Health Policy Commons^™

Addiction And Substance Abuse In Nevada, Andrea Blin

Social Health of Nevada Reports

Substance abuse is an issue with serious health and societal consequences in Nevada and throughout the nation. In 2016, drug overdoses were responsible for approximately 64,000 deaths in the United States, surpassing motor vehicle deaths by 60 percent (National Institute on Drug Abuse, 2018). Recent attention has been focused on the spike in opioid use and its implications for public health. Nationally, deaths from opioid overdoses increased from 6.1 per 100,000 in 1999 to 19.8 per 100,000 in 2016. Nevada’s experience has mirrored national trends, with the drug overdose death rate in the state increasing from 11.5 per 100,000 in …

The Health Care Expenditure And Income: A Global Perspective, Badi H. Baltagi, Raffaele Lagravinese, Francesco Moscone, Elisa Tosetti

Center for Policy Research

This paper investigates the long-run economic relationship between health care expenditure and income in the world using data on 167 countries over the period 1995-2012, collected from the World Bank data set. The analysis is carried using panel data methods that allow one to account for unobserved heterogeneity, temporal persistence, and cross-section dependence in the form of either a common factor model or a spatial process. We estimate a global measure of income elasticity using all countries in the sample, and for sub-groups of countries, depending on their geo-political area and income. Our findings suggest that at the global level, …

Chemical Reactions: Marijuana, Opioids, And Our Families, Denise A. Hines Ph.D, Staci Gruber Ph.D, John F. Kelly Ph.D, Kathleen M. Palm Reed, Hilary Smith Connery M.D., Ph.D.

Mosakowski Institute for Public Enterprise

Chemical Reactions: Marijuana, Opioids, and Our Families is the seventh Massachusetts Family Impact Seminar. This seminar was designed to emphasize a family perspective in policymaking on issues related to the legalization of marijuana and managing the opioid abuse crisis in the Commonwealth. In general, Family Impact Seminars analyze the consequences an issue, policy, or program may have for families.

Powerful Words: An Exploration Of Linguistic Hierarchy In Moroccan Hospitals, Ellelan Degife

Independent Study Project (ISP) Collection

Morocco is a country of distinct diversity, which exists as a result of the settling of multiple peoples and European colonization. As a result of this diversity, many languages are employed in different settings and spaces, and of these languages, French represents remnants of colonialism and continual elitism in the country. One of the spheres that French commands in Moroccan society is medicine, which creates a dichotomy between the educated health care providers and the underprivileged patients in public hospitals. The aim of this paper is to explore the effect of French on the doctor-patient relationship in urban, public Moroccan …

‘Project Spraoi’: A Randomized Control Trial To Improve Nutrition And Physical Activity In School Children, Tara Coppinger, Seán Lacey, Cian O'Neill, Con Burns

Publications

Background

Recent evidence predicts that by 2030, Ireland will have the highest rate of obesity in Europe. Consequently, there are concerns that health problems associated with this condition will present in childhood. Studies have shown that interventions based on increasing physical activity (PA) levels, reducing sedentary lifestyles and improving nutritional habits all pose protective mechanisms against obesity and its related disorders in youth. Yet, to date, there are no interventions being delivered in Ireland that concurrently target PA, nutritional habits and sedentary time amongst school children.

Purpose

The purpose of this study is to implement and evaluate an intervention that …

A Framework For Measurement Error In Self-Reported Health Conditions, Ling Li, Perry Singleton

Center for Policy Research

This study develops and estimates a model of measurement error in self-reported health conditions. The model allows self-reports of a health condition to differ from a contemporaneous medical examination, prior medical records, or both. The model is estimated using a two-sample strategy, which combines survey data linked medical examination results and survey data linked to prior medical records. The study finds substantial inconsistencies between self-reported health, the medical record, and prior medical records. The study proposes alternative estimators for the prevalence of diagnosed and undiagnosed conditions and estimates the bias that arises when using self-reported health conditions as explanatory variables.

