Health Policy Commons^™

Kenya's Fertility Transition: Trends, Determinants And Implications For Policy And Programmes, Ian Askew, Alex C. Ezeh, John Bongaarts, John Townsend

Reproductive Health

In Africa, fertility rates in the 1990s declined less rapidly than had been projected, and in a few cases the fertility transition appears to have stalled. This development has serious implications for future population growth because projected population size is sensitive to minor variations in current fertility trends. The 16 countries with three DHS surveys in sub-Saharan Africa can be divided into three subgroups: stalled transitions, insignificant declines, and significant declines. Half of the 16 countries experienced a stall, and an additional two experienced insignificant declines. The Population Council prepared a series of demographic and policy analyses that drew from …

Frequent Users Of The Emergency Department: A Policy Proposal, Tina Ann Olson

All Graduate Theses, Dissertations, and Other Capstone Projects

Research has extensively documented that a small number of Emergency Department (ED) patients make disproportionate use of emergency services (Okin et al., 2000). The term “Frequent Users” is used to describe patients who utilize ED services more than four times per year (Byrne et al., 2003). Frequent Users are often times patients with chronic medical, mental health, alcohol and drug problems, as well as other psychosocial issues (Fulde & Duffy, 2006). Homeless people also appear to have significantly higher ED rates than the general population (Pope et al., 2000). Immanuel St. Joseph’s-Mayo Health System (ISJ) ED appears to have many …

The Implementation Of The Kentucky Transitions: A Money Follows The Person Demonstration Grant Program, Amie Goodin

MPA/MPP/MPFM Capstone Projects

Kentucky Transitions is a Kentucky Medicaid program that is funded primarily by a grant from the Centers for Medicare and Medicaid Services. The purpose of this program is to transition individuals residing in long-term care facilities back into the community, where they will continue to receive health, social, and other benefits but do so in an approved residential setting. Individuals living in the community may experience higher quality of life and the increased ability to choose how and when they receive services, while Medicaid reaps the projected financial benefit of providing less-expensive community alternatives for care.

Though Kentucky Transitions operates …

Policy Issues Affecting Maine’S Hospitals, John A. Gale Ms, Jennifer D. Lenardson Mhs

Rural Hospitals (Flex Program)

Legislators and other policymakers will be continually challenged to balance the needs of hospitals for appropriate reimbursement and oversight with supporting their provision of important services to local communities.

Best Practices For Vulnerable Adult Investigation Policies And Procedures At Blue Earth County, Anna Stindt

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this project is to update the policies and procedures for conducting vulnerable adult investigations in Blue Earth County to reflect changes in the statute and to incorporate current best practices for conducting investigations.

Global Trends In Aids Mortality, John Bongaarts, Francois Pelletier, Patrick Gerland

Poverty, Gender, and Youth

This working paper reviews the evolution of the HIV/AIDS epidemic and provides estimates of past trends and future projections of AIDS mortality indicators, including numbers of AIDS deaths, the proportion of all deaths that are due to AIDS, and life expectancy. A cumulative total of 24 million people have died from AIDS between 1980 and 2007, and by 2030 this total is projected to reach 75 million. Despite the rapid spread of this new disease during the 1980s and 1990s, the epidemic has reached a major turning point in recent years as the rate of new infections peaked and began …

Reference Guides For Health Care Organizations Seeking Accreditation For High-Quality, Gender-Sensitive Reproductive Health Services, Patricia Riveros, Erica Palenque, Ricardo Vernon, Ignacio Carreno, John H. Bratt

Reproductive Health

Bolivia’s Integral Health Coordination Program (PROCOSI), a network of 33 nongovernmental organizations (NGOs) providing reproductive health care, has long promoted gender sensitivity as a necessary component of high-quality health care. PROCOSI encourages member NGOs to address gender-based differences in roles, relationships, access to services, and service needs in their reproductive health programs. The Reference Guides in this publication provide guidance to help health-care organizations and NGOs implement high-quality, gender-sensitive standards to achieve certification for their member clinics and administrative centers. The procedures and standards included here are based on the process developed by PROCOSI, but the approach and standards can …

