Health Services Research Commons^™

Pengaruh Rejimen Terhadap Ketidakpatuhan Berobat Tuberkulosis, Rizka Nur Fadila, Pandu Riono

Kesmas

Beban tuberkulosis di Indonesia termasuk lima tertinggi di dunia. Temuan kasus dan pengobatan adalah pilar utama program penanggulangan tuberkulosis. Survei nasional menunjukkan peningkatan penggunaan rejimen tidak standar dari 16,8% (2010) menjadi 55,6% (2013). Peningkatan penggunaan rejimen tidak standar diduga berpengaruh terhadap ketidakpatuhan berobat. Penelitian ini bertujuan untuk mempelajari ketidakpatuhan berobat pada orang dengan tuberkulosis yang menerima rejimen tidak standar dan rejimen standar. Penelitian menggunakan data sekunder Riset Kesehatan Dasar 2010. Analisis logistik multivariabel dilakukan pada sampel 971 orang dengan tuberkulosis yang selesai mendapatkan pengobatan. Hasil penelitian menunjukkan ada kecenderungan orang dengan tuberkulosis yang menerima rejimen tidak standar memiliki ketidakpatuhan berobat …

Perubahan Pola Konsumsi Pangan Sumber Zat Goitrogenik Sianida Dan Cara Pengolahannya Melalui Penyuluhan Gizi, Farida Wahyu Ningtyias, Ahmad Husain Asdie, Madarina Julia, Yayi Suryo Prabandari

Kesmas

Kabupaten Jember masih menghadapi masalah gizi gangguan akibat kekurangan iodium (GAKI), sebagian besar kecamatannya termasuk dalam kategori daerah endemik GAKI. Salah satu penyebabnya adalah faktor goitrogenik sianida yang mengganggu pembentukan hormon tiroid. Keberadaannya pada beberapa sayuran yang biasa dikonsumsi masyarakat menyebabkan diperlukannya pola konsumsi dan proses pengolahan yang baik agar aman dikonsumsi. Penelitian ini bertujuan mengubah pola konsumsi goitrogenik sianida dan cara pengolahannya melalui penyuluhan gizi dan demonstrasi cara pengolahan pangan sumber goitrogenik sianida yang benar. Penelitian ini adalah sebuah penelitian kuasi eksperimental dengan rancangan pretest-posttest control design. Jumlah sampel sebanyak 196 ibu rumah tangga, terdiri dari 98 orang di …

Upaya Peningkatan Status Gizi Balita Malnutrisi Akut Berat Melalui Program Home Care, Titih Huriah, Laksono Trisnantoro, Fitri Haryanti, Madarina Julia

Kesmas

Malnutrisi pada balita masih merupakan permasalahan di Indonesia termasuk di Daerah Istimewa Yogyakarta. Berdasarkan indikator berat badan menurut tinggi badan, 2,6% balita mengalami malnutrisi akut berat. Pada beberapa dekade terakhir, telah terjadi pergeseran paradigma dalam penanganan balita malnutrisi, yang sebelumnya berbasis pendekatan fasilitas kesehatan bergeser menjadi pendekatan berbasis komunitas. Tujuan penelitian ini adalah untuk menganalisis pengaruh program home care terhadap peningkatan status gizi balita malnutrisi pada anak usia 6-60 bulan. Penelitian menggunakan desain kuasi eksperimen dengan pretest dan posttest control group melalui tiga tahap pendampingan yaitu intensif, mandiri, dan penguatan dengan pendekatan asuhan keperawatan. Sampel adalah 56 balita malnutrisi akut …

Annual Parasite Incidence Malaria Di Kabupaten Banyumas, Dwi Sarwani Sri Rejeki, Ruthi Armita Sari, Nunung Nurhayati

Kesmas

Kabupaten Banyumas merupakan kabupaten endemis malaria di Provinsi Jawa Tengah. Data Dinas Kesehatan Kabupaten Banyumas tahun 2008 - 2013 menunjukkan angka annual paracite incidence (API) yang selalu mengalami fluktuasi. Dari 27 kecamatan, 22 di antaranya termasuk dalam kategori medium case incidence (MCI) dan low case incidence (LCI). Faktor lingkungan, perilaku, sosial ekonomi, dan iklim berdampak pada tinggi rendahnya kejadian malaria. Tujuan penelitian adalah mengetahui faktor yang berhubungan dengan API di Kabupaten Banyumas. Data dikumpulkan dari Januari 2011 - Desember 2013 menggunakan penelitian analitik dengan rancangan penelitian potong lintang dan menggunakan data sekunder dari Dinas Kesehatan, Dinas Pertanian, dan Badan Pusat …