So Many Hospitals, So Little Information: How Hospital Value Based Purchasing Is A Game Of Chance, Andrew I. Friedson, William C. Horrace, Allison F. Marier

Center for Policy Research

As part of the Patient Protection and Affordable Care Act, participating Medicare hospitals have part of their Medicare reimbursements withheld and then redistributed based on quality performance. The Hospital Value Based Purchasing reimbursement plan relies partly on ordinal rankings of hospitals to determine how money is distributed. We analyze the quality metric distributions used for payment and show that there is not enough information to reliably differentiate hospitals from one another near the payment cutoffs; and conclude that a large part of the payment formula is driven by sampling variability rather than true quality information. Alternative reimbursement plans are developed.

A Qualitative Investigation On The Effects Of The Uttar Pradesh Population Policy On Women Who Undergo Sterilization In Bahraich, Uttar Pradesh, Anna Wadhwani

Independent Study Project (ISP) Collection

The effectiveness of population policies is widely disputed by the international development community and is under constant scrutiny. While these policies have the potential to positively affect reproductive and child health indicators, they often focus too heavily on macro-demographic family planning goals and fail to acknowledge socioeconomic determinants of fertility indicators, often making for ineffective policy. Furthermore, target-based approaches have the potential to negatively impact women’s family planning choices and the quality of care they receive. This study seeks to analyze how the Uttar Pradesh Population Policy affects the decision-making process and experiences of women who undergo sterilization procedures in …

Exploration Of The State Of Mental Healthcare Services For Youth In Nairobi, Rashiidah Richardson

Independent Study Project (ISP) Collection

This paper is formative research concerning the state of mental health care for youth in Nairobi, Kenya. Using a mixed methods design, the objectives of this study were to identify the most prevalent mental health concerns among youth in Kenya, to explore the availability and acceptability of youth friendly mental health care services, and to explore the quality of and challenges to providing youth friendly mental health care services. Results indicate that substance abuse, conduct disorder, and family conflict may be among the most pressing mental health concerns for young people. Furthermore, while young people may be willing to seek …

The United Nations Sustainable Development Goals: Achieving The Vision Of Global Health With Justice, Eric A. Friedman, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

We are resolved to free the human race from the tyranny of poverty and want and to heal and secure our planet” (UN General Assembly, 2015, September 25, preamble). So pronounces the 2030 Agenda, the United Nations declaration on the Sustainable Development Goals (SDGs), adopted on September 25, 2015, succeeding the Millennium Development Goals (MDGs). If achieved, the SDGs will secure an improved level of health, development, and global justice. However, if the international community fails to live up to its commitments, an untold number of people will likely perish prematurely, people’s opportunities to thrive will be cut off, social …

An Analysis Of Women’S Access To Acute Opioid Detoxification Services In Maine: Identifying The Barriers To Treatment, Karen E. Conley

Muskie School Capstones and Dissertations

The lack of treatment facilities and services for opioid use disorder in Maine, combined with an increased prevalence of addiction, creates a potential for health inequity between men and women that may be intensified by barriers in access to care. This capstone study utilized detoxification screening inquiry forms and data obtained from the Milestone Foundation’s acute opioid detoxification program to assess and categorize barriers to access by gender. A barriers model was developed based on existing literature and was to identify potential associations among and between the known barriers to accessing treatment. Barriers were described as internally or externally based, …

Sustainable Development Goals Worth Sharing, Erika Simpson

Political Science Publications

The international community has agreed upon another set of goals for the next 15 years. On the table are no less than 169 objectives and 17 Sustainable Development Goals (SDGs). The new aspirations are summarized and the merits and demerits of further elaboration and measurement including country-specific deadlines and targets are discussed. The hefty budget to achieve all 17 goals is estimated at more than $4 trillion US a year. North American policy-makers need to be aware of humankind’s shared aspirations as they consider the new and expensive SDGs. Foreign aid is one of the instruments of North American foreign …

