to develop a financial performance index—Return on Assets (ROA), Return on Equity (ROE), Earnings Before Interest, Taxes, Depreciation, and Amortization (EBITDA) Margin, Current Ratio, and Net Profit Margin (NPM)—to assess the financial impact of BPJS Healthcare Security revenue. A partial model approach of multiple linear regression was employed using secondary data …

The Case For Compulsory Dna Testing At Birth To Confirm Paternity: Ethical, Legal, And Social Considerations, Michael Mncedisi Willie

Journal of Indonesian Health Policy and Administration

Compulsory paternity testing at birth has sparked significant legal, ethical, and social debate due to its potential impact on family dynamics, child well-being, and parental responsibility. This review explores the ethical, legal, and societal implications of such testing, using Bioecological Systems Theory and Rawls' Theory of Justice to frame the discussion. This review evaluates the benefits and challenges of mandatory DNA testing at birth, particularly in reducing paternity fraud, ensuring fairness in child support allocation, and enhancing socio-economic outcomes, especially in low-income households. This qualitative review draws on multidisciplinary literature from family law, genetic counseling, social policy, and fathers' rights …

Job Satisfaction Among Health Workers At Primary Health Care In Palembang City, Indonesia, Asmaripa Ainy, Merri Nurmala Sarri, Poppy Fujiyanti, Hartati Inaku, Tannia Tembo

Kesmas

Health workers at primary health care are the frontline providers of community health services. This study aimed to investigate the level of job satisfaction of health workers at primary health care in Palembang City, South Sumatra Province, Indonesia, and its influencing factors. Using a questionnaire developed by the authors' team, the study involved 257 samples. A total of 66.15% of respondents indicated high satisfaction, 21.79% reported moderate satisfaction, and 12.06% expressed dissatisfaction. A statistically significant correlation was found between knowledge, skills, income, promotion opportunities, work supervision, and relationships with colleagues and job satisfaction (p-value <0.001). The correlations were strong, with Spearman's rho of 0.822, 0.869, 0.912, 0.895, and 0.821, respectively. Statistical analysis of the Wilcoxon rank-sum and Kruskal-Wallis tests showed no significant differences in median satisfaction scores between sociodemographic groups (p-value 0.072 to 0.552>0.05). These findings showed that job …

Factors Associated With Caregivers' Concern In Maintaining The Oral Function Of Elderly Living In Long-Term Care Facilities, Susiana Nugraha, Tri Budi Wahyuni Rahardjo, Misako Higashijima, Yuko Hirano

Kesmas

This study investigated the attentiveness of elderly caregivers in long-term care facilities in maintaining oral function. A cross-sectional approach was used to achieve the study's purpose. The sample size formula accounted for 213 caregivers randomly selected from 18 long-term care facilities in 4 provinces. A self-reported questionnaire of sociodemographic characteristics and an adapted Leopold’s oral care checklist was distributed. The average age of study participants was 35.24 (±11.2 SD; aged 18–70 years), dominated by females (62.9%), and only 39% had experienced long-term care training. Multiple linear regression analysis indicated that younger caregivers likely pay more attention in the swallowing periods …

Availability And Distribution Of Stoma Bags For Colorectal Cancer Patients: A Case Study At National Referral And Private Hospitals, Ratna Aryani, Toar Jm Lalisang, Debie Dahlia, Evi Martha, Achir Yani S Hamid, Sukma Wicaturatmashudi, Helen Helen

Kesmas

Stoma bags are essential for colorectal cancer (CRC) patients with stomas. However, access and affordability in Indonesia remain challenging as the National Health Insurance (NHI) does not fully cover these devices. This study aimed to describe the availability and distribution of stoma bags for patients with CRC in national referral and private hospitals, focusing on outpatient access. A qualitative case study was conducted through observations and in-depth interviews with four enterostomal therapy nurses and six patients across three national referral hospitals and one private hospital in the Jakarta Metropolitan Area, Indonesia. Notably, the availability of stoma bags was limited in …

Addressing Gaps In Clinical Trial Access For African Americans, Vanessa Veltre, Michael Acevedo, Alexandra Stone, Lydell Lettsome, Brian Stone

Rowan-Virtua Research Day

Background: Clinical trials are essential for generating evidence on the safety and efficacy of new treatments. However, Black Americans remain underrepresented in clinical research, particularly for conditions that disproportionately affect them. This underrepresentation compromises the generalizability of findings and perpetuates health disparities. This study aimed to identify barriers and facilitators to African American participation in clinical trials and to inform culturally sensitive strategies to improve enrollment of diverse populations.