Riwayat Pemberian Air Susu Ibu Dengan Penyakit Infeksi Pada Balita, Abidah Nur, Nelly Marissa

Kesmas

Riset Kesehatan Dasar tahun 2013 menyebutkan angka insiden diare pada balita di Indonesia sebesar 6,7%. Aceh merupakan provinsi dengan insiden diare tertinggi, mencapai 10,2%. Profil Kesehatan Aceh menunjukkan bahwa secara umum terjadi peningkatan penyakit infeksi seperti influenza, tuberkulosis, dan diare dalam kurun waktu tujuh tahun (2006 - 2012). Penyakit tersebut dapat dicegah dengan pemberian ASI yang berperan dalam peningkatan kekebalan tubuh. Penelitian ini dilakukan untuk mengetahui hubungan riwayat pemberian ASI dengan penyakit infeksi pada balita. Penelitian ini menggunakan data sekunder dari Badan Pusat Statistik Provinsi Aceh, yaitu data Survei Sosial dan Ekonomi Nasional tahun 2012 dengan jumlah sampel 3.486 balita. …

Analisis Risiko Karakteristik, Sosial Ekonomi, Perilaku Dan Kondisi Lingkungan Rumah Terhadap Kejadian Malaria, Susy Sriwahyuni Sukiswo, Rinidar Rinidar, Sugito Sugito

Kesmas

Malaria merupakan penyakit menular yang menjadi perhatian global. Kecamatan Arongan Lambalek merupakan daerah rawan malaria di Kabupaten Aceh Barat dengan kategori Medium Incidence Area dengan nilai Annual Parasite Incidence (API) 3,67 per 1000 penduduk masih di atas target API Nasional pada fase eliminasi API kurang dari 1 per 1000 penduduk tahun 2013. Penelitian ini bertujuan menganalisis karakteristik, sosial ekonomi, perilaku, dan kondisi lingkungan rumah yang berpengaruh terhadap kejadian malaria di Kecamatan Arongan Lambalek, Kabupaten Aceh Barat. Jenis penelitian ini adalah observasional analitik dengan pendekatan kasus kontrol dengan metode penarikan sampel yaitu purposive sampling. Jumlah sampel dalam penelitian ini terdiri 33 …

Perbedaan Pendidikan Kelompok Sebaya Tentang Pendewasaan Usia Perkawinan Di Perkotaan Dan Perdesaan, Willa Follona, Ardini S. Raksanagara, Benny Hasan Purwara

Kesmas

Remaja berisiko terhadap pernikahan usia dini namun informasi tentang pendewasaan usia perkawinan masih kurang. Pendidikan kelompok sebaya merupakan metode pendidikan kesehatan yang sesuai untuk remaja, namun belum terlaksana di lingkungan masyarakat baik perkotaan maupun perdesaan. Selain itu, belum terfokus pada pendewasaan usia perkawinan, sehingga perlu diketahui perbedaan pengetahuan dan sikap tentang pendewasaan usia perkawinan setelah pendidikan kelompok sebaya pada remaja di perkotaan dan perdesaan. Tujuan penelitian ini adalah untuk menganalisis perbedaan pendidikan kelompok sebaya tentang pengetahuan dan sikap mengenai pendewasaan usia perkawinan antara remaja di wilayah perkotaan dan perdesaan. Penelitian ini merupakan eksperimen semu dengan desain pretest-posttest pada 60 remaja …

Mutu Pelayanan Puskesmas Perawatan Yang Berstatus Badan Layanan Umum Daerah, Putu Ayu Indrayathi, Rina Listyowati, Ni Made Sri Nopiyani, Luh Putu Sinthya Ulandari