Food Insecurity And Housing Instability In Vulnerable Families, Christian King

Department of Nutrition and Health Sciences: Faculty Publications

Reducing the prevalence of household food insecurity has been a long-standing objective of the federal government. Previous research has found many negative consequences of food insecurity for families and households but has not examined its relationship with housing instability. Using longitudinal data from the Fragile Families and Child Wellbeing Study, difference-in-difference models show that food insecurity is associated with housing instability. The association remains statistically significant after accounting for potential selection and unobserved heterogeneity using propensity score matching and excluding households that experienced prior housing instability from the sample. Examining potential mediating factors, I find that material hardship explains about …

The Disease Burden And The Extent Of Drug Therapy Problems In An Underserved Minority Population Receiving Medication Therapy Management At An Ambulatory Care Free Clinic, D. N. Ombengi, F. A. Ndemo, Ayman M. Noreddin, W. T. Harris

Pharmacy Faculty Articles and Research

Objective: To determine the common medical conditions, medications, and associated drug therapy problems in an underserved minority population receiving medication therapy management services at a large Community Free Clinic compared to the findings of the Minnesota Pharmaceutical Care Project.

Methods: Retrospective cohort study of a random sample of 60 minority patients referred for medication therapy management service at a Community Free Clinic from January 2012 to January 2014. Patient data including demographics, medication experience, past medical and medication history, medical conditions, active medications, allergies, immunization history and drug therapy was systematically evaluated to determine the most common conditions, …

Policies And Clinical Practices Regarding Candidacy And Auditory Treatment For Hispanic Pediatric Patients In Cochlear Implant Centers In The United States, Matthew Ehrenburg

Senior Independent Study Theses

This research sought to investigate the policies and clinical practices regarding candidacy and auditory treatment for Hispanic pediatric cochlear implant patients at cochlear implant centers in the United States. More specifically, the study investigated treatment services provided to pediatric patients who are raised in monolingual Spanish, English as a second language (ESL), and bilingual English-Spanish speaking homes. The study made use of survey research to examine cochlear implant centers regarding their policies, clinical practices, and their referral processes for this specific group of cochlear implant recipients. The survey was distributed electronically through the online survey software Qualtrics via email to …

Using A New Evidence-Based Health Workforce Innovation Research Framework To Compare Innovations In Community Health Center And Other Ambulatory Care Settings, Leah E. Masselink, Patricia Pittman, Claire Houterman

Health Workforce Research Center Publications

In the United States, changing demographics, rising costs, and the impact of new regulations and payment models arising from the Affordable Care Act have placed unprecedented pressures on healthcare providers to increase access to care, improve quality and to control costs. To meet these challenges, some providers are forming accountable care organizations (ACOs) while others are pursuing medical homes or other novel payment and care delivery models designed to help meet these challenges. Within established organizations such as federally funded community health centers (CHCs), healthcare leaders are exercising significant latitude in developing innovative solutions for meeting their patients’ needs more …

Confronting Cultural Challenges For Migrant Healthcare In Switzerland, Rebecca Weiss

Independent Study Project (ISP) Collection

Switzerland is home to many migrants, and migration exacerbates health risks. In addition to physical health problems, migrants are more likely than Swiss nationals to face mental health challenges and cultural barriers, which complicate their experiences seeking healthcare. Similarly, clinicians encounter numerous challenges related to the special circumstances of migrant patients. As a response to the specific health needs of migrants, hospital networks and migrant support organizations promote the migrant health situation. However, these services are not ubiquitous in Switzerland, partly due to the partial freedoms of each canton to create its own health policy. This paper explores the barriers …

Rac: A Program In Distress, Mary Squire

BYU Law Review

No abstract provided.

Law, Ethics, And Public Health In The Vaccination Debates: Politics Of The Measles Outbreak, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

The measles outbreak of early 2015 is symptomatic of a larger societal problem–the growing number of parents who decide against vaccinating their children. This failure is causing the resurgence of childhood diseases once eliminated from the United States.

This article explores the legal and ethical landscape of vaccine exemptions. While all states require childhood vaccinations, they differ significantly in the types of religious and/or philosophical exemptions permitted, the rigor of the application process, and available review mechanisms. States with relaxed exemption policies disproportionately experience more outbreaks of vaccine-preventable disease.

