Health Economics Commons^™

Poor Women With Sexually Transmitted Infections: Providers’ Perspectives On Diagnoses, Genevieve R. Cox

Sociology

This article presents results from a study of health care providers, mainly nurses and nurse practitioners, who routinely diagnose sexually transmitted diseases (STDs) in rural low-income populations in West Virginia (WV). A qualitative analysis of eighteen semi-structured interviews reveals that providers who consistently work with low-income populations believe patients undergo a negative change in self-image in response to a chronic STD diagnosis. Providers express concerns about a number of issues related to low-income, rural women’s access to sexual health care and see the need for more sexuality education, more funding for free and reduced cost clinics, and more available health …

Hiv And Concurrent Sexual Partnerships: Modelling The Role Of Coital Dilution, Larry Sawers, Alan G. Isaac, Eileen Stillwaggon

Economics Faculty Publications

Background: The concurrency hypothesis asserts that high prevalence of overlapping sexual partnerships explains extraordinarily high HIV levels in sub-Saharan Africa. Earlier simulation models show that the network effect of concurrency can increase HIV incidence, but those models do not account for the coital dilution effect (nonprimary partnerships have lower coital frequency than primary partnerships).

Methods: We modify the model of Eaton et al (AIDS and Behavior, September 2010) to incorporate coital dilution by assigning lower coital frequencies to non-primary partnerships. We parameterize coital dilution based on the empirical work of Morris et al (PLoS ONE, December …

Why The Master? Human Capital Development For Practicing U.S. Cycling Coaches, Daniel Larson, Joel Maxcy

Faculty Articles

The economic structure of the industry of cycling coaches has yet to be the subject of any apparent published inquiry. This study describes the basic characteristics of practicing cycling coaches and presents economic models of the determinants of commercial success for individual coaches. Data were collected through an independent survey of current and former U.S.A. Cycling (USAC) coaches in 2010 (N = 386). Results of ordinary least squares and negative-binomial regression models suggest that coaching and competitive experience are associated with larger clienteles, but formal human capital investments do not generally add to a coach's ability to garner more clients. …

Being Surveyed Can Change Later Behavior And Related Parameter Estimates, Alix Peterson Zwane, Jonathan Zinman, Eric Van Dusen, William Pariente

Dartmouth Scholarship

Does completing a household survey change the later behavior of those surveyed? In three field studies of health and two of microlending, we randomly assigned subjects to be surveyed about health and/or household finances and then measured subsequent use of a related product with data that does not rely on subjects' self-reports. In the three health experiments, we find that being surveyed increases use of water treatment products and take-up of medical insurance. Frequent surveys on reported diarrhea also led to biased estimates of the impact of improved source water quality. In two microlending studies, we do not find an …

Specialty Service Lines In The United States Hospital System: Old Wine, New Bottles, Michael Sajovetz

Electronic Theses and Dissertations

The emergence of specialty service lines in the United States health care system presents many significant questions regarding the access to, provision of, and financing of healthcare. In general terms, specialty service lines represent the newest development in several important trends in the American hospital system and reflect important trends in the wider economy. Many claims have been made regarding the effect of physician-owned specialty hospitals, from their exemption from self-referral prohibitions, their diversion of services away from general hospitals that use high profit margins to subsidize the "safety net," and concerns regarding the over-provision of technologically complex treatments in …

Put Your Money Where Your Butt Is: A Commitment Contract For Smoking Cessation, Xavier Giné, Dean Karlan, Jonathan Zinman

Dartmouth Scholarship

We designed and tested a voluntary commitment product to help smokers quit smoking. The product (CARES) offered smokers a savings account in which they deposit funds for six months, after which they take a urine test for nicotine and cotinine. If they pass, their money is returned; otherwise, their money is forfeited to charity. Of smokers offered CARES, 11 percent took up, and smokers randomly offered CARES were 3 percentage points more likely to pass the 6-month test than the control group. More importantly, this effect persisted in surprise tests at 12 months, indicating that CARES produced lasting smoking cessation. …

Concurrent Sexual Partnerships Do Not Explain The Hiv Epidemics In Africa: A Systematic Review Of The Evidence, Larry Sawers, Eileen Stillwaggon

Economics Faculty Publications

The notion that concurrent sexual partnerships are especially common in sub-Saharan Africa and explain the region’s high HIV prevalence is accepted by many as conventional wisdom. In this paper, we evaluate the quantitative and qualitative evidence offered by the principal proponents of the concurrency hypothesis and analyze the mathematical model they use to establish the plausibility of the hypothesis.