Kesmas

Kebijakan pusat pelayanan kesehatan masyarakat (puskesmas) sebagai Badan Layanan Umum Daerah (BLUD) diimplentasikan untuk meningkatkan kualitas pelayanan kesehatan dasar. Kebijakan BLUD puskesmas telah diterapkan di Kabupaten Gianyar sejak tahun 2010 dan berlaku pada puskesmas perawatan maupun nonperawatan. Pelaksanaan BLUD puskesmas tidak selalu meningkatkan mutu layanan. Penelitian ini bertujuan mengetahui gambaran mutu pelayanan puskesmas perawatan yang berstatus BLUD di Kabupaten Gianyar. Penelitian ini merupakan penelitian potong lintang dengan pendekatan kuantitatif dan kualitatif. Tempat dan waktu penelitian ini dilakukan di Kabupaten Gianyar, Agustus hingga Desember 2013. Data kuantitatif dikumpulkan melalui penyebaran kuesioner kepada 105 pengguna layanan di empat puskesmas yang dipilih dengan …

Tempat Penampungan Air Dan Kepadatan Jentik Aedes Sp. Di Daerah Endemis Dan Bebas Demam Berdarah Dengue, Wanti Wanti, Menofeltus Darman

Kesmas

Tingkat kepadatan jentik merupakan indikasi diketahuinya kepadatan nyamuk Aedes sp yang akan menularkan virus dengue sebagai penyebab penyakit demam berdarah dengue (DBD) dan juga sebagai salah satu indikator keberhasilan kegiatan pengendalian vektor. Penelitian ini bertujuan mengetahui karakteristik tempat penampungan air (TPA) dan perbedaan kepadatan jentik House Index, Container Index, Breatau Index (HI, CI, BI) di Kelurahan Alak sebagai daerah endemis dan Kelurahan Belo sebagai daerah bebas DBD di Kota Kupang Tahun 2011. Penelitian observasional analitik ini menggunakan rancangan studi potong lintang. Variabel penelitian adalah jenis, kondisi, letak, bahan TPA dan kepadatan jentik Aedes sp. Data dikumpulkan dengan observasi langsung pada …

Kondisi Kesehatan Lingkungan Pesantren Dan Perilaku Hidup Bersih Dan Sehat Siswa Dengan Kejadian Hepatitis, Ii Sumarni, Dewi Susanna

Kesmas

Kejadian luar biasa hepatitis A di Kabupaten Ciamis telah terjadi beberapa kali, satu di antaranya terjadi di Pondok Pesantren X. Penelitian ini bertujuan untuk menganalisis kondisi kesehatan lingkungan serta perilaku hidup bersih dan sehat dengan kejadian hepatitis A siswa/siswi di Pondok Pesantren X Kabupaten Ciamis. Rancangan penelitian menggunakan desain kasus kontrol dengan jumlah kasus 40 orang dan kontrol 80 orang, total sampel 120 orang. Populasi penelitian adalah siswa/siswi madrasah tsanawiyah dan madrasah aliyah negeri yang tinggal di asrama pondok pesantren. Data kasus merupakan data sekunder yang diperoleh dari Tim Surveilans Kabupaten Ciamis, dengan hasil pemeriksaan serologis positif. Sedangkan kontrol berdasarkan …

Determinants Of Multimorbidity Among The Elderly Population In Indonesia, Yeni Mahwati

Kesmas

Multimorbiditas adalah kehadiran dua atau lebih penyakit kronis pada satu orang. Prevalensi multimorbiditas meningkat dengan usia, terutama pada lanjut usia (lansia). Penelitian ini bertujuan untuk mengetahui prevalensi dan determinan multimorbiditas pada lansia di Indonesia. Data diambil dari survei keempat Indonesian Family Life Survey (IFLS) yang diadakan pada tahun 2007. IFLS adalah survei sosial ekonomi dan kesehatan longitudinal di Indonesia. Sampel yang digunakan dalam analisis adalah 2.960 lansia (³ 60 tahun). Regresi logistik dilakukan untuk menentukan prevalensi dan determinan multimorbiditas pada lansia. Hasil penelitian menunjukkan prevalensi multimorbiditas sebesar 15,8%, dengan prevalensi lebih tinggi pada lansia yang overweight/obesitas, tingkat pendidikan rendah, tidak …

Pemakaian Kelambu Berinsektisida Pada Anak Usia 0-4 Tahun Terhadap Kejadian Malaria, Raden Ayu Aisyah, Dewi Susanna