Vaccine exemptions are an illustration of the “tragedy of the commons,” …

An O'Neill Institute Briefing Paper: Ebola, The World Health Organization, And Beyond: Toward A Framework For Global Health Security, Lawrence O. Gostin, Eric A. Friedman, Daniel Hougendobler

Georgetown Law Faculty Publications and Other Works

The West African Ebola epidemic has demonstrated that the world remains ill-prepared to respond to infectious disease outbreaks. A host of institutions are now reviewing what went wrong, and new institutions are being considered, including an African Centers for Disease Control and Prevention and World Bank-initiated Pandemic Emergency Facility. The World Health Organization itself failed in one of its core functions by allowing a preventable infectious disease to spiral out of control in the world’s poorest region. The 68th World Health Assembly (WHA), held in May 2015, provided an opportunity for the Organization to reflect on what went wrong and …

Barriers To Health Care Among Laotian Americans In Middle Tennessee, Xaiyavong Saenphansiri

DNP Projects

Background. Laotian Americans have unique heath beliefs and practices. The cultural differences between Laotian American patients and American health care providers can create challenges in achieving not only evidence-based, but also culturally sensitive care. Although the current literature addresses barriers to health care for Asian Americans, there are few studies related to the Laotian-American minority.

Aim. Describing the particular barriers to preventive and curative care in the Laotian-American population in Middle Tennessee would inform strategies for successful prevention and early treatment programs for this population. The purpose of the study is to describe the health beliefs and barriers to …

Promoción De La Salud En La Ciudad De Buenos Aires: Un Estudio Sobre El Trabajo De Los Promotores De Salud Y Las Percepciones De Su Rol En La Comunidad. / Health Promotion In The City Of Buenos Aires: A Study Of The Work Of Community Health Workers And Perceptions Of Their Role In The Community, Elizabeth Sherwin

Independent Study Project (ISP) Collection

Contextual information: At the global level, inequities exist with respect to access and quality of healthcare. Primary Health Care is a strategy to respond to these inequities. It adopts an integral concept of health that includes no only illness but also the wellbeing of a person affected by many environmental factors. It is a strategy that aims to improve access to medical care and health information through health promotion and has the goal of giving the population more control over their health. Community health workers, people from the same neighborhood in which they work promoting health, are recognized on the …

Welfare Reform And Children’S Health, Badi H. Baltagi, Yin -Fang Yen

Center for Policy Research

This study investigates the effect of the Temporary Aid to Needy Families (TANF) program on children’s health outcomes using data from the Survey of Income and Program Participation (SIPP) over the period 1994 to 2005. The TANF policies have been credited with increased employment for single mothers and a dramatic drop in welfare caseload. Our results show that these policies also had a significant effect on various measures of children’s medical utilization among low-income families. These health measures include a rating of the child’s health status reported by the parents; the number of times that parents consulted a doctor; and …

Physicians' Perspectives On The Current Handling Of Medical Malpractice In Jordan, Jason Yohan Hwang

Independent Study Project (ISP) Collection

Research on medical malpractice has increased over the past few decades. However, such studies have primarily focused on malpractice in Western countries like America. In areas like the Middle East, studies on malpractice has been lacking. Thus, this study tries to fill this gap. The purpose of this study is to understand physicians’ perspectives on the current handling of medical malpractice in Jordan. To answer this research question, the study uses both surveys and interviews to focus on three main themes: one, physicians’ understanding of the term, malpractice; two, evaluation of the current malpractice system; and three, attitudes toward a …

Improv To Improve Interprofessional Communication, Team Building, Patient Safety, And Patient Satisfaction, Candace A. Campbell

Doctor of Nursing Practice (DNP) Projects

The purpose of this process improvement project was to implement a test of change within a healthcare team utilizing applied improvisational exercises (AIEs), and to lay the groundwork for more effective inter- and intra-professional communication.