We find that research seeking to establish a statistical correlation between concurrency and HIV prevalence either finds no correlation or has important limitations. Furthermore, in order to simulate rapid spread of HIV, mathematical models require unrealistic assumptions about frequency of sexual …

Hospital Performance Evaluation In Uganda: A Super-Efficiency Data Envelope Analysis Model, Bruno Yawe

Zambia Social Science Journal

Standard Data Envelope Analysis models result in a large fraction of the observations becoming 100 percent efficient. The article measures the technical efficiency of 25 district referral hospitals from three regions of Uganda over the 1999-2003 period. It applies a super-efficiency Data Envelopment Analysis model. The application of a super-efficiency model was occasioned by the failure of standard data envelopment analysis models to rank the efficient set of hospitals which attain an efficiency score of unity. The results of the standard data envelopment analysis models indicate the existence of different degrees of technical and scale inefficiency in Uganda’s district referral …

Complexity, Cofactors, And The Failure Of Aids Policy In Africa, Eileen Stillwaggon

Economics Faculty Publications

Global AIDS policy still treats HIV as an exceptional case, abstracting from the context in which infection occurs. Policy is based on a simplistic theory of HIV causation, and evaluated using outdated tools of health economics. Recent calls for a health systems strategy – preventing and treating HIV within a programme of comprehensive health care – have not yet influenced the silo approach of AIDS policy.

Evidence continues to accumulate, showing that multiple factors, such as malnutrition, malaria and helminthes, increase the risk of sexual and vertical transmission of HIV. Moreover, complementary interventions that reduce viral load, improve immune response, …

Opportunities For Comparative Research In Public Health Pbrns : A Baseline Analysis Of Local Practice Settings, Glen P. Mays, Sharla A. Smith, Elaine B. Wootten, Sylvia J. Porchia

Health Management and Policy Presentations

This analysis describes the organizational and operational characteristics of local public health agencies participating in an initial cohort of five (5) public health PBRNs in the U.S. We examine variation in practice settings within and between PBRNs; compare practice settings to state and national norms; and identify opportunities for comparative research that can be conducted through PBRNs.

Children's Health Insurance Program: The Dynamics Of Federalism And Health Care Policy, Erik White

Political Science Theses and Capstones

On February 4^th, 2009, President Obama signed into law the reauthorization of the Children Health Insurance Program. The federal government will now spend 30 billion dollars towards the goal of ensuring that more children in the United States are insured. I investigate this particular health care policy and look at the different dynamics that affect the ultimate goal of universal health insurance for children. Because this program allows for state flexibility under broad federal guidelines, one is able to look at individual states, and their particular actions and characteristics, to determine the best approach to insuring the most …

Is American Health Care Uniquely Inefficient?, Alan M. Garber, Jonathan Skinner

Dartmouth Scholarship

No abstract provided.

Positioning Hospice Care Within The Black And Hispanic Communities, Carol Armstrong

Graduate Theses

Nationally, hospice care and the signing of advance directives are underutilized by minority populations. Research on this phenomenon includes cultural differences, access to medical care and language barriers. A retrospective study of 1,817 closed patient charts from a local hospice was conducted to determine significant differences among the White, Black and Hispanic patient populations. The number of White patients admitted to both hospice homecare and to the hospice inpatient was significantly greater than the number of admissions of either the Black or Hispanic patients. There were no significant findings in the total number of services provided to each of the …

The Impact Of Being Born With Cleft And Cleft Reparative Surgery On Overall Health And Speech Outcomes, Khatansuudal Evsanaa

Master's Theses

Orofacial cleft is one of the most common and treatable birth defects in the world. If left untreated, orofacial cleft can impair normal speech development, growth, and could lead to a number of health consequences later in life. The main motivation of the study is to measure the impact of being born with cleft and the cleft reparative surgery on overall speech and health cleft for teenagers in India using difference-in-differences approach along with household fixed effects method. An overall health outcome was measured using height, weight, grip strength and BMI, and the speech acceptability was measured using a “Universal …

Productivity Spillovers In Healthcare: Evidence From The Treatment Of Heart Attacks, Amitabh Chandra, Douglas O. Staiger

Dartmouth Scholarship

A large literature in medicine documents variation across areas in the use of surgical treatments that is unrelated to outcomes. Observers of this phenomena have invoked “flat of the curve medicine” to explain these facts, and have advocated for reductions in spending in high-use areas. In contrast, we develop a simple Roy model of patient treatment choice with productivity spillovers that can generate the empirical facts. Our model predicts that high-use areas will have higher returns to surgery, better outcomes among patients most appropriate for surgery, and worse outcomes among patients least appropriate for surgery, while displaying no relationship between …

Caring For America’S Aging Population: A Profile Of The Direct-Care Workforce, Kristin E. Smith, Reagan A. Baughman

Sociology

Direct-care workers constitute a low-wage, high-turnover workforce with low levels of health insurance; taking these characteristics into account guides the challenge of how to deal with the growing demand for long-term care by an aging U.S. population.