Kesmas

Penelitian ini bertujuan untuk mengetahui hubungan pemakaian kelambu berinsektisida dengan kejadian malaria pada anak usia 0-4 tahun di wilayah Puskesmas Galang Kecamatan Galang Kota Batam tahun 2013. Desain penelitian adalah potong lintang pada 132 responden. Hasil penelitian membuktikan bahwa pada tingkat signifikansi 5% terdapat hubungan bermakna antara jenis kelambu (OR = 4,6), lama pemakaian kelambu (OR = 2,9), cara pencucian kelambu (OR = 3,6), cara menjemur kelambu (OR = 2,8), dan pencelupan ulang kelambu (OR = 3,6) memiliki hubungan yang bermakna dengan kejadian malaria. Pendidikan (OR = 2,9), pekerjaan (OR = 2,8), dan lama bermukim (OR = 3,1) memiliki hubungan …

Health Literate Organizations: Are Clinical Trial Sites Equipped To Recruit Minority And Limited Health Literacy Patients?, Jennifer Livaudais-Toman, Nancy J. Burke, Anna Napoles, Celia P. Kaplan

Journal of Health Disparities Research and Practice

Background. Racial/ethnic minority patients are less likely than non-Latino white patients to participate in cancer clinical trials. A key barrier to participation is limited health literacy which is more common among minorities. At the organizational level, it is important that clinical trials sites become better equipped to recruit minority patients by expanding their organizational health literacy including language competency and outreach efforts. We explored the characteristics of clinical trial sites that are associated with these health literate behaviors.

Methods. We identified 353 breast clinical trials recruiting participants in 2006 from four states (California, Florida, Illinois, and New York) through the …

Book Review: Questioning Protocol, Barbara Lewis Mba

Patient Experience Journal

In her review of Questioning Protocol by Randi Redmond Oster, Barbara Lewis shares how this new and award winning book takes the reader on Randi Oster's harrowing journey of navigating the healthcare system while helping her teenage son’s battle with Crohn’s disease. Seventeen chapters build a chronological story of success, frustration and failure in dealing with modern medicine and a healthcare industry that may appear foreign to the outsider.

Book Review: The Language Of Caring Guide For Physicians: Communication Essentials For Patient-Centered Care (2nd Edition), Chet Wyman Md

Patient Experience Journal

In thie book review for Wendy Leebov and Carla Rotering’s The Language of Caring Guide for Physicians: Communication Essentials for Patient-Centered Care (2nd edition), the author/reviewer conveys his perspective on the essential value of this publication. He offers his recommendation of this book for anyone who wants to improve their own communication skills and also for physician leaders responsible for initiatives to engage physicians and improve service quality, patient outcomes, and CAHPS scores for a department or organization, noting it is an essential read in today’s healthcare environment.

Learning What High Quality Compassionate Care Means For Cancer Patients And Translating That Into Practice, Fiona Mckenzie, Katherine Joel, Charlotte Williams, Kathy Pritchard-Jones Professor

Patient Experience Journal

In 2010, UCLPartners, a partnership of health care providers and universities in North Central London, began a collaboration with local commissioners that aimed to think about cancer care and diagnosis differently. Understanding that a good patient experience can only be delivered by putting patients first and working together along their journey from symptoms to recovery, we brought clinical leaders together with patients to think about how to improve outcomes for patients, outside institutional barriers. From the very beginning this new network, an integrated cancer system, focused on understanding what mattered most to patients and organising how it worked and how …

Exploring The Impact Of An Interprofessional Care Protocol On The Patient Experience And Outcomes For Seniors With Diabetes, Linda J. Mast Phd, Facmpe, Ateequr Rahman Phd, Diane Bridges Phd, Neil L. Horsley Dpm

Patient Experience Journal

Contemporary healthcare has placed intensified focus on the patient experience. Ultimately the patient experience is influenced by relationships with healthcare providers. In order to make a positive impact on patient outcomes and quality of care, the patient experience must be positive. Interprofessional collaboration is recognized as a key aspect of a culture that fosters patient-centered care and a positive patient experience. This quasi-experimental study explores the impact of interprofessional collaboration to develop a preventive services care protocol for seniors with diabetes. Patients were studied over six months using pre-test and post-test measures. Both quantitative data from clinical outcomes and qualitative …

Are We Providing Patient-Centered Care? Preferences About Paracentesis And Thoracentesis Procedures, Jeffrey H. Barsuk, Sarah E. Kozmic, Jordan Scher, Joe Feinglass, Aimee Hoyer, Diane B. Wayne