Methods: We developed a 38-question web-based survey, divided into three domains: (1) cultural affinity, (2) trust, and (3) background information. The survey was administered using Jotform, a HIPAA-compliant platform. Participants—Black adults …

Disparities In Demographics Of Patients Presenting To A Student-Run Free Clinic In South Jersey, Kirsten Carlberg, Sabah Iqbal, Christian Moya Gamboa, Daliza Diaz, Cerena Moreno, Rebecca Moore

Rowan-Virtua Research Day

Medical schools around the country have established free clinics to better serve the underserved patient populations. In this study, we aimed to evaluate demographic characteristics in the patient population at our free clinic, Rowan-Virtua Community Health Clinic (RVCHC), compared to the general population of Camden County. We found a disproportionately higher percentage of black patients at our clinic when compared to the county overall. Addressing these disparities would require targeted outreach to specific patient populations and improved transit access. Future studies should aim to identify RVCHC health outcomes through the management of chronic disease and understanding emergency room utilization.

State Case Count As An Indicator Of Successful Multistate Outbreak Investigation, Lorisa M. Pennell

Capstone Experience: Master of Public Health

Background/Objectives: Shiga-Toxin producing Escherichia coli (STEC) is a contaminant found in multiple food types and causes multistate outbreaks due to the industrialization of food production. In this report I examine the differences in outbreaks categorized by the regulating agency responsible in outbreak prevention and compare outbreak case counts when organized by positive outbreak investigation and response outcomes.

Methods: STEC Multistate outbreak data was obtained from the Center for Disease Control’s National Outbreak Reporting System (NORS) for outbreaks occurring from 2006-2023. Outbreaks were organized into those regulated by either the US Food and Drug Administration (FDA) or the US Department of …

Psychological Treatment Behind The Walls:Insights From The Inside, Rogelio Serrano

Psychology Division Scholarship

Repeated eras of mass incarceration, criminalization of marginalized communities, and substance use policies have created a revolving door of justice involved populations. The ever-increasing prison population has repeatedly become the largest contingency of mental health clientele for an overburdened mental health system. Those who work with formerly incarcerated individuals in the community often don’t know the unique set of challenges faced by practitioners within the system. Increased understanding and coordination of care can offer opportunities for sustained recovery and reduced levels of recidivism. In this presentation participants will learn about the unique insights on mental health treatment that can be …

Evaluating The Current State Of Quality Measure Reporting In The Merit-Based Incentive Payment System, Kinan Sawar, Geoffrey Potts Md

Medical Student Research Symposium

The Merit-Based Incentive Payment System (MIPS) requires physicians to report quality measures along with other metrics that are used to determine an annual percentage adjustment to physician Medicare Part B payments. Unfortunately, physicians have been forced to choose from an ineffective, limited set of quality measures. This has led to an overreliance on process measures, which fail to stratify physician performance effectively; it has also led to differences in the number of reporting options across specialties, resulting in unequal opportunity for physicians to succeed in MIPS. Using Centers for Medicare and Medicaid Services (CMS) public use file data from 2021-2024, …

Assessing Middle Eastern American Attitudes Towards Substance Use Disorders, Hazem Alata, Hussein Bazzi, Saleh Al-Juburi, Angie Achkar, Liam Browning, Nicole Oska, Adam Chaban, Arash Javanbakht

Medical Student Research Symposium

Assessing Middle Eastern American Attitudes Towards Substance Use Disorders

Introduction:

Substance use disorders (SUD) among Middle Eastern and North African (MENA) populations remain largely understudied, despite evidence of high prevalence rates and lower rates of treatment engagement. Unique cultural conceptualizations and beliefs surrounding substance use disorders may perpetuate stigma, further contributing to disparities in access to and utilization of treatment services. This study aims to explore the attitudes and perspectives of individuals from MENA communities regarding substance use disorders, with the goal of identifying and addressing barriers to treatment.

Methods:

An anonymous bilingual Qualtrics survey was administered, gathering responses from …

Analysis Of Systematic Trade-Offs Between Military And Healthcare Expenditure Alongside Gdp Growth Of Select Asian And Western Exporting Economies In The 21st Century, Rahul Balamurugan, Carlos Gershenson, Preethi Nanjundan, Hiroki Sayama

Northeast Journal of Complex Systems (NEJCS)

This study explores the complexity in the trade-offs between military expenditure, healthcare expenditure, and GDP growth across select Asian nations and major weapon-exporting countries, examining how nations allocate finite resources between national security and human well-being over the past two decades. Using a systems science approach, the research integrates Granger causality testing to analyze temporal and directional relationships among GDP growth, military expenditure, and healthcare expenditure, uncovering their dynamic interdependencies. The methodology includes trend and slope analysis, Granger causality testing, outlier detection, and clustering to identify heterogeneity in resource allocation strategies. Developed, weapon-exporting nations exhibit complementary trends, with strong causality …

Exploring Physician Well-Being: A Bibliometric Analysis Of Mental Health, Suriya Kumareswaran, Bala Murali Sundram, Vanitha Thurairasu