Reference Guides For Health Care Organizations Seeking Accreditation For High-Quality, Gender-Sensitive Reproductive Health Services—Appendixes, Patricia Riveros, Erica Palenque, Ricardo Vernon, Ignacio Carreno, John H. Bratt

Reproductive Health

Bolivia’s Integral Health Coordination Program (PROCOSI), a network of 33 nongovernmental organizations (NGOs) providing reproductive health care, has long promoted gender sensitivity as a necessary component of high-quality health care. PROCOSI encourages member NGOs to address gender-based differences in roles, relationships, access to services, and service needs in their reproductive health programs. Included in this document are the Appendixes to “The Reference Guides for Health Care Organizations Seeking Accreditation for High-Quality, Gender-Sensitive Reproductive Health Services,” which provide guidance to help health-care organizations and NGOs implement high-quality, gender-sensitive standards to achieve certification for their member clinics and administrative centers. The procedures …

The Refentse Model For Post-Rape Care: Strengthening Sexual Assault Care And Hiv Post-Exposure Prophylaxis In A District Hospital In Rural South Africa, Julia C. Kim, Ian Askew, Lufuno Muvhango, Ntabozuko Dwane, Tanya Abramsky, Stephen Jan, Ennica Ntlemo, Jane Chege, Charlotte Watts

Reproductive Health

The Refentse study aimed to develop a nurse-driven, post-rape care model that could be integrated into existing reproductive health/HIV services within a rural South African hospital, and to evaluate the impact of this model on the quality of care delivered. Following the intervention, there were significant improvements in the quality of clinical history and examination, and the provision of pregnancy testing, emergency contraception, STI treatment, HIV counseling and testing, post-exposure prophylaxis (PEP), trauma counseling, and referrals. The report concludes that it is possible to improve sexual assault services including PEP within a rural South African hospital at modest cost, using …

The Effectiveness And Adoption Of Market-Based State Health Care Expansion Programs, Nathan Gregory Myers

UNLV Theses, Dissertations, Professional Papers, and Capstones

Market-based state health expansion programs are alternatives to government programs like Medicaid and SCHIP which also seek to expand access to health insurance for uninsured populations. These programs either utilize the private health insurance market or function according to market principles. The market-based policies at issue in this research are state high-risk health insurance pools, limited benefit plans, group purchasing arrangements, reinsurance programs, and Health Insurance Flexibility and Accountability waivers. This research addresses two separate but related research questions: (1) Do these market-based programs provide general economic and social benefits for the citizens of a state? (2) What role does …

Disease In The Desert: Las Vegas As A Case Study Of How First Responders And Emergency Managers Understand Novel Threats To Human Health And Plan To Respond During Biological Emergencies, Monique Williamson

UNLV Theses, Dissertations, Professional Papers, and Capstones

Over recent years it has become clear that technological advancements, globalization, and ecological change, combined with the onset of increased terrorist incidents, are all currently working to create an extremely hazardous environment in terms of pathogenic invasion. Realizing that infectious diseases are both newly emerging and re-emerging in many parts of the world, the question of how prepared an expansive United States will be in the face of an oncoming global pandemic is easily raised. Using Las Vegas as an example of just how unequipped a largely visited U.S. city may be in the face of such a situation, this …

Variables In Health Care Policy Making: Resolving A Quandary, George P. Smith Ii

Scholarly Articles

Contemporary debate in health care resource management is tied to a central moral issue: how to achieve the optimum level of reasonable or appropriate treatment based on the medical condition of each patient. Failure to tackle and resolve this issue in a confident and forthright manner ensures that the present approach to health care decision-making will continue in a state of indecisiveness if not, indeed, lethargy. Undergirding this moral issue is the foundational economic dilemma of controlling costs while limiting access to health care resources. Crafting a just solution to an equitable distribution of finite health care resources is, indeed, …