Book Review: Social Justice: The Moral Foundations Of Public Health And Health Policy, Robin West

Georgetown Law Faculty Publications and Other Works

This essay is a review of Social Justice: The Moral Foundations of Public Health and Health Policy by Madison Powers & Ruth Faden (2006).

In this pathbreaking book, senior bioethicists Powers and Faden confront foundational issues about health and justice. How much inequality in health can a just society tolerate? In a world filled with inequalities in health and well-being, which inequalities matter most and are the most morally urgent to address? In order to answer these questions, Powers and Faden develop a unique theory of social justice that, while developed for the specific contexts of public health and health …

Desulfovibrio Desulfuricans G20 Tetraheme Cytochrome Structure At 1.5 A˚ And Cytochrome Interaction With Metal Complexes, Mrunalini Pattarkine, J J. Tanner, C A. Bottoms, Y H. Lee, Judy D. Wall

Faculty Works

The structure of the type I tetraheme cytochrome c3 from Desulfovibrio desulfuricans G20 was determined to 1.5 A˚ by X-ray crystallography. In addition to the oxidized form, the structure of the molybdate-bound form of the protein was determined from oxidized crystals soaked in sodium molybdate. Only small structural shifts were obtained with metal binding, consistent with the remarkable structural stability of this protein. In vitro experiments with pure cytochrome showed that molybdate could oxidize the reduced cytochrome, although not as rapidly as U(VI) present as uranyl acetate. Alterations in the overall conformation and thermostability of the metal-oxidized protein were investigated …

Examining Adherence And Sexual Behavior Among Patients On Antiretroviral Therapy In India, Avina Sarna, Indrani Gupta, Sanjay Pujari, A.K. Sengar, Rajiv Garg, Ellen Weiss

HIV and AIDS

With increased availability of ART, HIV-positive individuals are living healthier lives and continuing or resuming sexual activity. However, optimism related to ART’s success in slowing disease progression, reducing viral load, and improving health status may lead to more risky sexual practices and a possible increase in transmission of infections. To determining the sexual behavior of HIV-positive persons on ART, the Horizons program, in collaboration with research partners in Delhi and Pune, conducted a study to assess current levels of adherence to ART among a sample of people living with HIV/AIDS, identify the factors that influence their adherence to treatment, and …

Does Falling Smoking Lead To Rising Obesity?, Jonathan Gruber, Michael D. Frakes

Faculty Scholarship

The strong negative correlation over time between smoking rates and obesity have led some to suggest that reduced smoking is increasing weight gain in the U.S.. This conclusion is supported by the findings of Chou et al. (2004), who conclude that higher cigarette prices lead to increased body weight. We investigate this issue and find no evidence that reduced smoking leads to weight gain. Using the cigarette tax rather than the cigarette price and controlling for non-linear time effects, we find a negative effect of cigarette taxes on body weight, implying that reduced smoking leads to lower body weights. Yet …

Reducing Child Malnutrition: How Far Does Income Growth Take Us? By Lawrence Haddad, Harold Alderman, Simon Appleton, Lina Song And Yisehac Yohannes: A Review, Sani Bawa

Economic and Financial Review

This is a review of the article “Reducing Child Malnutrition: How Far Does Income Growth Take Us?” By Lawrence Haddad, Harold Alderman, Simon Appleton, Lina Song and Yisehac Yohannes which was published in the World Bank Economic Review, Vol.17, No. 1, 2003.