Kesmas

This bibliometric study examined the evolving research landscape on physician mental health from 2010 to 2023, analyzing key themes, publication trends, and global contributions. A total of 3,360 articles, including 3,137 original research and 223 reviews, were sourced from Web of Science and Scopus. Findings revealed a significant increase in research output, particularly during the COVID-19 pandemic, with burnout, depression, and anxiety emerging as dominant themes. The US accounted for most publications, while research from low- and middle-income countries remains limited, indicating a substantial global disparity. Thematic analysis highlighted variations in burnout assessment methodologies, underscoring the need for standardized evaluation …

Analysis Of Covid-19 Prevention And Control Policy Implementation In Islamic Boarding Schools In Dki Jakarta, Dickha Adi Wibowo, Fajar Ariyanti

Journal of Indonesian Health Policy and Administration

Indonesia, as one of the countries affected by COVID-19, has implemented various efforts to prevent the transmission of COVID-19. One effort that can be implemented is the implementation of COVID-19 prevention protocols. Apart from that, according to the COVID-19 Handling Task Force, Islamic boarding schools are locations with high mobility. This research aims to determine the implementation of policies related to the prevention and control of COVID-19 in Islamic boarding schools in the DKI Jakarta Province. This research used descriptive research with a qualitative approach, with the number of respondents being three Islamic boarding school leaders and students. The results …

Contextualizing Policy Adoption: A Case Study Of Tuberculosis Control Policy In Depok City, Tri Auri Putri Ayuningtyas, Adang Bachtiar

Journal of Indonesian Health Policy and Administration

This study analyzes the formulation and implementation process of Depok Mayor Regulation No. 61 of 2023 on Tuberculosis (TB) Control using Friedman’s legal system theory (1975) and the eight General Principles of Good Governance (Asas Umum Pemerintahan yang Baik – AUPB). The regulation provides a comprehensive framework, encompassing promotive, preventive, curative, and rehabilitative aspects to support TB control. The legal structure includes the establishment of a cross-sectoral Tuberculosis Control Acceleration Team, involving government agencies and community organizations. Findings reveal that while the regulation has fulfilled several AUPB principles, such as legal certainty, utility, and public interest, there are areas …

Implementation Of Emr System In Indonesian Health Facilities: Benefits And Constraints – A Case Study Of Two Clinics In Central Java, Rasyid Juliansyah, Bukhori Aqid, Andien Putri Salsabila, Kurnia Nurfiyanti

Journal of Indonesian Health Policy and Administration

This paper delves into the widespread implementation of Electronic Medical Records (EMR) within healthcare facilities across Indonesia. It addresses the challenges encountered by clinic owners and healthcare providers in transitioning to these digital systems. The study is supported by empirical data collected through a mixed-method approach, combining internal data from Klinik Pintar with qualitative validation from key stakeholders responsible for clinic operations. The research focuses on two case studies: Lembaga Pemasyarakatan (LAPAS) II Purwokerto Clinic and Palang Merah Indonesia (PMI) Purbalingga Clinic, where the adoption of EMR is analyzed in terms of efficiency, compliance with regulatory standards set by the …

An Evaluation Of Nhmrc Funded Dementia And Diabetes Research, Etienne Vignola-Gagné Phd, Dmitrii Malkov, Elisabeth Browning, Jörg Hellwig Phd, Luigi Rocco Phd, Henrique Pinheiro, Alexandre Bédard-Vallée

Public Reports

This report, commissioned by the National Health and Medical Research Council (NHMRC), provides comprehensive insights into the research outputs, outcomes, and impacts of NHMRC-funded health and medical research in the areas of dementia and diabetes to support NHMRC's mission of ‘building a healthy Australia.’

Rural Hospital Closure And Medicaid Expansion, Jason White

Theses, Dissertations and Capstones

Introduction: In the United States, hospitals in rural areas have been under financial pressure and have been closing at an increasing rate.  This reduces access to care for rural citizens.  The Affordable Care Act of 2010 was passed in order to increase access to medical care, partially through an optional expansion of Medicaid coverage to a larger percentage of the population.  As some states adopted the expansion and some states did not, an opportunity was created to examine the policy’s effect on rural hospital stability.

Purpose of the Study:  This study was designed to examine the effect of …

Black Birth Work As Radical Praxis: A Hermeneutic Phenomenological Inquiry Of Leadership Among Black Birth Workers, Lesa C. Clark

Antioch University Dissertations & Theses

This hermeneutic phenomenological study explores the leadership experiences of Black birth workers (BBWs), revealing critical insights into leadership dynamics within maternal healthcare. Through a theoretical framework integrating African feminism, Black feminism, and anti-racist feminism, the research examines how BBWs conceptualize and enact leadership through embodied, relational, and liberatory approaches. This study addresses a significant gap in leadership literature, particularly regarding generational knowledge and practices of BBWs, which remain understudied despite their vital role in Black maternal healthcare. This study reveals distinct leadership perspectives and methodologies through in-depth interviews with eight BBWs and a detailed interpretive analysis. The findings contribute to …