Patient Experience Journal

Procedures performed at the bedside are as safe and less expensive than Interventional Radiology (IR) procedures. Patient preferences regarding location are rarely taken into account. Therefore, in this study we compared patient satisfaction with bedside and IR paracentesis and thoracentesis procedures, and identified reasons for patient location preferences. We performed a cross-sectional survey of medical inpatients undergoing paracentesis or thoracentesis procedures at a tertiary care academic medical center. The survey had eight domains: overall experience, pain control, expertise, courtesy, bedside manner of the physician, time required, explanation of risks/benefits, comfort and privacy. Patients were also asked about their preference for …

Using A Data-Driven Organizational Improvement Model To Engage An Interdisciplinary Team In Transforming A Public Women’S Health Clinic, Kenneth J. Feldman, Molly Lopez, Morris Gagliardi

Patient Experience Journal

Gouverneur Health is the largest diagnostic and treatment center in New York State, and part of the New York City Health and Hospitals Corporation (HHC), a public benefit corporation with $6.7 billion in annual revenues. HHC is the largest municipal healthcare system in the United States serving 1.4 million patients, including more than 475,000 uninsured city residents.[1] Within Gouverneur, the Women’s Health department is committed to providing high quality services that improve patients' health and wellbeing, yet patient experience, flow, clinic access and education are in need of process improvements. To enhance patient experience and identify strategies replicable for other …

Feasibility Of Using Emergency Department Patient Experience Surveys As A Proxy For Equity Of Care, Helen Chiu, Nadia Batara, Robert Stenstrom, Lianne Carley, Catherine Jones, Lena Cuthbertson, Eric Grafstein

Patient Experience Journal

Collecting and examining equity data can help inform quality improvement initiatives but is a relatively new practice in health care. The overall goal of this study was to assess different methods of administering patient experience surveys as a feasible starting point in measuring equity in an urban Emergency Department (ED) that serves a diverse patient population. Socio-demographic characteristics of patients visiting an ED were compared with those of patients who responded to provincial patient experience surveys routinely administered by mail. Patient experience survey data were collected over an 11-week period in an urban ED using different survey administration methods (face-to-face …

The Relationships Between Hcahps Communication And Discharge Satisfaction Items And Hospital Readmissions, Fadi Hachem, Jeff Canar, Francis Fullam Ma, Andrew S. Gallan Phd, Samuel Hohmann, Catherine Johnson

Patient Experience Journal

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey has become a key metric used by organizations and patients to evaluate patient experience. Readmissions also continue to be a metric used to evaluate performance because of the added cost to both healthcare systems and patients. Both measures are also seen in programs such as Value Based Purchasing that have an effect on hospital reimbursements. Previous studies have demonstrated a relationship between patient perceptions and quality of care, and have found patients to be reliable evaluators of their care. While good communication and positive provider relationships have been related …

Evaluation Of An Advisory Committee As A Model For Patient Engagement, Cynthia Kendell, Robin Urquhart, Jill Petrella, Sarah Macdonald, Meg Mccallum

Patient Experience Journal

Patient engagement (PE) is not well defined and little guidance is available to those attempting to employ PE in decision-making relevant to health system improvement. After completing a 2-year PE project, overseen by an Advisory Committee, our objectives were: 1) to evaluate how effectively the project team engaged the Advisory Committee, 2) to examine how Advisory Committee members perceived PE and their role in PE, and 3) to identify barriers and facilitators to PE in order to improve future efforts. Five members of the Advisory Committee completed semi-structured interviews post-project about their experiences. Thematic analysis identified four themes: the approach, …

Improving The Patient Experience Through Nurse Leader Rounds, Judy C. Morton, Jodi Brekhus, Megan Reynolds, Anna Kay Dykes

Patient Experience Journal

While providing exceptional care experiences to patients is a priority for many organizations, creating and sustaining measureable success in this area remains a challenge for many. This article examines the impact of implementing nurse leader rounds on patient perception of care in the hospitals and emergency departments of a large healthcare system. Nurse leader rounds were implemented as a system-wide improvement practice at Providence Health & Services in 2012. Analysis of Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results indicates that implementation of nurse leader rounds is associated with statistically significant improvement in patient …

Creating And Sustaining A Culture Of Accountability For Patient Experience, Denise M. Kennedy Mba, Roshanak Didehban Mhs, Fache, John P. Fasolino Md

Patient Experience Journal

Improving the quality of the patient experience has become an imperative for healthcare organizations. Value-based payment models include patient perception data, and a negative experience can impact an organization’s finances. Sustainable improvement requires more than quick-fix cosmetic enhancements, ‘flavor-of-the-month’ service trainings, or bonuses for front-line staff. Organizations must actually improve the patient experience. Doing so requires a culture of accountability and a systematic framework for collecting and acting on patient perception data.