Communicable Disease And International Security: The Case Of Africa & Hiv/Aids, Amy L Rue

Archived Theses and Dissertations

In this thesis, I will look at how communicable disease fits into the human security discourse particularly with the disease being views as the 'potential threat' and the 'referent object' within the international sphere. The case of Africa will be used to illustrate the impact of HIV/AIDS on international security at country, regional and international levels. Ultimately, I will argue that communicable disease, as a human security issue, is a clear and important international security issue due to its status as a continual "potential threat" within international relations particularly in Africa. The elements that I will use to establish my …

Assessing The Effects Of Medicaid Documentation Requirements On Health Centers And Their Patients: Results Of A "Second Wave" Survey, Lee Repasch, Brad Finnegan, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This report represents a "second wave" follow-up to a "first wave" study whose purpose was to measure the effects of the Deficit Reduction Act's citizenship documentation requirements on health centers and their patients. The earlier study, conducted six months after implementation, found that the law had a widespread impact, including delayed applications, interrupted enrollment, disruptions in care, and at least anecdotal evidence of a growth in the number of uninsured patients as a result of the denial or loss of Medicaid coverage. This "second wave" survey underscores the existence of serious, ongoing problems more than a year after implementation. Specifically, …

Designation Of Medically Underserved And Health Professional Shortage Areas: Analysis Of The Public Comments On The Withdrawn Proposed Regulation, Emily Jones, Leighton C. Ku, Joseph Lippi, Ramona Whittington, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In February 2008, the Health Resources and Services Administration (HRSA) proposed new regulations that would have modified and combined the Health Professional Shortage Area (HPSA) and Medically Underserved Area/Population (MUA/P) designation processes. The comment period was extended twice in response to the large volume of comments, through June 30th. On July 23rd, HRSA effectively withdrew the proposed rule, announcing that in light of its preliminary review of comments, the agency had elected to develop a new proposal. This Research Brief highlights some of the salient issues surrounding the proposed rule, based on an analysis of the public comments by researchers …

Shea/Apic Guideline: Infection Prevention And Control In The Long-Term Care Facility, Philip W. Smith, Gail Bennett, Suzanne Bradley, Paul Drinka, Ebbing Lautenbach, James Marx, Lona Mody, Lindsay Nicolle, Kurt Stevenson

United States Department of Veterans Affairs: Publications

Long-term care facilities (LTCFs) may be defined as institutions that provide health care to people who are unable to manage independently in the community.¹ This care may be chronic care management or short-term rehabilitative services. The term nursing home is defined as a facility licensed with an organized professional staff and inpatient beds that provides continuous nursing and other services to patients who are not in the acute phase of an illness. There is considerable overlap between the 2 terms.

More than 1.5 million residents reside in United States (US) nursing homes. In recent years, the acuity of illness …

Uninsured And Medicaid Patients' Access To Preventive Care: Comparison Of Health Centers And Other Primary Care Providers, Avi Dor, Yuriy Pylypchuck, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This issue of Research Briefs examines health centers' role in reducing disparities in preventive health care access by medically vulnerable and high risk populations. The analysis uses information from several national data sources to examine differences in the provision of preventive health care to Medicaid and uninsured patients between health centers and other primary care providers.

Key Findings:

• Compared to those treated by other primary care providers, Medicaid and uninsured patients treated by health centers are significantly poorer, in significantly worse health, and in the case of uninsured patients, more likely to be members of racial and ethnic minority groups. …

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 …

Career Goals Of Trainee Physicians In Internal Medicine, Muhammad Junaid Patel, Mehmood Riaz, M. Tariq, Sajjad Jamil, Tayyaba Ansari, M. Shoaib Khan, Abdul Jawwad Samdani, Syed Imran Ayaz, Ayesha Sorathia, Jaweed Akhtar

Section of Internal Medicine

OBJECTIVE: To survey Internal Medicine trainees' future career choices and factors influencing their decision-making.