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 …

Using Incentives To Encourage Aids Programs And Policies In The Workplace: A Study Of Feasibility And Impact In Thailand, Simon Baker, Srisuman Sartsara, Patchara Rumakom, Philip Guest, Katie D. Schenk, Anthony Pramualratana, Suparat Suksakulwat, Surachai Panakitsuwan, Sikarat Moonmeung

HIV and AIDS

A recently completed Horizons study in Thailand examined the question of how to encourage the private sector to become actively involved in developing and improving workplace HIV/AIDS programs. The study found that the AIDS-response Standard Organization (ASO) initiative mobilized a moderate proportion of different types of companies to develop and improve HIV/AIDS workplace policies and programs. The data also reveal that companies that were eligible for the insurance discount made the greatest improvements. Thus a financial incentive combined with efforts to tap into managers’ willingness to respond to the epidemic can be important motivators for certain companies to improve their …

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 …

Microfinance And Households Coping With Hiv/Aids In Zimbabwe: An Exploratory Study, Carolyn Barnes, Erica Keogh, Nontokozo Nemarundwe, Loveness Nyikahadzoi, Ellen Weiss

HIV and AIDS

This study, conducted in Zimbabwe, sought to better understand the relationship between a microfinance program, Zambuko Trust, and how microentrepreneurs’ households cope with the impact of HIV/AIDS. The study examined how HIV/AIDS is affecting Zambuko’s operations and what microfinance institutions (MFIs) can do to lessen the impact of HIV/AIDS on their clients and operations. The findings indicate several small yet important ways that MFI programs help microentrepreneurs and their families respond to these impacts through access to credit and business management training. Participation in a microfinance program led to income smoothing and better financial management, which can help households mitigate …

State Regulations Of Smoking In Public Places: Determinants And Implications On The Demand For Smoking And Consumers' Behavior, Ioana Raluca Mazare

Dissertations

No abstract provided.

Studies On The Formation Of Dna-Cationic Lipid Composite Films And Dna Hybridization In The Composites, Murali Sastry, Vidya Ramakrishnan, Mrunalini Pattarkine, Krishna N. Ganesh

Faculty Works

The formation of composite films of double-stranded DNA and cationic lipid molecules (octadecylamine, ODA) and the hybridization of complementary single-stranded DNA molecules in such composite films are demonstrated. The immobilization of DNA is accomplished by simple immersion of a thermally evaporated ODA film in the DNA solution at close to physiological pH. The entrapment of the DNA molecules in the cationic lipid film is dominated by attractive electrostatic interaction between the negatively charged phosphate backbone of the DNA molecules and the protonated amine molecules in the thermally evaporated film and has been quantified using quartz crystal microgravimetry (QCM). Fluorescence studies …

Cationic Surfactant Mediated Hybridization And Hydrophobization Of Dna Molecules At The Liquid/Liquid Interface And Their Phase Transfer, Murali Sastry, Ashavani Kumar, Mrunalini Pattarkine, Vidya Ramakrishnan, Krishna N. Ganesh

Faculty Works

Hybridization of complementary oligonucleotides mediated by a cationic surfactant at the water/hexane interface leads to hydrophobic, double-helical DNA which may be readily phase transferred to the organic phase and cast into thin films on solid substrates.

The Market For Medical Ethics, Maxwell Gregg Bloche

Georgetown Law Faculty Publications and Other Works

At the core of Kenneth Arrow’s classic 1963 essay on medical uncertainty is a claim that has failed to carry the day among economists. This claim—that physician adherence to an anti-competitive ethic of fidelity to patients and suppression of pecuniary influences on clinical judgment pushes medical markets toward social optimality—has won Arrow near-iconic status among medical ethicists (and many physicians). Yet conventional wisdom among health economists, including several participants in this symposium, holds that this claim is either naïve or outdated. Health economists admire Arrow’s article for its path-breaking analysis of market failures resulting from information asymmetry, uncertainty, and moral …

Hybridization Of Dna By Sequential Immobilization Of Oligonucleotides At The Air-Water Interface, Murali Sastry, Vidya Ramakrishnan, Mrunalini Pattarkine, Anand Gole, K. N. Ganesh

Faculty Works

The hybridization of DNA by sequential electrostatic and hydrogen-bonding immobilization of single-stranded complementary oligonucleotides at the air-water interface with cationic Langmuir monolayers is demonstrated. The complexation of the single-stranded DNA molecules with octadecylamine (ODA) Langmuir monolayers was followed in time by monitoring the pressure-area isotherms. A large (and slow) expansion of the ODA monolayer was observed during each stage of complexation in the following sequence: primary single-stranded DNA followed by complementary single-stranded DNA followed by the intercalator, ethidium bromide. Langmuir-Blodgett (LB) films of the ODA-DNA complex were formed on different substrates and characterized using quartz-crystal microgravimetry (QCM), Fourier transform infrared …