This article revisits Mayo Clinic Arizona's (MCA) "7-prong" model for improving service quality: (1) multiple data sources to drive improvement; (2) accountability; (3) service consultation and improvement tools; …

Beyond Credentialing In Physician Selection: Application Of An Instrument That Measures Behavioral Aptitude, Edgar Staren Md, Phd, Mba, Susan Hirt Ph.D., Doug Rath M.A.

Patient Experience Journal

This article explores the idea that the assessment of candidates for the role of physician caregiver can be enhanced by evaluating their inter-personal and behavioral aptitude as well as their clinical skills. The objective of this work was to determine whether results of a structured interview correlate to performance ratings for physicians. Two data sets were collected: a structured aptitude assessment for physicians (the Physician Interview) and job performance data for physicians. Analysis of performance data allowed categorization of the physicians into three groups: top performers, contrast performers, and neither. The two data sets were then analyzed to assess the …

Hindsight Is 20/20: Lessons Learned After Implementing Experience Based Design, Kate Bak, Laura Macdougall, Esther Green, Lesley Moody, Genevieve Obarski, Lori Hale, Susan Boyko, Deborah Devitt

Patient Experience Journal

Experience Based Design (EBD) uses patient and staff experiences to identify quality improvement opportunities in healthcare settings. An EBD Collaborative was established to share successes and challenges related to the EBD projects. This paper summarizes the various lessons learned. A document analysis was conducted that examined meeting minutes and audio recordings, email communications, newsletters, project updates, project spotlights and evaluation surveys and interviews. A total of ten key themes were identified. While EBD teams encountered challenges, overall the experience led to successful quality improvement initiatives. In particular, staff gained new insights from the patients’ perspective, which enhanced their understanding of …

The Patient Experience Movement Moment, William Lehrman Phd, Geoffrey Silvera Mha, Jason A. Wolf Phd

Patient Experience Journal

For years, the patient experience movement has continued to gain momentum. From a novel concept, there is an emerging consensus that the patient experience is a fundamental aspect of provider quality; one that complements established clinical process and outcome measures but is neither subsumed nor secondary to them. An increasing volume of research as encouraged by publications such as Patient Experience Journal show this to be true. As the expectation of a high-quality patient experience becomes the norm, these developments have brought us to what we call the patient experience movement moment and there is little doubt that the patient …

To Serve Patients Is Our Greatest Privilege, David T. Feinberg Md, Mba

Patient Experience Journal

In his guest editorial, Dr. David Feinberg of UCLA Health System reminds us of the power of patient voice and the lessons we should be open to learning from those we serve every day. He offers, "It is a blessing for us to work in an environment where we have the opportunity every day to touch someone’s life so deeply. We must never lose sight of that. It is our responsibility to not just treat our patients, but also to embrace them."

A Gathering Place For Patient Experience Research: The Power Of Community, Jason A. Wolf Phd

Patient Experience Journal

In introducing Issue 2, we explore the power of community and its implications in shaping not only the purpose and intent of Patient Experience Journal, but of the patient experience movement itself. Community defined in this moment is simple, yet significant, the key being unity around common interest and its focus on ownership and participation. The idea of community bears great weight and has provided strong guidance and purpose for the work of experience excellence. It supports the goal of elevating the conversation, helps align the voices engaged and provides the space for listening, learning and impact.

Experience Framework …

The Dynamics Of Medicaid & Public Health Spending: Implications For Aca Implementation, Glen P. Mays

Health Management and Policy Presentations

We estimate the dynamics and interactions of governmental spending on Medicaid and other public health services in all 50 states over a 15 year period. Using a quasi-experimental design with instrumental variables estimation, we find evidence that increased Medicaid spending leads to reduced governmental spending on other public health services, consistent with a crowd-out effect. Over 10 years, such crowd-out has the potential to diminish the health status improvements generated through health insurance coverage expansions.