Literature review: AIEs have been shown to facilitate individual participant communication strengths through a process of un-learning certain common behavioral habits, and learning new habits that assist in creating and expanding closed-loop communication. Such un-learning and learning enriches the participant’s awareness of the environment and encourages participant adaptability through positive group interactions.

Method: An all-day AIE seminar/workshop was conducted with members of two healthcare teams …

Citizenship Documentation Requirement For Medical Eligibility: Effects On Oregon Children, Brigit A. Hatch, Jennifer E. Devoe, Jodi A. Lapidus, Matthew J. Carlson, Bill J. Wright

Sociology Faculty Publications and Presentations

BACKGROUND AND OBJECTIVES: The Deficit Reduction Act (DRA) of 2005 mandated Medicaid beneficiaries to document citizenship. Using a prospective cohort (n=104,375), we aimed to (1) determine characteristics of affected children, (2) describe effects on health insurance coverage and access to needed health care, and (3) model the causal relationship between this new policy, known determinants of health care access, and receipt of needed health care.

METHODS: We identified a stratified random sample of children shortly after the DRA was implemented and used state records and surveys to compare three groups: children denied Medicaid for inability to document citizenship, children denied …

“Obesity Is A Disease”: Examining The Self-Regulatory Impact Of This Public-Health Message, Crystal L. Hoyt, Jeni L. Burnette, Lisa Auster-Gussman

Jepson School of Leadership Studies articles, book chapters and other publications

In the current work, we examined the impact of the American Medical Association’s recent classification of obesity as a disease on weight-management processes. Across three experimental studies, we highlighted the potential hidden costs associated with labeling obesity as a disease, showing that this message, presented in an actual New York Times article, undermined beneficial weight-loss self-regulatory processes. A disease-based, relative to an information-based, weight-management message weakened the importance placed on health-focused dieting and reduced concerns about weight among obese individuals—the very people whom such public-health messages are targeting. Further, the decreased concern about weight predicted higher-calorie food choices. In addition, …

Behavioral And Mental Health In Nevada, David Caloiaro, Luana Ritch

Social Health of Nevada Reports

Until recently, the Nevada Division of Mental Health and Developmental Services (MHDS) was the public provider of mental health, substance abuse and developmental services. On July 1, 2013, the delivery of the mental health, substance abuse and developmental services in Nevada was restructured on several levels. With this reorganization, Developmental Services for persons with intellectual disabilities was transitioned into the Aging and Disability Services Division (ADSD), while mental health and substance abuse services were integrated to become Behavioral Health. Behavioral Health was then merged with the public health from the State Health Division to form the new Division of Public …

Gender Disparities In Access To Hiv Testing And Antiretroviral Treatment Services, Wyatt Lombard Smith

Independent Study Project (ISP) Collection

Throughout a six-week practicum period at TASO Mulago in Kampala, Uganda and St. Francis Naggalama Hospital in Naggalama, Uganda, the researcher aimed to find methods to increase male engagement in all facets of comprehensive HIV/AIDS care. Women and children generally receive most global attention on the issue of HIV/AIDS in Uganda but men are beginning to demand more attention. Antiretroviral treatment has been critical in allowing countless people to live functionally with HIV but many research projects have hypothesized that delayed access to HIV/AIDS treatment and prevention methods has resulted in men exhibiting higher mortality rates upon initiation of this …

The Association Between Insurance Status And Cervical Cancer Screening In Community Health Centers: Exploring The Potential Of Electronic Health Records For Population-Level Surveillance, 2008-2010, Stuart Cowburn, Matthew J. Carlson, Jodi A. Lapidus, Jennifer E. Devoe

Sociology Faculty Publications and Presentations

Introduction: Cervical cancer incidence and mortality rates in the United States have decreased 67% over the past 3 decades, a reduction mainly attributed to widespread use of the Papanicolaou (Pap) test for cervical cancer screening. In the general population, receipt of cervical cancer screening is positively associated with having health insurance. Less is known about the role insurance plays among women seeking care in community health centers, where screening services are available regardless of insurance status. The objective of our study was to assess the association between cervical cancer screening and insurance status in Oregon and California community health centers …