DESIGN: Cross-sectional study.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from November 2006 to January 2007.

SUBJECTS AND METHODS: A standard questionnaire was administered to the residents and Interns working in the Department of Internal Medicine of The Aga Khan University Hospital. The questionnaire covered demographic details, specialty choice, work-time distribution and factors influencing career choice. Descriptive statistics were applied.

RESULTS: A total of 49 doctors participated with 57% females; and 43% males, having 33% interns and 67% residents. A minority (22%) …

Grantee-Level Estimates Show That 31 Percent Of All Health Centers Would Fail To Meet Tier Two Status Under Hrsa's Proposed Mua/Mup/Hpsa Designation Regulations, Peter Shin, Leighton C. Ku, Emily Jones, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In April of 2008, we issued a research brief which analyzed the impact on various federal programs of a February 29, 2008 Notice of Proposed Rulemaking (NPRM) regarding the designation of Medically Underserved Populations and Health Professional Shortage Areas. Among its findings, the report estimated that resources for one-third of community health center sites would be jeopardized by this rule change because they could not attain a sufficiently high priority status, even under the newly-proposed, higher-scoring Tier 2 methodology. On May 1, 2008, we issued a revision in response to an April 21, 2008 clarification notice from the Health Resources …

Highlights: Analysis Of The Proposed Rule On Designation Of Medically Underserved Populations And Health Professional Shortage Areas, Peter Shin, Leighton C. Ku, Emily Jones, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

For decades, the federal government has targeted health care funding, resources and staff to meet the health care needs of areas designated as "medically underserved areas" and "health professional shortage areas." Areas that qualify may, for example, receive federal funding to support the establishment and operation of community health centers, or receive National Health Service Corps (NHSC) physicians and clinicians. In addition, physicians who practice in these health shortage areas may receive higher payments under Medicare. These designations thus affect the availability of health care in thousands of urban and rural areas all across the United States. Community health centers …

Analysis Of The Proposed Rule On Designation Of Medically Underserved Populations And Health Professional Shortage Areas, Peter Shin, Leighton C. Ku, Emily Jones, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Numerous safety net programs and health care providers depend on Medically Underserved Area and Population (MUA/P) and Health Professional Shortage (HPSA) designations to qualify for federal funding, physician subsidies and placement, and health-related investments to improve access to care for communities and populations at high risk of poor health. These resources are particularly critical for federally-qualified health centers at a time when the number of uninsured is growing and the capacity of the safety net shrinking. On February 29, 2008, the Department of Health and Human Services (HHS) released a proposed regulation to alter the way these designations are made. …

¨En Este País No Se Habla Con La Verdad¨: Investigando La Falta De Educación Sexual En El Ecuador¨, Laney Rupp

Independent Study Project (ISP) Collection

No abstract provided.

South Africa’S Unsung “She-Roes”: A Practicum Study Of Npo Grandmothers Against Poverty And Aids, Khayelitsha Township, Cape Town, Rachel Pryzby

Independent Study Project (ISP) Collection

Across Africa, the AIDS pandemic has forced HIV+ individuals and orphaned children into the care of elderly women. Though this has occurred in millions of families, little support has been offered for the grandmothers supporting children and grandchildren on a limited income. This study reports on a practicum study at Grandmothers Against Poverty and AIDS (GAPA), the first African organization to recognize the important role played by grandmothers in light of HIV/AIDS. The study was conducted in April 2008 at the GAPA center in Khayelitsha Township, Cape Town. The main objective of the study was to evaluate the organization’s origin, …

Differential Impacts Of Smoke-Free Laws On Indoor Air Quality, Kiyoung Lee, Ellen J. Hahn, Nick Pieper, Chizimuzo T.C. Okoli, James Repace, Adewale Troutman

Nursing Faculty Publications

The authors assessed the impacts of two different smoke-free laws on indoor air quality. They compared the indoor air quality of 10 hospitality venues in Lexington and Louisville, Kentucky, before and after the smoke-free laws went into effect. Real-time measurements of particulate matter with aerodynamic diameter of 2.5 µm or smaller (PM_2.5) were made. One Lexington establishment was excluded from the analysis of results because of apparent smoking violation after the law went into effect. The average indoor PM_2.5 concentrations in the nine Lexington venues decreased 91 percent, from 199 to 18 µg/m³. The average …

Children Served By Mainecare, 2007: Survey Findings, Deborah Thayer Mba, Nathaniel J. Anderson Ms, Mph

Population Health & Health Policy

This report presents findings from a telephone survey of children currently enrolled in or recently disenrolled from MaineCare, the State‘s Medicaid and State Children‘s Health Insurance Program (SCHIP). The sample was randomly selected, and stratified to include children enrolled in MaineCare through the Medicaid eligibility category, and through two SCHIP eligibility categories, Medicaid Expansion and the Separate Child Health Program (CHP). 1 These three eligibility categories include children ages 18 or under living in households with income up to 200% of the Federal Poverty Level. Income eligibility limits are lowest for the Medicaid eligibility category, followed by the Medicaid Expansion …

How Does Investment In Community Health Centers Affect The Economy?, Peter Shin, Brad Finnegan, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

The economic slowdown that began in 2007 has prompted policymakers to focus on investments that can produce rapid economic gains in communities. Building on a previous analysis, this Research Brief estimates that a $250 million appropriations increase in the community health centers program would yield health care for an additional 1.8 million patients and a nationwide four-to-one return on investment:

• nearly $1 billion in direct community economic benefits, and
• over $1.1 billion in indirect benefits in jobs and other community investments.

On a state-by-state basis, each $1 million in federal appropriations would assure care for an additional 8,400 patients and …

Urban Containment Policies And Physical Activity A Time–Series Analysis Of Metropolitan Areas, 1990–2002, Semra Aytur, Daniel A. Rodriguez, Kelly R. Evenson, Diane J. Catellier

Health Management & Policy

Background: Urban containment policies attempt to manage the location, character, and timing of growth to support a variety of goals such as compact development, preservation of greenspace, and efficient use of infrastructure. Despite prior research evaluating the effects of urban containment policies on land use, housing, and transportation outcomes, the public health implications of these policies remain unexplored. This ecologic study examines relationships among urban containment policies, state adoption of growthmanagement legislation, and population levels of leisure and transportation-related physical activity in 63 large metropolitan statistical areas from 1990 to 2002. Methods: Multiple data sources were combined, including surveys of …

Resuscitating A Healthcare Charity, R Akhileswaran, Seet Ai Mee

Social Space

When government funding policies change, voluntary welfare organisations that depend largely on subsidies to run their services can find their survival at stake. Dr R Akhileswaran and Dr Seet Ai Mee present the case study of HCA Hospice Care.

Assessment Of Risk Factors For Hiv Infection Among Men Who Have Sex With Men In The Metropolitan Area Of Campinas City, Brazil, Using Respondent-Driven Sampling, Maeve De Mello, Adriana De Araujo Pinho, Magda Chinaglia, Waimar Tun, Aristides Barbosa Junior, Maria Cristina, F.J. Ilario, Paulo Reis, Regina C.S. Salles, Suzanne Westman, Juan Diaz

HIV and AIDS

The Population Council, in collaboration with the Brazil Ministry of Health, the Municipal Program of STD/AIDS of Campinas, and the US Centers for Disease Control and Prevention/Global AIDS Program/Brazil, conducted a study to characterize the sociodemographic, behavioral, and environmental factors associated with subgroups of MSM who are most at risk for HIV infection. This research is the first Brazilian study to provide population-based estimates for HIV, syphilis, and HIV-related risk behaviors using an innovative sampling technique to reach members of the target population. Our data suggest the importance for HIV prevention programs to address not only sexual risk reduction, but …